Medicaid and the Chemical Industry

Figure 4: Medicaid is the third largest domestic program in the federal budget.

As of 2002, the majority of Medicaid beneficiaries (54%) were children under the age of six years. Contrary to the popular myth of aging slackers, drug addicts, and welfare queens sucking at the national teat, this majority of Medicaid provides healthcare to children and adolescents with limitation of activity due to chronic health conditions. Their numbers quadrupled from two percent in 1960 to over eight percent in 2012.[1],[2]

This increase parallels the growth in manufacture and use of agricultural chemicals.

One of the fastest growing patient groups covered by Medicaid is children with developmental disabilities. Over the last 12 years, the prevalence of developmental disabilities (DDs) has increased 17.1%—that’s about 1.8 million more children with DDs in 2006–2008 compared to a decade earlier: autism increased 289.5% and ADHD increased 33.0%.

According to a recently released study, children with special health care needs suffer conditions that include

autism, Down syndrome, and other intellectual and developmental disabilities (I/DD); physical disabilities such as cerebral palsy, spina bifida, and muscular dystrophy; mental health needs such as depression and anxiety; and complications arising from premature birth. They may need nursing care to live safely at home with a tracheotomy or feeding tube; attendant care to develop community living skills; medical equipment and supplies; mental health counseling; and/or regular therapies to address developmental delays.[3]

One source puts the annual cost of caring for a child with severe autism at $72,000.

What is happening?

Consider the case of Eva Galindos, a twelve-year-old girl with autism. At age three, she was diagnosed by her pediatrician, but he could not answer the parents’ urgent questions about why this happened to their child. Seeking answers, the Galindos family participated in a study. At the time of Magda Galindos’ pregnancy with Eva, “the family was living in Salida, a small town in central California surrounded by fields of almonds, corn, and peaches. The Galindos could see the planted fields just down the street from their stucco house.” Magda recalled the acrid smell of chemicals sprayed on the fields, very different from the fertilizer odor.

The study revealed that during pregnancy, Magda had been exposed to chlorpyrifos.

In 2014, the first and most comprehensive look at the environmental causes of autism and developmental delay, known as the CHARGE study, found that the nearby application of agricultural pesticides greatly increases the risk of autism.[4] Women who lived less than a mile from fields where chlorpyrifos was sprayed during their second trimesters of pregnancy, as Magda did, had their chances of giving birth to an autistic child more than triple. And it was just one of dozens of recent studies that have linked even small amounts of fetal chlorpyrifos exposure to neurodevelopmental problems, including ADHD, intelligence deficits, and learning difficulties.[5]

The American use of chemicals to eradicate insects both in homes and crops dates back to lead arsenate in 1892, but as early as 900 AD, poisonous arsenic sulfides were used in China.

The search for a substitute [to lead arsenate] commenced in 1919, when it was found that its residues remain in the products despite washing their surfaces. Alternatives were found to be less effective or more toxic to plants and animals, until 1947 when DDT was found. The use of lead arsenate in the US continued until the mid-1960s. It was officially banned as an insecticide on August 1, 1988.[6]

Total global pesticide production and global pesticide imports (1940s-2000) – Tillman et al. (2002)0

DDT (Dichlorodiphenyltrichloroethane) quickly took the place of lead arsenate, even though research as early the 1940s had shown its harmful effects. After Rachel Carson’s expose Silent Spring pointed the finger at DDT for poisoning wildlife and the environment and endangering public health, the chemical was targeted by a growing anti-chemical movement. In 1967, a group of scientists and lawyers founded the Environmental Defense Fund with the specific goal of banning DDT. Despite continuing efforts, DDT is still produced for ‘vector control’ and for agricultural purposes in India, North Korea, and possibly other locations. At least three to four thousand tons of the chemical is produced annually.

Like many chemicals, DDT persists in the environment as well as in tissue of all life forms. Its biological half-life in soil is up to thirty years. Organisms at the top of the food chain suffer greater exposure as the chemical and its major metabolites of DDE and DDD accumulate in animals and plants which are then consumed by other animals.[7] Among its effects, DDT is an endocrine disruptor which can cause cancerous tumors, birth defects, and other developmental disorders.

Specifically, “endocrine disruptors may be associated with the development of learning disabilities, severe attention deficit disorder, cognitive and brain development problems; deformations of the body (including limbs); breast cancer, prostate cancer, thyroid and other cancers; sexual development problems such as feminizing of males or masculinizing effects on females, etc.”[8]

With the ban on DDT, farmers and other chemical consumers turned to chlorpyrifos.

Estimated worldwide annual sales of pesticides 1960 to 1999 in billions of dollars (Herbicides, Insecticides, Fungicides, and others) – Agrios (2005)0Despite the overwhelming evidence that chemicals lead to ever-increasing negative health effects, chemical companies are willing to spend whatever it takes to discredit the evidence in efforts to delay any meaningful regulation of those chemicals. In a lengthy article published January 14, 2017, in The Intercept, an online newsletter, author Sharon Lerner details the efforts of Dow Chemical to protect its lucrative products from EPA regulation.[9] It’s a staggering indictment not only of Dow’s strong-arm tactics but also of the willingness of legislators and government agencies to ignore their duties to American citizens.

Exposure to chemicals which are wreaking havoc on the nation’s children is suffered disproportionately by the poor. Agricultural workers live near fields where chemical sprays drift in through open windows. Inner-city poor live in housing that is routinely sprayed with pesticides despite the presence of children and pregnant women. Long-term exposure plus ingesting food laden with pesticides means that while autism rates among children across the U. S. population is one in 68, for women in poor neighborhoods or near commercial agriculture, the rate of impaired children is one in 21.

Parents such as Magda Galindos can’t afford to move away from the fields where chemicals are sprayed. She also can’t afford to buy organic food, which is often twice as expensive. Her household income and the medical needs of her daughter Eva qualify for state and federal assistance.

Which brings us back to Medicaid.

Figure 1: Type of health insurance among children with special health care needs

Despite compelling and well-documented scientific studies showing the strong link between certain chemicals and a slate of neurodevelopmental disabilities including autism, the EPA has for decades postponed any meaningful action to more strictly regulate (or ban) the culprits. In a recent publication, scientists stated:[10]

In 2006, we did a systematic review and identified five industrial chemicals as developmental neurotoxicants: lead, methylmercury, polychlorinated biphenyls, arsenic, and toluene. Since 2006, epidemiological studies have documented six additional developmental neurotoxicants—manganese, fluoride, chlorpyrifos, dichlorodiphenyltrichloroethane, tetrachloroethylene, and the polybrominated diphenyl ethers. We postulate that even more neurotoxicants remain undiscovered.

This is the tip of a massive iceberg. As reported in a 2016 PBS report on “Science Friday,”

There are more than 80,000 chemicals registered for use today, many of which haven’t been studied for safety by any government agency. But that’s about to change…somewhat. President Obama today signed into law the Frank R. Lautenberg Chemical Safety for the 21st Century Act, named after the late senator who introduced a version of the bill in 2013. This marks the first overhaul in 40 years to the Toxic Substances Control Act of 1976, the nation’s main law governing toxic chemicals.

Absurdly, the law only requires the EPA to test twenty chemicals at a time and each one has a seven-year test deadline before a five-year period during which industry is supposed to comply with any new regulation. At that rate, it will take over a century for all the current chemicals to be tested, all while about 20,000 new chemicals hit the market each year.

New EPA head Scott Pruitt, who voted for the Lautenberg bill, has stated that the law “guarantees protection of the most vulnerable by placing emphasis on the effects of exposure to chemicals on infants, children, pregnant women, workers and the elderly.”[11]

This should be a hopeful note, but even in a best-case scenario where President Trump’s EPA enacts swift meaningful restrictions on chlorpyrifos and other chemicals saturating our soil, air, and waterways, the incidence of fetal exposure and the resultant impairment of so many of our nation’s young will not abate any time soon. These chemicals wash down our rivers and linger in oceans where we harvest seafood. They soak into the walls and floors of our homes, survive in cropland that produces our fruits and vegetables, and become even more concentrated in livestock feeding on those plants.

Since developmentally disabled children form over half the nation’s Medicaid caseload at an estimated cost of about $300 billion (2015), legislators looking to reduce Medicaid expenditures should turn first to the nation’s agrochemical industries. In 2015, for example, Dow AgroSciences reported a full year profit of $962 million. In 2016, even after some losses, the company still enjoyed an $859 million profit.  Monsanto and DuPont reported similar numbers.

Why not impose a 50% tax on such profits? This would yield a modest $1.5 billion toward the Medicaid costs resulting (in part) from their products and serve as a powerful incentive to ensure such products are safe before they’re marketed.

~~~

[1] https://www.nap.edu/read/10537/chapter/4#50

[2] http://www.deseretnews.com/article/865609389/10-common-disabilities-American-children-have.html

[3] http://kff.org/medicaid/issue-brief/medicaid-and-children-with-special-health-care-needs/

[4] https://ehp.niehs.nih.gov/wp-content/uploads/122/10/ehp.1307044.alt.pdf

[5] https://theintercept.com/2017/01/14/dow-chemical-wants-farmers-to-keep-using-a-pesticide-linked-to-autism-and-adhd/

[6] https://en.wikipedia.org/wiki/Lead_hydrogen_arsenate

[7] https://en.wikipedia.org/wiki/Dichlorodiphenyltrichloroethane

[8] https://en.wikipedia.org/wiki/Endocrine_disruptor

[9] See Footnote 5 above

[10] http://thelancet.com/journals/laneur/article/PIIS1474-4422(13)70278-3/abstract

[11] https://www.bna.com/trumps-pick-lead-n73014449061/

Straining on a Gnat

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In light of a recent update to federal regulation of commercial chemicals, pointed questions arise about laws governing controlled substances. Consider last week’s announcement of funding for a study of synthetic pot. The press release from the University of Arkansas for Medical Sciences emphasized the importance of knowing ‘what is safe.’ A federal grant of $2.7 million will fund research into K2 and Spice, a study to be led by Paul Prather, professor of pharmacology and toxicology.

“People who smoke K2 and Spice are basically playing Russian roulette,” Prather warned. “You’re injecting this compound that has literally never been tested.”

I had to laugh out loud. What are K2 and Spice compared to the 84,000 commercially used chemicals that have never been tested? What logic lies behind aggressive policing of intoxicants that a limited percentage of the population might voluntarily use periodically and the simultaneous abject failure to test chemicals that the entire population unwittingly touches, ingests, and inhales on a daily basis? Everything from dryer sheets to shampoo to spray sanitizers is loaded with mystery chemicals.

This lunacy fits perfectly with the hit-or-miss tradition of government policies rife with misinformation, driven by profiteering, and shrouded in hysteria and secret agendas instead of rational analysis of fact.

People who use K2 and Spice seek a legal alternative to marijuana.  Unlike these modern synthetics, however, marijuana has been in use as a medicine and intoxicant since pre-history. Archaeological evidence points to cannabis use in ancient China, ancient India, ancient Egypt, and by the Scythians contemporary to ancient Greece. If the criteria is ‘what is safe,’ then marijuana has long since exceeded the requirement.

If public policy were based on thoughtful analysis, marijuana would be legally sold like alcohol and this $2.7 million appropriated to study K2 would be spent on examination of why the U. S. has a higher rate of drug use and abuse than any other nation on earth (which goes hand in hand with our skyrocketing prison population).[1] The proportion of people in the United States who have used cocaine at some time during their lives is higher—by a factor of four—than in 16 other nations surveyed by the World Health Organization (WHO). The United States also leads in lifetime use of cannabis and tobacco.[2]

There’s a common misconception that drug laws are based on comprehensive scientific conclusions about the dangers of those drugs. Government funding to study drugs props up the fiction that our laws are based on ‘what is safe.’ This fantasy has been promoted by those with vested interests or a social agenda in mind. Drug laws have turned our local police departments into militaristic hit squads. Prisons are a growth industry. Selective enforcement of drug laws against immigrants, racial groups, the counter culture, and inner city poor places these potentially troublesome groups under government control.

Drug laws do nothing to stop addiction.

Consider the cautionary tale now unfolding about OxyContin. Blessed with extensive clinical testing and FDA approval, Oxy has been the darling of pain relief since the 1990s. Similarly, a century earlier Bayer Pharmaceutical introduced a new wonder drug named heroin.[3] “The sales pitch that created an instant market to American doctors and their morphine addicted patients was that heroin was a ‘safe, non-addictive’ substitute for morphine.”[4]

Now that OxyContin addiction rates have soared, a predictable crackdown has restricted supply. The result is a shift from oxy to black market heroin and rising overdose rates.

Drug warriors and doctors alike seem to be asking the wrong questions.

The more obvious right question: Why does the U.S. lead the world in substance abuse?

The less obvious: What role does our daily cocktail of manmade chemicals play in our mental and physical health, including addiction?

If the health and welfare of our citizenry were the force guiding federal and state policy, then why has it taken until June of this year for the federal government to authorize new provisions in the nation’s Toxic Substances Control Act? Originally passed in 1976, the TSCA allowed all 62,000 chemicals that were in commerce before that year to stay on the market unless the Environmental Protection Agency later found that they posed an “unreasonable risk.”

Now over 84,000 untested chemicals are in commercial use. In the intervening forty years, the EPA has required testing of only 250 chemicals and banned only nine, among them dioxin and hexavalent chromium. The new rules impose a mandatory requirement for the EPA to evaluate tens of thousands of in-use chemicals and establish risk-based safety standards along with requiring public transparency for chemical information. [5]

A day late and a dollar short. For decades, activists have pushed for laws more like those in Europe where substances generally can’t go to market unless manufacturers can provide data showing they’re safe.[6] Clearly we’ve got this backwards.

Before you start feeling reassured by this recent change in the U.S. regulation of chemicals, please note that

“The new law requires EPA to test tens of thousands of unregulated chemicals currently on the market, and the roughly 2,000 new chemicals introduced each year, but quite slowly. The EPA will review a minimum of 20 chemicals at a time, and each has a seven-year deadline. Industry may then have five years to comply after a new rule is made. At that pace it could take centuries for the agency to finish its review.”[7]

One gaping hole in our official ‘what is safe’ question is whether any of these chemicals might increase the risk of addiction. For example, the chemical Bisphenol A (BPA) is found in many products, including canned foods, plastics, and dental sealants, and is similar in structure to the hormone estrogen. Ask any woman whether hormones affect mood and attitude. Or any man, for that matter. Studies have linked BPA exposure with many health problems including obesity, early puberty, and miscarriage. Whether levels of BPA in the environment are harmful to people is still being studied.

Other chemical pollutants may affect mood, impair reproduction, and trigger cancer and other disease. Consider just one particular chemical, tributyltin, which is used as a wood preservative and glass coating among other things. In animal studies, it was found that exposure to tributyltin increased the number of fat cells, thus possibly setting into motion a genetic propensity at birth for obesity.  Some chemicals have been found to cause male frogs to become female.  It’s a long and terrifying list.

84,000.

Admittedly other factors in American life influence the rates of intoxicant abuse. As a multi-cultural society, we have few ties that bind. What are our rituals that serve as guideposts, rites of passage that help define a young person’s purpose or meaning? What shortcomings in Western medicine lead us to treat an ailment’s symptoms rather than dig out the cause? What ignorance and greed allows drug companies to saturate our media with ads that condition us to seek a pill for every ill?

Simultaneously, chemicals have become the modern savior for everything from bad odors to agriculture. We are routinely exposed to a smorgasbord of substances which may trigger our need for drugs or at least compromise us in myriad ways we hardly understand. While government awards contracts to study K2 which last year caused fifteen people to lose their lives, cause of death data from 2013 finds 29,000 deaths from alcohol, 18,893 deaths from prescription drugs, and 17,000 from all illegal drugs combined.

We can rest assured K2 will be proven harmful. Then what? Build more prisons?

Even those numbers pale in comparison to data from 2006 showing workers in chemical industries suffer more than 190,000 illnesses and 50,000 deaths annually related to chemical exposures. Workplace chemical exposures have been linked to cancers and other lung, kidney, skin, heart, stomach, brain, nerve, and reproductive diseases.

Consider the following abstract for a 2008 study by the National Institutes of Health:

“While proper brain function requires the complex interaction of chemicals perpetually occupied in purposeful biochemistry, it is well established that certain toxic substances have the potential to disrupt normal brain physiology and to impair neurological homeostasis. As well as headache, cognitive dysfunction, memory disturbance, and other neurological signs and symptoms, disruption of brain function may also manifest as subtle or overt alteration in thoughts, moods, or behaviors. Over the last four decades, there has been the unprecedented development and release of a swelling repertoire of potentially toxic chemicals which have the capability to inflict brain compromise.

“Although the ability of xenobiotics to induce clinical illness is well established, the expanding public health problem of widespread toxicant exposure in the general population is a relatively new phenomenon that has spawned escalating concern. The emerging area of clinical care involving the assessment and management of accrued toxic substances such as heavy metals, pesticides, plasticizers and other endocrine disrupting or neurotoxic compounds has not been fully appreciated by the medical community and has yet to be incorporated into the clinical practice of many consultants or primary care practitioners.”[8]

That pretty well says it all.

~~~ 

[1] http://www.cbsnews.com/news/us-leads-the-world-in-illegal-drug-use/

[2] https://www.drugabuse.gov/news-events/nida-notes/2009/11/united-states-ranks-first-in-lifetime-use-three-drugs

[3] https://en.wikipedia.org/wiki/Heroin

[4] http://www.narconon.org/drug-information/heroin-history.html

[5] https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/frank-r-lautenberg-chemical-safety-21st-century-act

[6] https://www.washingtonpost.com/news/energy-environment/wp/2015/03/19/our-broken-congresss-latest-effort-to-fix-our-broken-toxic-chemicals-law/

[7] http://www.pbs.org/newshour/updates/it-could-take-centuries-for-epa-to-test-all-the-unregulated-chemicals-under-a-new-landmark-bill/

[8] http://www.ncbi.nlm.nih.gov/pubmed/18621076

 

Photo credit: https://www.flickr.com/photos/jurvetson/131023758/