California’s dirty air caused more than $193 million in hospital-based medical care from 2005 to 2007 as people sought help for problems such as asthma and pneumonia that are triggered by elevated pollution levels, according to a new RAND Corporation study.

Researchers estimate that exposure to excessive levels of ozone and particulate pollution caused nearly 30,000 emergency room visits and hospital admissions over the study period. Public insurance programs were responsible for most of the costs, with Medicare and Medi- Cal covering more than two-thirds of the expenses, according to the report.

“California’s failure to meet air pollution standards causes a large amount of expensive hospital care,” said John Romley, lead author of the study and an economist at RAND, a nonprofit research organization. “The result is that insurance programs — both those run by the government and private payers — face higher costs because of California’s dirty air.”

While much work has been done previously to catalog the economic impact of air pollution across California, the RAND study is the first to quantify the cost of hospital-based medical care to various payers caused by the failure to meet federal clean air standards across the state. More people in California live in areas that do not meet federal clean air standards than in any other state.

Romley said the findings show that private insurers, employers and public insurance programs all have a financial stake in improving California’s air quality.

“These costs may not be the largest problem caused by dirty air, but our study provides more evidence about the impact that air pollution has on the state’s economy,” Romley said.

Researchers used records from air pollution agencies and hospitals to estimate how failing to meet federal and state standards for particulate matter and ozone would affect private and public insurer spending for hospital admissions for respiratory and cardiovascular causes, and emergency room visits for asthma throughout California from 2005-2007.

Researchers say the most common hospital-based medical care triggered by elevated air pollution levels are emergency room visits for asthma among children aged 17 and under, with more than 12,000 visits over the three-year study period.

The most costly conditions examined by researchers were hospital admissions triggered by air pollution for acute bronchitis, pneumonia and chronic obstructive pulmonary disease. Those conditions accounted for nearly one-third of the $193 million in health care spending documented over the study period.

Nearly three-quarters of the health events identified by researchers were triggered by high levels of fine particulate pollution — tiny pieces of soot that can lodge deep in lungs. The health events examined in the study were concentrated in the San Joaquin Valley and the four-county South Coast Air Basin.

The cost of treating health events caused by air pollution is equal to the expense of providing flu vaccines to 85 percent of California children under age 15, according to the report.

Researchers say their study provides a conservative estimate about the costs of medical care triggered by air pollution because it does not include outpatient care provided in clinics or medical offices. Details about that type of medical care are not routinely reported to state agencies and thus could not be analyzed.

The study also includes case studies of individual hospitals in Fresno, Lynwood, Palo Alto, Riverside and Sacramento. That analysis demonstrates that costs and types of illness reported vary by region.

To conduct the study, researchers used epidemiological studies that link elevated pollution levels to respiratory and cardiovascular illnesses, and compared that information to pollution levels measured across the state from 2005 to 2007 by various public agencies. Researchers also reviewed detailed records hospitals report to the state about the patients they treat, the illnesses diagnosed and who pays for that care.

Literature:

RAND Corporation*, Study finds dirty air in California causes millions worth of medical care each year, March 2, 2010

*The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world.

Postage stamps with aroma could affect the health of sensitive people

On January 7th, German Minister of Finance, Dr.Schaeuble, presented the new charity postage stamps to Federal President Horst Koehler and Ms. Donata Freifrau Schenck zu Schweinsberg, President of the Bundesarbeitsgemeinschaft der Freien Wohlfahrtspflege (a federal association of welfare organizations). The unique feature of these stamps for this year is: They are fruit scented – blueberry, strawberry, lemon and apple. The scenting agents are micro-encapsulated and are not supposed to be released until they are rubbed.

The perfumed stamps release a scent even without being rubbed

CSN wanted to know whether the stamps really do not smell until being rubbed and arranged to get samples of the scented stamps. As we asked to buy the new charity stamps, the lady behind the post office counter pulled out an extra folder and remarked almost devoutly, “Oh yes, this are the new perfumy stamps.” She took out a sheet of stamps which showed blueberries and delightedly announced: “Wow, these really can be smelled without rubbing!”

Two welfare stamps were purchased by CSN and examined carefully. Both stamps give off a smell without being rubbed with the finger. Strictly speaking, the strawberry-stamp emits the smell of a cheap toothpaste with strawberry flavor, and the odor of the lemon stamps are a reminder of a toilet cleaner with an artificial lemon aroma. It smells nothing like a natural fruit aroma. The lemon scent grew stronger after the stamp was left at room temperature for a short while. CSN refused to activate the odor by rubbing. It can be assumed that the smell of the stamps will grow by the inevitable friction of the letters during transport and by running them through the sorting system at the postal hubs. Therefore it is quite possible that the perfumed stamps will contaminate other mail.

CSN would like to know if the applied scents were tested for their health compatibility, and which safety criteria and methods they used for the tests. Was their safety criteria the tolerable toxic load for an average healthy adult or was it the tolerable toxic load for the weakest, i.e. for an embryo? Did they test the plain aroma agents or the printing ink equipped with the aroma? Has the material of the stamp an effect on the compatibility? The information of the Bundesdruckerei (German federal printing press) suggests that first amounts of the scents were emitted before even the printing process was completed.

People with asthma, allergy to scents, sensitivities to chemicals, and persons who respond severely to scents could be affected by this advertising stunt.

As an answer, at January 11, CSN wrote the following open letter:

Perfumed Postage Stamps Constrain People with Disabilities

Dear Mr. Federal President Dr. Horst Koehler,

Dear Ms. Frau Donata Freifrau Schenck zu Schweinsberg,

Dear Dr. Wolfgang Schaeuble,

On January 7th, you shared the presentation of the new charity stamps issued by the Ministry of Finance, which emit scents of apple, strawberry, blueberry and lemon when rubbed. We want you to think about that at first glance simpatico idea, and we politely request you Dr. Schaeuble, to withdraw these postage stamps from circulation as Minister of Finance, because there are groups of people with certain disabilities and health disorders, who would be at risk if exposed to these scents.

Wouldn’t it be ironic, if some of those people who should benefit from these charity stamps will be harmed, by putting them in circulation? Do you realize the critical position of the German Federal Environmental Agency (UBA/Umweltbundesamt) regarding scents? The UBA points out that scented products should be avoided in public areas. The German coalition for allergies and asthma the DAAB (Deutscher Allergie- und Asthmabund e.V.) assumes about 11 percent of general population, that was actually a good nine million cases, affected by olfactory hypersensitivity for scents (according to Meggs et al. 1996). They postulate warning signs for scented rooms.

Is it appropriate to characterize those as people with disabilities who respond to scents with health troubles?

According to the ‘Americans with Disabilities Act’ (ADA), an individual with a disability is defined as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.

The ‘Convention on the Rights of Persons with Disabilities’ (UN-convention) which was signed by the German government on March 30, 2007, defines persons with disabilities as those, who have long-term physical, mental, intellectual or sensory impairments which may hinder their full and effective participation in society on an equal basis with others.

Perfumed postage stamps limit the lifestyle of allergic, asthmatic, chemically diseased and other sensitive persons in an unreasonable way. This violates the UN-convention and does not meet the protection criteria set out for people with disabilities as outlined by the ADA. Severe sensitive cases and those who suffer from contact allergies caused by scents don’t even need to smell traces of those contaminants. Unsuspecting they will contaminate their living space which often is prepared safe from toxins under difficult financial conditions.

Thus far, people with health impairments from scents were able to at least receive and open their mail without help from others. This autonomy and normality of life is taken away from them. If someone encounters physical reactions by being exposed to scents, he/she will become unable to receive mail any longer and has to depend on other people to sort this type of ‘mail bomb’ out. Possibly a whole delivery is lost because one single letter with a perfumed postage stamp has contaminated all other mail.

During the Christmas season of 2004 there was a similar campaign with perfumed scratch stickers. Contrary to the statement of a German mail service personnel, the scents are not securely locked in the ink. None can be sure that somebody rubs the stamps on the dispatch or mechanical interaction will release these substances. At that time when the mail arrived it was already fragrant and it will be again this time.

Potentially such deliveries could sensitize people who have not suffered from an allergy yet. Have the applied scents adequately been tested for that risk? Would you bet your life on their harmlessness? Did you know that most of the scents used in Germany are not tested for tolerance? According to the “Special Report on Allergies, 2000″ (“Spezialbericht Allergien, 2000″) by the German Federal Government, there are about 15 to 25 percent of general population affected by an atopic disease, that was over 20 million cases, and one-third are sensitized for allergies, that was about 27 million. Should not everything be done, to keep this data from growing?

Scents trigger a variety of physical reactions for people with this sensitivity. Depending on disease and state of health, they range from harmless irritations to life threatening conditions. The following troubles can be caused individually or in combinations:

Tiredness, sneezing, irritated eyes, redness, itching, blisters, inflammations, swelling and burning of the lips, nasal mucosa burning, burning of the tongue, toothache, cough, voice failure, labored breathing, vertigo, sickness, headache, migraine, speech disorder, disturbance of memory, permanent painful vomiting, cardialgia, tachycardia, state of shock, absence, coma.

Often, such an incident increases the sensitivity for other substances or undoes a recovery which was hardly achieved by a strategy of avoidance and healthy living over a long period.

If nothing else, artificial scents could disturb the aesthetic perception of healthy ones and never reach the sensuality of their prototypes. Lay some apples from an organic farmer in your bedroom and compare it with the odor from these stamps.

Considering all of the above, we request, that the health damage which may be expected for those people in the general population who are sensitized by scents be recognized and, as under the terms of the Convention on the Rights of Persons with Disabilities, that the circulation of these perfumed postage stamps be immediately stopped.

Kind regards,

Silvia K. Mueller, Bruno Zacke

CSN – Chemical Sensitivity Network

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We thank Christi and Jim for translation help.

If your baby were suffering from colic, would you treat him with artificially dyed and sweetened simethicone (the chemical in drugs such as Mylanta and Mylicon) or first try an emulsion of fennel seed oil?  If your young daughter developed a persistent rash, would you prefer the doctor to prescribe antihistamines or a diet rich in omega fatty acids?

More and more, it’s likely you’d give the second choice a try. The big news is that mind-body pediatrics has come of age over the past generation. It’s a trend that seems very appropriate for a generation of parents looking for foods without pesticides and cosmetics without solvents.

A major symptom of its acceptance is the publication of the first textbook book on Integrative Pediatrics, edited by the avuncular and reassuring Dr. Andrew Weil, the U.S.’s best known non-conventional medicine practitioner and spokesperson.   The august National Institutes of Health has set up a center devoted to its study while the American Academy of Pediatrics has formed a practitioners’ Section.  And you can now find pediatricians across the nation who will use integrative practices to care for your children (click on hyperlink to members, select Section on Complementary and Alternative, for a listing by zip code; also www.aaemonline.org).

This kind of medical care works to keep children well by instilling a long-life pattern of healthy living and by treating simple problems such as ear aches without resorting to the overuse of drugs.  It particularly lends itself to caring for children with chronic illnesses, such as cancer, juvenile arthritis, obesity, asthma and developmental disorders such as autism and ADHD, where conventional medicine hasn’t a great track record of cures.  In fact, there’s been a major increase in the number of prescription medications used to treat symptoms of childhood chronic illnesses, despite the absence of data that they are effective in curing the underlying problems.

If the incidence of chronic childhood illnesses continues the upward climb it has taken over the past two decades, and as more families understand the link between prevention and treatment, integrative pediatrics may very well become the standard practice of the future.

Probably only grandmothers like me remember when revered New York Times journalist James Reston, returning from a 1972 reporting trip to China with President Nixon, wrote about his surprising experience in undergoing an emergency appendectomy with acupuncture as the only sedative.  That launched our nation’s first timid and by now vast interest in alternative medicine, from acupuncture to meditation, massage and body manipulation, biofeedback, exercise, nutrition and the use of botanically-based supplements.

Now that these techniques are no longer “alternative” to conventional western medicine but have become pretty much an accepted part of it, they are called “integrative” (meaning they’re integrated into standard practice) or “holistic” or “complementary” or “environmental” (a term especially acknowledging the effect of toxic exposures).

In my interviews with integrative pediatricians, they explain, first and foremost, that the power in holistic practice is their relationship with the child and her family, that healing is inexorably bound to the connection between practitioner and patient.

To create that connection, they spend lots of time meeting and talking and educating.  They build a team with the parents; the pediatrician acts like a quarterback helping the parents navigate the health care system.  In the first months of a child’s life, they focus on frequent well-baby care where they also design individualized schedules for vaccinations and treat problems that may arise, such as colic. These conversations with parents and patient continue as the child grows, so different from the usual harried, cookie-cutter 15-minute consultation.

If you visit Dr. Lawrence Rosen, a 43-year-old MIT grad and Mt Sinai-trained integrative pediatrician, you’ll find his pleasant office in New Jersey a paragon of green construction – the flooring, cabinetry and paint were chosen as the safest, least toxic (his website offers resources on green pediatrics construction based on his research and experiences). Even the staff’s dishware is either glass or nontoxic plastic made from recycled materials. Dr. Rosen explains that “the build-up of low-level toxic exposures is responsible for more illnesses than one-time higher exposure.”  He’s given him practice a name: The Whole Child Center, and he blogs when he can about natural parenting practices.

One of his patients is a ten-year-old girl (let’s call her Jenny) with asthma so severe she was using several different inhalers and several different allergy medications every day. Some of the steroid-based drugs were affecting her appetite and causing weight gain, while their continued use could have threatened her long-term development. Yet she still found it hard to participate in school sports. Jenny also had eczema and food allergies. “Rather than prescribing more medicines to suppress her symptoms, I looked for ways to balance her immune system response,” Dr. Rosen explained. He didn’t remove her from her medications immediately, to avoid an attack, but slowly over time worked with Jenny to integrate complementary therapies.

He started her on a daily probioitic, –which are supplements or foods like yogurt, rich in beneficial live microorganisms such as lactic acid bacteria.  He told her mom to ensure her diet included lots of fruits and vegetables with their healing antioxidants as well as foods with high levels of omega-3 fatty acids. Jenny was encouraged to build up her physical strength by swimming and walks outdoors in nature.  Dr. Rosen also worked with her on relaxation techniques including guided imagery and breathing (“Everyday Blessings: The Inner Work of Mindful Parenting,” by Jon Kabat-Zinn.and his wife, Myla). After careful monitoring, she’s now mostly weaned from her prescription meds, uses an inhaler infrequently, and has achieved her dream of participating in sports. Whereas last year she had missed 40 days of school, this year it was down to five.

A young patient with cancer in remission might be treated with similar practices, to support his immune system and his body’s overall strength and resilience.

“Conventional Western medicine is about fixing disease, mainly acute illnesses. It’s oriented around disease labeling and treatment,” Dr. Rosen says. Integrative pediatricians focus on wellness and innate balance of health.

Author: Alice Shabecoff for CSN – Chemical Sensitivity Network, January 9, 2010

Alice Shabecoff is the co-author with her husband Philip of Poisoned Profits: The Toxic Assault on our Children, published by Random House last year.  See their website, www.poisonedprofits.com

Related article from Alice Shabecoff:

• Our planet, our children – How are your children doing?
• My mother made me fat

Information Sources:

• A membership association of environmental physicians: American Academy of Environmental Medicine
• For families and practitioners; has a member directory: Holistic Pediatrics Association
• A practitioner group: Integrative Practitioner

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To my readers: I’m working on a related article that will focus on the way that nutrition can heal developmental disorders such as ADHD and autism.  And another article on how today’s health care system impedes the use of integrative pediatrics.

New York State (NYS) employees who responded to the World Trade Center (WTC) disaster on or after 11 September 2001 potentially experienced exposures that might have caused persistent respiratory effects. NYS responders represent a more moderately exposed population than typical first responders. 

To assess whether NYS employees who were WTC responders were more likely than controls to report lower respiratory symptoms (LRS) or a diagnosis of asthma 5 years post-9/11, persistence and severity of symptoms were also evaluated. 

Participants were initially mailed self-administered questionnaires (initial, Year 1, Year 2) and then completed a telephone interview in Year 3. Data were analysed using Poisson’s regression models. 

WTC exposure was associated with LRS, including cough symptoms suggestive of chronic bronchitis, 5 years post-9/11. When exposure was characterized using an exposure assessment method, the magnitude of effect was greater in those with exposure scores above the mean. WTC exposure was associated with persistence of LRS over the 3 year study period. Results also suggest that participants with the highest exposures were more likely to experience increased severity of their asthma condition and/or LRS. 

The findings suggest that even in a moderately exposed responder population, lower respiratory effects were a persistent problem 5 years post-9/11, indicating that some WTC responders require ongoing monitoring.  

Literature: Mauer MP, Cummings KR, Hoen R., Long-term respiratory symptoms in World Trade Center responders, Bureau of Occupational Health, Center for Environmental Health, New York State Department of Health, Occup Med (Lond). 2009 Dec 24.

The prevalence of allergic diseases such as asthma and pollinosis is steadily increasing and seems to be associated with modern lifestyle. Therefore, it has been hypothesized that high living standards and hygienic conditions reduce exposure to microbial components, and lead to an imbalance in the immune system, especially in the Thl and Th2 system, which increases the risk for the development of allergic diseases.

However, recent accumulated epidemiological evidences have demonstrated that air pollutants including diesel exhaust particulate (DEP) and NO2 are responsible for the increased prevalence of allergies. The effects of environmental chemicals have also been supported by the in vivo and in vitro studies. It is important to prevent allergy development in our life as early as possible (e.g., since our infancy). 

Reference: Nakamura H, Hitomi Y., Environmental factors in allergic diseases, Kanazawa University, Nippon Rinsho. 2009 Nov;67(11):2043-7.