Q J Med 2015; 108:757–758 doi:10.1093/qjmed/hcv031 Advance Access Publication 31 January 2015
Coda Labels unexpected in vitro toxic properties when less than c50nm in diameter. Since it is used in a number of cosmetic preparations, could it be hazardous in this form? Questions like this posed serious problems for toxicological testing and for regulators wishing to protect the public. But then the issue of labelling arose; should nanoparticles be labelled separately from their parent substance? This would again cause real problems in determining how much nano-stuff was in, what proportion of the total required specific labelling and how the product’s content should be controlled and assessed by regulatory bodies. We discussed this in the working group and decided that labelling should be recommended, though many of us saw difficulties. Some were particularly keen on labelling so, out of interest, I asked how many of the ladies had actually read the list of ingredients in their lipstick. None had, so I passed round a packet of my wife’s, borrowed from her that morning. Their faces were a picture. Of course few of us obsessively read the ingredients of packets of things we eat or use on our skins and, if we do, even fewer understand what the names mean. So here’s a personal story. A year or so ago my wife developed itchy eyelids which within a week had developed into a very nasty facial allergic dermatitis. She had recently changed her shampoo so it immediately came under suspicion. The list of contents was long and beyond my basic chemistry, though some looked very suspicious. A nephew, a consultant dermatologist, confirmed the diagnosis from a photograph and told me that he and colleagues had been seeing many patients with this reaction from agents containing a preservative, methyl isothiazolinone, apparently recently introduced. Sure enough, there it was on the list, so the shampoo was removed and I read the labels of everything in the house. It was present in no fewer than 10 different liquid skin and cleaning agents. You’ll be pleased to hear that my wife recovered quickly. I told my GP about it in case she saw new patients with allergic dermatitis. I believe that moves are now afoot in Europe to ban its use in household products but, since these
! The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 14, 2015
One of the earliest lessons I learnt as a doctor was the danger inherent in giving names to disease syndromes. Heart failure, chronic bronchitis, asbestosis and so on were terms that, written in the case notes, stopped logical deductive thought about causation of the patients’ ailments and thus the most effective management. In the case of a patient’s death, I got into the habit of requesting post-mortem examinations even when the cause appeared obvious, justifying this on educational and personal audit grounds. In life, I hoped to explain my patients’ illnesses both in terms of their interaction with their environment and the pathological dysfunction of their body. In this, I was trying to do what all good physicians should aspire to and should teach their apprentices. So often, a label is a poor descriptor of the multiple and complex problems that cause us to go into hospital. Some years later the problem list arrived, recognizing the issue but often including ill-considered labels among its components. A diagnosis requires a complete explanation of the patient’s illness that points towards both treatment and prognosis; a label in contrast forces patients and their illnesses into a box, a chapter in a textbook, a constraint on thought. Often in my professional life, I have encountered a patient to whom a label had been applied that had subsequently been accepted by other doctors and had led to inappropriate treatment or lack of treatment. In other areas of life, labels are quite specific; chemical and botanical nomenclature, for example. But sometimes even these can mislead or obfuscate. A decade ago I found myself on a rather highpowered working group of the Royal Society and the Royal Academy of Engineering, discussing the opportunities and possible hazards of nanotechnology. The members ranged from distinguished scientists, moral philosophers, household names to, well, me, and our Chair was a distinguished lady academic, Fellow of both Academies. We learnt that chemicals could change all their chemical, physical and biological properties when in nanoparticulate form. Titanium dioxide, for example, used in toxicology as an inert control powder, suddenly developed
758 preservatives are essentially toxic to bacteria, there is always the risk that another one will also cause dermatitis. Like people and bacteria and pretty well everything else, labels can be both useful and dangerous.
Coda Rather than stopping you from thinking, they should stimulate thought – what does it mean? Try googling isothiazolinone. Anthony Seaton
Downloaded from by guest on November 14, 2015
Coda Labels unexpected in vitro toxic properties when less than c50nm in diameter. Since it is used in a number of cosmetic preparations, could it be hazardous in this form? Questions like this posed serious problems for toxicological testing and for regulators wishing to protect the public. But then the issue of labelling arose; should nanoparticles be labelled separately from their parent substance? This would again cause real problems in determining how much nano-stuff was in, what proportion of the total required specific labelling and how the product’s content should be controlled and assessed by regulatory bodies. We discussed this in the working group and decided that labelling should be recommended, though many of us saw difficulties. Some were particularly keen on labelling so, out of interest, I asked how many of the ladies had actually read the list of ingredients in their lipstick. None had, so I passed round a packet of my wife’s, borrowed from her that morning. Their faces were a picture. Of course few of us obsessively read the ingredients of packets of things we eat or use on our skins and, if we do, even fewer understand what the names mean. So here’s a personal story. A year or so ago my wife developed itchy eyelids which within a week had developed into a very nasty facial allergic dermatitis. She had recently changed her shampoo so it immediately came under suspicion. The list of contents was long and beyond my basic chemistry, though some looked very suspicious. A nephew, a consultant dermatologist, confirmed the diagnosis from a photograph and told me that he and colleagues had been seeing many patients with this reaction from agents containing a preservative, methyl isothiazolinone, apparently recently introduced. Sure enough, there it was on the list, so the shampoo was removed and I read the labels of everything in the house. It was present in no fewer than 10 different liquid skin and cleaning agents. You’ll be pleased to hear that my wife recovered quickly. I told my GP about it in case she saw new patients with allergic dermatitis. I believe that moves are now afoot in Europe to ban its use in household products but, since these
! The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 14, 2015
One of the earliest lessons I learnt as a doctor was the danger inherent in giving names to disease syndromes. Heart failure, chronic bronchitis, asbestosis and so on were terms that, written in the case notes, stopped logical deductive thought about causation of the patients’ ailments and thus the most effective management. In the case of a patient’s death, I got into the habit of requesting post-mortem examinations even when the cause appeared obvious, justifying this on educational and personal audit grounds. In life, I hoped to explain my patients’ illnesses both in terms of their interaction with their environment and the pathological dysfunction of their body. In this, I was trying to do what all good physicians should aspire to and should teach their apprentices. So often, a label is a poor descriptor of the multiple and complex problems that cause us to go into hospital. Some years later the problem list arrived, recognizing the issue but often including ill-considered labels among its components. A diagnosis requires a complete explanation of the patient’s illness that points towards both treatment and prognosis; a label in contrast forces patients and their illnesses into a box, a chapter in a textbook, a constraint on thought. Often in my professional life, I have encountered a patient to whom a label had been applied that had subsequently been accepted by other doctors and had led to inappropriate treatment or lack of treatment. In other areas of life, labels are quite specific; chemical and botanical nomenclature, for example. But sometimes even these can mislead or obfuscate. A decade ago I found myself on a rather highpowered working group of the Royal Society and the Royal Academy of Engineering, discussing the opportunities and possible hazards of nanotechnology. The members ranged from distinguished scientists, moral philosophers, household names to, well, me, and our Chair was a distinguished lady academic, Fellow of both Academies. We learnt that chemicals could change all their chemical, physical and biological properties when in nanoparticulate form. Titanium dioxide, for example, used in toxicology as an inert control powder, suddenly developed
758 preservatives are essentially toxic to bacteria, there is always the risk that another one will also cause dermatitis. Like people and bacteria and pretty well everything else, labels can be both useful and dangerous.
Coda Rather than stopping you from thinking, they should stimulate thought – what does it mean? Try googling isothiazolinone. Anthony Seaton
Downloaded from by guest on November 14, 2015
