AMA House of Delegates

AMA supports tighter restrictions on products containing BPA

The move comes in the wake of numerous studies detailing the dangers of the organic compound.

By — Posted July 4, 2011

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The sale of baby bottles and infant feeding cups containing bisphenol A, also known as BPA, should be banned, states a report adopted by the American Medical Association House of Delegates.

BPA, an organic compound that was used in polycarbonate plastic products in the 1950s and is now used in a variety of products, has been found to be an endocrine-disrupting agent that has the potential to cause harmful effects on the brain, behavior and prostate gland in fetuses and children.

In addition to a ban on feeding products for babies and infants that contain BPA, the AMA would like to see better federal oversight of BPA and the clear labeling of products containing it, according to a report from the Council on Science and Public Health adopted by delegates on June 20 during their Annual Meeting.

Robert Gilchick, MD, MPH, a public health and preventive medicine specialist representing the American College of Preventive Medicine who spoke on behalf of the Council on Science and Public Health, said the report was written in response to a resolution introduced at the 2010 Annual Meeting asking for the AMA to support federal legislation restricting BPA in children's products.

"Biomonitoring studies of urine and blood have revealed human exposure to BPA to be nearly ubiquitous, with most of the exposure based on dietary intake," Dr. Gilchick said. "Accordingly, it is appropriate to take measures to limit human exposure, especially during critical periods of development."

The report stresses the importance of the Food and Drug Administration to "actively incorporate current science into the regulation of food and beverage BPA-containing products."

In online testimony, Kenneth Crabb, MD, an obstetrician from St. Paul, Minn., said that although he supported the report as written, he would oppose wording calling for more regulation.

"Adults are capable of making decisions for their children and themselves. We do not need the government to issue rules limiting uses. The government needs to just be sure we have all the facts available," he wrote.

Frederick vom Saal, PhD, professor of biological sciences at the University of Missouri, has been studying the adverse effects of BPA since 1997.

He wrote a 2008 report in The Journal of the American Medical Association that linked BPA to cardiovascular disease, type 2 diabetes and liver-enzyme abnormalities. He urged the FDA to take action similar to that taken by Canada to limit human exposure of BPA.

The FDA acknowledged in 2010 that BPA was of "some concern" for infants and children, and announced it was taking steps to help reduce human exposure in the food supply.

"Both the FDA and Canadian officials have recently expressed concern about potential harmful effects of BPA and taken interim actions to protect sensitive populations such as infants and toddlers by banning the sale of baby bottles, food containers and cups containing BPA," said Edward L. Langston, MD, then AMA Board of Trustees member. "The new policy adopted today supports these measures and a shift to a more robust, science-based federal regulatory framework for oversight of BPA."

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Meeting notes: Public health

Issue: Increased awareness by physicians and the public of sickle cell disease and its treatment is needed.

Proposed action: A Board of Trustees Report called on the AMA to recognize sickle cell disease as a chronic illness; to encourage educational efforts on treatment and prevention; and to support newborn screening programs, genetic counseling and new research designed to speed the clinical implementation of new treatment. [Adopted]

Issue: Exposure to potentially harmful levels of mercury is prevalent in the population and has been implicated in a variety of secondary health effects such as cardiovascular morbidity, leukemia and reproductive toxicity. Approximately 188 cement kilns emit more than 11,000 pounds of mercury each year.

Proposed action: Direct the AMA to support modern and strict monitoring of mercury emissions from cement plants. [Adopted]

Issue: The Centers for Disease Control and Prevention has reported an increase in bloodborne infection transmissions caused by the shared use of fingerstick and point-of-care blood testing devices.

Proposed action: Encourage improved labeling of devices to make clear that multiple-use fingerstick devices made for single patients are intended for use only on single patients. [Adopted]

Issue: Pills are not easily identifiable by patients or physicians, which has led to harmful and sometimes fatal outcomes.

Proposed action: Strongly recommend to drug manufacturers that they put a consumer-friendly, unique identifier on the solid dosage forms and recommend that publishers of medication lists include a list of the identifiers. [Adopted]

Issue: Advertisers often alter photographs to enhance the appearance of models' bodies. Such alterations can contribute to unrealistic expectations of appropriate body image, particularly among children and adolescents.

Proposed action: Urge advertising associations to work with organizations that focus on child and adolescent health to develop guidelines discouraging the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image. The focus should be on ads that appear in teen-oriented publications. [Adopted]

Issue: Transgender patients commonly undergo hormone replacement therapy, during which they experience continuously elevated levels of testosterone, estrogen or other hormones over a period of months, years or even decades. Effects of short and medium terms of treatment have been studied, but the effects of long-term use are unknown.

Proposed action: Direct the AMA to encourage research into the impact of long-term administration of hormone replacement therapy in transgender patients. [Adopted]

Issue: At one year postpartum, almost 25% of women retained at least 10 pounds of the weight gained during pregnancy, according to a 2007 study. Additionally, more than half of all obstetrician-gynecologists surveyed considered their training on weight management to be "inadequate" or "nonexistent," said a 2006 report.

Proposed action: Encourage physician referrals of pregnant and recent postpartum patients for nutrition counseling. The policy also directs the AMA to advocate for the extension of health insurance coverage for nutrition counseling among such patients. [Adopted]

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