Letters to Medical Journals

August 25, l998

Journal of the Canadian College of Family Physicians

Dear Editor,

In the August 1998 edition of Canadian Family Physician youidentify a web site provided courtesy of the Canadian Chemical Producers Association which gives reassuring information on endocrine disrupting chemicals.

For other perspectives on this interesting subject however

readers might refer to the World Wildlife Fund website

(www.wwfcanada.org/hormone-disruptors) or the International Joint Commission of the Great Lakes site (www.ijc.org).

Your statement that "potential adverse effects of endocrine disrupting chemicals in humans is still unproven" is certainly the view espoused by the CCPA. However

others believe that these adverse effects have been proven beyond question.

Sincerely yours, 

A. C. Goddard-Hill, M.D.

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The Editor,

Canadian Medical Association Journal

Ottawa

November 23, 1998

Dear Sir,

In a format reminiscent of that found in high school yearbooks of the fifties and lately and rather incongruously established as fashionable by The Lancet you are now including in your News and Analysis section rather facile interviews with eminent persons.

This highly irritating feature is always concluded with an apparently fundamental question about the particulars of the car that the individual drives. Does this have scientific import? Am I missing something here? Do you risk embarrassing the subject if they happen to ride a bicycle?

 Sincerely yours,

A.C. Goddard-Hill, M.D.

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January 17, 1999

The Editor
Journal of the SOGC
Maclean Hunter Healthcare
777 Bay Street, 5th floor
Toronto, Ontario M5W 1A7

Dear Editor,

In the article entitled The Canadian Consensus on Menopause and Osteoporosis, Part II (Journal SOGC December 1998) appears two paragraphs on the subject of Premature Ovarian Failure (page 1355) . A number of causes are listed, including chromosomal abnormalities, chemo and radiation therapy, surgical trauma, autoimmune disorders and a final idiopathic group .

However your list might well have included hormone disrupting environmental contaminants. One author specifically lists dioxins as a possible cause of premature ovarian failure. (1) This is of particular relevance to residents of the Great Lakes basin where menstrual disturbances have been documented and attributed to organochlorine intake from food sources. (2)

It is an irony that one of the principle sources of dioxin currently entering the North American environment is a current method of medical waste management, namely incineration of PVC plastic. This practice continues in many hospitals in North America. (3)

Sincerely yours,
A. C. Goddard-Hill

References

1. Cowan, Seifer; Clinical Reproductive Medicine, 1997, Chapter 9, Amennorhea
2. Mendola, Buck; American Journal of Epidemiology, December 2, 1998
3. Goldman, L, (U.S. EPA) , Medical facilities to focus on cleaner environment, JAMA, August 12, 1998

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February 1, 1999

To the Editor
The Lancet

In response to your query as to his greatest fear Harvard clinical epidemiologist Robert Fletcher replies destruction of the good earth by toxins, nuclear waste, or simply too many people. (1)

Ironically however as interest in the human health effects of environmental pollution has risen in the past few years the number of articles on the subject appearing in general medical journals has peaked and lately been in decline.

A survey of the past seven years of all editions of the Lancet, BMJ , CMAJ, NEJM and JAMA reviewed the relationship between industrial pollution and human health (2). This survey revealed the distribution of the numbers of articles on the subject which appeared in the years 1992 1998 in those general medical journals and is illustrated in Table 1.

What accounts for this decline? One possible explanation lies in the recent collapse of government funding for environmental programs observed in some jurisdictions. For example the operating budget of the Ministry of Environment of the Province of Ontario (3, Table 2) shows a decline congruent with and beginning one year in advance of the descending limb of the curve in Table 1 .

Physicians interested in research on the relationship between environmental pollution and human health should be aware that for some reason articles on the subject have been published with decreasing frequency in the general medical journals, a trend which itself is of concern.

Sincerely yours,

A. C. Goddard-Hill

References:

1. Lancet 1999; 353

2. Goddard-Hill A . Environmental Epidemiology of the Great Lakes Basin; Human Health Effects of Industrial Pollutants, Effluents and Toxics. November 1998. www.salu.net/gh

3. Mittelstaedt, M. Environmental protection thinning, Globe and Mail, August l9,

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Editor

Canadian Medical Association Journal

(Published November 2, 1999)

Re:  "TOYING WITH TITLES"

Dear Editor,

Your article "Vinyl toys, medical devices get clean bill of health" notes that The American Council on Science and Health is reassuring about the safety of phthalates in these items. (1) The article identifies the leader of this panel as Dr. Everett Koop, former US surgeon general

and by implication an independent authority.

However what is not revealed in your report is that ACSH may be heavily freighted with conflicted interest. One source claims it receives 76% of its funding from industry including Exxon, the largest manufacturer of phthalates in

the world, and that "most of the ACSH panel have ties to the chemical industry." (2)

The Pugwash Foundation which addresses health and environmental issues related to scientific advances claims that the scientific community has to a certain extent lost the trust of the public.(3) The title and content of your article illustrate one of the reasons. A firm conclusion

on a controversial scientific question is headlined and supported by an apparently credible source without mention of competing interests. A policy of stating such interests is applied elsewhere in the Journal but

apparently not in the News and Analysis section.

Sincerely yours,

A. C. Goddard-Hill, M.D

References.

(1) News and analysis. Vinyl toys, medical devices get clean bill of health. CMAJ 1999; 161(4):361-3.

(2) Montague P. Precaution and PVC in Medicine, Part 2. Rachel's Environment & Health Weekly 1999; 662.

(3) Atiyah M. Science for evil: the scientist's dilemma. BMJ 1999; 319 (7207): 448-9.

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The Editor, Canadian Medical Association Journal

November 14, 2000

"A Burning Issue"

Dear Editor,

 The new series in CMAJ on the environment is long overdue.

With respect to the issue of medical waste incineration, 2 years ago I set the year 2000 as the target date for shutting down our hospital incinerator.

Given the current rate of progress, I am thinking of re-establishing the date as the year 3000.

Alban Goddard-Hill

Reference

1. McCally, M. Environment and health: an overview (commentary). CMAJ 2000; 163(5):533-5