News-Medical speaks to Dr. Robert M. Sargis about his research into whether medication is exposing us to hormone-disrupting chemicals.
What led you to begin this research?
We have been studying endocrine-disrupting chemicals for many years now, and the focus of the field has largely been on exposures that occur due to industrial pollution, contaminated food, and water, or the use of personal care products.
Less attention has been trained on the presence of EDCs in medical care. As a practicing physician, this was quite disconcerting to me because it means that we, in the course of our efforts to improve health, exposing our patients to chemicals that may adversely affect their health. This realization crashes on the rocks of medical ethics, the rules that dictate how we perform our jobs.
Specifically, it raised the question of whether we are meeting our obligations to “do no harm” and to provide patients truly informed consent.
It is that realization that led us to put this manuscript together to raise the issue with the medical community and to provide a framework for moving forward in a way that minimizes harm in the provision of medical care.
Importantly, and this is critical, we are not in any way advocating for patients to stop taking their medications or to defer medical care. Modern medicine is a wonder that saves lives and improves the quality of those lives. Our goal in pursuing this work is to better understand the areas in which we can improve in order to ensure that our patients receive the best possible care.
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What are endocrine-disrupting chemicals (EDCs) and how do they affect the body?
EDCs are chemicals or mixtures of chemicals that come from outside the body and screw up the production or action of the body’s natural hormones. These are the molecules that circulate throughout our bodies to regulate the development and function of all of our organ systems.
There are many different EDCs, and each has its own set of effects. Many EDCs that have been identified interfere with the male and female sex hormones, testosterone, and estrogen. Others disrupt the function of the thyroid gland and its hormones.
While others disrupt hormones and hormonal pathways that control metabolism. In addition, some EDCs can do several of these. The result from many studies in cells, animals, and human populations is that various EDCs have been associated with infertility, birth defects, cancer, anxiety, depression, learning disorders, obesity, and diabetes. EDCs have the potential to harm our health in multiple ways.
What sort of medication and medical equipment could contain these EDCs?
Various medications used in clinical practice for a variety of purposes contain chemicals that are believed to be endocrine disruptors. These include medication used to treat gastrointestinal disorders, psychiatric conditions, and osteoporosis among others.
Also, some over-the-counter medications contain classes of chemicals with hormone-altering properties. Plastic medical devices can leach out EDCs. This includes syringes, intravenous tubing, ultrasound gels, and others.
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Why are so many people unaware of these risks and why is it important to spread awareness now?
First, there has not been enough education about endocrine disruption. Indeed, with rare exceptions, I think most physicians are unaware of the ability of environmental contaminants to screw up the body’s hormones.
Second, there is a lack of transparency about what chemicals are used in medications and medical devices.
Third, we have very little understanding of whether the chemicals we use in all aspects of our lives, not just in medical care, can act as EDCs. For the most part, endocrine toxicity is not assessed much less reported. Finally, there have been deliberate efforts to disparage the concept of endocrine disruption, often motivated by financial gain.
Why is this an ethical issue?
First, in the exercise of medical care, we commit to “do no harm” based on the principle of non-maleficence. If the medications we prescribe and the medical devices we use contain hormone-harming chemicals, there is the chance that we may be doing some harm that violates this principle. In most instances, medical care is all about the balance of risks and benefits.
If there are hidden risks that we did not previously appreciate, that could change the risk-benefit balance. Perhaps that will not change our clinical approach, but it might. And at the very least it argues for alternatives that better reduce those risks by not posing as much of a threat to our endocrine system.
The second ethical point relates to informed consent. For patients to freely make informed decisions about their care, they require all the necessary information to make those decisions. This includes the benefits, risks, and expected side effects.
If we know that our treatments expose patients to EDCs but do not inform them of this, we are not providing them with all the information they need to make informed decisions about their care. This violates the physician-patient contract.
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How could this information influence the future of medicine and medical practices?
Moving forward several things need to happen. First, we need to educate healthcare providers and their students about the risks of EDCs. Second, we need to educate patients about the potential for various chemicals to screw up their hormonal systems. Third, we need regulatory agencies to screen chemicals used in medications and medical devices for endocrine-disrupting activity.
This includes understanding the impact of mixtures of chemicals that occur through the simultaneous prescription of multiple medications and concurrent use of multiple medical devices. If present, those items should be clearly labeled to allow physicians and their patients to know of the potential risk.
Fourth, manufacturers must develop lower risk formulations that are EDC-free. Fifth, we need more data on the total burden of exposure and linkage to adverse health effects. This includes understanding how various disease states might potentiate the adverse effects of these EDCs.
Finally, we need engagement from professional societies to address these hidden risks. Implementing these changes is likely to improve both the effectiveness of our therapies while limiting the side effects—with the overall impact of improving the health of our patients.
How can EDCs be eliminated and safer alternatives to affected medications and devices be developed and made widespread?
Interestingly, there are a few examples that we cite in our paper where some, but not all, formulations of medications contained EDCs. In many instances, we may have clear alternatives without EDCs that do not alter the properties of the medications.
In other instances, alternative formulations may need to be developed that use chemicals without hormone-disrupting properties. This will likely require a better understanding of which chemicals used to formulate medications have hormone-disrupting effects and which do not.
What are the next steps for your research?
As a field, we need to have a better idea of what medications and medical devices contain EDCs currently. This includes looking at more classes of EDCs. This is important because you only know what you look for, and the studies to date have been restricted to only a few classes of EDCs.
I think we also need to understand what these exposures mean concerning levels in patient’s blood and tissues as well as their associations with adverse health effects.
Importantly, I think we need to know how polypharmacy (the simultaneous use of multiple drugs by a single patient) influences the total burden of exposure. Many patients are prescribed many medications, and much of the harm may arise from the totality of these exposures.
Furthermore, we need to know how different disease states might augment (or reduce) the impact of EDCs on health. In addition, our work continues to focus on how EDCs disrupt hormonal pathways that lead to disorders like obesity and diabetes, just two of the many diseases linked to exposure to these chemicals.
Where can readers find more information?
About Dr. Robert M. Sargis
Robert is a physician-scientist. He sees patients with endocrine and metabolic disorders and runs a research laboratory focused on understanding the impact of environmental contaminants on metabolic health.
We are specifically interested in how environmental exposures promote the development of obesity, diabetes, and lipid disorders.
The ultimate goal of the laboratory is to understand these environmental disease drivers to inform public policy and individual action to reduce these exposures and improve human health.