A visual summary of managing patients disclosing gender dysphoria, encouraging cooperation and respect to get the best experiences and outcomes for patients
It can be very distressing for a person to tell a health professional about conflict between their sense of self and the sexual characteristics they were born with. They will need reassurance, and careful guidance about what kinds of treatment are available.
About 0.6% of the population identifies as transgender according to healthcare records, although the actual number might be higher. In the 50 years since UK NHS services started, more than 130 000 people have changed social gender role. A variety of doctors, including non-specialists, might at some time in their career be approached for help by someone with gender dysphoria.
In her latest book, Professor Barbara Demeneix explains how exposure to endocrine disrupting chemicals is resulting in reduced IQ levels in children and higher rates of Autism Spectrum Disorder (ASD). The author also explains the approaches needed to reduce exposure to today’s toxic cocktails.
Presents evidence, derived from a wide spectrum of scientific and epidemiological studies, that many of these chemicals are interfering with one of our bodies’ most essential regulators of brain development: thyroid hormone.
Offers number of recommendations for individuals to apply in their day-to-day life and suggest actions that should be taken at the regulatory level.
Goes through the main catalogue of chemicals that can interfere with thyroid hormone production and action.
Tells the personal story of how the author became aware of these problems.
Simply presented ways to decrease your individual chemical load to protect yourself and unborn children.
Dans la période contemporaine, plus que jamais, les expériences de la santé, de la maladie, de la vieillesse et du handicap se constituent à l’intersection des sphères privée et publique. D’un côté la santé publique “dé-privatise” les actes et les préoccupations de santé, de l’autre, les pratiques individuelles façonnent certains dispositifs institutionnels et/ou législatifs et en même temps se “dé-singularisent“. Les individus doivent à la fois se réapproprier le message institutionnel et être en capacité de donner à une expérience intime un caractère public.
Si la sociologie de la santé s’est amplement développée depuis les années 1970, l’interface public-privé et la porosité de ses frontières a été peu interrogée. Les analyses de cet ouvrage apportent un nouveau regard sur ce qui circule entre les sphères privée et publique afin de rendre intelligibles les mécanismes sociaux qui sous-tendent cette interface.
– Comment s’opère le mouvement de dé-privatisation de la santé, selon quels ressorts, enjeux, limites ?
– Comment le privé s’immisce-t-il, façonne-t-il, imprègne-t-il la sphère publique de la santé ?
En partant des situations empiriques les plus représentatives, cet ouvrage invite sociologues, étudiants, professionnels de santé, usagers et citoyens à porter leur attention sur l’articulation public/privé dans le champ de la santé.
This 2015 edition – download here – is not simply an update but a more detailed review; we take into account changes in the major environmental hazards to children’s health over the last 13 years, due to increasing urbanization, industrialization, globalization and climate change, as well as efforts in the health sector to reduce children’s environmental exposures. Inheriting a sustainable world? Atlas on children’s health and the environment aligns with the Global Strategy for Women’s, Children’s and Adolescents’ Health, launched in 2015, in stressing that every child deserves the opportunity to thrive, in safe and healthy settings.
This book seeks to promote the importance of creating sustainable environments and reducing the exposure of children to modifiable environmental hazards. The wide scope of the SDGs offers a framework within which to work and improve the lives of all children. To this end, we encourage further data collection and tracking of progress on the SDGs, to show the current range of global environmental hazards to children’s health and identify necessary action to ensure that no one is left behind.
Science has shown that many thousands of people have been exposed to now mostly banned chemicals such as lead and PCBs at high enough levels to have had their brain development negatively affected. This report finds that there are other chemicals which are still in routine use in our homes where there is evidence of similar developmental neurotoxic (DNT) properties, and also identifies huge gaps in our knowledge of the impacts of other chemicals on brain development. It also points out the unpleasant reality that we are constantly exposed to a cocktail of chemicals, something which is still largely ignored by chemical safety laws.
In spite of the lessons of the past, regulators are continuing to only regulate after harm is caused, instead of acting to effectively protect the most precious of things; children’s developing brains.
In June 2007 CHEM Trust wrote the briefing Chemicals Compromising Our Children, which highlighted growing concerns about the impacts of chemicals on brain development in children. Almost 10 years later, CHEM Trust has revisited the issue with this report, which includes contributions from two of the most eminent scientists in this area, Professor Barbara Demeneix (Laboratory of Evolution of Endocrine Regulations, CNRS, Paris) and Professor Philippe Grandjean (Department of Environmental Medicine, University of Southern Denmark, Denmark & Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA), who also peer reviewed the report.
Our brain and its development
Our brains are astoundingly complex, made up of over 85 billion neurons, which have grown, developed and interconnected during our lives. The brain is the organ that takes the longest to develop, with initial stages of cell division, creation of neurons and their migration taking place from the first hours after fertilisation and throughout the foetus’ time in the womb. However, brain development does not stop at birth – it’s not until our twenties that neurons are fully developed with their myelin coats.
Throughout this complex developmental process a range of signalling chemicals and other processes operate in order to control what happens. The thyroid hormone system is intimately involved in brain development and function, yet it is well established that this system can be disrupted – for example by a lack of iodine (essential to make thyroid hormone) or by certain chemicals. If developmental processes are disrupted, this most often creates permanent problems.
The complexity of brain development and function means that deficits can be very subtle – small reductions in IQ, disabilities that exist with a broad spectrum of seriousness such as autism, or in some cases conditions which do not have fully agreed diagnostic criteria.
Disruption of brain development by chemicals
We are all exposed to hundreds of man-made chemicals in our daily life, coming from everyday products including food, furniture, packaging and clothes. Many of these chemicals will have no negative effects on us, but it is now well established that some are able to disrupt normal development of the brain. Chemicals with long established DNT properties such as lead, PCBs and methylmercury, have been joined by others where DNT effects have been identified more recently, and which are being used in everyday products. There are also rising concerns about chemicals that are very similar to chemicals that have had their use restricted, but which we continue to use as there isn’t sufficient information about their toxic effects. We know even less about thousands of other chemicals in routine use, which have had no testing for DNT properties.
Chemical exposures are so ubiquitous that experts have recognized that babies are born “pre-polluted”. Scientific paediatric and gynaecology & obstetrics societies have consistently warned about chronic health implications from both acute and chronic exposure to chemicals such as pesticides and endocrine disruptors.
The report identifies evidence of DNT properties for the following chemicals:
Bisphenol A (BPA)
a chemical that was used to make baby bottles, is currently being phased out of till receipts (in the EU), but is still used in the making of food can linings and many polycarbonate plastics. There are also concerns about closely related chemicals that are not restricted, including Bisphenol S.
Brominated Flame Retardants (BFRs)
a group of chemicals added to furniture, electronics and building materials. The evidence for neurodevelopmental effects is strongest for the PBDE (polybrominated diphenyl ether) group of BFRs, which are already banned or nearly banned in the EU, though they are still in furniture in our homes, and in dust. However, other BFRs are now being found in dust and human blood serum, with concerns that these BFRs might have similar effects.
a group of chemicals used as plasticisers in PVC and in other products. Some chemicals in this group are now banned in the EU, but many others are still in use.
Per- and poly-fluorocarbons (PFCs)
used as non-stick coatings or breathable coatings, are a large group of chemicals, a few of which are in the process of being restricted by the EU. There is evidence that some PFCs can disrupt the action of the thyroid hormone. PFCs are very persistent in the environment, and many of them can accumulate in our bodies – they are routinely found in blood.
a contaminant of food, related to the use of certain fertilisers and hypochlorite bleach, and is known to disrupt the thyroid hormone system.
Are we protected?
The EU has the most sophisticated regulations in the world for controlling chemical use. However, there are a number of key flaws in this system:
There is often inadequate safety information about individual chemicals, including a lack of information about neurodevelopmental effects.
The processes to ban chemicals are too slow, and the restrictions created often have big loopholes as a result of industry lobbying.
Chemicals are addressed one at a time, so one chemical may have its use restricted, but closely related chemicals remain in use.
We are always exposed to multiple chemicals, but regulations almost always assume we are only exposed to one at a time, even though numerous scientists have shown that chemical effects can add together in our bodies.
It is clear that our children are not currently being protected from chemicals that can disrupt brain development. We have identified a range of policy measures that could improve the situation, including:
Acting faster to ban chemicals of concern, including addressing groups of similar substances, not just those where we have the most information.
Ensuring that any safety testing of chemicals includes evaluation of DNT effects.
Ensuring better identification and regulation of neurodevelopmental toxic chemicals.
Ensuring that all uses of chemicals are properly regulated; for example there is a lack of effective regulation of chemicals in food packaging including paper, card, inks, glues and coatings.
The UK and Ireland should remove the requirement for an open flame test for furniture. This test is not required in the rest of the EU, and leads to increased use of flame retardant chemicals.
Finally, it is important to note that EU regulations have already controlled a number of chemicals of concern, and that EU laws provide a tool to address these problems. We therefore think it is vital for the UK Government to work to stay aligned with EU chemicals laws, whatever the eventual outcome of the UK’s Brexit process.
Though full protection will only come from proper regulation of chemicals, the report also includes a chapter with tips for reducing your and your family’s exposures in daily life.
Sources and More Information
Download the full report “No Brainer The impact of chemicals on children’s brain development: a cause for concern and a need for action”, chemtrust, 2017.
IT’S A NO BRAINER! Action needed to stop children being exposed to chemicals that harm their brain development!, chemtrust, MARCH 7, 2017.
Human health and well‑being are intimately linked to environmental quality
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.
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.
An investment in knowledge pays the best interest ~ Benjamin Franklin ~
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.
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.
The precautionary principle and false alarms — lessons learned
Lead in petrol ‘makes the mind give way’
Too much to swallow: PCE contamination of mains water
Minamata disease: a challenge for democracy and justice
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 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.
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