Dioxin Pollution Could be Prevented with the Support of Institutions Which are the Worst Polluters
I. The Story
Hospitals are dedicated to preventing and curing disease, but they are the greatest single contributor to dioxin pollution. Dioxins are created when chlorine and organic matter react in the presence of heat. Polyvinyl chloride which is burned in medical waste is the major source. In the last decade, medical waste generation has rapidly increased because of the switch from reusables to disposables. Many hospitals are still using small waste incinerators which do not burn at a high enough heat to destroy the dioxins. Medical waste incinerators are also the largest sources of mercury emissions in the United States. The American Hospital Association disputes the findings of the Environmental Protection Agency. (1)
II. A Brief History of the Issues Behind the Story
The EPA completed a reassessment of dioxin in 1994. No threshold level of human safety for dioxin exposure could be established. Thirty pounds of dioxins are released each year in the USA. Every American has a measurable level of dioxin in his or her body. The half-life of dioxin in a human body is seven years. Dioxin in the environment is worldwide. (2)
The reactions of institutions to the EPA reassessment are in keeping with their interests. The Chemical Manufacturers Association bankrolled $5 million for public relations to promote the idea that the chemicals are innocent until proven guilty. (3) The Chlorine Chemistry Council pronounced that more research was needed, saying, "no conclusions should be drawn" from the EPA reassessment. The National Cattlemen's Association disputed that dioxin exposure could come from eating beef. The National Wildlife declared that dioxin is a grave public health threat. The Environmental Defense Fund, Greenpeace, and Veteran's Legal Services Project requested that the EPA declare a moratorium on burning hospital wastes and an end to the use of chlorine in bleaching paper. The environmental groups wanted the EPA to act swiftly. (4)
III. Why This is an Under Reported Story.
There is a lag time in the change of perception from 2,4,5-T as natural and safe to dioxin as a dangerous trace contaminant. There is an institutional inertia. Agent Orange, the most widely used herbicide in the Vietnam War, contained 2.4.5-T which was thought to be a harmless imitation of a natural substance. No one knew about the presence of the trace contaminant, dioxin. The original report of dioxin carcinogenesis from Batelle Northwest sat in a government archive for three years during the height of the Vietnam War before one of Nader's Raider's discovered it in 1969.
The cause and effect is difficult to measure. The damage is not immediately apparent. Some people are more susceptible to dioxin toxicity than others. Some people have more exposure than others and the environmental exposure is mostly unmeasurable.. It is not feasible to test everyone for dioxin contamination and toxicity.
IV. Why this is an Important Story to Cover.
Dioxins have a great potential for making the planet an unhealthy place to live. Dioxins are persistent in the environment. Dioxins accumulate in the food chain. Everyone has been exposed to dioxins. This global pollution is as serious as ozone and global warming. Dioxins are fat soluble and become more concentrated as they move up the food chain in animal products. Dioxins get into aquatic sediments. They are in the Arctic food chain. The Inuit Eskimos of Canada have some of the highest body burdens of dioxins, furans and PCBs on record. Their native diet is mostly animal products with lots of fat. (1)
The best known harmful effects of dioxins are to reproduction, development, immune system and carcinogenesis. Some scientists think that dioxins and related aromatic hydrocarbons may be causing the global trends since the 1950s of falling sperm counts, abnormalities of the reproductive tract, and an increasing incidence of cancer. A nursing infant gets about 10% of lifetime exposure to dioxins in the first year of life. Infants in the first year of life get 10 to 20 times more exposure than adults. (1)
When pregnant rats were exposed to dioxin, the male offspring showed signs of reproductive dysfunction in the form of smaller sex organs, lower sperm counts and feminized sexual behavior. Normal male rats exposed to 100 times the level of dioxin given to the pregnant rats did not have any such damage. This research was done by Richard Peterson at the University of Wisconsin. (5)
Dioxins and other aryl hydrocarbons cause harm by binding to the Ah receptor. This receptor is vital for immune function in the cells. (6) The Ah receptor is a cellular protein. When it combines with a pollutant such as dioxin and then combines with an HIV-1 virus, it activates the HIV genes. This enables the HIV virus to enter the cell nucleus and turn the cell's genes on or off. (7)
V. Validity of the claims.
Dioxin has been researched for many years by competent scientists. Dioxin exposure is not easy to measure. The effects are not easy to measure.
VI. Where the Story is Going
The American Public Health Association is promoting an precautionary phase-out of the chlorinated organic chemicals which are the source of dioxin emissions from incineration. It is unusual for an organization of this standing in the health care industry to champion such an issue. The senior hospital management has to be convinced that the preventive approach is affordable and in the hospital's best interests. (1)
The methodology is an issue. The EPA makes control-oriented regulations. These do not eliminate the production of hazardous pollutants, but establish an "acceptable" level of pollutant discharge and exposure. The quantitative risk assessments which are used for predicting possible health impacts are not completely "characterized." The preventive approach seeks to anticipate causes of environmental damage to health and remove them from the chain of causation before damage occurs. Instead of waiting until after the damage has occurred and is fully quantified with epidemiological studies, the preventive approach assumes that there will always be uncertainty about what the damage really is and how bad it is. (1) This preventive approach sounds similar to the 14 points of quality assurance which were advocated by the late W. Edwards Deming.
- Public Health Reports, July-August, 1996, 111:298.
- Environmental Action Magazine, Fall, 1994, pp. 22-24.
- Sierra, Jan-Feb, 1995, p. 30.
- Bioscience, December, 1994, pp. 738-739.
- Time, September 19, 1994, p. 68.
- Science, May 5, 1995, p. 638.
- Science News, April 8, 1995, p. 214.