A modern “chemical revolution” that began in earnest in the last half of the twentieth
century has released thousands of man-made synthetic compounds into the environment.
To date some 80,000 have been registered for use in the United States, including
components of products ranging from pesticides to plastics, from detergents to cosmetics.
Today, many of these synthetic compounds—never part of the environment our
ancestors lived and evolved in—can be measured in drinking water, soils, foods, the air,
and even in our own bodies. And yet, in contrast to regulation imposed on pharmaceutical
manufacturers, there is no requirement that chemical industry manufacturers test
their products (other than new kinds of pesticides and some food additives) for effects
on human health before commercial introduction. It falls to federal and state agencies
to do this testing after products are already on the market and in the environment, and
then only if specific concern about the health risks of a chemical is raised. The result is
that more than 85 percent of the 80,000 synthetic chemicals registered have never been
assessed for their effects on human health.
Many of these compounds may be harmless, but a significant number of those that
have been tested are now known to be reproductive toxicants. What especially concerns
environmentalists, health groups, and reproductive specialists is that in some notorious
cases, the very features that make synthetic compounds attractive to modern industry
also make them particularly difficult environmental problems. Consider polychlorinated
biphenyls (PCBs), which were used for decades in a wide range of products
(including electrical transformers, adhesives, and paints) particularly because they tend
to be chemically stable, or persistent. Although banned in the late 1970s because of
suspected links to cancer, PCBs persist in lake and river sediments and elsewhere in
the environment, and continue to work their way into and concentrate up food chains
in ecosystems. This means PCBs end up in people, where they also persist, or bioaccumulate,
because they tend to bind to fatty tissue and aren’t easily broken down.
Other examples of notably persistent contaminants include the pesticide DDT; a class
of industrial byproducts called dioxins; certain flame retardants; and perfluorinated
compounds, which are used to create nonstick cookware coatings and in fabrics and
carpets for their stain and water-resistant qualities.
FETAL ORIGINS OF ADULT DISEASE—THE DES EXAMPLE
Hormones also play vitally important roles during fetal development, orchestrating in
intricate detail aspects of development ranging from the formation of the sex organs to
the structure of the brain. A key idea proposed by scientists working with endocrine
disruptors is that some of these compounds can do their most serious damage during the
critical months that a fetus is in the womb.
The human experience with a compound called diethylstilbestrol (DES), a synthetic
estrogen, provides important clues about how this might work. Over a period of more
than 30 years beginning in the late 1930s, DES was administered to more than five million
pregnant women, and perhaps as many as 10 million. Doctors believed the synthetic
estrogen would help prevent miscarriages and premature births.
That assumption proved to be wrong. Still, the drug at least seemed safe (for humans,
anyway; rodent studies had shown it to be carcinogenic as early as the 1930s).
Through years of prescribed use, mothers who took the artificial hormone
showed no serious health effects. But in 1971, scientists came to
a stunning conclusion: although there still was no evidence of health
problems in the exposed mothers, a significant number of their daughters
were experiencing reproductive health problems. Those maladies
usually appeared only after the daughters were well into their own
child-bearing years, long after they had been exposed to the substance
in the womb.
Symptoms among DES daughters included a higher risk of an
otherwise exceedingly rare vaginal and cervical cancer called clear
cell adenocarcinoma, as well as abnormalities of the uterus and other
parts of the reproductive tract. DES daughters also clearly suffer from
an unusually high rate of infertility problems— at least double that in
the unexposed population. Additionally, DES daughters suffer more
ectopic (tubal) pregnancies, which occur when a fertilized egg lodges in the fallopian
tube instead of the uterus. And when DES daughters do conceive, 40 percent or more
are unable to achieve a full-term live birth. Laboratory scientists have observed many of
these kinds of results in mice they have exposed to DES experimentally.
ENVIRONMENT, DISEASE, AND GENES: NEW CLUES, AND SHOCKWAVES
As noted above, some contaminants interfere with signaling by acting like hormones
themselves, for example, binding with the hormone receptor and thereby stimulating
genes that respond to that hormone. But newly developing science is revealing yet another
mechanism of impact, another layer of the system that controls how genes behave.
This newer evidence suggests that even when a specific gene is present, and even when
the proper hormone signal is being sent, certain chemicals can actually act like a protective
screen, preventing the hormone from reaching the switch that normally turns a gene
on. The gene may be there, but because the signal can’t get to its switch, the gene remains
in the switched-off state and therefore it can’t produce the proteins that would normally
catalyze a given response in a cell.
One mechanism cells use to control whether genes are switched on or off is called
DNA methylation. In this case, molecules called methyl groups are attached to the
DNA in locations that prevent the signal molecule from reaching the switch. These
methyl groups naturally control whether a gene can be turned on when its signal arrives,
in other words, whether the gene will be “expressed.” If access is blocked, the hormone
signal has no effect. Different types of cells within a single person have different methylation
patterns. That’s how cells in all tissue types—eye tissue or muscle tissue or fat
tissue—can share the exact same set of genes but differ widely in what they do. While
methylation occurs naturally, scientific research has proven that DNA methylation is
also influenced by the environment. In fact, some scientists suggest that one purpose
of DNA methylation is to fine tune an individual’s genetic makeup to the environment
into which it will be born
CONTAMINANTS AND FEMALE INFERTILITY
While research focused on the effects of contaminants in the womb has lead to important
breakthroughs in recent years, other studies continue to highlight that contaminants can
cause harm later in childhood and in adulthood. In addition to the evidence that high
occupational exposures to some compounds can lead to sterility in men, one scientist
at Vallombrosa noted that at least six studies have shown links between PCBs, lead,
and other compounds and early onset of puberty in girls. Other investigations have
demonstrated correlations between adult reproductive system effects and exposures to
a range of pesticides; chemicals in cigarette smoke; fuel, hobby and industrial solvents,
such as benzene and dry cleaning fluids; and water disinfection byproducts. Although
the effects sometimes are as striking as increased risk of pregnancy loss (or damaged
sperm and poor fertility in men), often they are more subtle: ovarian and menstrual
cycle alterations, for example, or delays in the amount of time it takes to conceive. Scientists
still know little, however, about the long-term effects of what one Vallombrosa
CHALLENGED CONCEPTIONS:
ENVIRONMENTAL CHEMICALS AND FERTILITY
CHALLENGED CONCEPTIONS:
ENVIRONMENTAL CHEMICALS AND FERTILITY
DOES THE DOSE MAKE THE POISON?
The Renaissance-era physician Paracelsus wrote that “All substances are poisons…The
right dose differentiates a poison and a remedy.” That very idea—that there is a predictable
relationship between the dose of a potentially toxic substance and the health effects
it causes—lies at the heart of the traditional approach to environmental risk assessment
and regulation. Regulators have operated on the assumption that it is possible to identify
a level below which exposure to a given substance poses no risk, allowing them to set a
“no observable effects” exposure threshold. Typically, scientists do such an analysis by
starting with high-dose testing and working down to a dose level where the effects being
observed disappear. Although this holds true for many compounds, newer research,
particularly on endocrine disrupting compounds, has revealed that some chemicals and
health responses do not behave according to this seemingly logical assumption. Some
chemicals have effects at very low doses that can’t be predicted from the results of high-
dose studies.
This means that standard toxicity testing that relies on testing high doses
could miss important effects.
Scientists at the University of Missouri, for instance, have found that when male
mice are exposed in the womb to bisphenol A or the drug DES, low doses cause enlargement
of the prostate gland once the mice mature. Intermediate doses caused no apparent
effects, and higher doses actually caused the prostate to be smaller.
How can this happen? Scientists believe that at low doses
these compounds can stimulate the expression of genes involved
in controlling prostate size. At higher doses, in contrast, they
become toxic and damage the prostate outright. The bottom line:
although the dose-makes-the-poison rationale seems logical, new
science casts serious doubts at least on the way the principal has been
used to develop health standards, particularly when it comes to the
dose it takes to alter the hormonal or genetic signaling systems in a
still-developing fetus.
CHALLENGED CONCEPTIONS:
ENVIRONMENTAL CHEMICALS AND FERTILITY
CHALLENGED CONCEPTIONS:
ENVIRONMENTAL CHEMICALS AND FERTILITY
emerge as the children are born and as they develop.
Which leaves everyone involved with a lingering question: what to do while the
science moves ahead? Viewpoints at the workshop varied. Physicians pointed out that
while patients are eager for information about contaminants and environmental risk
factors, doctors can be reluctant to “get ahead of the science”—that is, unwilling to
make recommendations based on speculation or early and incomplete research. Other
participants made countervailing note of the “precautionary principle”—the notion that
health professionals, or in a broader scope, government regulators, should promote precautionary
action in the face of “weight of credible evidence” of serious toxicity (from,
say, animal studies), even if all the scientific “i’s” haven’t yet been dotted, nor “t’s”
crossed. It seems clear that this is a debate that medical and regulatory communities still
need to resolve.
Issues around communication and education emerged as a powerful theme. Despite
scientists’ and clinical researchers’ hard work investigating the impacts of environmental
chemicals on health, so far there’s been limited information transfer to infertility patients
and reproductive health advocacy groups—and some measure of uncertainty about the
most effective ways to communicate information accumulated so far to physicians and
the general public. One clinician emphasized that medical students are taught little, if
anything, about even well-established environmental chemical threats to reproduction,
and thus they enter their profession with limited ability to ask the right questions about
environmental exposures their patients may face, and limited perspective on the full
range of potential culprits as they conduct diagnostic workups and determine infertility
treatment strategies. Patient advocates stressed that they need translational models and
lay-friendly materials in order to share information with their constituencies.
Among scientists at the workshop, the need for effective communication of another
kind—between scientific disciplines—was stressed as a critical aspect of an expanded
and more coherent environmental reproductive health research program. For example,
researchers attempting to study links between environmental exposures and health
problems in human populations are often limited to conducting either retrospective
(historical) statistical studies of groups to trace trends, or to waiting patiently for the
results of long-term prospective studies like the National Children’s Study that follow
their subjects over periods of many years. Better interdisciplinary communication and
collaboration with scientists conducting actual experiments on lab animals could give
those studying humans a better sense of what endpoints, or potential effects, to look for.
SHOULD PATIENTS/ INDIVIDUALS GET TESTED
FOR THEIR “BODY BURDENS” OF TOXIC CHEMICALS?
SHOULD PATIENTS/ INDIVIDUALS GET TESTED
FOR THEIR “BODY BURDENS” OF TOXIC CHEMICALS?
Biomonitoring, or the testing of human biospecimens such as blood, urine, hair, adipose tissue, bone, etc., for the presence and level of toxic chemicals is a public health tool that has been used primarily by epidemiologists and health researchers for decades to identify trends in chemical use; to determine if some populations or communities might be more highly exposed than others; to establish exposure levels for average Americans; and to determine whether regulations limiting exposures are effective. Biomonitoring data are also used to examine possible linkages between chemical exposures and health outcomes. But in order to generate data that is useful for this purpose, studies need to test large populations as is standard in epidemiological studies.