Time for new policy on environmental risk

The Environmental Protection Agency keeps a list of more than 83,000 commercially manufactured or imported chemicals, with 700 more being added every year. Of all of those chemicals, bisphenol A is the poster child illustrating the need for a better, more efficient way to research and take action on the substances on that list.

Bisphenol A -- BPA for short -- has gained that stature because of its pervasiveness and the growing body of research listing the ill health effects it has on people, especially fetuses, babies and children.

According to the EPA, more than 2 billion pounds of the chemical, used as a plastics hardener, is manufactured or imported in the United States every year. And, according to 21 years of research assembled by the American Medical Association's Council on Science and Public Health, traces of BPA are found in more than 90% of Americans. BPA has been linked to numerous health issues, including reproductive and developmental problems. Those issues are related to BPA's ability to mimic hormones in the body.

As a result of that report, which is being circulated for publication in peer-reviewed journals, the AMA House of Delegates in June adopted policy recognizing BPA as an endocrine-disrupting agent and urged that BPA-containing products that could be exposed to humans be clearly identified as containing the chemical.

The policy gave AMA support to ongoing industry efforts to stop producing BPA-containing baby bottles and infant feeding cups. Given the bad publicity about the chemical, it's hard to find a baby aisle that doesn't have products noting that they are BPA-free. The policy also supports a ban on the sale of such products for infant use, something that has happened at local and state levels, though not at the national level -- at least not in the U.S. Canada and the European Union have enacted such bans.

Under the Toxic Substances Control Act of 1976, the EPA can test chemicals on its list, but only after the manufacturer, or another outside source, informs the agency that there is a proven problem. Even then, the testing is relatively crude, with ever-increasing doses given to lab rodents. Only five chemicals or classes have been limited by the act since it was approved in 1976.

With BPA, scientific research has looked at the molecular or cellular level to find the pervasiveness and effects of the chemical, found in plastic bottles, canned goods, eyeglass lenses, dental sealants, cash register receipts, cigarette filters, compact discs and certain medical devices.

Not every study comes to the same conclusion about the level of risk and toxicity of BPA. But the results show the need for a different regulatory framework when it comes to testing and evaluating chemicals.

The AMA is among those in organized medicine supporting the implementation of what it calls a national, modern and comprehensive policy. The key elements of such an approach is that it is in line with current scientific knowledge on human and environmental health, and the requirement of a full evaluation of the health impacts of newly developed chemicals and those now in use.

There are some legislative efforts in Washington to make such changes, though it's unclear whether those bills would bear any fruit. The EPA is taking comment until Sept. 26 on a rule that would require environmental testing in "the vicinity of expected BPA releases" -- but the monitoring does not extend to human absorption. The FDA also regulates BPA, and in 2010 it said it would do more to reduce its presence in the food supply.

For now, the AMA's policy gives added weight to cities and states trying to restrict the sale of BPA-related products. For example, legislators in Pennsylvania recently asked for a copy of the Council on Science and Public Health's BPA report so they can use it in crafting a bill.

The BPA situation underscores the need for a better, national way to assess and address the risk that chemicals have on the human body. BPA got the spotlight, and there has been progress -- even if not enough. Meanwhile, the list of 83,000 other chemicals remains, with no certainty when the next BPA will be discovered among them.