Introduction

A 1988 article by Robert Gould in Cosmopolitan, a magazine targeted primarily at women, reassured readers that:

[There] is practically no risk of becoming HIV-infected through ordinary vaginal or oral sex even with an HIV-infected male. The vaginal secretions produced during sexual arousal keep the virus from penetrating the vaginal walls. [The author's] explanation: "Nature has arranged this so that sex will feel good and be good for you."

This claim is absurd, of course, and it was known even in 1988 to be absurd. Nineteen eighty-eight is hardly so early in the HIV/AIDS epidemic that holding or publishing such an irresponsible opinion could be considered excusable.

Cosmopolitan, of course, is not a medical journal. Still, we might expect that its editors have a journalistic and perhaps even an ethical obligation to their readers to refrain from publishing an opinion that could have such potentially devastating health consequences.

Now, more than a decade later, it is widely recognized that claims such as those made in the Cosmopolitan article were highly irresponsible, and that the failure to prevent such articles from being published was ethically problematic and showed appalling journalistic standards.

Today, when we are witnessing the emergence of another epidemic, this time an epidemic of toxicant induced illnesses, similar misrepresentations of these disorders have appeared in the popular press, misrepresentations which are often abetted by corporate interests that do not wish to see their chemicals given a bad name. Only with the knowledge and understanding which come with time will we eventually be able to look back on this era and recognize the level of journalistic standards (and corporate influence) that have allowed such stories to be published. Even with all that is currently known about the health effects of long term exposure to low doses of toxicants, much more still needs to be discovered. In addition, communities need to be made more aware of the health risks to which they are daily being exposed without their knowledge and without their consent. John Wargo, in the penultimate chapter of his book, Our Children's Toxic Legacy: How Science and Law Fail to Protect Us from Pesticides, says (and provides persuasive evidence to the effect) that there is "little hope that we are even aware of the magnitude and distribution of significant threats to environmental health."'

This Book's Scope

This book focuses essentially on a small portion of the field of environmental health, and on an even smaller portion of the field of environmental ethics. In order to more precisely delineate the concerns examined here, we shall now look briefly at each of those two fields.

ENVIRONMENTAL HEALTH

Environmental and occupational health is a broad field encompassing a wide variety of subdisciplines, but this book is primarily concerned only with the following areas of environmental health.

It discusses the human health effects more than the health effects on wildlife, although it clearly recognizes that effects on wildlife may be strongly suggestive of potential effects in human beings.

It discusses the human health effects of exposure to toxicants that are relatively ubiquitous in the environment. These include a wide variety of chemicals: for example, many solvents, aldehydes (e.g., formaldehyde), pesticides, room "deodorizers," artificial fragrances, as well as all the byproducts of industrial waste and the burning of fossil fuels (including those used in internal combustion engines).

Let us look briefly at three chemicals, chosen almost at random, to which we are commonly exposed in daily life.

Formaldehyde is a toxicant found in a bewildering number of consumer products including bed mattresses, boxsprings, padded furniture, as well as in a wide variety of everyday articles such as some new clothing, much carpeting, and most of the plywood and fiberboard with which most homes, cabinets, and some furniture are built. If formaldehyde were to somehow stay locked in those products it might not result in adverse human health effects, but it does not stay locked in. It volatilizes, sometimes for years, into indoor environments where it is then inhaled by the inhabitants.

Artificial fragrances are simply mixtures of volatile organic chemicals and solvents, often over 100 of them in any one fragrance product, and most of those chemicals are petroleum derivatives. Some of the most common chemicals found in these artificial fragrances include toluene, xylene, acetone, benzene derivatives, and various aldehydes. These chemicals are simply compounded in such a way as to trick the brain into thinking that it is smelling something pleasant. Artificial fragrances are found in an enormously wide variety of products besides the perfumes, colognes, aftershaves and lotions that are applied directly to the skin (and thereby given relatively direct access to the bloodstream). Fragrances are also found in many home cleaning products, and in most laundry detergents, dryer sheets, toilet paper, fabric softeners, and so on. For months after clothing, bed sheets, and other materials are washed in these products, their fumes can pass onto the skin (and thence into the bloodstream) and into the indoor environment where they are then inhaled.

Pesticides (i.e., insecticides, fungicides, herbicides, microbicides, etc.) are also found almost everywhere in the environment, both indoors and outdoors. Many homes, most schools, virtually all grocery stores, restaurants, malls, department stores, and most public office buildings are regularly fumigated with insecticides. Most public parks and other public areas are regularly sprayed with herbicides, and sometimes with insecticides. Almost all federal, state, and county roadways are regularly sprayed with herbicides. Large areas of agricultural crops and private timberlands are sprayed regularly with herbicides and insecticides. Some of the worst pesticide spraying takes place on golf courses, in cemeteries, and on private neighborhood lawns.

These three classes of toxicants (and many others) can thus be found almost everywhere in the environment; in fact, it is almost impossible to avoid exposure to them daily by breathing, by ingestion, and by absorption through the skin and mucus membranes. The focus of this book will be on the human health effects of exposure to chemicals such as these.

This book discusses the human health effects of long-term exposure to these ubiquitous toxicants. Virtually everyone has endured and is continuing to endure long-term exposure, even when they wish to avoid it, to many of these toxicants.

It discusses the human health effects of long-term exposure to what we still call low doses of these ubiquitous toxicants; that is, to levels of these toxicants which have heretofore been considered acceptable, or "generally regarded as safe" (GRAS).

Toxicologists often like to quote Paracelsus' famous dictum to the effect that "the dose makes the poison," by which they mean to suggest that nothing is actually toxic in itself, but that things instead become toxic depending on the dose which is absorbed by the organism. Everything, even water, they say, is toxic in some dose. And, by extension, they also suggest that almost every substance is therefore not poisonous at some very low dose.

In reality, however, Paracelsus' dictum is incomplete. He should rather have said that it is the dose plus the host which makes the poison. That is, the quantity and quality of the toxic substance, and the characteristics — both inherited and acquired — of the exposed host are the two factors which truly determine whether a substance will prove toxic to a particular organism. Moreover, there is the phenomenon of bioaccumulation which must be factored in as well. When small, seemingly nontoxic doses of a substance accumulate in an organism over time, the cumulative dose can become seriously large and clearly toxic. Furthermore, these built-up quantities are often not easily or accurately measurable with current technologies. (In addition, the mixtures of these chemicals which bioaccumulate within an organism in low doses may have toxic effects many times those of any one chemical.)

Finally, this book discusses the chronic effects of these exposures rather than the immediate, acute health effects. We will be less concerned, therefore, with the immediate symptoms people might exhibit after exposure to a large chemical spill, for example, symptoms such as abdominal pain, vomiting, dizziness, constriction or dilation of the pupils, sweating, muscle twitching, seizures or even respiratory arrest and death. We will instead be more concerned with the long-term adverse health effects that people might experience as a result of such an exposure.

For example, a story in the Seattle news media on January 20, 1998, reported that a large dose of extra chlorine had been accidentally added to the water supply of one of Seattle's large neighborhoods the previous day. The story concluded by reporting that fortunately no one had suffered any serious, long-term, or irremediable harm. How the writer could have determined within one day that no one would suffer any long-term or irreversible adverse effects was not explained. Indeed it could not have been explained because it could not have been determined. If there were adverse health effects which may not have become evident for days, weeks or months after exposure, it was clearly premature for the news media to announce that no one had been harmed. Yet the media do this regularly, assuring us that no one has been chronically or seriously harmed by an accidental local exposure to toxicants.

Thus, while the medical specialists in toxicology may be interested in the immediate acute adverse health effects of exposure to toxics, in this book we will be more concerned with the chronic effects, some of which may not become clinically evident until quite some time after the exposure has occurred.

In summary, then, this book will primarily focus on the chronic human health effects that may result from long-term exposure to low doses of toxicants that are ubiquitous in the environment, and which have, in the past, been generally regarded as safe.

Arriving at a name for some of the disorders that seem to be caused by long-term exposure to low doses of ambient chemicals has been somewhat problematic. The following names, among others, have been suggested for some of these conditions: Allergic Hypersensitivity induced by chemicals (a term the World Health Organization has recently chosen to use), Multiple Chemical Sensitivity (MCS), Chemical Sensitivity (CS), Environmental Illness (EI), Sick Building Syndrome, and Toxicant Induced Loss of Tolerance (TILT). These disorders have in the past been sometimes referred to as a kind of "allergic" reaction, or even as "total allergy syndrome." Although many modern allergists prefer to use the term "allergy" in its much narrower designation — to indicate only those conditions characterized by certain kinds of antibody reactions induced by specific antigens — when the term allergy was first coined (by Von Piquet In 1906) it was used to mean "altered reactivity of whatever origin." Nevertheless, by consensus the term allergy is not now commonly used to designate the symptoms of certain toxicant induced illnesses.

Although I will use the somewhat broad term Toxicant Induced Pathology, or Toxicant Induced Illness, in referring to this class of conditions, the terms MCS and CS are more descriptive of the symptoms of some of these conditions. Environmental Illness, though it does say something about the etiology of toxicant induced illnesses, seems perhaps a little too broad. And "chemical sensitivity" does not adequately express the sometimes dramatically disabling nature of many of these conditions. As physician and researcher Claudia Miller says, "Although chemical sensitivity certainly sounds like an inconvenient problem to have, the words fail to convey the potentially disabling nature of the condition and its postulated origins in a toxic exposure." I particularly like her use of the term Toxicant Induced Loss of Tolerance (TILT) because it indicates both something about the etiology and something about the disabling symptoms experienced by sufferers. She draws an analogy here with the tilt, or "game over," message of a pinball machine:

[With] a pinball machine, a player has just so much latitude — he can jiggle the machine, nudge it, bump it, rock it, but when he exceeds the limit for that machine, the "TILT" message appears, the lights go out, and the ball cascades to the bottom. The machine's tolerance has been exceeded and no amount of effort will make the bumpers or flippers operate as they did before. The game is over.

This name, then, at least has the additional virtue (which the term "sensitivity" does not have) of hinting at some of the disabling and incapacitating nature of toxicant induced illnesses. This term would probably be appreciated by the toughened old truck driver who, after he had been badly disabled by a chemical sensitivity disorder, said "Chemical sensitivity? Hell, let's cut this sensitivity BS. If your kid runs out in the street and gets hit by a truck and his body is broken and crippled, you don't say, poor child, he's sensitive to trucks. Let's quit with this sensitivity crap. These chemicals are poison."

This fellow simply wanted the name of the disorder which had disabled him to at least hint at its intensely destructive nature.

In any case, chemical sensitivity disorders probably constitute quite an extensive class, and not just one uniform disorder. If Miller and others are correct, chemical sensitivity disorders (or TILT) may represent an entirely new disease mechanism, much as the germ theory did in the l8th century. Microbe induced diseases — what we now refer to as infectious diseases — were certainly not all of the same kind, nor did they all exhibit the same symptomology. They did, however, all fall into the same class of conditions in the sense that they were all caused by microbes. Toxicant induced pathologies likewise do not all exhibit the same symptoms (though there do seem to be some intriguing similarities among many of them). But even if the illnesses do not present themselves in a physician's office in the same way, it may well be that they all have the same cause, namely pathogenic toxicants.

In any case, this is the class of conditions we will be examining in this book: those chronic conditions that appear to have been brought on by exposure to low doses of ubiquitous environmental toxicants at levels which have in the past been generally regarded as safe.

ENVIRONMENTAL ETHICS

Like environmental health, environmental ethics is a broad field comprising numerous subdisciplines, and we will also be examining only a small segment of it. This book discusses only those portions of the field of environmental ethics which consider the ethical issues surrounding the human health effects that result from exposure to what have been considered nonsignificant levels of ambient environmental toxicants. These ethical issues, as we will see in Chapters Two and Three, are quite complex, and can be approached from at least two different perspectives outlined by ethicists: the method called teleological and the method called deontological. We will examine both the teleological-consequentialist method of environmental health risk assessment, and the deontological approach represented in human rights documents. Before we do that, however, we will, in Chapter One, look at the array of adverse human health effects associated with exposure to environmental toxicants.

The Problem

Why is the threat of low dose exposure to environmental toxicants so dangerous and so problematic? There are actually several reasons.

One of the simplest and most important reasons these exposures are problematic is that low doses of toxicants are completely invisible, often completely unsmellable (i.e., they often occur in concentrations well below the olfactory threshold), and thus are virtually undetectable by all normal human abilities to perceive. There is thus no simple way to determine when and whether one is being exposed to these chemicals. One function of our long-evolved sensory apparatus is to warn us of the presence of dangers and threats, so that we can take action to protect ourselves. In the case of exposure to low doses of environmental toxicants, however, our senses are often not able to detect any clues that would alert us to danger, so we remain completely unaware that we are being exposed to dangerous substances.

Of course high doses of airborne chemical fumes sometimes are visible (appearing perhaps as a cloud) and may even be readily detected by smell and other sensations. High doses of chemical contaminants in water might be detected by a bitter or chemical taste or smell. In addition, some occupational settings where high doses of airborne chemicals might be found — for example, in areas where those chemicals are stored and used — are often required by law to be clearly labeled. Thus, even though high concentrations may not actually be visible to the naked eye or sensible in other ways, they are in a sense made visible by clear notification and labeling practices. People in these situations are verbally warned about the presence of toxic substances, so they have the opportunity to know what they are being exposed to. But low doses of chemicals, because they are legally considered to be at negligible levels, have no such notification or labeling requirements. Since they are usually well below our normal sensory threshold detection limits, and are therefore invisible and insensible to us, they pose a hazard that may be more insidious than other risks which might be more readily detected by human senses.

Because many of these environmental toxicants are invisible and sometimes difficult to detect (especially without the use of expensive technical environmental assays) we sometimes must rely on written records of chemical dispersal or pollution in a given locale in order to know what people in that locale might be exposed to. Written records can sometimes help by documenting the dispersal of toxicants into a given region. Unfortunately, the records documenting these chemical dispersals sometimes disappear or are lost, so that the toxicants remaining in an environment can last much longer than their records. This can happen particularly in the case of highly persistent toxicants, such as the organochlorine pesticides, PCBs, and dioxins, as well as many of the chemicals and heavy metals associated with mining and smelting.

Another significant problem is that many of these toxicants are ubiquitous. They can actually be found virtually everywhere around us in our air, in our buildings, in our water, in our soil, on our food, embedded in the fabrics from which our clothing is made, embed-ded in many of the materials that we encounter in everyday life, and
can be found as well on the surfaces of furniture, bedding, walls, floors, lawns, streets and roadways.

Besides the chemicals we manufacture and deliberately put into our consumer products each year, there are also industrial chemical byproducts that are unintentionally released into the environment each year.

Examples of the former include formaldehyde, which is deliberately added to so many of our consumer products; millions of pounds of pesticides are applied in virtually all public places, indoors and outdoors, in the United States every year; a high volume of artificial fragrance chemicals is added to our water and air space in the form of laundry detergents, perfumes, colognes, aftershaves, hairsprays, lotions and handsoaps, in addition to the artificial scents often added to pesticides. All these chemicals have been deliberately put into our daily environment each year. Industrial waste chemical byproducts are also released by American (and other) manufacturers, mostly unintentionally, and are dispersed into our air, our water, and over our land, and sometimes underground. According to an Environmental Protection Agency (EPA) report, in 1995, the most recent year for which data are currently available:

[The] volume of toxic waste containing all TRI [Toxics Release Inventory] chemicals ... was over 35 billion pounds. Since 1991, when EPA first began collecting TRI waste data, there has been a 7 percent increase in [chemical] waste generation.

Thirty-five billion pounds of toxic industrial byproducts certainly seems like a significant quantity of toxicants to be adding to the environment each year, the environment which human beings and other life forms need in order to live, to live well, and to reproduce. This quantity of toxic industrial waste is added each year. Moreover, this number does not come close, unfortunately, to indicating the total quantity of industrial chemical byproducts dumped into our environment. It represents only those individual environmental pollutants that are formally listed in the federal Toxics Release Inventory (TRI), i.e., only the reportable toxicants, and even then only that portion of those designated toxicants which American industry chooses to report.

Though we might hope that these data covered all the toxics released by industry each year, we sadly know they do not. There are approximately 80,000 chemicals in common industrial use today (almost none of which existed before World War II). Only 600 or so — those pollutants currently recognized to be the most highly toxic chemical byproducts of major industrial processes — are designated on the TRI. Thus we might expect that some quantity of environmental toxicants greater than 35 billion pounds is actually released each year. Furthermore, these data cover only toxic releases by American manufacturers; they do not include data on toxics released by non-American manufacturers in other parts of the world. Nor do these data cover small businesses, since they have been legally exempted from any TRI reporting. In addition, there was only a 66 percent compliance rate for reporting in 1995; i.e., only 66 percent of those industries that were required to report their TRI releases actually did report them. Furthermore, since TRI data rely entirely on self-reporting by industry, and the "EPA has never assigned any staff to check the quality of the self-reported data, we might well wonder whether even these 66 percent of manufacturers have been forthcoming about the full extent of their toxic byproduct releases. We should probably not be surprised to learn that many industries have underreported their actual releases.

These industrial toxic byproducts and the chemicals (like formaldehyde, pesticides and artificial fragrance chemicals) which are deliberately added to our environment in consumer products, foods and so on, add up to a huge quantity of environmental toxicants circulating every day in our air, water and soil. They have become an inherent part of the vegetable and animal food chain. In their work Toxic Deception, Fagin and Lavelle state:

Nearly six trillion pounds [of chemicals are] produced annually for plastics, glues, fuels, dyes, and other chemical products. In 1995, the 100 largest U.S.-based chemical manufacturers sold more than $234 billion worth of chemical products — a 17 percent increase over the previous year-and made $35 billion in profits. Their products have become such a pervasive part of American life, in fact, that an estimated 98 percent of all families now use pesticides at least once a year Every year more than a billion pounds of pesticides are used in the United States [alone].

We can see, therefore, that these toxicants are inescapably ubiquitous in the environment. They are perhaps somewhat more concentrated in certain locations than in others, but they are nonetheless present almost everywhere in our lives.

The ubiquity of these toxicants creates yet another problem: exposure to them is virtually unavoidable. Almost every piece of clothing we purchase, every piece of furniture, all carpeting, most of our food, much of our water, many of our building and remodeling materials, all of our office machines and our home computers, in fact, practically all of our manufactured consumer products are contaminated to some degree with a variety of chemical compounds, some of them intentionally applied or added, and some of them present only as accidental contaminants and byproducts. Much of the air we breathe -- in our office buildings, in our homes and apartment buildings, in urban areas, in areas where there is industry and the large scale use of fossil fuels, in agricultural areas (where pesticides are used), in forest lands (again, due to pesticide use), in our city, county, and state parks (pesticide use), on our golf courses (heavy pesticide use), in our neighborhoods (toxic lawncare products and pesticides) in our stores and malls (pesticides), and along virtually all of our roadways (again, pesticide use as well as lead and other byproducts of auto and diesel exhaust) -- much of our air is contaminated with detectable levels of a wide variety of synthetic chemical pollutants.

If a person tries to avoid exposure to these synthetic toxicants, as sufferers of multiple chemical sensitivity must, they will find it virtually impossible to do so. The most that a person will be able to accomplish is to somewhat reduce their level of toxicant exposure. Most of the 75,000 to 80,000 synthetic chemical compounds in common industrial use today were not even in existence before the middle of the 20th century, and approximately 1,000 new chemicals are being added to that number each year. Many of these chemicals are so widespread that no one can successfully avoid breathing, touching, absorbing, eating or drinking at least some of them. Exposure to a wide variety of these newly developed xenobiotic toxicants is virtually inevitable.

Yet another problem is that adequate information about the full extent to which we are exposed to these toxicants, and about what the potential health effects of all these exposures are likely to be, has not been adequately developed, and what little is known is not readily available.

... continued.

More information at McFarland Publishers, Inc.

Environmentally Induced Illnesses:
Ethics, Risk Assessment and Human Rights
Thomas Kerns
McFarland & Company, Inc., Publishers
ISBN: 0-7864-0827-8
304pp $39.95
2001

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