Exposure to endocrine-disrupting chemicals in medicine and medical devices is grossly underestimated, and physicians have an ethical obligation to talk about these exposures with their patients, according to a new study.
Authored by researchers at the University of Illinois at Chicago, the paper synthesizes scientific literature on the presence and potential health impacts of endocrine disruptors in medication and in the many plastic devices (e.g., catheters and blood bags) used in medical procedures. Such chemicals can mimic the body's hormones and have been linked to multiple health impacts, including infertility, cancer, heart disease and stroke, neurodevelopmental problems and immune system dysfunction.
The study, published today in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism, finds strong evidence that these chemicals found in health care might not only be promoting disease, but antagonizing the efficacy of treatment, and concludes that failure to disclose this information to patients violates core medical ethics. The authors acknowledge the life-saving and health promoting benefits of these medicines and treatments, but say the risks must be weighed against the benefits.
"There's this ethical obligation for physicians to actually do something about it," said lead author Robert Michael Sargis, an endocrinologist in the Department of Medicine at the University of Illinois at Chicago.
"Health care becomes this exposure paradigm," he added. "It's not just pollutants in the air and water, and it's not [just] personal care products. Now it's something that physicians are actually doing to patients."
Many physicians, however, remain unaware of the risks of endocrine disruptors, or the extent of the problem in medical care, Sargis and colleagues warned.
"They're so right, there's an ethical issue here," said Ted Schettler, Science Director of the Science and Environmental Health Network, which was not involved in the study.
The chemical dangers in medical devices is "a story that doesn't seem to want to end," he added, recalling his work with Health Care Without Harm 20 years ago to remove polyvinyl chloride tubing from medical devices because it contained the plasticizer diethylhexyl phthalate (DEHP).
Among the findings of the new research review:
- Dibutyl phthalate (DBP) and diethyl-phthalate (DEP) were found in a broad spectrum of over-the-counter and prescription medication, and are commonly added to drugs for gastrointestinal disorders, such as omeprazole.
- Parabens are added to drugs for their antimicrobial activities and were similarly found in many medications, including fluoxetine (Prozac), ibuprofen and acetaminophen.
- Parabens are incorporated in intravenous solutions, ultrasound gels and heparin lock solutions for their broad-spectrum antimicrobial activity.
- Phthalates were found in some strengths of the drug Cardizem CD, but not all, and one butterfly blood draw kit released significantly higher levels of parabens than others, suggesting that safer options are possible.
- Studies document the release of phthalates, bisphenol A (BPA), parabens, perfluoroalkyl substances (PFAS) and triclosan from medical supplies, such as syringes, endotracheal tubes, blood bags and catheters. Phthalates account for 30 to 40 percent of the weight of medical use plastics.
- A 2019 study on 52 common neonatal intensive care unit (NICU) items found that three-fifths contained BPA and four-fifths contained parabens.
Many of the studies detected endocrine disruptor metabolites in urine following medical interventions.
Given the complex, and oftentimes delayed, ways in which these chemicals impact health, few studies have been able to connect those exposures to health endpoints. However, Sargis did point out one study that found thyroid hormone changes when people were put on a certain set of medications.
Exposure to endocrine disruptors in neonatal intensive care units is "most concerning" said Sargis, "because the children are some of the most vulnerable patients that we ever see," and they receive a lot of medical interventions that use plastic devices found to contain endocrine disruptors. Low levels of exposure to endocrine disruptors during development is associated with impacts years later in life.
The authors stress that the risk from these medical exposures is likely understated because our knowledge is restricted to a few known classes of endocrine disruptors and a limited set of medical devices.
They call on physicians to learn about their role in exposing patients to these chemicals, and urge them to live up to their ethical mandates to discuss the risks with their patients. They also call on regulatory agencies and manufacturers to identify and eliminate endocrine disruptors in medications and medical devices and develop safer alternatives.
While Schettler agrees that raising awareness is important, he said, "there's only so much you can do in that regard and, at some point, the regulatory agencies really need to step in and do their job."
Sargis emphasized the importance of proper medical care. "These devices and [medicines] … save life and improve health. This is really meant to be a moment to reflect on what we're doing, and try to identify ways to move forward in a better way."
Our goal is "to ensure that we're doing best by our patients…in essence what we're asking for is a shift in the system such that we can ensure that the meds and medical devices we use protect endocrine health," he added.
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