Plastic Read online

  Of course, it's possible to set the safety bar too high as well as too low. Plastics have proven benefits in medicine and other fields. Proposing unachievable standards—demanding that substances be proven absolutely benign—could produce the same regulatory "paralysis by analysis" we're now experiencing. But when adequately funded research indicates significant evidence of harm, we are betraying our children if we fail to take action against a potentially dangerous chemical, especially when alternatives are available.

  Who's responsible for taking action? Often the first step is made by an ordinary person paying attention. A person like Paula Safreed. In the early 1990s, Safreed was a nurse in the NICU at the Brigham and Women's Hospital in Boston. In addition to caring for babies, she was in charge of ordering supplies for the unit, which put her in regular conversation with the vendors of medical equipment. She began hearing rumblings about the chemical in the plastic IV bags and tubing she used to treat her tiny patients. What caught her attention wasn't anything to do with DEHP's potential reproductive effects. Rather, it was a comment by a vendor that DEHP had been linked with damage to the liver. It reminded her of a baby she had cared for years earlier, one of a set of twins born prematurely. One twin died, but this boy survived and spent months in the Brigham NICU, receiving blood transfusions, proteins, and lipids, as well as intravenous nutrients, via vinyl IV bags and tubing. Safreed was thrilled to see him get strong enough to go home and utterly devastated when he later developed liver cancer and died at the age of three. She knew he had liver troubles, a common complication in preemies who spend a long time taking artificial nutrients. Still, Safreed was haunted by the possibility that the very things the NICU staff did to save his life had contributed to ending it.

  "That was when I started to get interested in plastics," she said. She began quizzing vendors about the contents of their products and pushing the hospital administrators to buy bags and tubing and other equipment made without DEHP. At the time, alternatives were few and far between and significantly more expensive. Still, Safreed kept pushing.

  She was not alone. During that same period, a coalition of environmental groups started a new organization, Health Care Without Harm, aimed at getting hospitals to phase out their use of vinyl IV bags, tubing, and other equipment that contained the plasticizing chemical DEHP. The drive was an outgrowth of a broader campaign to get hospitals to stop using PVC in general, because incineration of medical waste containing PVC had made hospitals a leading source of dioxin emissions. Discovery of that fact was "an incredible irony and a teachable moment," according to Health Care Without Harm founder Gary Cohen. "Because if you want to detoxify the economy, you start with the sector of people who have taken an oath to do no harm."

  Organizers from the group began talking about the risks of DEHP with hospitals around the country, quickly winning the support of influential university-affiliated hospitals such as the Brigham, as well as powerful chains like Kaiser Permanente and Catholic Healthcare West, both of which made far-reaching pledges to completely eliminate PVC and its additive DEHP from their facilities. (Kaiser has even replaced its vinyl carpet and flooring with alternative materials.) As of 2010, about 120 of the more than 5,000 hospitals in the United States had publicly signed on to Health Care Without Harm's campaign.

  The Brigham NICU was one of the nation's first to start adopting alternatives to PVC, and nurses there give the credit to Safreed, who has since retired. "All our products are DEHP-free," the NICU's assistant manager Julianne Mazzawi said proudly while showing me a package containing a slender coil of IV tubing that had a prominent label to that effect. The FDA may not require labeling yet, but some manufacturers are going ahead and doing it on their own.

  But what's really driven change in the medical marketplace has been Health Care Without Harm's success in reaching the half dozen or so organizations that negotiate bulk purchases on behalf of most of the nation's hospitals. These group-purchasing organizations hold enormous sway over the market; when they began asking about alternatives to PVC and DEHP, medical manufacturers sat up and listened.

  Most major medical suppliers now offer products, particularly many types of IV bags, tubing, and neonatal care equipment, that are free of DEHP and PVC. Some suppliers, such as Baxter, have introduced alternatives while continuing to defend the safety of PVC and DEHP, which lends a certain schizophrenic quality to their promotional brochures. Other suppliers embraced new approaches early and with gusto. Starting in the 1970s, leaders of the company B. Braun (now B. Braun McGaw) saw the opportunity to carve out a new market niche by developing alternatives to PVC and DEHP. It mainly uses the common plastic polypropylene (the stuff of bottle caps, disposable diapers, and monobloc chairs). "Polypropylene is a cleaner material than vinyl because it doesn't contain chloride. And it doesn't contain plasticizers" so there's nothing to leach out, said David Schuck, vice president of pharmaceutical testing for the company. He said safety testing has shown the resin has no hormonal effects. (Still the company uses glass containers only for its intravenous nutritional supplements for infants.) Other companies are using other types of plastics—such as polyurethane, polyethylene-like polymers, and silicone—that they say are safer and don't require the use of chemical additives.

  Meanwhile, the makers of additives are coming out with alternative, ostensibly safer plasticizers that can be used to soften PVC. At least four are already used in children's products, including citrates, compounds based on citric acid. These have been available for years but were rarely used because they cost more than phthalates. Another alternative softener is a chemical called Hexamoll DINCH, introduced by BASF, one of the world's leading makers of phthalates. BASF spokesman Patrick Harmon said the company spent seven million dollars on safety testing and is "very confident" it is safe. Though American manufacturers have not yet adopted it, he said it is being used in Europe for toys, food packaging, and medical devices, including the IV tubing and bags used to deliver nutritional supplements to preemies.

  Given the growing availability of alternative materials and additives, I was surprised to find they constitute only about a quarter of the medical market. There are many hospitals—and even neonatal intensive care units—that are still using equipment that contains PVC and DEHP. They are understandably cautious about trying something new—better to stay with the devil you know. And it's a market reality that alternatives still cost more. In the absence of a federal mandate—the FDA warning was only an advisory—it's not hard to see why cash-strapped hospitals would be reluctant to make a change.

  The NICU at Children's National has switched where it can, said Short. The babies now get nutritional supplements from non-PVC bags—an important changeover, because those fatty liquids are particularly good at sucking DEHP out of vinyl. But Short said she hasn't found a satisfactory alternative for the tubing used with those bags or for the regular kits of IV bags and tubing that were essential to baby Amy's care. "The tubing has to be soft," she explained, rubbing her fingers along one of the impossibly thin pipelines running into Amy's impossibly tiny veins.

  And there are also applications for which no alternatives have yet been found. Heart-lung machines still use only vinyl tubing that contains DEHP. Ironically, the same is true for the object that first triggered critics' scrutiny: the blood bag. DEHP, it turns out, acts as a preservative for red blood cells, preventing them from breaking down. To many blood bankers, the fact that DEHP leaches out of the bags is a plus, not a minus, said Gary Moroff, a spokesman for the American Red Cross. No other plasticizer works as well, he insisted.

  "That's because no one has evaluated them!" Luban responded in a tone of plain aggravation when I told her what Moroff had said. She has long been frustrated with the blood bankers' stay-put position and their apparent lack of interest in further investigating the potential risks of DEHP. But she also acknowledged that changing the basic material used in blood banking would require "an astronomical amount of work, time, effort, and money." The alar
ms aren't yet ringing loud enough to motivate anyone in the blood-banking field to undertake such an immense project.

  Are the alternatives to phthalates safer than the chemicals they're replacing? One would hope so. DINCH has passed the scrutiny of EU regulators, and citrates seem to have a safe track record. But absent reliable methods of assessing chemical risks and without a precautionary chemical policy, there's no way to be certain that the substitute introduced today won't turn out to be the DEHP of tomorrow.

  Markets are an unreliable force for protecting the broad public interest. They respond to public pressure, but the public is not always equipped to provide it. Until Americans have stringent laws in place designed to prevent harm before it occurs, we will be left to navigate a world of imperfect choices. For instance, even those neonatal intensive care units that have largely eliminated DEHP and PVC may still harbor other plastic-based risks. In a recent study of the vinyl-free Brigham NICU, researchers found the babies had bisphenol A in their urine. The source is unclear, according to Steve Ringer, the chief of the unit and one of the authors of the study. But given the ubiquity of bisphenol A, there are many possibilities, including the polycarbonate incubators, the plastic containers that hold the fats the babies are fed, and even the babies' mothers' breast milk.

  If breast milk turns out to be a significant source, what should the hospital do?

  "Our opportunities for intervention are pretty limited," Ringer said. The babies could be given formula instead, but in light of the uncertain, long-term risks posed by bisphenol A and the well-established, immediate health advantages of breast milk, he said, "I think I'd still come down on the benefits of breast milk."

  And of course, even if market pressures could succeed in completely eliminating suspect chemicals like bisphenol A and DEHP from medical settings, we're still going to encounter them in every corner of our daily lives. It's nearly impossible to escape the plastic bubble.

  When I consider how much of our lives are a little plastic, I find myself confused about how to negotiate this new world of risks. That's one reason I asked most of the researchers I interviewed how they dealt with plastics.

  Knowing that there are bloggers and websites urging wholesale abandonment of plastics, I was surprised at how moderate most of the experts were. Joel Tickner, an associate professor of environmental health at the University of Massachusetts in Lowell and a longtime critic of DEHP, was typical. "I try to be as careful as I can, but I'm not obsessive," he explained. When his kids were little, he let them have vinyl squeeze toys—the sort that typically contain phthalates—but not a lot of them. He uses Tupperware, plastic wrap, and baggies. He doesn't heat or microwave foods in plastics, since that accelerates the breakdown of the polymer. (Every expert took that precaution, at a minimum.) Tickner swapped out his children's bisphenol A-containing polycarbonate water bottles for metal ones, but he isn't too worried about using them himself. He's careful about the amount of canned foods his family eats—to avoid bisphenol A—but hasn't banished cans from the pantry. When his son had hernia surgery, he checked to see if the IVs and other equipment contained DEHP. As it turned out, they didn't, but even if they had contained phthalates, Tickner would have been sanguine. It was a one-time procedure, not ongoing therapy, and the benefits clearly outweighed the risks. "You do the best you can do, while keeping in mind there is no easy answer," Tickner said. "I'd rather change the rules so people don't have to worry about this than spend all my time worrying about it."

  5. Matter Out of Place

  LIKE SO MANY CHILDREN, when I was young I was captivated by the idea of a message in a bottle. There was something appealingly random yet intimate about this most primitive form of long-distance communication. The thought that you could launch a missive from an American beach and that someone might pick it up in China or Tanzania or Ireland made the vast world suddenly seem much smaller and more negotiable. The oceans connected us all.

  I was reminded of that point recently when I was talking to a researcher about a remote stretch of the Pacific Ocean northeast of Hawaii. For a long time, this area was known only as a windless becalming spot that sailors tried to avoid. More recently it has gained prominence as the site of an enormous swirl of plastic trash. The researcher and his colleagues had gone there to investigate just how bad conditions were in the so-called garbage patch. Twice a day they trawled nets through the clear blue waters, and every trawl brought up plastic. Most of what they recovered was unidentifiable bits and pieces, but one day, he said, the net contained a clear plastic disposable lighter. It was in such good shape you could even see an address printed on its side. He told me there was a picture of it on his lab's website.

  I looked up the photo and peered closely at the writing—which was in both Chinese and English—until I finally made out a Hong Kong address and phone number. Feeling as if I'd found a message in a bottle, I decided to give the number a call.

  It turned out to belong to a company that sells and distributes Chinese wine. Alex Yueh, the very patient office manager who surely regretted taking my call, didn't know about any promotional lighters. The company didn't give them out. But maybe it did in the past, he suggested, for the address listed on the lighter was where the company had been located seven years ago. "I don't know how this got into the ocean," he said. "It is very strange."

  But in fact, in the age of plastic, the strange becomes commonplace: a lighter designed for a lifetime of mere months will easily survive for years bobbing across miles of open ocean.

  One place that a castaway lighter could land is on Midway atoll, a tiny island among many in the Hawaiian archipelago. Midway is the site of a historic World War II battle. Today it is under a very different kind of assault from the piles of trash that wash up there with every storm. Volunteers collect tons of debris from its white-sand beaches each year. They have gathered hundreds of beached lighters.

  Midway is also home to the Laysan albatross, an impressive sea bird that stands nearly three feet tall and has a wingspan twice that length. Those broad wings allow the birds to fly great distances in their daily forage for food in the seawater surrounding Midway. Some 1.2 million of the birds nest on the atoll, and almost every one has some quantity of plastic in its belly. The contents of the birds' stomachs "could stock the check-out counter at a convenience store," said one expert.

  John Klavitter, a wildlife biologist with the U.S. Fish and Wildlife Service who has worked on Midway since 2002, has autopsied hundreds of dead albatrosses. He routinely finds bottle caps, pen tops, toys, fishing line, plastic tubes used in oyster farms, and lighters—all scooped up accidentally by the birds in their hunt for the squid and clumps of flying-fish roe that make up their normal diet. "And then there are all sorts of little plastic pieces, you can't tell what they are," Klavitter added. While rooting through the bird's stomach in the course of an autopsy there's often a sickening sound of clinking plastic. One dead chick had more than five hundred pieces of plastic in its stomach, including an olive green tag that was traced to a U.S. Navy bomber shot down more than ninety-six hundred kilometers away—in 1944!

  A century ago, the biggest danger to the birds was feather hunters. Today, a major threat is plastic. The most vulnerable are the chicks, who rely on their parents for nourishment. Normally the parents regurgitate slurries of squid and fish eggs scavenged from the open sea into the mouths of their young. But since scientists started checking, in the 1960s, the birds have been returning to the nests with growing amounts of plastic. "If you sit and watch the parents feeding the chicks, you can see them passing plastics to their chicks," said Klavitter. In one two-month cleanup of the areas around the rookeries, volunteers collected more than a thousand disposable lighters.

  Death is common among albatross chicks. Of the five hundred thousand chicks born each year, about two hundred thousand die—most often of dehydration or starvation. But a new factor likely contributing to that death toll is the birds' increasingly synthetic diet. With their stomachs
stuffed full of plastic odds and ends, the chicks may not be able to eat or drink, or even recognize that their bodies need food or water. In one study funded by the Environmental Protection Agency, researchers found that the chicks that died of dehydration or starvation had twice as much plastic in their stomachs as those that died of other causes. Then too, plastic is sometimes a direct cause of death, as when a chick swallows a piece of plastic sharp enough to puncture its stomach lining or so large it blocks its esophagus.

  Klavitter can't usually tell if a bird is being affected by plastic while it's still alive. The birds don't typically show signs of distress, and since their stomachs are designed to deal with indigestible items, such as squid beaks, they often will just regurgitate plastics they've swallowed. But once he spotted an adult albatross trying to cough up a piece of plastic that was apparently stuck in its throat. He caught the bird and massaged its throat to carefully extract what turned out to be the long white handle of a child's pail. The Laysan albatross is just one of more than 260 species of animals in the world that are being killed or injured by plastic. And, said Klavitter, "what we see in the albatross is happening further down the food chain." Fish large and small and even dime-sized jellyfish are ingesting plastic. "It's pretty spooky how far down it goes."

  I've looked at photos of dozens of dead Laysan albatrosses—pictures that capture in the starkest way the threat plastics pose to the natural world. Every carcass seems a mockery of the natural order: a crumbling bird-shaped basket of bleached bones and feathers filled with a mound of gaily colored lighters and straws and bottle caps. The birds are dissolving back into the ground; the plastics promise to endure for centuries.