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Environmental Epidemiology of the Great Lakes Basin

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Title: Environmental Epidemiology of the Great Lakes Basin


1
Environmental Epidemiology of the Great Lakes
Basin
  • Industrial Pollution and Human Health
  • August 1999

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

3
1968
  • University of Waterloo
  • Dr.Bryce Kendrick, Professor of Botany
  • University of Toronto
  • Dr. Don Chant, Professor of Zoology
  • Pollution Probe

4
1989
  • Dr. Paul Connett, Professor of Chemistry
    St. Lawrence University, New York State
  • dioxin chemist
  • Work on Waste USA

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

6
500 Journal articles on Toxics1992 - 1998
7
Medline computer searchdioxins and human
health1995 -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

8
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

9
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

10
Toxics
  • I. Any industrial pollutants
  • II. Chlorinated Organic chemicals, COCs

11
Environmental Epidemiology of the Great
Lakes
  • Human Health Effects of Industrial Pollutants,
    Effluents and Toxics
  • November 1998 presentation, Oakville Ontario, to

12
Canadian Association of Physicians for the
Environment
  • C.A.P.E.

13
Health Canada, l997
  • State of Knowledge Report
  • on Environmental Contaminants
  • and Human Health
  • in the
  • Great Lakes Basin
  • 300 pages

14
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

15
Where do contaminants goin North America?
  • Great Lakes Basin
  • St. Lawrence River
  • Rocky Mountains
  • Arctic

16
Cdn J of Public HealthSupplement, 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

17
What are the causes of illnesses?
  • 1. Genes
  • 2. Environmental factors

18
McGinnis Foege, DHSSJAMA, Nov 10, l993Actual
Causes of Death in U.S.
  • 2 components to the cause of illness
  • 1. Genes
  • 2. Environmental factors

19
Genetic factors in illness
  • Genetic resistance/susceptibility
  • some individuals more susceptible than others
  • e. g. cancer
  • tumor suppressor genes
  • cancer families

20
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

21
Toxics exposure in theGreat Lakes Basin?
  • How many people?
  • 36 million

22
How many chemicals are in the Great Lakes?
  • 800
  • sources agricultural
  • industrial
  • municipal

23
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

24
What chemicals??What pollutants??
  • 1. Organic chemicals
  • a. non chlorinated
  • methanol, ammonia
  • toluene, benzene, methyl ethyl ketone, ethylene
    glycol

25
  • 2. Chlorinated/brominated organic chemicals,
    COCs
  • Persistent toxic substances
  • Persistent organic pollutants, POPs
  • e.g. pcbs, dioxins, furans

26
Dioxins
27
Barry Commoner2nd 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.

28
WHO Tolerable Daily IntakeDioxin, 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

29
Source of Daily Intake
  • Food
  • 90

30
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

31
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)

32
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

33
Daily Intake of Dioxin/furan from Breast milk (
pg/kg bw/day)
34
Concentrations of dioxins and furans in Canadian
human milkpg/Kg Whole milk
35
1992 estimated daily intake of dioxin from breast
milk/formulapg TEQ/Kg body wgt/day
36
WHO TDI Dioxin 19981 - 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

37
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

38
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,

39
Mean levels of PCDDs and PCDFs in Human Adipose
Tissue
40
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)

41
comparable
  • Levels in Canadians/ NY State residents sampled
    from accidental death (unexposed) victims
  • comparable to
  • countries where residents were exposed to dioxins

42
What pollutants? II
  • 2. Heavy Metals
  • Mercury, lead, arsenic, cadmium
  • Copper, zinc
  • (No discussion of health effects)

43
What pollutants? III
  • 3. Classic Air Pollutants
  • Particulates (PM 10, PM 50)
  • Ozone
  • Acid Gases (Sox, Nox, HCl)
  • CO

44
What pollutants? IV
  • 4. CO2
  • Global Warming

45
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

46
Municipal Solid Waste backyard barrel burning
  • PVC plastic
  • significant source of dioxin

47
Incineration of Medical Waste, I
  • U. S. E. P. A.
  • 3rd largest source of Dioxin
  • major source of Mercury
  • North American environment

48
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

49
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

50
What is the Current toxic load entering the Great
Lakes Basin?
  • Great Lakes United, 1997
  • 2500 tonnes per week
  • (100 truck loads)

51
Provincial Auditor of Ontario1996
  • 1200 tonnes in Province of Ontario
    /week
  • (1000 tonnes into the air)

52
NAFTA CECToxic Load in North America1998
  • 1 million tonnes per year

53
(No Transcript)
54
What are (or could be) the Human Health Effects
of Toxics?
  • 1. Proven
  • 2. Speculative/unproven

55
Public health Officials
  • Concerned citizens
  • ask questions
  • about hazardous chemicals
  • in their communities

56
Public health officials offerReassurance
  • The following are some local, provincial,
    national and international examples

57
Bay of Quinte Hazardous Waste Sites
  • 1. Trenton Norampac Dombind
  • 2. Aikens Road landfill
  • 3. Zwicks Island Park landfill
  • 4. Meyers Pier coal gasification site, pahs
  • 5. Bakelite plant, phenols
  • 6. Deloro mines arsenic/radioactivity
  • 7. Rednersville Road , TCE
  • 8. Richmond municipal landfill site, Napanee

58
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 (PAHs)

59
1
  • Rednersville, Ontario

60
Rednersville, Ontario, 1990
  • Illegal hazardous waste site
  • 200 barrels of VOCs TCE, benzene
  • 1973-1988 15 years
  • 16 (25) families contaminated water
  • compare Woburn, Mass case
  • MoH Health Study

61
Woburn, Massachusetts1970 - 1990
  • Drinking water contamination with TCE
  • 2 local plants W.R.Grace, Beatrice Foods
  • 12 children died of leukemia (70s)
  • civil action by citizens,
  • EPA action, 1990
  • 70,000,000 liability, cleanup operation
  • Civil Action, Jonathan Harr,

62
Rednersville Health Study, 1990
  • no evidence of human health effects.

63
2
  • Zwicks Island landfill, Meiers Pier
  • Belleville, Ontario

64
Zwicks Island Park, Meyers PierBelleville, l998
  • Municipal/hazardous waste landfill
  • Creasy engineering Report
  • leaking PAHs (benzo (a) pyrene),
  • VOCs (chloroform)
  • compare NY State and Eurohazcon studies
  • Municipal Health study risk assessment shows
    elevated cancer risk at Meiers Pier

65
  • NY State ATSDR June l998 cancer
  • Eurohazcon study, Dolk,1998 congenital
    defects
  • (The Lancet)

66
Zwicks Island/Meyers 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)

67
Zwicks Island/Meyers Pier Health Study, 1998
  • These places are not unsafe for people.
  • City Administrator,
  • Belleville
    Intelligencer, Nov.3,98

68
3
  • Dombind, Eastern Ontario

69
Dombind, 1993 - 98 Hastings/Northumberland/Peterb
oroughTrent 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)

70
1994, Times Beach, Missouri
  • 2nd Citizens Conference on Dioxin
  • St. Louis/Times Beach
  • 1970s
  • dioxin-contaminated waste oil as
  • dust suppressant on roads

71
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

72
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

73
4
  • Richmond landfill site, Napanee, Ont

74
Richmond (Napanee) landfill site
  • 2 million tonnes existing
  • Canadian Waste Services
  • application for 750,000 more annual tonnes
  • leachate flow intoMarysville,Sucker Creek
  • thence into Bay of Quinte
  • Committee of Concerned Residents
  • Paul Finkle, Stephen Geneja, Residents
  • community press, April 2, 1999

75
5
  • Kingston landfill site

76
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

77
6
  • Arsenic leakage into Moira River Deloro, Ontario

78
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

79
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

80
7
  • Peterborough,Ontario

81
Peterborough, Ontario
  • Feasibility hearings for municipal incinerator
    construction, April 1999

82
8
  • Cornwall, Ontario
  • Material resources recovery unit

83
Cornwall, Ontariomaterial resources recovery unit
  • Public hearings, attended by Ellen and Paul
    Connett, August 1999
  • application for permit to burn 30,000 ppm PCBs,
    current permitted for 50 ppm
  • Cornwall/Massena area already heavily
    contaminated with PCBs

84
Cornwall hazardous waste incinerator
  • October 1998, began operation
  • PCBs 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.

85
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 malefemale birth ratio in Cornwall
    in passing)

86
9
  • West Lincoln, Ontario
  • failed proposal of 1980s

87
OWMC hazardous waste facilityWest Lincoln,
Ontario, 1980s
  • Hazardous waste incinerator
  • 60,000 tonnes per year
  • Joint Board Hearings, Oakville Ontario
  • 1991 - 1993
  • Health Risk Assessment

88
West Lincoln Risk Assessment
  • Negligible Cancer risks
  • No Non Cancer health effects
  • No evidence of significant health effects

89
Examples from elsewhere in Canada and United
States
90
1
  • Sydney Tar Ponds, Nova Scotia

91
Sydney Mines, Cape Breton, NSTar ponds, 1995
  • CMAJ, March l5, l995
  • cokes ovens, steel plants
  • PAHs in tar ponds (700,000 tonnes
    sediment)
  • Cancer mortality 25 higher in women, 49 higher
    in men than provincial average
  • Provincial Epidemiologist

92
Sydney tar ponds
  • Lifestyle factors, namely smoking and poor diet,
    were said to be responsible by public health
    officials

93
2
  • East Liverpool, Ohio
  • hazardous waste incinerator

94
WTI hazardous waste incineratorEast 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

95
East Liverpool Risk Assessment
  • Negligible Cancer risk
  • No additional Non Cancer health effects
  • No evidence of significant health effects

96
Citizens ask questions about toxic substances in
their communities
  • Public health officials
  • 1. Epidemiology
  • 2. Risk Assessment

97
No evidence of human health risk.
98
Hamilton, March 1999EverydayCarcinogens
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

99
Reassurance
  • Pattern of Denial ?
  • by public health authorities

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

101
Denial by developers, II
  • Charlie Cray, Greenpeace, Chicago
  • PVC emits dioxin when it burns. Its very toxic

102
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

103
Medical literature
  • 1992 - 1998

104
Non reassuringmedical literature
  • 1. Limitations of Epidemiology and
  • Risk Assessment
  • 2. Reports changes in disease patterns
  • strong hints
  • industrial chemicals are implicated

105
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 ..

106
.The LancetEnd 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

107
I. Cancer
108
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.

109
Epidemiology(has a problem)
  • Do
  • industrial effluents
  • cause
  • cancer?

110
Dr. Anthony Miller,U of T EpidemiologyJAMA 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.

111
Dr. David KesslerU. 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.

112
  • CLASSIFICATION OF CANCER
  • by Age
  • 1. Childhood Cancer, lt age l7, 19
  • 2. Adult cancer

113
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

114
Canadian Childhood Cancer Control Program , I
Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994
115
Canadian Childhood Cancer Control Program II,
Gibbons, Mao, Levy, Miller, CMAJ, Dec l5, l994
116
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

117
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.

118
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

119
Childhood Cancer and Environmental Contaminants
  • Cdn J Public Health, June 1998
  • Mary Mcbride, B.C. Cancer Control Agency
  • 185 references

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

122
Common Cancers
123
Lung Cancer
  • Genes

124
Tumor suppressor genes
  • Control cell reproduction
  • Individuals/families who are
  • genetically RESISTANT
  • SUSCEPTIBLE to cancer

125
Tumour suppressor genesNormal vs.
Mutations
126
Lung Cancer
  • Tang, (Smithville, USA)
  • Lancet Oct 26, l996
  • 4000 chemicals in Cigarette smoke
  • Benzo (a) pyrene
  • DNA damage to p53 tumor suppressor gene

127
Tang
  • (one) mechanism
  • by which
  • Toxics cause cancer

128
Benzo (a) pyrenein 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

129
Bowel cancerChlorine and drinking water (I)
  • Will King, OCTRF/Queens University
  • Dec 6 , l995
  • chlorinated water
  • 10 increase in bowel (and bladder) cancer
  • ?Trihalomethanes

130
Bowel cancerchlorinated drinking water (II)
  • Doyle, Univ of Minnesota
  • Lancet, Aug 23, l997
  • 28,000 post menopausal women in Iowa
  • chlorinated drinking water
  • increased colon cancer

131
Breast Cancer industrial chemicals
  • Dr. Devra Davis
  • World Resources Institute
  • JAMA, Feb 9, l994
  • 1973 - 1987
  • 19 increase
  • ? Environmental xenoestrogens

132
CCO graphBreast cancer incidence
  • Rising
  • on display at Everyday Carcinogens conf
  • March 1999

133
Devra Davis (contd)
  • 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.

134
Breast cancer and chemicalsCON
  • Stephen Safe, Ph.D, Texas AM University
  • editorial, NEJM, Oct 30, l997
  • chemophobia, the unreasonable fear of chemicals
  • paparazzi science
  • 2 problems ??

135
Safes editorial
  • Hunter ? Doubtful conclusions
  • ?undeclared interests (CMA)

136
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)

137
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 system.

138
...Recipient of this toxic flush
  • ...Newborn breast feeding infant

139
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

140
Prostate cancer, II
  • Gallagher, Fleshner
  • CMAJ, October 6, l998
  • strong relationship to Dietary Fat intake

141
Uncommon Cancers(that are increasing)
  • 1. NHL
  • 2. Brain tumors
  • 3. Melanoma
  • 4. Testicular cancer

142
Non Hodgkins Lymphomas, I
  • Adami et al, Sweden
  • BMJ, June 10, l995
  • 2 - 4 annual increase
  • in a number of countries
  • ?role of u/v exposure

143
Non-Hodgkins Lymphomas, II
  • Freedman
  • BMJ May 17, l997
  • mortality NOT associated with u/v exposure
  • ? Unsuspected environmental agents

144
Non-Hodgkins Lymphomas, III
  • Rothman, Cantor
  • Lancet, July 26, l997
  • occurrence of NHL related to PCB levels
  • ?immunosuppression, with EBV susceptibility

145
Non Hodgkins Lymphomas
  • 2 - 4 annual increase
  • Rothman, Cantor
  • Lancet, July 26, l997
  • occurrence of NHL related to PCB levels

146
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

147
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

148
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

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

150
Melanoma
  • BMJ Jan 20, l996
  • DOUBLING of rate in Southern Hemisphere
  • chlorofluorocarbon release
  • ozone loss, increased u/v exposure

151
II. Non Cancer illnesses
152
Non-cancer illnesses
  • 1. CardioRespiratory
  • 2. Reproductive and Developmental
  • 3. Neuropsychological
  • 4. Endocrine
  • 5. Immunological

153
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)

154
  • Classic Air Pollutants
  • Particulates (PM 10, PM 50)
  • Ozone
  • Acid Gases (Sox, Nox, HCl)
  • CO

155
2. Reproduction and Development
156
Environmental EstrogensXenoestrogens
  • 1. Chlorinated organic chemicals
  • 2. APEs (alpha phenyl ethoxylates),
    surfactants, detergents
  • 3. Bisphenols (polycarbonate subunit)
  • 4. phthalates (plasticizers)

157
2.Reproduction Development
  • a. (Canadian) MEN
  • 1. declining sperm counts
  • 2. declining malefemale birth ratio
  • 3. Increasing abnormalities of male sex organs
    (hypospadias)
  • 4. Shrinking testicle size(Klotz, CMAJ,Jan99)
  • 5. Increasing testicular cancer

158
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 COCs into
    industrial production in 1940

159
Declining Sperm Counts, II
  • French (Thibeault, Bujan
  • British (Irvine, Sharp)
  • American (Fisch)
  • Scandinavian (Pajarinen)

160
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

161
Declining Sperm Counts, IV
  • Swan (California)
  • Lancet Nov 29, l997
  • reanalysis of Carlsens meta analysis, l992
  • USA 1.5 reduction annually, 1938 - 90
  • Europe 3.1 reduction annually,l971- 90

162
?Declining Sperm Counts
  • NIH
  • ACDCP
  • started study Nov l997

163
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 l980s

164
Declining malefemale 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)

165
Declining malefemale 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

166
2.Reproduction Development
  • b. WOMEN
  • 1. Shorter menstrual cycles
  • 2. Threatened miscarriage
  • 3. Endometriosis
  • 4. Premature ovarian failure

167
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

168
Premature ovarian failure/menopause
  • Cowan Seifer
  • Clinical Reproductive Medicine, 1997
  • 7 causes of premature menopause
  • environmental dioxin

169
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

170
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 its a human, a fish or a
    bird, it goes through much the same process. So
    if theres 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.

171
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

172
Fetal development
  • Vivyan Howard
  • University of Liverpool Fetal toxicopathology
    group
  • 2nd Citizens Conference on Dioxin, l994
  • IUGR as a conseqence of toxics exposure

173
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

174
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
  • NTDs, cardiac septal defects, transposition of
    great arteries and veins
  • statistically significant

175
Breast feeding, I
  • Frank, Newman
  • CMAJ, July 1993
  • pcbs and other toxics in breast milk
  • good evidence of subtle fetal and infant health
    effects resulting from prenatal (intrauterine)
    exposure

176
Breast feeding, II
  • WHO committee
  • Lancet, BMJ, May l997
  • 2 month old breast fed infant
  • receives 17 times the TDI of pcbs and dioxins
    from breast milk (50 times)
  • breast feeding a significant risk ??

177
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

178
Canadian Breast milk studies
  • Summary Persistent Environmental Contaminants
    and the Great Lakes Basin Population An Exposure
    Assessment
  • Health Canada, 1998
  • Douglas Haines, GLHEP

179
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 DF/kg whole milk
  • B/C Pg Teq DF/kg body wgt/day daily intake,
    Breast milk/formula
  • C. WHO TDI, l998 D. factor over WHO

180
3. Brain
  • PCBs and brain injury in
  • babies/children of fish-eating residents of
  • Lake Michigan (Jacobson)
  • Lake Ontario (Daley)
  • adults
  • St. Lawrence River (Mergler)

181
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?

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

183
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)

184
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

185
4. Immunologic Effects
186
Immunologic Effects, I
  • McConnachie, Illinois, 1994
  • 2nd Citizens Conference on Dioxin
  • Times Beach, Missouri, dioxin exposure
  • children
  • lymphocyte dysfunction

187
Immunologic Effects, II
  • Repetto, World Resources Institute
  • JAMA March 27, l996
  • Pesticides and the Immune System
  • immune system dysfunction in children

188
5. Endocrine Effects
189
Endocrine Effects
  • Koppe, Netherlands
  • Lancet Feb 3, l996
  • thyroid neonatal dysfunction after dioxin
    exposure
  • structural similarilty between dioxin and
    thyroxine molecules

190
Conclusions
  • Environmental
  • Economics

191
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

192
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

193
Government of Ontario II(and the human brain)
194
Government of Ontario , III
  • 1995 - 1998 MoE
  • number of pollution investigators fell 28
  • total staffing fell 32

195
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

196
Provincial Auditor of Ontario,1996
  • 226 air-pollutant standards required reassessment
    (1992 MoE study)
  • substantial reductions needed in releases of air
    pollutantsaggressive 3 year MoE plan

197
Provincial Auditor , 1998
  • Erik Peters
  • followup November 4,1998
  • not a single one of the 226 air pollutant
    standards has been updated

198
Minister of Environment, 1998
  • Norman Sterling, Nov 4, l998
  • When you are striking scientific-based
    standards, it does take a bit of time.

199
Waste water standards, l996MoE 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

200
MoE, 1996, II
  • Karen Vaux, spokeswoman
  • Our priority is to get them to fix it and ensure
    that these type of occurrences dont happen
    again.

201
500 Journal articles on Toxics1992 - 1998
202
Government of Ontario II
203
Linkage
  • Government funding for environmental work
  • environmental research

204
Montreal Biosphere1999
  • Multimedia presentation
  • Mission Bios H20
  • but in the last 15 years the situation has
    greatly improved
  • (How would you know?)

205
Dr. Pierre Belandformer commissioner, IJC1998
GLU Citizens 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.

206
Eva LigetiEnvironmental 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

207
International Joint Commissionof 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.

208
IJC, 9th Biennial Report, II
  • as a major part of their diet. Particularly at
    risk are developing embryos and nursing
    infants.
  • July l998

209
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