Environment and human health

Human health and well‑being are intimately linked to environmental quality

Preface

Human health and well-being are intimately linked to environmental quality. This has been recognised for decades amongst policymakers in Europe, and most recently appears as a cornerstone in the European Commission’s proposal for the 7th Environment Action Programme. This report, produced jointly by the European Environment Agency and the European Commission’s Joint Research Centre, outlines a number of environmental issues with a direct influence on people’s health and well-being and is a follow-up and update to the 2005 EEA/JRC report.

In the 8 years that have passed, the political context of environment and health has evolved. As highlighted in EEA’s The European Environment — state and outlook 2010 the policy focus is increasingly shifting from single environmental pollution issues towards systemic challenges regarding the maintenance of ecosystem resilience and the delivery of ecosystem services to human society. Climate change is a good example with its combined impacts on food and water security, heat waves, flooding risks and potential spread of diseases.

Human health and well‑being are intimately linked to environmental quality. This report, produced jointly by the European Environment Agency (EEA) and the European Commission’s Joint Research Centre (JRC), outlines a number of environmental issues with a direct influence on people’s health and well-being.

Where problem detection and measures in the environment and health area have typically been based on dose-effect studies of individual polluting substances and stressors, this new report makes the case for a more integrated take on health issues, acknowledging the complex inter-linkages between resource-use patterns, environmental pressures, multiple exposures and disease burden, as well as the key role that social inequalities play.

It also touches upon emerging issues resulting from long-term environmental and socio-economic trends, such as climate change, lifestyle and consumption changes and the rapid uptake and application of new chemicals and technologies. As such, it complements the recent EEA publication Late lessons from early warnings; science, precaution and innovation, which makes a strong argument for precautionary science in political decision-making, allowing us to strike a better balance between using economic opportunities and avoiding disproportionate risks to the environment and human health and well-being.

Environment and health is not just ‘an aspect’ of environmental policy, it is at the heart of it. In fact, it is central to Europe’s ambition to move towards a Green Economy. With this report, taking stock of the most pertinent environment and health issues, and combining the expertise of our two institutes in environmental reporting and scientific research, we hope to contribute to this goal.

Overview
  1. Setting the scene
  2. Chemicals
  3. Outdoor air
  4. Indoor air
  5. Radon
  6. Water
  7. Noise
  8. Electromagnetic fields
  9. Ultraviolet radiation
  10. Nanotechnology
  11. Green spaces and the natural environment
  12. Climate change
  13. Analytical and policy considerations
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Endocrine Disruptors

Late lessons from early warnings : science, precaution, innovation

An investment in knowledge pays the best interest ~ Benjamin Franklin ~

Preface

There is something profoundly wrong with the way we are living today. There are corrosive pathologies of inequality all around us — be they access to a safe environment, healthcare, education or clean water. These are reinforced by short-term political actions and a socially divisive language based on the adulation of wealth. A progressive response will require not only greater knowledge about the state of the planet and its resources, but also an awareness that many aspects will remain unknown. We will need a more ethical form of public decision-making based on a language in which our moral instincts and concerns can be better expressed. These are the overall aims of Volume 2 of Late lessons from early warnings.

Volume 1 of Late lessons from early warnings was published at a time when the world was experiencing an economic slowdown, China had joined the World Trade Organization and western Europe was still a 15-member Union. Global grain production had declined for the third time in four years due mainly to droughts in North America and Australia, and the world saw major recalls of contaminated meat, foot and mouth disease and bovine spongiform encephalopathy (mad cow disease). Global temperatures continued to climb and many bird populations were in decline, but the United States of America had rejected the Kyoto Protocol. We were seeing ourselves through the lens of the first human genome sequence, yet we were trying to manage chemicals known to be harmful to humans and ecosystems, through international conventions and treaties such as the Basel Convention to deal with toxic waste dumping in the developing world; the OSPAR/HELCOM Conventions to reduce the discharges, emissions and the loss of hazardous substances into the sea and the Montreal Protocol, to phase out ozone-depleting substances. The destruction of the World Trade Center had just happened.

The 2013 Late lessons from early warnings report is the second of its type produced by the European Environment Agency (EEA) in collaboration with a broad range of external authors and peer reviewers.

Since then, we have witnessed a period of extraordinary hubris. Most visibly, the financial profligacy of the first decade of the century led inexorably to the crises of 2007–2009 whereby the major components of the international financial system were weakened to the extreme by indebtedness, mispriced products, lax monetary policies and mis-engineered protection against risks and uncertainty. The world experienced more not less volatility. Political systems became silted up by vested interests and a determination by citizens to protect assets accumulated in easier times, and beneath it all lay a deeper environmental crisis epitomised by climate change and biodiversity loss.

There was also a collapse of trust, not only in financial institutions but in big companies, as they abandoned staff, pensions and health care schemes. Recent evidence from social psychology has shown that despite rising levels of education and innovation in products and services, people trust only those they know and not strangers. As Stephen Green said in Good value: reflections on money, morality, and an uncertain world in 2009:

‘There has been a massive breakdown of trust: trust in the financial system, trust in bankers, trust in business and business leaders, trust in politicians, trust in the media, trust in the whole process of globalisation — all have been severely damaged, in rich countries and poor countries alike’.

The scientific elites have also been slowly losing public support. This is in part because of the growing number of instances of misplaced certainty about the absence of harm, which has delayed preventive actions to reduce risks to human health, despite evidence to the contrary.

Suddenly, our problems have grown into what Charles W. Churchman in 1967 termed wicked problems — difficult or impossible to solve because of incomplete, contradictory and changing requirements, difficult to recognize, resistant to resolution because of the complexity of their interdependencies and needing to be tackled not by one but via many forms of social power. Solving them requires a new combination of hierarchical power, solidarity and individualism.

What could this mean, for example, for the 100 thousand chemicals currently in commercial use?

To begin with we have more conventions and treaties in place than a decade ago: the 2004 Rotterdam Convention on the Prior Informed Consent (PIC) Procedure covering international trade of 24 pesticides, four severely hazardous pesticide formulations and 11 industrial chemicals; the 2004 Stockholm Convention on Persistent Organic Pollutants to protect human health and the environment from substances which are highly toxic, persistent, bio-accumulative and move long distances in the environment, such as DDT, PCBs, various industrial chemicals, and a set of unintentional chemical by-products such as dioxin. But these conventions only address the top-down hierarchical approach to power.

At the same time Europe has put in place legislation to achieve a global regulatory influence including the EU Cosmetic Directive banning the use of chemicals known or strongly suspected of being carcinogens, reproductive toxins, or mutagens causing cancer, mutation or birth defects; the EU Restriction of Hazardous Substances Directive, which restricts the use of hazardous materials in the manufacture of various types of electronic and electrical equipment including lead, mercury, cadmium, hexavalent chromium, the flame retardents polybrominated biphenyls and polybrominated diphenyl ethers, and which encourages the substitution to safe/or safer alternatives in the electric and electronic equipment industry; the closely linked 2006 EU Waste Electrical and Electronic Equipment Directive for collection, recycling and recovery of electrical goods; the 2006 Strategic Approach to International Chemicals Management (SAICM); and the 2007 EU Registration, Evaluation and Authorisation of Chemicals, widely known as REACH, to assign greater responsibility to industry to manage the risks from chemicals and to provide safety information on substances. The effects of these regulatory tools are described in different chapters, but once again point to the main economic actors rather than communities or individuals.

One thing that has become clearer over the past decade is that certain chemical substances are highly stable in nature and can have long-lasting and wide ranging effects before being broken down into a harmless form. The risk of a stable compound is that it can be bio-accumulated in fatty tissues at concentrations many times higher than in the surrounding environment. Predators, such as polar bears, fish and seals, are known to bio-magnify certain chemicals in even higher concentrations with devastating consequences for both humans and ecosystems. So exposure to toxic chemicals and certain foodstuffs are at risk of causing harm, especially to vulnerable groups such as foetuses in the womb or during childhood when the endocrine system is being actively built. Even with small dose exposures, the consequences can in some instances be devastating with problems ranging from cancer, serious impacts on human development, chronic diseases and learning disabilities. Here the power to act could be more properly set by well-informed individuals and communities.

The relationship between knowledge and power lies at the heart of Volume 2. In many chapters, the implicit links between the sources of scientific knowledge about pollutants, changes in the environment and new technologies, and strong vested interests, both economic and paradigmatic, are exposed. A number of authors also explore in greater depth, the short-sightedness of regulatory science and its role in the identification, evaluation and governance of natural resources, physical and chemical hazards. By creating a better understanding of these normally invisible aspects, it is hoped that this volume will enable communities and people to become more effective stakeholders and participants in the governance of innovation and economic activities in relation to the associated risks to humans and the planet.

Much of what we are able to learn from the histories of past environmental and public health mistakes is also directly applicable to the better regulation and governance of global institutions and financial and economic risks. Robin G. Collingwood argued in his Autobiography (1939), that:

‘History can offer something altogether different from [scientific] rules, namely insight. The true function of insight is to inform people about the present…we study history in order to see more clearly into the situation in which we are called upon to act… the plane on which, ultimately, all problems arise is the plane of ‘real’ life: that to which they are referred for their solution is history.’

In this volume, we go further. Whilst still drawing lessons from such widely accepted tragedies as leaded petrol, mercury poisoning in Japan’s Minamata Bay and older pesticides which sterilised many men who used it, we have ventured into the uncertainties of potential yet contested harm, from genetically modified products; nanotechnologies; chemicals such as Bisphenol A; new pesticides and mobile phones. There is also an examination of the 80 or so potential ‘false positives’ where there had been indications of harm but where it was subsequently claimed that there were in fact no risks to prevent: these cases too can provide information that can help to improve future decision-making about innovation and emerging technologies.

A major part of effective decision-making lies in the way issues are framed. In the case of climate change, the first order question is whether it is worth worrying about at all. US Vice President Al Gore chose to make the question a matter of choice between believers and sceptics. However, problems arose when the public was asked to make a scientific decision when too few people had the qualifications to make any kind of reasoned judgement. They were in fact asked to make a false choice. Instead the question should have been framed around which areas should people and governments make decisions and which should be delegated to experts.

In the end there are few certain and enduring truths in the ecological and biological sciences, nor in the economics, psychologies, sociologies and politics that we use to govern them. One, however, comes from the work of Elinor Ostrom, a late and widely missed colleague, who showed from her work on managing fisheries and ecosystems that complex problems can be solved if communication is transparent and open, visions are shared, trust is high and communities are activated to work from the bottom-up as well as from the top down.

As we navigate the Anthropocene, the epoch named in recognition of our impact on the planet, we will need to encourage more people to become involved in solving the wicked problems of our times. Whether through gathering local information or becoming more aware of the many uncertainties and unpredictabilities in our surroundings, the power structures of knowledge will need to change. And if we are to respond more responsibly to the early warning signals of change, we will need to re-design our style of governance to one which reflects a future defined by the local and specific rather than only the global and the average. We hope that Volume 2 of Late lessons from early warnings with its many lessons and insights can help us all meet such a challenge.

Overview
  1. Introduction
  2. The precautionary principle and false alarms — lessons learned
  3. Lead in petrol ‘makes the mind give way’
  4. Too much to swallow: PCE contamination of mains water
  5. Minamata disease: a challenge for democracy and justice
  6. Beryllium’s ‘public relations problem’
  7. Tobacco industry manipulation of research
  8. Vinyl chloride: a saga of secrecy
  9. The pesticide DBCP and male infertility
  10. Bisphenol A: contested science, divergent safety evaluations
  11. DDT: fifty years since Silent Spring
  12. Booster biocide antifoulants: is history repeating itself?
  13. Ethinyl oestradiol in the aquatic environment
  14. Climate change: science and the precautionary principle
  15. Floods: lessons about early warning systems
  16. Seed‑dressing systemic insecticides and honeybees
  17. Ecosystems and managing the dynamics of change
  18. Late lessons from Chernobyl, early warnings from Fukushima
  19. Hungry for innovation: from GM crops to agroecology
  20. Invasive alien species: a growing but neglected threat?
  21. Mobile phones and brain tumour risk: early warnings, early actions?.
  22. Nanotechnology — early lessons from early warnings
  23. Understanding and accounting for the costs of inaction
  24. Protecting early warners and late victims
  25. Why did business not react with precaution to early warnings?
  26. Science for precautionary decision‑making
  27. More or less precaution?
  28. In conclusion.
More Information
Endocrine Disruptors

European Environment Agency Technical Report No 2/2012

The impacts of endocrine disrupters on wildlife, people and their environments – The Weybridge+15 (1996–2011) report

The impacts of endocrine disrupters on wildlife, people and their environments – The Weybridge+15 (1996–2011) report.

Rates of endocrine diseases and disorders, such as some reproductive and developmental harm in human populations, have changed in line with the growth of the chemical industry, leading to concerns that these factors may be linked. For example, the current status of semen quality in the few European countries where studies have been systematically conducted, is very poor: fertility in approximately 40 % of men is impaired. There is also evidence of reproductive and developmental harm linked to impairments in endocrine function in a number of wildlife species, particularly in environments that are contaminated by cocktails of chemicals that are in everyday use. Based on the human and wildlife evidence, many scientists are concerned about chemical pollutants being able to interfere with the normal functioning of hormones, so-called endocrine-disrupting chemicals (EDCs), that could play a causative role in these diseases and disorders. If this holds true, then these ‘early warnings’ signal a failure in environmental protection that should be addressed.

The impacts of endocrine disrupters on wildlife, people and their environmentsThe Weybridge+15 (1996–2011) report.

Endocrine Disruptors

Pesticide Action Week 2017 Poster

Call for a pesticide-free Spring! Join us!

The Pesticide Action Week is an annual and international event, open to everyone, with the aim to promote alternatives to pesticides. The campaign takes place during the first ten days of every spring (20th-30th of march) when usually the spreading of pesticides resumes.

Call for a pesticide-free Spring!
Pesticide Action Week,
20th-30th of march.

The public is invited to get better informed about the sanitary and environmental challenges caused by pesticides and learn more about possible alternatives to pesticides by taking part in one of the hundreds of organised activities: conferences, panel discussions, film showings, workshops, open days at organic farms, information stands, exhibitions, shows…

The goals of this event are:

  • Raising awareness on the health and environment risks of synthetic pesticides
  • Highlighting and promoting alternative solutions
  • Building a global grassroots movement for a pesticide-free world

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Sources, fate and effects of microplastics in the marine environment

A global assessment, Part 2, 2016

gesamp-2
GESAMP 2017 2nd report on the microplastics issue.

This report provides an update and further assessment of the sources, fate and effects of microplastics in the marine environment, carried out by Working Group 40 (WG40) of GESAMP (The Joint Group of Experts on Scientific Aspects of Marine Protection). It follows publication of the first assessment report in this series in April 2015 (GESAMP 2015). The issue of marine plastic litter was raised during the inaugural meeting of the United Nations Environment Assembly (UNEA) in June 2014. Delegates from 160 countries adopted Resolution 1/6 on ‘Marine plastic debris and microplastics’ (Annex I). The resolution welcomed the work being undertaken by GESAMP on microplastics and requested the Executive Director of UNEP to carry out a study on marine plastics and microplastics. This was to be based on a combination of existing and new studies, including WG40. This provided the motivation for GESAMP to revise the original terms of reference to reflect both the request from UNEP to contribute to the UNEA study, and the key recommendations from the WG40 2015 report.

Each main section begins with key messages followed by a short summary of related findings from the first report. Each section ends with conclusions, knowledge gaps and research priorities. Greater effort has been made to describe the nature, distribution and magnitude of sources of macro- and microplastics. These are described by sea-based and land-based sectors, together with the main entry points to the ocean. Spatial (regional) and temporal differences in both sources and entry points are examined. One previously unrecognized source of secondary microplastics highlighted is debris from vehicle tyres.

The distribution of microplastics in the five main ocean compartments (sea surface, water column, shoreline, seabed and biota) are described, together with the transport mechanisms that regulate fluxes between compartments. Regional ‘hot-spots’ of sources, distribution and accumulation zones are reported, in response to the UNEA request.

The effects of microplastics on marine biota have been explored in greater detail.

Greater attention has been given to the interaction of microplastics with biota. A comprehensive literature review has been assembled with tables summarising the occurrence of microplastics in a wide variety of marine organisms and seabirds. There does appear to be an association between uptake of microplastics and changes in the physiological or biochemical response in some species, observed in laboratory experiments. It is not clear whether this will be significant at a population level with current observed microplastic numbers. The current understanding of the interaction of plasticassociated chemicals with biota is reviewed, using laboratory-based experiments, theoretical studies and field-based observations. It appears very likely that this interaction will be dependent on:

  • the species;
  • the relative degree of contamination of the plastic, the biota concerned and the marine environment (sediment, water, foodstuff) in that region;
  • the size, shape and type of plastics;
  • and several time-related variables (e.g. environmental transport, gut desorption rates).

This remains a contentious area of research. The occurrence of nano-sized plastics in the marine environment has yet to be established and we are dependent on drawing inferences from other fields of science and medicine when considering possible effects. Microplastics can act as vectors for both indigenous and non-indigenous species. Examples include pathogenic Vibrio bacteria, eggs of marine insects and the resting stages of several jellyfish species.

A new section considers the possible effect of microplastics on commercial fish and shellfish. Microplastics have been found in a variety of commercial fish and shellfish, including samples purchased from retail outlets. Generally the numbers of particles per organism are very small, even for filter-feeding bivalves in coastal areas bordered by high coastal populations. At these levels it is not considered likely that microplastics will influence the breeding/development success of fish stocks (food security) nor represent an objective risk to human health (food safety). However, data are rather scarce and this is an area that justifies further attention.

The economic aspects of microplastic contamination are considered in another new section. This relies heavily on studies looking at the effects of macrodebris on various sectors (e.g. fisheries, shipping, tourism, waste management), given the paucity of knowledge of direct economic effects of microplastics. Acting on macroplastics may be easier to justify, as the social, ecological and economic effects are easier to demonstrate. This in turn will reduce the quantities of secondary microplastics being generated in the ocean. One significant cost that may be incurred would be the provision of wastewater treatment capable of filtering out microplastics. Such systems are relatively common in some rich countries but absent in many developing nations. Clearly, there are many other reasons to introduce improved wastewater treatment (nutrient reduction, disease prevention), with reduction in microplastics being an additional benefit.

Social aspects are focused around factors influencing long-term behaviour change, including risk perceptions, perceived responsibility and the influence of demographics. This is key to implementing effective, acceptable measures.

A separate section summarizes good practice guidance on sampling and analysis at sea, in sediments and in biological samples. There are no global ‘standards’ but if these guidelines are followed then it will be easier to generate quality-assured data, in a cost-effective manner, and for datasets to be compared and combined with more confidence.

The final main section presents an initial risk assessment framework. Having described some basic principles about risk, likelihood and consequences the section provides a conceptual framework and two case examples (one real, one hypothetical) of how the framework can be utilized.

The report concludes with key conclusions and recommendations for further research.

Sources, fate and effects of microplastics in the marine environment

A global assessment, Part 1, 2015

gesamp-1
GESAMP 2015 1st report on the microplastics issue.

The Joint Group of Experts on the Scientific Aspects of Marine Environmental Protection (GESAMP) is a scientific body advising the United Nations (UN) and whose secretariat is the International Maritime Organization (IMO).

Society has used the ocean as a convenient place to dispose of unwanted materials and waste products for many centuries, either directly or indirectly via rivers. The volume of material increased with a growing population and an increasingly industrialized society. The demand for manufactured goods and packaging, to contain or protect food and goods, increased throughout the twentieth century. Large-scale production of plastics began in the 1950s and plastics have become widespread, used in a bewildering variety of applications. The many favourable properties of plastics, including durability and low cost, make plastics the obvious choice in many situations. Unfortunately, society has been slow to anticipate the need for dealing adequately with end-of-life plastics, to prevent plastics entering the marine environment. As a result there has been a substantial volume of debris added to the ocean over the past 60 years, covering a very wide range of sizes (metres to nanometres in diameter). This is a phenomenon that has occurred wherever humans live or travel. As a result there are multiple routes of entry of plastics into the ocean, and ocean currents have transported plastics to the most remote regions. It is truly a global problem.

The GESAMP assessment focuses on a category of plastic debris termed ‘microplastics’. These small pieces of plastic may enter the ocean as such, or may result from the fragmentation of larger items through the influence of UV radiation.

Section 1 provides an introduction to the problem of microplastics in the marine environment, and the rationale for the assessment. The principal purpose of the assessment is to provide an improved evidence base, to support policy and management decisions on measures that might be adopted to reduce the input of microplastics to the oceans.

The GESAMP assessment can be considered as contributing to a more formal Assessment Framework, such as the Driver-Pressure-State-ImpactResponse (DPSIR) Assessment Framework, which is introduced in Section 2.

The nature of man-made polymers, different types and properties of common plastics and their behaviour in the marine environment are introduced in Section 3. There is no internationally agreed definition of the size below which a small piece of plastic should be called a microplastic. Many researchers have used a definition of <5 mm, but this encompasses a very wide range of sizes, down to nano-scales. Some microplastics are purposefully made to carry out certain functions, such as abrasives in personal care products (e.g. toothpaste and skin cleaners) or for industrial purposes such as shot-blasting surfaces. These are often termed ‘primary’ microplastics. There is an additional category of primary particle known as a ‘pellet’. These are usually spherical or cylindrical, approximately 5 mm in diameter, and represent the common form in which newly produced plastic is transported between plastic producers and industries which convert the simple pellet into a myriad of different types of product.

The potential physical and chemical impacts of microplastics, and associated contaminants, are discussed in detail in Section 4. The physical impacts of larger litter items, such as plastic bags and fishing nets, have been demonstrated, but it is much more difficult to attribute physical impacts of microplastics from field observations. For this reason researchers have used laboratory-based experimental facilities to investigate particle uptake, retention and effects. Chemical effects are even more difficult to quantify. This is partly because seawater, sediment particles and biota are already contaminated by many of the chemical substances also associated with plastics. Organic contaminants that accumulate in fat (lipids) in marine organisms are absorbed by plastics to a similar extent. Thus the presence of a contaminant in plastic fragments in the gut of an animal and the measurement of the same contaminant in tissue samples does not imply a causal relationship. The contaminant may be there due to the normal diet. In a very small number of cases, contaminants present in high concentrations in plastic fragments with a distinctive chemical ‘signature’ (a type of flame retardant) can be separated from related contaminants present in prey items and have been shown to transfer across the gut. What is still unknown is the extent to which this might have an ecotoxicological impact on the individual.

It is recognized that people’s attitudes and behaviour contribute significantly to many routes of entry of plastics into the ocean. Any solutions to reducing these sources must take account of this social dimension, as attempts to impose regulation without public understanding and approval are unlikely to be effective. Section 5 provides an opportunity to explore issues around public perceptions towards the ocean, marine litter, microplastics and the extent to which society should be concerned. Research specifically on litter is rather limited, but useful analogies can be made with other environmental issues of concern, such as radioactivity or climate change.

Section 6 summarizes some of the main observations and conclusions, divided into three sections: i) sources, distribution and fate; ii) effects; and, iii) social aspects. Statements are given a mark of high, medium or low confidence. A common theme is the high degree of confidence in what we do not know. The assessment report concludes (Section 7) with a set of six Challenges and related Recommendations. Suggestions for how to carry out the recommendations are provided, together with a briefing on the likely consequences of not taking action. These are divided into three Action-orientated recommendations and three recommendations designed to improve a future assessment:

Action-orientated recommendations:

  • Identify the main sources and categories of plastics and microplastics entering the ocean.
  • Utilize end-of-plastic as a valuable resource rather than a waste product.
  • Promote greater awareness of the impact of plastics and microplastics in the marine environment.

Recommendations for improving a future assessment: • Include particles in the nano-size range.

  • Evaluate the potential significance of plastics and microplastics as a vector for organisms.
  • Address the chemical risk posed by ingested microplastics in greater detail.

Dissenting Diagnosis

Voices of Conscience from the Medical Profession

dissenting diagnosis book cover image
Dissenting Diagnosis,
Voices of Conscience from the Medical Profession, by Dr Arun Gadre and Dr Abhay Shukla.

Complaints about the state of medical care are increasing in today s India; whether it s unnecessary investigations, botched operations or expensive, sometimes even harmful, medication. But while the unease is widespread, few outside the profession understand the extent to which the medical system is being distorted.

Dr Arun Gadre and Dr Abhay Shukla have gathered evidence from seventy-eight practising doctors, in both the private and public medical sectors, to expose the ways in which vulnerable patients are exploited by a system that promotes unscrupulous medical practices. At a time when the medical sector is growing rapidly, especially in urban areas, with the proliferation of multi-specialty hospitals and the adoption of ever-more sophisticated technologies, rational and ethical medical care is becoming increasingly rare. Honest doctors feel under siege, professional bodies meant to regulate the medical sector fail to do so, and the influence of the powerful pharmaceutical industry becomes even more pervasive.

Drawing on the frank and courageous statements of these seventy-eight doctors dismayed at the state of their profession, Dissenting Diagnosis lays bare the corruption afflicting the medical sector in India and sets out solutions for a healthier future.

  • See more DES books on this Flickr album.
  • Read How Pharmaceutical Companies Entice Doctors Into Prescribing Expensive Medication, the Caravan, 16 April 2016.
  • Read Customer Reviews on Amazon and GoodReads.

Fracking Fluid’s Secret Recipe

Can we measure the hydraulic fracturing health effects easily without knowing exactly what chemicals are used?

Another classic Rob Rogers‘ cartoon that nails some of the absurd messaging and rationale by the fracking industry.

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A smear test lasts 5 minutes

Cervical Cancer Prevention and Awareness Poster

Cervical Cancer Prevention : see what Jo’s Trust is doing.

Image source: Cervical screening and cervical abnormalities Jo’s Cervical Cancer Trust Information.

Good Coffee?

Fracking Chemicals Detected in Pennsylvania Drinking Water

In 2015, the New York Times reported that fracking fluid had been found in well water in Bradford County, Pennsylvania.

The industry criticized the study, saying that it provided no proof that the chemical came from a nearby well.

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