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Editor's Note
November 2016

Simple Measures to Reduce Chemical Exposure

JAMA Intern Med. 2016;176(11):1707. doi:10.1001/jamainternmed.2016.5773

Possible health consequences related to chemical exposure through common items, such as plastic, fruits, and furniture, are receiving increased attention. In the current Evidence to Practice article, Gore1 summarizes the evidence supporting the Endocrine Society’s Scientific Statement on endocrine-disrupting chemicals, such as polychlorinated biphenyls; dioxins; pesticides, plastics, and plasticizers (bisphenol A [BPA] and phthalates); perfluorinated compounds; and flame retardants.2 The Statement considered basic, translational, and clinical evidence examining chemical exposure and the development of various diseases and concludes that exposure to chemicals are strongly associated with, and may be causative of, endocrine diseases.

In medical science, at least 1 randomized clinical trial (RCT) is necessary to infer causation. In the field of chemical exposure, there are no RCTs; they are unethical. It is also unlikely that comparative cohort studies will become available because the products that use these chemicals are so commonly used that there is virtually no “unexposed population.” Thus, we are limited to animal, in vitro and simple cohort studies. While we have seen associative links established in animal models that are subsequently found to be untrue for humans, some scientists in this field feel the associative finding is so strong that they have banded together to advocate for policy changes and advance public knowledge.

Project TENDR (Targeting Environmental Neuro-Developmental Risks) includes several medical societies, such as the American College of Obstetricians and Gynecologists, the National Medical Association, and the Endocrine Society.3 Their goal is to advance policy changes and public knowledge to reduce exposures to chemicals and pollutants that contribute to neurodevelopmental disorders. For example, Project TENDR is advocating that manufacturers of any new chemicals must prove they are safe,4 instead of the current process with assumes chemicals to be safe until harm is proven (eg, BPA use in human products); this change in policy would stop potentially unsafe chemicals being used by a generation, possibly causing substantial health harm before being pulled from the market. This would result in chemicals being held to the same approval process standard as a drug or technology before being used in human products.

In addition, there are also new federal policy changes. In a rare bipartisan act, on June 22, 2016, President Barack Obama signed the Frank R. Lautenberg Chemical Safety for the 21st Century Act (an update to the 1976 Toxic Substances Control Act5), which will set safety standards for dangerous chemicals and enable effective regulation of the chemical industry.

As these initiatives begin to implement change, this Evidence to Practice summary outlines simple things we can do to limit our chemical exposure: washing fruits and vegetables and not heating food in plastic. Consider sharing this message with your patients as a preventative public health measure now to be ahead of the game.

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Article Information

Conflict of Interest Disclosures: None reported.

References
1.
Gore  AC.  Endocrine-disrupting chemicals  [published online September 26, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.5766
2.
Gore  AC, Chappell  VA, Fenton  SE,  et al.  EDC-2: the Endocrine Society’s second scientific statement on endocrine-disrupting chemicals. Endocr Rev. 2015;36(6):E1-E150.PubMedArticle
3.
Project TENDR. http://projecttendr.com/. Accessed August 5, 2016.
4.
Bennett  D, Bellinger  DC, Birnbaum  LS,  et al; American College of Obstetricians and Gynecologists (ACOG); Child Neurology Society; Endocrine Society; International Neurotoxicology Association; International Society for Children’s Health and the Environment; International Society for Environmental Epidemiology; National Council of Asian Pacific Islander Physicians; National Hispanic Medical Association; National Medical Association.  Project TENDR: Targeting environmental neuro-developmental risks: the TENDR Consensus Statement. Environ Health Perspect. 2016;124(7):A118-A122.PubMedArticle
5.
US Government. Toxic Substances Control Act. http://www.epw.senate.gov/tsca.pdf. Accessed August 24, 2016.
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