Category Archives: Pollution

My TEDx Talk: Yes, You Can Live Healthy in China

“Ideas worth spreading.” That’s the slogan of the amazing TED collection of talks, and when I was invited last October to give a lecture at TEDx at UIBE, I came up with a topic that I hoped could be challenging and inspiring: living in China can be a healthy, positive experience. I’ve lived and worked — and thrived — in China for more than seven years, but I always sense much more negative than positive vibes here concerning health matters. I’m very aware of all of our environmental issues, as I’ve blogged considerably about them. But I’m also sure that health involves much more than just our external environment; it involves our personal outlook, our lifestyle choices, and our reactions to what happens around us — wherever we live. We all have much more control over our health than many of us realize.

It was a great honor to contribute to the prestigious TED series, and I’m excited to share my health advice with a much wider community via this internet video and Chinese subtitles. You can watch it here on Youku, or click below. I apologize for the painful one minute of ads, as I have no control over Youku’s methods (nor do I get any royalties). The video quality is a bit off, especially the last two minutes, but the UIBE TEDx team did a great job with the bilingual subtitles. I would like to again thank the great students at UIBE for inviting me, and all of their support in getting this video prepared. (You can watch the other TEDxUIBE videos here, all in Chinese).

 

Air Pollution 101: Here’s Your Syllabus

Due to the incredible media exposure this week to our emergency pollution, I’ve been inundated with questions from both patients and international media about pollution. There’s still quite a lot of misinformation about pollution, so here are what I consider to be the most high yield, evidence-based and readable articles. I think reporters, scholars, parents — anyone concerned about air pollution — may find a few articles to be useful. So grab a comfy chair, smoke your favorite cigar, sit back and have a good read:

General Topics:

Masks and Pollution:

Children and Pollution:

OK, that’s enough to keep everyone busy for a few days. I don’t expect us to work miracles here; I just hope to share the evidence and continue the discussion, and at the very least have us take proper precautions for our own families — and lead by example. Does anyone else have a favorite article? Please leave links in the comments below. (By the way, the cigar recommendation was sarcasm…a bit of dark humor in the midst of dark times…although “everything in moderation”, yes?)

totoboto mask CBD clinic N95 air pollution
Don’t leave home without one.

Is PM2.5 From Air Pollution The Same As From Smoking?

I’m facing a bit of a quandary here. Just last week I was bragging about how air pollution isn’t as much a risk factor to health than much less glamorous topics such as overweight and lack of exercise. Since then, of course, we’ve had the biggest public health emergency I’ve seen in my six years here, with air pollution skyrocketing to an astounding 755 AQI and higher in much of northern China. So does this change anything I said? Can such a dramatic short term toxin change my overall assumptions about long term risks?

To help answer these questions, I emailed C. Arden Pope III, PhD, the Mary Lou Fulton Professor of Economics at Brigham Young University and one of the world’s most cited researchers of air pollution. I’ve based much of my articles on his excellent research, especially his important article comparing health risks of air pollution and smoking. Here’s a bit of our revealing conversation below:

Me: Even with a PM2.5 of 880 ug/m3 recorded last weekend in Beijing, that still only comes out to ~14 mg of PM2.5 per 24 hours, barely the equivalent of one cigarette which has 12 mg on average. Despite the scary news reports about our pollution emergency, is it still accurate to say this is still not even the same risk as 2 cigarettes, and any casual smoker every day is exposing his heart and lungs to much more dangerous levels than even today’s air pollution?

Pope: Yes. Cigarette smoking is an incredibly effective way to expose an individual’s body to very high levels of harmful fine particulate matter and combustion-related nasty stuff. High levels of ambient air pollution are an effective way to expose whole populations to harmful fine particulate matter and associated combustion-related pollutants. These high levels of air pollution that we are seeing in Beijing may be similar, in terms of excess risk, to smoking a cigarette or two per day.

We are learning that just one or two cigarettes per day substantially increases the risk of cardiopulmonary disease. Furthermore, who would suggest that there would not be large adverse health implications of having an entire population, including children, elderly, asthmatics, those with COPD or coronary artery disease, start smoking a cigarette or two per day for a while? Unlike cigarette smoking, exposure to ambient air pollution is involuntary and ubiquitously effects entire populations.

Is it accurate to compare PM2.5 from a cigarette versus air pollution as having the exact same health effects? In general the actual compounds are generally similar enough to compare them, and their morbidity would be equal?

I don’t know for sure, but I think so. I have attached my most recent work (that you already familiar with) that integrates air pollution, second hand cigarette smoke, and active smoking into a single integrated response function for cardiovascular disease and for lung cancer. As you know I think that the best evidence suggests that you can compare them, but for cardiopulmonary disease the response function is not linear. (For a more complete and nuanced discussion, see the discussion section of the attached paper.) It is also interesting to note that in the Institute of Medicine (of the National Academies of Sciences) report that reviews the effects of second hand smoke on cardiovascular disease, they conclude that “Both smoking and air pollution have been associated with heart attacks” providing further evidence of biological plausibility and suggesting that there are similar effects of exposure to fine particulate matter from cigarette smoke and ambient air pollution.

If we only use relative risks of PM2.5, which you generally use in your research, are we ignoring the cumulative RR from other air pollution compounds? Or is PM2.5 an accurate surrogate for overall health effects especially since most morbidity/mortality is associated with PM2.5 and not ozone/NOx/SOx etc? So it’s fair to say that the vast majority of morbidity/mortality from air pollution is from PM2.5?

Again, we don’t know for sure. However, PM2.5 seems to be the best indicator/index, so far, with regards to impact on health.

So there you go. Does this change anything for you? This is actually a very important discussion in terms of public health; isn’t the overall impact of smoking in China in terms of morbidity, mortality, and Disability Adjusted Life Years (DALY) still much worse for smoking than for outdoor air pollution? I think there’s plenty of room for further debate on this. I’m certainly not done with my own research and hope to further discuss with other leaders in their field. Leave your thoughts below…

Beijing AQI Emergency Hazardous

Potassium Iodide and Radiation Exposure: Who Needs It?

It’s been a hectic couple days, but at least for today there is no radioactive cloud approaching us. But this certainly is bringing up a good debate about what to do in case this actually happens. Usually, if a community is exposed, people take the OTC medicine potassium iodide to use just before and during exposure. If you want more information about potassium iodide, you can read the entire Q&A from the U.S. CDC website, which I have cut and paste in full here:

What is Potassium Iodide (KI)?
Potassium iodide (also called KI) is a salt of stable (not radioactive) iodine. Stable iodine is an important chemical needed by the body to make thyroid hormones. Most of the stable iodine in our bodies comes from the food we eat. KI is stable iodine in a medicine form. This fact sheet from the Centers for Disease Control and Prevention (CDC) gives you some basic information about KI. It explains what you should think about before you or a family member takes KI.

What does KI do?
Following a radiological or nuclear event, radioactive iodine may be released into the air and then be breathed into the lungs. Radioactive iodine may also contaminate the local food supply and get into the body through food or through drink. When radioactive materials get into the body through breathing, eating, or drinking, we say that “internal contamination” has occurred. In the case of internal contamination with radioactive iodine, the thyroid gland quickly absorbs this chemical. Radioactive iodine absorbed by the thyroid can then injure the gland. Because non-radioactive KI acts to block radioactive iodine from being taken into the thyroid gland, it can help protect this gland from injury.

What KI cannot do
Knowing what KI cannot do is also important. KI cannot prevent radioactive iodine from entering the body. KI canprotect only the thyroid from radioactive iodine, not other parts of the body. KI cannot reverse the health effects caused by radioactive iodine once damage to the thyroid has occurred. KI cannotprotect the body from radioactive elements other than radioactive iodine—if radioactive iodine is not present, taking KI is not protective.

How does KI work?
The thyroid gland cannot tell the difference between stable and radioactive iodine and will absorb both. KI works by blocking radioactive iodine from entering the thyroid. When a person takes KI, the stable iodine in the medicine gets absorbed by the thyroid. Because KI contains so much stable iodine, the thyroid gland becomes “full” and cannot absorb any more iodine—either stable or radioactive—for the next 24 hours.

Iodized table salt also contains iodine; iodized table salt contains enough iodine to keep most people healthy under normal conditions. However, table salt does not contain enough iodine to block radioactive iodine from getting into your thyroid gland. You should not use table salt as a substitute for KI.

How well does KI work?
Knowing that KI may not give a person 100% protection against radioactive iodine is important. How well KI blocks radioactive iodine depends on how much time passes between contamination with radioactive iodine and the taking of KI (the sooner a person takes KI, the better), how fast KI is absorbed into the blood, and the total amount of radioactive iodine to which a person is exposed.

Who should take KI?
The thyroid glands of a fetus and of an infant are most at risk of injury from radioactive iodine. Young children and people with low stores of iodine in their thyroid are also at risk of thyroid injury.

Infants (including breast-fed infants): Infants need to be given the recommended dosage of KI for babies (see How much KI should I take?). The amount of KI that gets into breast milk is not enough to protect breast-fed infants from exposure to radioactive iodine. The proper dose of KI given to a nursing infant will help protect it from radioactive iodine that it breathes in or drinks in breast milk.

Children: The United States Food and Drug Administration (FDA) recommends that all children internally contaminated with (or likely to be internally contaminated with) radioactive iodine take KI, unless they have known allergies to iodine. Children from newborn to 18 years of age are the most sensitive to the potentially harmful effects of radioactive iodine.

Young Adults: The FDA recommends that young adults (between the ages of 18 and 40 years) internally contaminated with (or likely to be internally contaminated with) radioactive iodine take the recommended dose of KI. Young adults are less sensitive to the effects of radioactive iodine than are children.

Pregnant Women: Because all forms of iodine cross the placenta, pregnant women should take KI to protect the growing fetus. However, pregnant women should take only one dose of KI following internal contamination with (or likely internal contamination with) radioactive iodine.

Breastfeeding Women: Women who are breastfeeding should take only one dose of KI if they have been internally contaminated with (or are likely to be internally contaminated with) radioactive iodine. Because radioactive iodine quickly gets into breast milk, CDC recommends that women internally contaminated with (or are likely to be internally contaminated with) radioactive iodine stop breastfeeding and feed their child baby formula or other food if it is available. If breast milk is the only food available for an infant, nursing should continue.

Adults: Adults older than 40 years should not take KI unless public health or emergency management officials say that contamination with a very large dose of radioactive iodine is expected. Adults older than 40 years have the lowest chance of developing thyroid cancer or thyroid injury after contamination with radioactive iodine. They also have a greater chance of having allergic reactions to KI.

When should I take KI?
After a radiologic or nuclear event, local public health or emergency management officials will tell the public if KI or other protective actions are needed. For example, public health officials may advise you to remain in your home, school, or place of work (this is known as “shelter-in-place”) or to evacuate. You may also be told not to eat some foods and not to drink some beverages until a safe supply can be brought in from outside the affected area. Following the instructions given to you by these authorities can lower the amount of radioactive iodine that enters your body and lower the risk of serious injury to your thyroid gland.

How much KI should I take?
The FDA has approved two different forms of KI—tablets and liquid—that people can take by mouth after a nuclear radiation emergency. Tablets come in two strengths, 130 milligram (mg) and 65 mg. The tablets are scored so they may be cut into smaller pieces for lower doses. Each milliliter (mL) of the oral liquid solution contains 65 mg of KI.
According to the FDA, the following doses are appropriate to take after internal contamination with (or likely internal contamination with) radioactive iodine:
Adults should take 130 mg (one 130 mg tablet OR two 65 mg tablets OR two mL of solution).
Women who are breastfeeding should take the adult dose of 130 mg.
Children between 3 and 18 years of age should take 65 mg (one 65 mg tablet OR 1 mL of solution). Children who are adult size (greater than or equal to 150 pounds) should take the full adult dose, regardless of their age.
Infants and children between 1 month and 3 years of age should take 32 mg (½ of a 65 mg tablet OR ½ mL of solution). This dose is for both nursing and non-nursing infants and children.
Newborns from birth to 1 month of age should be given 16 mg (¼ of a 65 mg tablet or ¼ mL of solution). This dose is for both nursing and non-nursing newborn infants.

How often should I take KI?

A single dose of KI protects the thyroid gland for 24 hours. A one-time dose at the levels recommended in this fact sheet is usually all that is needed to protect the thyroid gland. In some cases, radioactive iodine might be in the environment for more than 24 hours. If that happens, local emergency management or public health officials may tell you to take one dose of KI every 24 hours for a few days. You should do this only on the advice of emergency management officials, public health officials, or your doctor. Avoid repeat dosing with KI for pregnant and breastfeeding women and newborn infants. Those individuals may need to be evacuated until levels of radioactive iodine in the environment fall.

Taking a higher dose of KI, or taking KI more often than recommended, does not offer more protection and can cause severe illness or death.

Medical conditions that may make it harmful to take KI
Taking KI may be harmful for some people because of the high levels of iodine in this medicine. You should not take KI if
• you know you are allergic to iodine (If you are unsure about this, consult your doctor. A seafood or shellfish allergy does not necessarily mean that you are allergic to iodine.) or
• you have certain skin disorders (such as dermatitis herpetiformis or urticaria vasculitis).

People with thyroid disease (for example, multinodular goiter, Graves’ disease, or autoimmune thyroiditis) may be treated with KI. This should happen under careful supervision of a doctor, especially if dosing lasts for more than a few days.

In all cases, talk to your doctor if you are not sure whether to take KI.

What are the possible risks and side effects of KI?
When public health or emergency management officials tell the public to take KI following a radiologic or nuclear event, the benefits of taking this drug outweigh the risks. This is true for all age groups. Some general side effects caused by KI may include intestinal upset, allergic reactions (possibly severe), rashes, and inflammation of the salivary glands.

When taken as recommended, KI causes only rare adverse health effects that specifically involve the thyroid gland. In general, you are more likely to have an adverse health effect involving the thyroid gland if you take a higher than recommended dose of KI, take the drug for several days, or have pre-existing thyroid disease.

Newborn infants (less than 1 month old) who receive more than one dose of KI are at particular risk for developing a condition known as hypothyroidism (thyroid hormone levels that are too low). If not treated, hypothyroidism can cause brain damage. Infants who receive KI should have their thyroid hormone levels checked and monitored by a doctor. Avoid repeat dosing of KI to newborns.

The same CDC website has more information on radiation exposure here (http://www.bt.cdc.gov/radiation/factsheets.asp). You can also read the official potassium iodide guidelines for doctors from the FDA (a PDF file):  http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM080542.pdf

Indoor Plants: Natural Air Purifiers

Are you aware that certain plants can act as natural air purifiers? Indoor air pollution is a serious problem in many communities, especially in cities. But there are also issues with indoor pollutants such as formaldehyde or varnishes that can also cause problems. There are many air purifiers on the market, but why not save a lot of money and also bring some warmth to your home or office with plants that also scrub your air clean?

There are three plants in particular, which you can see in this link (Natural Indoor Air Purifiers – How To Grow Indoor Fresh Air With Plants, Nature’s Air Filters). They are the snake plant, golden palm and money plant. Fortunately, these are both very common and inexpensive. This combination of plants is especially effective as they combine different functions to clean air of toxins both night and day, as well as to add pure oxygen. This was studied in a 1989 NASA study (PDF file) and was recently discussed in a TED Conference video from India, where scientists used an apartment complex as a trial and found strong improvements in people’s indoor air. Here’s a quote:

These three plants where tested for 15 years at Paharpur Business Centre and Software Technology Incubator Park in New Delhi, India. The building is 20 years old, 50,000 square feet, employing over 1,200 plants for 300 working occupants. The Parharp office building is rated the healthiest building in Delhi by the Government of India. This study was published on September 8, 2008 by The Goverment of India, Central Pollution Control Board and Chittaranjan National Cancer Institute, Kolkata, India

The study found that there is a 42% probability of increasing blood oxygen by 1% if one is inside the building for 10 hours. Compared to other non-planted buildings in Delhi, the Parharpur Office Building showed reductions of:

Eye Irritation – 52%
Respiratory Conditions – 34%
Headaches – 24%
Lung Impairment – 12%
Asthma – 9%

15% in energy costs where saved by injecting much less that the 15-20 cubic feet per minute of fresh air into the building as suggested by ASHRAE industry standards. This is significant considering how 40% of the worlds energy is used to maintain all building environments.

The most surprising discovery in this study was a measured increase in human productivity of 20%, a result of fewer sick days and increased employee productivity.

Air Pollution: Do Your Schools Have Action Plans?

Air pollution is a growing problem in many urban areas. Many people may not realize that over the last five years there is a lot of new research proving more serious health effects at lower levels than we had previously thought. The danger is especially acute in children, whose lungs are not fully formed and therefore more vulnerable. Now, there’s a great new review as well as a patient handout to explain the basics. It’s from my specialty’s Journal of the American Family Physician. Their recently published review (Outdoor Air Pollutants and Patient Health) describes the main culprits of air pollution.

It also discusses the US EPA’s Air Quality Index as well as action plan. Notice how the recommendation states how levels over 200 are “very unhealthy” and that “everyone should avoid all physical activity outdoors“. How many of us do that? Does your school have an air pollution action plan? The action plan is below: