tag:theconversation.com,2011:/global/topics/toxicity-12937/articlesToxicity – The Conversation2024-02-26T18:59:32Ztag:theconversation.com,2011:article/2239722024-02-26T18:59:32Z2024-02-26T18:59:32ZFrom a ‘magic mineral’ to the stuff of nightmares: a 6,700-year history of asbestos<p>Asbestos is making national news once again after being found in contaminated mulch used in hundreds of locations, including <a href="https://www.theguardian.com/australia-news/2024/feb/24/sydney-asbestos-crisis-epa-following-up-on-whether-second-mulch-supplier-is-involved">schools and hospitals</a>, <a href="https://www.theguardian.com/australia-news/2024/feb/19/asbestos-mulch-locations-sydney-sites-near-me-nsw-map-full-list-when-where-found-schools-parks-epa-news">across Sydney</a> and regional New South Wales. </p>
<p>With headlines featuring terms such as “<a href="https://www.reuters.com/world/asia-pacific/sydney-school-supermarket-tainted-with-asbestos-crisis-widens-2024-02-18/">crisis</a>”, “<a href="https://www.youtube.com/watch?v=v6ewhMFXf08">nightmare</a>” and “<a href="https://www.news.com.au/lifestyle/health/childrens-hospital-at-westmead-among-54-locations-contaminated-with-asbestos/news-story/97aa31383db6f492718d82f099f89d14">deadly</a>”, it’s hard to believe the toxic mineral was once hailed for its supposedly “magical” properties.</p>
<p>In fact, the history of asbestos goes back at least 6,700 years. Its prevalence in our built environment means it’s (unfortunately) here to stay for a long time.</p>
<h2>Before it became a ‘killer dust’</h2>
<p>Asbestos is a naturally occurring mineral found in rock formations across the globe, including in <a href="https://www.australianasbestosnetwork.org.au/asbestos-history/asbestos-wittenoom">some national parks</a> in Australia.</p>
<p>It gets its name from the Greek word for inextinguishable (<em>ásvestos</em>), alluding to its resistance to fire and corrosion. It was these characteristics, along with its insulating properties, that made asbestos seem like a “<a href="https://www.amazon.com.au/Mineral-Killer-Turner-Newall-Asbestos/dp/0199243999">magic mineral</a>” in centuries prior.</p>
<p>Researchers have found ancient clay pottery from East Finland, dated to 2500 BC, with asbestos fibres mixed into it – <a href="https://www.researchgate.net/publication/291349782_Early_Asbestos_Ware">likely added for</a> extra strength and resilience. Some of the <a href="https://www.researchgate.net/publication/357560672_Asbestos_Ceramics_from_Archaeological_Sites_of_Southern_Fennoscandia_Karelia_Mineralogical_and_Geochemical_Aspects">earliest asbestos</a> pottery, also found in Finland, has been dated to 4700 BC. Asbestos use has also been recorded at other neolithic sites, including in Central Russia and Norway.</p>
<p>In (Western) literature, the first known reference to what might have been asbestos comes from Theophrastus (circa 372-287 BC), a student of Greek philosopher Aristotle and his successor at the Lyceum. In his book <a href="https://www.xtal.iqfr.csic.es/Cristalografia/archivos_01/THEOPHRASTUS_CALEY.pdf">On Stones</a>, Theophrastus writes:</p>
<blockquote>
<p>In the mines at Scapte Hyle a stone was once found which was like rotten wood in appearance. Whenever oil was poured on it, it burnt, but when the oil had been used up, the stone stopped burning, as if it were itself unaffected.</p>
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<p>In the 10th century, Christian pilgrims travelling to Jerusalem were <a href="https://www.sciencedirect.com/science/article/abs/pii/S0305440314000399">sold</a> pieces of asbestos as fragments of the True Cross – their divinity supposedly evidenced by their incombustibility. By the medieval ages, trading asbestos-containing items had become common. This fascination continued for millennia.</p>
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<a href="https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577818/original/file-20240226-24-3mlrqk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This earthenware pilgrim flask (circa 1585-1600) has an impresa with burning asbestos and the words ‘ardet aeternum’, meaning ‘burn forever’. It’s painted with a medallion showing a nude male (Bacchus) holding two bunches of grapes.</span>
<span class="attribution"><span class="source">British Museum</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>In 1725, a young Benjamin Franklin found himself broke and living in London. In need of cash to pay his bills, he sold a <a href="https://royalsocietypublishing.org/doi/pdf/10.1098/rsnr.1952.0018">purse</a> made of fibrous mineral asbestos that he’d brought from North America. The recipient was <a href="https://www.britishmuseum.org/about-us/british-museum-story/sir-hans-sloane">Hans Sloane</a>, whose collections would later be used to <a href="https://www.smithsonianmag.com/history/british-museum-was-wonder-its-time-also-product-slavery-180966997/">establish the British Museum</a>.</p>
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<h2>A class I carcinogen</h2>
<p>The carcinogenic effect of asbestos – even at brief, transient and “low” doses (such as bystander exposure) – has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069377/">recognised since</a> at least 1965. Today, it is classified as a class I carcinogen and considered a deadly threat to humans.</p>
<p>Asbestos is the main <a href="https://pubmed.ncbi.nlm.nih.gov/13782506/">cause of mesothelioma</a>, a cancer of the surface of the lung. It can also cause lung cancer and is implicated in other cancers, including throat and stomach cancers. </p>
<p>In Australia, there are more than <a href="https://www.aihw.gov.au/about-our-data/our-data-collections/australian-mesothelioma-registry-database-amr">700 cases</a> of mesothelioma each year. We don’t know how many of the roughly 6,000 yearly cases of lung cancer are caused, wholly or partially, by asbestos. </p>
<p>Although asbestos use has been banned in Australia <a href="https://www.asbestossafety.gov.au/countries-asbestos-bans#:%7E:text=Asbestos%20has%20been%20banned%20in,on%20all%20types%20of%20asbestos.">since 2003</a>, people the world over continue to deal with its harmful effects.</p>
<h2>The spread of ‘fibro houses’</h2>
<p>Australia started using asbestos goods from around the 1880s, largely for steam-driven machines that benefited from its insulating properties. Only small local mines operated at the time. </p>
<p>Eventually, the world wars increased demand and active exploration led to larger-scale mining, <a href="https://theconversation.com/more-than-2-000-people-from-wittenoom-died-of-asbestos-related-diseases-a-powerful-and-compelling-requiem-brings-their-story-to-the-stage-198779">especially at Wittenoom</a> in Western Australia. Even then, local production wasn’t meeting demand.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-2-000-people-from-wittenoom-died-of-asbestos-related-diseases-a-powerful-and-compelling-requiem-brings-their-story-to-the-stage-198779">More than 2,000 people from Wittenoom died of asbestos-related diseases. A powerful and compelling requiem brings their story to the stage</a>
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<p>It was initially miners who presented with the disease, followed by workers in industries manufacturing asbestos-containing products, as well as builders, plumbers and fitters. The Wittenoom miners and their families are still being <a href="https://www.nature.com/articles/bjc201223">followed by researchers</a> to determine the effects of exposure.</p>
<p>The economic boom that followed WWII further drove demand for asbestos. In addition to local production, more than <a href="https://www.researchgate.net/publication/285994368_Asbestos">50,000 tons of asbestos</a> were imported to Australia each year throughout the 1950s and into the late 1970s.</p>
<p>Asbestos afforded many Australians a home. Timber-framed houses clad in flat asbestos cement sheeting (called “fibro houses”) were favoured by people who built or legally supervised the building of their own home.</p>
<p>In <a href="https://www.booktopia.com.au/asbestos-in-australia-lenore-layman/book/9781925835618.html?msclkid=3d5f43a20ad011798598267e19af1c3d&utm_source=bing&utm_medium=cpc&utm_campaign=Booktopia%20-%20AU%20-%20Shopping&utm_term=4585169650599087&utm_content=All%20Custom%20Label">the mid-1960s</a>, nearly 20% of Australia’s housing stock was made up of fibro houses – with the highest uptake (more than 50%) in the Northern Territory. It’s impossible to say exactly what percentage of existing buildings contain asbestos.</p>
<p>When cyclone Tracy swept through Darwin in 1974, the <a href="https://www.miragenews.com/ken-s-journey-with-asbestos-disease-ends/">death and disease</a> that resulted from the uncoordinated cleanup served as a warning of the possible dangers of asbestos removal.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/asbestos-still-haunts-those-exposed-as-kids-in-mining-towns-9487">Asbestos still haunts those exposed as kids in mining towns</a>
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<h2>Asbestos is here to stay</h2>
<p><a href="https://www.researchgate.net/publication/292053877_Dail_and_Hammar's_Pulmonary_Pathology">Asbestos-related cancers</a> have a long lag time between exposure and detectable disease. Although this lag is typically about 30 years, it can range anywhere between 10 and 70 years. As such, it can be difficult to trace exposure retrospectively.</p>
<p>Many buildings constructed before the mid-1980s contain asbestos. It’s often inseparably bound to other materials, such as tiles, vinyl and cement. </p>
<p>Regulations demand <a href="https://www.asbestossafety.gov.au/find-out-about-asbestos/asbestos-safety-information/brochures/asbestos-safety-householders-and-home-renovators">specialist removal</a> for asbestos-affected areas of more than 10 square metres. In reality, whether this happens comes down to how effectively it can be detected, and whether the people affected can afford removals. Without specialised assessment and analysis, asbestos can be difficult to recognise.</p>
<p>Since there is no recognised “safe” dose – a dose below which there’s no risk of developing asbestos-related cancer – <a href="https://www.safeworkaustralia.gov.au/sites/default/files/2023-09/guidance_material_-_asbestos_registers_guide_-_august_2023.pdf">workplace standards</a> can only minimise risk, not eliminate it.</p>
<p>Only time will tell what the long-term outcomes are from the latest exposure in NSW. The risk from asbestos depends on several factors, including the overall amount inhaled, the type of asbestos and the number of years since exposure.</p>
<p>Among the most heavily exposed Wittenoom miners, about 20% have developed mesothelioma so far.</p>
<h2>Documenting cases</h2>
<p>Since July 2010, the <a href="https://www.aihw.gov.au/about-our-data/our-data-collections/australian-mesothelioma-registry-database-amr">Australian Mesothelioma Registry</a> has collected information on new mesothelioma cases diagnosed in Australia. The national <a href="https://www.asbestossafety.gov.au/national-asbestos-exposure-register/online">Asbestos Exposure Register</a> also allows any person to register a documented or suspected case of exposure. </p>
<p>If you’re worried about your neighbourhood, the Asbestos and Silica Eradication Agency has produced a national heat map showing the <a href="https://www.asbestossafety.gov.au/what-we-do/news-and-announcements/national-residential-asbestos-heatmap-2023-update">probability of asbestos</a> presence in buildings by geographic area.</p><img src="https://counter.theconversation.com/content/223972/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sonja Klebe works for SA Pathology and gets called as a paid expert to court. She has received funding from NHMRC, MRFF, AstraZeneca, Roche and Ventana.
</span></em></p>One of the earliest known references to asbestos may come from Theophrastus, a student of Aristotle and his successor at the Lyceum in Athens.Sonja Klebe, Associare Professor, College of Medicine and Public Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2236452024-02-22T02:44:21Z2024-02-22T02:44:21ZOutrage culture is a big, toxic problem. Why do we take part? And how can we stop?<p>“Outrage culture” is pervasive in the digital age. It refers to our collective tendency to react, often with intense negativity, to developments around us.</p>
<p>Usually this ire is directed at perceived transgressions. The internet wasted <a href="https://www.smh.com.au/culture/celebrity/the-taylor-swift-backlash-is-here-was-it-inevitable-20240208-p5f3dn.html">no time</a> in <a href="https://www.tiktok.com/@uzumakihottie/video/7332848140459986218">raging at</a> Taylor Swift when she received Album of The Year at the Grammys, seemingly frustrated by her lack of acknowledgement of Celine Dion, who presented the award.</p>
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<p>Whether or not Swift’s behaviour could be considered rude isn’t the point. The point is the backlash arguably wasn’t <a href="https://trends.google.com/trends/explore?date=2024-02-05%202024-02-07&q=taylor%20celine,gaza%20war&hl=en">proportionate</a> to the crime. This so-called “snub” incident is, therefore, a good example of how quickly and easily people will jump on the online hate train.</p>
<p>Modern outrage culture, which is also known as <a href="https://briarpatchmagazine.com/articles/view/a-note-on-call-out-culture">call-out culture</a> and is linked to <a href="https://www.vox.com/culture/2019/12/30/20879720/what-is-cancel-culture-explained-history-debate">cancel culture</a>, often devolves into a toxic spiral. People wanting clout compete to produce the meanest and most over-the-top commentary, <a href="https://theconversation.com/is-cancel-culture-silencing-open-debate-there-are-risks-to-shutting-down-opinions-we-disagree-with-142377">stifling open dialogue</a> and demonising those who make mistakes.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-news-sites-online-comments-helped-build-our-hateful-electorate-70170">How news sites' online comments helped build our hateful electorate</a>
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<h2>A tale as old as time</h2>
<p>Collective outrage isn’t a new phenomenon – nor is it necessarily bad. Humans <a href="https://psycnet.apa.org/fulltext/2012-24858-004.html">have adapted</a> to become highly sensitive to the threat of social exclusion. Being called out hurts our feelings, which <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2015.00040/full">motivates us to change</a>. We learn how this feels for us and we learn how to use it to influence others.</p>
<p>In <a href="https://philpapers.org/rec/NIRTIA-2">pre-digital societies</a>, expressing outrage to shame someone as a group served crucial social functions. It reinforced group norms, deterred potential rule-breakers, and fostered a sense of order and accountability within communities.</p>
<p>Expressing outrage can also challenge norms in a way that leads to positive societal change. The <a href="https://theconversation.com/a-human-being-not-just-mum-the-womens-liberationists-who-fought-for-the-rights-of-mothers-and-children-182057">women’s liberation movement</a> in the latter part <a href="https://theconversation.com/i-am-woman-review-helen-reddy-biopic-captures-the-power-and-excitement-of-womens-liberation-143344">of the 19th century</a> is a good example of this.</p>
<p>The technological innovations of the internet, smartphones and social media have now enabled communal outrage on a global scale. Multiple societies can be affected at once, as witnessed with the <a href="https://theconversation.com/women-take-a-hit-for-reporting-sexual-harassment-but-metoo-may-be-changing-that-116794">#MeToo movement</a>.</p>
<h2>When outrage spirals</h2>
<p>We’ve all seen it play out. Someone says or does something “controversial”, some posts draw attention to it and soon enough a whirlwind of comments appears, echoing over and over the person in question is fundamentally <em>bad</em>. </p>
<p>The Johnny Depp and Amber Heard <a href="https://theconversation.com/the-johnny-depp-amber-heard-defamation-trial-shows-the-dangers-of-fan-culture-182557">defamation trial</a> is an example where, regardless of how you feel about the case, it’s hard to deny the discourse <a href="https://www.theswaddle.com/anti-amber-heard-campaign-one-of-the-worst-instances-of-cyberbullying-report">turned toxic</a>.</p>
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<p>The collective moral outrage that drives such negativity spirals has parallels with people brandishing their pitchforks during the 1690s Salem <a href="https://socialpsyq.com/2014/10/31/the-salem-witch-trials-groupthink-at-its-worst/">witch trials</a>. Sharing <a href="https://theconversation.com/group-think-what-it-is-and-how-to-avoid-it-161697">similar beliefs</a> helps us feel like we’re part of the group. </p>
<p>Beyond that, the conviction we witness in others’ comments and behaviour on an issue can stir up our own emotions, in what’s called “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066473/">emotional contagion</a>”. With our own emotions heightened and our convictions strengthened, we may feel <a href="https://www.pnas.org/doi/abs/10.1073/pnas.1618923114">compelled to join</a> the choir of negative discourse. </p>
<p>The overall tone and style of language used by others can also influence how <a href="https://journals.sagepub.com/doi/full/10.1177/2056305116664220">we act and feel</a>. <a href="https://psycnet.apa.org/record/2014-24373-001">Social modelling</a> dictates that if many others are piling on with negative comments, it can make it seem okay for us to do so, too. </p>
<p>And the more exposed we are to one-sided discourse, the more likely we are to resist alternative viewpoints. This is called “<a href="https://www.psychologytoday.com/au/basics/groupthink">groupthink</a>”. </p>
<p><a href="https://sproutsocial.com/insights/social-media-algorithms/">Social media algorithms</a> are also generally <a href="https://theconversation.com/wrong-elon-musk-the-big-problem-with-free-speech-on-platforms-isnt-censorship-its-the-algorithms-182433">set up to feed</a> us more of what we’ve previously clicked on, which further contributes to the one-sidedness of our online experience. </p>
<p>Scholars have <a href="https://www.pnas.org/doi/full/10.1073/pnas.2024292118">suggested</a> algorithms can prioritise certain posts in a way that shapes the overall <a href="https://insight.kellogg.northwestern.edu/article/social-media-algorithms-have-hijacked-social-learning">nature of commentary</a>, essentially fuelling the flames of negativity.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/feed-me-4-ways-to-take-control-of-social-media-algorithms-and-get-the-content-you-actually-want-204374">Feed me: 4 ways to take control of social media algorithms and get the content you actually want</a>
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<h2>Two sides of speaking up</h2>
<p>Unlike Salem in the late 1690s, today’s outrage culture is multiplied in intensity and scale due to changing cultural norms around “speaking up”. Combined with the anonymity and global reach afforded by the internet, the culture of speaking up has likely fuelled the kind of vocalisation we see online. </p>
<p>For example, in the past two decades there has been growing societal recognition that it’s <a href="https://theconversation.com/bullying-why-most-people-do-nothing-when-they-witness-it-and-how-to-take-action-181746">good to speak up</a> against bullying. This can be associated with <a href="https://kidshelpline.com.au/teens/issues/bullying">more education on bullying</a> in schools. There’s also a growing trend of encouraging <a href="https://theconversation.com/why-employees-hesitate-to-speak-up-at-work-and-how-to-encourage-them-154357">a speak-up culture</a> in workplaces. So it’s not surprising many people now <a href="https://consciousyouth.co.uk/over-70-of-young-people-feel-more-confident-than-ever-sharing-their-views-online/">report feeling confident</a> in voicing their opinions online. </p>
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<a href="https://images.theconversation.com/files/576946/original/file-20240221-18-tkzr3l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/576946/original/file-20240221-18-tkzr3l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/576946/original/file-20240221-18-tkzr3l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/576946/original/file-20240221-18-tkzr3l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/576946/original/file-20240221-18-tkzr3l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/576946/original/file-20240221-18-tkzr3l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/576946/original/file-20240221-18-tkzr3l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/576946/original/file-20240221-18-tkzr3l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Encouraging speaking up is important in many contexts, but more vocal people online means more opportunity for conflict.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>It’s also easier to express negative opinions online since we can <a href="https://www.sciencedirect.com/science/article/abs/pii/S1359178923000435">remain anonymous</a>. We don’t directly witness the emotional pain inflicted upon our target. Nor do we have to worry about the potential threat to our personal safety that would be associated with saying the same horrible thing to a person’s face. As summed up <a href="https://theconversation.com/should-taylor-swift-be-taught-alongside-shakespeare-a-professor-of-literature-says-yes-223312">by Taylor Swift</a> herself in <a href="https://www.youtube.com/watch?v=Dkk9gvTmCXY">You Need to Calm Down</a>:</p>
<blockquote>
<p>Say it in the street, that’s a knock-out. But you say it in a tweet, that’s a cop-out.</p>
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<h2>How can we combat negativity?</h2>
<p>Navigating the pitfalls of outrage culture requires us to adopt a more reflective approach before participating in public condemnation. Consider also that outrage culture runs counter to the moral ideals most of us admire, such as:</p>
<ul>
<li>everyone makes mistakes </li>
<li>people are worth more than their worst actions</li>
<li>people are capable of growth and change, and deserve second chances</li>
<li>it’s okay to have different opinions to others </li>
<li>the punishment should fit the crime.</li>
</ul>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/23294884231200244">Research suggests</a> positive comments can be a productive counter-influence on negativity spirals. So it’s worth speaking up if you do witness matters getting out of hand online. Before clicking the send button, consider asking yourself: </p>
<ul>
<li>do I really believe what I’m about to say or am I going along with the group?</li>
<li>how might this comment affect the person receiving it, and am I okay with that?</li>
<li>would I communicate like this if it was a face-to-face situation? </li>
</ul>
<p>By encouraging reflection, <a href="https://theconversation.com/compassionate-courage-moves-beyond-cancel-culture-to-challenge-systemic-racism-but-its-hard-work-158264">empathy</a> and open dialogue, we can avoid toxic outrage culture – and instead use our collective outrage as a <a href="https://theconversation.com/the-backlash-against-black-lives-matter-is-just-more-evidence-of-injustice-85587">force for positive change</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-cannot-deny-the-violence-of-white-supremacy-any-more-86139">We cannot deny the violence of White supremacy any more</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/223645/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shane Rogers does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Have you ever joined an online hate spiral for the sake of it, and not because you actually cared all that much?Shane Rogers, Lecturer in Psychology, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2235282024-02-19T13:44:01Z2024-02-19T13:44:01ZLung cancer: Predicting which patients are at high risk of recurrence to improve outcomes<figure><img src="https://images.theconversation.com/files/575433/original/file-20240205-29-abkjt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chemotherapy is used to treat all lung cancer patients. Yet many would not need such invasive treatment if diagnosis of the risk of recurrence were more refined. A new technology could change all that.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Lung cancer <a href="https://cancer.ca/en/research/cancer-statistics/cancer-statistics-at-a-glance">is responsible for more deaths than breast, colon and prostate cancer combined</a>. </p>
<p>With advancements in lung cancer screening, it is expected that more patients will be diagnosed at earlier stages, enabling them to undergo surgery, the primary treatment modality for early-stage patients.</p>
<p>However, a significant proportion of patients will have a recurrence of their cancer after resection (surgery to remove the tumour). Unfortunately, current clinical guidelines cannot help predict which patients are at risk. Better knowledge of who is at risk has significant implications for systemic therapy selection such as chemotherapy for early-stage lung cancer patients after surgery. </p>
<p>To find solutions to this problem, our research group at McGill University launched a project in collaboration with Université Laval. <a href="https://www.nature.com/articles/s41586-022-05672-3#MOESM1">Preliminary results were published in <em>Nature</em></a>. In our work we discovered that the use of a new imaging technology, along with artificial intelligence, could improve outcomes for cancer patients.</p>
<h2>Too much or too little intervention</h2>
<p>This clinical dilemma has important implications for the choice of treatment, such as chemotherapy. For example, lung cancer patients who are cured by surgery could be spared the toxicity of chemotherapy. Patients at risk of their cancer recurring could benefit from additional therapeutic interventions.</p>
<p>The challenge of predicting recurrence for patients with early-stage lung cancer has important implications for the 31,000 Canadians who are diagnosed with this terrible disease every year.</p>
<h2>Mass cytometry imaging</h2>
<p>To address this clinical problem, we used <a href="https://www.mcgill.ca/gci/facilities/single-cell-imaging-and-mass-cytometry-analysis-platform-scimap">imaging mass cytometry</a> (IMC), a new technology that allows for a comprehensive characterization of the tumour microenvironment. </p>
<p>The tumour microenvironment is a complex ecosystem composed of interactions between tumour cells, immune cells, and various structural cells. IMC can be used to visualize up to 50 markers at the cell surface, significantly more than was previously possible. </p>
<p>This technology makes it possible to identify different types of cells and determine their spatial organization, i.e. how they interact. IMC produces images that can be analyzed to determine the frequency of cell subpopulations, their activation states, the other cell types with which they interact and their organization in cellular communities. </p>
<p>The results of our study, published in <em>Nature</em>, reveal that various cell types can interact in cellular communities, and that communities composed of B cells were strongly associated with prolonged survival in lung cancer patients. Our study highlights that beyond cellular frequency, cellular interactions and spatial organization also correlate strongly with important clinical outcomes such as survival.</p>
<h2>Using artificial intelligence to make better predictions</h2>
<p>Based on our initial results, we hypothesized that important spatial features embedded within IMC images, such as cellular interactions, could be important in predicting clinical outcomes. </p>
<p>Our dataset of 416 patients and over 1.6 million cells provided sufficient power to make predictions using artificial intelligence. We sought to predict which patients with early-stage lung cancer would have a recurrence of their cancer after surgery. </p>
<p>Using 1 mm2 tumour samples, material readily available from surgical resections or biopsies, we used artificial intelligence algorithms together with IMC images to make our predictions. Our algorithm was able to predict with 95 per cent accuracy which patients would experience a cancer recurrence by using the spatial information contained within the images. </p>
<h2>Six markers can make all the difference</h2>
<p>One of the challenges in applying our results in a clinical setting is that IMC is not readily available. Clinical pathologists typically use less complex technologies such as immunofluorescence, which are often limited to three or fewer markers. </p>
<figure class="align-center ">
<img alt="image obtained using immunofluorescence" src="https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573537/original/file-20240205-17-2oj4zm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Immunofluorescence image of a tumour treated with immunotherapy. This technology is often limited to the use of three or fewer markers at a time.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>To address this challenge, we sought to identify the minimum number of markers needed to make meaningful predictions about recurrence in lung cancer patients after surgery. By using six markers, we obtained an accuracy rate of 93 per cent, a result that is close to the 95 per cent accuracy rate obtained by using 35 markers. </p>
<p>These results suggest that by harnessing the power of artificial intelligence with existing technologies available in hospitals, we may be able to improve the post-surgical clinical management of patients with early-stage lung cancer. Our ultimate goal is to increase cure rates for those at high risk of cancer recurrence, while minimizing toxicity for those who can be cured by surgery.</p><img src="https://counter.theconversation.com/content/223528/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Sorin has received funding from the Fonds de recherche du Québec and Vanier Canada Graduate Scholarships.</span></em></p><p class="fine-print"><em><span>Logan Walsh has received funding from McGill University's Interdisciplinary Infection and Immunity Initiative, the Brain Tumour Funders' Collaborative, the Canadian Institutes of Health Research (CIHR; PJT-162137), the Canada Foundation for Innovation and holds the Rosalind Goodman Research Chair in Lung Cancer.</span></em></p>Treatment for lung cancer patients is the same for everyone, regardless of the risk of recurrence. The use of a new technology could refine diagnosis.Mark Sorin, Étudiant au MD-PhD, chercheur en cancer du poumon, McGill UniversityLogan Walsh, Assistant Professor, Department of Human Genetics, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2180052023-12-05T13:19:06Z2023-12-05T13:19:06Z‘Inert’ ingredients in pesticides may be more
toxic to bees than scientists thought<figure><img src="https://images.theconversation.com/files/563090/original/file-20231203-27-yyo7nl.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3048%2C2162&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A honeybee approaches a sunflower at Wards Berry Farm in Sharon, Mass.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sharon-ma-a-honeybee-buzzes-a-sunflower-in-bloom-at-wards-news-photo/1242574226">John Tlumacki/The Boston Globe via Getty Images</a></span></figcaption></figure><p>Bees help pollinate over a third of the world’s crops, contributing <a href="https://www.ipbes.net/article/press-release-pollinators-vital-our-food-supply-under-threat">an estimated US$235 billion to $577 billion</a> in value to global agriculture. They also face a myriad of stresses, including pathogens and parasites, loss of suitable food sources and habitat, <a href="https://theconversation.com/how-air-pollution-is-making-life-tougher-for-bugs-213122">air pollution</a> and <a href="https://theconversation.com/bees-face-many-challenges-and-climate-change-is-ratcheting-up-the-pressure-190296">climate-driven weather extremes</a>.</p>
<p>A <a href="https://doi.org/10.1038/s41598-023-46948-6">recent study</a> has identified another important but understudied pressure on bees: “inert” ingredients in pesticides. </p>
<p>All pesticide products in the U.S. contain <a href="https://www.epa.gov/ingredients-used-pesticide-products/basic-information-about-pesticide-ingredients">active and inert ingredients</a>. Active ingredients are designed to kill or control a specific insect, weed or fungus and are listed on product labels. All other ingredients – emulsifiers, solvents, carriers, aerosol propellants, fragrances, dyes and such – are considered inert.</p>
<p>The new study exposed honeybees to two treatments: the isolated active ingredients in the fungicide <a href="https://www3.epa.gov/pesticides/chem_search/ppls/007969-00199-20221130.pdf">Pristine</a>, which is used to control <a href="https://agriculture.basf.us/content/dam/cxm/agriculture/crop-protection/products/documents/BASF_Pristine_Almonds_TIB_medres.pdf">fungal diseases in almonds</a> and <a href="https://www3.epa.gov/pesticides/chem_search/ppls/007969-00199-20221130.pdf">other crops</a>, and the whole Pristine formulation, including inert ingredients. The results were quite surprising: The whole formulation impaired honeybees’ memory, while the active ingredients alone did not. </p>
<p>This suggests that the inert ingredients in the formula were actually what made Pristine toxic to bees – either because the inerts were toxic on their own or because combining them with the active ingredients made the active ingredients more toxic. As a <a href="https://scholar.google.com/citations?user=B1qAtjIAAAAJ&hl=en">social scientist focusing on bee declines</a>, I believe that either way, these findings have important implications for pesticide regulation and bee health. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/QKTRYP2OF44?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Threats to bees include single-crop agriculture, habitat loss, air pollution and pesticide exposure.</span></figcaption>
</figure>
<h2>What are inert ingredients?</h2>
<p>Inert ingredients have a variety of functions. They may extend a pesticide’s shelf life, reduce risks for people who apply the pesticides or help a pesticide work better. Some inerts, called adjuvants, help pesticides stick to plant surfaces, reduce pesticide drift or help active ingredients better penetrate a plant’s surface. </p>
<p>The “inert” label is a colloquial misnomer, though. As <a href="https://www.epa.gov/ingredients-used-pesticide-products/basic-information-about-pesticide-ingredients">the U.S. Environmental Protection Agency notes</a>, inerts aren’t necessarily inactive or even nontoxic. In fact, pesticide users <a href="https://doi.org/10.1289%2Fehp.118-a168">sometimes know very little</a> about how inerts function in a pesticide formula. That’s partly because they are regulated very differently than active ingredients. </p>
<h2>Measuring bee effects</h2>
<p>Under the <a href="https://www.epa.gov/laws-regulations/summary-federal-insecticide-fungicide-and-rodenticide-act">Federal Insecticide, Fungicide, and Rodenticide Act</a>, or FIFRA, the EPA oversees pesticide regulation in the U.S. To register a pesticide product for outdoor use, chemical companies must provide <a href="https://www.epa.gov/sites/default/files/2016-07/documents/guidance-exposure-effects-testing-assessing-risks-bees.pdf">reliable risk assessment data</a> on the active ingredients’ toxicity for bees, including the results of an acute honeybee contact test. </p>
<p>The acute contact test tracks how honeybees react to a pesticide application over a short period of time. It also aims to establish the dose of a pesticide that will kill 50% of a group of honeybees, a value known as the LD50. To determine the LD50, scientists apply the pesticide to bees’ midsections and then observe the bees for 48 to 96 hours for signs of poisoning. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CrBYxo4g0U4/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>In 2016, the EPA <a href="https://www.epa.gov/sites/default/files/2016-07/documents/guidance-exposure-effects-testing-assessing-risks-bees.pdf">expanded its data requirements</a> by requiring an acute honeybee oral toxicity test, in which adult bees are fed a chemical, as well as a 21-day honeybee larval test that tracks larval reaction to an agrochemical from the egg to their emergence as adult bees. </p>
<p>These tests all help the agency determine what potential risk an active ingredient may pose for honeybees, along with other data. Based on the information from these varied tests, pesticides are labeled as nontoxic, moderately toxic or highly toxic. </p>
<h2>A chemical black box</h2>
<p>Despite this rigorous testing, much remains unknown about how safe pesticides are for bees. This is particularly true for pesticides that have sublethal or chronic toxicities – in other words, pesticides that don’t cause immediate death or obvious signs of poisoning but have other significant effects.</p>
<p>This lack of knowledge about sublethal and chronic effects is problematic, because bees can be repeatedly exposed over long time spans to pesticides on floral nectar or pollen, or to pesticide contamination that builds up <a href="https://doi.org/10.1371/journal.pone.0009754">in beehives</a>. They even may be exposed <a href="https://doi.org/10.1093/aesa/saaa041">through miticides</a> that beekeepers use to control Varroa mites, a <a href="https://www.ars.usda.gov/pacific-west-area/tucson-az/carl-hayden-bee-research-center/research/varroa/varroa-overview/">devastating bee parasite</a>.</p>
<p>Complicating the issue, symptoms of sublethal exposure are often more subtle or take longer to become apparent than acute or lethal toxicity. <a href="https://dx.doi.org/10.5772/62487">Symptoms might include</a> abnormal foraging and learning ability, decreased egg laying by the queen, wing deformation, stunted growth or decreased colony survival. The EPA doesn’t always require chemical companies to perform the tests that could detect these symptoms.</p>
<p>Inert ingredients add another level of mystery. While the EPA reviews and <a href="https://www.epa.gov/ingredients-used-pesticide-products/basic-information-about-pesticide-ingredients">must approve all inert ingredients</a>, it does not require the same toxicity testing as for active ingredients. </p>
<p>This is because under FIFRA, inert ingredients are protected as trade secrets, or <a href="https://www.epa.gov/ingredients-used-pesticide-products/basic-information-about-pesticide-ingredients">confidential business information</a>. Only the total percentage of inert ingredients is required on the label, often lumped together and described as “other ingredients.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/563091/original/file-20231203-27-omw458.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A box shows that a pesticide has 0.375% active ingredients and 99.625% 'other' ingredients." src="https://images.theconversation.com/files/563091/original/file-20231203-27-omw458.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563091/original/file-20231203-27-omw458.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=167&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563091/original/file-20231203-27-omw458.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=167&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563091/original/file-20231203-27-omw458.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=167&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563091/original/file-20231203-27-omw458.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=210&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563091/original/file-20231203-27-omw458.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=210&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563091/original/file-20231203-27-omw458.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=210&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sample pesticide ingredient label from an EPA training guide, showing that just 0.375% of ingredients are disclosed and tested for bee safety.</span>
<span class="attribution"><a class="source" href="https://www.epa.gov/pesticide-labels/label-review-training-module-3-special-issues-page-34">EPA</a></span>
</figcaption>
</figure>
<h2>Sublethal weapons</h2>
<p>A growing body of evidence suggests that inerts are not as harmless as the name suggests. For example, exposure to two types of adjuvants – organosilicone and nonionic surfactants – can <a href="https://doi.org/10.1371/journal.pone.0040848">impair honeybees’ learning performance</a>. Bees rely on learning and memory functions to gather food and return to the hive, so losing these crucial skills can endanger a colony’s survival. </p>
<p>Inerts can also affect bumblebees. In a 2021 study, exposure to alcohol ethoxylates, a coformulant in the fungicide Amistar, <a href="https://doi.org/10.1038/s41598-021-00919-x">killed 30% of the bees exposed to it</a> and caused a number of sublethal effects.</p>
<p>While some inerts may be nontoxic on their own, it’s hard to predict what will happen when they are combined with active ingredients. Research has shown that when two or more agrochemicals are combined, they can <a href="https://doi.org/10.1038/s41586-021-03787-7">become more toxic for bees</a> than when applied on their own. This is known as <a href="https://www.ccohs.ca/oshanswers/chemicals/synergism.html">synergistic toxicity</a>. </p>
<p>Synergism can also occur when inerts are combined with pesticides. Another 2021 study showed that adjuvants that were nontoxic on their own caused <a href="https://doi.org/10.1007/s41348-021-00541-z">increased colony mortality when combined with insecticides</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/563093/original/file-20231203-17-uekt6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A bee in flight, covered with yellow pollen grains." src="https://images.theconversation.com/files/563093/original/file-20231203-17-uekt6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/563093/original/file-20231203-17-uekt6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=506&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563093/original/file-20231203-17-uekt6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=506&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563093/original/file-20231203-17-uekt6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=506&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563093/original/file-20231203-17-uekt6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=635&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563093/original/file-20231203-17-uekt6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=635&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563093/original/file-20231203-17-uekt6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=635&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A sweat bee (<em>Halictus ligatus</em>) covered with pollen.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/dJ9ZZ4">Sam Droege, USGS/Flickr</a></span>
</figcaption>
</figure>
<h2>A better testing strategy</h2>
<p>Mounting evidence on the toxicity of inerts points to three key changes that could better support bee health and minimize bees’ exposure to potential stressors. </p>
<p>First, environmental risk assessments for pesticides could test the whole pesticide formulation, including inert ingredients, to provide a more complete picture of a pesticide’s toxicity to bees. This is already done <a href="https://www.epa.gov/pollinator-protection/pollinator-risk-assessment-guidance">in some cases</a> but could be required for all outdoor uses where bees are at risk of exposure.</p>
<p>Second, inerts could be identified on product labels to enable independent research and risk assessment. </p>
<p>Third, more testing could be required on pesticides’ long-term sublethal effects on bees, such as learning impairment. Such research would be especially relevant for pesticides that are applied to blooming crops or flowers that attract bees.</p>
<p>Researchers and environmental groups have been arguing for changes like these since <a href="https://doi.org/10.1289/ehp.9374">at least 2006</a>. However, because pesticide regulation is dictated by federal law, changes require congressional action. This would be challenging politically, since it would increase the regulatory burden on the chemical industry. </p>
<p>Nonetheless, rising concerns about <a href="https://doi.org/10.1146/annurev-ento-011118-111847">bumblebee declines</a> and beekeepers’ significant <a href="https://beeinformed.org/wp-content/uploads/2023/06/BIP-2022-23-Loss-Abstract.pdf">annual colony losses</a> make a strong case for a more precautionary approach to pesticide regulation. With a growing world population and <a href="https://theconversation.com/cop28-7-food-and-agriculture-innovations-needed-to-protect-the-climate-and-feed-a-rapidly-growing-world-218414">food supplies under increasing stress</a>, supporting bees’ contribution to agriculture is more important then ever.</p><img src="https://counter.theconversation.com/content/218005/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennie L. Durant has worked as a Science and Technology Policy Fellow with the Association for the Advancement of Science (AAAS) in USDA's Office of Pest Management Policy.</span></em></p>Inert ingredients are added for purposes other than killing pests and are not required under federal law to be tested for safety or identified on pesticide labels.Jennie L. Durant, Research Affiliate in Human Ecology, University of California, DavisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083452023-07-16T11:56:56Z2023-07-16T11:56:56ZPollution timebombs: Contaminated wetlands are ticking towards ignition<figure><img src="https://images.theconversation.com/files/534433/original/file-20230627-29982-kxs94r.jpg?ixlib=rb-1.1.0&rect=820%2C20%2C3780%2C1669&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A flaming peatland fire in Alberta, Canada.</span> <span class="attribution"><span class="source">(Greg Verkaik)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Wetlands across the globe have long served as natural repositories for humanity’s toxic legacy, absorbing and retaining <a href="https://doi.org/10.1016/j.gloplacha.2006.03.004">hundreds to thousands of years’ worth of pollution</a>. </p>
<p>These swampy vaults have quietly been trapping air and water pollution for thousands of years, protecting the world from some of the worst effects of lead, mercury, copper, nickel and other poisonous materials. </p>
<p>Now, however, a combination of human disruptions and ever increasing wildfires threaten to open these vaults, unleashing their long dormant toxic contents upon the world. </p>
<h2>Threats to releasing toxic legacies</h2>
<p>The soil in many wetlands is composed of dead and decaying vegetation known as peat. Peat accumulates because perpetually sopping wetland conditions prevent the complete decomposition of dead vegetation. As these deposits accumulate, they form peatlands. </p>
<p>For centuries, peat has been drained, dried and extracted for heating fuel where wood is scarce. Though humans have long burned bricks of peat in their homes, climate change and wetland draining are drying entire wetlands, <a href="https://doi.org/10.1038/s41558-023-01657-w">transforming them into perfect fuel for huge smoky wildfires</a>.</p>
<figure class="align-center ">
<img alt="Stacks of dried peat logs to be used for warmth and cooking." src="https://images.theconversation.com/files/534443/original/file-20230627-18-49gaiz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534443/original/file-20230627-18-49gaiz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534443/original/file-20230627-18-49gaiz.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534443/original/file-20230627-18-49gaiz.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534443/original/file-20230627-18-49gaiz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534443/original/file-20230627-18-49gaiz.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534443/original/file-20230627-18-49gaiz.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Peat logs have long been used for warmth and cooking in communities across the globe.</span>
<span class="attribution"><span class="source">(Colin McCarter)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Centuries of fallout from industrial processes such as smelting has deposited toxic metals in wetlands hundreds or even thousands of kilometres away from their point of origin. Human and industrial wastewater has, in places, added to this burden. </p>
<p>Wetlands have absorbed and stored these contaminants, holding them back from vulnerable aquatic ecosystems and saving humans from ingesting them. </p>
<p>Peat has a tremendous ability to capture and retain toxic metals by binding the metals to the peat itself through a process called adsorption. Once bound, the toxic metals are immobilized and pose little threat to the surrounding environment unless the peatland is disturbed, like from a wildfire.</p>
<h2>Wetlands and fire</h2>
<p>Human activities such as road building and resource extraction have seriously disrupted wetland ecosystems, <a href="https://doi.org/10.1088/1748-9326/aaa136">leaving drained wetlands vulnerable to fire</a>, as Canadians saw in the catastrophic Fort McMurray, Alta., wildfire of 2016.</p>
<p>As climate change and human actions further degrade wetlands, the resulting wildfires threaten to return humanity’s toxic legacy. This cycle carries frightening implications for the health of people and the environment. </p>
<figure class="align-center ">
<img alt="Copious amounts of smoke produced from a smouldering peat fire." src="https://images.theconversation.com/files/534429/original/file-20230627-23-goy4k4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534429/original/file-20230627-23-goy4k4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534429/original/file-20230627-23-goy4k4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534429/original/file-20230627-23-goy4k4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534429/original/file-20230627-23-goy4k4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534429/original/file-20230627-23-goy4k4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534429/original/file-20230627-23-goy4k4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fire burns away the peat as the resulting smoke is carried on the breeze.</span>
<span class="attribution"><span class="source">(Greg Verkaik)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>In 2015, Indonesia recorded about <a href="https://www.nytimes.com/2016/09/20/world/asia/indonesia-haze-smog-health.html">35,000 excess deaths after a major peatland fire</a>. Meanwhile, Canada and the United States are far from immune from exposure to peat fire smoke. In early June 2023, cities as far away as Washington, D.C., and New York were blanketed in thick smoke from peat fires in northern Canada, which is home to many of the world’s peatlands.</p>
<p>At the same time, climate change is accelerating the drying of peatlands everywhere, turning their huge stores of carbon into a carbon burden. Furthermore, as concentrated pollutants build up in wetlands, the accumulation of toxic metals is killing plants that act as their natural lid, allowing moisture to escape and speeding the conversion of more wetlands to tinderboxes. </p>
<p>Once ignited, peatland fires are difficult to contain as they can smoulder for weeks, months or even years. They produce copious amounts of smoke and ash, filling the air with microscopic particles.</p>
<figure class="align-center ">
<img alt="A smoke filled peatland forest from smouldering fires lurking just below the surface." src="https://images.theconversation.com/files/534431/original/file-20230627-15-5b1mn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534431/original/file-20230627-15-5b1mn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534431/original/file-20230627-15-5b1mn2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534431/original/file-20230627-15-5b1mn2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534431/original/file-20230627-15-5b1mn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534431/original/file-20230627-15-5b1mn2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534431/original/file-20230627-15-5b1mn2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Peatland fires can smoulder underground for months re-emerging under the right conditions.</span>
<span class="attribution"><span class="source">(Greg Verkaik)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Even without metal pollution, these airborne particles can cause severe illness and death. Making a bad situation worse, toxic metals once safely stored in wetlands bind to these airborne particles and spread everywhere.</p>
<h2>Restoring wetlands</h2>
<p>As with many global environmental issues, it is easy to feel helpless to control such a huge and complex problem. Fortunately, nature-based solutions can have a substantial positive impact on keeping this toxic legacy from being released. </p>
<p>We can restore drying or dried-out wetlands back to their original state as functional ecosystems through, at the most basic level, <a href="https://doi.org/10.1016/j.jhydrol.2021.126793">preventing them from draining down canals and other human infrastructure</a>. Indeed, even without further intervention, re-wetting wetlands can reduce their risk of wildfire ignition. However, restoration must be managed carefully, to avoid flushing toxic metals from wetlands into neighbouring streams, rivers and lakes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/up-in-smoke-human-activities-are-fuelling-wildfires-that-burn-essential-carbon-sequestering-peatlands-202816">Up in smoke: Human activities are fuelling wildfires that burn essential carbon-sequestering peatlands</a>
</strong>
</em>
</p>
<hr>
<p>To preserve wetland plants and return ecosystem functionality without releasing the stored toxic legacy, <a href="https://doi.org/10.1016/j.jhydrol.2021.126793">we need to bring back fire-resistant mosses such as <em>Sphagnum</em></a>. <a href="https://doi.org/10.1016/j.ecoleng.2022.106874">Recent research shows that old-fashioned peat “transplants” may be effective</a>, though new restoration techniques in contaminated wetlands need to be further developed and tested. </p>
<p>Although ecosystem restoration can be costly in terms of time and money, actively restoring wetlands appears to be our best chance to defuse the ticking time-bomb that our pollution vaults have become. <a href="https://doi.org/10.1088/1748-9326/acddfc">Preventing a pollution explosion demands urgent global research, investment and action</a>. The cost of doing nothing will certainly be much greater.</p><img src="https://counter.theconversation.com/content/208345/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin McCarter receives funding from the Natural Sciences and Engineering Research Council of Canada, Nipissing University, and the Canada Research Chair program. </span></em></p><p class="fine-print"><em><span>Mike Waddington receives funding from the Natural Sciences and Engineering Research Council of Canada, Blazing Star Environmental, McMaster University, Ganawenim Meshkiki, and Henvey Inlet Wind LP.</span></em></p>Peatlands safely store hundreds to thousands of years’ worth of humanity’s toxic legacy but climate change and physical disturbances are putting these pollution vaults, and us, at risk.Colin McCarter, Assistant Professor, Faculty of Arts and Science, Nipissing UniversityMike Waddington, Professor, School of Earth, Environment & Society, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2051672023-05-09T18:56:06Z2023-05-09T18:56:06ZDisinfectants and cleaning products harboring toxic chemicals are widely used despite lack of screening for potential health hazards<figure><img src="https://images.theconversation.com/files/525175/original/file-20230509-15-fcxskp.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2119%2C1414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Quaternary ammonium compounds can linger on surfaces and in indoor air and dust long after the disinfectant has dried.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/spraying-disinfection-on-surface-royalty-free-image/1213050764">Guido Mieth/DigitalVision via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p><a href="http://dx.doi.org/10.1021/acs.est.2c08244">Concerns about unnecessary use</a> of a common class of antimicrobial chemicals used in disinfectants <a href="https://www.cdc.gov/hygiene/cleaning/cleaning-your-home.html">reinforces recommendations</a> to opt for <a href="https://ceh.org/household-cleaners/">soap and water</a> or <a href="https://www.turi.org/Our_Work/Cleaning_Laboratory/Safely_Clean_Disinfect/Safer_Disinfecting_Products">safer products</a>, my colleagues <a href="https://scholar.google.com/citations?user=1BQRKAsAAAAJ&hl=en">and I</a> determined in our recent critical review of the scientific literature.</p>
<p><a href="https://www.turi.org/TURI_Publications/TURI_Chemical_Fact_Sheets/Quaternary_Ammonium_Compounds_Fact_Sheet">Quaternary ammonium compounds, or QACs</a>, are increasingly marketed and used in homes, schools and workplaces with limited evidence for their appropriateness or safety. These chemicals can be found in common disinfectant solutions, wipes, hand sanitizers, sprays and even foggers.</p>
<p>Laboratory animal studies have found that some QACs can have <a href="http://dx.doi.org/10.1021/acs.est.2c08244">developmental and reproductive toxicity</a> with sustained exposure, may contribute to weight gain, and can impair energy production in cells.</p>
<p>Surprisingly, despite these concerns, studies on people <a href="http://dx.doi.org/10.1021/acs.est.2c08244">have been limited</a> to patients with allergic contact dermatitis and workplace-induced asthma among workers in hospitals and other facilities that require a sterile environment. We were even more surprised to find a lack of comprehensive screening for health hazards in the majority of this large class of common and widely used chemicals.</p>
<p>One of the top reasons to use antimicrobials only when needed is that overuse leads to the rise of <a href="https://theconversation.com/antibiotic-resistance-is-at-a-crisis-point-government-support-for-academia-and-big-pharma-to-find-new-drugs-could-help-defeat-superbugs-169443">antimicrobial resistance</a>, which contributes to millions of deaths per year worldwide. QACs and other antimicrobials create “superbugs” that not only can’t be killed by disinfectants but can also become resistant to lifesaving antibiotics.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525199/original/file-20230509-21883-op1iqx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Gloved hands wiping doorknob" src="https://images.theconversation.com/files/525199/original/file-20230509-21883-op1iqx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525199/original/file-20230509-21883-op1iqx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525199/original/file-20230509-21883-op1iqx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525199/original/file-20230509-21883-op1iqx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525199/original/file-20230509-21883-op1iqx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525199/original/file-20230509-21883-op1iqx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525199/original/file-20230509-21883-op1iqx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Unnecessary disinfectant use can contribute to antimicrobial resistance and increase exposure to toxic chemicals.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hands-with-glove-wiping-doorknob-royalty-free-image/1212740392">martinedoucet/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>Why it matters</h2>
<p>When the COVID-19 pandemic began, recommendations circulated in the news and social media to disinfect almost everything, from doorknobs to desks <a href="https://www.npr.org/sections/health-shots/2020/04/12/832269202/no-you-dont-need-to-disinfect-your-groceries-but-here-s-to-shop-safely">to groceries</a>. Because COVID-19 is not primarily transmitted from surfaces, many of these disinfection practices <a href="https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html">don’t substantially reduce transmission risk</a>.</p>
<p>Our team became concerned that frequent disinfectant use could lead to adverse health effects from QACs. Most people probably don’t know about existing health concerns regarding QACs, or aren’t aware that QACs can <a href="https://doi.org/10.1021%2Facs.estlett.0c00587">remain on surfaces and in indoor air and dust</a> long after the product has dried, exposing more people to these chemicals than just the initial user. Researchers have found that the <a href="https://doi.org/10.1021%2Facs.est.1c01654">average levels of these chemicals in people’s bodies</a> have risen since the pandemic began.</p>
<h2>What still isn’t known</h2>
<p>One of the most commonly used QACs is <a href="https://doi.org/10.1128%2FAEM.00377-19">benzalkonium chloride</a>. Others may be identified on ingredient labels with names that end in “<a href="https://www.turi.org/TURI_Publications/TURI_Chemical_Fact_Sheets/Quaternary_Ammonium_Compounds_Fact_Sheet/Regulations">ammonium chloride” or similar terms</a>.</p>
<p>While reading labels can help consumers identify QACs, some products <a href="https://cen.acs.org/articles/96/i12/US-chemical-industry-group-takes.html">may not require disclosure</a> of these chemicals in the ingredient list. For example, pesticide labels are required to list QACs whereas paint labels are not. QACs can be used in a wide variety of consumer products where they may or may not be listed when used, including personal care products, textiles, paints, medical instruments and more.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525201/original/file-20230509-12843-axffgt.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Table of common subclasses of QACs and associated products" src="https://images.theconversation.com/files/525201/original/file-20230509-12843-axffgt.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525201/original/file-20230509-12843-axffgt.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=604&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525201/original/file-20230509-12843-axffgt.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=604&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525201/original/file-20230509-12843-axffgt.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=604&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525201/original/file-20230509-12843-axffgt.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=759&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525201/original/file-20230509-12843-axffgt.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=759&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525201/original/file-20230509-12843-axffgt.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=759&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This table shows common subclasses of QACs and their associated products. QACs may not always be disclosed in the product label.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1021/acs.est.2c08244">Arnold et al./ACS</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>What’s next</h2>
<p><a href="https://prhe.ucsf.edu/strengthening-chemical-regulatory-process">Reducing the harm of QACs</a> requires their disclosure in all products, comprehensively screening them for health hazards and closely monitoring their broader effects in people and on the environment.</p>
<p>In the meantime, my colleagues and I recommend that <a href="https://www.cdc.gov/hygiene/cleaning/cleaning-your-home.html">individuals</a>, <a href="https://www.cdc.gov/hygiene/cleaning/facility.html">schools and workplaces</a> take a close look at their cleaning practices to see where disinfectants can be replaced with <a href="https://ceh.org/household-cleaners/">safe cleaners</a> or <a href="https://www.turi.org/Our_Work/Cleaning_Laboratory/Safely_Clean_Disinfect/Safer_Disinfecting_Products">safer disinfectants</a>. </p>
<p>Cleaning with soap or detergent <a href="https://theconversation.com/is-bar-soap-as-gross-as-millennials-say-not-really-and-were-all-covered-with-microbes-anyway-141679">removes most types of harmful germs</a> like COVID-19 from surfaces. While disinfection can help kill any remaining microbes, it should be limited to situations <a href="https://www.cdc.gov/hygiene/cleaning/facility.html">where people have been actively ill</a>, such as vomit on a surface, and during certain disease outbreaks. </p>
<p>For disinfectants to work properly, they must be left on the surface long enough to kill the germs, and this required contact time may be noted on the product. When you <a href="https://www.epa.gov/coronavirus/cleaning-and-disinfecting-best-practices-during-covid-19-pandemic">use or handle disinfectants</a> you should wear protective gloves and eyeglasses or safety glasses, and you should open windows and doors to ventilate indoor spaces.</p><img src="https://counter.theconversation.com/content/205167/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Courtney Carignan receives funding from the National Institute of Environmental Health Sciences, National Institutes of Health, USEPA National Priorities Program, and USDA National Institute of Food and Agriculture. This document has not been formally reviewed by the funding agencies. The views expressed in this document are solely from the authors and do not necessarily reflect those from the funding agencies. </span></em></p>Quaternary ammonium compounds, also known as QACs or quats, are commonly used antimicrobials also found in many household products. Soap and water may be a safer bet when cleaning surfaces.Courtney Carignan, Assistant Professor of Food Science and Human Nutrition, Pharmacology and Toxicology, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2015062023-03-21T12:41:39Z2023-03-21T12:41:39ZSeabirds that swallow ocean plastic waste have scarring in their stomachs – scientists have named this disease ‘plasticosis’<figure><img src="https://images.theconversation.com/files/516127/original/file-20230317-28-upallj.jpeg?ixlib=rb-1.1.0&rect=5%2C1%2C1192%2C795&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scientists have identified a condition they call plasticosis, caused by ingesting plastic waste, in flesh-footed shearwaters.</span> <span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/8/8a/Flesh-footed_Shearwater_%28Puffinus_carneipes%29_%2823760497308%29.jpg">Patrick Kavanagh/Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>As a <a href="https://scholar.google.com/citations?user=uo1sSBwAAAAJ&hl=en">conservation biologist</a> who studies plastic ingestion by marine wildlife, I can count on the same question whenever I present research: “How does plastic affect the animals that eat it?” </p>
<p>This is one of the biggest questions in this field, and the verdict is still out. However, a recent study from the <a href="https://adriftlab.org">Adrift Lab</a>, a group of Australian and international scientists who study plastic pollution, adds to a growing body of evidence that ingesting plastic debris has discernible chronic effects on the animals that consume it. This work represents a crucial step: moving from knowing that plastic is everywhere to diagnosing its effects once ingested. </p>
<h2>From individual to species-level effects</h2>
<p>There’s wide agreement that the world is facing a <a href="https://www.science.org/doi/abs/10.1126/science.aba3656">plastic pollution crisis</a>. This deluge of long-lived debris has generated gruesome photos of <a href="http://www.chrisjordan.com/gallery/midway/#CF000313%2018x24">dead seabirds</a> and <a href="https://www.nytimes.com/2019/03/18/world/asia/whale-plastics-philippines.html">whales</a> with their stomachs full of plastic. </p>
<p>But while consuming plastic likely killed these individual animals, deaths directly attributable to plastic ingestion have not yet been shown to cause population-level effects on species – that is, declines in population numbers over time that are linked to chronic health effects from a specific pollutant. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/LiH3f6AKFbc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Microplastic fragments are widely distributed in the ocean, from surface waters to some of its deepest reaches.</span></figcaption>
</figure>
<p>One well-known example of a pollutant with dramatic population effects is the insecticide DDT, which was widely used across North America in the 1950s and 1960s. DDT built up in the environment, including in fish that eagles, osprey and other birds consumed. It caused the birds to lay eggs with shells so thin that they often broke in the nest. </p>
<p>DDT exposure led to <a href="https://www.epa.gov/caddis-vol1/case-ddt-revisiting-impairment">dramatic population declines</a> among <a href="https://www.fws.gov/sites/default/files/documents/bald-eagle-fact-sheet.pdf">bald eagles</a>, <a href="https://theconversation.com/ospreys-recovery-from-pollution-and-shooting-is-a-global-conservation-success-story-111907">ospreys</a> and other raptors across the U.S. They gradually began to recover after the Environmental Protection Agency banned most uses of DDT in 1972.</p>
<p>Ingesting plastic can harm wildlife without causing death via starvation or intestinal blockage. But subtler, sublethal effects, like those described above for DDT, could be much farther-reaching.</p>
<p>Numerous laboratory studies, some <a href="https://doi.org/10.1038/srep03263">dating back a decade</a>, have demonstrated chronic effects on invertebrates, mammals, birds and fish from ingesting plastic. They include <a href="https://doi.org/10.1039/C9EN01335K">changes in behavior</a>, <a href="https://doi.org/10.1016/j.scitotenv.2019.136279">loss of body weight and condition</a>, <a href="https://doi.org/10.1016/j.envpol.2016.08.020">reduced feeding rates</a>, <a href="https://doi.org/10.1021/es504525u">decreased ability to produce offspring</a>, <a href="https://doi.org/10.1016/j.envpol.2021.117800">chemical imbalances in organisms’ bodies</a> and <a href="https://doi.org/10.1016/j.envpol.2020.115090">changes in gene expression</a>, to name a few. </p>
<p>However, laboratory studies are often poor representations of reality. Documenting often-invisible, sublethal effects in wild animals that are definitively linked to plastic itself has remained elusive. For example, in 2022, colleagues and I published a study that found that some baleen whales ingest <a href="https://doi.org/10.1038/s41467-022-33334-5">millions of microplastics</a> per day when feeding, but we have not yet uncovered any effects on the whales’ health. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1633189369551937537"}"></div></p>
<h2>Scarring seabirds’ digestive tracts</h2>
<p>The Adrift Lab’s research focuses on the elegant <a href="https://www.audubon.org/field-guide/bird/flesh-footed-shearwater">flesh-footed shearwater (<em>Ardenna carneipes</em>)</a>, a medium-size seabird with dark feathers and a powerful hooked bill. The lab studied shearwaters nesting on <a href="https://en.wikipedia.org/wiki/Lord_Howe_Island">Lord Howe Island</a>, a tiny speck of land 6 miles long by one mile wide (16 square kilometers) in the Tasman Sea east of Australia.</p>
<p>This region has only moderate levels of floating plastic pollution. But shearwaters, as well as petrels and albatrosses, are part of a class known as tube-nosed seabirds, with tubular nostrils and an excellent senses of smell. As I have found in my own research, tube-nosed seabirds are <a href="https://www.science.org/doi/10.1126/sciadv.1600395">highly skilled</a> at seeking out plastic debris, which may smell like a good place to find food because of algae that coats it in the water. Indeed, the flesh-footed shearwater has one of the highest plastic ingestion rates of any species yet studied. </p>
<p>Marine ecologist <a href="https://scholar.google.com/citations?user=cLd6oOgAAAAJ&hl=en&oi=ao">Jennifer Lavers</a>, head of the Adrift Lab, has been studying plastic debris consumption in this wild shearwater population for over a decade. In 2014 the lab began publishing research linking ingested plastic to <a href="https://doi.org/10.1016/j.envpol.2013.12.020">sublethal health effects</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/516132/original/file-20230317-420-vpv8es.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Dead seabird with plastic fragments in dishes next to it." src="https://images.theconversation.com/files/516132/original/file-20230317-420-vpv8es.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516132/original/file-20230317-420-vpv8es.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=348&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516132/original/file-20230317-420-vpv8es.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=348&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516132/original/file-20230317-420-vpv8es.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=348&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516132/original/file-20230317-420-vpv8es.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=437&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516132/original/file-20230317-420-vpv8es.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=437&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516132/original/file-20230317-420-vpv8es.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=437&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In a 2021 study, scientists found 194 plastic fragments in the stomach of this great shearwater (<em>Ardenna gravis</em>).</span>
<span class="attribution"><a class="source" href="https://www.jstage.jst.go.jp/article/emcr/1/0/1_20210009/_article">Yamashita et al., 2021</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In 2019, Lavers led a study that described correlations between ingested plastic and <a href="https://doi.org/10.1021/acs.est.9b02098">various aspects of blood chemistry</a>. Birds that ingested more plastic had lower blood calcium levels, along with higher levels of cholesterol and uric acid. </p>
<p>In January 2023, Lavers’ group published a paper that found <a href="https://doi.org/10.1016/j.jhazmat.2022.130117">multiorgan damage in these shearwaters</a> from ingesting both microplastic fragments, measuring <a href="https://oceanservice.noaa.gov/facts/microplastics.html#">less than a quarter inch (five millimeters) across</a>, and larger macroplastic particles. These findings included the first description of overproduction of scar tissue in the birds’ proventriculus – the part of their stomach where chemical digestion occurs. </p>
<p>This process, known as <a href="https://www.news-medical.net/health/What-is-Fibrosis.aspx">fibrosis</a>, is a sign that the body is responding to <a href="https://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/symptoms-causes/syc-20353690">injury or damage</a>. In humans, fibrosis is found in the lungs of longtime smokers and people with repeated, prolonged exposure to asbestos. It also is seen in the livers of heavy drinkers. A buildup of excessive scar tissue leads to reduced organ function, and may allow diseases to enter the body via the damaged organs. </p>
<h2>A new age of plastic disease</h2>
<p>The Adrift Lab’s <a href="https://doi.org/10.1016/j.jhazmat.2023.131090">newest paper</a> takes these findings still further. The researchers found a positive relationship between the amount of plastic in the proventriculus and the degree of scarring. They concluded that ingested plastic was causing the scarring, a phenomenon they call “plasticosis.” </p>
<p>Many species of birds purposefully <a href="https://www.allaboutbirds.org/news/do-all-birds-have-gizzards/">consume small stones and grit</a>, which collect in their gizzards – the second part of their stomachs – and help the birds digest their food by pulverizing it. Critically, however, this grit, which is sometimes called pumice, is not associated with fibrosis. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/516131/original/file-20230317-24-7g2jqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="images of birds' stomach tissues, stained pink and blue." src="https://images.theconversation.com/files/516131/original/file-20230317-24-7g2jqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516131/original/file-20230317-24-7g2jqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=172&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516131/original/file-20230317-24-7g2jqe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=172&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516131/original/file-20230317-24-7g2jqe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=172&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516131/original/file-20230317-24-7g2jqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=216&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516131/original/file-20230317-24-7g2jqe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=216&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516131/original/file-20230317-24-7g2jqe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=216&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These images show scarring (blue) in the stomachs of flesh-footed shearwaters, from least affected, at left, to most affected, at right. Researchers attributed the scarring to ingestion of plastic fragments.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1016/j.jhazmat.2023.131090">Charlton-Howard et al., 2023</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Scientists have observed associations between <a href="https://doi.org/10.1016/j.scitotenv.2022.161191">plastic ingestion and pathogenic illness</a> in fish. Plasticosis may help explain how pathogens find their way into the body via a lacerated digestive tract. </p>
<p>Seabirds were the <a href="https://doi.org/10.2307/4083505">first sentinels</a> of possible risks to marine life from plastics: A 1969 study described examining young <a href="https://www.allaboutbirds.org/guide/Laysan_Albatross/overview">Laysan albatrosses (<em>Phoebastria immutabilis</em>)</a> that had died in Hawaii and finding plastic in their stomachs. So perhaps it is fitting that the first disease attributed specifically to marine plastic debris has also been described in a seabird. In my view, plasticosis could be a sign that a new age of disease is upon us because of human overuse of plastics and other long-lasting contaminants, and their leakage into the environment. </p>
<p>In 2022, United Nations member nations voted to negotiate a <a href="https://www.unep.org/news-and-stories/press-release/historic-day-campaign-beat-plastic-pollution-nations-commit-develop">global treaty to end plastic pollution</a>, with a target completion date of 2024. This would be the first binding agreement to address plastic pollution in a concerted and coordinated manner. The identification of plasticosis in shearwaters shows that there is no time to waste.</p><img src="https://counter.theconversation.com/content/201506/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Savoca does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many marine animals, birds and fish are ingesting plastic. New research identifies the first named health effect from it.Matthew Savoca, Postdoctoral researcher, Stanford UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1929182023-01-23T13:25:03Z2023-01-23T13:25:03ZCheap sewer pipe repairs can push toxic fumes into homes and schools – here’s how to lower the risk<figure><img src="https://images.theconversation.com/files/505650/original/file-20230120-26-n0sihx.jpg?ixlib=rb-1.1.0&rect=132%2C28%2C3201%2C2207&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">With many CIPP repairs, this isn't just steam.</span> <span class="attribution"><span class="source">Andrew Whelton/Purdue University</span></span></figcaption></figure><p>Across the U.S., children and adults are increasingly exposed to harmful chemicals from a source few people are even aware of. </p>
<p>It begins on a street outside a home or school, where a worker in a manhole is repairing a sewer pipe. The contractor inserts a <a href="https://youtu.be/rBMOoa2XcJI">resin-soaked sleeve</a> into the buried pipe, then heats it, transforming the <a href="https://doi.org/10.1002/awwa.1042">resin</a> into a hard plastic pipe. </p>
<p>This is one of the <a href="https://www.stratviewresearch.com/287/Cured-in-Place-Pipe-CIPP-Market.html">cheapest</a>, <a href="https://blogs.cdc.gov/niosh-science-blog/2017/09/26/cipp/">most common</a> pipe repair methods, but it comes with a serious risk: Heating the resin generates harmful fumes that can travel <a href="https://doi.org/10.1016/j.jhazmat.2019.02.097">through the sewer lines</a> and into surrounding buildings, sometimes several blocks away.</p>
<p>These chemicals have <a href="https://engineering.purdue.edu/CIPPSafety/resources/incidents">made hundreds of people ill</a>, forced building evacuations and even led to hospitalizations. <a href="https://www.youtube.com/watch?v=luYH4Vtnx_0">Playgrounds</a>, <a href="https://www.telegram.com/story/news/state/2011/10/28/worcester-day-care-center-evacuated/49854145007">day care centers</a> and schools in several states have been affected, including in <a href="https://engineering.purdue.edu/CIPPSafety/resources/incidents">Colorado</a>, <a href="https://www.thehour.com/news/article/Nathan-Hale-evacuated-will-dismiss-from-Norwalk-14910380.php?_ga=2.128513420.1491261553.1673491226-2096328188.1671464695">Connecticut</a>, <a href="https://www.wickedlocal.com/story/saugus-advertiser/2011/10/26/veterans-school-reopens-thursday/40700819007/">Massachusetts</a>, <a href="https://www.mlive.com/news/detroit/2011/10/foul_odor_sickens_students_lea.html">Michigan</a>, <a href="https://www.post-gazette.com/local/east/2019/09/24/Propel-Schools-Pitcairn-construction-fumes-six-sick-evacuation/stories/201909240139?_ga=2.194591149.1491261553.1673491226-2096328188.1671464695">Pennsylvania</a>, <a href="https://www.columbian.com/news/2018/oct/10/odor-from-sewer-work-causes-teachers-to-get-sick-at-riverview-elementary/">Washington</a> and <a href="https://www.wpr.org/northern-wisconsin-school-remains-closed-after-odor-prompts-dozens-seek-medical-treatment?_ga=2.35917088.1491261553.1673491226-2096328188.1671464695">Wisconsin</a>.</p>
<figure class="align-center ">
<img alt="Steam and gases rise out of a sewer manhole." src="https://images.theconversation.com/files/505622/original/file-20230120-24-7mysjw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505622/original/file-20230120-24-7mysjw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=478&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505622/original/file-20230120-24-7mysjw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=478&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505622/original/file-20230120-24-7mysjw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=478&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505622/original/file-20230120-24-7mysjw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=601&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505622/original/file-20230120-24-7mysjw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=601&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505622/original/file-20230120-24-7mysjw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=601&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">With this sewer pipe repair method, the chemical waste is blown into the air and can enter buildings through buried sewer pipes, plumbing, foundation cracks, windows, doors and HVAC units.</span>
<span class="attribution"><a class="source" href="https://pubs.acs.org/cms/10.1021/acs.estlett.7b00237/asset/images/large/ez-2017-00237j_0001.jpeg">Andrew Whelton/Purdue University</a></span>
</figcaption>
</figure>
<p>With the 2022 <a href="https://www.epa.gov/infrastructure/water-infrastructure-investments">Bipartisan Infrastructure Law</a> now sending hundreds of millions of dollars <a href="https://www.epa.gov/infrastructure/2022-bipartisan-infrastructure-law-clean-water-and-drinking-water-state-revolving">into communities across the U.S.</a> to fix broken pipes, the number of children and adults at risk of exposure will likely increase. </p>
<p>For more than a decade, my colleagues and I have worked to <a href="https://www.CIPPSafety.org">understand and reduce the risks</a> of this innovative pipe repair technique. In two new studies, in the <a href="https://www.neha.org/bystander-chemical-exposures-and-injuries">Journal of Environmental Health</a> and <a href="https://doi.org/10.1021/acs.estlett.2c00710">Environmental Science and Technology Letters</a>, we show that workers, and even bystanders, including children, lack adequate protection. </p>
<p>Our research also shows the technology can be used safely if companies take appropriate action.</p>
<h2>Fixing aging pipes with harmful chemicals</h2>
<p>As U.S. water infrastructure ages, communities nationwide are grappling with thousands of broken sewer pipes in their <a href="https://infrastructurereportcard.org/cat-item/wastewater-infrastructure/#:%7E:text=The%20nation%E2%80%99s%20wastewater%20footprint%20includes%20over%20800%2C000%20miles,sewers%20and%20500%2C000%20miles%20of%20private%20lateral%20sewers.">1.3 million-mile</a> inventory.</p>
<p>The new law <a href="https://www.epa.gov/infrastructure/bipartisan-infrastructure-law-resources-clean-water#:%7E:text=The%20Bipartisan%20Infrastructure%20Law%20is%20a%20once-in-a-generation%20investment,conveyance%2C%20and%20water%20storage%20infrastructure%20in%20American%20history.">provides US$11 billion</a> for sewer fixes, about <a href="https://www.epa.gov/archive/epa/newsreleases/epa-survey-shows-271-billion-needed-nations-wastewater-infrastructure.html">one-fifth of the EPA’s estimate</a> of the need.</p>
<figure class="align-center ">
<img alt="A face-on view into a sewer pipe, with a blue lining visible within the outer gray wall." src="https://images.theconversation.com/files/505487/original/file-20230119-22-en6jc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505487/original/file-20230119-22-en6jc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=558&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505487/original/file-20230119-22-en6jc3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=558&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505487/original/file-20230119-22-en6jc3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=558&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505487/original/file-20230119-22-en6jc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=702&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505487/original/file-20230119-22-en6jc3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=702&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505487/original/file-20230119-22-en6jc3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=702&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The blue cured-in-place pipe, or CIPP, can be seen inside this damaged storm sewer pipe. The CIPP was created by steam cooking the resin into the hard plastic.</span>
<span class="attribution"><span class="source">Andrew Whelton/Purdue University</span></span>
</figcaption>
</figure>
<p>The least expensive repair method is called <a href="https://youtu.be/rBMOoa2XcJI">cured-in-place pipe, or CIPP</a>. It avoids the need to dig up and replace pipes. Instead, contractors insert <a href="https://doi.org/10.1002/awwa.1042">a resin-saturated sleeve</a> in the manhole and through the buried pipe. The resin is then “cooked,” <a href="https://www.stratviewresearch.com/287/Cured-in-Place-Pipe-CIPP-Market.html">typically with steam or hot water</a>, and transformed into a hard plastic.</p>
<p>One challenge is that the resin <a href="https://doi.org/10.1016/j.jclepro.2022.131803">safety data sheets</a> do not disclose all of the <a href="https://doi.org/10.1016/j.jhazmat.2019.02.097">chemicals</a>, and some entirely new <a href="https://doi.org/10.1021/acs.estlett.2c00710">ones</a> are <a href="https://doi.org/10.1039/D0EM00190B">created</a> during heating.</p>
<p>Chemical plumes rising from nearby manholes and contractor exhaust pipes are also <a href="https://doi.org/10.1021/acs.estlett.7b00237">not just “steam</a>.” These plumes contain highly concentrated chemical mixtures, uncooked resin, particulates and <a href="https://doi.org/10.1038/s41565-022-01219-9">nanoplastics</a> that can harm human health. When we examined the heating process in the lab, we found that as much as <a href="https://doi.org/10.1016/j.jclepro.2022.131803">9% of the resin</a> was emitted into the air.</p>
<p>CIPP production is known to discharge about 40 chemicals. Some <a href="https://www.floridahealth.gov/environmental-health/hazardous-waste-sites/_documents/final_fdoh_cipp.pdf?_ga=2.229170844.1491261553.1673491226-2096328188.1671464695">cause</a> nausea, headaches and eye and nasal irritation. They can also lead to vomiting, breathing difficulties and other effects. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/l9whaSz5rz0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Waste that contains chemicals, uncooked resin, particulates, and nanoplastics is discharged into the air during CIPP manufacture. This complex emission is not steam. Andrew Whelton/Purdue University.</span></figcaption>
</figure>
<p>Styrene, the most frequently documented chemical, is acutely toxic, and “<a href="https://www.nationalacademies.org/news/2014/07/styrene-reasonably-anticipated-to-be-a-human-carcinogen-new-report-confirms">reasonably anticipated” to cause cancer</a>, according to the National Research Council. Chemicals other than styrene can be responsible for <a href="https://doi.org/10.1080/08958378.2019.1621966">plume toxicity</a>. </p>
<h2>CIPP-associated illnesses in nearby buildings</h2>
<p>So far, chemical exposures have been reported in at least <a href="https://doi.org/10.1021/acs.estlett.2c00710">32 states and seven countries</a>. In addition to schools, this process has contaminated <a href="https://www.bendbulletin.com/localstate/woman-plans-to-sue-bend-over-sewer-pipe/article_80382718-3191-57ad-864a-a28e2fb75b19.html">homes</a>, <a href="https://www.wtvr.com/2018/05/22/fan-residents-claim-they-fell-ill-because-of-fumes-from-city-project?_ga=2.112210884.1776755142.1673913806-2032358368.1673913806">restaurants</a>, <a href="https://herald-review.com/news/local/public_safety/cancer-care-center-of-decatur-evacuates-due-to-odor-caused/article_041e3218-81a6-5615-8723-99149edce72a.html">medical</a> <a href="https://www.scientificamerican.com/article/health-concerns-mount-as-more-old-sewer-pipes-are-lined-with-plastic1/">facilities</a> and <a href="https://www.cbc.ca/news/canada/ottawa/chemical-odour-leads-to-hintonburg-home-evacuations-1.2955145">other</a> <a href="https://helenair.com/news/smelly-gas-begins-to-dissipate/article_d305a00e-00d3-11df-8a80-001cc4c002e0.html">businesses</a>. Companies have been cited for exposing their workers to <a href="https://engineering.purdue.edu/CIPPSafety/resources/OSHA-Region5-CIPP-Fatality-Notification-of-Penalty-2018.pdf">unsafe levels of styrene</a>.</p>
<p>The earliest U.S. incident we know about was in 1993 at an <a href="https://doi.org/10.1016/j.jhazmat.2019.02.097">animal shelter in Austin, Texas</a>. Seven people were overcome by fumes and transported to a hospital. In 2001, fumes entered a hospital inn <a href="https://www.tampabay.com/archive/2001/04/27/odor-forces-hospital-evacuation/">Tampa, Florida</a>, causing employee breathing problems. Since then, <a href="https://doi.org/10.1016/j.jhazmat.2021.126832">hundreds more</a> people are known to have been exposed, and the numbers are likely much higher.</p>
<p>In our experience, exposures are rarely made public. Municipalities have encouraged people <a href="https://pubs.acs.org/doi/10.1021/acs.estlett.7b00237">affected by the fumes</a> to only contact the CIPP contractor and pipe owner. In some cases, people were told the exposures were always harmless. </p>
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<p><div data-react-class="Tweet" data-react-props="{"tweetId":"506865406435655680"}"></div></p>
<p>Chemicals <a href="https://doi.org/10.1016/j.jhazmat.2021.126832">can enter buildings</a> through sinks, toilets, foundation cracks, doors, windows and HVAC systems. The chemicals can even enter buildings that have water-filled plumbing traps. Anticipating this risk, bystanders have been told to <a href="https://blog.timesunion.com/bethlehem/9270/bethlehem-installing-new-sewer-lines-without-digging/">cover their toilets</a> and <a href="https://www.kron4.com/news/video-dublin-sewer-construction-project-causes-foul-smell-for-residents/?_ga=2.229692060.1491261553.1673491226-2096328188.1671464695">close all windows and doors</a>.</p>
<p>Wind can help dilute outdoor chemical levels. However, <a href="https://doi.org/10.1016/j.jhazmat.2021.126832">concentrated plumes</a> can rush through buried pipes into nearby buildings. Bathroom <a href="https://doi.org/10.1016/j.jhazmat.2021.126832">vent fans</a> may sometimes increase the indoor chemical levels. Levels that should prompt firefighters to <a href="https://doi.org/10.1016/j.jhazmat.2021.126832">wear respirators</a> have been found in the buried pipes.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/504839/original/file-20230117-16-d5uwp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An illustration shows how fumes can move from the source into homes and buildings." src="https://images.theconversation.com/files/504839/original/file-20230117-16-d5uwp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504839/original/file-20230117-16-d5uwp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=307&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504839/original/file-20230117-16-d5uwp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=307&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504839/original/file-20230117-16-d5uwp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=307&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504839/original/file-20230117-16-d5uwp8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=385&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504839/original/file-20230117-16-d5uwp8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=385&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504839/original/file-20230117-16-d5uwp8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=385&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fumes generated during sewer line repair, on the right, can enter nearby homes, schools and other buildings.</span>
<span class="attribution"><span class="source">Andrew Whelton/Purdue University</span></span>
</figcaption>
</figure>
<p>The <a href="https://scholarworks.uno.edu/td/2126/">highest levels</a> have been found during and <a href="https://doi.org/10.1016/j.jclepro.2022.131803">after the heating process</a>. </p>
<p>Hand-held air testing devices commonly used by some firefighters and contractors <a href="https://doi.org/10.1021/acs.estlett.2c00710">do not accurately identify</a> specific chemical levels. An <a href="https://doi.org/10.1016/j.jhazmat.2019.02.097">earlier study</a> showed the styrene levels were sometimes wrong by a thousandfold.</p>
<h2>How to protect public health</h2>
<p>With the wave of infrastructure projects coming, it’s clear that controls are needed to lower the risk that people will be harmed.</p>
<p>Our research points to several actions that residents, companies and health officials can take to keep communities safe.</p>
<p>We advise residents to:</p>
<ul>
<li><p>Close all windows and doors, fill plumbing traps with water and leave the building during pipe-curing operations, especially when children are in the building. </p></li>
<li><p>Report unusual odors or illnesses to health officials or call 911. Seek medical advice from health officials, not the contractors or pipe owners. Evacuate buildings when fumes enter. </p></li>
</ul>
<p>Companies can minimize risks too. They can:</p>
<ul>
<li><p>Stop the cooking process when fumes leave the worksite to lessen the spread of contamination and exposures.</p></li>
<li><p>Use resins that release <a href="https://doi.org/10.1016/j.jclepro.2022.131803">less</a> air pollution than standard resins. </p></li>
<li><p>Ask federal agencies to evaluate hand-held air testing device use.</p></li>
<li><p>Capture and treat air pollution from the process. While this has not yet been done at scale, it is straightforward and would be a fraction of the overall project cost. This waste will be <a href="https://www.epa.gov/rcra">hazardous</a> because of <a href="https://doi.org/10.1021/acs.estlett.7b00237">its</a> <a href="https://doi.org/10.1021/es5018637">toxicity</a>.</p></li>
</ul>
<p>Public health and environmental agencies should also get engaged. Federal agencies <a href="https://engineering.purdue.edu/CIPPSafety/resources/ATSDR-Contaminated-Office-Building-Investigation-2005.pdf">know</a> that the practice poses health <a href="https://www.cdc.gov/niosh/hhe/reports/pdfs/2019-0080-3379.pdf?id=10.26616/NIOSHHHE201900803379#:%7E:text=NIOSH.%20Evaluation%20of%20exposures%20and%20emissions%20during%20cured-in-place,during%20pipe%20repairs%20using%20hot%20water%20and%20steam.">risks</a> and can be <a href="https://www.ehstoday.com/archive/article/21911727/iowa-osha-issues-808000-fine-following-des-moines-drownings">fatal</a> to <a href="https://engineering.purdue.edu/CIPPSafety/resources/OSHA-Region5-CIPP-Fatality-Notification-of-Penalty-2018.pdf">workers</a>. <a href="https://engineering.purdue.edu/CIPPSafety/resources/CIPP-Safety-Alert-2020-Update-ADA.pdf">California</a> and <a href="https://www.floridahealth.gov/environmental-health/hazardous-waste-sites/_documents/final_fdoh_cipp.pdf?_ga=2.265943311.1491261553.1673491226-2096328188.1671464695">Florida</a> recognize in safety documentation that bystanders could be harmed. But, so far, few steps have been taken to protect workers’ and bystanders’ health.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"722452603880079360"}"></div></p><img src="https://counter.theconversation.com/content/192918/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew J. Whelton receives funding from the U.S. National Science Foundation. U.S. Environmental Protection Agency, U.S. Federal Highway Administration, and Purdue University. He was named in patent 11486530, which pertains to the technologies for capturing, identifying, analyzing, and addressing emissions that are potentially hazardous to the environment and humans. The invention was developed with support from the U.S. National Science Foundation.</span></em></p>A wave of infrastructure projects is coming as federal funds pour in. Cities and everyone in them needs to know the risks from the cheapest, most popular repair method and how to avoid harm.Andrew J. Whelton, Professor of Civil, Environmental & Ecological Engineering, Director of the Healthy Plumbing Consortium and Center for Plumbing Safety, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1915592023-01-11T13:25:40Z2023-01-11T13:25:40ZTriggering cancer cells to become normal cells – how stem cell therapies can provide new ways to stop tumors from spreading or growing back<figure><img src="https://images.theconversation.com/files/503356/original/file-20230105-19-bvp86r.jpg?ixlib=rb-1.1.0&rect=6%2C6%2C2038%2C2038&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This image shows pancreatic cancer cells (blue) growing, encased within membranes (red).</span> <span class="attribution"><a class="source" href="https://flic.kr/p/GAACEb">Min Yu/Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research at USC via NIH/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>How cells <a href="https://doi.org/10.3390%2Fijms21186489">become cancerous</a> is a process researchers are still trying to fully understand. Generally, normal cells grow and multiply through controlled cell division, where <a href="https://doi.org/10.3389/fcell.2021.645593">old and damaged cells</a> are replaced after they die by new cells. Sometimes this process stops working, leading cells to start growing uncontrollably and develop into a tumor.</p>
<p>Traditionally, cancer treatments like chemotherapy, immunotherapy, radiation and surgery focus on killing cancer cells. Another type of treatment using stem cells called <a href="https://doi.org/10.1177/1010428317729933">differentiation therapy</a>, however, focuses on persuading cancer cells to become normal cells. </p>
<p><a href="https://scholar.google.com/citations?user=GNSivG8AAAAJ&hl=en">We are</a> <a href="https://chen.uchicago.edu/abhimanyu-thakur-ph-d/">researchers</a> who study how stem cells, or immature cells that can develop into different types of cells, behave in states of health and disease. We believe that stem cells can provide potential treatments for cancer of all types in many different ways.</p>
<h2>How do stem cells contribute to cancer?</h2>
<p><a href="https://www.the-scientist.com/university/brush-up-what-is-stemness-and-pluripotency-70571">Stem cells</a> are unspecialized cells, meaning they can eventually become any one of the various types of cells that make up different parts of the body. They can replenish cells in the skin, bone, blood and other organs during development, and regenerate and repair tissues when they’re damaged.</p>
<p>There are different types of stem cells. Embryonic stem cells are the first cells that initially form after a sperm fertilizes an egg, and can give rise to all other cell types in the human body. Adult stem cells are more mature, meaning they can replace damaged cells only in one type of organ and have a limited ability to multiply. Researchers can <a href="https://doi.org/10.1007%2Fs13238-021-00863-6">reprogram adult stem cells, or differentiated cells</a>, in the lab to act like embryonic stem cells.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/t3g26p9Mh_k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Cells become specialized over the course of development.</span></figcaption>
</figure>
<p>Because stem cells can survive longer than regular cells, they have a much higher probability of accumulating genetic mutations that can result in loss of control over their growth and ability to regenerate. This is why many tumors harbor a small subpopulation of cells that <a href="https://doi.org/10.1038%2Flabinvest.2008.14">function like stem cells</a>. These so-called cancer stem cells are <a href="https://doi.org/10.1186/s13578-017-0188-9">thought to be responsible</a> at least in part for cancer initiation, progression, metastasis, recurrence and treatment resistance.</p>
<h2>What is differentiation therapy?</h2>
<p>Accumulating evidence is also showing that cancer stem cells can differentiate into multiple cell types, including noncancerous cells. Researchers are taking advantage of this fact through a type of treatment called <a href="https://doi.org/10.1177/1010428317729933">differentiation therapy</a>. </p>
<p>The concept of differentiation therapy <a href="https://doi.org/10.1038/nrc.2017.103">originated from scientists observing</a> that hormones and cytokines, which are proteins that play a key role in cell communication, can stimulate stem cells to mature and lose their ability to regenerate. It followed that forcing cancer stem cells to differentiate into more mature cells could subsequently stop them from multiplying uncontrollably, making them become normal cells.</p>
<p>Differentiation therapy has been successful in treating <a href="https://doi.org/10.1182/blood-2009-01-198911">acute promyelocytic leukemia</a>, an aggressive blood cancer. In this case, retinoic acid and arsenic are used to block a protein that stops myeloid cells, a type of blood cell derived from the bone marrow, from fully maturing. By allowing these cells to fully mature, they lose their cancerous qualities.</p>
<p>Furthermore, because differentiation therapy doesn’t focus on killing cancer cells and doesn’t surround healthy cells in the body with harmful chemicals, it can be <a href="https://doi.org/10.1182%2Fblood-2009-01-198911">less toxic</a> than traditional treatments.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/503362/original/file-20230105-22-8a0umi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopy image of acute promyelocytic leukemia" src="https://images.theconversation.com/files/503362/original/file-20230105-22-8a0umi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503362/original/file-20230105-22-8a0umi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503362/original/file-20230105-22-8a0umi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503362/original/file-20230105-22-8a0umi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503362/original/file-20230105-22-8a0umi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503362/original/file-20230105-22-8a0umi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503362/original/file-20230105-22-8a0umi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Acute promyelocytic leukemia, as shown in this microscopy image, can be treated with differentiation therapy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/acute-promyelocytic-leukemia-cells-royalty-free-image/1417347912">jarun011/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Using stem cells to treat cancer</h2>
<p>There are many other potential ways to use stem cells to treat cancer. For example, cancer stem cells can be <a href="https://doi.org/10.1038/s41392-020-0110-5">directly targeted</a> to stop their growth, or turned into “<a href="https://doi.org/10.1515/iss-2016-0005">Trojan horses</a>” that attack other tumor cells.</p>
<p><a href="https://doi.org/10.1155/2016/1740936">Quiescent cancer stem cells</a>, which don’t divide but are still alive, are another potential drug target. These cells typically play a big role in treatment resistance for various cancer types because they are able to regenerate and avoid death even better than regular cancer stem cells. Their quiescent quality can persist for decades and lead to a cancer relapse. They are also challenging to distinguish from regular cancer stem cells, making them difficult to study.</p>
<p>Researchers can also genetically engineer stem cells to express a protein that binds to a desired target in a cancer cell, increasing the efficacy of treatments by releasing drugs right at the tumor. For example, <a href="https://doi.org/10.3389%2Ffbioe.2020.00043">mesenchymal stem cells</a> derived from bone marrow naturally migrate toward and stick to tumors, and can be used to deliver cancer drugs directly to cancer cells.</p>
<p>Stem cells can also be used to make <a href="https://doi.org/10.1002/wdev.399">organoid models</a>, or miniature versions of organs, to screen potential cancer drugs and study the underlying mechanisms that lead to cancer. </p>
<h2>Challenges in stem cell therapy</h2>
<p>Although, stem cells hold numerous advantages in their use in cancer therapy, they also <a href="https://doi.org/10.18632%2Foncotarget.20798">face various challenges</a>. For example, many current stem cell therapies that aren’t used in combination with other drugs are unable to completely eliminate tumors. There are also concerns about stem cell therapies potentially promoting tumor growth.</p>
<p>Despite these challenges, we believe that stem cell technologies have the potential to open new avenues for cancer therapy. Integrating genetic engineering with stem cells can overcome the major drawbacks of chemotherapeutics, such as toxicity to healthy cells. With further research, cancer stem cell therapies may one day become part of the standard of care for many types of cancer.</p><img src="https://counter.theconversation.com/content/191559/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many tumors have cancer stem cells that help them grow and evade treatments. Differentiation therapy forces these cells to mature, stopping growth with less toxicity than traditional treatments.Huanhuan Joyce Chen, Assistant Professor of Molecular Engineering, University of Chicago Pritzker School of Molecular EngineeringAbhimanyu Thakur, Postdoctoral Scholar in Molecular Engineering, University of Chicago Pritzker School of Molecular EngineeringLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1965312022-12-15T16:04:33Z2022-12-15T16:04:33ZFungal toxins are widespread in European wheat – threatening human health and the economy<figure><img src="https://images.theconversation.com/files/500999/original/file-20221214-1149-y34rfu.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C3478%2C2309&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Harmful fungal toxins are a growing threat for European wheat.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/production-wheat-flour-535439188">Sergey Butin/Shutterstock</a></span></figcaption></figure><p>Wheat <a href="https://link.springer.com/article/10.1007/s12571-013-0263-y">provides</a> 19% of the calories and 21% of the protein consumed by humans globally. But a fungal disease called <a href="https://ahdb.org.uk/knowledge-library/fusarium-and-microdochium-in-cereals">fusarium head blight (FHB)</a>, which can infect wheat crops and contaminate the grain with toxins, is on the rise. </p>
<p>These so-called mycotoxins – which include deoxynivalenol, commonly called “vomitoxin” – are a <a href="https://www.mdpi.com/1420-3049/26/2/454">threat</a> to human and livestock health and can cause vomiting, intestinal damage, weakened immune system, hormone disruption and cancer. </p>
<p>To protect consumers, the EU commission set <a href="https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2006:364:0005:0024:EN:PDF">legal limits</a> on vomitoxin levels in wheat produced for food. Grain deemed too contaminated for human consumption is often downgraded to animal feed. But downgrading comes at a cost to farmers and the economy because animal feed has a lower monetary value than food. </p>
<p>Governments and agribusinesses routinely monitor mycotoxin levels in the food and animal feed supply chains. Yet the scale of FHB mycotoxin contamination in European wheat supplies is understudied and its economic impact had previously not been quantified.</p>
<p>With colleagues from the universities of Bath and Exeter, we <a href="https://www.nature.com/articles/s43016-022-00655-z">analysed</a> the largest available mycotoxin datasets and found that FHB mycotoxins are widespread in wheat produced for food and animal feed across Europe. We also found that the threat of mycotoxins – particularly in the south of Europe – is increasing over time. </p>
<h2>European wheat contaminated</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/501003/original/file-20221214-4682-q7fm05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A wheat spike in the palm of a hand showing discolouration." src="https://images.theconversation.com/files/501003/original/file-20221214-4682-q7fm05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/501003/original/file-20221214-4682-q7fm05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501003/original/file-20221214-4682-q7fm05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501003/original/file-20221214-4682-q7fm05.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501003/original/file-20221214-4682-q7fm05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501003/original/file-20221214-4682-q7fm05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501003/original/file-20221214-4682-q7fm05.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A wheat spike showing Fusarium Head Blight symptoms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/typical-fusarium-head-blight-fbh-symptom-2140986197">Dan Gabriel Atanasie/Shutterstock</a></span>
</figcaption>
</figure>
<p>Vomitoxin was present in every European country studied, and overall it was found in half of all wheat samples destined for food. In the UK, vomitoxin was found in 70% of the food wheat produced between 2010 and 2019. </p>
<p>Almost all (95%) of the vomitoxin contamination recorded in European wheat was within legal limits. This confirms that current legislation and the monitoring of FHB mycotoxin levels in food effectively safeguard European consumers against acute poisoning.</p>
<p>Yet the widespread presence of vomitoxin in our food is concerning. It is not yet known how constant, low-level dietary exposure to mycotoxins can affect human health in the long term. This is compounded by the fact that one-quarter of the wheat contaminated with vomitoxin also contained other FHB mycotoxins, raising concerns of <a href="https://www.sciencedirect.com/science/article/pii/S0041010112007143?via%3Dihub">synergism</a>, where toxins interact with each other and cause greater harm than the sum of the individual toxins acting alone.</p>
<h2>Economic cost of fungal toxins</h2>
<p>We also estimated the cost of vomitoxin to the European economy.</p>
<p>Vomitoxin was recorded in concentrations above legal limits in 5% of the wheat produced for food in Europe. Between 2010 and 2019, this was equivalent to 75 million tonnes of wheat. If all of this affected wheat was diverted to animal feed, we calculated that the loss in value for wheat producers would be €3 billion (£2.6 billion) over the period studied. </p>
<p>However, the total economic cost of the FHB disease in Europe is likely to be far higher. Our calculation does not include the reduction in wheat yields as a result of the disease, contamination with other harmful but less routinely tested mycotoxins, or the costs of applying fungicide to prevent the growth of the fungal pathogen.</p>
<figure class="align-center ">
<img alt="A tractor spraying fungicide on a wheat field as it drives through the field." src="https://images.theconversation.com/files/501302/original/file-20221215-17-purmy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501302/original/file-20221215-17-purmy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501302/original/file-20221215-17-purmy2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501302/original/file-20221215-17-purmy2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501302/original/file-20221215-17-purmy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501302/original/file-20221215-17-purmy2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501302/original/file-20221215-17-purmy2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A tractor spraying fungicide on a wheat field to prevent the growth of fungi.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/farmer-spraying-green-wheat-field-504107407">oticki/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Increasing threat</h2>
<p>FHB is a disease that fluctuates annually. But we found that mycotoxin levels increased in lower latitude countries between 2010 and 2019, with this particularly the case in the Mediterranean. The vomitoxin concentrations recorded during the 2018 and 2019 outbreak years, for example, were the highest across the period studied.</p>
<p>Our study did not investigate the causes of this increase. But it is likely that changes in farming practices, climate change, and the dwindling effectiveness of fungicides are all contributing factors.</p>
<p><a href="https://defrafarming.blog.gov.uk/sustainable-farming-incentive-pilot-guidance-use-min-till-or-no-till-farming/">Minimum tillage</a>, where land is cultivated using methods other than ploughing to reduce soil disturbance, is an increasingly popular farming method. The method is beneficial for soil health but leaves crop debris behind and enables the FHB fungus to survive the winter. Maize, a crop highly susceptible to FHB, is also <a href="https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Agricultural_production_-_crops">grown extensively</a> across Europe. Combined, these farming practices increase the FHB pathogen load in the environment. </p>
<p>Climate change may also encourage the spread of FHB disease. Warmer and wetter weather coinciding with when wheat is in flower provides conditions ideal for the FHB fungus to infect and produce mycotoxins.</p>
<p>Resistance to azoles, a commonly used fungicide, has been increasingly <a href="https://www.science.org/doi/10.1126/scitranslmed.3004404?cookieSet=1">reported</a> in recent years. Naturally and through repeated exposure, fusarium fungal species are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546618/">more resistant</a> to these fungicides than other fungal pathogens. </p>
<p>FHB contamination is widespread across Europe, carrying a substantial cost. Understanding the FHB disease and its mycotoxins is therefore important. But monitoring of FHB outbreaks must be improved to allow researchers to predict which environments are most at risk of mycotoxin-causing fungal diseases in the future. </p>
<p>Methods of containing the disease must also be further developed. These include new fungicides or future crop protection strategies that inhibit the development of mycotoxins. Climate change is leading to more crop disease outbreaks and our need for secure food supplies is increasing, the issue of mycotoxins is therefore only going to become more important.</p><img src="https://counter.theconversation.com/content/196531/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Neil Brown works for the University of Bath. He receives funding from the BBSRC Future Leader Fellowship BB/N011686/1, an internal University of Bath grant, and a Royal Society grant RGS\R2\202128.</span></em></p><p class="fine-print"><em><span>Louise Johns is a PhD student at the University of Bath. Louise Johns was funded by a University of Bath URSA studentship and a British Society for Plant Pathology Covid-19 PhD student support grant.</span></em></p>Wheat is an important global crop, but new research suggests that fungal toxins have contaminated half of all European wheat produced for food.Neil Brown, Senior Lecturer, Molecular Fungal Biology, University of BathLouise Johns, Postgraduate Research Student, Department of Life Sciences, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1947162022-11-17T03:58:49Z2022-11-17T03:58:49ZToxic poppy seeds are sending people to hospital. 3 experts explain what’s behind the latest food scare<figure><img src="https://images.theconversation.com/files/496004/original/file-20221117-17-madsvi.jpg?ixlib=rb-1.1.0&rect=4%2C1%2C994%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Poisonous poppy seeds have sent a number of people around Australia to hospital with severe symptoms – from muscle cramping and spasms to seizures and cardiac arrests – prompting a nationwide recall of <a href="https://www.foodstandards.gov.au/media/Pages/Additional-brands-listed-in-national-poppy-seed-recall.aspx">certain batches and brands</a> of this common pantry item.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1592706604905873408"}"></div></p>
<p>We work for two major poisons information services (<a href="https://www.health.nsw.gov.au/news/Pages/20221115_00.aspx">New South Wales</a> and <a href="https://www.childrens.health.qld.gov.au/chq/our-services/queensland-poisons-information-centre/">Queensland</a>), where we have been advising and caring for people with poppy seed poisoning. There have also been cases in <a href="https://www.health.vic.gov.au/health-alerts/health-warning-on-on-poppy-seeds">Victoria</a>, Australian Capital Territory, <a href="https://glamadelaide.com.au/urgent-recall-on-two-popular-poppy-seed-brands-amid-poisoning-concerns/">South Australia</a> and <a href="https://ww2.health.wa.gov.au/Media-releases/2022/November/WA-Health-warns-community-of-severe-reactions-after-consuming-poppy-seed-tea">Western Australia</a>. </p>
<p>To date, there have been around 32 cases of poppy seed toxicity reported in Australia over the past month, all in adults.</p>
<p>This is what we know about what’s behind these cases and what you need to do if you’ve consumed poppy seeds recently, or have poppy seeds in your kitchen cupboards.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-want-to-use-bleach-and-antiseptic-for-covid-and-are-calling-us-for-advice-168660">People want to use bleach and antiseptic for COVID and are calling us for advice</a>
</strong>
</em>
</p>
<hr>
<h2>How could these poppy seeds be dangerous?</h2>
<p>The poppy seeds involved in the latest national recall are non-food grade seeds that are not intended for human consumption and are not safe to consume. Investigations are under way to determine how non-food grade seeds ended up in the shops.</p>
<p>Food-grade poppy seeds – the type that you’d usually see sprinkled on cake or bread – are not dangerous.</p>
<p>Poppy seeds come from the poppy plant <em>Papaver somniferum</em>. This plant produces a number of chemicals called alkaloids. Some, like morphine and codeine, have been used medicinally for thousands of years to treat pain and other conditions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495762/original/file-20221116-13-cv3jy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Poppy plant Papaver somniferum" src="https://images.theconversation.com/files/495762/original/file-20221116-13-cv3jy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495762/original/file-20221116-13-cv3jy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495762/original/file-20221116-13-cv3jy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495762/original/file-20221116-13-cv3jy9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495762/original/file-20221116-13-cv3jy9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=520&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495762/original/file-20221116-13-cv3jy9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=520&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495762/original/file-20221116-13-cv3jy9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=520&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Poppy seeds come from the plant <em>Papaver somniferum</em> and are used to make medicines, as well as food products.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/opium-poppy-heads-close-papaver-somniferum-2004569264">Shutterstock</a></span>
</figcaption>
</figure>
<p>Other naturally occurring poppy alkaloids – such as thebaine, noscapine, laudanosine and papaverine – are less-well described in terms of their effects on humans, but they can have a wide range of toxic effects.</p>
<p>Different varieties of poppy plants contain different amounts of these alkaloids.</p>
<p>Some have very low amounts, which tend to be used to produce food-grade poppy seeds. Varieties with higher amounts are used to produce medicines, such as morphine and codeine.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-codeine-doesnt-work-for-some-people-and-works-too-well-for-others-58067">Weekly Dose: codeine doesn't work for some people, and works too well for others</a>
</strong>
</em>
</p>
<hr>
<h2>What happened recently then?</h2>
<p>The non-food grade poppy seeds that incorrectly entered the human food supply contain high amounts of the alkaloid thebaine. </p>
<p>Thebaine has very different effects to morphine. <a href="https://pubmed.ncbi.nlm.nih.gov/31670127/">In large doses</a> it causes severe and prolonged muscle cramps, spasms, seizures and cardiac arrests, as seen in the recent cluster of poisonings. </p>
<p>High concentrations of thebaine have been identified in the blood of affected people in this latest cluster.</p>
<p>To our knowledge, this is the first time that thebaine has entered the food chain in Australia. However, there are a couple of reports of people who have had severe toxicity after consuming non-food grade poppies in recent decades.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indian-viagra-herbal-drug-kamini-contains-morphine-and-can-quickly-lead-to-dependence-191509">'Indian Viagra' – herbal drug Kamini contains morphine and can quickly lead to dependence</a>
</strong>
</em>
</p>
<hr>
<h2>How many poppy seeds are we talking about?</h2>
<p>All reported cases in the current cluster at the time of the recall occurred after people consumed poppy seeds as part of a drink – similar to a brewed tea. </p>
<p>Most people had consumed more than 100g poppy seeds (about 11 tablespoons). Although, 50g (5-6 tablespoons) may be sufficient to cause poisoning. Thebaine can build up in the body if you ingest it several times over the same day.</p>
<p>There have been no reports to date of people being poisoned after eating poppy seeds in baked goods. However, the investigation is ongoing. Owing to the nature of the contamination, we’d recommend avoiding poppy seeds from <a href="https://www.foodstandards.gov.au/media/Pages/Additional-brands-listed-in-national-poppy-seed-recall.aspx">affected brands</a> in any form.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495557/original/file-20221116-13-p2a308.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=1000&fit=clip"><img alt="Bread rolls with poppy seeds on brown paper" src="https://images.theconversation.com/files/495557/original/file-20221116-13-p2a308.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495557/original/file-20221116-13-p2a308.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495557/original/file-20221116-13-p2a308.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495557/original/file-20221116-13-p2a308.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495557/original/file-20221116-13-p2a308.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495557/original/file-20221116-13-p2a308.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495557/original/file-20221116-13-p2a308.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">So far, there have been no poisonings reported after eating poppy seeds in bread or cake.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kaiser-rolls-poppy-seeds-bakery-concept-1043931433">Shutterstock</a></span>
</figcaption>
</figure>
<h2>What if I have poppy seeds at home?</h2>
<p>The non-food grade poppy seeds we’re currently concerned about likely entered the food supply in the past two months. So, if you bought poppy seeds <a href="https://www.health.vic.gov.au/health-alerts/health-warning-on-poppy-seeds">before September 2022</a>, these are likely to be safe. </p>
<p>If you’ve bought poppy seeds in the past two months and these <a href="https://www.foodstandards.gov.au/industry/foodrecalls/recalls/Pages/default.aspx?k=poppy">are listed</a> as part of the national recall, you may be at risk.</p>
<p>You can throw them in the bin or return them to where you bought them for a refund.</p>
<h2>What if I’ve eaten poppy seeds or drunk the tea?</h2>
<p>If you or someone you know develops the following symptoms after consuming poppy seeds, seek urgent medical assistance by calling triple zero:</p>
<ul>
<li>severe muscle cramping, muscle spasms and abnormal movements </li>
<li>seizures </li>
<li>collapses or is unresponsive.</li>
</ul>
<p>If symptoms are mild, or you’re not sure if these are because of consuming poppy seeds, call the Poisons Information Centre for advice (details below).</p>
<p>If you’ve consumed poppy seeds more than four hours ago and you feel fine, you can be reassured. That’s because these poisoning symptoms typically happen quickly, within four hours. </p>
<p>If you’ve consumed a large number of poppy seeds as a drink, especially from an affected batch of seeds, in the past four hours, go to the emergency department regardless of symptoms.</p>
<hr>
<p><em>If this article raises health concerns for you or for someone you know about consuming poppy seeds, call the <a href="https://www.poisonsinfo.nsw.gov.au/">Poisons Information Centre</a> from anywhere in Australia on 131 126. This evidence-base advice is available 24 hours a day. For life-threatening symptoms, call 000.</em></p>
<hr>
<p><em>Update: the article has been updated to reflect prior poppy poisonings.</em></p><img src="https://counter.theconversation.com/content/194716/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darren Roberts is the Medical Director of the NSW Poisons Information Centre and a clinical Toxicologist at Royal Prince Alfred Hospital, Sydney.
</span></em></p><p class="fine-print"><em><span>Jared Brown is a Senior Poisons Specialist in Toxicovigilance at NSW Poisons Information Centre.</span></em></p><p class="fine-print"><em><span>Katherine Isoardi is the Director of the Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, and Medical Director of Queensland Poisons Information Centre, Queensland Children’s Hospital, Brisbane, Australia</span></em></p>Affected poppy seeds made into a tea have led to seizures and cardiac arrests.Darren Roberts, Conjoint Associate Professor in clinical pharmacology and toxicology, St Vincent’s Healthcare Clinical Campus, UNSW SydneyJared Brown, Clinical Associate Lecturer, School of Pharmacy, University of SydneyKatherine Isoardi, Conjoint Associate Professor, Faculty of Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1702932021-11-10T14:42:49Z2021-11-10T14:42:49ZHerbal skin treatments in Uganda get an important scientific boost<figure><img src="https://images.theconversation.com/files/429696/original/file-20211102-5521-7dk07t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Herbal remedies are commonplace in Uganda; testing these scientifically is a good way to ensure they're safe and effective.</span> <span class="attribution"><span class="source">Ava Peattie/Shutterstock</span></span></figcaption></figure><p>Herbal medicine is used all over the world, and Uganda is no exception. <a href="https://www.who.int/traditional-complementary-integrative-medicine/WhoGlobalReportOnTraditionalAndComplementaryMedicine2019.pdf#page=79">Figures suggest</a> that up to 79% of the East African nation’s population favours herbal medicine for a variety of ailments rather than pursuing other treatment options. </p>
<p>COVID-19 has escalated the use of herbal medicine. In June 2021 the government <a href="https://www.bloomberg.com/news/articles/2021-07-22/uganda-backs-herbal-treatments-for-covid-19-amid-delta-surge">approved the use of a herbal remedy</a>, Covidex, as a treatment for COVID-19. The remedy had not undergone clinical trials and the World Health Organisation <a href="https://www.voanews.com/a/covid-19-pandemic_uganda-approves-herbal-treatment-covid-19/6207668.html">warned against its use</a>. Communities are also using other herbal remedies to treat and manage COVID-19.</p>
<p>At first glance, this should not be an issue. Herbal medicine has proven to be very effective in treating several ailments like malaria, tuberculosis, cough and skin diseases. But using it is not without risks. There is a myth among the local population and some herbalists that medicinal plants do not produce toxic effects: they think that, since medicinal plants are natural, there are no negative effects and you can take any amount you want. However, a lot of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894275/">research</a> has shown that <a href="https://www.intechopen.com/chapters/58270">some medicinal plants</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664710/">can be toxic</a>.</p>
<p>The problem is that herbal remedies don’t always undergo proper scientific tests for quality, efficacy and safety. Sometimes people might underdose, meaning that even if the remedy is safe, it doesn’t help them. On the other hand, some may take too much of a remedy and this can be toxic.</p>
<p>It is important that herbal medicine – just like the medication usually found on pharmacy shelves – be checked for its safety, its potential to treat particular ailments, and to ascertain its chemical components. This is also very useful in drug discovery. Uganda could add herbal treatments to the global market, knowing they are safe and effective; this would be good news for Uganda’s scientists, its economy, and ordinary people all over the world who could benefit from new remedies.</p>
<p>That’s why the team I’m part of, the organic research group at Makerere University’s Department of Chemistry led by Professor Robert Byamukama, focuses <a href="https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-021-00342-y">on testing</a> the safety, quality and efficacy of herbal remedies. To do so, we work closely with herbalists and communities. For instance, we have trained people in Mpigi, Kamuli, Kayunga and Buikwe districts to formulate herbal cosmetics (sunscreens and skin creams) they can use safely and sell. </p>
<h2>A thorough process</h2>
<p>Our <a href="https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-021-00342-y">latest research</a> examined how medicinal plants commonly used in Uganda might be used to treat various skin infections.</p>
<p>The first step was to consult with herbalists and communities to learn what plants, or parts of plants, are used for these sorts of ailments. They identified <em><a href="https://plants.jstor.org/compilation/spermacoce.princeae">Spermacoce princeae</a></em>, <em><a href="https://tropical.theferns.info/viewtropical.php?id=Psorospermum+febrifugum">Psorospermum febrifugum</a></em>, <em><a href="https://www.gbif.org/species/3905666/metrics">Plectranthus caespitosus</a></em>, and <em><a href="https://plants.jstor.org/compilation/Bothriocline.tomentosa">Erlangea tomentosa</a></em>.</p>
<p>We then collected the plants, either early in the morning or late in the evening. That’s because the plants’ chemical components are in their most natural state during these times. During the day when the sunshine is at its peak, some active chemicals can either evaporate or can be exchanged for inactive ones.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/south-africa-is-rich-in-plants-used-for-skincare-rural-women-helped-us-document-some-163911">South Africa is rich in plants used for skincare: rural women helped us document some</a>
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<p>The plant parts were then taken to the research facility and dried under shade to prevent the loss of any chemical components that can escape into the atmosphere in sunshine. Shade drying also prevents active components from degrading into an inactive state.</p>
<p>Next, dried plant material was ground into fine powder and extracted using water and organic solvents to obtain the active components. The resultant liquid was filtered to remove any solid material, then dried so it can be thoroughly tested for efficacy and toxicity, and its chemical components analysed. By identifying the chemical components, we were able to ascertain which chemicals were responsible for a plant’s effectiveness as a treatment.</p>
<h2>Positive findings</h2>
<p>Some of the plants we tested <a href="https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-021-00342-y">proved</a> to be very safe and effective as skin antibacterials and sunscreens. Using these findings, we have formulated herbal cosmetics – soap, jelly and cream. We have shared this formulation with the communities we consulted, so they can make their own products and use them knowing they are scientifically sound. We plan to share it more widely. </p>
<p>We’ll also be doing further tests on the formulated products – a step, we hope, towards bringing it in line with international standards so that these African plants can step onto the world stage.</p><img src="https://counter.theconversation.com/content/170293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Namukobe works for Makerere University, Uganda. She receives funding from AESA-RISE postdoctoral fellowship implemented by the African Academy of Sciences through funding from the Carnegie Corporation of New York. She is affiliated with NAPRECA. </span></em></p>It is important that herbal medicine be checked for its safety, its potential to treat particular ailments, and to ascertain its chemical components.Jane Namukobe, Lecturer, Makerere UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1686602021-10-17T19:14:16Z2021-10-17T19:14:16ZPeople want to use bleach and antiseptic for COVID and are calling us for advice<figure><img src="https://images.theconversation.com/files/425387/original/file-20211008-21-ofpnwd.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-gargling-throat-holding-galss-1797736726">Shutterstock</a></span></figcaption></figure><p>Through our work at the <a href="https://www.poisonsinfo.nsw.gov.au">New South Wales Poisons Information Centre</a>, we’re used to receiving calls from concerned parents about what to do if their child has accidentally drunk some cleaning product. We also take calls from health professionals for advice on how to manage poisonings.</p>
<p>But over the past 18 months, we’ve seen an increasing number of people calling us about home remedies to prevent or cure COVID-19, particularly during an outbreak. They’re calling for advice before using items such as bleach or disinfectant. Or they’re calling to ask about side-effects after gargling, spraying or bathing in them.</p>
<p>When asked about the reason for using such products, callers say they did not know they could be harmful. Some say they thought it was better to do something, rather than nothing. </p>
<p>We’re concerned about the use of unproven COVID-19 home remedies. Here are some of the more common ones people have called our 24-hour poisons information service about, the types that can need medical care.</p>
<h2>1. Inhaling hydrogen peroxide</h2>
<p>Hydrogen peroxide is used in household disinfectants, chlorine-free bleaches, stain removers and hair dyes. And people have been calling about inhaling products containing hydrogen peroxide as a fine mist (called <a href="https://theconversation.com/what-are-nebulisers-and-how-could-they-help-spread-covid-19-155032">nebulising</a>).</p>
<p>Hydrogen peroxide (1-1.5%) mouthwashes <a href="https://pubmed.ncbi.nlm.nih.gov/34196047/">have been recommended</a> as an antiseptic before a dental procedure. However, results about whether it kills SARS-CoV-2, the virus that causes COVID-19, <a href="https://pubmed.ncbi.nlm.nih.gov/34399189/">are conflicting</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1446942764235698177"}"></div></p>
<p>Nebulising hydrogen peroxide <a href="https://pubmed.ncbi.nlm.nih.gov/15298493/">can cause</a> irritation and swelling to the nose, throat and lungs. People can develop a cough and become short of breath; it can cause persistent damage to the lungs. These symptoms can be misinterpreted as a lung infection. If you have COVID-19, nebulising hydrogen peroxide can make you sicker and prolong your recovery. </p>
<p>People also report nausea and vomiting after nebulising hydrogen peroxide. The risk is increased with solutions of higher concentrations, although we do not believe any concentration is safe.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-trying-ivermectin-for-covid-heres-what-can-happen-with-this-controversial-drug-167178">Thinking of trying ivermectin for COVID? Here's what can happen with this controversial drug</a>
</strong>
</em>
</p>
<hr>
<h2>2. Gargling or swallowing antiseptics</h2>
<p>People have also called about gargling or swallowing strong antiseptics. These can cause irritation, swelling and pain to the mouth, as well as vomiting, diarrhoea and stomach pains. </p>
<p>Gargling or swallowing <a href="https://pubmed.ncbi.nlm.nih.gov/32348645/">corrosive</a> household cleaning products, such as the type you’d use in your kitchen or bathroom, is <a href="https://pubmed.ncbi.nlm.nih.gov/30689457/">particularly unsafe</a>. This can lead to life-threatening injuries, including rupture and bleeding of the upper gut, between the mouth and stomach.</p>
<p>A <a href="https://www.rollingstone.com/culture/culture-news/betadine-anti-vaxxer-covid-treatment-iodine-1225438/">recently promoted</a> home remedy is gargling antiseptics containing povidone-iodine.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1439996535815684105"}"></div></p>
<p>Some low concentration (0.5-1%) of products containing povidone-iodine can be gargled. And povidone-iodine (0.5%) mouthwash has been recommended before a dental procedure to <a href="https://pubmed.ncbi.nlm.nih.gov/34561086/">prevent transmission</a> <a href="https://pubmed.ncbi.nlm.nih.gov/34399189/">of SARS-CoV-2</a>.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/34628705/">Small pilot studies</a> have suggested that similar low-strength gargle and nasal sprays may shorten the survival of SARS-CoV-2 in the nose and mouth. But these results should be confirmed in larger studies. </p>
<p>Although some people are allergic to povidone-iodine, low concentration solutions are <a href="https://pubmed.ncbi.nlm.nih.gov/32520599/">usually safe</a> when applied in the nose or mouth for a few months. </p>
<p>However, many products contain much higher concentrations of povidone-iodine and other chemicals designed for use on the skin. </p>
<p>So swallowing, gargling or inserting these products in the nose is not recommended.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gargling-with-iodine-wont-stop-you-getting-covid-167946">Gargling with iodine won't stop you getting COVID</a>
</strong>
</em>
</p>
<hr>
<h2>3. Bathing in bleach or disinfectant</h2>
<p>Bathing in household cleaning products (such as bleach or disinfectant), or applying them directly to the skin, can cause mild-to-moderate irritation and rashes.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/30689457/">Burns</a> <a href="https://pmj.bmj.com/content/59/693/472">can occur</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529601/">with stronger products</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bleach-bonfires-and-bad-breath-the-long-history-of-dodgy-plague-remedies-137658">Bleach, bonfires and bad breath: the long history of dodgy plague remedies</a>
</strong>
</em>
</p>
<hr>
<h2>4. Spraying face masks</h2>
<p>Routinely spraying disinfectants into face masks, and then breathing in the fumes and residue for a prolonged period, can also harm.</p>
<p>This can result in irritation to the throat and lungs, dizziness, headache and nausea.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/425389/original/file-20211008-13-wdygg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person spraying disposable face mask" src="https://images.theconversation.com/files/425389/original/file-20211008-13-wdygg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/425389/original/file-20211008-13-wdygg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/425389/original/file-20211008-13-wdygg9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/425389/original/file-20211008-13-wdygg9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/425389/original/file-20211008-13-wdygg9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/425389/original/file-20211008-13-wdygg9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/425389/original/file-20211008-13-wdygg9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you spray your face mask, you’ll breathe in the fumes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-woman-spraying-alcohol-on-medical-1737708047">Shutterstock</a></span>
</figcaption>
</figure>
<h2>5. Taking high-dose vitamins</h2>
<p>Taking over-the-counter supplements, including vitamins, for a prolonged period is also a concern as high doses can have <a href="https://www.nps.org.au/australian-prescriber/articles/the-safety-of-commonly-used-vitamins-and-minerals">side-effects</a>:</p>
<ul>
<li><p>vitamin C can cause kidney stones</p></li>
<li><p>zinc can cause loss of taste or smell</p></li>
<li><p>vitamin D can cause high concentrations of calcium in the blood, with effects including headache, thirst and, uncommonly, seizures.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vitamins-and-minerals-arent-risk-free-here-are-6-ways-they-can-cause-harm-165399">Vitamins and minerals aren't risk-free. Here are 6 ways they can cause harm</a>
</strong>
</em>
</p>
<hr>
<h2>It’s a confusing time</h2>
<p>COVID-19 is arguably the most confusing time in recent history for making decisions about our health care. While people debate if any of these proposed home remedies work, it is essential to also consider their potential harms. </p>
<p>Deaths and other complications are <a href="https://www.nps.org.au/australian-prescriber/articles/covid-19-and-the-quality-use-of-medicines-evidence-risks-and-fads">reported in people overseas</a> due to well-meaning use of proposed treatments and home remedies. We hope to avoid this in Australia. </p>
<hr>
<p><em>If this article raises concerns for you or for someone you know about a COVID-19 home remedy, call the <a href="https://www.poisonsinfo.nsw.gov.au/">Poisons Information Hotline</a> from anywhere in Australia on 131 126. This evidence-base advice is available 24 hours a day. For life-threatening symptoms, call 000.</em></p><img src="https://counter.theconversation.com/content/168660/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darren Roberts is the medical director of the NSW Poisons Information Centre, and a clinical toxicologist/pharmacologist at Royal Prince Alfred Hospital and St Vincent’s Hospital (Sydney).</span></em></p><p class="fine-print"><em><span>Nicole Wright is the Acting Department Head, NSW Poisons Information Centre</span></em></p>They’re calling for advice before using bleach or disinfectant. Or they’re calling to ask about side-effects after gargling, spraying or bathing in them. It’s a worry.Darren Roberts, Conjoint Associate Professor in clinical pharmacology and toxicology, UNSW SydneyNicole Wright, Clinical Educator, Faculty of Pharmacy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1665482021-08-30T12:33:58Z2021-08-30T12:33:58ZBreathing wildfire smoke can affect the brain and sperm, as well as the lungs<figure><img src="https://images.theconversation.com/files/418289/original/file-20210827-15-2ilngf.jpg?ixlib=rb-1.1.0&rect=0%2C202%2C4782%2C3113&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A runner wears a respirator on a smoky day in Portland, Oregon, in 2020.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/local-resident-wears-a-respirator-as-he-jogs-in-downtown-news-photo/1228516107">Robyn Beck/AFP via Getty Images</a></span></figcaption></figure><p>Wildfires burning in the western U.S. are sending smoke into communities far from the fires themselves, creating hazardous air for days or weeks at a time. A lot of people are wondering: What does breathing all that smoke do to our bodies?</p>
<p>Wildfire smoke is a <a href="https://theconversation.com/whats-in-wildfire-smoke-a-toxicologist-explains-the-health-risks-and-which-masks-can-help-164597">mix of chemicals</a> and tiny particles that are <a href="https://www.epa.gov/pm-pollution/particulate-matter-pm-basics">small enough</a> to evade the body’s defenses and directly affect the lungs. But the damage may not stop there.</p>
<p>As <a href="https://www.researchgate.net/profile/Luke-Montrose-2">environmental</a> <a href="https://www.researchgate.net/profile/Adam-Schuller">toxicologists</a>, we have been investigating the health effects of wildfire smoke on humans, including on parts of the body that you might not expect: sperm and the brain.</p>
<p>Given the <a href="https://doi.org/10.1029/2018GH000144">large number of people</a> now breathing wildfire smoke each summer – numbers that are likely to increase as <a href="https://nca2018.globalchange.gov/chapter/6/">wildfire conditions worsen</a> in a warming world – it’s important to understand how wildfire smoke can harm your body and how to protect yourself.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/418313/original/file-20210828-27-h51zzw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Map of wildfire smoke showing thickest smoke across large parts of California, Nevada, Utah, Oregon and Washington" src="https://images.theconversation.com/files/418313/original/file-20210828-27-h51zzw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418313/original/file-20210828-27-h51zzw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418313/original/file-20210828-27-h51zzw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418313/original/file-20210828-27-h51zzw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418313/original/file-20210828-27-h51zzw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418313/original/file-20210828-27-h51zzw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418313/original/file-20210828-27-h51zzw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smoke from large western wildfires was detected as far east as the Dakotas on Aug. 28, 2021.</span>
<span class="attribution"><a class="source" href="https://fire.airnow.gov/#">Interagency Wildland Fire Air Quality Response Program, EPA</a></span>
</figcaption>
</figure>
<h2>Pollution can change sperm’s genetic material</h2>
<p>Urban air pollution, which has a slightly different chemical profile than wildfire smoke, has already been linked with harmful effects to the male reproductive system. Studies have shown how air pollution produced from sources like industrial stacks and automobile exhaust can <a href="https://doi.org/10.1515/reveh-2020-0136">affect sperm shape, their ability to swim and the genetic material they carry</a>. However, <a href="https://doi.org/10.1038/s41467-021-21708-0">few studies</a> have looked at wildfire smoke as an independent source of toxicity.</p>
<p>One recent study found that baby rats born to parents that had been exposed to wood smoke could <a href="https://doi.org/10.3390/toxics9010003">end up with behavioral and cognitive problems</a>. That prompted our team at Boise State University, in collaboration with researchers at Northeastern University, to look closer at what happens to sperm of mice exposed to wildfire smoke.</p>
<p>Our goal was to look for small changes at the cellular level that might show us how negative effects could be passed from parents to the next generation. Mice aren’t humans, of course, but damage to their systems can provide clues about potential harm to ours.</p>
<figure class="align-center ">
<img alt="An older man with a cane crosses n empty road in smoky conditions." src="https://images.theconversation.com/files/418290/original/file-20210827-27217-1e796le.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418290/original/file-20210827-27217-1e796le.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418290/original/file-20210827-27217-1e796le.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418290/original/file-20210827-27217-1e796le.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418290/original/file-20210827-27217-1e796le.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418290/original/file-20210827-27217-1e796le.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418290/original/file-20210827-27217-1e796le.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Exposure to wildfire smoke can also harm the lungs, heart and brain.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/man-walks-along-ventura-ave-as-the-thomas-fire-leaves-smoke-news-photo/888932848">Wally Skalij/Los Angeles Times via Getty Images</a></span>
</figcaption>
</figure>
<p>We simulated a wildland fire in the laboratory by burning Douglas fir needles and chose a smoke exposure amount similar to what a wildland firefighter with 15 years of service would experience. We found that this exposure in a mouse <a href="https://www.mdpi.com/2305-6304/9/9/199">resulted in changes in sperm DNA methylation</a>. DNA methylation is a biological mechanism that can regulate how a gene is expressed, kind of like a dimmer switch on a light bulb. Environmental factors can influence DNA methylation, and this can be <a href="https://doi.org/10.1002/em.22311">harmful</a> if it occurs at the wrong time of life or at the wrong gene.</p>
<p>We were surprised to find that the effects of wood smoke were similar to the effects of <a href="https://doi.org/10.1038/s41598-020-72783-0">cigarette and cannabis smoke exposure</a> on sperm. Much more work is still needed to understand if and how these changes in sperm affect the offspring they create, and what the effect is in humans. Studying populations with extreme levels of smoke exposure, like wildland firefighters, would help to answer these questions. However, very <a href="https://doi.org/10.1016/j.ccm.2020.08.017">little data currently exists</a> for long-term exposure monitoring and health tracking in this group of workers. </p>
<h2>Links to Alzheimer’s and other ways smoke affects the brain</h2>
<p>Wood smoke exposure has also been linked to poor brain health, including conditions like Alzheimer’s disease. There is data that suggests wood smoke exacerbates symptoms of cognitive decline such as <a href="https://doi.org/10.1016/j.bj.2018.06.001">loss of memory or motor skills</a>.</p>
<p>In a recent <a href="https://doi.org/10.1177/2516865720954873">review article</a> in the journal Epigenetics Insights, we outlined the latest research showing how wildfire smoke particles or the inflammatory signals released by the immune system after exposure might reach the brain and contribute to these health problems. </p>
<p>One possibility is for very small particles to be inhaled into the lungs, escape into the blood stream and travel to the brain. A second possibility is the particles stay in the lungs but generate inflammatory signals that travel in the blood to the brain. Lastly, evidence suggests that particles may not need to travel to the lungs at all, but rather could get to the brain <a href="https://doi.org/10.1177/0192623317729222">directly from the nose</a> by following nerve bundles.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/418280/original/file-20210827-24-18b0u3u.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration showing PM2.5 compared to a human hair's width." src="https://images.theconversation.com/files/418280/original/file-20210827-24-18b0u3u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418280/original/file-20210827-24-18b0u3u.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=326&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418280/original/file-20210827-24-18b0u3u.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=326&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418280/original/file-20210827-24-18b0u3u.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=326&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418280/original/file-20210827-24-18b0u3u.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=409&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418280/original/file-20210827-24-18b0u3u.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=409&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418280/original/file-20210827-24-18b0u3u.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=409&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wildfire smoke particles include PM2.5 particulate matter that is much smaller than a human hair.</span>
<span class="attribution"><a class="source" href="https://ww2.arb.ca.gov/wildfire-smoke-health">California Air Resources Board</a></span>
</figcaption>
</figure>
<p>DNA methylation changes are especially crucial in brain areas like the hippocampus that are involved in learning and memory. If environmental exposures are changing DNA methylation, that may <a href="https://doi.org/10.1186/s13148-020-00893-7">help to explain</a> why Alzheimer’s disease can affect only one identical twin even though their genetic code is exactly the same.</p>
<h2>What can you do to stay safe?</h2>
<p>The potential impact of breathing wildfire smoke on lungs alone should be concerning enough to make people think twice about their level of exposure. Now, we’re seeing the potential for additional risks, including to the sperm and brain. Other research suggests connections between wildfire smoke and <a href="https://doi.org/10.1186/s12989-020-00394-8">heart inflammation</a> and the risk of <a href="https://doi.org/10.1016/j.envres.2021.111872">pre-term births</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-in-wildfire-smoke-a-toxicologist-explains-the-health-risks-and-which-masks-can-help-164597">What's in wildfire smoke? A toxicologist explains the health risks and which masks can help</a>
</strong>
</em>
</p>
<hr>
<p>So, what can you do to lower your health risk during wildfire season?</p>
<p>Start by staying alert to wildfire smoke warnings. The <a href="https://www.airnow.gov/">Environmental Protection Agency</a> and companies like <a href="https://www2.purpleair.com/">PurpleAir</a> have robust air monitoring networks with interactive maps that can show you how bad or good the air quality is in your area. You can also find low-cost air quality monitors.</p>
<p>In your home, change the filter on your furnace and air conditioner regularly and make sure it is the proper size. Portable HEPA air purification units in the rooms you spend the most time in can help, too.</p>
<p>Face masks can be a great tool when used properly. A mask labeled N-95 or higher is <a href="https://doi.org/10.1038/s41370-020-00267-4">designed to filter</a> out 95% or more of the harmful particles that get deep into the lungs, but only if they have the proper fitment. While cloth masks can help <a href="https://doi.org/10.1073/pnas.2014564118/">stop the spread of COVID-19</a>, they do not do a good job of filtering out wildfire smoke particles. This is partly because they don’t seal well on the face and because the material is not designed to capture dangerously small smoke particles.</p>
<p>As the planet warms and the West continues to dry, wildfire smoke is likely to become a common feature of summer. It’s important to understand the health risks so you can protect yourself.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/166548/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Luke Montrose receives funding from the technology access award provided by the Data Science core of the Idaho INBRE program under NIH/NIGMS Grant #P20GM103408 and Boise State COBRE program in Matrix Biology through NIH/NIGMS Grant #P20GM109095.</span></em></p><p class="fine-print"><em><span>Adam Schuller receives funding from the technology access award provided by the Data Science core of the Idaho INBRE program under NIH/NIGMS Grant #P20GM103408 and Boise State COBRE program in Matrix Biology through NIH/NIGMS Grant #P20GM109095.</span></em></p>To stay healthy, it’s important to understand how wildfire smoke can harm your body and how to protect yourself.Luke Montrose, Assistant Professor of Community and Environmental Health, Boise State UniversityAdam Schuller, Researcher in Biomolecular Sciences, Boise State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1645972021-07-15T19:10:09Z2021-07-15T19:10:09ZWhat’s in wildfire smoke? A toxicologist explains the health risks and which masks can help<figure><img src="https://images.theconversation.com/files/411549/original/file-20210715-17-gyrj5r.jpg?ixlib=rb-1.1.0&rect=0%2C99%2C4413%2C2959&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Wildfires filled Seattle with smoke in September 2020.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-take-photos-against-the-backdrop-of-the-space-needle-news-photo/1228482175?adppopup=true">Lindsey Wasson/Getty Images</a></span></figcaption></figure><p>Smoke is turning the sky hazy <a href="https://twitter.com/TWCChrisBruin/status/1415723640528719881">across</a> <a href="https://twitter.com/JamesGilbertWX/status/1415711862449184773">a large swath of the country</a> as <a href="https://www.nifc.gov/fire-information/nfn">dozens of large fires burn</a>, and a lot of people are wondering what’s in the air they’re breathing. </p>
<p>As an <a href="https://www.boisestate.edu/phps/luke-montrose/">environmental toxicologist</a>, I study the effects of wildfire smoke and how they <a href="https://www.nature.com/articles/s41467-021-21708-0">differ</a> from other sources of air pollution. We know that breathing wildfire smoke can be harmful. Less clear is what the <a href="https://theconversation.com/the-year-the-west-was-burning-how-the-2020-wildfire-season-got-so-extreme-148804">worsening wildfire landscape</a> will mean for public health in the future, but research is raising red flags.</p>
<p>In parts of the West, wildfire smoke now makes up <a href="https://www.doi.org/10.1029/2018GH000144">nearly half the air pollution</a> measured annually. A new <a href="https://ww2.arb.ca.gov/news/new-analysis-shows-spikes-metal-contaminants-including-lead-2018-camp-fire-wildfire-smoke">study</a> by the California Air Resources Board found another threat: high levels of lead and other metals turned up in smoke from the 2018 Camp Fire, which destroyed the town of Paradise. The findings suggest smoke from fires that reach communities could be even more dangerous than originally thought because of the building materials that burn.</p>
<figure class="align-center ">
<img alt="Map of showing smoke across the entire country" src="https://images.theconversation.com/files/411541/original/file-20210715-13-jwt6fi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/411541/original/file-20210715-13-jwt6fi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/411541/original/file-20210715-13-jwt6fi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/411541/original/file-20210715-13-jwt6fi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/411541/original/file-20210715-13-jwt6fi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=527&fit=crop&dpr=1 754w, https://images.theconversation.com/files/411541/original/file-20210715-13-jwt6fi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=527&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/411541/original/file-20210715-13-jwt6fi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=527&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">NOAA’s smoke forecast based on where fires were burning on July 15, 2021.</span>
<span class="attribution"><a class="source" href="https://rapidrefresh.noaa.gov/hrrr/HRRRsmoke/displayMapLocalDiskDateDomainZipTZA.cgi">NOAA</a></span>
</figcaption>
</figure>
<p>Here’s a closer look at what makes up wildfire smoke and what you can do to protect yourself and your family.</p>
<h2>What’s in wildfire smoke?</h2>
<p><a href="http://doi.org/10.1038/s41370-018-0064-7">What exactly is in a wildfire’s smoke</a> depends on a few key things: what’s burning – grass, brush or trees; the temperature – is it flaming or just smoldering; and the distance between the person breathing the smoke and the fire producing it.</p>
<p>The distance affects the ability of smoke to “age,” meaning to be acted upon by the Sun and other chemicals in the air as it travels. <a href="http://doi.org/10.1021/acs.est.9b01034">Aging can make it more toxic</a>. Importantly, large particles like what most people think of as ash do not typically travel that far from the fire, but small particles, or aerosols, can travel <a href="https://doi.org/10.1016/j.atmosenv.2018.06.006">across continents</a>.</p>
<p>Smoke from wildfires contains <a href="https://www3.epa.gov/airnow/wildfire-smoke/wildfire-smoke-guide-revised-2019.pdf">thousands of individual compounds</a>, including carbon monoxide, volatile organic compounds, carbon dioxide, hydrocarbons and nitrogen oxides. The most prevalent pollutant by mass is particulate matter less than 2.5 micrometers in diameter, roughly 50 times smaller than a grain of sand. Its prevalence is one reason health authorities issue air quality warnings using PM 2.5 as the metric.</p>
<p>The new study on smoke from the 2018 Camp Fire found <a href="https://ww2.arb.ca.gov/news/new-analysis-shows-spikes-metal-contaminants-including-lead-2018-camp-fire-wildfire-smoke">dangerous levels of lead</a> in smoke blowing downwind as the fire burned through Paradise, California. The metals, which have been linked to health harms including high blood pressure and developmental effects in children with long-term exposure, traveled more than 150 miles on the wind, with concentrations 50 times above average in some areas.</p>
<h2>What does that smoke do to human bodies?</h2>
<p>There is another reason <a href="https://www.calhospital.org/sites/main/files/file-attachments/wildfire_smoke_considerations_for_californias_public_health_officials_august_2019.pdf">PM2.5 is used to make health recommendations</a>: It defines the cutoff for particles that can travel deep into the lungs and cause the most damage.</p>
<p>The human body is equipped with natural defense mechanisms against particles bigger than PM2.5. As I tell my students, if you have ever <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/mucociliary-clearance">coughed up phlegm</a> or blown your nose after being around a campfire and discovered black or brown mucus in the tissue, you have witnessed these mechanisms firsthand.</p>
<p>The really small particles bypass these defenses and disturb the air sacs where oxygen crosses over into the blood. Fortunately, we have specialized immune cells present called macrophages. It’s their job to seek out foreign material and remove or destroy it. However, <a href="http://doi.org/10.2105/AJPH.2020.305744">studies have shown</a> that repeated exposure to elevated levels of wood smoke can suppress macrophages, leading to increases in lung inflammation.</p>
<h2>What does that mean for COVID-19 symptoms?</h2>
<p>Dose, frequency and duration are important when it comes to smoke exposure. Short-term exposure can irritate the eyes and throat. Long-term exposure to wildfire smoke over days or weeks, or breathing in heavy smoke, can raise the risk of <a href="https://www.calhospital.org/sites/main/files/file-attachments/wildfire_smoke_considerations_for_californias_public_health_officials_august_2019.pdf">lung damage</a> and may also contribute to <a href="https://health.ny.gov/environmental/outdoors/air/smoke_from_fire.htm">cardiovascular problems</a>. Considering that it is the macrophage’s job to remove foreign material – including smoke particles and pathogens – it is reasonable to make a <a href="http://doi.org/10.3109/08958378.2012.756086">connection</a> between smoke exposure and risk of viral infection.</p>
<p>Recent evidence suggests that long-term exposure to PM2.5 may make the coronavirus more deadly. A nationwide study found that even a small increase in PM2.5 from one U.S. county to the next was associated with a <a href="https://doi.org/10.1101/2020.04.05.20054502">large increase in the death rate</a> from COVID-19.</p>
<h2>What can you do to stay healthy?</h2>
<p>Here’s the advice I would give just about anyone downwind from a wildfire.</p>
<p>Stay informed about air quality by identifying local resources for air quality alerts, information about active fires and recommendations for better health practices. </p>
<p>If possible, avoid being outside or doing strenuous activity, like running or cycling, when there is an air quality warning for your area.</p>
<figure class="align-center ">
<img alt="Dark smoke over tree tops looks menacing" src="https://images.theconversation.com/files/353785/original/file-20200820-20-dsdu2t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/353785/original/file-20200820-20-dsdu2t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/353785/original/file-20200820-20-dsdu2t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/353785/original/file-20200820-20-dsdu2t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/353785/original/file-20200820-20-dsdu2t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/353785/original/file-20200820-20-dsdu2t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/353785/original/file-20200820-20-dsdu2t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Wildfire smoke pours over palm trees lining a street in Azusa, California, on Aug. 13, 2020.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/California-Wildfires/90e2257bf5394b46835b9d8b75b70e5c/15/0">AP Images/Marcio Jose Sanchez</a></span>
</figcaption>
</figure>
<p>Be aware that not all face masks protect against smoke particles. Most cloth masks will not capture small wood smoke particles. That requires an N95 mask that fits and is worn properly. Without a proper fit, N95s do not work as well.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>Establish a clean space. Some communities in western states have offered “clean spaces” programs that help people take refuge in buildings with clean air and air conditioning. However, during the pandemic, being in an enclosed space with others can create other health risks. At home, a person can create clean and cool spaces using a window air conditioner and a <a href="https://www.youtube.com/watch?v=kH5APw_SLUU">portable air purifier</a>. </p>
<p><a href="https://www.epa.gov/pm-pollution/how-smoke-fires-can-affect-your-health">The Environmental Protection Agency also advises</a> people to avoid anything that contributes to indoor air pollutants. That includes vacuuming that can stir up pollutants, as well as burning candles, firing up gas stoves and smoking.</p>
<p><em>This is an <a href="https://theconversation.com/whats-in-wildfire-smoke-and-why-is-it-so-bad-for-your-lungs-144790">update to a story</a> originally published on Aug. 20, 2020.</em></p><img src="https://counter.theconversation.com/content/164597/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Luke Montrose does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research found that smoke from the Camp Fire in Paradise, California, carried high concentrations of lead. An environmental toxicologist explains what else you’re breathing and how to stay safe.Luke Montrose, Assistant Professor of Community and Environmental Health, Boise State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1585142021-04-28T15:51:58Z2021-04-28T15:51:58ZOverdose crisis: The COVID-19 pandemic has laid bare decades of drug policy failures<p>A <a href="https://doi.org/10.15288/jsad.2020.81.556">syndemic</a> occurs when multiple public health emergencies interact to make each other worse. This past year clearly fits the label: the global COVID-19 pandemic has indisputably <a href="https://www.ctvnews.ca/health/pandemic-aggravates-opioid-crisis-as-overdoses-rise-and-services-fall-out-of-reach-1.5189677?">intensified the existing drug overdose crisis</a> in Canada. </p>
<p>For over a year now, there has been non-stop coverage of COVID-19, while a number of other issues continue to be neglected as “newsworthy.” For people who use drugs in particular, a public sense of the crisis has never quite taken hold, despite years of growing overdose deaths and harm across communities. </p>
<p>The pandemic has <a href="https://www.cbc.ca/news/canada/manitoba/margaret-swan-covid-matt-murray-raske-chief-john-lane-1.5756872">exacerbated risk and harm for people who use drugs</a>. However, it would be inaccurate and short-sighted to suggest that the spike in drug-related deaths over the past year is solely, or even primarily, the result of the pandemic.</p>
<p>Rather, current realities should be understood as the result of decades-long, pre-pandemic political decisions and the consequent, entrenched policy failures. From the <a href="https://www.vice.com/en/article/xdmgpj/how-canadas-rehab-centres-are-failing-opioid-users">lack of welfare and treatment services</a> to the <a href="https://drugpolicy.org/issues/discrimination-against-drug-users">criminalization of drug use and resulting stigmatization</a>, it is long-standing political inaction and failed policy measures that have resulted in the thousands of lives lost to overdoses and now, drug toxicity. </p>
<p>The pandemic has simultaneously intensified the problem and laid bare the urgent and immediate need for radical change to Canada’s drug policies. </p>
<h2>Drug-related deaths during the COVID-19 pandemic</h2>
<p>Earlier this month, <a href="https://thetyee.ca/News/2021/04/14/BC-Marks-Fifth-Anniversary-Overdose-Emergency-Decriminalization/">B.C. entered its fifth year of a public health emergency</a> related to drug overdoses. And this past year has been the worst so far: across the country, overdose deaths reached a record high with <a href="https://calgaryherald.com/news/postpandemic/canadas-hidden-crisis-how-covid-19-overshadowed-the-worst-year-on-record-for-overdose-deaths">4,000 lives lost in 2020</a>. The vast majority of these deaths are <a href="https://www.publichealthontario.ca/-/media/documents/o/2020/opioid-mortality-covid-surveillance-report.pdf?la=en">accidental</a>. </p>
<p>However, these numbers do not include overdoses that are not fatal but still produce harm, pain and health consequences for users, loved ones and communities. <a href="https://doi.org/10.1016/j.drugpo.2020.102958">Research has only begun to examine</a> the ways drug use and associated harms have changed in the face of increased drug toxicity and increased social vulnerability. </p>
<p>There are a number of pandemic-related reasons for the reported spike in drug-related deaths. For one, drug supply chains have been disrupted by the closure of the Canada-United States border which has resulted in <a href="https://www.cbc.ca/news/canada/ottawa/drugs-border-closed-fentanyl-1.5622414">increased drug toxicity</a>. Users and advocates are now signalling a shift from a drug “overdose” to a drug “toxicity” crisis. Last year, <a href="https://thetyee.ca/News/2021/04/15/For-One-Day-BC-Activists-Handed-Out-Clean-Heroin-Cocaine/">over one-third</a> of all deaths of people under the age of 44 were caused by poisoned drugs in B.C. Many other provinces are seeing a similar trend.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/M8oDFT_RUtI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">B.C. marks five years since declaring public health emergency due to toxic drug deaths.</span></figcaption>
</figure>
<p>What is more, public health measures aimed at curbing the spread of COVID-19 have had a number of <a href="https://bcmj.org/blog/crossroads-intersecting-public-health-emergencies-covid-19-and-overdose-crisis-bc">unintended consequences</a> that have gravely impacted the well-being and survival of people who use drugs. </p>
<p><a href="https://www.policyalternatives.ca/publications/reports/state-inner-city-report-2020">Community-based organizations</a> have noted the extent to which access to life-saving supports (like overdose prevention services, food and housing) have been restricted by physical distancing and other public health guidelines. </p>
<p>But as these organizations have struggled to pivot their services in response to ever-changing COVID-19 conditions, their ability to provide direct support and interact with people who use drugs has become more challenging. </p>
<p>This has meant that <a href="https://doi.org/10.1016/j.drugpo.2020.102896">people are more likely to use drugs alone</a>, which increases risk and limits access to care and support that contribute to safety and survival if an emergency should arise. </p>
<p>This particular gap in COVID-19 policy has starkly highlighted the pressing need for access to safe consumption supplies (<a href="https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/">including Naloxone</a>) during the pandemic and beyond.</p>
<h2>Crisis as an opportunity for radical policy change</h2>
<p>It is important that we study and understand how the pandemic and the overdose crisis are connected. But it is even more important that we remember the decades of drug policy failures that have provided the perfect breeding ground for the devastation that has been unfolding this past year. </p>
<p>Crises, like COVID-19, can be pivotal moments in recognizing problems in need of a solution and clarifying our views about how society should work by allowing us to push for real systemic change. As researchers studying the nature of and criminal legal and public health responses to a so-called <a href="https://www.ctvnews.ca/canada/winnipeg-s-meth-crisis-requires-immediate-action-advocates-1.4488571?cache=fntnfcwxeqoveki%3FclipId%3D68596">“meth crisis” in Manitoba</a>, we believe it is essential to identify the <a href="https://c0c42d9a-a170-4571-949c-ea8bd55b102f.filesusr.com/ugd/3ac972_5e8f476e080541b790a8dd4d6187a9d3.pdf">relationship between current cascading and overlapping crisis points</a> and understand them within wider political and social context. </p>
<p>We need to consider radical remedies to drug overdoses and deaths. First and foremost, <a href="https://drugpolicy.ca/about/publication/harm-reduction-in-canada-what-governments-need-to-do-now/">decriminalizing the possession of illicit drugs for personal use </a>. <a href="https://www.theguardian.com/us-news/commentisfree/2016/jul/05/why-de-criminalize-all-drugs-stigma">Decriminalization</a> promises the opportunity to prevent accidental deaths and harm due to a toxic drug supply. It also contributes to <a href="https://drugpolicy.org/resource/stigma-and-people-who-use-drugs">reducing stigma</a> and associated barriers to accessing supports. </p>
<p>Earlier this month, B.C. <a href="https://thetyee.ca/News/2021/04/14/BC-Marks-Fifth-Anniversary-Overdose-Emergency-Decriminalization/">announced</a> that the province will “seek an exemption from drug possession laws under Section 56 of the Controlled Drugs and Substances Act.” Users and advocates alike are wary of the announcement, however, stifling their excitement until words turn to action. </p>
<p>In the meantime, <a href="https://www.dulf.ca/">people who use drugs and activists</a> will continue to advocate for decriminalization and access to safe, regulated supply. For the <a href="https://thetyee.ca/News/2020/06/23/Safe-Supply-Drug-Demo/">second year</a> in a row, people have <a href="https://thetyee.ca/News/2021/04/15/For-One-Day-BC-Activists-Handed-Out-Clean-Heroin-Cocaine/">distributed</a> clean heroin, cocaine and methamphetamine to people over 18 who already use illicit drugs in Vancouver’s Downtown Eastside. </p>
<p>If COVID-19 has not provided the push for our governments to take radical action, and if now is not the time to undo the harms of past drug policies, when will it be?</p><img src="https://counter.theconversation.com/content/158514/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katharina Maier and her research team receive funding from the Social Sciences and Humanities Research Council of Canada for her research on drugs and crisis. </span></em></p><p class="fine-print"><em><span>Rebecca Hume does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Across the country, overdose deaths have spiked during the COVID-19 pandemic.Katharina Maier, Assistant Professor, Criminal Justice, University of WinnipegRebecca Hume, Senior Research Assistant, Criminal Justice, University of WinnipegLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1481282020-10-20T14:52:02Z2020-10-20T14:52:02ZSouth Africans aren’t being protected from fake sanitisers: what needs to be done<figure><img src="https://images.theconversation.com/files/364241/original/file-20201019-19-1o3mzv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The WHO recommends sanitisers with an alcohol content of at least 70%.</span> <span class="attribution"><span class="source">Phill Magakoe / AFP via Getty Images</span></span></figcaption></figure><p>A wave of panic buying struck many countries when national states of disaster were announced in response to the global COVID-19 pandemic. Overnight, toilet paper, cleaning products and hand sanitisers became the most sought-after products on the <a href="https://www.bbc.com/news/stories-52126847">market</a>. </p>
<p>This was true in South Africa too. Production facilities for raw materials of hand sanitisers experienced an increase of nearly 400% in bulk <a href="https://www.chemengonline.com/sasol-roquette-join-growing-list-of-manufacturers-adapting-plants-to-produce-hand-sanitizer/">orders</a>. Suppliers could not keep up with sudden mass orders for hundreds of thousands of <a href="https://www.dailymaverick.co.za/article/2020-04-03-the-sanitiser-conundrum-its-complicated-but-improving/">litres</a>. </p>
<p>In response to the shortage, governments across the world adopted temporary policies. These allowed for the production of hand sanitiser by entities that weren’t registered manufacturers and for alcohol <a href="https://www.dailymaverick.co.za/article/2020-04-03-the-sanitiser-conundrum-its-complicated-but-improving/">distillers</a> to shift their production to hand sanitisers. </p>
<p>In South Africa’s economic hub, Gauteng province, non-specialist companies were speedily registered to secure government contracts. The surge in demand also opened doors for exploitation and corruption. Some companies supplying government departments saw an opportunity to supply hand sanitisers at inflated prices – at an estimated R66 million ($398,532) above market <a href="https://www.dailymaverick.co.za/article/2020-08-30-gauteng-healths-deadly-r500m-ppe-rip-off/">prices</a>. </p>
<p>Concern has been growing about safety issues related to hand sanitisers – in South Africa as well as other countries. But South Africa has been behind the curve in putting in place measures to ensure products are safe.</p>
<h2>Filling a gap</h2>
<p>In the absence of a vaccine, hand hygiene has become a critical part of the response to COVID-19. Washing hands at regular intervals during the day is viewed as essential. If water and soap are unavailable, hand sanitisers have served as a useful alternative. </p>
<p>The purpose of a hand sanitiser is to disrupt the enveloping lipid membrane of SARS-CoV-2. This kills the <a href="https://wwwnc.cdc.gov/eid/article/26/7/20-0915_article">virus</a>. The World Health Organisation (WHO) has recommended that consumers use an alcohol-based sanitiser with an alcohol content of at least 70%, based on effective and fast anti-microbial <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf?ua=1">activity</a>. </p>
<p>The WHO further <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf?ua=1">recommends</a> that hand sanitisers comprise ethyl alcohol (ethanol) or isopropyl alcohol (2-propanol) as the active ingredient, in addition to inactive ingredients listed as follows:</p>
<ul>
<li><p>Water as a diluent;</p></li>
<li><p>Glycerol to prevent drying out users’ skin; and</p></li>
<li><p>Hydrogen peroxide to inactivate contaminating bacterial spores in the <a href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf?ua=1">solution</a>.</p></li>
</ul>
<p>The guide, as well as statements issued by the US Food and Drug Administration, recommends that perfumes or dyes not be added due to risk of allergic <a href="https://www.fda.gov/media/136289/download">reactions</a>. The Australian Department of <a href="https://www.legislation.gov.au/Details/F2020L00340#:%7E:text=Therapeutic%20Goods%20(Excluded%20Goods%E2%80%94Hand%20Sanitisers)%20Determination%202020,-%2D%20F2020L00340&text=This%20instrument%20excludes%20specified%20hand,to%20the%20COVID%2D19%20emergency.">Health</a> goes so far as to say that hand sanitisers may not contain any other active or inactive ingredients. These include colourants, fragrances or emollients.</p>
<p>But the policing of these conditions has been weak in countries like South Africa.</p>
<h2>Maintaining standards</h2>
<p>In the US, the Food and Drug Administration has played a leading role in identifying inferior products. By early October more than 200 products had been <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use">recalled</a> that contained either methanol, 1-propanol or less than the required amount of alcohol. </p>
<p>Methanol is a cheaper alcohol, but repeated use of methanol-based hand sanitiser can cause it to be absorbed through the skin. This can cause chronic toxicity, hallucinations or even death in <a href="https://www.mdpi.com/1660-4601/15/7/1440">extreme cases</a>. As for 1-propanol, not to be confused with 2-propanol, the substance can be toxic and life-threatening when ingested and is therefore not an acceptable ingredient for <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitizers-consumers-should-not-use">hand sanitisers</a>. </p>
<p>Countries across the globe have detected other toxic substances in hand sanitisers that can also pose acute or chronic toxicity. These include <a href="https://www.bbc.com/news/uk-england-birmingham-51979932?intlink_from_url=&link_location=live-reporting-story">glutaraldehyde</a>, <a href="https://chemycal.com/news/eca0070d-04ff-48fa-867e-81fb3d18913d/Danish_EPA__Hand_disinfection_products_are_recalled">polyhexamethylene biguanide</a> and <a href="https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/73385a-eng.php#:%7E:text=Ethyl%20acetate%3A%20Frequent%20use%20of,respiratory%20system%20irritation%20and%20headaches">ethyl acetate</a>. </p>
<p>Sub-potent levels of alcohol have been recorded in the <a href="https://nltimes.nl/2020/06/24/hand-sanitizers-public-spaces-always-scratch-report">Netherlands</a>, the <a href="https://english.alarabiya.net/en/News/gulf/2020/04/02/Coronavirus-Dubai-recalls-these-6-hand-sanitizers-for-containing-methanol">UAE</a>, <a href="https://thenewdaily.com.au/finance/consumer/2020/07/16/hand-sanitiser-ineffective/">Australia</a>, <a href="https://www.inewsguyana.com/food-and-drug-recalls-substandard-purcill-hand-sanitizers/#:%7E:text=The%20Government%20Analyst%20Food%20and,as%20stated%20on%20the%20labels.">Guyana</a>, <a href="https://businesstoday.co.ke/kebs-kenya-bureau-of-standards-quality-concerns-kebs-bans-hand-sanitizers/#:%7E:text=KEBS%20Bans%20More%20Sanitizer%20Brands%20Over%20Quality%20Concerns%20In%20July,brands%20over%20the%20same%20reason&text=The%20Kenya%20Bureau%20of%20Standards,failure%20to%20meet%20quality%20threshold.">Kenya</a>, <a href="https://www.nafdac.gov.ng/public-alert-no-003-2020-alert-on-illegal-distribution-and-sale-of-unregistered-hand-sanitizers/">Nigeria</a> and <a href="https://www.iol.co.za/news/africa/rwanda-food-and-drug-authority-recalls-locally-manufactured-hand-sanitiser-45986888">Rwanda</a>. Zambia <a href="https://www.themastonline.com/2020/06/20/zamra-recalls-unsafe-sanitisers-disinfectants/">recalled</a> products from a number of producers, including South Africa. </p>
<p>In South Africa, the Bureau of Standards recently issued a press release, raising concerns about substandard sanitisers produced by “unscrupulous” manufacturers who were falsely claiming that their products had been <a href="https://www.sabs.co.za/Media/SABS-comments-on-the-illegal-us-of-its-Mark-on-sanitizers.asp">certified</a>. Reference was made to low-quality versions that can trigger skin allergies and can damage the skin, often presenting as a form of eczema.</p>
<p>In May 2020, a <a href="https://www.timeslive.co.za/news/consumer-live/2020-07-08-investigation-your-hand-sanitiser-might-not-be-keeping-you-as-safe-as-you-think/">laboratory</a> found that two out of the 11 hand sanitisers bought from retailers in the city of Pietermaritzburg contained 1-propanol. Four contained only between 46% and 67% alcohol while claiming to contain 70%.</p>
<p>Yet no hand sanitiser products in South Africa have been recalled. The country also has no regulatory system in place to assess hand sanitisers intended for household use. Companies have been <a href="https://ipasa.co.za/wp-content/uploads/2020/04/Comm-to-Industry_Covid-19_Reg-Status-of-Equipment-to-prevent_09April2020_vF.pdf">required</a> to voluntarily comply with the national standard on disinfectant alcohol-based hand-rubs, but this is woefully inadequate. </p>
<p>Part of the <a href="https://www.gov.za/sites/default/files/gcis_document/201409/321864670.pdf">Consumer Protection Act</a> seeks to ensure that consumers are provided with adequate evidence-based information. This is critical, especially since consumers are inundated with all sorts of brands and types of sanitisers that are intended for frequent use. </p>
<h2>What needs to be done</h2>
<p>A number of urgent steps need to be considered.</p>
<p>Firstly, labelling requirements should be standardised and enforced. The following information should be indicated on every bottle of hand sanitiser: </p>
<ul>
<li><p>an alcohol content of at least 70%; </p></li>
<li><p>a list of the active and inactive ingredients and the adverse effects they may cause; </p></li>
<li><p>instructions for use;</p></li>
<li><p>mandatory warnings;</p></li>
<li><p>the batch code and expiry date; and</p></li>
<li><p>the full address of the manufacturer. </p></li>
</ul>
<p>Secondly, public awareness programmes about correct hand hygiene techniques and the safe use, storage and effectiveness of hand sanitisers should be launched. </p>
<p>Thirdly, products that don’t comply with specifications or are not properly labelled should not be sold or provided in public spaces. </p>
<p>Fourth, a national task team should be established to investigate the regulatory framework and current levels of compliance. </p>
<p>Fifth, imports of raw material used in manufacturing of hand sanitisers and ready-to-use formulated products should be regulated more effectively. Likewise, products that are exported from South Africa to neighbouring <a href="https://www.timeslive.co.za/politics/2020-05-29-sa-exporting-millions-of-facemasks-hand-sanitiser-patel/">countries</a> should be monitored better. </p>
<p>Finally, environmental health inspectors or the <a href="https://www.nrcs.org.za/">National Regulator for Compulsory Specifications</a> should mercilessly track down fake products and have them confiscated and destroyed.</p>
<p><em>Dr Tracy Muwanga, a trans-disciplinary postdoctoral fellow in the faculties of Law and Natural and Agricultural Sciences at the University of Pretoria, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/148128/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Willeke de Bruin receives funding from the University of Pretoria's UNICEF One Health for Change project. </span></em></p><p class="fine-print"><em><span>Lise Korsten does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hand hygiene is a critical part of the response to COVID-19. Washing hands at regular intervals during the day is essential. If water and soap are unavailable, hand sanitisers are an alternative.Lise Korsten, Professor in the Department of Microbiology and Plant Pathology and Co-Director at the Centre of Excellence in Food Security, University of PretoriaWilleke de Bruin, Postdoctoral fellow - Faculty of Natural and Agricultural Sciences, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1451812020-10-05T04:19:50Z2020-10-05T04:19:50ZCurious Kids: what happens if you breathe pure oxygen?<figure><img src="https://images.theconversation.com/files/358790/original/file-20200918-14-19ewyu1.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C582&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breathing pure oxygen would be like fireworks exploding in your body. And that's not always a good thing.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/abstract-colored-firework-background-free-space-516676762">Shutterstock</a></span></figcaption></figure><blockquote>
<p><strong>What happens if you breathe pure oxygen and why? Stephen, age 9, Muntinlupa City, The Philippines</strong></p>
</blockquote>
<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>Hi Stephen!</p>
<p>That’s a great question. We can’t live without <a href="https://kids.britannica.com/kids/article/oxygen/353585">oxygen</a>. But too much can harm us. Let’s find out why.</p>
<p>Our bodies make the energy we need to run around, play and do schoolwork, by burning the food we eat. Think of this a bit like a candle burning. To burn our food, we need oxygen, which we get from breathing in the air around us.</p>
<p>Oxygen isn’t the only gas in the air. In fact, air’s mostly made of <a href="https://kids.britannica.com/kids/article/nitrogen/353537">nitrogen</a>. This has a very important job. Nitrogen slows down the burning process so you get enough energy through the day, bit by bit.</p>
<p>If you breathed pure oxygen, the energy from your food would be released all at once. So forget candles. This is more like a firework exploding. Bang! If you breathed pure oxygen, you wouldn’t actually explode. But you would damage your body.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-when-i-swipe-a-matchstick-how-does-it-make-fire-116673">Curious Kids: when I swipe a matchstick how does it make fire?</a>
</strong>
</em>
</p>
<hr>
<p>Breathing pure oxygen sets off a series of runaway chemical reactions. That’s when some of that oxygen turns into its dangerous, unstable cousin called a “radical”. Oxygen radicals harm the fats, protein and DNA in your body. This damages your eyes so you can’t see properly, and your lungs, so you can’t breathe normally.</p>
<p>So breathing pure oxygen is quite dangerous.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/m6haYrvAQ5s?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Food, oxygen and explosions!</span></figcaption>
</figure>
<p>But breathing pure oxygen can sometimes be necessary. <a href="https://www.nasa.gov/audience/forstudents/k-4/stories/nasa-knows/what-is-a-spacewalk-k4.html">Astronauts</a> and <a href="https://www.scubadoctor.com.au/scuba-diving-gas-analysis.htm">deep-sea scuba divers</a> sometimes breathe pure oxygen because they work in very dangerous places.</p>
<p>The length of time they breathe pure oxygen, and how much they breathe, is carefully controlled so they’re not harmed.</p>
<p>Sick people, including <a href="https://medlineplus.gov/ency/article/007242.htm">premature babies in hospital</a> or people in hospital <a href="https://theconversation.com/how-are-the-most-serious-covid-19-cases-treated-and-does-the-coronavirus-cause-lasting-damage-134398">with the coronavirus</a>, might also need some extra help breathing. They might be given a bit of extra oxygen on top of what’s in the air. It acts like a medicine to help calm and settle their breathing. </p>
<p>Again, too much oxygen can be dangerous. That’s why doctors and nurses keep a close eye to make sure people get just the right amount they need.</p>
<p>So we need oxygen to help us get energy from our food. We might also need a little extra if we’re sick in hospital, or if we’re an astronaut or deep-sea diver. But too much oxygen can harm us.</p>
<hr>
<p><em>Hello, Curious Kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/145181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Lynch does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You might think the more oxygen you breathe in the better. But too much oxygen can make you sick.Mark Lynch, Lecturer in Chemistry, University of Southern QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1391532020-06-07T08:41:19Z2020-06-07T08:41:19ZWhy it’s vital to look beyond the hype about repurposed malaria drugs<figure><img src="https://images.theconversation.com/files/337959/original/file-20200527-20219-1ncjwns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The World Health Organisation has suspended the use of hydroxychloroquine in a global drug trial.</span> <span class="attribution"><span class="source">George Frey/AFP via Getty Images</span></span></figcaption></figure><p>There are many examples in history of drugs that have been <a href="https://www.tandfonline.com/doi/full/10.1080/17460441.2020.1704729">repurposed</a> for different diseases. One such drug is chloroquine, which was and is still used for malarial treatment. It has been repurposed as an anti-inflammatory, anti-diabetic and, most recently, as an anti-viral drug. </p>
<p>Chloroquine was first produced in 1934, and <a href="https://blogs.sciencemag.org/pipeline/archives/2020/03/20/chloroquine-past-and-present">widely distributed</a> to soldiers who were training or stationed in malaria hot spots during World War II. By 1945, the drug became the <a href="https://www.astmh.org/ASTMH/media/Documents/Presidential%20Addresses/1962-G-Robert-Coatney.pdf">standard recommendation</a> for malaria treatment by the World Health Organisation (WHO). </p>
<p>The wide distribution of chloroquine led to the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052376/">observation</a> that the drug improved rashes and arthritis in soldiers. Not long after, it was prescribed to <a href="https://www.elsevier.com/books/dubois-lupus-erythematosus-and-related-syndromes/wallace/978-1-4377-1893-5">lupus and arthritis</a> patients globally. </p>
<p>But these patients also suffered from blurry vision, gastrointestinal problems and weakened muscles. To decrease the side-effects of chloroquine, hydroxychloroquine, which is identical to chloroquine with the exception of one chemical group, was produced in <a href="https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=reportsSearch.process&rptName=1&reportSelectMonth=4&reportSelectYear=1955&nav">1955</a> and has been used since. </p>
<p>Observational studies in arthritis and lupus patients who received chloroquine or hydroxychloroquine over a long time period suggested that these patients were less likely to develop <a href="https://jamanetwork.com/journals/jama/fullarticle/207908">type 2 diabetes</a>, and a new role for these drugs as a potential anti-diabetic treatment emerged in <a href="https://diabetes.diabetesjournals.org/content/33/12/1133.long">1984</a>.</p>
<p>But reports have also <a href="https://www.sciencedirect.com/science/article/abs/pii/S1473309907701871">suggested</a> that high doses of chloroquine and hydroxychloroquine can be harmful to the heart. We set out to <a href="https://link.springer.com/article/10.1007/s10557-018-06847-9">investigate</a> this and found that there were indeed cardiovascular effects which might outweigh the drug’s advantages. This risk needs to be considered carefully, especially when researchers are looking for quick solutions to urgent health problems.</p>
<h2>Anti-diabetic</h2>
<p>To understand how hydroxychloroquine works against diabetes, it’s necessary to know something about the human body’s response to food.</p>
<p>Insulin resistance develops when there is a surplus of nutrients present in the diet (for example in obesity) over long time periods. The excess glucose present in the blood stimulates a continuous release of insulin. Cells throughout the body become desensitised to the extra glucose and insulin. They decrease their uptake of both, which influences cell behaviour. </p>
<p>In type 2 diabetes, the body can’t produce any insulin in response to the extra glucose. Hydroxychloroquine stimulates the body to produce more insulin and keep it in the blood for longer by protecting it from being broken down. This gives the cells more time to take up both insulin and glucose. </p>
<p>But this does not come cheap. Hydroxychloroquine can also lower blood pressure, cause an irregular heartbeat and further decrease already low blood sugar levels. All of these are serious side effects.</p>
<p>The advantages and disadvantages of chloroquine and hydroxychloroquine as repurposed drugs have led to a debate in <a href="https://www.tandfonline.com/doi/abs/10.3109/08923973.2013.780078">scientific literature</a> about its use and dosages. </p>
<p>Our study <a href="https://link.springer.com/article/10.1007/s10557-018-06847-9">investigated</a> the effect of different chloroquine concentrations on the rat heart. We found that a single low dose of chloroquine is enough to significantly decrease heart rate and function. Long-term treatment with low doses of chloroquine worsened heart function in healthy and obese rats and did not improve glucose uptake in the obese animals.</p>
<p>Overall, our study concluded that the side effects of chloroquine on the heart, after as little as a single low dose, outweigh any therapeutic advantages that the drug might have for diabetic patients, especially when there are more effective and less toxic anti-diabetic drugs available.</p>
<p>There have been reports of <a href="http://www.jrheum.org/content/39/5/1099.long">heart complications</a> in patients with diabetes, arthritis, <a href="https://journals.sagepub.com/doi/full/10.1177/2048872612471215?casa_token=tCzcx5PRxGUAAAAA%3A0Jsrk4nQVHEi23QvVCGMkpeSvsVYs4piljrU6cCTVTG4cTm8xf9CsgxdlmsYgbBsJ3YDMzqqoYcI">lupus</a> and <a href="https://academic.oup.com/jac/article/70/6/1608/728687">malaria</a> treated with chloroquine or hydroxychloroquine. This has been blamed, partly, on the drug’s ability to stop the cellular recycling machinery from working. This also prevents insulin from being degraded and can result in a buildup of toxic byproducts. </p>
<p>Both chloroquine and hydroxychloroquine accumulate in cells over time. It’s <a href="https://www.tandfonline.com/doi/full/10.3109/08923973.2013.780078">believed</a> that this accumulation leads to some of the side effects observed after prolonged use or very high doses. Both drugs are still widely prescribed for arthritis, lupus and malaria, but patients are <a href="https://www.onlinecjc.ca/article/S0828-282X(14)01284-7/fulltext">advised</a> to undergo annual electrocardiograms.</p>
<h2>From anti-malarial to anti-viral</h2>
<p>Recently, chloroquine and hydroxychloroquine have come to the fore in the search for a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102549/">treatment</a> for COVID-19. This is because the drugs were shown to prevent viruses from multiplying inside a cell under laboratory conditions.</p>
<p>They were tested against <a href="https://retrovirology.biomedcentral.com/articles/10.1186/s12977-015-0178-0">HIV</a> and the <a href="https://europepmc.org/article/med/15351731">human coronavirus</a> that caused the severe acute respiratory syndrome outbreak of 2002-2003. But these studies were mainly done in laboratories and rarely tested in patients. </p>
<p>A recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102549/">study</a> (20 patients) in France found that hydroxychloroquine lowered the viral load of SARS-CoV-2, the virus that causes COVID-19. The study did not report any side-effects, but has been widely <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25898">criticised</a> for design flaws in the methodology. This was followed by a <a href="https://www.medrxiv.org/content/10.1101/2020.04.07.20056424v2">larger study</a> in Brazil where 81 patients were treated with either low or high doses of chloroquine. Within three days of the study, several of the patients developed an irregular heartbeat (arrhythmia). After six days, 11 patients had died. The high dose arm of the study was stopped, citing a 25% increased risk of developing arrhythmia. </p>
<p>The WHO recently <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---25-may-2020">suspended the use</a> of hydroxychloroquine in a global drug trial. This followed the publication of a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext">study</a> that showed no benefits from the use of chloroquine or hydroxychloroquine for COVID-19, and suggested that the drugs might actually be harmful. But data from this study and <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2021225">others</a> by the authors could not be independently verified, and have been <a href="https://www.thelancet.com/lancet/article/s0140673620313246">retracted</a>. </p>
<h2>Way forward</h2>
<p>At this stage, the scientific community <a href="https://www.nature.com/articles/d41586-020-01165-3">warns</a> that the <a href="https://www.sciencemag.org/news/2020/04/antimalarials-widely-used-against-covid-19-heighten-risk-cardiac-arrest-how-can-doctors">hype</a> around chloroquine and hydroxychloroquine could derail the search for more effective treatments. There is an urgent need to develop effective treatments against COVID-19. But there are also many pitfalls in small, uncontrolled <a href="https://www.nature.com/articles/d41586-020-01391-9">drug trials</a>, and the accelerated pace at which data is published. </p>
<p>If these drugs are prescribed for COVID-19, it should be done with extreme caution and a detailed risk assessment of the patient. The Food and Drug Administration in the US has <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or">warned</a> against the use of chloroquine and hydroxychloroquine outside of a clinical setting or drug trial. </p>
<p>In the hope of finding a cure for COVID-19, it is easy to get lost in the hype and rapid publication of data. For now, chloroquine and hydroxychloroquine should be handled with caution, at least until more information from robust and peer-reviewed studies is available about its effect on the hearts of compromised COVID-19 patients.</p><img src="https://counter.theconversation.com/content/139153/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marguerite Blignaut does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In the hope of finding a cure for COVID-19, it is easy to get lost in the hype. But chloroquine and hydroxychloroquine should for now be set aside.Marguerite Blignaut, Postdoctoral research fellow, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1241692019-10-02T20:03:40Z2019-10-02T20:03:40ZHere’s what happened when codeine was made prescription only. No, the sky didn’t fall in<figure><img src="https://images.theconversation.com/files/295175/original/file-20191002-101447-15o2pee.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C998%2C652&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When people went to their GP asking for painkillers, they weren't prescribed higher doses of codeine or stronger opioids, as some feared.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/british-gp-talking-senior-woman-surgery-98521166?src=CyaCbhqZljZiIOusQJyLog-1-11">from www.shutterstock.com</a></span></figcaption></figure><p>Fears switching the painkiller codeine to a prescription only medicine would lead to more people misusing stronger painkillers are unfounded, according to research published today.</p>
<p>Our research, in the journal <a href="https://onlinelibrary.wiley.com/doi/10.1111/add.14798">Addiction</a>, found the 2018 switch resulted in a 50% drop in codeine overdoses and sales. There was also no increase in overdoses with stronger opioids or high strength codeine, as some had feared.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/trust-me-im-an-expert-the-science-of-pain-91907">Trust Me I'm An Expert: The science of pain</a>
</strong>
</em>
</p>
<hr>
<h2>Remind me again, how did we get here?</h2>
<p>Australia has a love affair with codeine. It has historically been our <a href="https://www.ncbi.nlm.nih.gov/pubmed/26781123">most used opioid</a>, and 2013 data showed we <a href="https://www.ncbi.nlm.nih.gov/pubmed/26690771">took more codeine</a> as a country than the USA, despite having roughly 7% the population.</p>
<p>However, from <a href="https://www.tga.gov.au/codeine-info-hub">February 2018</a>, you could only buy codeine in Australia with a prescription. Before then, you could buy low strength codeine (up to 15mg per tablet) in combination with paracetamol, ibuprofen and aspirin over-the-counter (OTC) at pharmacies. Higher strength codeine has always required a prescription.</p>
<p>The 2018 change was not an overnight decision. Codeine has been on the government’s radar for <a href="https://ris.pmc.gov.au/sites/default/files/posts/2017/02/codeine_re-scheduling_ris.pdf">over a decade</a>; the Therapeutic Goods Administration (TGA) set up a codeine working party in 2008 in response to increasing misuse. Codeine is an opioid analgesic, meaning people can become dependent on it, and there is a risk of harm from overdose.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-making-codeine-products-prescription-only-is-a-good-idea-34745">Why making codeine products prescription-only is a good idea</a>
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</em>
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<p>There was also an <a href="https://ris.pmc.gov.au/sites/default/files/posts/2017/02/codeine_re-scheduling_ris.pdf">earlier attempt at reducing harm</a> when in 2010, all codeine painkillers were moved behind the counter at pharmacies. Before that, the lower strength products could be picked up off the pharmacy shelf without consulting a pharmacist.</p>
<p>Unfortunately, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27177599">our previous study</a> showed this move to stocking codeine behind the counter had little impact. Other studies also showed that <a href="https://www.mja.com.au/journal/2015/203/7/trends-and-characteristics-accidental-and-intentional-codeine-overdose-deaths">deaths from codeine continued to increase</a>. </p>
<p>The <a href="https://www.aihw.gov.au/getmedia/15db8c15-7062-4cde-bfa4-3c2079f30af3/21028a.pdf.aspx?inline=true">2016 National Drug Strategy Household Survey</a> reported codeine available from behind the counter at a pharmacy was the most misused legal opioid in Australia and misuse was particularly common in adolescents. </p>
<p>This left the TGA with little choice but to bring Australia in line with most other countries that restrict codeine to prescription only. The TGA announced the change in <a href="https://www.tga.gov.au/scheduling-decision-final/scheduling-delegates-final-decision-codeine-december-2016">December 2016</a> following a lengthy consultation, and the change took effect on February 1, 2018.</p>
<h2>Not everyone was happy</h2>
<p>The announcement <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12568">divided community and health-care professional groups</a>. <a href="https://www.pulseitmagazine.com.au/news/australian-ehealth/2770-rescheduling-otc-codeine-could-cost-316m-a-year-guild">Pharmacy organisations</a> opposed the change, whereas <a href="https://www1.racgp.org.au/newsgp/professional/gps-criticise-pharmacy-guild-on-codeine-rescheduli">GPs were in favour</a>. </p>
<p>There were also fears the change would lead to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29699742">massive burden on GPs</a> as patients came to request codeine.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-claims-used-to-justify-pulling-codeine-from-sale-without-a-prescription-and-why-theyre-wrong-87257">Three claims used to justify pulling codeine from sale without a prescription, and why they're wrong</a>
</strong>
</em>
</p>
<hr>
<p>Some people were concerned the move would drive people to use <a href="https://www.abc.net.au/news/2018-05-11/panadeine-shortage-pushing-patients-onto-stronger-painkillers/9741946">higher strength codeine</a>. This was because people wanting codeine would need to see their doctor, so they might request the stronger products that had always been prescription only. <a href="https://www.tga.gov.au/scheduling-submission/public-submissions-scheduling-matters-referred-acms17-march-2016-codeine">There was also concern</a> the change would push people towards even stronger painkillers, like oxycodone and morphine. </p>
<h2>What happened next?</h2>
<p>In our work at the <a href="https://www.poisonsinfo.nsw.gov.au/">NSW Poisons Information Centre</a> we get hundreds of calls about opioid overdoses every month. So we were keen to evaluate whether the change in codeine availability affected the number of overdoses. We, like others, were also worried there might also be unintended consequences of the change in its availability.</p>
<p>In the year after the change, we saw a 51% drop in codeine poisonings overall. This mainly affected low strength preparations (the category no longer available without prescription), where poisonings dropped by 79%. </p>
<p>There was no increase in poisonings with high strength codeine or other opioids. Similarly, sales data showed overall use of codeine dropped by almost 50%, with use of low strength codeine most affected, dropping by 87%. Again, there was no increase in use of high strength codeine.</p>
<h2>Your genetics are also important</h2>
<p>Concerns over misuse and addiction were not the sole reason behind the change in codeine availability. A person’s response to codeine is <a href="https://theconversation.com/weekly-dose-codeine-doesnt-work-for-some-people-and-works-too-well-for-others-58067">determined by their genes</a>, specifically a gene that codes for the enzyme CYP2D6. This enzyme activates codeine by converting it to morphine in the body. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-codeine-doesnt-work-for-some-people-and-works-too-well-for-others-58067">Weekly Dose: codeine doesn't work for some people, and works too well for others</a>
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</em>
</p>
<hr>
<p>So, depending on their DNA, some people don’t get any effect from codeine, some get a “normal” effect, while others find it toxic at what is normally considered a safe dose. </p>
<p>The latter is the most dangerous scenario, and has resulted in <a href="https://www.ncbi.nlm.nih.gov/pubmed/28520350">several deaths</a>. This has included a <a href="https://www.ncbi.nlm.nih.gov/pubmed/17872605">newborn baby</a> who died after their mother had a normal dose of codeine for pain after childbirth. The mother was later found to have the gene that results in excessive codeine activation, and a lethal dose of morphine was transmitted to her baby in her breast milk. </p>
<p>Even if the misuse problems disappeared overnight, people who advocated codeine be available only by prescription argued that a medicine with such a variable effect should only be available after seeing a doctor.</p>
<h2>How about unintended consequences of the codeine switch?</h2>
<p>Future research needs to look into possible unintended consequences of the change in codeine availability.</p>
<p>For instance, people may have switched to simple analgesics, like paracetamol and ibuprofen. These don’t have the same potential to be abused, are generally safer, and are <a href="https://www.ncbi.nlm.nih.gov/pubmed/21257263">more effective</a> than low-strength codeine products. Yet they can still be toxic when overdosed.</p>
<p>Our research didn’t look at whether the codeine switch led to more people using paracetamol or ibuprofen, or were harmed by them.</p>
<h2>Limiting availability works</h2>
<p>Prescription drug misuse and overdoses are problems that are very much <a href="https://www.nps.org.au/australian-prescriber/articles/pharmaceutical-drug-misuse-in-australia">driven by drug availability</a>. And when the availability of other medicines in Australia and internationally have been restricted, we’ve seen the benefits, namely reductions in misuse and poisoning.</p>
<p>This has happened with the opioid painkillers <a href="https://www.ncbi.nlm.nih.gov/pubmed/20407028">tramadol</a>, <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2484293">hydrocodone</a> and <a href="https://www.mja.com.au/journal/2013/199/4/trials-and-tribulations-removal-dextropropoxyphene-australian-register">dextropropoxyphene</a>; and the benzodiazepine <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2530900">alprazolam</a>.</p>
<p>Our study shows a good example of how effective simple strategies can be in tackling opioid misuse. Codeine is just one small piece of the puzzle, and we would like to see further investment and a systematic strategy to address causes of the <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02018?OpenDocument">rise in fatal poisonings</a> from prescription drugs in the past decade.</p>
<p>We would like to see a National Centre for Poisoning Research set up, which would bring together and support existing and new researchers. This would focus on preventing and managing poisoning, to provide a national response to this clinical and public health problem.</p><img src="https://counter.theconversation.com/content/124169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rose Cairns receives funding from the NHMRC for suicide prevention research. She has previously been an associate investigator on an untied educational grant from Seqirus to study tapentadol misuse (this funder had no role in the current study).</span></em></p><p class="fine-print"><em><span>Nicholas Buckley has received funding from the NHMRC to support research into poisoning prevention.</span></em></p>When codeine became a prescription only drug in 2018, the number of overdoses dropped, our new research shows. But restricting sales of codeine is only one way to reduce harm from opioids.Rose Cairns, Lecturer in Pharmacy, University of SydneyNicholas Buckley, Professor of Clinical Pharmacology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/998302018-12-19T11:43:42Z2018-12-19T11:43:42ZWhat is ‘green’ dry cleaning? A toxics expert explains<figure><img src="https://images.theconversation.com/files/251043/original/file-20181217-185255-12ljky.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Do you know what have your clothes been soaking in?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/clothes-after-dry-cleaning-laundry-1042685950?src=7HaKlmdfkCOLTGmnGGlKfA-1-8">ET1972/Shutterstock</a></span></figcaption></figure><p>The winter holidays are a busy time for many businesses, including retail stores, grocers, liquor stores – and dry cleaners. People pull out special-occasion clothes made of silk, satin or other fabrics that don’t launder well in soap and water. Then there are all those specialty items, from stained tablecloths to <a href="https://people.com/style/30-ugly-christmas-sweater-wearing-celebs-to-get-you-in-the-holiday-spirit/">ugly holiday sweaters</a>.</p>
<p>Few consumers know much about what happens to their goods once they hand them across the dry cleaner’s counter. In fact, dry cleaning isn’t dry at all. Most facilities soak items in <a href="https://en.wikipedia.org/wiki/Dry_cleaning">a chemical called perchloroethylene</a>, or perc for short.</p>
<p>Exposure to perc is associated with <a href="https://www.turi.org/TURI_Publications/TURI_Chemical_Fact_Sheets/Perchloroethylene_PCE_Fact_Sheet">a variety of adverse human health effects</a>. The International Agency for Research on Cancer, a unit of the World Health Organization, has designated perc as <a href="https://monographs.iarc.fr/wp-content/uploads/2018/06/mono106-002.pdf">a probable human carcinogen</a>. The most direct risk is to dry-cleaning workers, who may <a href="https://www.osha.gov/dsg/guidance/perc.html">inhale perc vapors or spill it on their skin</a> while handling clothes or cleaning equipment.</p>
<p>At the <a href="https://www.turi.org/">Toxics Use Reduction Institute</a> at UMass Lowell, we work with small businesses and industries to find ways they can reduce the use of toxic materials and find more benign substitutes. For over a decade the Toxics Use Reduction Institute has worked with dry cleaners to help them move to a safer process called <a href="https://www.turi.org/Our_Work/Business/Small_Businesses/Dry_Cleaning/Professional_Wet_Cleaning">professional wet cleaning</a>, which uses water and biodegradeable detergents. This is a clear trend nationwide: In a 2014 industry survey, 80 percent of respondents said they used professional wet cleaning for <a href="https://americandrycleaner.com/articles/survey-majority-dry-cleaners-immersed-wet-cleaning-process">at least 20 percent of their plant’s volume</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/_pab09Cr2vI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Joon Han, owner of AB Cleaners in Westwood, Massachusetts, demonstrates wet cleaning technology and explains why he decided to stop using perc.</span></figcaption>
</figure>
<h2>Perc’s long history</h2>
<p>Perc has been the standard dry cleaning solvent for over 50 years because it is effective, easy to use and relatively inexpensive. But improper use, storage and disposal of perc have resulted in <a href="https://drycleancoalition.org/download/citizens_guide_drycleaner_cleanup.pdf">widespread soil and groundwater contamination</a> at dry cleaning sites. Studies show that long-term exposure can harm the <a href="https://www.atsdr.cdc.gov/phs/phs.asp?id=263&tid=48">liver, kidneys, central nervous system and reproductive system</a> and may harm unborn children.</p>
<p>According to a widely cited estimate from federal agencies, there are about 36,000 professional garment care facilities in the United States, and <a href="https://www.cdc.gov/niosh/topics/dryclean/default.html">about 85 percent of them use perc</a> as their main cleaning solvent. Industry surveys in <a href="https://americandrycleaner.com/articles/only-half-drycleaners-now-use-perc-survey-says">2009</a> and <a href="https://americandrycleaner.com/articles/survey-given-updated-epa-assessment-most-cleaners-believe-percs-days-are-numbered">2012</a> indicate that that figure has fallen to between 50 and 70 percent.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/251046/original/file-20181217-185261-1r1aq64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/251046/original/file-20181217-185261-1r1aq64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1036&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251046/original/file-20181217-185261-1r1aq64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1036&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251046/original/file-20181217-185261-1r1aq64.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1036&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251046/original/file-20181217-185261-1r1aq64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1302&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251046/original/file-20181217-185261-1r1aq64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1302&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251046/original/file-20181217-185261-1r1aq64.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1302&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tensioning equipment, such as this form finisher, is used to shape clothes after the washing and drying process.</span>
<span class="attribution"><span class="source">TURI</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>EPA has identified perc as a <a href="https://www.epa.gov/sites/production/files/2015-01/documents/tsca_work_plan_chemicals_2014_update-final.pdf">high priority chemical</a>. Under amendments to the Toxic Substances Control Act adopted in 2016, the agency has a mandate to study the health and environmental effects of perc and other priority chemicals, and potentially take action to <a href="https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/risk-evaluations-existing-chemicals-under-tsca#ten">reduce risk from exposure to them</a>. However, in June 2018, EPA announced it was adopting a new approach to chemical risk screening that could <a href="https://www.nytimes.com/2018/06/07/us/politics/epa-toxic-chemicals.html">exclude consideration of many sources of exposure</a>, including exposure to perc contamination in drinking water. </p>
<h2>Safer alternatives</h2>
<p>It could be a <a href="https://www.edf.org/blog/2013/11/12/regrettable-substitution-swapping-devil-you-know-devil-you-dont">regrettable substitution</a> for dry cleaners to switch to other solvents if those substances also pose potential or unknown health and environmental risks. Accordingly, in 2012 the Toxics Use Reduction Institute <a href="https://www.turi.org/TURI_Publications/TURI_Chemical_Fact_Sheets/Fact_Sheet_-_Alternatives_to_Perchloroethylene_Used_in_Professional_Garment_Care">evaluated a half-dozen alternative solvents</a>, along with professional wet cleaning. </p>
<p>Overall, we found that the alternative solvents exhibited less persistence in the environment, potential to accumulate in the human body or the environment, or toxicity to aquatic life than perc. Most also appeared to be safer overall to human health. However, toxicological data were lacking for some of them, so future analyses may find that they are less benign than currently thought.</p>
<p>Some of these alternatives are combustible, so using them would require cleaners to buy specialized equipment to protect against fires or explosions. On the other hand, professional wet cleaning is water-based and poses no such risks. It uses computer-controlled washers and dryers, along with biodegradable detergents and specialized finishing equipment, to process delicate garments that would otherwise be dry cleaned. </p>
<p>We suggest that dry cleaners who want a safer alternative to perc should consider the key environmental and human health criteria, and then think about financial and technical issues at their own facilities to find the best alternative for them. Anecdotal information in Massachusetts indicates that cleaners are switching to petroleum-based alternatives such as <a href="https://www.exxonmobilchemical.com/en/solutions-by-industry/industrial-applications/dry-cleaning">DF2000™</a> at a higher rate than wet cleaning, and to other solvent alternatives at about the same rate as wet cleaning. Some operators doubt that <a href="https://www.rit.edu/affiliate/nysp2i/sites/rit.edu.affiliate.nysp2i/files/professional_wet_cleaning_implementation_guide_final_8-2013_0.pdf">a wet cleaning process can clean as well as solvent cleaning</a>, but the Toxics Use Reduction Institute is working to dispel that myth through case study analysis, grants, demonstrations and training events. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/251045/original/file-20181217-185243-mbd2fa.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/251045/original/file-20181217-185243-mbd2fa.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/251045/original/file-20181217-185243-mbd2fa.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251045/original/file-20181217-185243-mbd2fa.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251045/original/file-20181217-185243-mbd2fa.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251045/original/file-20181217-185243-mbd2fa.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251045/original/file-20181217-185243-mbd2fa.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251045/original/file-20181217-185243-mbd2fa.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Logo for Massachusetts cleaners that have adopted professional wet cleaning.</span>
<span class="attribution"><span class="source">TURI</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Making the switch</h2>
<p>When the Toxics Use Reduction Institute began working with dry cleaners on this issue in 2008, to our knowledge there were no dedicated wet cleaners operating in Massachusetts. Today the state has over 20 <a href="https://www.turi.org/Our_Work/Business/Small_Businesses/Dry_Cleaning/Professional_Wet_Cleaning/List_of_Dry_Cleaners">dedicated wet cleaners</a>. Other cleaners seeking options for moving away from perc can obtain data from the <a href="http://www.neha.org/node/58806">Toxics Use Reduction Institute</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/17355078">other researchers</a> to help them make informed decisions about equipment purchasing and staff training.</p>
<p>At the Toxics Use Reduction Institute we also work with many other sectors to help steer them away from harmful chemicals and towards safer alternatives. Examples include removing flame retardants from foam pit cubes at <a href="https://www.turi.org/Our_Work/Business/Small_Businesses/Gymnastics_Facilities">gymnastics training facilities</a>; helping companies develop <a href="https://www.turi.org/Our_Work/Cleaning_Laboratory">cleaning products</a> without harsh solvents and acids; and researching and reformulating <a href="https://www.cbsnews.com/video/researchers-advocate-for-safer-alternative-to-paint-stripper-chemical/">alternatives to methylene chloride for paint stripping</a>.</p>
<p>In each case, the goal is to identify safer alternatives and then find champions of change who are willing to make the switch and show their peers how to get good results without using harmful chemicals. This model has shown that industry and consumer choices can push change from the bottom up.</p><img src="https://counter.theconversation.com/content/99830/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>TURI work with dry cleaners has been supported by EPA Region 1 Pollution Prevention grant monies in the past.</span></em></p>Dry cleaning isn’t really dry – it uses chemical solvents. Perc, the most common option, has contaminated soil and groundwater and poses serious health risks, but safer choices are emerging.Joy Onasch, Business & Industry Program Manager, Toxics Use Reduction Institute, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1031762018-09-14T11:02:26Z2018-09-14T11:02:26ZTerrorism has a hidden health legacy – as 9/11 shows<figure><img src="https://images.theconversation.com/files/236412/original/file-20180914-177947-12gc21s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/jersey-city-nj-usa-september-11-481747063?src=Xx-_NUSnkdByQlic_uTVvA-2-47">Evan El-Amin/Shutterstock.com</a></span></figcaption></figure><p>On September 11, 2001, Al Qaeda hijackers took control of four commercial airliners and launched a series of coordinated attacks. As two of the commandeered planes hurtled into the World Trade Centre that morning, they devastated the urban landscape of Manhattan and killed <a href="https://www.bbc.co.uk/news/world-us-canada-45487709">2,996</a> people, including 400 emergency <a href="https://www.merriam-webster.com/dictionary/first%20responder">responders</a>. </p>
<p>Fires smouldered among the remains of the Twin Towers for <a href="https://www.theguardian.com/world/2001/dec/20/september11.usa">99 days</a> after the attack. It took <a href="http://edition.cnn.com/2002/US/05/30/rec.wtc.cleanup/">eight months and 19 days</a> for responders and volunteers to clear away the wreckage of rubble, gnarled concrete and twisted girders. Architects and developers began to design a new centre of commerce in 2004 and <a href="https://www.onewtc.com">One World Trade Centre</a> was completed a decade later, taking its place alongside the other new skyscrapers that decorate the Manhattan skyline. The architectural scars of the attack are now almost erased and this urban space has been reinvented. </p>
<p>But recent studies have shown that there are long-term <a href="https://www.sciencedirect.com/science/article/pii/S0013935118300070">physical</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898905/">mental</a> health challenges arising for the people who survived 9/11. Acts of terrorism and <a href="https://www.tandfonline.com/doi/abs/10.1080/15027570.2010.491340?src=recsys&journalCode=smil20">irregular warfare</a> can have unforeseen long-term public health consequences. </p>
<p>The collapse of the Twin Towers released plumes of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240917/">toxic substances</a> into the air. Inhalable contaminants included powdered cement, pulverised glass, asbestos, jet fuel, silica and splinters of metal. This dust and chemical “<a href="https://www.bbc.co.uk/news/av/stories-42357608/death-by-smog-london-s-fatal-four-day-pea-souper">peasouper</a>” lingered across Lower Manhattan, corralled and <a href="http://web.mit.edu/nature/archive/student_projects/2009/jcalamia/Frame/05_canyonwind.html">canyoned</a> by the surrounding high-rise architecture. The fire released <a href="https://link.springer.com/chapter/10.1007/978-3-319-59372-2_6">carcinogens</a> across the city. While emergency responders and local people worked together to recover from the attack, they were unknowingly exposing themselves to contaminated dust and debris.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/236413/original/file-20180914-177968-1jihtoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/236413/original/file-20180914-177968-1jihtoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236413/original/file-20180914-177968-1jihtoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236413/original/file-20180914-177968-1jihtoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236413/original/file-20180914-177968-1jihtoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236413/original/file-20180914-177968-1jihtoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236413/original/file-20180914-177968-1jihtoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">New York City firefighters working after the collapse of the Twin Towers on September 11, 2001.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/new-york-september-11-city-firefighters-25159549?src=Xx-_NUSnkdByQlic_uTVvA-1-10">Anthony Correia/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Responders received a greater <a href="http://www.who.int/occupational_health/publications/airdust/en/">airborne exposure</a> to <a href="https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1196/annals.1371.002">contaminants</a>. They are more likely to develop respiratory illnesses and certain cancers, and have an increased all-cause mortality and <a href="https://www.sciencedirect.com/science/article/pii/S0013935118300070">suicide</a> rate, compared to other exposed groups. Rescue and recovery workers are also at greater risk of depression and post-traumatic stress disorder (<a href="https://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/posttraumaticstressdisorder.aspx">PTSD</a>), alongside those who work and live near Ground Zero. This is an <a href="https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/forgotten-responders-the-ongoing-impact-of-911-on-the-ground-zero-recovery-workers/96D50123E56946BEE88D5ECE86E1C41D">ongoing</a> issue, and more people have now died due to pollution from 9/11 than from the attack itself.</p>
<p>It is difficult to ascertain the full scale of future health challenges that could arise. Responders have already been affected by decreased <a href="https://www.sciencedirect.com/science/article/pii/S2352873717300586">cognitive function</a>, increased risk of <a href="https://journals.lww.com/joem/Abstract/2018/08000/Risk_of_Stroke_Among_Survivors_of_the_September.14.aspx">strokes</a>, and there is evidence that cancer <a href="https://link.springer.com/chapter/10.1007/978-3-319-59372-2_6">likelihood and incidence</a> has increased – especially lung, throat, stomach, myeloma, leukemia and lymphoma type cancers. </p>
<p>Standardised incidence ratios for these conditions are already moderately elevated among New York emergency services and humanitarian aid responders who worked on 9/11. Approximately <a href="https://www.theguardian.com/us-news/2018/sep/10/911-attack-ground-zero-manhattan-cancer">10,000</a> people have been diagnosed with cancer linked to 9/11, to date. The <a href="https://www.sciencedirect.com/science/article/pii/S0013935118300070">statistics</a> suggest that many more will be killed by toxic exposure than by the original act of terrorism. The average age of a 9/11 first responder is now about <a href="https://eu.poughkeepsiejournal.com/story/news/local/2018/09/06/9-11-aftermath-deaths-soon-outpace-sept-11/1206191002/">55</a>. Many people face a cancer diagnosis as they age, but this community are much more likely to become unwell.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/236414/original/file-20180914-177950-1janfwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/236414/original/file-20180914-177950-1janfwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236414/original/file-20180914-177950-1janfwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236414/original/file-20180914-177950-1janfwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236414/original/file-20180914-177950-1janfwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236414/original/file-20180914-177950-1janfwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236414/original/file-20180914-177950-1janfwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We don’t yet know the full extent of 9/11’s effects.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/new-york-city-september-11-2016-505531384?src=LcK1MQHxQtP_HPtMNhThYg-1-79">BravoKiloVideo/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Supporting survivors</h2>
<p>So, what can be done to manage and support the responders and local community who are suffering from the long-term effects of 9/11? A lot can be learned from the historical outcomes for similar communities who have been affected by a toxic environmental exposure.</p>
<p>We know from studies of the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/gec3.12325">atomic veterans</a> who worked on nuclear weapons tests during the <a href="https://www.ctbto.org/nuclear-testing/history-of-nuclear-testing/nuclear-testing-1945-today/">Cold War</a> that when communities become aware of a previously unknown risk from exposure, then they are more likely to worry about it. This then creates a burden of mental health for survivors. The greatest challenge for these communities is that of gaining an understanding of the long-term <a href="https://www.tandfonline.com/doi/abs/10.1080/01459740.2012.757606">implications</a> of their exposure. </p>
<p>The long-term outlook for 9/11 survivors is uncertain. Their outcome is compounded by day-to-day exposure to other pollutants, and their lifestyle choice – for instance, drinking or smoking. These other circumstances are known as <a href="https://www.ucl.ac.uk/child-health/short-courses-events/about-statistical-courses/statistics-and-research-methods/chapter-1-content-8">confounding factors</a> and make it more difficult to discern if illness is occurring due to environmental exposure, or for other reasons. There is also something that is known as the “<a href="https://www.sciencedirect.com/science/article/pii/S104727970800286X">healthy soldier effect</a>”, where the regular exercise and bodily monitoring of a military lifestyle offers a protective effect, long after military service has ended. </p>
<p>The <a href="https://www.cdc.gov/wtc/">World Trade Centre Health Program</a> has been set up to provide monitoring and treatment for responders who were at the World Trade Centre and related sites, and survivors who were in the <a href="https://www.cdc.gov/wtc/define.html">New York City Disaster Area</a>. The US government allocated US$4.2 billion to support this provision, under the “<a href="https://www.gpo.gov/fdsys/pkg/BILLS-111hr847enr/pdf/BILLS-111hr847enr.pdf">James Zadroga 9/11 Health and Compensation Act of 2010</a>” – named after a <a href="https://www1.nyc.gov/site/nypd/index.page">NYPD</a> officer who died from toxic exposure. This act was extended in 2015, to provide medical support and benefits to affected people until 2090.</p>
<p>But it does not provide support to those who have since moved, and neglects those who are part of the informal economy. There are also difficulties in proving exposure and effectively being diagnosed as a “<a href="https://www.sciencedirect.com/science/article/pii/S0277953611003224">deserving</a>” 9/11 survivor, similarly to those who have experienced other toxic exposures.</p>
<p>There is also a globally uneven distribution of support for terrorism survivors. We must remember that when an act of terror occurs in the <a href="http://www.un.org/en/development/desa/policy/wesp/wesp_current/2014wesp_country_classification.pdf">Global North</a>, it gains extensive media coverage. But the US and Europe make up only <a href="http://visionofhumanity.org/app/uploads/2017/11/Global-Terrorism-Index-2017.pdf">1%</a> of terrorism fatalities. The other 99% of terrorism occurs in places in political conflict across the less developed world such as <a href="https://www.bbc.co.uk/news/world-middle-east-41270791">Iraq</a>, <a href="https://www.bbc.co.uk/news/world-asia-44677823">Afghanistan</a>, <a href="https://www.bbc.co.uk/news/world-africa-43967738">Nigeria</a>, <a href="http://www.bbc.co.uk/programmes/b07cblx9/topics/Terrorism_in_Syria">Syria</a> and <a href="https://www.bbc.co.uk/news/world-asia-44847295">Pakistan</a>. Survivors in these places have few opportunities for long-term monitoring and support. </p>
<p>These differences matter a great deal, as they represent the uneven distribution of vulnerability to terrorism. It is now time to extend support to terrorism survivors worldwide.</p><img src="https://counter.theconversation.com/content/103176/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Becky Alexis-Martin receives funding from the NCCF to explore the lives of people who have been affected by nuclear weapons testing. </span></em></p>Approximately 10,000 people have been diagnosed with cancer due to 9/11. What support is available to this community, and is it working?Becky Alexis-Martin, Lecturer in Political Geographies of Health, Manchester Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/935232018-03-20T10:42:01Z2018-03-20T10:42:01ZEager to dye your hair with ‘nontoxic’ graphene nanoparticles? Not so fast!<figure><img src="https://images.theconversation.com/files/211082/original/file-20180319-31624-18d3y07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Subbing new risks for the current dyes’ dangers?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hairdresser-salon-woman-during-hair-wash-1044886945">Evgeny Savchenko/Shutterstock.com</a></span></figcaption></figure><p>Graphene is something of a celebrity in the world of nanoscale materials. Isolated in 2004 by Nobel Prize winners <a href="https://www.nobelprize.org/nobel_prizes/physics/laureates/2010/">Andre Geim and Konstantin Novoselov</a>, these ultrathin sheets of carbon atoms are already finding novel uses in areas like <a href="https://www.nist.gov/programs-projects/graphene-electronics">electronics</a>, <a href="https://spectrum.ieee.org/nanoclast/green-tech/conservation/graphene-heating-system-dramatically-reduces-home-energy-costs">high-efficiency heating systems</a>, <a href="https://www.ft.com/content/d768030e-d8ec-11e7-9504-59efdb70e12f">water purification technologies</a> and <a href="http://cmp.callawaygolf.com/2018/01/23/chrome-soft-golf-balls-need-know/">even golf balls</a>. According to recent research published in the journal Chem, <a href="https://doi.org/10.1016/j.chempr.2018.02.021">hair dyes can now be added to this list</a>. </p>
<p>But how safe and responsible is this new use of the carbon-based wonder-material?</p>
<p>Northwestern University’s <a href="https://www.eurekalert.org/pub_releases/2018-03/nu-gfn031218.php">press release</a> proudly announced, “Graphene finds new application as nontoxic, anti-static hair dye.” The announcement spawned headlines like “<a href="http://www.sciencemag.org/news/2018/03/enough-toxic-hair-dyes-we-could-use-graphene-instead">Enough with the toxic hair dyes. We could use graphene instead</a>,” and “<a href="http://en.brinkwire.com/215369/miracle-material-graphene-used-to-create-the-ultimate-hair-dye/">’Miracle material’ graphene used to create the ultimate hair dye</a>.” </p>
<p>From these headlines, you might be forgiven for getting the idea that the safety of graphene-based hair dyes is a done deal. Yet <a href="https://scholar.google.com/citations?user=b8NhWc4AAAAJ&hl=en&oi=ao">having studied the potential health and environmental impacts</a> of engineered nanomaterials for <a href="http://dx.doi.org/10.1038/nnano.2016.270">more years than I care to remember</a>, I find such overly optimistic pronouncements worrying – especially when they’re not backed up by clear evidence.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/211008/original/file-20180319-31602-zpomir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211008/original/file-20180319-31602-zpomir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211008/original/file-20180319-31602-zpomir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211008/original/file-20180319-31602-zpomir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211008/original/file-20180319-31602-zpomir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211008/original/file-20180319-31602-zpomir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211008/original/file-20180319-31602-zpomir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211008/original/file-20180319-31602-zpomir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As the dye wears off, where do the nanoparticles go?</span>
<span class="attribution"><span class="source">Jiaxing Huang, Northwestern University</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Tiny materials, potentially bigger problems</h2>
<p>Engineered nanomaterials like graphene and graphene oxide (the particular form used in the dye experiments) aren’t necessarily harmful. But nanomaterials can behave in unusual ways that depend on particle size, shape, chemistry and application. Because of this, researchers have long been cautious about giving them a clean bill of health without first testing them extensively. And while a <a href="http://dx.doi.org/10.1021/acsnano.7b04120">large body of research to date</a> doesn’t indicate graphene is particularly dangerous, neither does it suggest it’s completely safe.</p>
<p>A quick search of scientific papers over the past few years shows that, since 2004, over 2,000 studies have been published that mention graphene toxicity; nearly 500 were published in 2017 alone.</p>
<p>This growing body of research suggests that if graphene gets into your body or the environment in sufficient quantities, it could cause harm. A 2016 review, for instance, indicated that graphene oxide particles could <a href="http://dx.doi.org/10.1016/j.addr.2016.04.028">result in lung damage at high doses</a> (equivalent to around 0.7 grams of inhaled material). Another review published in 2017 suggested that these <a href="http://dx.doi.org/10.1088/2053-1583/aa5476">materials could affect the biology</a> of some plants and algae, as well as invertebrates and vertebrates toward the lower end of the ecological pyramid. The authors of the 2017 study concluded that research “unequivocally confirms that graphene in any of its numerous forms and derivatives must be approached as a potentially hazardous material.” </p>
<p>These studies need to be approached with care, as the precise risks of graphene exposure will depend on how the material is used, how exposure occurs and how much of it is encountered. Yet there’s sufficient evidence to suggest that this substance should be used with caution – especially where there’s a high chance of exposure or that it could be released into the environment.</p>
<p>Unfortunately, graphene-based hair dyes tick both of these boxes. Used in this way, the substance is potentially inhalable (especially with spray-on products) and ingestible through careless use. It’s also almost guaranteed that excess graphene-containing dye will wash down the drain and into the environment. </p>
<p>Here, due diligence is needed to ensure that the material is acceptably safe. This is something that goes beyond the seeming authority of a press release headline. In fact, such misleading headlines could end up being counterproductive, as they undermine efforts to demonstrate trustworthiness with consumers and investors.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/211020/original/file-20180319-31627-1nv890z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211020/original/file-20180319-31627-1nv890z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211020/original/file-20180319-31627-1nv890z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=317&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211020/original/file-20180319-31627-1nv890z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=317&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211020/original/file-20180319-31627-1nv890z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=317&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211020/original/file-20180319-31627-1nv890z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211020/original/file-20180319-31627-1nv890z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211020/original/file-20180319-31627-1nv890z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Simulation of a graphene oxide framework, pictured in black, to remove contaminants from water.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/oakridgelab/14006201292">Adrien Nicolaï/RPI</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>Undermining other efforts?</h2>
<p>I was alerted to just how counterproductive such headlines can be by my colleague Tim Harper, founder of <a href="http://g2o.co/">G2O Water Technologies</a> – a company that uses graphene oxide-coated membranes to treat wastewater. Like many companies in this area, G2O has been working to use graphene responsibly by minimizing the amount of graphene that ends up released to the environment.</p>
<p>Yet as Tim pointed out to me, if people are led to believe “that bunging a few grams of graphene down the drain every time you dye your hair is OK, this invalidates all the work we are doing making sure the few nanograms of graphene on our membranes stay put.” Many companies that use nanomaterials are trying to do the right thing, but it’s hard to justify the time and expense of being responsible when someone else’s more cavalier actions undercut your efforts.</p>
<p>Here, naïve claims of safety and gung-ho approaches to promoting graphene-containing products could very easily threaten the responsible development and use of this material. And if companies pull back from acting responsibly, there’s a danger that consumers, investors and even regulators, will lose trust in their ability to ensure the safety of products of all kinds. </p>
<p>If this happens, consumers will be the ultimate losers. Used responsibly, graphene could lead to more sustainable and environmentally benign products. Yet having watched the public backlash against technologies like genetic engineering over the past couple of decades, I’m acutely aware that failing to earn the trust of stakeholders and consumers can stymie technologies, regardless of how safe and beneficial they are.</p>
<h2>Overpromising results and overlooking risk</h2>
<p>This is where researchers and their institutions need to move beyond an “<a href="https://doi.org/10.1038/nnano.2008.14">economy of promises</a>” that spurs on hyperbole and discourages caution, and think more critically about how their statements may ultimately undermine responsible and beneficial development of a technology. They may even want to consider using guidelines, such as the <a href="http://societyinside.com/sites/default/files/Principles%20for%20Responsible%20Innovation%20Short%20February%202018_0.pdf">Principles for Responsible Innovation</a> developed by the organization <a href="http://societyinside.com/">Society Inside</a>, for instance, to guide what they do and say.</p>
<p>To their credit, the authors of the dye study did give a passing mention to research on graphene safety, mostly focusing on an assumed level of safety compared to current dye products. Yet even this perfunctory level of caution failed to make it into the <a href="https://www.eurekalert.org/pub_releases/2018-03/nu-gfn031218.php">press release</a>, which touted a “new hair dye that is nontoxic, nondamaging and lasts through many washes without fading.”</p>
<p>It may turn out that graphene-based hair dyes can be developed safely. To be fair, the reported application isn’t even close to commercial R&D yet, never mind the salon shelf. And certainly, there’s a case to be made for substituting some of the <a href="https://www.nytimes.com/2018/03/16/science/hair-dye-graphene.html">harsh chemicals currently used in some products</a> with more benign ones. But this won’t happen while researchers and their institutions gloss over legitimate concerns and cautions with blind optimism. </p>
<p>Rather, by taking more care in how nanomaterial research is framed and promoted, researchers and their academic institutions could do a lot to ensure future nano-enabled consumer products are safe, beneficial and, above all, responsible.</p><img src="https://counter.theconversation.com/content/93523/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Maynard receives support from the National Science Foundation as part of the Nanotechnology-Enabled Water Treatment (NEWT) Engineering Research Center. </span></em></p>Less-toxic hair dye would be a great invention. But discounting the risks that come with nanoparticles could undermine other efforts to protect human health and environmental from their effects.Andrew Maynard, Director, Risk Innovation Lab, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/907212018-02-09T10:30:24Z2018-02-09T10:30:24ZThree reasons why scientific advice on drugs is ignored<figure><img src="https://images.theconversation.com/files/205489/original/file-20180208-180833-wkyft.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/454891150?src=waZ8GlkR7o7e4xLqGXZjhA-1-20&size=medium_jpg">Syda Productions/Shutterstock</a></span></figcaption></figure><p><a href="https://www.imperial.ac.uk/people/d.nutt">David Nutt</a>, along with many other leading scientists, published a <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61462-6/abstract">study</a> a few years ago that showed how the overall harms associated with some legal drugs, such as alcohol and tobacco, dramatically exceed the harms of some illegal drugs, such as cannabis, ecstasy and LSD – and even the harms of heroin and cocaine. Of course, these top scientists were right, but politicians continue to ignore scientific advice, and society continues to be largely <a href="https://yougov.co.uk/news/2015/03/19/support-for-legal-pot-not-so-high-Britian/">in favour of current drug laws</a>. </p>
<p>Here are three factors that might explain this paradox:</p>
<h2>1. Capitalism and class</h2>
<p>Noam Chomsky, an American social critic and political activist, offered some interesting arguments to explain how capitalism and class shape the legal status of drugs.</p>
<p>Cannabis, for instance, is a plant that can be easily grown in someone’s backyard, so it is not as easy to commercialise for profit. Tobacco, on the other hand, needs industrial technologies and hence is a suitable product for commercialisation. Similarly, making high quality alcoholic drinks – a fine wine or a decent bottle of whisky – is not nearly as easy as growing cannabis or magic mushrooms in your garden. </p>
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<p>It can be argued, however, that the recent US experience with cannabis legalisation has shown that it can be <a href="https://www.statista.com/statistics/765671/value-of-the-us-cannabis-market-current-and-future/">successfully commercialised</a>, but let’s not forget that commercialisation of the plant was one of the <a href="https://ndarc.med.unsw.edu.au/blog/assessing-costs-and-benefits-legalising-cannabis">major arguments</a> used for legalising cannabis in many US states.</p>
<p>Drug policies can also be used as a tool for “social cleansing”. Governments will ban drugs that are associated with poorer people, such as cannabis. This will fulfil a common goal by the elites of selectively isolating lower classes. For example, governments can sometimes find homeless people to be a <a href="https://www.theguardian.com/society/2018/jan/05/princes-and-paupers-homeless-fear-windsor-has-social-cleansing-plan">nuisance</a>, and banning drugs such as cannabis would provide a legal excuse to get rid of them.</p>
<p>During alcohol prohibition in the US in the 1920s, the government made an <a href="https://www.atlasobscura.com/articles/doctors-booze-notes-prohibition">exception for whisky</a>, a more expensive alcoholic drink, which you could buy with a doctor’s prescription. This ensured that those who were poor could be locked up for drinking alcohol, while the elites could legally obtain the drug if they wanted to.</p>
<h2>2. Poor understanding of risk</h2>
<p>We overreact to immediate threats and under react to long-term dangers. This is a well-known phenomenon that was described by psychologist <a href="http://articles.latimes.com/2006/jul/02/opinion/op-gilbert2">Daniel Gilbert</a> of Harvard University.</p>
<p>A person will generally perceive a <a href="https://academic.oup.com/aje/article/164/12/1233/76936">14% risk of developing lung cancer</a> from tobacco to be lower than the <a href="http://journals.sagepub.com/doi/abs/10.1177/0269881108099672">0.01% chance of immediate death</a> following the overdose of a party drug, such as ecstasy. In statistical terms, though, you are more than a thousand times more likely to die from using tobacco than you are from taking ecstasy.</p>
<p>This human ineptness in perceiving long-term risks is revealed in our attitudes to the impending doom of climate change. Because the most serious consequences of global warming are still decades away, many people are apathetic towards its threat of wiping out the human race. The same people might nevertheless overreact to the danger of a terrorist attack that could result in very few fatalities in comparison.</p>
<h2>3. Confusion between effect and toxicity</h2>
<p>We can easily think that the more obvious the psychological effect of a drug, the greater health risk it poses. We have evolved over millions of years to associate sudden and unusual psychological changes with fear. Unusual mental states serve an evolutionary function: they warn us that something is not quite right.</p>
<p>The effects of alcohol and tobacco are very subtle and gradual in comparison to, say, LSD. LSD is one of the <a href="https://www.economist.com/blogs/dailychart/2010/11/drugs_cause_most_harm">safest psychoactive compounds</a>, yet the effects are <a href="https://youtu.be/IwlxnjptV9I?t=48m55s">profound and intense</a>.</p>
<p>It is, however, difficult to realise that the extreme mental transformation caused by LSD is independent of its effect on your health. That is because the change it creates is a direct result of a safe modification in neurotransmitter levels in the brain, not an indirect change that is meant to alarm us from a physiological malfunction.</p>
<p>Of course, social attitudes to things like drugs are extremely complex and can never be reduced to a finite number of reasons. The above is speculation, but being aware of some of the reasons that affect our social attitudes to psychoactive drugs will hopefully help us fight for more rational and less harmful drug policies and laws.</p><img src="https://counter.theconversation.com/content/90721/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ghaith Aljayyoussi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>LSD is far safer than alcohol or tobacco, so why don’t drug laws reflect it?Ghaith Aljayyoussi, Post Doctoral Research Associate, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/892112018-01-04T04:26:21Z2018-01-04T04:26:21ZCan road salt and other pollutants disrupt our circadian rhythms?<figure><img src="https://images.theconversation.com/files/200733/original/file-20180103-26151-1tdify3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Salting streets in Milwaukee.</span> <span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/c/c2/Salt_truck_Milwaukee.jpg">Michael Pereckas</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Every winter, local governments across the United States apply <a href="https://minerals.usgs.gov/minerals/pubs/commodity/salt/myb1-2014-salt.pdf">millions of tons of road salt</a> to keep streets navigable during snow and ice storms. Runoff from melting snow carries road salt into streams and lakes, and causes many bodies of water to have extraordinarily <a href="http://dx.doi.org/10.1126/science.aad3488">high salinity</a>. </p>
<p>At Rensselaer Polytechnic Institute, my colleague <a href="https://science.rpi.edu/biology/faculty/rick-relyea">Rick Relyea</a> and his lab are working to quantify how increases in salinity affect ecosystems. Not surprisingly, they have found that high salinity has <a href="http://dx.doi.org/10.1002/eap.1487">negative impacts on many species</a>. They have also discovered that some species have the ability to cope with these increases in salinity. </p>
<p>But this ability comes at a price. In a recent study, Rick and I analyzed how a common species of zooplankton, <em>Daphnia</em> <em>pulex</em>, adapts to increasing levels of road salt. We found that this exposure affected an important biological rhythm: The circadian clock, which may govern <em>Daphnia</em>‘s feeding and predation avoidance behaviors. Since many fish prey on <em>Daphnia</em>, this effect could have ripples throughout entire ecosystems. Our work also raises questions about whether salt, or other environmental pollutants, could have similar impacts on the human circadian clock.</p>
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<span class="caption">Daphnia pulex.</span>
<span class="attribution"><span class="source">Brian Mattes</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<h2>Daily biological rhythms and the circadian clock</h2>
<p>In studying how road salt affects aquatic ecosystems, the Relyea lab showed that <em>Daphnia</em> <em>pulex</em> can <a href="https://doi.org/10.1016/j.envpol.2016.12.024">adapt to handle moderate exposures</a> in as little as two and a half months. These levels ranged from 15 milligrams of chloride (a building block of salt) per liter of water to a high of 1,000 milligrams per liter – a level found in highly contaminated lakes in North America. </p>
<p>However, an organism’s ability to adapt to something in its environment can also be accompanied by negative trade-offs. My lab’s collaboration with Rick’s began in an effort to identify these trade-offs in salt-adapted <em>Daphnia</em>. </p>
<p>In <a href="http://homepages.rpi.edu/%7Ehurlej2/">my lab</a>, we study how our circadian rhythms <a href="https://doi.org/10.1016/bs.mie.2014.10.009">allow us to keep track of time</a>. We investigate how the molecules in our cells work together to tick like a clock. These circadian rhythms allow an organism to anticipate 24-hour oscillations in its environment, such as changes from light (daytime) to dark (nighttime), and are <a href="https://doi.org/10.1177/074873098129000309">essential to an organism’s fitness</a>. </p>
<p>Rick and I hypothesized that adaptation to high salinity could disrupt <em>Daphnia’s</em> circadian rhythms based on recent evidence showing that other environmental contaminants can disrupt <a href="https://doi.org/10.1016/j.aquatox.2016.11.007">circadian behavior</a>. One important behavior in <em>Daphnia</em> that <a href="http://dx.doi.org/10.1016/j.cub.2017.06.025">may be controlled by the circadian clock</a> is the <a href="http://www.cell.com/current-biology/pdf/S0960-9822(14)01067-7.pdf">diel vertical migration</a> – the largest daily biomass migration on Earth, which occurs in oceans, bays and lakes. Plankton and fish migrate down to deeper water during the day to avoid predators and sun damage, and back up toward the surface at night to feed. </p>
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<span class="caption">Echogram illustrating the ascending and descending phases of diel vertical migration, in which organisms ascend and descend through the water column. The color scale reflects acoustic scattering by concentrations of organisms at different depths.</span>
<span class="attribution"><a class="source" href="http://oceanexplorer.noaa.gov/explorations/17deepsearch/background/water-column-research/water-column-research.html">DEEP SEARCH - BOEM, USGS, NOAA</a></span>
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<p>Given what we know about circadian function, it would be logical to assume that exposure to pollution would not affect an organism’s circadian rhythms. While circadian clocks can incorporate environmental information to tell the time of day, they are <a href="https://doi.org/10.1007/978-3-642-45218-5_6">heavily buffered against most environmental effects</a>. </p>
<p>To understand the importance of this buffering, imagine that the timing of an organism’s day length responded to environmental temperature. Heat speeds up molecular reactions, so on hot days the organism’s 24-hour rhythm could become 20 hours, and on cold days it might become 28 hours. In essence, the organism would have a thermometer, not a clock. </p>
<h2>Adaptation to pollution affects key circadian genes</h2>
<p>To determine whether clock disruption is a trade-off to pollutant adaptation, we first had to establish that <em>Daphnia</em> is governed by a circadian clock. To do this, we identified genes in <em>Daphnia</em> that are similar to two genes, known as <em>period</em> and <em>clock</em>, in an organism that serves as a circadian model system: <em>Drosophila melanogaster</em>, the common fruit fly. </p>
<p>We tracked the levels of <em>period</em> and <em>clock</em> in <em>Daphnia</em>, keeping the organisms in constant darkness to ensure that a light stimulus did not affect these levels. Our data showed that the levels of <em>period</em> and <em>clock</em> varied over time with a 24-hour rhythm – a clear indication that <em>Daphnia</em> have a functional circadian clock. </p>
<p>We also tracked the same genes in populations of <em>Daphnia</em> that had adapted to increased salinity. Much to my surprise, we discovered that the daily variation of <em>period</em> and <em>clock</em> levels deteriorated directly with <a href="http://dx.doi.org/10.1002/ece3.3490">the level of salinity the <em>Daphnia</em> were adapted to</a>. In other words, as <em>Daphnia</em> adapted to higher salinity levels, they showed less variation in the levels of <em>period</em> and <em>clock</em> over the day. This demonstrated that <em>Daphnia</em>’s clock is indeed affected by pollutant exposure.</p>
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<figcaption><span class="caption">Daphnia and other plankton are among the most abundant organisms on Earth and play critical ecological roles.</span></figcaption>
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<p>We currently don’t understand what causes this effect, but the relationship between salinity levels and decreased variation in the levels of <em>period</em> and <em>clock</em> offers a clue. We know that exposure to pollutants causes Daphnia to undergo <a href="http://onlinelibrary.wiley.com/doi/10.1002/etc.2887/abstract">epigenetic regulation</a> – chemical changes that affect the function of their genes, without altering their DNA. And epigenetic changes often show a gradual response, becoming more pronounced as the causal factor increases. Therefore, it is likely that high salinity is inducing chemical changes through these epigenetic mechanisms in <em>Daphnia</em> to suppress the function of its circadian clock. </p>
<h2>The broad effects of circadian clock disruptions</h2>
<p>We know that environmental conditions can affect what the clock regulates in many species. For example, changing the sugar that the fungus <em>Neurospora crassa</em> grows on <a href="http://dx.doi.org/10.1073/pnas.1418963111">changes which behaviors the clock regulates</a>. But to our knowledge, this study is the first to show that genes of an organism’s core clock can be directly impacted by adapting to an environmental contaminant. Our finding suggests that just as the gears of a mechanical clock can rust over time, the circadian clock can be permanently impacted by environmental exposure. </p>
<p>This research has important implications. First, if <em>Daphnia’s</em> circadian clock regulates its participation in the diel vertical migration, then disrupting the clock could mean that <em>Daphnia</em> do not migrate in the water column. <em>Daphnia</em> are key consumers of algae and a food source for many fish, so disrupting their circadian rhythms <a href="http://dx.doi.org/10.1073/pnas.1600366113">could affect entire ecosystems</a>.</p>
<p>Second, our findings indicate that environmental pollution may have broader effects on humans than previously understood. The genes and processes in <em>Daphnia’s</em> clock are very similar to those that regulate the clock in humans. Our circadian rhythms control genes that create cellular oscillations affecting cell function, division and growth, along with physiological parameters such as body temperature and immune responses. </p>
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<span class="caption">The human circadian clock regulates the cycles of many bodily functions.</span>
<span class="attribution"><a class="source" href="https://publications.nigms.nih.gov/findings/sept11/lightliferhythms.asp">NIH</a></span>
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<p>When these rhythms are disrupted in humans, we see increased rates of <a href="https://doi.org/10.1016/B978-0-12-396971-2.00010-5">cancer, diabetes, obesity, heart disease, depression and many other diseases</a>. Our work suggests that exposure to environmental pollutants may be depressing the function of human clocks, which could lead to increased rates of disease. </p>
<p>We are continuing our work by studying how the disruption of <em>Daphnia</em>’s clock affects its participation in the diel vertical migration. We are also working to determine the underlying causes of these changes, to establish whether and how this could happen in the human brain. The impacts we have found in <em>Daphnia</em> show that even a simple substance such as salt can have extremely complex effects on living organisms.</p><img src="https://counter.theconversation.com/content/89211/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer M. Hurley receives funding from the National Institutes of Health and the Department of Energy. </span></em></p>A recent study shows plankton that have adapted to road salt have disrupted circadian rhythms. This finding suggests that environmental pollutants could also affect human circadian clocks.Jennifer Marie Hurley, Assistant Professor of Biological Sciences, Rensselaer Polytechnic InstituteLicensed as Creative Commons – attribution, no derivatives.