Chemical Safety, Health Care Costs and the Affordable Care Act Philip J. Landrigan,



and Lynn R. Goldman,



On May 22, 2013, the late Senator Frank Lautenberg (D-NJ), Senator David Vitter (R-LA) and 19 of their colleagues introduced bipartisan chemical safety legislation in the US Senate, “The Chemical Safety Improvement Act of 2013.” The bill’s purpose is to protect human health and the environment against the hazards of toxic chemicals, by requiring the US Environmental Protection Agency (EPA) to examine the safety of all chemicals in consumer products. The bill is currently before the Senate Committee on Environment and Public Works, chaired by Senator Barbara Boxer (D-CA). This legislation is critically important for physicians and healthcare organizations because it creates significant new opportunities to prevent disease and cut healthcare costs. Am. J. Ind. Med. 57:1–3, 2014. ß 2013 Wiley Periodicals, Inc. KEY WORDS: Affordable Care Act; Safe Chemicals Act; Health Costs

NEED FOR CHEMICAL SAFETY LEGISLATION New chemical safety legislation is badly needed in the United States. Synthetic chemicals, despite their many benefits, have repeatedly been responsible for tragic episodes of disease, death, and environmental degradation (Table I). A recurrent pattern in these episodes has been that new

1 Dean for Global Health, Ethel H.Wise Professor and Chairman, Department of Preventive Medicine, Professor of Pediatrics,Icahn School of Medicine at Mount Sinai, NewYork, New York 2 Dean,SchoolofPublicHealthandHealthServices,TheGeorgeWashington University, Washington, District of Columbia Disclosure Statement: Authors declare no conflict of interest.  Correspondence to:Philip J.Landrigan,MD,MSc,Dean for Global Health,Ethel H.Wise Professor and Chairman, Department of Preventive Medicine, Professor of Pediatrics, Icahn School of Medicine at Mount Sinai, 17 East102nd Street, Room D3-145, New York, NY10029-6574. E-mail: [email protected]

Accepted13 September 2013 DOI10.1002/ajim.22268. Published online17 October 2013 in Wiley Online Library (

ß 2013 Wiley Periodicals, Inc.

chemicals were brought to market with great enthusiasm, underwent little or no premarket testing, and were presumed safe in the absence of data. Then only years or decades later, after they had come into wide use were the chemicals found to have harmful consequences. In many instances, early warnings of toxicity were ignored or dismissed. The Toxic Substances Control Act of 1976 (TSCA), the current federal law on chemical safety, is considered by parties as diverse as the Obama administration, the EPA Inspector General, environmental groups, and the chemical industry to be obsolete and broken. TSCA was pioneering legislation in its time, intended to protect human health and the environment by requiring chemicals already in commerce to be tested for safety and new chemicals to undergo testing before coming to the market. TSCA never fulfilled those intentions. Within months of its passage, the law was grievously weakened by a decision to “grandfather in” 62,000 chemicals already in commerce. Those chemicals were simply presumed to be safe, were never subjected to safety testing, and could not be regulated unless EPA made a finding that they posed “unreasonable risk.” Moreover, EPA was required to demonstrate that any proposed strategy to control


Landrigan and Goldman

TABLE I. Untested Synthetic Chemicals and Human Health More than 85,000 synthetic chemicals have been developed in the past 75 years.Most did not previously exist in nature.They are used extensively today in myriad consumer products and are widely disseminated in the environment. Many have undergone no safety testing. Exposures to untested synthetic chemicals have been responsible for episodes of disease, death, and environmental degradation. Prenatal exposures appear especially damaging. Historical examples include the following: Thalidomide.This sedative, taken by women as an antiemetic in early pregnancy caused a global epidemic of more than10,000 cases of phocomelia. Diethylstilbestrol (DES).This synthetic estrogen was taken by pregnant women to prevent premature labor. It was responsible for adenocarcinoma of the vagina in the women’s daughters. Tetraethyl lead was added to gasoline from the early1930s until1980 to boost octane.It was responsible for widespread low-level lead poisoning with reductions in IQ and alterations of behavior across two generations of children. DDT.This persistent pesticide nearly caused extinction of the osprey and the American bald eagle.Prenatal exposures have been linked to increased risk for breast cancer. Polychlorinated biphenyls (PCBs).These highly persistent pollutants continue today to contaminate major lakes and rivers. Prenatal exposures are linked to loss of IQ and disruption of behavior. More recent examples include: Phthalates, chemicals widely used in plastics, cosmetics, and common household products. Prenatal exposures have been linked to increased risk for reproductive abnormalities in baby boys and heightened risk for behavioral abnormalities that resemble attention-deficit/hyperactivity disorder (ADHD). Polybrominateddiphenyl ethers (PBDEs). Prenatal exposures to PBDEs, used as flame retardants in carpets,furniture and electronic equipment, have been linked to persistent loss of intelligence and disruption of behavior. Organophosphate insecticides. Prenatal exposures are linked to reduced head circumference at birth, developmental delays, cognitive impairments, and pervasive developmental disorder (PDD). Bisphenol A. Prenatal exposure to this chemical used in manufacture of polycarbonate plastics has been linked to behavioral abnormalities.

chemicals was the “least burdensome” approach [Landrigan and Goldman, 2011]. The “unreasonable risk” standard and the “least burdensome” requirement have made it almost impossible for EPA to regulate consumer chemicals. The final straw in destruction of TSCA occurred in 1991 when the federal Fifth Circuit court struck down EPA’s ban on asbestos stating that EPA had “exceeded its authority” in proposing this ban. Since then EPA has virtually ceased enforcement of TSCA. The only recent actions in the United States to ban or restrict consumer chemicals have been actions taken by state and county governments and voluntary moves by chemical manufacturers [Landrigan and Goldman, 2011]. As a result of the failure of TSCA, only five chemicals have been banned in the United States since 1976. Moreover, only about half of the 3,000 most widely used chemicals (termed high-production volume chemicals) have ever had any safety assessments. Only about 20% have been tested for reproductive or developmental toxicity. Untested chemicals have become widely disseminated in the environment. Measurable quantities of several hundred high-production volume chemicals are routinely detected by CDC’s national biomonitoring program in the blood and urine of virtually all Americans [CDC, 2011]. Their possible impacts on human health are largely unknown. Even less is known about their possible effects on children’s health and development or on pregnant women.

CHEMICAL SAFETY LEGISLATION AND HEALTHCARE COSTS Largely overlooked so far in the debate on the Lautenberg-Vitter bill is the recognition that strong, vigorously enforced chemical safety legislation could reduce healthcare costs in the United States. Diseases caused by synthetic chemicals are very expensive. A recent study of disease in children caused by toxic chemicals found that these illnesses cost $76.6 billion each year [Trasande and Liu, 2008]. Occupational diseases caused by toxic chemical exposures in workers cost millions more [Leigh, 2011]. Previous efforts to control toxic chemicals have produced massive cost savings. EPA’s removal of lead from gasoline produced a 95% reduction in children’s blood lead levels and has yielded a cumulative economic benefit since 1980 estimated to be more than $3 trillion [Grosse et al., 2002]. This benefit was largely the result of a 3–5-point increase in population mean IQ that followed the reduction in blood lead levels and has given the United States a smarter, more highly productive workforce. Reducing the cost of disease matters more today in the United States than ever before. Under the Affordable Care Act (ACA), healthcare providers, and Accountable Care Organizations will now be responsible for preserving the health of the populations they serve while reducing costs. Emphasis on prevention will increase. For the first time ever

Chemical Safety, Health Costs and the ACA

American physicians and healthcare systems have powerful economic incentives to seek out and control the preventable causes of disease. Poorly controlled exposures to toxic chemicals are prominent among these risk factors.

SENATOR LAUTENBERG’S LEGACY For the last decade of his life Senator Lautenberg courageously and often single-handedly led the effort to reform chemical safety. In each of the last three Congresses, he introduced chemical safety legislation. Each time his efforts were blocked. Many of his opponents’ blocking strategies were identical to those used by the tobacco industry and were orchestrated by law and public relations firms that had worked with big tobacco [Michaels, 2008]. The introduction this year of a bipartisan chemical safety bill marks a dramatic departure from the unyielding opposition of that recent past. It signals that the chemical industry and their Congressional allies are for the first time willing to consider compromise. Concerned by widely publicized reports of human health effects of consumer chemicals, especially on children, and by the emergence of an unpredictable patchwork chemical safety legislation in states and counties that could severely disrupt national markets, the industry is now willing to reach across the political aisle to seek federal legislation. This is a tectonic shift.

AN UNANTICIPATED OPPORTUNITY The introduction of the Lautenberg-Vitter bill this year at the same time as implementation of the next phase of ACA and the roll-out of Accountable Care Organizations creates a grand and unexpected opportunity for physicians, healthcare organizations and organized medicine to argue that strong chemical safety legislation is urgently needed in the United States. This juxtaposition of events enables us to make the case that chemical safety legislation has the power not only to


improve human health but also to substantially reduce healthcare costs. The Lautenberg-Vitter bill is not perfect. It contains no provisions explicitly protecting children’s health. It does not set clear timelines and targets for EPA to take action. It will not permit states to set chemical safety standards that are stricter than federal standards—a provision which, if enacted, will set aside stringent standards established in states like California. But no bill is perfect when introduced, and this bill will be improved as it moves through the Congress. It deserves our strong support. If we are to seize this opportunity, we must work with the Congressional committees that will be holding hearings on the Lautenberg-Vitter bill. We in medicine need to give them expert advice and informed advocacy that will guide them in crafting legislation that is truly protective of human health. A strong chemical safety law will benefit our patients, it will control healthcare costs, and it will be good for the United States. This is truly a strategic opportunity.

REFERENCES Centers for Disease Control Prevention. 2011. National report on human exposure to environmental chemicals. Atlanta, GA: CDC. Available at: (accessed February 28). Grosse SD, Matte TD, Schwartz J, Jackson RJ. 2002. Economic gains resulting from the reduction in children’s exposure to lead in the United States. Environ Health Perspect 110:563–569. Landrigan PJ, Goldman LR. 2011. Children’s vulnerability to toxic chemicals: A challenge and opportunity for health and environmental policy. Health Affairs 30:842–850. Leigh JP. 2011. Economic burden of occupational injury and illness in the United States. Milbank Q 89:728–772. Leigh 2011, doi: 10.1111/ j.1468-0009.2011.00648.x Michaels D. 2008. Doubt is their product: How industry’s assault on science threatens your health. London: Oxford University Press. Trasande L, Liu Y. 2011. Reducing the staggering costs of environmental disease in children, estimated at $76.6 billion in 2008. Health Affairs 30:863–870.

Chemical safety, health care costs and the Affordable Care Act.

On May 22, 2013, the late Senator Frank Lautenberg (D-NJ), Senator David Vitter (R-LA) and 19 of their colleagues introduced bipartisan chemical safet...
75KB Sizes 0 Downloads 0 Views