A Grave Lapse of Stewardship: Why Pediatricians Need TSCA Reform by Philip J. Landrigan, MD MSc

Healthcare professionals and public health advocates across the country are speaking out about the harmful role that toxic chemicals play in our lives, and the need for a robust regulatory strategy to address them. With a bill under consideration in the Senate (the Safe Chemicals Act of 2011), and 12 Senators already signed on to co-sponsor it, will 2012 be the year of comprehensive chemical policy reform? In this month’s Environmental Health Policy Institute, we present official statements on the need for chemical policy reform from the American College of Preventive Medicine and the American Public Health Association. We also hear from a prominent pediatrician, a reproductive health nurse, advocates from the learning and developmental disabilities community, and Safer Chemicals Healthy Families, a national coalition working toward commonsense limits on toxic exposures. Together they explain how reforming the outdated Toxic Substances Control Act will improve the health of Americans.

Chemical production has increased dramatically in the past half century. Today, there are more than 80,000 chemicals registered with the EPA for commercial use. Commercial introduction and wide dissemination of these new chemicals preceded any systematic effort to assess their potential toxicity. Especially absent were advance efforts to examine possible impacts on children’s health or potential to disrupt early development.
Children are most at risk of exposure to the 3,000 synthetic chemicals produced in quantities of more than 1 million pounds per year. EPA classes these materials as high-production-volume (HPV) chemicals. HPV chemicals are found in consumer goods, cosmetics, medications, motor fuels and building materials. They are detectable in much of the US in air, food, and drinking water.
These chemicals are also finding their way into our bodies.  Measurable quantities of several hundred HPV chemicals are routinely found in the blood and urine of virtually all Americans (CDC, 2008). Elevated levels of HPV chemicals are seen also in the breast milk of nursing mothers and the cord blood of newborn infants (Environmental Working Group, 2005).
There has been a systematic failure to conduct premarket evaluations of potential toxicity of synthetic chemicals before their introduction to commerce:
Information on potential toxicity is publicly available for only about half of the 3,000 HPV chemicals.
Information on developmental toxicity or capacity to harm infants and children is available for fewer than 20% of HPV chemicals (Goldman, 1998). Phthalates, Bisphenol A, and perfluorinated compounds are examples of industrial chemicals that became widespread before any assessment of their potential hazards. They are produced in high volumes, used in myriad consumer products, and are widespread in children’s environments. Only now, decades after their introduction, are their possible hazards to children’s health beginning to be assessed.
This failure represents a grave lapse of stewardship. It puts children at risk daily of exposure to technologies whose potential for hazard is virtually unknown. It reflects a combination of industry’s unwillingness to take responsibility for their products coupled with failure of government.
The failure of government reflects the failure of the Toxic Substances Control Act (TSCA). TSCA was intended at the time of its passage in 1976 to be pioneering legislation that would require premarket evaluation of all new chemicals for potential toxicity. TSCA was also intended to require retroactive testing of industrial chemicals already in commerce. TSCA never fulfilled these noble intentions. A particularly egregious lapse was an early decision to “grandfather in” 62,000 chemicals already on the market and thus to require no toxicity testing of them. These chemicals were simply presumed safe and allowed to remain in commerce.
The section of EPA responsible for enforcing TSCA has been chronically underfunded, understaffed, and overwhelmed by the sheer number of new chemicals and technologies that come before it.  By default, emerging technologies and new materials have been presumed by EPA to be safe unless there was overwhelming evidence of their potential to cause harm.
To better defend children against the unforeseen consequences of chemical exposures, the US needs to adopt a new national framework and new strategies for responsible stewardship. This new framework must be designed explicitly to protect children due to their greater vulnerability to toxic chemicals. A legally mandated, strictly enforced requirement that all new technologies be examined for potential toxicity before commercial introduction must be its cornerstone. New chemicals must be shown to be safe before they are disseminated.
Two other innovations would help protect children from the potential health effects of chemical exposure:
Enhanced toxicity testing of chemicals.  Today, most chemicals are tested for toxicity by administering them to experimental animals during adolescence; the animals are then sacrificed and examined for toxic effects 12-24 months later. This truncated approach makes it impossible to study late consequences of early exposures, and it precludes assessment of developmental toxicity. The duration of toxicity testing should be extended to incorporate administration of chemicals in early life — ideally in utero or even before conception —  coupled with lifelong follow-up (Landrigan et al. 2004).
Prospective Epidemiological Studies. Large-scale, prospective epidemiological studies such as the National Children’s Study are critical engines for discovering the health consequences of children’s exposures to emerging technologies. The National Children’s Study will follow 100,000 children, a statistically representative sample of all children born in the United States, over a 21-year period from conception to adulthood (Landrigan et al., 2006). The goal is to discover the preventable environmental causes of chronic diseases of children and then to translate that knowledge into a national blueprint for disease prevention. Such large-scale epidemiological investigations have the power to discover new hazards and to identify critical windows of vulnerability in early development.
Children have been suffering from a lapse of stewardship. But with a combination of enhanced toxicity testing, prospective epidemiological studies, and child-protective chemical legislation, such as the Safe Chemicals Act of 2011, we can protect our nation’s future.
This essay is adapted from: American Academy of Pediatrics Council on Environmental Health. Emerging Technologies and Materials. In: Etzel, RA, ed. Pediatric Environmental Health, 3rd Edition. Elk Grove Village, IL: American Academy of Pediatrics; 2012:749-755.
REFERENCES
Centers for Disease Control and Prevention  National Report on Human Exposure to Environmental Chemicals. Atlanta, 2001  http://www.cdc.gov/nceh/dls/report.
Environmental Working Group.  Body Burden — The Pollution in Newborns.  A benchmark investigation of industrial chemicals, pollutants and pesticides in umbilical cord blood. Washington, DC. Environmental Working Group: July 14, 2005
Goldman LR. Chemicals and children’s environment: What we don’t know about risks.

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