Environmental Epidemiology of the Great Lakes

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					Environmental Epidemiology of
        the Great Lakes Basin


   Industrial Pollution and Human
                Health
             August 1999


                                    1
                                 Overview


1. Pollutants
2. Local examples, reaction of public health
                                   officials
3. Medical literature: health effects
4. Economics and politics


                                               2
                                      1968


• University of Waterloo
•    Dr.Bryce Kendrick, Professor of Botany
• University of Toronto
•    Dr. Don Chant, Professor of Zoology


• Pollution Probe
                                              3
                                      1989

• Dr. Paul Connett, Professor of Chemistry
  St. Lawrence University, New York State
      • dioxin chemist



     • Work on Waste USA

                                             4
    500 articles on Environmental
             toxics , 1992 - 1998


•   Canadian Medical Association Journal
•   JAMA
•   New England Journal of Medicine
•   British Medical Journal
•   The Lancet
•   (others)
                                           5
500 Journal articles on Toxics
        1992 - 1998

100
 90
 80
 70
 60
 50
 40                                        Number of articles
 30                                        appearing 1992 -1998
 20
 10
  0
      1992 1993 1994 1995 1996 1997 1998
                    Year


                                                              6
      Medline computer search:
      dioxins and human health
           1995 -Dec 1998
• 217 articles in many other journals: e.g.

•   J. Epidemiology and Community Health
•   Early Human Development
•   Environmental Health Perspectives
•   Chemosphere
•   Am J of Epidemiology
                                              7
              Robert Fletcher, M.D.
  internist, clinical epidemiologist

• Prof, Harvard Medical School
• Founding editor , Journal of General
                       Internal Medicine
• Editor, Annals of Internal Medicine
• author, Clinical Epidemiology


                                           8
                     Robert Fletcher, II

• What is your greatest concern?

• “Destruction of the good earth by toxins or
  nuclear waste.” (or simply too many people)

                The Lancet, Lifeline, Jan 2, l999



                                                    9
                                “Toxics”

I. Any industrial pollutants



II. Chlorinated Organic chemicals, COC‟s




                                           10
Environmental Epidemiology
        of the Great Lakes

 Human Health Effects of Industrial
  Pollutants, Effluents and Toxics

November 1998 presentation, Oakville Ontario, to:


                                                    11
   Canadian Association of
Physicians for the Environment



     C.A.P.E.
                                 12
              Health Canada, l997


       “State of Knowledge Report
     on Environmental Contaminants
           and Human Health
                  in the
           Great Lakes Basin”

• 300 pages                          13
               Arctic Pollution Issues

• Arctic Pollution Issues, A State of the Arctic
  Environment Report, Arctic Monitoring and
  Assessment Program, Oslo, l997

• Highlights of the Canadian Arctic
  Contaminants Assessment Report, a
  community reference manual, Northern
  Contaminants Program, Ottawa, l997
                                               14
    Where do contaminants go
       in North America?

• Great Lakes Basin
• St. Lawrence River

• Rocky Mountains
• Arctic

                               15
            Cdn J of Public Health
        Supplement, May/June l998

• What on Earth? A National Symposium on
  Environmental Contaminants and the
  Implications for Child Health (selected
  papers)

• Canadian Institute of Child Health

• May l997, Ottawa
                                            16
What are the causes of illnesses?



  1. Genes

  2. Environmental factors


                                17
    McGinnis & Foege, DHSS
      JAMA, Nov 10, l993
    “Actual Causes of Death
            in U.S.”

2 components to the cause of illness:
    1. Genes
    2. Environmental factors

                                        18
           Genetic factors in illness


• Genetic resistance/susceptibility
• some individuals more susceptible than
  others
• e. g. cancer:
                 tumor suppressor genes
        cancer families
                                           19
 Environmental factors in illness
       (McGinnis, JAMA, 1993)

1. Smoking
2. Animal fat
3. Alcohol
4.infectious disease
5. TOXICS exposure
6. Automobiles
7. Firearms
8.drugs                         20
       Toxics exposure in the
        Great Lakes Basin?

• How many people?



         36 million


                                21
How many chemicals are in the
               Great Lakes?


         800

           sources: agricultural
                    industrial
                    municipal
                                   22
                    How many chemicals

•   100,000
•   3,000 in high volume use
•   95% have incomplete health data
•   43% have no health data (Bev Thorpe,1999)
•   present in: dirty dozen: Epstein



                                                23
                   What chemicals??
                   What pollutants??

1. Organic   chemicals:

 a. non chlorinated:

    methanol, ammonia
    toluene, benzene, methyl ethyl ketone,
      ethylene glycol
                                             24
2. Chlorinated/brominated organic
  chemicals, COC‟s

“Persistent toxic substances”
“Persistent organic pollutants, POPs”

e.g. pcb’s, dioxins, furans

                                        25
Dioxins




          26
                       Barry Commoner
      2nd Citizens Conference on Dioxin, St. Louis,
                              Missouri, July, l994




• “Dioxin and dioxin-like substances
  represent the most perilous chemical
  threat to the health and biological integrity
  of human beings and the environment.”

                                                 27
   WHO Tolerable Daily Intake
      Dioxin, Sept l998
• 1990: 10 picogram/kg for 2378 tet dioxin
• new epidemiologic data on effects on
  nervous and endocrine systems
• new TDI, tolerable daily intake
• 1 to 4 pg/kg
                Medical Post,Sept 22, l998



                                             28
Source of Daily Intake



  Food

   90%
                     29
  Dioxin intake:         Breast feeding
“In the Great Lakes Basin exposure to TCDD
 during Breast feeding exceeds the
 established TDI for this contaminant.”

• Cdn J of Public Health, May/June l997,
  from Haines et al, Environ Res, 1998


                                           30
      Canadian Breast milk survey

• Twenty five Years of Surveillance for
  Contaminants in Human Breast Milk

• A. G Craan, D. A. Haines, Great Lakes
  Health Effects Program, Health Canada,
• Archives of Environ Contam and
  Toxicology. 35, 702 - 710 (1998)
                                           31
                             Misleading?

• “There are indications that dioxin and furan
  levels in breast milk are decreasing (see
  Table 4 of the Craan and Haines article.)
  Further monitoring over the next ten years
  will be needed to confirm this trend.”

• D. Haines, personal communication,
  January 29, 1999
                                             32
    Daily Intake of Dioxin/furan
from Breast milk ( pg/kg bw/day)

100
 90
 80
 70
 60
 50                                             Dioxins + Furans in
 40                                             TEQs
 30
 20
 10
  0
      1967   1970   1975   1982   1986   1992


                                                                 33
   Concentrations of dioxins and
 furans in Canadian human milk
              pg/Kg Whole milk
900
800
700
600
500
                           2,3,7,8 TCDD
400                        TEQ D + F
300
200
100
  0
      1982   1986   1992


                                     34
   1992 estimated daily intake of
 dioxin from breast milk/formula
       pg TEQ/Kg body wgt/day
60

50

40

30                           Breast milk
                             formula
20

10

 0
      1992    WHO TDI 1998


                                      35
           WHO TDI Dioxin 1998
    1 - 4 (2.5) pg/kg body wgt/day


• 5 - 6 month Canadian infant taking in 750
  ml milk daily:

• Breast milk: 25 times TDI

• formula: 5 times
                                              36
                            Misleading?

• “Table 6-5 shows that the mean levels ofd
  total PCDDs/PCDFs in adipose tissue of
  Canadians are comparable to those reported
  for other countries.” Page 65,
• State of Knowledge Report on
  Environmental Contaminants and Human
  Health in the Great Lakes Basin , Health
  Canada, 1997
                                           37
                                 Table 6-5

• Ryan, 1985, Canadian samples collected in
  1976 throughout Canada , post mortem.
  U.S. samples collected l983-84,NY state
• Schecter, 1986, Vietnam. Southern areas
  were sprayed with Agent Orange while
  northern areas were not.
• 1029, 985, 1577, 147 respectively. (see also
  Sweden, Japan, East Germany,
                                             38
    Mean levels of PCDDs and
PCDFs in Human Adipose Tissue

  1600
  1400
  1200
  1000
   800
   600                                       Total PCDDs
   400                                       Total PCDFs
   200
     0
                                   Vietnam
                           Japan
         Sweden



                  Canada




                                    South




                                                      39
                                countries

•   Sweden, 1986, Dsgren (some exposed)
•   New York State, USA , Ryan, 1983 (MVA)
•   Canada, Ryan, 1976, &Teschke, 1992 ( “ )
•   Japan, 1986, Ono
•   North Vietnam, Schecter, 1986 (no AO)
•   South Vietnam,     “      (Agent Orange)
•   Fed Rep Germany, Rappe, 1987 (exposed)
                                          40
                         “comparable”

• Levels in Canadians/ NY State residents
  sampled from accidental death
  (“unexposed”) victims
• comparable to:
• countries where residents were exposed to
  dioxins


                                              41
                   What pollutants? II

2. Heavy Metals:

Mercury, lead, arsenic, cadmium
Copper, zinc

                (No discussion of health effects)


                                                    42
                  What pollutants? III

3. Classic Air Pollutants

•   Particulates (PM 10, PM 50)
•   Ozone
•   Acid Gases (Sox, Nox, HCl)
•   CO
                                     43
      What pollutants? IV

 4.      CO2

Global Warming




                        44
              Sources
• Industrial processes,
     e.g. petrochemical industry e.g. PVC
• coal fired power plants
• automobile engines, (gas, diesel)
• pulp and paper industry
• waste incineration (3)
• cement kilns
• hazardous waste landfilling, dumping      45
             Municipal Solid Waste:
            backyard barrel burning


• PVC plastic
• significant source of dioxin




                                  46
    Incineration of Medical Waste, I

• U. S. E. P. A.

•    3rd largest source of Dioxin

•    major source of Mercury

• North American environment
                                    47
                    Incineration of
          hospital/medical waste, II

• Lynn R. Goldman, MD, JAMA, Aug 12,98
• EPA: assistant administrator for toxic
                          substances

• 2% of hospital waste needs incineration

• 75% -100% actual
                                            48
 What is the Current toxic load
entering the Great Lakes Basin?

• Canadian NPRI, (1993)
• U. S. EPA TRI , (l990)

• 1000 tonnes per week

• US GAO: 5% of total:
•     20,000 tonnes per week
                               49
 What is the Current toxic load
entering the Great Lakes Basin?

     Great Lakes United, 1997


 2500 tonnes per week
              (100 truck loads)

                                  50
    Provincial Auditor of Ontario
                            1996


• 1200 tonnes in Province of Ontario
                                  /week
    (1000 tonnes into the air)



                                      51
          NAFTA: CEC
   Toxic Load in North America
              1998


• 1 million tonnes per year



                                 52
53
What are (or could be) the
 Human Health Effects
       of Toxics?


           1. Proven
    2. Speculative/unproven


                              54
     Public health Officials


    Concerned citizens
       ask questions
about hazardous chemicals
   in their communities
                            55
Public health officials offer
       Reassurance


   The following are some local,
provincial, national and international
              examples


                                         56
                      Bay of Quinte
               Hazardous Waste Sites

1. Trenton Norampac: Dombind
2. Aikens Road landfill
3. Zwick‟s Island Park landfill
4. Meyer‟s Pier coal gasification site, pah‟s
5. Bakelite plant, phenols
6. Deloro mines: arsenic/radioactivity
7. Rednersville Road , TCE
8. Richmond municipal landfill site, Napanee  57
     Other Hazardous Waste Sites

• West Lincoln, Ontario (incinerator)

• East Liverpool, Ohio   (     “    )

• Times Beach, Missouri (dioxin in waste oil
                         dust suppressant)
• Sydney Mines, Cape Breton Island (PAH‟s)
                                          58
                        #1


Rednersville, Ontario




                         59
         Rednersville, Ontario, 1990

•   Illegal hazardous waste site
•   200 barrels of VOC‟s: TCE, benzene
•   1973-1988: 15 years
•   16 (25) families: contaminated water
•   compare Woburn, Mass case

• MoH Health Study
                                           60
               Woburn, Massachusetts
                        1970 - 1990

•   Drinking water contamination with TCE
•   2 local plants: W.R.Grace, Beatrice Foods
•   12 children died of leukemia („70‟s)
•   civil action by citizens,
•   EPA action,                1990
•   $70,000,000 liability, cleanup operation
•   Civil Action, Jonathan Harr,
                                            61
 Rednersville Health Study, 1990



• “no evidence of human health effects”.




                                       62
                                        #2


Zwick‟s Island landfill, Meier‟s Pier
        Belleville, Ontario



                                         63
Zwick’s Island Park, Meyers Pier
                 Belleville, l998
• Municipal/hazardous waste landfill
• Creasy engineering Report
• leaking : PAH‟s (benzo (a) pyrene),
            VOC‟s (chloroform)
• compare NY State and Eurohazcon studies

• Municipal Health study: risk assessment
  shows elevated cancer risk at Meier‟s Pier   64
• NY State ATSDR June l998: cancer



• Eurohazcon study, Dolk,1998: congenital
                               defects
           (The Lancet)



                                            65
       Zwick’s Island/Meyer’s Pier
       Creasy (Engineering), 1998


• Belleville City Council says reports show
  the following compounds in the landfill
  sites:
•     sodium chloride, “table salt”
         (Belleville Intelligencer)
•   “ammonia”         (smelling salts)
         (Community Press, Dec.24, 98)
                                              66
      Zwick’s Island/Meyer’s Pier
               Health Study, 1998



“These places are not unsafe for people.”

                          City Administrator,
           Belleville Intelligencer, Nov.3,98




                                                67
                           #3


Dombind, Eastern Ontario




                            68
                    Dombind, 1993 - 98
    Hastings/Northumberland/Peterborough
              Trent River-Moira watershed
•   Dust suppressant in 90 townships
•   Domtar spent black liquor
•   50 million litres/yr (6100 tanker trucks)
•   Dioxins, furans, metals, phenols
•   compare Times Beach, Missouri

• MoH Health Study (Hukowich):
                                                69
   1994, Times Beach, Missouri


• 2nd Citizen’s Conference on Dioxin
• St. Louis/Times Beach
• 1970‟s
• dioxin-contaminated waste oil as
  dust suppressant on roads

                                       70
      Dombind Health Study, 1998


• “On the very narrow issue of whether the
  use of Dombind constitutes a health hazard
  within the Health Protection and Promotion
  Act, I have concluded that it does not.”
          Alex Hukowich, MOH, Peterborough


            Belleville Intelligencer, Oct 21, l998
                                                     71
              Norampac Inc, Trenton

• Dombind disposal problem
• consideration underway (1999) for
  hazardous waste incinerator construction as
  an alternative to Dombind method of
  disposal of pulp liquor




                                            72
                                       #4


Richmond landfill site, Napanee, Ont




                                        73
                   Richmond (Napanee)
                           landfill site

•   2 million tonnes existing
•   Canadian Waste Services
•   application for 750,000 more annual tonnes
•   leachate flow into:Marysville,Sucker Creek
•   thence into Bay of Quinte
•   Committee of Concerned Residents
•   Paul Finkle, Stephen Geneja, Residents
•           community press, April 2, 1999   74
                         #5


Kingston landfill site




                          75
       Kingston landfill case, 1999

• Janet Fletcher
• private prosecution, federal Fisheries Act
• joined eventually by MoE who initially
  declined the opportunity
• guilty
• fine
•                see 1999 press file
                                               76
                                   #6


Arsenic leakage into Moira River
         Deloro, Ontario



                                    77
                       Deloro, Ontario

• Arsenic leakage into river at Deloro
• 100,000 tonnes of arsenic tailings
• 10 tonnes per yr leak into Moira R
• Deloro human health Risk study,1999: no
                 human health effects
• Moira River Impact study, 1999, screening
  human health risk assessment under way
                                              78
         Deloro hazardous waste site

•   Spring, 1999 MoE health study
•   urine samples
•   control urines: ?neighbouring community
•   number of people: ?200
•   MoE toxicologist:
•   likelihood of stat sign findings: low
•   “crackerjack teams of experts in Toronto”
                                                79
                       #7


Peterborough,Ontario




                        80
              Peterborough, Ontario

• Feasibility hearings for municipal
  incinerator construction, April 1999




                                         81
                                   #8


      Cornwall, Ontario
Material resources recovery unit



                                    82
               Cornwall, Ontario
 material resources recovery unit

• Public hearings, attended by Ellen and Paul
  Connett, August 1999
• application for permit to burn 30,000 ppm
  PCB‟s, current permitted for 50 ppm
• Cornwall/Massena area already heavily
  contaminated with PCB‟s


                                            83
           Cornwall hazardous waste
                         incinerator

•   October 1998, began operation
•   PCB‟s from fluorescent light ballast
•   In the new permit they also want to burn:
•   pharmaceuticals, chloroflurocarbons,
    electrical equipment, poisonous and reactive
    gasses, “controlled substances” and waste
    oils.

                                              84
                          Response
       of Medical Officer of Health

• Dr. Bourdeau: 5 county Eastern Ontario
  Health Unit, quoted the: 1996 Harvard
  Report on Cancer Prevention (R. Clapp) to
  explain cancers:
• 30% from smoking, 30% from obesity and
  fat and lack of exercise
• and 2% from environmental sources.
• (noted lower male:female birth ratio in
  Cornwall in passing)                      85
                            #9


 West Lincoln, Ontario
failed proposal of 1980‟s



                             86
    OWMC hazardous waste facility
     West Lincoln, Ontario, 1980’s

•   Hazardous waste incinerator
•   60,000 tonnes per year
•   Joint Board Hearings, Oakville Ontario
•   1991 - 1993

• Health Risk Assessment
                                             87
     West Lincoln Risk Assessment


• Negligible Cancer risks
• No Non Cancer health effects

• “No evidence of significant health effects”



                                                88
   Examples from elsewhere
in Canada and United States




                          89
                                #1


Sydney Tar Ponds, Nova Scotia




                                 90
  Sydney Mines, Cape Breton, NS
                Tar ponds, 1995

• CMAJ, March l5, l995
• cokes ovens, steel plants
• PAH‟s in tar ponds (700,000 tonnes
                                 sediment)
• Cancer mortality: 25% higher in women,
  49% higher in men than provincial average

• Provincial Epidemiologist:
                                              91
                      Sydney tar ponds



• Lifestyle factors, namely smoking and poor
  diet, were said to be responsible by public
  health officials



                                           92
                              #2


   East Liverpool, Ohio
hazardous waste incinerator



                               93
    WTI hazardous waste incinerator
         East Liverpool, Ohio, 1997
•   Hazardous waste incinerator
•   200 miles south of Oakville
•   60,000 to 170,000 tonnes per year
•   EPA hearings, East Liverpool, 1997
•   Dioxin output ?????? (UNKNOWN)

• Health Risk Assessment,   3500 pages
                                         94
   East Liverpool Risk Assessment


• Negligible Cancer risk
• No additional Non Cancer health effects

• “No evidence of significant health effects”



                                                95
Citizens ask questions about toxic
 substances in their communities


• Public health officials

•   1.   Epidemiology
    2.   Risk Assessment



                                 96
    “No evidence
of human health risk.”




                         97
         Hamilton, March 1999
EverydayCarcinogens conference

•   Dr. Richard Schabas
•   head, cancer prevention, CCO
•   keynote speaker
•   did not address the issue of environmental
    carcinogens

• citizen delegation to CCO, July 1999,
  presentation made to Dr. Ken Shumak
                                                 98
                        Reassurance


Pattern of Denial ?

   by public health authorities


                                  99
               Denial by developers


• Royal Group Technologies, Woodbridge
• “plastic houses”
• PVC interlocking panels for wall
                           construction
• filled with cement
• since 1996
                                          100
             Denial by developers, II


• Charlie Cray, Greenpeace, Chicago

• “PVC emits dioxin when it burns. It‟s very
  toxic”



                                           101
           Denial by developers, III


• Gwain Cornish, senior VP and chemist
• Royal Group Technologies
• “The amount of dioxin emitted by burning
  PVC is negligible. Even mashed potatoes
  give off more toxins than PVC.”
               Globe and Mail, Jan 23, l999

                                              102
   Medical literature


1992 - 1998




                   103
                      Non reassuring
                    medical literature


1. Limitations of Epidemiology and
             Risk Assessment

2. Reports: changes in disease patterns
      strong hints:
      industrial chemicals are implicated
                                            104
         “More controversy,
        little clarification”…

• “The impact of low-level exposures on
  human health has proved difficult to
  investigate but refined environmental
  epidemiological methods and mechanistic
  studies are providing new
  insights…..Although environmental health
  risks are of low magnitude and difficult to
  prove, they may still pose …..
                                            105
             ……….The Lancet
  End of Year Review, Dec 1998

 ….an important public health problem if
large numbers of people are exposed, and
if certain populations are
disproportionately exposed…..The need
for better risk assessment and better
education of the public regarding
environmental risks is being recognized.”
    Carrie Redlich, MD, Yale University
                                        106
I. Cancer




            107
         Dr. Bernard Dixon,
                editor BMJ,
                 June 11, l995

“Cancer is essentially a disease of genes
 which are triggered into mischief by
 external carcinogens such as chemicals
 and radiation.”



                                            108
Epidemiology
  (has a problem)
        Do
industrial effluents
       cause
     cancer?
                       109
         Dr. Anthony Miller,
            U of T Epidemiology
               JAMA Feb 9, l994



• “We must remember the long natural
  history of cancer, and that the full effect of
  exposures to carcinogens in early life may
  not be seen until those exposed reach
  advanced age.”

                                               110
           Dr. David Kessler
                    U. S. FDA,
     Joint Report of Pesticide Use, June l993



• “We know that children are overexposed,
  and we know that the chemicals are toxic.
  But when cancer or chronic neurological,
  immune or reproductive problems show up
  years later there will be no footprints left.”

                                                111
CLASSIFICATION OF CANCER
               by Age



  1. Childhood Cancer, < age l7, 19

           2. Adult cancer
                                      112
            Childhood Cancer

•   Dr. Anthony Miller
•   CMAJ Dec l5, l994
•   1969 - 1988
•   overall incidence:
              rose from 13 to 17 per 100,000


• 20% increase in 20 years
                                               113
Canadian Childhood Cancer Control
           Program , I
Gibbons, Mao, Levy, Miller, CMAJ,
  18
          Dec l5, l994
  16
  14
  12
  10                                        No. of cases of cancer
   8                                        per 100,000 children,
                                            1969 - 1988
   6
   4
   2
   0
       1969 1972 1975 1978 1981 1984 1987                    114
Canadian Childhood Cancer Control
           Program II,
   Gibbons, Mao, Levy, Miller,
       CMAJ, Dec l5, l994
   5
 4.5
   4
 3.5
   3                                        No of cases of
 2.5                                        childhood leukemia
   2                                        per 100,000, 1969 -
 1.5                                        1988
   1
 0.5
   0
       1969 1972 1975 1978 1981 1984 1987                  115
                          Childhood ALL

•   Landrigan and Pui
•   NEJM Nov 9, l995
•   SEER data
•   from l973 to l991
•   increased from 2.7 to 3.3 cases per 100,000
    children
• 20% increase in 20 years
• causes: unknown, ? Environmental toxins     116
              Childhood Brain Tumors

•   Dr. Rutka, Neurosurgeon, HSC
•   Medical Post, September l5, l998
•   1990: 60
•   1997: 100
•   Dr. John McLaughlan,U of T Epidemiology
• “There is strong evidence that children who live in
  close proximity to hydro transformers, nuclear
  power plants and industrial toxins are at greater
  risk of brain tumors.”                            117
     Parliamentary Assistant
 to the federal Minister of the Environment

• Paddy Torsney
• AAUW/CFWW Cross Border Conference
• October l998
•    male:      “25% increase”
•    female: “42% increase”
         in rates of Childhood Cancer
• ? Reference/source
                                              118
         “Childhood Cancer and
   Environmental Contaminants”

• Cdn J Public Health, June 1998
• Mary Mcbride, B.C. Cancer Control
                                 Agency

• 185 references


                                          119
Adult Cancer




               120
                         Adult Cancers
• Common, increasing: lung, (bowel), breast,
                         prostate.
• Uncommon, increasing:
   1. NHL
   2. Brain tumors
   3. Melanoma
   4. Testicular cancer
                                          121
Common Cancers




            122
        Lung Cancer



Genes



                 123
            Tumor suppressor genes

• Control cell reproduction

• Individuals/families who are:

    genetically RESISTANT
        “       SUSCEPTIBLE       to cancer

                                          124
   Tumour suppressor genes:
       Normal     vs.       Mutations

100%
 90%
 80%
 70%
 60%
                                               Mutant
 50%
                                               Normal
 40%
 30%
 20%
 10%
  0%
   resistant    TO CANCER        susceptible


                                                   125
                            Lung Cancer

•   Tang, (Smithville, USA)
•   Lancet Oct 26, l996
•   4000 chemicals in Cigarette smoke
•   Benzo (a) pyrene

• DNA damage
        to p53 tumor suppressor gene
                                        126
                      Tang


 (one) mechanism
     by which
Toxics cause cancer


                        127
            Benzo (a) pyrene
             in the Great Lakes Basin

• PAH (polyaromatic hydrocarbon)
• by product of petrochemical processes

• IJC, International Joint Commission
• 11 critical contaminants: pcb, dioxin,
  furan, ddt, toxaphene, mirex, dieldrin, hcb,
  methyl mercury, alkylated lead,
  benzo(a)pyrene
                                             128
            Bowel cancer:
    Chlorine and drinking water (I)

• Will King, OCTRF/Queen‟s University
• Dec 6 , l995
• chlorinated water
• 10% increase in bowel (and bladder)
  cancer
• ?Trihalomethanes
                                        129
            Bowel cancer:
    chlorinated drinking water (II)

•   Doyle, Univ of Minnesota
•   Lancet, Aug 23, l997
•   28,000 post menopausal women in Iowa
•   chlorinated drinking water
•   increased colon cancer

                                           130
Breast Cancer & industrial chemicals

•   Dr. Devra Davis
•   World Resources Institute
•   JAMA, Feb 9, l994
•   1973 - 1987
•   19 % increase

• ? Environmental xenoestrogens
                                  131
                       CCO graph
            Breast cancer incidence

• Rising
• on display at Everyday Carcinogens conf
• March 1999




                                            132
                   Devra Davis: (cont’d)


• “There are critical periods in development,
  e.g. the first trimester of pregnancy and
  adolescence, when sensitivity to
  carcinogenesis is high. Timing of exposure
  to chemicals and radiation can be more
  important than dose.”

                                           133
Breast cancer and chemicals:CON

• Stephen Safe, Ph.D, Texas A&M University
• editorial, NEJM, Oct 30, l997
• “chemophobia, the unreasonable fear of
  chemicals”
• “paparazzi science”

• 2 problems ??
                                        134
                         Safe’s editorial


• Hunter ? Doubtful conclusions

• ?undeclared interests (CMA)




                                       135
 Breast Cancer and chemicals:          CON

• Hunter, Organochlorines and the risk of
  breast cancer, NEJM, Oct 30, l997
• 240 women, case control study
• pcb, dde levels
• No difference on organochlorine levels

• (? Breast cancer group genetically
  susceptible)
                                             136
    Breast cancer & Breast feeding
• Moysich, Vena, SUNY Buffalo, l997
• women from Love Canal area, western NY
• organochlorine exposure
• breast feeding was a protective factor vs
      breast cancer: lower blood levels of
  DDE
• “The chief mechanism for eliminating
  organochlorides from the breast is
  lactation, which flushes them from the 137
    ...Recipient of this toxic flush



…...Newborn   breast feeding infant




                                      138
                        Prostate Cancer

• Morrison,       LCDC
• Cdn Journal of Public Health,
• July/Aug „96
• predicted tripling in rates over next 20 yrs
• “part of the increase may be due to
  chemicals in the environment ” ????
• no evidence
                                                 139
                     Prostate cancer, II


• Gallagher, Fleshner
• CMAJ, October 6, l998
• strong relationship to Dietary Fat intake




                                              140
             Uncommon Cancers
             (that are increasing)


* 1. NHL
  2. Brain tumors
  3. Melanoma
* 4. Testicular cancer
                                141
     Non Hodgkin’s Lymphomas, I


• Adami et al, Sweden
• BMJ, June 10, l995
• 2 - 4% annual increase
• in a number of countries
• ?role of u/v exposure

                             142
    Non-Hodgkin’s Lymphomas, II

•   Freedman
•   BMJ May 17, l997
•   mortality NOT associated with u/v exposure
•   ? Unsuspected environmental agents



                                            143
    Non-Hodgkin’s Lymphomas, III


•   Rothman, Cantor
•   Lancet, July 26, l997
•   occurrence of NHL related to PCB levels
•   ?immunosuppression, with EBV
    susceptibility


                                              144
       Non Hodgkin’s Lymphomas

• 2 - 4 % annual increase


• Rothman, Cantor
• Lancet, July 26, l997
• occurrence of NHL related to PCB levels
                                            145
                  Testicular cancer, I

• 2 - 4 % annual increase
              for last 25 years


• Scandinavia, Europe, North America
• Danish EPA, l995
• Canada, 2% annual increase ,
        over 30 yrs,Weir, Jan 26,1999,CMAJ
                                        146
                  Testicular cancer, II

• “It is a reasonable hypothesis that toxins
  acting during the early fetal development of
  the gonads are involved in the ….increase
  in the incidence of testicular germ cell
  cancer…..The likely culprits include DDT,
  PCBs, nonylphenol, bisphenols and
  vinclozolin.”
•     L. Klotz, MD, CMAJ, Jan 26, 1999
                                            147
                    Testicular cancer, III

• “Changes in male genitalia, such as the
  increasing incidence of testicular cancer in
  the U. S., could be like a canary in a mine
  shaft.”
•                       Harry Fisch, director,
  Male Reproductive Centre, Columbia Presbyterian
  Medical Centre, New York
         Globe and Mail, Jan 26, l999

                                                 148
                    Adult Brain Cancer


•   Workshop Group on Brain cancer
•   CMAJ, March l5, l992
•   DOUBLING of rate, 1969 - 1985
•   age > 65
•   occupational and non-occupational
    exposure to chemicals
                                        149
                               Melanoma


• BMJ Jan 20, l996
• DOUBLING of rate in Southern
  Hemisphere
• chlorofluorocarbon release:
• ozone loss, increased u/v exposure


                                       150
II. Non Cancer illnesses




                           151
                Non-cancer illnesses

• 1. CardioRespiratory
• 2. Reproductive and Developmental
• 3. Neuropsychological
  4. Endocrine
  5. Immunological


                                      152
                   1. CardioRespiratory

• Asthma
• Chronic lung disease
• Myocardial infarction

• 1800 deaths annually in Ontario from
  cardio-respiratory disease related to air
  pollutants      (Eva Ligeti, Ontario government
  Environment commissioner, 1998)
                                                    153
Classic Air Pollutants:

•   Particulates (PM 10, PM 50)
•   Ozone
•   Acid Gases (Sox, Nox, HCl)
•   CO
                                  154
2. Reproduction
      and
 Development




                  155
     Environmental Estrogens
        “Xenoestrogens”
1. Chlorinated organic chemicals

2. APE‟s (alpha phenyl ethoxylates),
           surfactants, detergents
3. Bisphenols (polycarbonate subunit)

4. phthalates (plasticizers)
                                        156
  2.Reproduction & Development

           a.   (Canadian)   MEN
1. declining sperm counts
2. declining male:female birth ratio
3. Increasing abnormalities of male sex organs
  (hypospadias)
4. Shrinking testicle size(Klotz, CMAJ,Jan99)
5. Increasing testicular cancer
                                            157
             Declining Sperm Counts, I

•   Carlsen, Skakkebakk (Copenhagen)
•   BMJ, l992
•   metanalysis of 61 studies:
•   50 years, 1940 - 1990
•   40% reduction in sperm count
•   coincidental introduction of COC‟s into
    industrial production in 1940
                                              158
          Declining Sperm Counts, II

•   French         (Thibeault, Bujan
•   British        (Irvine, Sharp)
•   American       (Fisch)
•   Scandinavian   (Pajarinen)




                                       159
         Declining Sperm Counts, III

•   Canadian study: Feb l998
•   Health Canada/McMaster University
•   49,000 Canadian men
•   1984 - 1996, 11 centers

• 1.4 % reduction per year

                                        160
       Declining Sperm Counts, IV

• Swan (California)
• Lancet Nov 29, l997
• reanalysis of Carlsen‟s meta analysis, l992

• USA: 1.5% reduction annually, 1938 - 90
• Europe: 3.1% reduction annually,l971- 90

                                            161
          ?Declining Sperm Counts

• NIH

• ACDCP

• started study Nov l997



                               162
Male genital malformations:
                   Hypospadias
• Paulozzi, (Pediatrics, 100, l997)
• Atlanta, l968 - 1992
• DOUBLING to 30 per 10,000 births

• similar increases documented in:
• US wide Birth defects monitoring program
• European/Scandinavian studies of l980‟s
                                        163
 Declining male:female birth ratio
                                 I
• Usual ratio: 51.5% are male
               106: 100
• declines documented in:

• Davis & Gottlieb, JAMA April 1, l998
        (European countries)
• Patterson, Lancet Aug 10, l996 (Seveso)
• Williams, Int‟ J Epidem, l992 (incinerators)
                                             164
Declining male:female birth ratio
                               II

•   Allan, Jarrell et al
•    CMAJ Jan 1, l997
•   Canada, 1930 - 1990
•   after l970: 2.2 less male births/1000/year
•   ovulation inductions drugs could NOT
    account for all of the reduction
                                                 165
  2.Reproduction & Development

        b. WOMEN

1. Shorter menstrual cycles
2. Threatened miscarriage
3. Endometriosis
4. Premature ovarian failure

                               166
                 Delay in Conception?

•   Mendola, Buck
•   Am J Epidemiology, Dec 2, l998
•   New York State residents
•   eating Lake Ontario fish for 7 yrs
•   No significant delay in conception
•   Menstrual cycle was 1.1 days shorter

                                           167
           Premature ovarian
           failure/menopause


•   Cowan & Seifer
•   Clinical Reproductive Medicine, 1997
•   7 causes of premature menopause
•   “environmental dioxin”



                                           168
 2.Reproduction & Development

c. EMBRYO, FETUS AND NEONATE:
 Birth cycle:
    1. Ovary contamination
    2. IUGR
    3. Congenital birth defects
    4. Increased gonadal intersex
    5. Breast milk contamination    169
 Soderstrom, Michigan State Medical Society
                           CMAJ, Oct 1, l998

• “The development of embryos of different
  species is a very similar thing, especially in
  the first few weeks. Whether it‟s a human, a
  fish or a bird, it goes through much the
  same process. So if there‟s an extensive
  problem for (wildlife such as) fish and
  birds, and there certainly has been, there is
  no reason to think that there cannot be
  effects on humans.”                           170
          Preconceptual environment

•   Jarrell
•   CMAJ, April l5, l993
•   ? 6 Canadian cities
•   fluid in human ovarian follicles
•   measurable levels of 5 organochlorines:
    dde, pcb, hexachlorobenzene, chlordane,
    heptachlor
                                              171
                   Fetal development


• Vivyan Howard
• University of Liverpool Fetal
  toxicopathology group
• 2nd Citizens Conference on Dioxin, l994
• IUGR as a conseqence of toxics exposure


                                            172
        Congenital Birth Defects I

• Lie, NEJM July 7, l994:
      cause of 2/3 of birth defects is
  unknown
• Rodgers, University of Kentucky, 1994:
  increased birth defects in Times Beach,
  Missouri after dioxin contamination
• U. S. IOM, Lancet June 8, l996:
      Agent Orange (dioxin) and Spina
  Bifida in children of Vietnam veterans    173
         Congenital Birth Defects II

• Helen Dolk, London School of Hygiene
• Lancet, August 8, l998
• Eurohazcon study (hazardous waste sites)
• residents within 3 km of landfill
• 1.33 Odds Ratio : congenital anomalies
• NTD‟s, cardiac septal defects, transposition
  of great arteries and veins
• statistically significant                  174
                         Breast feeding, I

•   Frank, Newman
•   CMAJ, July 1993
•   pcb‟s and other toxics in breast milk
•   “good evidence of subtle fetal and infant
    health effects resulting from prenatal
    (intrauterine) exposure”


                                                175
                     Breast feeding, II

• WHO committee
• Lancet, BMJ,       May l997
• 2 month old breast fed infant
• receives 17 times the TDI of pcb‟s and
  dioxins from breast milk (50 times)
• breast feeding a “significant risk” ??


                                           176
                    Breast feeding, III

• Craan & Haines, GHEP, Canada
• Arch Environ Contam Toxicol, l998. 35,
                                  702-10
• Twenty five years of Surveillance for
  Contaminants in Human Breast Milk
• Canada: 6 surveys of human breast milk .
  1967, 1970, 1975, 1982, 1986, 1992

                                             177
     Canadian Breast milk studies

• Summary: Persistent Environmental
  Contaminants and the Great Lakes Basin
  Population: An Exposure Assessment

• Health Canada, 1998
• Douglas Haines, GLHEP


                                           178
                 Canadian Breast milk

            A        B      C       D   E
•   1982: 889       95
•   1986: 562       60
•   1992: 522        56    12      2.5 25/5
•   A . pg TEQ D+F/kg whole milk
•   B/C Pg Teq D+F/kg body wgt/day daily
            intake, Breast milk/formula
•   C. WHO TDI, l998 D. factor over WHO    179
                  3. Brain

• PCB’s and brain injury in:
• babies/children of fish-eating residents of:
      Lake Michigan          (Jacobson)
      Lake Ontario           (Daley)

• adults
       St. Lawrence River (Mergler)
                                                 180
        Human brain development:
                            Lancet Oct 11, l997

• 20th week of gestation .
• number of new synapses (nerve cells and
  connections) being formed per second:


          40,000

• Can toxic exposures interfere?
                                            181
              Neuropsychological, I

• Jacobson & Jacobson
• NEJM Sept 12, l996
• followup of original cohort, now age 11
• pcb‟s in utero from contaminated Lake
  Michigan fish eaten during pregnancy
• abnormal body wgt/head circ at birth
• 6 point IQ reduction at age 11
                                            182
            Neuropsychological II

• Helen Daly
• SUNY Oswego NY
• mothers ate pcb-contaminated Lake
  Ontario fish during pregnancy
• newborn babies
• “abnormal psychological reactions”
• (No abnormal body weights/head circ)
                                         183
             Neuropsychological , III

• Kosatsky, Mergler           1997
• Gt. Lakes/St. Lawrence Health Conference
• Lac St. Louis, Lac St. Francois
• deficits in attention, concentration and
  cognitive intellectual function in fish eaters
• pcb levels in fish eaters were “well within
  Health Canada guidelines”
                                               184
4. Immunologic Effects




                    185
               Immunologic Effects, I


•   McConnachie, Illinois, 1994
•   2nd Citizen‟s Conference on Dioxin
•   Times Beach, Missouri, dioxin exposure
•   children
•   lymphocyte dysfunction

                                             186
              Immunologic Effects, II


•   Repetto, World Resources Institute
•   JAMA March 27, l996
•   Pesticides and the Immune System
•   immune system dysfunction in children



                                            187
5. Endocrine Effects




                  188
                     Endocrine Effects

• Koppe, Netherlands
• Lancet Feb 3, l996
• thyroid neonatal dysfunction after dioxin
  exposure
• structural similarilty between dioxin and
  thyroxine molecules


                                          189
Conclusions

 Environmental
  Economics



                 190
Comparison: Intel Corporation
         (and the Silicon Chip)

•   New York Times , December 3, l995
•   Semiconductor manufacturing plant
•   New Mexico
•   environment is “thousands of times cleaner
    than an operating room”
• Price:     $ 1 Billion

                                             191
          Government of Ontario, I
            (and the human brain)


• Ministry of Environment Operating Budget
•   l993/94               $ 390 million
•   1994/95, 95/96          240 “
•   1996/97                 150 “



                                         192
             Government of Ontario II
               (and the human brain)
400
350
300
250
                                  Annual Operating
200
                                  Budget, MoE,
150                               1994 - l997
100
 50
  0
      1994   1995   1996   1997


                                                 193
        Government of Ontario , III


• 1995 - 1998: MoE:

• number of pollution investigators: fell 28%
• total staffing: fell 32%



                                            194
        Government of Ontario, IV


• “We truly believe that this government has
  done more than any previous government
  to aid the environment. ”
                 Norman Sterling
               June 22, l998
               Minister of Environment

                                          195
                 Provincial Auditor of
                        Ontario,1996

• 226 air-pollutant standards required
  reassessment (1992 MoE study)

• substantial reductions needed in releases of
  air pollutants:“aggressive 3 year MoE plan”


                                            196
           Provincial Auditor , 1998

• Erik Peters
• followup November 4,1998

• “not a single one of the 226 air pollutant
  standards has been updated”



                                               197
    Minister of Environment, 1998

• Norman Sterling, Nov 4, l998

 “When you are striking scientific-based
  standards, it does take a bit of time.”



                                            198
        Waste water standards, l996
                 MoE enforcement

•   1000 violations
•   sewage, pulp & paper, mining,chemical, etc
•   3 fines: Malette, Domtar, Russell
•   FoI Act: Sierra Legal Defense Fund
•   $20,000 charge levied
•   1 1/2 year process
•   Privacy commissioner settled eventually
                                            199
                           MoE, 1996, II


• Karen Vaux, spokeswoman:

• “Our priority is to get them to fix it and
  ensure that these type of occurrences don‟t
  happen again.”


                                            200
500 Journal articles on Toxics
        1992 - 1998

100
 90
 80
 70
 60
 50
 40                                        Number of articles
 30                                        appearing 1992 -1998
 20
 10
  0
      1992 1993 1994 1995 1996 1997 1998
                    Year


                                                            201
             Government of Ontario II

400
350
300
250
                                  Annual Operating
200
                                  Budget, MoE,
150                               1994 - l997
100
 50
  0
      1994   1995   1996   1997


                                                 202
                                Linkage

• Government funding for environmental
  work

• environmental research




                                         203
                    Montreal Biosphere
                                  1999

• Multimedia presentation:
                Mission Bios H20

• but: “in the last 15 years the situation has
  greatly improved”

• (How would you know?)
                                                 204
                Dr. Pierre Beland
        former commissioner, IJC
     1998 GLU Citizen’s Hearings

“Governments are becoming more and more
  uninterested in the environment…..
 Knowledge of the health of the Beluga in
  the St. Lawrence River is now uncertain.
  There is no 1998 data because there is no
  money to analyze and research.”

                                              205
                     Eva Ligeti
  Environmental commission, Ont

• State of Environment report 1998
• released 1999
• Ligeti met with new Minister of
  Environment August 1999, Tony Clement
  who said he “could do business with her”
• Ligeti fired the next day by the government
•     Globe and Mail, week of August 16, 1999


                                            206
  International Joint Commission
  of the Great Lakes, 9th Biennial Report

• “The evidence is overwhelming: certain
  persistent toxic substances impair human
  intellectual capacity, change behaviour,
  damage the immune system and
  compromise reproductive capacity. The
  people most at risk are children, pregnant
  women, women of child bearing age and
  people who rely on fish and wildlife…….
                                           207
         IJC, 9th Biennial Report, II


• …as a major part of their diet. Particularly
  at risk are developing embryos and
  nursing infants.”

                     July l998


                                                 208
209

				
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