|
THE LANCET -- WORLD REPORT
Chemical danger
Day-to-day chemicals have been blamed for recent increases in several
diseases including asthma and childhood cancer. Fighting this threat means
tackling some of the biggest companies in the world. But, says Robert
Walgate, WHO is prepared for battle
Chemicals could be the next tobacco for WHO, which put this issue high up on
the agenda of their 52-country conference on environment and health in
Budapest, Hungary. There are thousands of artificial chemicals floating
around in each individual and according to Vyvyan Howard, a
toxicopathologist at Liverpool University, this chemical "soup" is major
worry. "We're talking literally of 10s of thousands of novel molecules", he
says.
Far from being harmless, as the chemical industry protests, these substances
have been linked to several diseases--and children are particularly at risk.
"We know these chemicals are contributing to disease in children. This is
not speculation. It's fact", says Philip Landrigan, Chair of the Department
of Community and Preventive Medicine at the Mount Sinai School of Medicine,
New York.
The danger posed by day-to-day chemicals has led WHO to make moves to
strengthen existing guidelines on safety testing. The chemical industry
looks set to take on WHO's challenge, but if past tussles with industry are
anything to go by, WHO could be in for a fight. The organisation's
anti-tobacco legislation was met by massive opposition from industry leaders
and similar reactions were seen by the food industry to WHO's resolution on
diet, nutrition, and exercise, announced earlier this year. But the chemical
industry is keeping a close eye on developments. Observers and lobbyists
from large companies journeyed to Budapest to argue their case.
According to Marc Danzon, European regional director for WHO, the chemical
industry has "ignored health for many years". He said chemical industry
executives have "been a bit stressed by what's happening with the tobacco
industry" and nerves are starting to show. But, he emphasised that WHO was
looking for "consensus and dialogue" not conflict. "Health cannot be
negotiated . . . We cannot be weak on that."
The European council for the chemical industry (CEFIC) welcomed a European
Commission directive on chemical safety that was put together in 2000.
"Broadly we agree there's a need for sensible precaution" said Colin
Humphris, Executive Director for Research and Science at CEFIC. "No
manufacturer would want to put out products that harm children". He says
that industry representatives want a framework, proportionality, and a fair
basis in relative risk--which they believe the EC guidelines provide--but he
says WHO wants to move further.
WHO seems committed to targeting chemicals. Although the conference
declaration had no targets or timelines, even environmental groups came away
impressed at WHO's motivation.
Danzon believes the conference marked a real achievement. He has made his
name by establishing detailed interactions with countries in Europe, and
does not believe in setting global targets. Using the Declaration, WHO's
European office will help member countries define their own specific
priorities, and measure progress during the next 3 years. "We are not
obsessed by models", he explains. "We give directions, share experience, and
then help every member state adapt."
Top <http://www.thelancet.com/search/search.isa#top>
Chemical soup
Howard says chemicals can be found in breast milk and travel across the
placenta. They can cause malformation of tissues in the growing fetus
because as they occur in similar concentrations to the cell signalling
molecules at work during organ building.
According to Landrigan, chemicals also contribute to asthma, childhood
cancer, birth defects, and learning disabilities. "Asthma has more than
doubled. Pollution is part of the problem. Rates of cancer are going up.
Rates of certain birth defects of the male reproductive organs in baby boys
have doubled", he says.
"These are new problems that relate to new exposures that need new
solutions", he adds.
Landrigan believes a change of a change in thinking is required. He suggests
that chemicals need to be tested more thoroughly before they get on the
market. And that agents already approved for sale should be retested with
revised criteria. "Individuals, families, leaders of local and national
governments must know what is in the products they are purchasing so they
can make decisions", he says.
Top <http://www.thelancet.com/search/search.isa#top>
The precautionary principle
According to Howard politicians need to take steps that will minimise
exposure to chemicals by first assuming they cause harm. "If chemicals
persist and accumulate in the body then they should be phased out. That's
the short message", he says.
Adherence to this "precautionary principle" will be the new bone of
contention between WHO and industry. It was endorsed in the Rio Declaration
on Environment and Development in 1992, and was reiterated in a more subtle
way in the EC document that satisfied CEFIC in 2000.
Now, the health and environment ministers of the 52 delegate countries that
participated in the Budapest conference, have also pledged to abide by the
precautionary principle "as a risk management tool".
Great scientific uncertainty about many of the issues debated remains,
however. "We know from painstaking efforts over decades what lead, PCB and
methyl mercury can do, and we have a long list of chemicals that we believe
can act the same way but we just don't have the evidence", says Philippe
Grandjean, of the Institute of Public Health, University of Southern
Denmark.
The precautionary principle is one immediate solution, but there were also
calls for a European version of the US National Children's Study, which aims
to follow environmental exposures and consequences to brain development in
100 000 children from birth to 21 years of age."They'll be enrolled when
their mums come in for prenatal care" says Landrigan.
Unlike previous studies which have looked at one chemical at a time,
attraction of the NCS cohort, according to Landrigan, is that investigators
will be able to look at several chemicals in a vast number of children and
look at how these agents interact.
The study will cost a huge $250 million. But Landrigan says this figure is
tiny compared to the cost of exposure-related disease. He estimates that the
annual cost of environmental diseases in children in the USA is $54.9
billion. "While Europe is ahead of us in policy, we have made some good
advances in the science", he says.
McGlade affirms the need for more large-scale studies. "If we told our
children what we don't know and what we do know, I think many of them would
be shocked", he says.
Meanwhile WHO is addressing the fact that the impact of the environment on
health, especially of children, is not just an issue for Europe. All the six
WHO regions are likely to become involved.
WHO Director-General Lee Jong-wook told The Lancet in Budapest "To me this
meeting is very important because WHO Euro is not only traditional Western
Europe, but East Europe, Central Asia and the Far East." A spokeswoman
added: "We hope all six regions of WHO will take up the issue."
But Lillian Corra, of INCHES in Argentina, is concerned that European
resolutions will mean chemical companies look to the developing world for
business. "Many European chemical companies make profits on dirty business
outside Europe" she claims. "We want equality. When [European country] makes
a decision we want the same decision to be made for our industry. And we
want to be sure that the dirty business and chemicals are not going to be
relocated [to the developing world]."
Margaret Chan, Director of Health and Environment Coordination at WHO in
Geneva, told The Lancet that WHO is looking at this issue. "Globally 25-35%
of diseases have an environmental cause, particularly in vulnerable people
like children and women . . . So WHO is working with other regional offices
trying to role out the same kind of process as Europe's meetings of
ministers of environment and health."
Lee concluded that environmental action in Europe is providing the lead to
WHO. "Yesterday, [22 June] I spent a whole day in a meeting on the
implementation of the tobacco free initiative. Countries of the EU like
Norway and Ireland are already taking very strong measures" by banning
smoking in public places. "WHO is concerned with whole world", he said, "but
Europe is giving us lessons."
Robert Walgate
|
The LANCET-world report-chemical danger and health
