Miriam E Tucker, Medscape, Mar 6, 2015
The findings were presented March 5 at a press briefing here at the Endocrine Society's annual meeting, ENDO 2015, and were also published online in a series of four articles in the Journal of Clinical Endocrinology and Metabolism.
With exposures occurring via pharmaceuticals, industrial solvents, personal-care products, aluminum-can linings, plasticizers, pesticides, and environmental pollutants, chemicals known to be endocrine disrupting include diethylstilbestrol, polychlorinated biphenyls (PCBs) , dioxins, perfluoroalkyl compounds, solvents, phthalates, bisphenol A (BPA), dichlorodiphenyldichloroethylene organophosphate/organochlorine pesticides, and polybrominated diphenyl.
Affected hormones include estrogen, androgen, thyroid, retinol, aryl hydrocarbon, and the peroxisome proliferator-activated receptor (PPAR) pathway. In all, 13 chronic conditions have strong scientific evidence for causation by endocrine-disrupting chemicals, Dr Trasande said.
Although this is a complex global, environmental public-health issue, on a clinical level physicians can counsel patients about avoiding these exposures, he told Medscape Medical News.
"There are safe and simple steps that families can take to limit their exposure to endocrine-disruptive chemicals. They can avoid microwaving plastic. They can avoid eating from aluminum cans or drinking fluids from aluminum cans. They can eat organic. Or even simply air out their homes every couple of days to remove some of the chemical dust that can disrupt hormones in their bodies."
He added, "I recognize that doctors have extremely busy practices and many competing priorities. But in the context of the substantial burden of disease that we've identified and for which endocrine-disrupting chemicals are responsible and the opportunities for prevention that are much easier than perhaps intervening on diet and physical activity, there can be substantial impact."
Briefing moderator R Thomas Zoeller, PhD, from the University of Massachusetts, Amherst, and a coauthor of the paper on the costs of endocrine-disrupting chemical-associated neurobehavioral deficits and diseases, agreed. "In the conversation about diet and exercise, it should come up. I think it's beginning to be, and it's even mentioned in clinical textbooks right now."
The European Food Safety Authority (EFSA has recently ruled, however, that at least one such chemical, BPA - used to stiffen some plastic food containers - poses no health risk to consumers of any age, including unborn children, at current levels of exposure. The Food and Drug Administration banned BPA from baby bottles in 2012 but said there was not enough evidence for a wider ban and has found the chemical safe at low levels. The EFSA acknowledged in its assessment in January that BPA residues could migrate into foods and drinks and be ingested by consumers or be inhaled or absorbed, but exposure of this kind was "considerably under" the safe level known as the "tolerable daily intake," it said.
High Cost of Endocrine Disruption
The new analysis reported at ENDO 2015 is a response to an EU call for an impact assessment of laws enacted in 2009 and 2011 mandating limits on endocrine-disrupting pesticides and biocides.
Using estimates based on the literature and established statistical methods adapted from those used by the Intergovernmental Panel on Climate Change, Dr Trasande led a 12-member scientific steering committee, which determined that there was probable causation of endocrine-disrupting chemicals for IQ loss and associated intellectual disability, autism, attention-deficit/hyperactivity disorder (ADHD), childhood obesity, adult obesity, adult diabetes, cryptorchidism, male infertility, and mortality associated with reduced testosterone.
Using mid-point estimates for probability of causation, the panel calculated a median cost of 157 billion, or 1.23% of the EU gross domestic product, with a lower median range of 119 billion and a high end estimate of 270 billion.
Dr Trasande summarized results from the four papers at the briefing, including these data points:
By health effect, the greatest cost was for neurological problems, including ADHD, at 132 billion. By endocrine-disrupting chemical type, pesticides were the most costly, accounting for 120 billion.
Pesticides accounted for 13 million lost IQ points in each EU country, costing 124 billion in earning potential. They were also responsible for 59,300 infants born with intellectual disability (24.6 million), and 28,200 people aged 50-64 years with type 2 diabetes, at a cost of 835 million.
Phthalates, used in food wraps, cosmetics, shampoos, and vinyl flooring, resulted in 24,800 additional deaths among 55- to 64-year-old men, costing 7.96 billion in lost economic productivity; and 618,000 additional assisted-reproductive-technology procedures, costing 4.71 billion, Dr Trasande reported. Phthalates also accounted for an excess of obesity and diabetes among women aged 50 to 64, totaling more than 15.6 billion.
Flame retardants used in electronics, furniture, and mattresses resulted in 873,000 lost IQ points, leading to 8.4 billion in lost earning potential; 3290 intellectually disabled children, costing an additional 1.9 billion; 6,830 new cases of testicular cancer, at 850 million; and 4615 children born with undescended testes, at 130 million.
Other estimates of burden and disease and costs include 316 autistic 8-year-olds each year from multiple endocrine disrupting chemicals, costing 199 million; 31,200 10-year-olds with ADHD (also from multiple endocrine-disrupting chemicals), at 1.7 billion; and BPA used in aluminum-can linings and thermal-paper receipts, being associated with 42,400 obese 4-year-olds at an annual cost of 1.54 billion.
Dr Trasande said that a similar analysis for the United States would be "the logical next step" and that he would anticipate analogous findings, although there are some differences. Brominated flame retardants are more stringently limited in Europe, for example, but levels of phthalates have decreased 17% to 37% in the United States between 2001 and 2010.
"Silent Epidemic Taking Away Human Potential"
In response to a reporter's somewhat skeptical question about whether this is a "real problem," Dr Trasande acknowledged that this is in many ways a "silent epidemic" that isn't manifested in any obvious way, but rather in subtle shifts in public health.
Nonetheless, he said, "It's a real epidemic supported by a substantial mountain of human and laboratory evidence suggesting that endocrine-disrupting chemicals [disturb] a broad array of hormonal processes [necessary] for human health."
According to Dr Zoeller, "There's a concept that if there isn't overt toxicity then you don't really have a problem. With endocrine disruption, we see effects on the population level that aren't consistent with overt toxicity like death or in some cases cancer.
"But think about a decrease in IQ levels. It's not visible on the surface, but you're taking away human potential. It's very well-documented that PCBs and other chemicals have this effect. I think we need to begin to think in a little more sophisticated way than there's either normality or abnormality that's visible on the face of your children."
The studies were supported by the Endocrine Society, the John Merck Fund, the Broad Reach Foundation, and the Oak Foundation. Dr Trasande and Dr Zoeller report no relevant financial relationships. Disclosures for the coauthors are listed in the articles.
ENDO 2015: The Endocrine Society 97th Annual Meeting. Abstract S65-2, presented March 7, 2015.
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