E113: The Environmental Domain of Risks

Kirtly: The Centers for Disease Control has divided up the risks of your health and lifespan into four categories. And they're these: unhealthy lifestyle is a risk; your own genetics and biological makeup; lack of access to healthcare, health screenings, and timely healthcare and vaccinations; and the environment.

And at the "7 Domains of Women's Health," we are working on the Environmental Domain of Risk as we think our way through the 7 Domains of Risk.

I'm Dr. Kirtly Jones from obstetrics and gynecology at the University of Utah. And as a reproductive endocrinologist, I have become increasingly concerned about the environmental risk to fertility and early human development, and as an older person, the risk to my own brain and heart.

With me, and as always sharpening my thinking, is my co-host, Dr. Katie Ward. She has a doctorate in nursing practice and a PhD in anthropology and has a practice in women's health and teaches in the School of Nursing.

So Katie, what's risky in your environment?

Katie: Well, first of all, I was thinking this is the environmental domain of risk, but maybe it needs a reframe that we're talking about the risk of the environment, right? I had to sort of twist that in my brain for a minute to make sense of what I wanted to say today.

But honestly, I find at this stage of my life, I'm less concerned about what the environment means for me now. I've had a great life, I've had some fun, but what keeps me up is what I'm leaving behind.

Of the things you were just talking about, I can't change the genes I've passed on to my children. They're kind of stuck with them. And I really do want them to travel and enjoy modern conveniences and live rich, exciting, and healthy lives. And there's a cost to that to the planet.

But there's this idea . . . I looked it up, and as far as anyone can tell, it's not actually a Native American proverb, but it's still a good saying. We don't inherit the earth, we're borrowing it from our descendants. And so that's my good intention, is to do my part to leave a planet for my children and grandchildren and beyond. It's sort of less about me anymore, but more about them.

Kirtly: I agree with that. It's less about me, except when the air quality is really bad, my eyes burn, and I can't see so well, and I don't want to run into anybody.

But thinking back to the risks of your health, often the risks are combined. If you're a small kid with a developing brain, you're at increased risk of neurologic damage from lead poisoning. And if you're an older person with asthma, the risk of air pollution causing pulmonary disease is greater. If you already have a marginal sperm count, then air pollution or pesticide exposure can push you over to infertility.

So to help us think about the risks to our health from the environment we have, Dr. Brian Moench is going to join us in the Virtual Scope studio. His medical training and practice was in anesthesia, but he's been an environmental health activist for decades. And he's the president and co-founder of Utah Physicians for a Healthy Environment.

He was recently honored with the School of Medicine's Distinguished Humanitarian Award for his advocacy and education about health and the environment. Thanks for joining us, Brian. Thanks for being here.

So Brian, I want to play a clip from a song by a very famous satirist, Tom Lehrer. It was written 60 years ago. He was a favorite of my dad's, and as a kid, my dad would play it and we would hop around and chant, "Don't drink the water," and, "Don't breathe the air." We didn't really have a clue as to what it was.

[Begin soundbite of "Pollution" by Tom Lehrer]

If you visit American City, you will find it very pretty. Just two things of which you must beware, don't drink the water and don't breathe the air. Pollution, pollution, they got smog and sewage and mud. Turn on your tap and get hot- and cold-running crud.

[End soundbite of "Pollution" by Tom Lehrer]

Kirtly: This song is 60 years old, and our awareness of the dangers to health of air pollution is older than that. Thanks to the Clean Air Act, which was originally passed in 1963 and substantially enhanced in 1970 and passed with overwhelming congressional support, our air is cleaner, but our knowledge of the risks is deeper. So I want to talk about how strong is the science about air pollution. Can you talk to me about that?

Dr. Moench: Well, over about the last 40 to 50 years, there have been approximately 70,000 studies on air pollution. And if you look at the general trend, every single year, we learn more and more about how pervasive the impact of air pollution is on public health.

I remember about 17 years ago, when we first started our physicians group, we made public statements trying to help everybody understand what we were talking about, that there's a serious comparison between air pollution exposure and cigarette smoke.

And the state agency employees in the Division of Air Quality just had a fit that we would make that comparison. They even had the state toxicologist come up with a very elaborate presentation trying to explain and debunk our comparison.

We were right back then, but in all the medical literature published ever since then, we have just become all the more validated that there is tremendous comparison between cigarette smoking and public air pollution.

It shouldn't be all that surprising because cigarette smoking is just your own personal air pollution. Community air pollution is obviously something that affects everyone else.

To help people get a little bit of better understanding of how and why air pollution has such an impact, the average person takes about maybe 30,000 breaths a day in a 24-hour period.

Kirtly: Wow. That many?

Dr. Moench: Your lungs have a surface area of about that of a tennis court. We only exchange carbon dioxide and absorb oxygen through about half of that. So about 15,000 tennis courts' worth of exposure to air pollution is what the average person endures every single day.

Think about how much air pollution can land on 15,000 tennis courts. That's just an enormous amount. So, given that, I don't think anybody should be surprised that if we're inhaling air pollution to that extent, it's going to have some problems.

And so now, probably the most disturbing air-pollution-related studies are we know air pollution particles are penetrating all of our critical organs right up from the moment of birth, literally. And we know that virtually no one is spared of that.

So if a person doesn't think that all the air pollution that I'm breathing can actually penetrate and lodge in and remain in, at least for some time, every critical organ that I've got, my brain, my heart, my lungs, my kidneys, my liver, bone marrow, on and on and on, if you can't perceive how profound a public health risk that could be, then you're really not paying any attention to the evidence.

Kirtly: We have some evidence in the lab. I know mice aren't humans, but you can put mice in an environment that looks like regular bad air in any given city, and then mice in good air. Particularly in mice that are trying to make babies, we find that the babies of moms who were growing them when there was air pollution have fewer eggs.

So for me, from the fertility side, I happen to know that just like cigarette smoking, bad air increases miscarriages and maybe even stillbirths. Bad air lowers sperm counts, just like smoking does. And it decreases the number of eggs that you have, just like smoking does.

So we have laboratory evidence, and I think that the comparison between bad air and cigarette smoking is a really important one.

Katie: This is interesting, and I hope we're going to get into this a little bit too. Historically, it's been around the inversion, right? So we counsel patients about air quality and especially pregnant women, as you were saying.

So it's been the inversion, and when you see that settle in and people are asking what they should do, we tell them to avoid outdoor exercise and keep their windows closed and use the recirculate feature in the car and maybe get a HEPA filter at home.

Even pre-COVID, we were telling people to get an N95 mask and not a surgical mask. And now, thanks to COVID, at least people know the difference between those two. So the surgical masks don't filter the particulate matter and have a lot of gaps in them.

And of course, we tell people with asthma or heart disease to be meticulous with their medications. And for pregnant women, we're emphasizing, as you were saying, that the air pollution is associated with preterm birth and low birth weight and miscarriage. So we definitely take it really seriously with our patients.

What I'm concerned about right now, though, is the wind coming off of the Great Salt Lake as we lose our lakebed and that's exposed. So the inversion, people know to be careful because you can see it. But the dust coming off the Great Salt Lake that we're now really worried about, it's a little bit less obvious and we don't know where it's going.

Kirtly: I can see it on my windows, Katie.

Katie: I can too.

Kirtly: If you want to know what you're breathing, look at your windows after a dust storm, and then the rain picks up the dust and your windows are filthy. And you, if you were out there, were breathing that stuff. Sorry. I just had my windows cleaned and it might rain this week, so I'm thinking, "Oh my god, my windows."

Katie: And Brian, this is my wild and crazy idea, but I'd love your . . . You know those signs on the freeway that say, "Your waiting time at this emergency room is 15 minutes"? I would like to buy a bunch of billboards, just put them on buildings to say, "This is what's in your air today."

Dr. Moench: Oh, absolutely. And I'm glad you brought up the dust from the Great Salt Lake and the peril to public health that that represents. Twenty-eight sewage treatment plants discharge into the Great Salt Lake, either directly or indirectly. We have 120 years of huge mining operations in Kennecott dumping their waste riddled with heavy metals into the Great Salt Lake. We have 55 years of MagCorp dumping some of the worst chemicals you can possibly imagine into the Great Salt Lake ecosystem. Dioxins, furans, things like that.

We now have virtually every single toxic byproduct of modern civilization that has been found in Great Salt Lake dust in significant quantities, things like microplastics, PFAS chemicals, forever chemicals, which are, I think, inarguably the most toxic intentionally-produced chemical ever produced by modern civilization. All of that is in Great Salt Lake dust.

We have studies that show that dust is more toxic than dust from other areas of the Great Basin. We even have studies that suggest that that dust is more toxic than coal fly ash. Coal fly ash is what's left over from burning coal. So that should give you an idea of really what we're talking about.

So the dust all by itself, if it's just mineral dust, that's toxic because that's a foreign particle that you inhale that then kicks up an inflammatory response in your lungs that then becomes systemic.

But now add to that mix all kinds of highly toxic chemicals, heavy metals, some of them radioactive isotopes, microplastics, pesticides of every possible kind, and even microorganisms, things like cyanotoxins, lipopolysaccharides, fragments of gram-negative cell bacteria that have been proven to be the cause of a lot of the respiratory illness around the population that lives by the Salton Sea.

In short, that dust is a toxic brew of all the toxic byproducts of modern civilization. So we absolutely have to protect the lake and keep it from shrinking if we have any hope of protecting public health along the northern Wasatch Front.

Kirtly: And we have data from the Salton Sea and the Aral Sea, the people who lived in these other huge inland seas that dried up and the consequences of living near that and the dust storms decreased lifespans, health, miscarriages, stillbirths.

Brian, now that we're all totally discouraged and we need rain to come through, we need these storms to come through, what should we be doing about not just dust, but what should we be doing in our own bodies, in our home, and in our community?

Dr. Moench: I like to tell people there are two dimensions of how you should respond. One is how do you protect yourself as an individual and as a member of your family? And the other is how do you help out the community at large?

So let's talk first about how you can protect yourself individually. Of all the behaviors that can possibly improve, or I should say decrease your exposure to air pollution in general, putting an air purifier in your bedroom may be number one.

We know from multiple studies, hundreds of them, that air pollution is uniquely toxic to not only brain development in children, but brain function in adults. And that's across genders. That's across the age spectrum.

We even have studies that show that children will perform better in school, on tests, on a day when the air pollution has been mitigated with air purifiers compared to a day when it hasn't been.

So I would say for your overall health, get an air purifier and put it in your bedroom. And you want an air purifier that has been rated to pick up particles that are 0.1 microns in size and smaller. Those are called ultrafines.

There are a lot of expensive brand-name air purifiers that will say, "We can capture particles 0.3 microns in size." That's not good enough. You want 0.1 microns in size and smaller.

You want a KADR rating of about 130, and that's an expression of how quickly can a room's air be captured and turned over by that air purifier. So those are two specs that you want to pay attention to.

And then you don't want to run an ionizer feature, which most of them have, because that creates ozone, which is a toxic gas in and of itself. So those are three things to keep in mind about an air purifier.

The second thing I'd pay attention to, if you are unfortunate enough to have a gas stove in your kitchen and you can't afford to replace it, make sure that you don't use the gas stove unless you have the vent on or a window open.

And if you can't afford any of that and it's the middle of the winter and you don't want to have a window open, use your crock pot for cooking as much as possible instead of a gas stove.

We know that gas stoves put out nitrogen oxides and VOCs even when they're not turned on. And when they're turned on, they are major sources of pollution.

So if I were to look at all the behavioral modifications that people could engage in to improve their own health and reduce their exposure to these toxins, those would be my top two.

Kirtly: Yeah, I might add, as the woman who did all the cooking in the house and as someone who looks at women's health around the world, the biggest cause around the world, not in the U.S., of lung cancer and early death is smoke from cooking.

And I must say, I know I have polluted my house because I wasn't careful about what was either in my oven . . . and I have an electric oven. But I cooked it at a temperature that was higher than it was going to tolerate, and I have polluted my own house substantially. I have a little alert, and I know what my air quality is inside my home. And so there are ways that you can be more careful in your own home.

So that's what we do in our home. What do we do for our neighborhood and our community?

Dr. Moench: Well, we obviously want to try and be a good neighbor. So the first thing is don't add pollution to the atmosphere that you don't really have to. First on that list is don't burn wood unless it's your only source of heat. And if it's your only source of heat, then we ought to try and come up with community funds to help you get a cleaner source.

Wood combustion is uniquely toxic for two reasons. It's heavily saturated with the most toxic chemicals around, like benzene, for example. And the particles are extremely small, and there's an inverse correlation between the size of the particles and the human health impact.

So number one, if you don't have to burn wood to keep your home warm in the winter, and hopefully you don't, please don't do that recreationally.

The other thing is obviously the things that people are well familiar with, which is try and limit the use of your car if you can. Carpool, take mass transit, use your bike if you're physically able to. All those kinds of things.

Now, if that's not possible . . . For example, I spent about 17 years as a bicycle commuter to the hospital. I would deliberately go along less-traveled roads for two reasons. One is I didn't want to get hit by a car. That's pretty obvious. But two, there's less pollution on those less traveled roads. Even 100, 200 yards away from the most heavily trafficked corridors, there can be significantly less pollution.

So if you have to drive a car and you have a choice of where you go, you can do that. That's helping yourself, obviously, but it also helps the community in general.

And then I think you have to get down to policy. We have to elect leaders who take this seriously.

The medical literature would suggest that 80% to 90% of cancer has an environmental trigger. Think of all the people in your life who have been influenced, who have had their health marginalized, or their lifespan shortened with cancer. Eight of the 14 immediate family members that I have, have had cancer, including 2 of my children and me twice.

This has real consequences, so we need to elect leaders who can look at their constituents and say, "I'm going to make you and your health and your future my top priority." And right now, frankly, we just don't have much of that.

Kirtly: No. While we're talking about policy, can we talk about pesticides and what we know now about risk from exposure? I know that everything from spraying crops for our food versus spraying against mosquitoes, those pesticides now have been shown to have increasing risks.

I mean, we've known about them some of the time, and my mom certainly would make us hide in the house when the DDT truck would come and spray fumes of DDT for mosquitoes. She would make us all stay in the house when they came around, and I don't know how good that was.

Dr. Moench: It was terrible.

Kirtly: But we've known for a while. So can we talk about pesticides?

Dr. Moench: Well, it never made any sense that we could spray throughout our environment into our soil, on our crops, in our water. Pesticides are biologic poisons, period. It never made any sense for anyone to think that we could do that to the broader environment and not impact human health. That just never made any sense.

But now we know so much more about what pesticides do because we know two things. Most pesticides, and that term is a reference to both insecticides and herbicides, are endocrine disruptors. And endocrine disruptors is a term that describes chemicals that mimic human hormones. They can either antagonize hormones or they can augment hormones.

But human hormones are extremely potent biologic compounds. So what pesticide exposure does is it messes with the hormone balance of anyone who's exposed to that. And the bottom line is that means that the health impacts are profound at very low doses.

Insecticides had their origin as highly toxic and deadly nerve agents in World War I. Well, they're still toxic. They're still deadly. The neuron that a newborn baby depends on for its future is very similar, almost identical, to the neuron in a mosquito.

So why would anybody think that we can plaster our environment with those kinds of chemicals and yet emerge unaffected? It didn't make sense. And now we have literally thousands of studies that show the harm.

Kirtly: Once again, we go back to the fact that we want legislators to think about how we make rules, or the EPA and funding it to make rules. And sometimes corporations have a heavy foot on the scale of equality here. It's very difficult, because just as we know about cigarettes and we know about the coal industry, they know that there are issues here.

How do we begin to act out what I call the precautionary principle in public health? If there's good evidence that something is damaging to human health, we should act in a way that it mitigates that. Do we have to have perfect evidence? No. Good enough should be good enough to make policy.

Dr. Moench: We have a very long and dark history of not paying attention to the evidence that we have on various environmental toxins.

If you think about tobacco and smoking, you think about asbestos exposure, lead, ionizing radiation, heavy metal exposure, and now forever chemical exposure, PFAS, and you can certainly throw pesticides in there, almost across the board the most significant and relevant environmental toxins have all gone through this pattern.

And that is evidence emerges of harm, but then policymakers/governments, for whatever reason, and frequently succumbing to pressure from corporations, want to push back because it threatens their profits.

So almost all of the things that I just mentioned have followed this pattern. Evidence emerges of harm, industry pushes back, and then decade after decade of delay happens before something serious is done about it.

Look at tobacco. We had enough medical research evidence even from Nazi Germany about the harms of tobacco smoke by the 1930s, but we didn't start regulating it until the 1970s.

You could say the same thing about asbestos. You could say the same thing about lead. They've all followed that pattern. And we're doing it again with PFAS. We're doing it again with pesticides.

Kirtly: Well, the good news . . . I know we've known about lead for a thousand years. We've known about how toxic lead is for a thousand years. But actually, we did get a lot of lead out of the environment. We got it out of paints. We got it out of things in our household. We got it out of at least car fuel.

So there are ways to lower the lead levels in our children, and that's good news. I mean, we're not perfect at it. So we made, as a country, some big steps in that regard, and we could do it again.

Dr. Moench: We certainly can do it again. The only thing about lead is we did it 50 years later than we should have.

Kirtly: Oh, yeah. That's true.

Dr. Moench: We knew that it was toxic in the '20s, and we didn't really do anything about it until the late '70s and early '80s. But we're following the same pattern now and I really worry about that in terms of things like PFAS contamination, pesticides.

Now, with this new push in the state and nationally for a resurrection of nuclear power, every phase of the nuclear fuel cycle emits radiation into the environment. There's no safe level of radiation exposure, period. We're making the same mistakes over and over and over.

You mentioned the precautionary principle a few minutes ago. Well, what that states is when there is evidence of harm, even if it's not complete, but it's consistent with existing research, then that's when you should start taking action in terms of public policy, not wait until there's absolutely no further doubt about the issue. By then, you've already created massive public harm.

And there's virtually no example you can find where public policy was too strict and acted too soon when it comes to environmental toxins. You just can't come up with an example.

Katie: I heard somebody say this and it's really stuck with me because I see it in myself and I see it in corporations and policy. And I think it just is a nice framework of thinking about that we all sort of choose our immediate incentives over our intentions.

So for example, I'm also a bike commuter and I will ride my bike on bad air days because then I can feel virtuous about not contributing to the air pollution. But I don't wear a respirator when I ride my bike, and that's because my incentive is to be comfortable and be able to breathe in hard getting up the hill to the university. And the discomfort of wearing a respirator sort of is my immediate incentive.

My intention is not to make myself sick, but I just think all of us, and corporations too, make that calculation of, "What's in my best interest? I need to make money. I need to pay my stockholders," whatever.

So I think the trick for us who are interested in policy is how do we create friction that makes it easy to do the right thing and sort of harder to do the wrong thing?

And so I agree with you. We've got to think about who our electeds are, but be sympathetic. Everybody is choosing their intentions, whether it's convenience or cost or fun or comfort, in the case of my mask.

Anyway, it was just a framework I thought, "Oh, that helps me be sympathetic towards what's happening."

Kirtly: Well, I think the fact that you're going to go to the grocery store, and it's a little bit more expensive, but it's very easy in most of the big grocery stores to choose organic vegetables and organic fruit. And the Environmental Working Group has that ewg.org. I can't recommend it more strongly.

But there are some that are definitely safer than others in terms of pesticides. Actually, it costs a little bit more, but it's easy to find. And so I think we have more and more room on the shelves now for organic food, and we just have to keep regulating it to make sure it really is organic.

Dr. Moench: I know that you have primarily a woman's audience, or at least I assume so.

Kirtly: We're trying to go big brand, but . . .

Dr. Moench: And this is not a plug for the books that I've written, but of the two books that I've written, one, "Death by Corporation," and two, "The Great Brain Robbery: Why Women Are Smarter Than Men," they both incorporate this theme that, in fact, women do have, by and large, statistically from studies shown, a better respect for the precautionary principle. They are more environmentally aware.

And in fact, some studies have shown that female CEOs of major corporations actually deliver better returns than their male counterparts because they're more risk-averse.

So if we can get more women in charge of public policy, just by virtue of their tendency to be better respecters of the precautionary principle, more risk-averse . . . If you look at who's pushing nuclear power, it's all men because they're not paying attention to the risk, but women generally do.

So we need more women in charge of public policy for that reason. The data show that they actually do better in terms of protecting health, protecting the environment, and taking less risk when it comes to big business decisions and public policy if they're government officials.

Kirtly: Brian, thanks for the thumbs up for women in tough places. And thanks for helping us out here.

For all of you listening, I know it feels overwhelming, but there's a lot you can do. I mean, think about what you do when the air is bad. Think about the chemicals you put on your body and your children's bodies and your grandchildren's bodies.

If you aren't sure about the safety of your lotions and potions, check out the Environmental Working Group's website, ewg.org. They have a database called Skin Deep. It can help you make decisions better. And they have one on household and consumer products, so you can choose what to bring into your house.

And join us for all of our 7 Domains of Risk and our other podcasts in the "7 Domains of Women's Health," wherever you get your podcasts, or at womens7.com.

And we will all work to live in a community of lower health risk where we can drink the water and we can breathe the air. Brian, thank you for joining us.

Katie: Yes, thank you so much.

Dr. Moench: Thanks for having me.

Katie: I want to add one thing that I just always turn back to. It's a phrase Jane Goodall used to say, that if we all do a little bit, that adds up to a lot. And I think, as you were saying, Kirtly, this feels overwhelming. But I take some comfort in feeling like if everybody does something, that's going to be what it takes.

Dr. Moench: Go look at a picture or some of your family photos. These are the people whose lives you are protecting and improving and giving them a chance to live a normal lifespan that everybody deserves and wants.