Blog #7 - The Burden of Environmental Toxins

The healthcare system in the United States has historically been notorious for waiting until illness requires treatment or hospitalization before intervening. That is why a significant portion of the annual cost of environmentally-related conditions like asthma goes to direct medical costs, such as emergency room visits and hospitalizations, that are often paid for by private insurance companies and out of the pockets of patients and families. As a health care provider, the most important factor to consider is prevention. Teaching patients and parents about exposure to allergens and other exacerbating substances that are found in surrounding environments and how to reduce exposure is crucial. Primary prevention should be the immediate and principal goal in health care as a general rule. 

I was not fully aware of the potential links between environmental exposures and neurodevelopmental disorders. I was also not terribly surprised that exposure to substances like lead and pesticides can lead to the development of learning disabilities and autism. I appreciate that the speaker in the video from UC Davis makes the point that the marked increases in certain diseases and cancers cannot be solely genetic. She also mentions that aging begins at conception. This is such an interesting prospect that I had never before considered. These ideas would be useful in practice to stress the importance of reducing exposure to environmental toxins during and even prior to pregnancy. I will also put in my back pocket the understanding that some substances have no safe exposure dose. Minuscule amounts can even be harmful.

In my current practice, I do not see children or women of childbearing age, but I will certainly see this patient population in the future as a FNP. Based on what I have read and learned so far in this module, adopting the FIGO recommendations would be beneficial in the narrative of primary prevention. FIGO supports advocacy for policies that reduce or prevent harmful environmental exposure and make environmental health a part of health care. Environmental exposure is such an important contributing factor to our health that adopting these policies would only make sense. Primary prevention starts with us.

After watching the UCSF video, there are several takeaways that I will save for future practice. First of all, I was amazed at the dramatic reproductive changes that occurred in the frogs exposed to atrazine. This chemical is widely used on corn and for grass on golf courses in the U.S., and California uses a large portion of the atrazine in the growing and production of our food. We are all exposed on a regular basis. All patients should be made aware of this fact, and the fact that exposure can affect risk for breast cancer and other conditions as well as serious birth defects. Also, patients should be aware that their children, and even grandchildren, can be affected by their current and past exposure. In addition to education, I think it is our duty as health care providers to get involved in policymaking and perhaps get this substance banned as it is in most of Europe.

One important takeaway from Dr. Lamphear’s video is that some toxins can be harmful at very low levels, and in many cases, there is no safe level of exposure. Parents should be aware that exposure to substances such as pesticides and lead can decrease IQ in children and cause an array of developmental and cognitive disabilities. Exposure during pregnancy can even cause decreases in intellectual abilities. To avoid exposure eat fresh or frozen foods, preferably organic, avoid canned and processed foods as much as possible, significantly reduce or discontinue intake of fish that have high levels of mercury, keep pesticides out of the home, and have your home tested for lead, radon, and other harmful substances.