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12.21.15

Two things we should STOP doing in the name of public health in 2016

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In 2013, my colleague Brian Honermann wrote a popular blog post on four things we should probably stop doing in the name of public health: 1) Vitamin supplementation amongst otherwise healthy individuals; 2) PSA-Based Prostate Cancer Screenings, 3) Asymptomatic Mammography-Based Breast Cancer Screening; and 4) Obsessive Concern with Obesity based on BMI.
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Unfortunately, all of Brian’s recommendations are still in need of change with the exception of PSA-based prostate cancer screenings. As reported last week by the NYT, the Public Health Service Task Force has changed its recommendations to reflect the science on PSA-based Prostate Cancer Screenings. In the last two years however, there has been no notable change on the other three. And so, I encourage you to read Brian’s blog post here.
In 2016, I propose adding two more things that we should STOP doing in the name of public health: (1) Stop using antibacterial soaps and hand-sanitizers, and (2) Stop throwing out food past the date label on the package.
Stop using antibacterial soaps and hand-sanitizers
According to a 2010 lawsuit filed by the Natural Resources Defense Council (NRDC), the Food and Drug Administration (FDA) first considered regulating topical antiseptic products, including triclosan in 1972, but never finished its review. In 1978, FDA proposed banning triclosan directly as an active ingredient in soaps, but that proposal never amounted to anything more. Again in 1994, the agency initiated similar steps towards banning triclosan, but again failed to actually authorize a rule.
And so, in 2010, NRDC sued FDA to finish what it started in evaluating the safety of triclosan in consumer products. In 2013, FDA issued a proposed rule to ban the use of antibacterial chemicals in soaps for consumer purchase unless companies can offer scientific data to prove they are safe and effective for long term use. As a condition of settlement, FDA promised to issue a final action on triclosan by 2016. What will happen in 2016 remains a mystery, in the meantime, consumers should stop using products with antibacterial ingredients.
What’s the issue?
Antibacterial soaps (sometimes called antimicrobial or antiseptic soaps) contain drug-chemicals, typically triclosan, intended to reduce or prevent bacterial contamination. According to the US Centers for Disease Control (CDC), “studies have shown that there is no added health benefit for consumers (this does not include professionals in the healthcare setting) using soaps containing antibacterial ingredients compared with using plain soap.” And, according to FDA “[n]ew data suggest that the risks associated with long-term, daily use of antibacterial soaps may outweigh the benefits. There are indications that certain ingredients in these soaps may contribute to bacterial resistance to antibiotics, and may have unanticipated hormonal effects that are of concern to FDA.”
In short, antibacterial soaps do not kill bacteria any better than plain old soap and water. They do however, introduce a number of other serious concerns including health problems, antibiotic resistance, environmental issues and specific hazards for children.
A recent CDC study detected triclosan in the blood stream of nearly 75% of people in the US, making the following concerns very real for the overwhelming majority of the population.
Health Concerns
In animal studies, scientists found that triclosan acts as an endocrine disruptor, altering the way hormones work in the body and raising concerns over infertility, artificially-advanced puberty, obesity and cancer (for more detail see here). A 2014 study published by the National Academy of Sciences found “[t]riclosan causes liver fibrosis and cancer in laboratory mice through molecular mechanisms that are also relevant in humans.”
Antibiotic Resistance*
Studies have linked the use of tricolosan in consumer products with antibiotic resistance in the humans. The American Medical Association recommends avoiding the use of any product with triclosan in the home, because of the threat of antibiotic resistance
*What is antibiotic resistance? Antibiotic resistance is a naturally occurring process. Bacteria adapt to resist susceptibility to antibiotics. Each time bacteria are exposed to antibiotics, some of the organisms are likely to develop resistance and some will be killed off. Resistant strains multiply and find a new host. As bacteria become more resilient, treating the infections they cause becomes more difficult and in some cases, impossible. When people expose themselves to antibiotics on a routine basis, their bodies have more opportunities to develop mutations and resistance to bacteria.
Environmental Concerns
Wastewater treatment does not adequately remove triclosan from our water. Triclosan is very toxic to aquatic life. Consequently, this chemical pollutes waterways, exposing nature and humans to unnecessary levels of antibiotics.
Special considerations for children
Babies build their immune systems by adapting to their environment. Developing immunity requires exposure to environmental pathogens. A baby’s memory T cells, or white blood cells learn to “remember” pathogens the body encounters to fight infection. Consequently, if you limit exposure to environmental pathogens, you also limit the body’s opportunity to develop those memory T-cells necessary to fight infections. Routine antibiotic use limits exposure to certain pathogens necessary for building a healthy immune system. Of course, exposure to certain pathogens and viruses is dangerous for a baby, but in non-healthcare settings proper handwashing with regular soap and water is proven to be equally effective at eliminating dangerous pathogens.
Another consideration for parents of young children, is a CDC finding linking the overuse of antibacterial products to allergic reactions. Shielding children from certain bacteria that tax the immune system may cause the body to have misguided reactions to otherwise harmless substances. Studies have found that limiting a baby’s exposure to certain pathogens increases the risk of developing allergies to common things like hay and peanuts.
A Note about Hand Sanitizers
“Washing” your hands with hand sanitizer is a misnomer. Waterless cleaners are designed to kill bacteria, but they do not remove dust or dirt from your hands. Additionally, the chemicals in the hand sanitizers are left to absorb into your skin, including antibiotics.
If soap and water are not available, CDC recommends using an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol based sanitizers are not linked to antibiotic resistance.
How SHOULD you wash your hands? The U.S. Centers for Disease Control (CDC) dubs handwashing a five-step “do-it-yourself” vaccine (Wet, Lather, Scrub, Rinse, Dry).
Stop Throwing out Food Past the Date Label on the Package. It’s not (necessarily) spoiled.
sell by, use by, best before – In the US, almost none of those dates indicate the safety of food, nor does the law require them to (*with one exception for infant formula. FDA strictly regulates the nutritional content of infant formula. If infant formula is not consumed before its expiration date it should be thrown away). By and large, “dates” printed on food are set by the manufacturer based on the expected peak quality of the product, not the microbial safety of the food.
According to the Food Marketing Institute, nine out of ten consumers throw away food based on a listed date. But most of the time, the food is still perfectly edible. Generally, the average family of four wastes more than two million calories, worth nearly $1500, of uneaten food each year. Somewhere around 40% of food in America is wasted annually.
Food waste is a public health issue because decomposing organic matter in landfills emits an unbelievable amount of methane into our atmosphere, contributing to global warming. If global food waste were a country, it would rank behind only the United States and China in terms of harmful emissions. Still, decomposing food is only part of the equation. Throwing out food also wastes the energy that went into the original production, transportation and storage of the food, adding to its total carbon footprint. Food waste also amounts to throwing out 25 percent of all freshwater used in the US. Reducing your personal food waste, starting with healthy, viable “expired” food is a great place to start.
FAO
And, we can’t consider food waste without considering the one in seven Americans who go hungry each day. Experts at USDA project reducing food waste in the US by just 15% would feed roughly 25 million hungry Americans every year. Regulating date labels would be one place to start.
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And a note on vitamin supplementation
Since Brian reported in 2013, the science hasn’t changed. It is still true that “[s]ystematic reviews of vitamin supplementation have produced a fairly clear picture that taking vitamin supplements has little to no effect on overall health outcomes and has produced some conflict as to whether vitamin supplementation is actively harmful or only marginally beneficial.”
Still, if you need a different reason to avoid supplements, or at least think twice before taking them, here are a few things you ought to know.
This past October, the New England Journal of Medicine published a study led by CDC doctor Dr. Andrew Geller. The study analyzed why tens of thousands of Americans ended up in the ER between 2004-2013 complaining of an adverse reaction to a dietary supplement. Complaints included everything from irregular heart beat and chest pain, to children’s accidental ingestion and chocking. Weight-loss and energy boosting supplements were responsible for almost three-quarters of the problems (71.8%). Of the 23,005 analyzed ER visits, 2,154 patients were admitted to the hospital. And note, the study did not include anyone who died enroute to the hospital or in the ER.
As I reported earlier this year, the dietary supplement industry has repeatedly been found guilty of selling fraudulent and mislabeled products leading to serious illness and death.
One of the biggest issues with dietary supplements is simply a lack regulatory authority and oversight. While FDA is responsible for regulating the dietary supplement industry, its actual authority is enormously limited. By law, the dietary supplement industry is essentially responsible for regulating itself. The companies are required to conduct their own safety and efficacy studies and are not required to prove anything to FDA before they actually begin selling their products. FDA only has the authority to stop a company from selling its product after an injury has occurred.
For most people, you are much better off eating a well-balanced diet to get the nutrients you need from food. If you are committed to supplements, talk to your doctor. And, make sure to only buy brands that carry the seal of a reputable third-party accreditor like the US Pharmacopeia.
Conclusions
You know the old adage, a little goes along way? Nothing could be truer about the actions I propose for 2016. Antimicrobial resistance is too real and incredibly frightening. So is climate change. Remediating each of these public health threats depends upon individuals changing behaviors. On an individual level using plain soap and water to clean our hands and making sure to eat the food we buy are not huge tasks, but if done collectively, the pay off could be.
 

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