By David Tuller, Dr.PH.
Everyone wants to know more than we currently do about the long-term effects of everyday exposures to toxic chemicals. Even obstetricians, who could be expected to have a handle on the science, report not knowing how to advise their pregnant patients, according to a recent survey led by colleagues at the University of California at San Francisco’s (UCSF) Program on Reproductive Health and the Environment.
Why has it been so difficult to draw authoritative conclusions about the impacts of toxic exposures? For one thing, we lack data. In the case of pharmaceuticals, drug companies are required to prove safety and efficacy with clinical trials in which some participants are given the medication and others are not. Such experiments are impossible with chemicals. The kinds of data that the Food and Drug Administration uses to make decisions about pharmaceuticals is simply not available—and not obtainable—for chemicals.
That means relying on other sources of information. Laboratory and animal experiments can demonstrate a chemical’s negative impacts on living organisms, but interpreting what those findings mean for human beings is difficult. Human observational studies provide solid evidence of associations between chemical exposures and specific health outcomes but drawing conclusions about causes is more challenging. That’s because of the possibility that some other, unmeasured factor—another environmental exposure, a genetic predisposition, or something else—was responsible for the outcomes observed.
In the field of medicine, the push for “evidence-based” decision-making—clinical care based on solid reviews of the available data rather than on doctors’ hunches and instincts—has transformed practice in recent decades. Without the same kind of evidence base as medicine, environmental health has lagged behind in applying findings from the science to public policy. The field lacks a rigorous method for assessing the quality and strength of the data streams from both laboratory experiments and human observational studies—and emerging with conclusions that are solidly grounded in the scientific literature.
To address that methodological gap, UCSF’s Program on Reproductive Health and the Environment has been leading an initiative to develop such a method, with participation from other academic centers, government agencies, and non-governmental organizations. In four papers just published by Environmental Health Perspectives, the researchers describe the method, called the Navigation Guide, and road-test it with a widely used chemical that virtually everyone in the U.S. is routinely exposed to—perfluorooctanoic acid, or PFOA.
The goal of the Navigation Guide is to help reduce the time lapse between scientific discoveries and the development of appropriate health policies. Speeding the process of translating findings into action could help to significantly reduce disease prevalence and health care expenditures. The U.S. health care system, for example, was estimated to have spent more than $75 billion on childhood illnesses associated with environmental exposures; changed policies leading to lower exposure levels could both improve health outcomes and trim costs.
“Due to deficiencies in the current regulatory structure for manufactured chemicals, a failure or delay in acting on the science means that exposure to toxic chemicals persists while evidence of harm mounts,” reports one of the papers. “To the extent that science informs public policy to prevent harm, a robust method to synthesize what is known about the environmental drivers of health in a transparent and systematic manner is a necessary foundational step to making the science actionable.”
In the series of EHP papers, the researchers tackled the question of whether PFOA exposure affects fetal growth in humans. The chemical has been used widely in industrial and consumer products for more than 50 years, and it persists in the environment. Virtually all Americans are exposed to it, and numerous studies have examined its relationship to fetal growth.
The Navigation Guide methodology involves four steps:
In the PFOA case study, the team was able to synthesize the human and non-human findings and issue a clear, “strength-of-evidence” conclusion: developmental exposure to PFOA, wrote the researchers, “adversely affects human health based on sufficient evidence of decreased fetal growth in both human and non-human mammalian species.” The chemical, they determined, is “known to be toxic.”
So what are the health policy implications of that direct, evidence-based statement? That question—the heart of Step 4 of the Navigation Guide—has not yet been fully explored. Creating policy from science is always a messy business, given that people approach the problem from a vast array of political, social and economic perspectives. But no effective action is possible without a neutral, authoritative statement of what the science tells us. And now, at least in the case of PFOA’s effects on fetal growth, we know.
David Tuller, Dr.PH. is academic coordinator of UC Berkeley's joint masters program in public health and journalism. He was a reporter and editor for 10 years at the San Francisco Chronicle, served as health editor at Salon.com and frequently writes about health for The New York Times.
Posted by Breast Cancer Fund on July 08, 2014 at 10:45 AM in Chemicals policy reform, Cosmetics, Create a Healthy Home, Eat & Live Better, Pesticides, Phthalates, Plastics | Permalink | Comments (0) | TrackBack (0)
Technorati Tags: Environmental Health Perspectives, evidence base, Food and Drug Administration, observational studies, PFOA, Reproductive Health, San Francisco Chronicle, The New York Times, UC Berkeley, University of California at San Francisco
When Marlyss Bird signed up to represent The North Face at Climb Against the Odds, she didn't really know what she was getting herself into. She's not a breast cancer survivor and nobody in her immediate family has had the disease. Summiting a mountain was on her bucket list and she wanted to do it for a cause.
But after arriving at Mt. Shasta and learning about some of the stories driving her teammates, she started to understand the significance of the Climb.
Her rope team included Leslie Kelly and Bridget Vanoni, a mother-and-daughter pair from Sonoma, Calif. Leslie has survived two breast cancer diagnoses and has climbed Mt. Shasta three times with the Breast Cancer Fund.
Marlyss was inspired by Leslie's determination and strength. "Just to see her strength out there- after what she’s been through and going through. And just to see Bridget’s quiet strength and to think about how scary that must be to have your mom go through that twice and to see mom sick and struggling. It was really impressive to see them work so hard to get to the top."
Marlyss, Leslie and Bridget were the first to summit Mt. Shasta that day.
"I was not aware that we were on our way to being first to the summit until our guide, Eric, said something at the top of the West Face," Leslie said. "It made me smile; not in a competitive way, but at the ease of which it was happening."
The three women barely spoke.
"There was this quiet focus about the three of us...almost eerie, but beautiful," Leslie said. "Marlyss and I didn’t know each other well, we barely spoke the entire climb, but we know each other now. I don’t know how to explain that feeling; there were no words, we didn’t need them."
The 2015 team is forming! Reserve your spot: www.breastcancerfund.org/climb
The sun still shining, the inside of our tent warm and bright, we are told to at least rest even if we can't fall asleep. Bridget whispers to me "I am nervous". I whisper back, "Me too". Earlier she told me she wished people would stop treating us like we were the experts because we have climbed before. I agreed; all it really meant was we knew how much work was ahead.
On the hard, uneven ground in my sleeping bag beside Bridget - I can't sleep; the tent flapping in the heavy wind holds my attention. I will the wind to stop but it keeps blowing. I turn on my side, my face inches from Bridget's. She is asleep. My eyes fill with tears looking at her bleach blond curls and tanned face peaking out of a bright blue mummy sleeping bag. Was I crazy to bring my young daughter not once, but twice, with me to climb Mt. Shasta? Or am I the luckiest mom in the world? I decide I am both.
Frederique (a close friend of my sister's and now like a sister to me) emailed me the day we started our climb last year to tell me she'd been diagnosed with breast cancer. In passing, I told her we were climbing again this year and suggested she join us, and bam!, she and her son signed up. I have been so grateful to share this experience with her, her son Arthur, as well as Bridget this year.
With the wind howling and head lamps lighting the way, our team of six left base camp at 3 AM. Slowly and methodically we followed our guides up the mountain, split into groups of three. We roped ourselves together and changed to crampons and ice axes. Frequent but short breaks for water and food kept us warm as we progressed. On one break, we sat under the Red Banks with the sun just coming up and our guide asked how long I'd been in remission. Two and a half years since my second diagnosis, I told him. Eric then shared that his mother was diagnosed a second time with metastatic breast cancer (just like me) when he was in the 7th grade (young, like Bridget). For a few moments there was only silence - each one of us acutely aware of why we were there, roped together. Finally I gathered the courage to ask if she survived. When he replied "it's been over twenty years, and she will be at the dinner Thursday night"...my heart filled with hope.
Eric, Marlyss, Bridget and I reached the summit first. Totally spent, Bridget and I laid on the ground, barely aware of our photo being taken, and a fellow climber asked how it felt to reach the top this time. With relief, I realized I hadn't thought about reaching the summit at all this year. The following morning - dirty, dazed and euphoric - we hiked back down. Arthur said "you're my Aunt Leslie now".
My spirit continues to heal with every step on every Climb Against the Odds with the Breast Cancer Fund.
Thank you for supporting the work of the Breast Cancer Fund to prevent Breast Cancer before it starts.
Our Climb Against the Odds 2014 team made it back to civilization today in high spirits. Twenty of the 25 climbers made it to the top of the 14,179-foot Mount Shasta. The remaining five climbers made it to at least 11,500 feet, which is also an amazing feat.
As they arrived at Bunny Flat they were greeted by friends, family and supporters after having transformative experiences up on the mountain with their teammates.
Jill Zastko, a breast cancer survivor who carried Breast Cancer Fund Founder Andrea Martin's talisman up the mountain called the Climb the most incredible experience of her life. At one point, other people on her rope team had turned back and her guide wasn't sure whether or not she could keep going. She decided she to go on, and as she approached the West Face of Mt. Shasta, another rope team that was farther ahead started cheering for her. It was an emotional and inspiring moment, which helped her push through and make it to the top. Congratulations to Jill and all the other climbers.
For Ruth Walter, a cheese shop owner from Bronxville, N.Y., the climb was humbling. She climbed Mt. Shasta to mark her five year anniversary from treatment and reached the top. "I couldn't have done it without my teammates,
"I have never been drawn to the walk for the cure or anything like that. I don’t really like pink or ribbons or self identifying as a breast cancer survivor. I feel like it’s kind of inundated our lives and I really like the Breast Cancer Fund's emphasis on prevention."
Stay tuned as more pictures from the mountain are posted to Flickr and as we wrap up this year's Climb Against the Odds.
Many of the climbers glissaded, or slid, back to base camp as you can see below.
Leslie Kelly, Bridget Vanoni, Marlyss Bird, Lucas Parsons, Arthur Morgan, Lindsey Dal Parto, Tessa Montgomery, Cathy Ann Taylor, Frederique Mary, Barbara Winter and Maryann Maineri are all relaxing at base camp.
We expect the final last group to arrive at base camp in the next 30 minutes.
Everyone is doing great despite their tired feet.
It's incredibly rare for a whole Climb Against the Odds team to make it this far, and we are so proud of our whole team.
Twenty of the 25 climbers have reached the pinnacle of Mt. Shasta:
The other five climbers did an amazing job and are currently making their way back to base camp. They're close by and we will provide updates in the next hour. Sherry Erickson made it 12,000 feet, Nancy Klimah made it 11.5k, Frederique Mary, Barbara Winter and Maryann Maneiri made it 13.3k
Robert Abramowitz, Ruth Walter, Katie Bernell and Cristin Bailey have made it 14,179 feet to the top of Mt. Shasta!
Ruth Walter lived only one mile away from Ground Zero on 9/11 and was breast feeding her daughter. After that catastrophe, she wondered about the environmental toxins that were released and what effect they might have on her. Almost eight years later in 2009, Ruth underwent treatment for stage 2 breast cancer. Ruth wanted to do something meaningful to mark 5 years since treatment. Go, Ruth!
Rob Abramowitz, of Frederick, Maryland is climbing in honor of his mother, a breast cancer survivor.
"In these past four years, my mother has shown our family what true courage and strength really is when faced with a terrifying situation. I'm happy to say that Mom has been cancer free since her treatment and I couldn't be prouder of her. The climb represents both a personal endeavor to honor the courage and strength my mother displayed while undergoing treatments and a collective effort to stop the disease before it starts."
Cristin Bailey is celebrating her birthday on the mountain and honoring her Grammy Tibbets who died after a five-year battle with breast cancer in 1987.
And Katie Bernell, who works in sales at Clif Bar & Co., is climbing in honor of two breast cancer survivors in her family: her grandmother and her aunt.
"Women may not be able to fully control their odds against this disease, from a genetic sense, however we do have the power to speak louder and create higher standards on what we put in our bodies, the chemicals we use in our beauty regimens, and the toxins that surround us in our homes and the world we live in."
We have confirmation that at least three people have reached the summit and others are close behind.
Leslie Kelly, her daughter Bridget Vanoni and the North Face-sponsored climber, Marlyss Bird, have all reached the summit!
Leslie Kelly was diagnosed with breast cancer for the first time on her twin daughters’ fourth birthdays. Her girls watched their mother cry as her hair fell out, they saw the fear in her eyes, they saw her deteriorate—both physically and emotionally. In remission, Leslie participated in Climb Against the Odds for the first time in 2012, but didn’t reach the summit because of acute altitude sickness. In 2013 she and her daughter reached the summit and this year they were two of the three first climbers to reach the top.
“My girls ask me all the time if they will get breast cancer. I wish I knew that the answer was no, but I don't. What I do know is that the Breast Cancer Fund is working every day to make sure fewer people ever have to get the terrible diagnosis. And I know I will continue to do what I can to support this work.”
Marlyss Bird is the North Face's sponsored climber. She's an avid hiker and outdoorswoman, but has never summited a mountain. Congratulations, Marlyss!
Past climber and 2014 Sacred Trekker, LaDawn Beardsley, one of our dedicated volunteers working at base camp needs to stand on one foot and reach as high as she can to get cell phone service so she can remain in communication with us. Thank you, LaDawn for keeping us all in the loop! And thanks to all our basecamp volunteers.