Call Notes

1. Welcome: Michael Lerner

Welcome. We have a very important call this morning on environmental contaminants in breastmilk. You all know that biomonitoring (bodyburden testing) is central to CHE's interest and work. The assessment of environmental contaminants in breastmilk is one form of biomonitoring that has particular benefits and particular challenges. We're going to look at this in two consecutive takes: Science and Policy/Advocacy Issues.


2. Science: Gina Solomon, M.D., M.P.H., Natural Resources Defense Council

Testing breastmilk is the best way to detect fat-loving or lipophilic chemicals. Lipophilic chemicals can also be tested in the fat in blood, but that requires a huge amount of blood to sample from, which is more difficult to acquire than breastmilk. From breastmilk it is possible to test for the presence of many persistent organic pollutants (DDT, metabolites, PCBs, dioxins, and emerging chemicals of concern.)

Sweden has developed a model breastmilk monitoring program that has helped identify chemical trends over time and aided in evaluating the effectiveness of current regulations and the need for additional regulations or policy change. By identifying new spikes, Swedish studies have detected PBDEs, which are a class of flame retardants, some of which have PCB-like properties. These studies indicate that the levels of PBDEs are doubling every five years and this knowledge has spurred dramatic policy action to eliminate these chemicals.
 
Biomonitoring in the U.S. has been patchy, and mostly focused on chemicals that are already banned. New efforts are being made to broaden biomonitoring and to look at a wider range of chemicals, including newer chemicals.

Breastmilk is so useful because it gives a sense of what is in the mother's body and what the infant is being exposed to. For more information visit www.nrdc.org/breastmilk/.


3. Science: Pete Myers, Ph.D., United Nations Foundation and Co-author of Our Stolen Future (on endocrine disruption)

Pete would like to draw attention to emerging scientific results relevant to concerns of the group. Last week in Environmental Health Perspectives (a publication of the National Institute of Environmental Health Sciences) there were two independent reports describing a dramatic rise in PBDE levels in the U.S. One was a California study of women using breast tissue and serum. The other was an Indiana study of women and fetal cord blood. Both show levels that were 20 to 100 times higher than in Sweden where PBDEs were banned. While there are no firm human epidemiological data demonstrating harm, they are potent thyroid disruptors, and strong laboratory evidence (mice) shows interference with brain-growth spurts (development of life during the last trimester through the first few years of brain organization). PBDEs interfere with brain-growth spurts and effect adult behavior as a result of exposure during that time period.

An analysis done at the University of Missouri shows how low-levels of exposure (previously considered too low to matter) can actually cause very large effects. In some cases small amounts, depending on timing of exposure, may be more harmful to a developing fetus than larger amounts. Current methods of testing would have no way of detecting these low-level effects.

To view all three of these articles visit www.protectingourhealth.org


4. Policy and Advocacy Issues: Sharyle Patton, Commonweal

Sharyle has recently been part of constructive dialogue between environmental health activists who want to test breastmilk for body burdens and breastfeeding groups who feel that this may discourage breastfeeding.

International La Leche League, International Lactation Consultants Association, and other breastfeeding advocacy groups feel that breastmilk monitoring usually results in advocacy headlines that frighten women away from breastfeeding and should be avoided. Many women have difficulties learning to breastfeed. Inadequate maternity leave, extensive advertising for use of formula, and other factors may cause women to choose formula over breastmilk. Breastfeeding groups feel that the period of time after birth is a critical time of bonding between mother and child, and information about chemicals in breastmilk is intrusive and distracting.

One of the initiatives discussed at a recent international meeting of WABA, the World Alliance for Breastfeeding Action, was the idea of developing standards for breastmilk monitoring, to help ensure that such studies fully support breastfeeding. Northern European and U.S. groups attending this international meeting tended to be wary of breastmilk monitoring under any conditions, but organizations representing breastmilk advocacy group in developing countries saw monitoring as a means to discover information about chemical exposures, especially pesticide exposures. This information is not generally available from their health departments or government sources. Cooperation between environmental groups and breastfeeding advocacy groups is beginning.


5. Comments and Questions

Question:
How much blood would be required to test?

Pete Myers:
The more chemicals you want to look for, the more blood you would need. It's sometimes difficult to obtain sufficient quantities of blood for testing, whereas it's relatively simple to obtain adequate amounts of breastmilk.

Sharyle, Is there some sort of follow up program for how to help women who have participated in these studies?

Sharyle Patton:
W.H.O. has had no information in that regard. In their California study, Kim Hooper and Jane Williams have been developing methods and materials for counseling and information. I assume studies in Washington State will be doing the same thing.

Sonya Lunder:
I've been collaborating with Kim Hooper and Jane Williams. We are discussing what is appropriate to tell and not tell women about study results. We are comparing the levels of the women in our study with those of other women in the U.S. and in Sweden. Sweden saw an immediate decline in women's body burdens as soon as PBDEs were phased out.

Question:
Can you say something about what the Hooper study is looking at and what your national sample is looking at?

Sonya Lunder:
Kim Hooper works at CalEPA and has received money from the Pollution Prevention Program at USEPA to analyze PBDE levels in 60 women in California. We are using NGOs for recruitment, study collection and to talk about what these levels mean in the communities. Environmental Working Group is also collecting samples from 20 women nationally with identical study materials that emphasize the importance of breastfeeding even with knowledge of chemical body burdens in women.Our national participants are great, committed spokespeople for this.


6. Policy and Advocacy Issues: Janet Nudelman, Director of Programs, The Breast Cancer Fund

Breast cancer rates are increasing at a shocking rate. In the 1940s the lifetime risk of Breast Cancer was 1 in 22, now it's 1 in 8 and rising. We believe this rise is due to the vast increase in the use of synthetic chemicals that began around WWII. Around 85,000 chemicals are used in commerce today with about 2,000 new ones introduced each year. More than 90% of those have never been tested for their effects on human health, and they accumulate in our body fat and remain in breastmilk for decades. Studies have shown the reliability of breastmilk for its ability to show the exposure of toxic chemicals to humans. Studies in Germany and Sweden have shown more than 200 synthetic and toxic chemicals in women's breastmilk (flame retardants, dioxins, PCBs, DDTs and other pesticides).

Breastmilk monitoring can also tell us about the health of a community. The systematic collection and study can help us extrapolate the levels of exposure to environmental toxins in a community as a whole. Monitoring is of great interest to The Breast Cancer Fund as well. California legislative initiative SB689 (Deborah Ortiz, Senator) was passed to develop a model breastmilk monitoring program in 3 racially and economically diverse communities throughout the state. It would also create model protocols, a model training program, and model resource and outreach materials. These would communicate the benefits of assessing community body burdens, while promoting breastmilk as the best, most nutritious food for infants. We've been working with Commonweal to expand this bill into a larger initiative, which would create a $10 million biomonitoring program financed by a 1cent California tobacco tax. This program would test blood, urine and breastmilk, as well as other bio-specimens as appropriate to identify chemicals in Californians, establish links to environmental toxins and initiate a plan to eliminate these contaminants.


7. Partner Comments and Questions

Clark Williams-Derry, Northwest Environmental Watch:
We're planning to test 40 samples of breastmilk from first time moms throughout the Pacific Northwest (British Columbia, Washington, Idaho, Oregon). We're using the protocols developed in California by Sonya Lunder, Kim Hooper and Jane Williams. We're also working with local lactation consultants to identify moms.

Nerissa Wu, Ph.D. Candidate, Boston University School of Public Health (for Tom Webster, Boston University):
We're doing a similar range-finding study in the Boston area for first-time moms. We're also exposure surveying using diet, occupational and household exposure.

Tessa Hill, President Kids for Saving Earth, Minnesota:
We're working with MNCHEC and the Minnesota Department of Health to do a pilot project in a yuppie suburb to reach moms who can be educated and who may speak out. They will be tested and we will implement training programs for what to do in homes to eliminate toxins. We will also teach the importance of breastmilk, and then retest to see if progress has been made. We're also trying to expand and reach out to urban and rural moms, as well as establish training programs for visiting nurses.

Sharon Koshar, Project Coordinator Massachusetts Breast Cancer Coalition/Alliance for a Healthy Tomorrow:
We are testing an urban woman, a suburban woman and a pregnant woman and will publicize those results in an effort to promote bills that are up for review. These bills are looking at making safer substitutes for some of the most toxic chemicals (PCBs, dioxins, furans, hexo-chloro-benzene, DDTs, heavy metals) in Massachusetts. We will also have moms speak out about results.

Sandra Miller Ross, Ph.D. Health and Habitat:
Marin Breast Cancer Watch is testing breastmilk. They recently had a pilot series, which they are currently assessing.

Question:
What proportion of a woman's body burden gets downloaded to her infant during breastfeeding?

Sonya Lunder:
Twenty-five percent with each nursing infant, according to Kim Hoopers' research.

Sharyle Patton:
A baby can receive 30%-90% of his lifetime of allowable levels of from breastmilk.

Nina Moliver, M.Sc., Earth Save Boston, Alliance for Democracy:
A woman can significantly reduce the levels of dioxins by avoiding animal products for up to three years prior to breastfeeding.

Question:
How much exposure is occurring in utero and not just from breastmilk?

Pete Myers:
The Indiana Study showed that PBDEs are crossing the placenta in utero and are present in the same concentration in the fetal placenta as they are in the mother.

Sharyle Patton:
All of the studies in the past decade that indicate the enormous importance and advantages of breastfeeding have been done with breastmilk have chemicals in them, because there is no other kind.

Would CHE partners want to consider a medical ethics review process? Would those CHE partners working on these studies want to get Institutional Review Board (IRB ) clearance from a university in doing these studies?

Sonya Lunder:
We went through the IRB process for the California study. They were overall very supportive. We were worried that they would be concerned about our informal recruitment strategies, but they seemed fine with them.

Tessa Hill:
It would be helpful to the Minnesota group to hear what's going on and to learn about other people's experiences. Is there any way that we can begin some communication between people that are doing this nationwide?

Jeanette Meyers:
I would be happy to coordinate this. Anyone who is interested should email Jeanette Meyers at jeanettemeyers22@aol.com.

Sharyle Patton:
I think we should keep an eye on the American Academy of Pediatrics. I'm not sure whether it is a study or just comments about what a study should look like, but there is a move to look at breastmilk and chemicals in breastmilk and suggest that they are insignificant. I will be happy to do some research about this and send it out.

Also La Leche League International and others aren't adverse to monitoring breastmilk, but they are adverse to using breastmilk as an advocacy issue. I encourage those who are using it as an advocacy issue to let La Leche know what you are doing so they won't be taken by surprise.

Tessa Hill:
We've had some concerns about what would happen if we found a mom with dangerous chemicals in her breastmilk. So we contacted a pediatric specialty unit in Chicago to work on problem solving. I'm wondering if this is happening nationally. P.E.S.U.s are pediatric environmental specialty units; they're sponsored by A.T.S.D.R. They deal with environmental health problems for children. When we have the listserv I'll report back on this.

Sonya Lunder:
If anyone's involved with the American Academy of Pediatrics it seems crucial that they also look at in-utero exposures and risk of in-utero exposures.

What is the oldest baseline data that we have on breastmilk, I assume it's from Sweden?

Sharyle Patton:
I think they started testing in Sweden about 1967.


8. Conclusion

Michael Lerner:
The takeaway message is that in Scandinavia, Sweden particularly, breastmilk monitoring is done in a responsible, careful, respectful way and it is used to guide policy. So a policy question for the CHE community is whether we want American mothers and children to be protected any less than is true in Sweden and other Scandinavian countries. I think that within the broader scope of biomonitoring, breastmilk has a very special place. It reflects the fetal environment and it is so salient as an issue that it requires tremendous responsibility in how we handle it. Our open dialogue encourages all CHE Partners to be state of the art in terms of the ethical issues, the scientific issues and the whole approach. This is a good example of using CHE to raise the level of capacity of Partners on a very important issue.


9. Recent and Upcoming CHE Meetings:

Jeanette Meyers:
We had our third regional meeting in Boston on March 7, held at the Harvard Club with a full-house of 80 people. The Boston and New England area is unique in that it has an established network called the Alliance for a Healthy Tomorrow. We were able to bring in people involved with the Alliance as well as CHE Partners and people who are new to the environmental health movement. Speakers included Ted Schettler, Pete Myers, Julia Brody, Anthony Robbins, as well as other organizations from the community.

Coming up we have our fourth regional meeting on March 26, which will be held at the University of Washington. This is booked with a waitlist. It will be an afternoon session, which will focus primarily on neurotoxins. The science will be presented by Pete Myers and Mike McCally. Tito Rodrigues will talk about farm workers and pesticides, and Ticiang Diangson will also speak.

If anyone is in a particular region and would like to have a regional meeting and would be willing to work with us to coordinate that please let us know.

Michael Lerner:
These regional meetings are very time-consuming and require resources to put on, so we can't do all of the ones we'd like to do, but we really welcome recommendations for places that would like to host regional meetings and would like to do all the groundwork involved in pulling a regional CHE Partners meeting together.

Steve Heilig:
We will have a national full-day conference in San Francisco on Friday, November 14 (the day before the American Public Health Association conference, also in San Francisco) that will cover many issues of interest to CHE Partners, including a state of the art scientific update and policy and advocacy issues. This meeting will be modeled on the inaugural CHE meeting in March of last year, but will be expanded. We think it will be of interest to anybody who is interested in CHE issues.


10. Final Issues and Questions

Question:
Where is CHE going with the EPA's new body burden information with respect to children?

Michael Lerner:
That's a very good issue and let's think about it together. It might be the subject of a future call.

Tessa Hill:
I have a question about the Partnership. I'm on the CHEC board and we form the MNCHEC group. So, can MNCHEC join as a Partner separately?

I'm also president of Kids for Saving Earth, which my son started before he died of a brain tumor. I'd like to have Kids for Saving Earth be a Partner as well.

Michael Lerner:
Be in touch with Jeanette Meyers. We really welcome it when organizations join as well as individuals, so we would be honored to have your organizations join.

Steve Heilig:
There has been legislation introduced by the leader of the state assembly to phase PBDEs out in California. The process has just begun, but getting support from the San Francisco Medical Society was very difficult. We have some very skeptical medical professors on the board who had to look very carefully at the science first. After directing them to the latest research (provided by the CHE science team) they have become converts and new allies. I think we have a good chance of this bill moving forward.

Jeanette Meyers:
The next call will be held April 23rd at 9:00 a.m. Pacific, 12:00 noon Eastern.

Michael Lerner:
We welcome recommendations for Partner calls.