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Doctors must warn about chemicals, health groups say

A mother gives a bottle to her baby.
Some of the chemicals mentioned in a controversial new health statement have been clearly shown to be harmful -- mercury and lead, for instance. But the evidence about some of the others, such as bisphenol A, or BPA, and a large group of chemicals called phthalates, is less clear.FRED DUFOUR

Two top reproductive health organizations have taken on the controversial subject of chemicals in the environment, saying the federal government isn’t doing enough to keep people safe.

They say chemicals might cause a range of problems, from birth defects to diabetes, but also say there isn’t enough research to show which ones are the most dangerous. 

But other experts say the joint statement from the American College of Obstetricians and Gynecologists (ACOG) and the American Society of Reproductive Medicine (ASRM) is too broad, and that it will probably needlessly scare pregnant women without offering much useful new advice.

“The real goal is to raise awareness, increase the education of health care professionals -- physicians, nurses, office staff -- and patients who are either pregnant or are thinking of getting pregnant with regard to some of the environmental threats,” said Dr. Jeanne Conry, president of ACOG.

“There is a backdrop of disease processes that have increased in the past 30-40 years. In that backdrop we have seen an increase in the release of chemicals into the environment.”

The statement, published in the journals Fertility and Sterility, calls for doctors to help patients reduce their exposure to chemicals. “Reducing exposure to toxic environmental agents is a critical area of intervention for obstetricians, gynecologists, and other reproductive health care professionals,” it reads.

The problem, says Dr. Janet DiPietro, associate dean of research at Johns Hopkins University, is that what they can do isn’t always very clear. “What is your average OB going to say?” asked DiPietro, a reproductive health expert who was not involved in writing the statement.

It’s true that pregnant women have chemicals circulating in their bodies, say DiPietro and other experts. Studies have shown that chemicals such as DDT are in virtually every human being’s body.

“There is very little that a provider can tell women to do or that women can avoid, from a practical perspective,” DiPietro said in a telephone interview. “We have relatively little data on either the fetal effects or long-term developmental effects,” she added.

“So you tell a woman, ‘OK you have DDT in your system. It may have come from your mother. It may have come from your environment when you were a kid.’ But what are you going to do about it?”

Some of the chemicals mentioned in the ACOG/ASRM statement have been clearly shown to be harmful -- mercury and lead, for instance. But the evidence about some of the others, such as bisphenol A (BPA) and a large group of chemicals called phthalates, is less clear. The Food and Drug Administration says BPA, for instance, is safe, even if it does get into food. 

The FDA stopped allowing the use of BPA in baby bottles and sippy cups, but only after manufacturers of those products stopped using it voluntarily.

Tracey Woodruff, director of the Program on Reproductive Health and the Environment at the University of California, San Francisco, -- who played a role in developing the statement -- says agencies like the FDA should do more. 

“The problem with the regulatory agencies is they are not keeping up with the science,” Woodruff said in a telephone interview.

But she agreed it could be difficult to tell people to avoid chemicals without knowing whether the alternatives are any safer. “This issue about alternatives are a real challenge. Maybe you choose another plastic water bottle. Maybe it is BPA-free but we don’t know what’s in another plastic water bottle,” Woodruff said.

But she said government agencies should ask these questions. “You know why we don’t know? It is because the government doesn’t have the power to require the testing.”

Scientists working to test the safety of chemicals say it is very hard to determine if a specific chemical is harmful because people have so many circulating in their bodies. Is it the chemical that is harmful, or something else that causes it to build up in the body? And other factors, such as obesity and a lack of exercise, may play a bigger role in reducing fertility in both men and women, studies suggest.

Dr. Linda Giudice, president of ASRM, says there is good evidence in many areas. “I think a really good example is cigarette smoking,” she said. Women who smoke are more likely to have dangerously small babies, she said. “Women who smoke actually have almost two times the need for services, medical therapy, for achieving pregnancy,” Giudice added.

And she defended the need to talk to patients about chemicals whose threats are not yet clearly established. “If it is biologically plausible and we have a way to minimize exposures, I think that is an important contribution,” Giudice said. “We don’t want everyone being afraid to go outside or to use their personal care products or to walk outside and breathe the air. But it is important that if it is a very polluted day that one may choose to stay indoors.”

“I think they make it sound like the knowledge base is clearer than it is,” counters DiPietro. “I tell pregnant women you should be issued a pair of earmuffs to wear. We know we are all living in a chemical brew and what about it?”