Better Health Care Newsletter - October 2024

It’s a paradox of modern life: We want more and more stuff, and we want to get all of it faster, cheaper, more conveniently. And yet, does our consumerism bear hidden costs to our health and the health of our planet?

Environmentalists and medical scientists have sounded the alarms about products with which most of us are surrounded and all too comfortable: Microplastics. Forever chemicals. Ultraprocessed foods. And, yes, even the family-familiar gas kitchen stove.

Lawmakers and regulators have responded to the increasingly urgent warnings about health threats these things may pose — with many crackdowns likely to take more than a while before they achieve the desired improvements.

Still, the health-savvy are hearing expert suggestions already about minimizing risks. Here is the latest.

What are they: As the federal government explains on one of its websites, the substances popularly dubbed forever chemicals are known more formally as “per- and polyfluoroalkyl substances (PFAS) …[They] are a large, complex group of synthetic chemicals that have been used in consumer products around the world” for decades. Researchers say at least 15,000 synthetics fall into a U.S. database that attempts to catalog these long-lasting substances that break down slowly.

Why do they get used: Here is Consumer Reports’ description of the utility and ubiquity of PFAs: “These chemicals are added to many materials to make them resistant to grease, water, and stains, and to add nonstick properties …In 2022 Consumer Reports tests of more than 100 food packaging products from U.S. restaurants and supermarkets, [we] found dangerous PFAS chemicals in many of them, including paper bags for French fries, wrappers for hamburgers, molded fiber salad bowls, and single-use paper plates … Previous CR tests found [the substances] in drinking water and bottled water. We’ve also identified dental flosses that contain these chemicals and found certain PFAS in nonstick cookware that manufacturers said were not present.”

What health risks have been identified about them: The New York Times Magazine has reported this about the growing body of research on the perils of forever chemicals: “DuPont funded a study to determine if residents had been harmed by the chemicals. Its major conclusions, published online in 2012, were damning: The evidence, including blood samples and health surveys, indicated a ‘probable link’ between PFOA and high cholesterol, ulcerative colitis, thyroid disease, testicular cancer, kidney cancer and pregnancy-induced hypertension. [Other scientists] published their own paper in 2012 showing that PFAS reduced the number of antibodies that children maintained after they received tetanus and diphtheria vaccinations … potentially [other harms from the chemicals] have yet to be proven as persuasively. Those include endocrine disruption, metabolism and immune dysfunction, liver disease, asthma, infertility and neurobehavioral issues — their diversity a potential result, as Linda Birnbaum, former director of the National Institute of Environmental Health Sciences and the National Toxicology Program put it to me, of the fact that ‘PFAS [have] a great deal of complexity.’”

The U.S. Environmental Protection Agency considered the perils from PFAS so great that the agency, the New York Times reported, “has ordered municipal water systems to remove six [of the] synthetic chemicals linked to cancer and other health problems that are present in the tap water of hundreds of millions of Americans … The EPA estimated it would cost water utilities about $1.5 billion annually to comply with the rule, though utilities maintain that the costs could be twice that amount and are worried about how to fund it. States and local governments have successfully sued some manufacturers of PFAS for contaminating drinking water supplies, but the settlements awarded to municipalities have been dwarfed by the costs of cleaning up the chemicals, municipal officials said … The 2021 bipartisan infrastructure law provides $9 billion to help communities address PFAS contamination and the EPA said $1 billion of that money would be set aside to help states with initial testing and treatment.”

What can consumers do now: The New York Times has reported that consumers can reduce their exposure to PFAS by researching and avoiding products that fail to explicitly deny using them. This includes nonstick cookware, grease-proof food packaging, and water-resistant clothing. Until the EPA rules take full force, customers in known areas with PFAS pollution should find water-filtering devices. Consumer Reports recommends that diners remove meals from commercial take-out containers — and avoid reheating foods in this packaging.

What are they: The scientific journal Nature Medicine has reported this of microplastics: “The world is awash with plastic — 6 billion tons’ worth. In 2019, 353 million tons of plastic waste were produced, with a tripling of that number to more than one billion tons predicted by 2060. More than 10,000 chemicals are present in plastics, including carcinogens and endocrine disruptors. Plastics find their way into the human body in the form of tiny particles called microplastics (less than 5 mm in diameter) and nanoplastics (less than 1 μm in diameter). Microplastics and nanoplastics can arise from a variety of sources, including by design, as in the case of microbeads used in cosmetic and personal care products, or inadvertently, as the result of degradation of larger plastic products, such as through the laundering of synthetic clothes or abrasion of tires. [The substances] are found everywhere on the planet, including the oceans, air, and food supply. [They] enter the body mainly through ingestion or inhalation. For example, one might ingest [them] by drinking liquid or eating food that has been stored or heated in plastic containers from which [they] have leached, or by using toothpaste containing [them]. One startling study found that infants may be exposed to high levels of microplastics by ingesting formula prepared in propylene feeding bottles.”

Why do they abound: Fortune’s Well section has reported this about how plastic proliferated around the planet: “Since the inception of plastics in the decade after World War II, their production has accelerated at a dizzying pace … Roughly two-thirds of [plastics are] designed for short-term use (things like water bottles and snack wrappers), yet the lifespan of plastics is incredibly long (450 to 1,000 years for some products), with the material continually degrading into tinier and tinier particles along the way.” Consumer Reports observed that plastics, as early as the 1920s, were described as a boon for consumers, “a [cheap] material of a thousand uses.” As CR noted: “Today, beyond the plates we eat from, the straws we drink through, the furniture we sit on, and the toys our kids play with, there is plastic in the clothes we wear, in the cars we drive, even in the lifesaving medical equipment in our hospitals. And — more than anywhere else — plastic is in our packaging, encasing everything from laundry detergent to prescription pills, from the food we eat to the beverages we drink.”

What are their health risks: As Nature Medicine has reported of microplastics: Their “biological effects … have been researched for decades, mainly in studies of laboratory rodents and human cells. In rodent studies, microplastics have been shown to have detrimental effects on a wide variety of organs, including the intestine, lungs and liver, as well as the reproductive and nervous systems4. More recently, [they] have been found in a variety of tissues and organs in humans, including blood, lungs, placenta, and breast milk. [Their] effects … on human health are just beginning to be documented. For example, a recent report described a potential link between [their presence] in blood vessels and cardiovascular disease.” While researchers are finding associations with illnesses and microplastics, they have not yet been shown to be direct causes of negative conditions.

Still, Fortune Well reported this: “By one estimate, health problems related to plastic chemicals cost the U.S. health care system $249 billion in 2018 alone. Infertility in both males and females, cancers, neurodevelopment disorders, cardiovascular and kidney disease all have been linked to the chemical additives that can be embedded in microplastics. And plastic production workers at textile facilities die of lung cancer and lung disease at higher rates.”

The state of California has taken aggressive actions to combat plastics’ pollution. The state has sued Exxon Mobil, a leading provider of chemicals used in plastic making, arguing the petroleum giant has deceived the public as to whether plastics can be recycled. The state also approved its second crackdown on grocers and their supplying to customers plastic bags of varying thickness and purported, possible reuse.

What can consumers do now: Consumer Reports has urged its audience to get ahead of medical-scientific research and start curbing the use of plastics, urgently. CR says regular folks can skip bottled water and drink the stuff from the tap. They can get their food — in storage or heating up — out of plastics and into glass, silicone, or foil. Healthy people will prefer fresher foods, rather than heavily packaged items that have sat on shelves for a while, CR says. The New York Times reported that consumers should look twice at plastics in furniture, clothing, and in other home goods. The newspaper said regular vacuuming and more care in laundering — washing items less, doing full loads, and line drying — are helpful in reducing plastics’ spread.

Will the heavy scrutiny of plastics’ potential harms contribute to a broader re-think of modern consumerism and materialism? The jury is out.

What are they: The Associated Press reported this about ultraprocessed foods: “Most foods are processed, whether it’s by freezing, grinding, fermentation, pasteurization, or other means. In 2009, Brazilian epidemiologist Carlos Monteiro and colleagues first proposed a system that classifies foods according to the amount of processing they undergo, not by nutrient content. At the top of the four-tier scale are foods created through industrial processes and with ingredients such as additives, colors, and preservatives that you couldn’t duplicate in a home kitchen, said Kevin Hall, a researcher who focuses on metabolism and diet at the National Institutes of Health. ‘These are most, but not all, of the packaged foods you see,’ Hall said.”

Why do they abound: Ultraprocessed foods “are often made to be both cheap and irresistibly delicious,” Dr. Neena Prasad, director of the Bloomberg Philanthropies’ Food Policy Program, told the AP. The doctor added that “such foods are often made to be both cheap and irresistibly delicious.” She noted that ultraprocessed foods “have just the right combination of sugar, salt and fat and you just can’t stop eating them.” The news service reported that “most Americans don’t go a day — or often a single meal — without eating [such] foods. From sugary cereals at breakfast to frozen pizzas at dinner, plus in-between snacks of potato chips, sodas, and ice cream, ultraprocessed foods make up about 60% of the U.S. diet. For kids and teens, it’s even higher – about two-thirds of what they eat.”

What are their health risks: Yale Medicine has posted online an article about the increasing research with worrisome findings, reporting: “A review, published in the British Medical Journal (BMJ) in 2024, looked at 45 studies involving almost 10 million participants. The review authors suggest that eating more ultraprocessed foods is linked to a higher risk of dying from any cause and has ties to 32 health conditions, including heart disease, mental health disorders, type 2 diabetes, and other problems.” The AP reported that nutrition studies are notoriously difficult, relying on observation and study subjects’ self-reporting on their diet and habits. “[M]ost research so far has found connections, not proof, regarding the health consequences of these foods,” the AP reported. “Food manufacturers argue that processing boosts food safety and supplies and offers a cheap, convenient way to provide a diverse and nutritious diet.”

With caveats noted, the Yale Medicine article reported this: “While it is hard to definitively say how and why ultraprocessed foods can lead to health problems, the BMJ researchers have theories. For example, in the review, researchers say ultraprocessed foods might replace more nutritious meal options, including fresh fruits and vegetables. A diet composed mainly of ultraprocessed foods also exposes people to unhealthy additives and increases the risk of chronic inflammatory diseases, they add. ‘A growing body of data shows instances of exposure to combinations of multiple additives, which may have potential “cocktail effects” with greater implications for human health than exposure to a single additive,’ the review authors say. ‘Finally, ultraprocessed foods can contain contaminants with health implications that migrate from packaging materials, such as bisphenols, microplastics, mineral oils, and phthalates.’”

What consumers can do now: The New York Times reported that the health savvy can try to skip ultraprocessed foods, choosing “to swap flavored yogurt for plain yogurt with fruit, for example, or to buy a fresh loaf from a local bakery instead of packaged bread, if you can afford to do so.” The newspaper, noting the huge prevalence of ultraprocessed items in U.S. diets, said a “more moderate strategy” also is an option, “focusing on limiting [ultraprocessed foods] that don’t provide valuable nutrients, like soda and cookies.” Experts also have “recommended eating more fruits, vegetables, whole grains (ultraprocessed or not), legumes, nuts, and seeds. Cook at home as much as you can, using minimally processed foods.”

An online article from Harvard Health concurs, reporting these ideas: Avoid processed foods, which can include chips and other snack foods, industrial breads and pastries, packaged sweets and candy, sugar-sweetened and diet sodas, instant noodles and soups, ready-to-eat meals and frozen dinners, and processed meats such as hot dogs and bologna. Eat unprocessed or minimally processed foods, which — when combined with a healthy Mediterranean menu of foods — include fish, olive oil, avocados, whole fruits and vegetables, nuts and beans, and whole grains.”

What are their health risks: As the New York Times reported, gas stoves emit “poisonous gases called nitrogen oxides, including nitrogen dioxide, a respiratory irritant thought to trigger asthma (cars, boats and other machines also release these gases). A study published last year found that families who use gas stoves in homes with poor ventilation, or without range hoods, can blow past the national standard for safe hourly outdoor exposure to nitrogen oxides within just a few minutes; there are no agreed upon standards for nitrogen oxides in indoor air. Rates of nitrogen oxide emission levels were in direct proportion to the amount of gas the stove was burning, said Eric Lebel, a senior scientist at P.S.E. Healthy Energy, a nonprofit science and policy research institute focusing on energy and the environment, and the lead author on the study. Ms. Seals co-authored a paper published in [2022] that found that gas-burning stoves may be linked to nearly 13% of childhood cases of asthma in the U.S. Past research shows that gas stoves led to more exacerbated asthma symptoms as well, she said.” ProPublica, a Pulitzer Prize-winning investigative site, has reported that researchers also have found that gas stoves can leak potentially explosive and polluting methane, as well as benzene, a chemical linked to leukemia. As this nation also campaigns for smarter, more efficient energy use, gas stoves have drawn increased scrutiny.

Although the potential perils of gas stoves have been known before (with the research increasing by the day), federal and state officials in energy and consumer safety agencies have stoked recent political flames about the appliances and their potentially increased regulation. Simply put, no, the administration and federal agencies won’t be banning gas stoves any time soon, as USA Today reported.

U.S. energy officials have issued new rules on stoves’ efficiency — regulations that a preponderance of existing appliances will meet and will help curb stoves’ greenhouse gas emissions, officials say. Consumer safety officials at the federal level are studying whether further regulations are needed. They are not banning stoves, though New York and Berkeley, Calif., have enacted measures affecting them. New York will bar their installation five years from now in new buildings. The restaurant industry has successfully challenged and stopped, for now, Berkeley’s proposed ban on natural gas installation in new homes and buildings.

What consumers can do now: Home cooks can take several steps to reduce health-related issues with gas stoves, experts say. They can open windows and doors while cooking and use their range hood, if it ventilates to the outdoors and does not simply recirculate air in a room. Cooks can minimize stoves’ use by prepping parts of meals with microwave units, portable electrical induction plates, electric ovens (including toaster-sized models), and electrical multicookers (of the slow or pressure varieties). If their gas stoves need replacing because they’re too old, have failed, or for other reasons, consumers can consider going electric, especially with energy-efficient induction models.

The nation is moving on a multiyear campaign to clean up a once hidden threat to the public’s health: an estimated 9 million lead pipes that leach poisonous lead into drinking water.

Getting rid of them is taking even more time and more money than foreseen. The Biden Administration and bipartisan votes in Congress approved in 2021 an infrastructure law that provided $15 billion to rid the country of lead pipes, made of the familiar, cheap-to-use, widely available substance about which the New York Times reported:

“Lead is a neurotoxin that can cause irreversible damage to the nervous system and the brain. It poses a particular danger to infants and children and can impair their cognitive development, cause behavioral disorders and lead to lower I.Q.s. From the nation’s earliest days, lead was used to make pipes to carry water to homes and businesses. But when plumbing corrodes, lead can leach into drinking water. The problem drew national attention in 2014 in Flint, [Mich.] when a change in the water source and inadequate treatment and testing caused significant lead contamination. Lead and Legionella bacteria leached into the tap water of about 100,000 residents between 2014 and 2015.”

In late 2023, the administration and its Environmental Protection Agency proposed new rules that would call for the elimination of lead pipes in this country within a decade, at a hefty price, the newspaper reported. “The EPA estimates the price at $20 billion to $30 billion over the course of a decade. The rule would require the nation’s utilities — and most likely their ratepayers — to absorb most of that cost, but $15 billion is available from the 2021 infrastructure law to help them pay for it.”

The administration in recent months has started to dole out infrastructure sums, working closely with the lowest level of affected governments to try to get assistance out where it is most needed. State-appointed officials in Michigan were slammed — along with some city leaders — for disastrous decisions that destroyed the potablitity of local waters. State lawmakers raked a former governor over the coals for his neglect and incompetence in connection with the Flint scandal, though he escaped criminal prosecution due to appellate rulings questioning the process in which he and others were indicted.

While the infrastructure bill and the funding it provides won congressional approval with only a slice of GOP votes, Republicans in Congress — many of whom voted against the bill — have sought to claim credit for public works projects launched in their district and supported by the measure.

Governing magazine has reported that Pennsylvania and Wisconsin have become leaders among the states in seizing on the opportunity provided by the infrastructure bill to speed efforts to rip out lead pipes.

The magazine cited a study by the Center for American Progress think tank, pointing out, for example, that about “$160 million of the $240.2 million in [federal infrastructure money allocated to Pennsylvania] will support the replacement of 19 miles of lead pipes and upgrades to water facilities in Philadelphia.” In Wisconsin, the think tank said half the state’s lead pipes are in its biggest city, Milwaukee. In the city, infrastructure funds are “expected to accelerate the pace at which [lead pipe] projects can now take place … reducing the city’s timeline to replace all [such pipes] from 70 [years] to 20 years.”

Climate extremes have not only increased the size, intensity, frequency, and duration of wildfires, they also have spread and intensified the health harms of the smoke and other air pollutants from these huge blazes, experts say.

Respiratory specialists already had warned that patients with heart and lung conditions, asthma, allergies, and other breathing impairments must take precautions against wildfire smoke and its related pollutants. They should try staying indoors, with doors and windows shut and air conditioning or air cleaning systems running. They should limit outdoor exposure and avoid strenuous activities.

If their symptoms — stinging eyes, scratchy throat, runny nose, a hacking cough, headache, fatigue, rapid heartbeat, and shortness of breath — become severe and don’t respond to common measures such as resting, showering, and taking over-the-counter or prescribed medications, they should seek medical help.

Those with chronic conditions and older patients are at higher risk from wildfire smoke and its particulate matter, increasing research shows.

A study, still under review and involving data on more than 1.2 million people 60 or older in Southern California from 2009 to 2019, “links the long-term exposure of … wildfire smoke to brain health, suggesting that it greatly increases risk of dementia compared with other sources of air pollution,” CNN reported, adding, “The research also indicates that associations between wildfire smoke and dementia diagnoses are most pronounced among people from racially and ethnically [minority] groups and in high-poverty areas.”

A new study published by researchers at Yale and other institutions reported this: “[D]ata from 2007 to 2020 showed positive associations between long-term exposure to wildland smoke [particulates] and nonaccidental, cardiovascular, ischemic heart disease, digestive, endocrine, diabetes, mental, and chronic kidney disease mortality rates.”

The New York Times earlier this year reported that wildfires and their health threats are expected to soar due to climate extremes: “More than 125 million Americans will be exposed to unhealthy levels of air pollution by the middle of the century, largely because of increased smoke from wildfires, according to estimates released [in February.] Yet there are few good ways to protect communities, experts said. The United States has gotten better at coping with other climate perils, like floods, hurricanes and even wildfires themselves. Smoke is different: It’s more challenging to anticipate, to get people to take seriously and to keep out of people’s homes.”

The newspaper noted that Americans have learned through harsh experience that protections they might have relied on earlier against wildfires and their pollution — considerations like distance, geography, and certain times of year thought to be free of the threat (e.g., winter) — no longer are so certain, the New York Times reported:

“[S]moke can travel great distances with little warning. Unlike flooding, smoke’s movement through a community can’t easily be guessed by mapping the local topography, and it can’t be blocked or diverted. That makes wildfire smoke more akin to extreme heat. But unlike heat waves, people can’t respond by moving their activities to dawn or evening hours. And people may not know when they’re being exposed to dangerous levels of air pollution.”