Environmental Crisis – Raising all our Elijahs (a reprise from over ten years ago)

The following post was written over ten years ago, but remains a beacon. I cite the findings of Dr. Sandra Steingraber, who is one the most grounded scientists on the subject of what the environment does to us, especially our children. Her voice has been heard any several halls of governance and is worth heeding.

Earlier this week, I had the distinct pleasure to hear Dr. Sandra Steingraber speak on the significant environmental crisis that has been with us for some time and the impact past, current and future events will have on the environment and us in the future. I say pleasure, but in fact, she scared the crap out of me and everyone in attendance which was her purpose. Dr. Steingraber is an ecologist, author, cancer survivor* and mother of two. Her most recent book about her son is called “Raising Elijah – Protecting our Children in an Age of Environmental Crisis” and it follows her earlier book called “Living Downstream: An Ecologist’s Personal Investigation of Cancer.” She is a frequent public speaker and has testified in front of Congress, the United Nations and the European Parliament to name a few. Her first book has been made into a film by The People’s Picture Company of Toronto.

She tells her stories from each of her lenses, but her most impactful lens is the one told as a mother of two. I am currently reading “Raising Elijah” and would encourage each of you to read it and tell others about it. I will move onto her first book after this one. She attests that when you speak of these issues as a mother (or parent), it resonates with everyone as we all wish for our children to live healthy lives. She notes she has been able to bring pro-life and pro-choice believers together on these issues.

In her mind, there are two types of crises with the environment – the toxic crisis and the climate change crisis. The toxic crisis has been with us for some time and decisions and exposures from many years ago are still affecting people now. The climate change crisis is very real and, in addition, to the other issues it creates, it heightens the impact of the toxic crisis even more. Elevated temperatures and the impact on the ozone will only make current matters worse. From a mother’s perspective, the impact on our children is worse than it is on adults. She notes the obvious, but children are closer to the ground where many of the toxins reside, they have a much higher degree of mouth breathing meaning they will take in more air per pound, they put their hands in their mouth about ten times an hour plus they will be exposed for longer periods due to their age than adults to toxins. A few facts that will heighten the issue

– 1 out of 8 US children are born prematurely which is traceable to the environment; early births mean the lungs are not fully created, so life long breathing issues will result;

– 1 out of 11 US children have asthma (1 out of 4 in Harlem);

– 1 in 10 US children will have a learning disability;

– 1 in 110 US children will have some form of Autism; and

– 1 in 10 US white girls and 1 in 5 US black girls will have breast development before the age of 8, which translates into menopausal and other issues.

I wish to tell you these numbers are made up, but they are well-grounded. And, the higher propensity can be traced to toxins that have been allowed to exist in the air, water and even playgrounds. The latter will make you furious, but the pressurized wood we have in many of our playgrounds is loaded with arsenic, copper and chromium, so our children and adults with our pressurized decks, are exposed to these chemicals. Adding to that, it  is measured that 60% of Americans live in areas where the air is unhealthful. So, from her perspective, “an investment in green energy is also an investment in cancer prevention.”

I went to hear her speak as she is one of the biggest opponents of hydro-fracturing or fracking to release and harvest natural gas. What I expected to hear is the impact fracking has on the nearby water where the chemicals used to fracture the shale gets in the water table. I also expected to hear about the significant increase in earthquakes in areas where fracking is done. These are a problem. Yet her major concern is what is released into the air and its impact on many today and in the future. Air pollution is what is causing the conditions in children and adults.

She notes the US is now doing and promoting Four Extreme Measure of Fossil Fuel Extraction – (1) mountain top removal, (2) tar sands, (3) deep-sea oil drilling and (4) fracking. All of these impact our environment greatly, but fracking gives her the most alarm. She advocates we must have a strategy to cease all new fossil fuel extraction now and invest in renewable forms of energy. Her point is any change will not impact the climate change for about 15 years, so we must divorce ourselves now from new fossil fuels.

What can we do? Reading from “Climate Change and Your Health – Rising Temperatures, Worsening Ozone Pollution,”  by the Union of Concerned Scientists, we should be doing the following:

– investing in more fuel-efficient cars and reducing the miles driven;

– developing fuels that are less carbon-intensive;

– providing good public transit and other commuting/ travel alternatives;

– increasing energy efficiency at industrial and commercial facilities;

– developing and retrofitting homes and buildings to be more efficient;

– using more renewable energy resources – such as wind, solar and geothermal – to generate electricity;

– ensuring that ozone and carbon-reduction standards are strong enough to be truly protective of public health; and

– working collaboratively with global partners to reduce carbon emissions from other countries.

The issues and solutions require concerted effort and input from all parties. This issue more than any scares me most if the GOP takes the White House. I feel we will not only lose momentum, but many of the policies of the GOP are the exact opposite of what we need to do. When Newt Gingrich has to disavow that he changed his mind on global warming when he appeared with Nancy Pelosi (I guess we are to shake up our Etch-a-Sketch to erase it from our memories) that is a telling point for me. The President is on the right track, but he needs to do more and he needs the Republicans to join him at the table and stop being ostriches with their head in the sand. And, once you read Dr. Steingraber’s book I hope you have a better grasp that we need a concerted effort now to save our children – our Elijahs. Forget the debt, forget the economy, forget social values – none of that will matter if we don’t fix this problem. The human and economic cost will dwarf any of these issues.

*Note: Steingraber is a survivor of bladder cancer, which is called a bell weather cancer as it is often associated with environmental causes. She grew up between four different factories. Other relatives also got various cancers, including bladder cancer. Yet, here is the gist – Steingraber was adopted, so it was not a hereditary cause. Eventually, the cancer was linked to environmental toxins from the factories.

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A few Earth Day observations (from ten years ago)

The following was written ten years ago. Since then, the US helped push and sign the Paris Climate Change Accord, decided to leave it under the last president, then decided to stay with the current president. As an independent and former Republican and Democrat voter, this difference in doing something about climate change is the primary reason (among several) to avoid voting for Republicans. Full stop. We have no more time to waste and need to fund and do bigger things to stave off what is already happening. Just look at some of the predictions referenced from 2013 below looking forward until today.

Today is a good day to reflect on what more we can do to protect our planet and make it a life-sustaining environment for eons to come. I would encourage you to spend a few minutes perusing my friend Z’s blog at www.playamart.wordpress.com and check out her Earth Day post of yesterday. She has captured in her photos and quotes a very meaningful journey on this Earth Day, as she often does with other topics of import. Below are a few odds and ends for your review as well.

It is all about water and air

These are our dearest resources. We must be vigilant on how we use and impact these resources. I have written recently about “water is the new oil.” We can not only avoid polluting our precious resource, we have to be very thoughtful about its overall supply. Do not let anyone tell you this is not a major issue.

On the air side, we must guard against the emissions that come from the mining, collection, use and disposal of fossils fuels and petro-chemicals. For those who want to protect our kids from future debt problems, this will impact their health and the debt in far greater way, with the high cost of fixing problems and tending to those impacted mentally and physically.

Some skeptics will see the word “mentally” and say that is overblown. Yet, one of the key tenets of Dr. Sandra Steingraber’s books “Living Downstream” and “Raising Elijah” is most environmental models look at the impact of pollution on a 50-year-old man. The models need to look at the impact on children who are of lesser weight, closer to the ground, mouth breathe more, put hand to mouth more, and have developing brains. The data are showing the impact of various chemical pollutants heightens the propensity to certain mental and physical challenges such as autism and its various manifestations, asthma and other breathing disorders and more premature births which creates a vicious cycle for future health issues. Her data is very compelling and her voice needs to be heard.

Global warming will accelerate many bad things

In her books, Dr. Steingraber, who is an ecologist, biologist, and bladder cancer survivor, also notes that a problem we do not talk enough about in the discussion of global warming is its impact on the toxins that are in our air, water and environment. She says it is like a chemical crockpot. As the earth warms, so will these toxins and our ability to reduce them will be challenged. She highlights her bladder cancer as a bellweather cancer, as it is typically caused by environmental issues. She had other relatives nearby who also had bladder cancer – the key is she was adopted, so it was environmental not hereditary.

We are already seeing worse things in the global warming models than forecasted, so as one of the US’s political parties is fiddling, Rome is burning. Last year at this time, I read a report that showed hurricanes will more significantly impact the coastal regions with the higher sea levels. The analogy used is it is easier to dunk a basketball when the court is raised. This was before Hurricane Sandy which many scientists note was heightened by the raised sea levels. In addition to lives, livelihoods, and homes, the cost to fix is at least the $50 billion the federal government provided in January.

The other predictions in the model are heightened forest fire prevalence and intensity, worsened droughts in the drier areas along with more stalled weather systems. So some areas get way too much precipitation, while others get way too little. The human and economic cost of these worsening conditions is huge says Mercer Investment Consulting and major pension trust sponsors around the globe. This study done in 2011 talked of these increasing forest fires, worsening droughts, and intensifying hurricanes, which had already been occurring and are now more prevalent around the globe.

Already too much carbon in the air

People like to talk about global warming as a future event, yet as noted above, it is already impacting our lives. We have too much carbon in the air today and it will only get worse. China is firing up more coal plants and Beijing is coming closer to being an inhabitable city. If you do not believe this, then ask why it is getting harder for companies to get their ex pats to move and stay there.

There are solutions in addition to moving more quickly away from fossil fuels. We need to adopt older ways of grazing cattle that will let the grasslands flourish. We need to plant even more trees than we are doing now and stop taking them down at such an accelerated rate. And, we need to move more food growth and distribution closer to the sale and consumption of food. The greener areas will absorb more carbon at of the atmosphere and coupled with more renewable energy sources, will move us down the right path.

And it is not just humans

Finally, our ability to survive on this planet is not just in human hands. We are seeing the impact of global warming and environmental toxins on animals, fish and insects that matter to us. The honey bee population continues to fall and the culprit is most likely the pesticides sprayed on adjacent crops. These bees cross-pollinate a non-inconsequential percentage of our food and farmers and beekeepers are worried.

Our coral reefs are dying off in greater numbers. The Great Barrier Reef outside of Australia is shrinking for example. This is of vital importance due to the numbers of fish and other species that swim and grow there. And, species we do not eat are eaten by species we do. So, it is a major concern. And, closer to home the populations of cod are much smaller in Cape Cod, so the fishermen have to go further out to sea.  The US Fisheries Department has been tracking the impact of global warming on fish populations for over ten years, while the fiddlers still fiddle.

And, in the animal species, it is not just polar bears who are being impacted. The huge amount of fracking going on in our national parklands is impacting animals there. In Pennsylvania, small animals and birds are impacted by drinking the chemically laden water that cannot be kept out of the water supply. There is a domino effect that will impact us humans at some point, either directly, or through the animals, fish and insects we come in contact with.

Conserve and advocate

Now that I have scared the crap out of you, what can we do? Continue to conserve, compost and reuse. Do small things and big things. I wrote a post on last year’s Earth Day about conservation. But, also advocate. Change the conversation with others and leaders. Write them and be matter of fact. If someone starts a conversation about their doubts over global warming, say “that train has left the station, we need to talk about what to do about it.” If they insist, say “97% of scientists believe it to be so and only 26% of Republican Congresspeople. I choose to believe the 97% of scientists.” My advice is to not to debate the obvious, but discuss what to do about it. It will change the tenor of the conversation to be action-oriented.

And, that is precisely what is needed – action. We really do not have any time or resources to waste. Happy Earth Day.

*Note: Our friend Jill posted an old Earth Day post as well. Here is a link.

https://jilldennison.com/2023/04/22/happy-earth-day-2023/

Tuesday troubles

I read where Turkey has experienced another earthquake on top of the tragic one several days ago. It shows how fragile life is and how the planet is indiscriminate on who is impacted by its rumblings.

With such tragedy, it makes me more perturbed by weak-minded tyrants and elected officials who feel the need to invade other countries. Putin has shown how fragile his ego is by not realizing he has harmed his own country by trying to take over land from another.

But, before the US gets too high and mighty, we should not forget we invaded Iraq under false pretenses. This was determined to be the case by a British commission that found British PM Tony Blair and US President George W. Bush at fault for deceiving the British people about invading Iraq.

To be frank, we are focusing on the wrong things. The two most significant long term concerns by the members of the World Economic Forum are the global water crisis and impact of climate change. The latter makes the former independent concern even more troubling hastening evaporation and threatening fresh water aquifers with rising sea levels. But, climate change also is cooking the chemicals left in the earth like a crockpot making them worse per ecologist and biologist Sandra Steingraber.

So, we need to tell so-called leaders to stand down and quit being so narrow-minded with their war games. Always remember the line from the movie “Troy.” “War is old men talking and young men dying.” That sums it up nicely. We have more important things to deal with.

Top of mind issues that aren’t

Issues that need to be top of mind aren’t being discussed because we would rather talk about more exaggerated and contrived issues.

The global water crisis lives here, especially in drought prone areas like the Southwest United States, which is running dangerously low on water. Climate change only makes matters worse. And, this is even before we speak of the lead water pipe structures which have their own set of toxic issues as in Flint, Michigan.

Miami is the most at risk city in the world for encroaching sea levels due to climate change, but the governor calls more dramatic solutions liberal based ideas. Miami has built right to the coast and the limestone guarding the largest aquifer is porous. The fact the number of sunny days flooding has increased with sea water coming up through the street drains in Miami Beach should give people pause. Call me crazy, but when you are surrounded on three sides by sea water as Florida is, climate change should be a huge issue.

Toxins in our environment due to manufacturing run off of chemicals or middle of the night storage elsewhere are causing bell weather cancers years later. The water at Camp Lejeune in NC has been killing and making Marines, their spouses and their children sick for decades and yet we are still screwing around with a decision. Thank you for your service, just don’t drink the water. Recent stories on environmental cancers from Teflon and Round-up chemicals also continue to get press.

Dr. Sandra Steingraber, an ecologist, biologist, author and speaker (who has testified to Congress and the EU Parliament), spoke at an event I attended. She noted our tests are designed for a 50 year-old man, but we really should be testing for children. Our children have lungs and brains that are not fully developed, they have lesser body weight and are closer to the ground, they mouth breath more and they touch things more and put their hands in their mouths. They are easy targets for toxins to poison them.

I want people to remember her words. She added some hope, though. When we act in a serious manner we can fix things. She used the example of the Rabies vaccine, as she and her son were exposed. Rabies is a horrible way to die and it only takes a bite. But, we long ago created a series of vaccines that prevent Rabies, even if exposed. We learned and acted. She said that is a lesson that we should follow on dealing with other environmental issues – learn and act whether it’s getting rid of arsenic on playground equipment, removing asbestos out of building materials or knowing how to handle PVC pipes in a closed environment.

People matter. Children matter. Short term profits matter less than human life. I would argue companies that aggressively act to fix things will do better with long term profits due to goodwill.* Let’s act like parents and grandparents in governing what is needed. Let’s shine a spotlight on legislators and business leaders who do not.

*Years ago, Dow Chemical had a huge chemical spill in India. Because of their reputation as a good community citizen and by acting quickly to fix things, the long-term profits of the company did not suffer. The same held true with Johnson and Johnson, the makers of Tylenol after product tampering incidents killed some people. They acted quickly to fix things and we now have tamper identifying bottles.

A herbicide lives inside of us

A very alarming article called “‘Disturbing’: weedkiller ingredient tied to cancer found in 80% of US urine samples” by Carey Gillam in The Guardian is must reading for us all. The article can be linked to below, but here are the first few paragraphs that sound the bell.

“More than 80% of urine samples drawn from children and adults in a US health study contained a weedkilling chemical linked to cancer, a finding scientists have called ‘disturbing and concerning’.

The report by a unit of the Centers for Disease Control and Prevention (CDC) found that out of 2,310 urine samples, taken from a group of Americans intended to be representative of the US population, 1,885 were laced with detectable traces of glyphosate. This is the active ingredient in herbicides sold around the world, including the widely used Roundup brand. Almost a third of the participants were children ranging from six to 18.

Academics and private researchers have been noting high levels of the herbicide glyphosate in analyses of human urine samples for years. But the CDC has only recently started examining the extent of human exposure to glyphosate in the US, and its work comes at a time of mounting concerns and controversy over how pesticides in food and water impact human and environmental health.

‘I expect that the realization that most of us have glyphosate in our urine will be disturbing to many people,’ said Lianne Sheppard, professor at the University of Washington’s department of environmental and occupational health sciences. Thanks to the new research, ‘we know that a large fraction of the population has it in urine. Many people will be thinking about whether that includes them.’

Sheppard co-authored a 2019 analysis that found glyphosate exposure increases the risk of non-Hodgkin lymphoma, and also co-authored a 2019 scientific paper that reviewed 19 studies documenting glyphosate in human urine.“

If you are a homeowner in the US and abroad, you have likely used a weedkiller, even Roundup, on those pesky weeds. We have. So, that would likely mean we are candidates to be in the 80% category of the above statistic not the 20% one.

This disturbing statistic reminds me of the movie “Dark Waters” where the factories that made Teflon existed, the workers and their families and citizens that lived close by had high degrees of cancers and other abnormalities. Yet, the other statistic cited by this true story, is the chemicals in Teflon are forever chemicals. And, a substantial percentage of humans likely have these chemicals in their bodies from use of the product.

Dr. Sandra Steingraber, an ecologist, biologist and bladder cancer survivor noted in her books and speeches to Congress and the European Parliament that we do not emphasize enough the environmental causes of cancer. When we do, they make movies out of the hard fight to expose the Dupont’s, Monsanto’s and Pacific Gas and Electric’s of the world for poisoning our environment. She also notes, we need to test more for the impact on kids (as done in this urine sampling). Kids’ lungs and brains are not fully developed until they become adults, they put hand to mouth more after touching things, they mouth breathe more, and they are lower to the ground. As these toxins spread onto things, the kids become infected faster and more frequently than an average adult. It should be noted that for the longest while, outdoor playground equipment was treated with an insecticide that was made of arsenic.

We must insist companies follow the “precautionary principle” meaning if they know of a problem, they need to stop and test it before going on. They cannot cover it up which is an even worse crime. People died because of these chemicals. People died because of the cover-ups.

Per a website called organiconsumers.org the following blurb can be found:

“Monsanto has falsified data on Roundup’s safety, and marketed it to parks departments and consumers as ‘environmentally friendly’ and ‘biodegradable,’ to encourage its use it on roadsides, playgrounds, golf courses, schoolyards, lawns and home gardens. A French court ruled those marketing claims amounted to false advertising.”

This finding is supported by this piece from the Sierraclub.org:

“The internal communications made clear that Monsanto—the company that created saccharine and went on to develop DDT and Agent Orange—was not only aware that independent scientific studies had found that its blockbuster weed killer, Roundup, and the primary ingredient in Roundup, glyphosate, were probably carcinogenic and harmful to human health, but the company had also tried to bury the findings.”

In another blaring example of this, per “Dark Waters,” Dupont moved pregnant women off the Teflon line as they knew of the danger but did not tell them why. And, they did not tell the public what they knew. And, after the largest data-driven sampling was conducted proving the risk to the public, Dupont reneged on its offer to help people if the study found them at fault. Then Dupont lost every individual lawsuit for millions of dollars until they realized they needed to settle.

So, if you have these chemicals in your body, do some research on what, if anything, you can do about it. For the future, avoid the weedkillers, use masks when handling chemicals and throw out all of your Teflon plated cookware. And, per Steingraber, bladder cancer is a bell weather cancer. If someone you know he gets it, the cause is usually environmental related. If you don’t follow-up, you are risking your and your family’s lives.

https://www.theguardian.com/us-news/2022/jul/09/weedkiller-glyphosate-cdc-study-urine-samples

A Few Earth Day Observations (from eight years ago)

The following post has been briefly edited from its origin eight years ago. It remains pertinent today. Progress has been made, but some progress has been waylaid. We need to move more rapidly than before.

Today is a good day to reflect on what more we can do to protect our planet and make it a life-sustaining environment for eons to come. Below are a few odds and ends for your review as well.

It is all about water and air

These are our dearest resources. We must be vigilant on how we use and impact these resources. I have written recently about “water is the new oil.” We can not only avoid polluting our precious resource, we have to be very thoughtful about its overall supply. Do not let anyone tell you this is not a major issue.

On the air side, we must guard against the emissions that come from the mining, collection, use and disposal of fossils fuels and petro-chemicals. For those who want to protect our kids from future debt problems, this will impact their health and the debt in far greater way, with the high cost of fixing problems and tending to those impacted mentally and physically.

Some skeptics will see the word “mentally” and say that is overblown. Yet, one of the key tenets of Dr. Sandra Steingraber’s books “Living Downstream” and “Raising Elijah” is most environmental models look at the impact of pollution on a 50-year-old man. The models need to look at the impact on children who are of lesser weight, closer to the ground, mouth breathe more, put hand to mouth more, and have developing brains. The data are showing the impact of various chemical pollutants heightens the propensity to certain mental and physical challenges such as autism and its various manifestations, asthma and other breathing disorders and more premature births which creates a vicious cycle for future health issues. Her data are very compelling and her voice needs to be heard.

Global warming will accelerate many bad things

In her books, Dr. Steingraber, who is an ecologist, biologist, and bladder cancer survivor, also notes that a problem we do not talk enough about in the discussion of global warming is its impact on the toxins that are in our air, water and environment. She says it is like a chemical crockpot. As the earth warms, so will these toxins and our ability to reduce them will be challenged. She highlights her bladder cancer as a bellweather cancer, as it is typically caused by environmental issues. She had other relatives nearby who also had bladder cancer – the key is she was adopted, so it was environmental not hereditary.

We are already seeing worse things in the global warming models than forecasted, so as one of the US’s political parties is fiddling, Rome is burning. Last year at this time, I read a report that showed hurricanes will more significantly impact the coastal regions with the higher sea levels. The analogy used is it is easier to dunk a basketball when the court is raised. This was before Hurricane Sandy which many scientists note was heightened by the raised sea levels. In addition to lives, livelihoods, and homes, the cost to fix is at least the $50 billion the federal government provided in January.

The other predictions in the model are heightened forest fire prevalence and intensity, worsened droughts in the drier areas along with more stalled weather systems. So some areas get way too much precipitation, while others get way too little. The human and economic cost of these worsening conditions is huge says Mercer Investment Consulting and major pension trust sponsors around the globe. This study done in 2011 talked of these increasing forest fires, worsening droughts, and intensifying hurricanes, which had already been occurring and are now more prevalent around the globe.

Already too much carbon in the air

People like to talk about global warming as a future event, yet as noted above, it is already impacting our lives. We have too much carbon in the air today and it will only get worse. China is firing up more coal plants and Beijing is coming closer to being an inhabitable city. If you do not believe this, then ask why it is getting harder for companies to get their ex pats to move and stay there.

There are solutions in addition to moving more quickly away from fossil fuels. We need to adopt older ways of grazing cattle that will let the grasslands flourish. We need to plant even more trees than we are doing now and stop taking them down at such an accelerated rate. And, we need to move more food growth and distribution closer to the sale and consumption of food. The greener areas will absorb more carbon at of the atmosphere and coupled with more renewable energy sources, will move us down the right path.

And it is not just humans

Finally, our ability to survive on this planet is not just in human hands. We are seeing the impact of global warming and environmental toxins on animals, fish and insects that matter to us. The honey bee population continues to fall and the culprit is most likely the pesticides sprayed on adjacent crops. These bees cross-pollinate a non-inconsequential percentage of our food and farmers and beekeepers are worried.

Our coral reefs are dying off in greater numbers. The Great Barrier Reef outside of Australia is shrinking for example. This is of vital importance due to the numbers of fish and other species that swim and grow there. And, species we do not eat are eaten by species we do. So, it is a major concern. And, closer to home the populations of cod are much smaller in Cape Cod, so the fishermen have to go further out to sea.  The US Fisheries Department has been tracking the impact of global warming on fish populations for over ten years, while the fiddlers still fiddle.

And, in the animal species, it is not just polar bears who are being impacted. The huge amount of fracking going on in our national parklands is impacting animals there. In Pennsylvania, small animals and birds are impacted by drinking the chemically laden water that cannot be kept out of the water supply. There is a domino effect that will impact us humans at some point, either directly, or through the animals, fish and insects we come in contact with.

Conserve and advocate

Now that I have scared the crap out of you, what can we do? Continue to conserve, compost and reuse. Do small things and big things. I wrote a post on last year’s Earth Day about conservation. But, also advocate. Change the conversation with others and leaders. Write them and be matter of fact. If someone starts a conversation about their doubts over global warming, say “that train has left the station, we need to talk about what to do about it.” If they insist, say “97% of scientists believe it to be so and only 26% of Republican Congresspeople. I choose to believe the 97% of scientists.” My advice is to not to debate the obvious, but discuss what to do about it. It will change the tenor of the conversation to be action-oriented.

And, that is precisely what is needed – action. We really do not have any time or resources to waste. Happy Earth Day.

Internal Bleeding – Be your own Health Care Advocate

The following post was written about nine years ago. Since that time, some of the changes noted below have taken shape, but the message remains important. Be your own health care advocate.

A few years ago, two doctors looking to improve the quality of health care in the US, wrote a book called “Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes.” Since Drs. Robert Wachter and Kaveh Shojania wrote their book, improvements have and continue to be made, but with the concern over the US’ 38th position in health care quality, while being the most expensive system in the world (according to the World Health Organization), I think it is appropriate to belabor a few of their key points, in particular, being your own health care advocate.

In today’s world, we must be the navigators of any customer service we receive whether it is at a bank, the driver’s license office or in a retail store. We must be diplomatically relentless in trying to gain the service we expect and need to resolve an issue. Service providers, in particular those in a Call Center, need to stay on script as much as possible. When your problems get them off script, then your navigation diplomacy skills are needed the most.  I mention this as context for what we also must do in gleaning good health care service.

A few years back there was a study conducted by a combined group called the “Leapfrog Group” to improve the quality of health care in hospitals. Leapfrog came up with three major ideas – (1) Electronic orders were a must (poorly written prescription orders were killing people), (2) Intensive Care units need to always have a doctor on site and (3) Medical procedures of import need to be done in centers of excellence, not where a hospital may have done only a handful of surgeries in this area. “Internal Bleeding” echoes many of these same issues, especially the one on electronic order taking. Yet, they also go beyond these Leapfrog issues.

They noted that often times in hospitals, fewer critical questions are asked closer to the time of the procedure. Sometimes, the critical mistake may have occurred very early in the process. They used the analogy of all of the holes in Swiss cheese aligning to allow a mistake to pass all the way through. They used the example at Duke University where a famous heart transplant for a minor child occurred. The doctors at this very fine medical center, one of the best, were so excited when a heart of a young deceased donor became available, that they assumed others had checked that the type of blood of the donor matched the patient. It did not and the patient died. Similar examples occurred when doctors operated on the wrong leg, arm, kidney, lung, etc. The doctors failed to ask the very basic of questions and assumed these issues had been resolved.

In addition to the above and related to the Rx orders, the authors advocate the patient understand fully what is being done to them in the hospital or before they get there. They recommend you introduce yourself to every care giver who comes into the room, ask questions of them relative to medications you are being given and make them fully aware of other medications you are taking. They recommend if you cannot speak for yourself or are uncomfortable in so-doing, to delegate this important role to someone you trust. In other words, they are recommending being your own health care advocate. This will help minimize mistakes.

Health care is both a science and an art. It also is a trial and error business, so the doctors may not know for certain what is wrong with you and have to figure it out. They will do their best, but they do not know you very well or at all. So, you have to play the role of information provider and advocate.  Using the authors’ recommendation supplemented by other sources of information and experience, you must be your own health care advocate and do the following to get the care you expect and need.

– Write as good a summary of your and your family medical history as possible. Make it available to others you trust who may need to speak on your behalf.

– Before you see the doctor, write down your symptoms and questions as you may get stage fright when you see the doctor’s white coat.

– Do not be scared to ask questions, especially if you do not understand the diagnosis or remedy – he or she is there to serve you. I tell my kids you show your intelligence by asking questions, not by failing to ask.

– Get a second opinion on major diagnoses. For example, it takes a lot of practice to read a mammogram correctly and a non-inconsequential percentage of misdiagnoses occur. Using this example, computers cannot take the place of human fingers in doing a self-test. If you feel a lump and the first mammogram shows negative, get a second opinion.

– Make sure you inform your doctors and pharmacists what drugs you are taking. There are a number of drugs that contraempt the drug you need (make its use less effective) and some which are toxic when taken together. I ask my pharmacist questions all the time about some over counter drugs that may be harmful when taken with the prescriptions my family is taking, including me.

– Take your medications as prescribed and through the dosage. Many people stop taking their meds when they start feeling better.

– Be truthful with the doctor about your drinking and extra-curricular drug use. Doctors tend to believe patients understate their drinking, so help them out and tell them the truth. You drink more than you say you do.

– Make sure you get treatment for a major problem at a place that does a lot of what you need – a center of excellence. This is especially true with back or spinal surgeries and surgeries on any major organs. If you are having heart surgery, do you want it done where they have done 25 in the past year or 250, e.g? I have two friends who are having major back complications after spinal surgeries were done poorly.

– Get all the information you can around procedures to make informed decisions. In some cases, living with a mild discomfort with medication may be better than invasive surgery. Ask the doctor what are the options, what are the chances for success and what are the risks. If he/ she doesn’t know, ask him/ her with whom you can speak.

– Be diplomatically relentless with Call Center personnel at insurance companies. Mistakes do occur and sometimes you may be allergic to a substituted generic prescription. So, you can appeal a claim if you feel under-served.

– This one comes courtesy of Dr. Sandra Steingraber, an ecologist, biologist and cancer survivor. Family history needs to recognize your environment as well. She was adopted, but her bladder cancer at the age of 21, also occurred in other family members who lived nearby (as well as other cancers). Bladder cancer is a bell-weather cancer. It is largely caused by environmental toxins. If your family, neighbors or community has some longevity in an area and more than one or two bladder cancers have occurred, start doing some fact-finding. It may be more than a coincidence. Since people move around, showing environmental causes is difficult as the exposure may have occurred years before.

– Finally, take care of yourself in a sustainable way. Walk more. Reduce portions. Eat more slowly and ingest more calories earlier in the day. These measures can be sustained whereas diets cannot.

These are just a few ideas, but the key message is be your own health care advocate as you are the only constant in any equation about your health. If you feel you cannot serve this role well, please take a trusted friend or family member with you. Doctors and nurses are marvelous care givers, but they are not perfect. You have to improve their service by being present in the conversations. It is only your or your children’s lives.

The Frackers – the Outrageous Inside Story of the New Billionaire Wildcatters (a reprise from 2014)

The following piece is a reprise from a post in 2014. It is important to read the concerns of six years ago about this industry. Fortunately, the renewable energy industry continues to make huge strides.

I recently completed a very interesting book written by Gregory Zuckerman, a Wall Street Journal reporter called “The Frackers – the Outrageous Inside Story of the New Billionaire Wildcatters,” published by Portfolio/ Penguin Press in 2013. Zuckerman is also author of “The Greatest Trade Ever.” I highly recommend this book as it is as entertaining as it is informative, in multiple ways. It gives you a clearer picture of the risks and rewards of fracking, but also shows how hard it is to both glean the fossil fuel you are seeking and to be so highly leveraged in debt as you do.

The successful fracking companies, usually bucked the odds and the more measured risk takers in the larger companies who had much more capital to withstand some of the risk. As a result, even the ones who had success, usually failed before, after and sometimes during their success, due to the need to be land rich which came at a highly collaterized cost of debt. When some went public, they also had to contend with impatient shareholders. These wildcat developers made and lost huge sums of money, oftentimes with their egos getting in the way of knowing when to stop.

Zuckerman does an excellent job of telling the story of people like George Mitchell, who has been called the “father of shale fracking,” Aubrey McClendon, Tom Ward, Harold Hamm, Charif Souki, Robert Hauptfurher and Mark Papa, among countless others who were key to the success of gleaning natural gas and oil from places that were perceived too difficult to crack. He also defines why methods and strategies are so secretive, as companies will follow suit to leverage off your success. These men and their companies, Mitchell Energy, Oryx Energy, Chesapeake Energy, Continental Resources, Chenier Energy and EOG Resources, were truly the path finders in this process called fracking. They led the US to become more energy independent, yet in so doing, understated or overlooked the risks that came with those rewards.

As I read this entertaining book, I found myself convinced of a preconceived notion, that the main mission of these guys was to make a lot of money, as well as proving others wrong. Some even took delight that their hypothesis was true, even if they had not benefitted as greatly as the company that bought out their rights. Yet, what I also found this lust for money also was an Achilles Heel, and there seemed to be less consideration of what fracking was doing to the environment. They were more content to let the problems be handled by someone else and often belittled the complaints and complainers.

Zuckerman addresses these concerns from the frackers viewpoint earlier in the book, yet does devote an Afterword to the environmental risks that are real. But, before doing so, he notes that George Mitchell, late in life continued to buck convention. Per Zuckerman, Mitchell “gave millions to research clean energy even as he, along with his son and Joe Greenberg, invested in a new shale formation in Canada.” But the quote that interests me most, is by Mitchell who responds to those who contend how safe fracking is:

“Fracking can be handled if they watch and patrol the wildcat guys. They don’t give a damn about anything; the industry has to band together to stop isolated incidents.”

This dovetails nicely with a well-worn phrase I gleaned early on. Even if fracking were safe, it is only as safe as its worst operator. Mitchell, the father of fracking is more than acknowledging the bad operators. His son Todd, who was also in business with his father, said “his father’s work will have had a negative impact on the world if it forestalls progress on renewable energy, instead of giving innovators time to improve wind, solar and other cleaner energy sources.”

Let me close with an even-handed quote from Zuckerman, which frames the issue, yet also notes a caution. He answers the question “Is fracking as bad as activists say, and what will its impact be as drillers continue to pursue energy from shale and other rock formations?” His conclusion is as follows:

“The short answer: Fracking has created less harm than the most vociferous critics claim, but more damage than the energy industry contends. And, it may be years before the full consequences of the drilling and fracking are clear.”

With my reading I would agree with both of these sentences, yet not place the fulcrum in the middle of the scale. I would be more on the side of vociferous critics as the evidence continues to mount and as non-industry scientists are revealing issues. The massive water usage, the seepage of the poisonous slickwater fracking fluid into the environment, the particles that are blasted into the atmosphere which are causing breathing difficulty, and the degradation to the surrounding environment just to get vehicles and equipment into frack are compelling arguments by themselves.

But, the great caution in his last sentence is where we need to focus. “And, it may be years before the full consequences of the drilling and fracking are clear.”This is the bane of any environmental group fighting for people and the environment. Oftentimes, it takes years for the true damage to be seen and felt. Some show up in shorter order, yet when the companies making the money do not want to stop a mission, they can afford to fight people who cannot clearly make a connection. The developers want to settle with each complaint at minimal outlay and move on. Unfortunately, the people exposed to the problem, remain in harm’s way.

The Precautionary Principle – revisiting a relevant post from 2012

We are at a crossroads in our country and on our planet. We must all become better stewards with the environment and address these issues today and in the future. The business side of energy retrieval and production along side the development of mass-produced products made out of or enhanced by petro-chemicals have placed our planet in a precarious position. For the longest time, these industries have been able to delay addressing issues citing the data is not conclusive or shows causality. Proof or true causality oftentimes takes thirty years or more. In the interim, the data can show a high correlation that an activity is leading to a problem. For those who did not take statistics, correlation means things rise and fall together.

In the US, we place the burden of proof on the Environmental Protection Agency (EPA) and like agencies who govern other areas of commerce. Other countries have a variation of the EPA.  In some countries that burden resides with the developer to show that something is not toxic or harmful to others. Several scientists and concerned citizens got together at Wingspread in Canada to discuss these issues. One of the tenets of that meeting can be summed up by a statement made by Bradford Hill, a medical statistician and inventor of the randomized clinical trial, back in 1965:

“All scientific work is incomplete – whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have or postpone the action that it appears to demand at a given time.”

In short, we should not wait to do something later if the evidence is telling us something is amiss now. With toxic chemicals, for example, if you wait to fully prove something is bad, the damage is already done. Especially when you are dealing with children who are still developing and breathe in more than adults.

The group at Wingspread developed the following Precautionary Principle

“When an activity raises threat of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context, the proponent of an activity, rather than the public, should bear the burden of proof.”

“The process of applying the Precautionary Principle must be open, informed and democratic and must include potentially affected parties. It must also involve an examination of the full range of alternatives, including no action,” noted Dr. Sandra Steingraber in her book “Living Downstream – An Ecologist’s Personal Investigation of Cancer and the Environment.” In this book and her second book called “Raising Elijah” she notes industry has tended to stiff arm science to continue to conduct practices that are harmful to the environment and people. The democratic process she references is hard to conduct, when so much money is at stake.

If I have not scared you enough, I am reading a book now called “Water – The Epic Struggle for Wealth, Power and Civilization” by Steven Solomon. If you like history, you will love this book. I have not finished it, so I don’t know the ultimate punch line. Yet, through history it has been shown that great civilizations have risen and fallen by their ability to manage the water and sewage supply. The data he has shown thus far is very compelling. Water is our dearest resource next to air. Without either, we cannot survive on this planet. If we do not protect what is happening to either we are destined to fail as country, planet and people.

I use fracking as a good case in point. The data is highly correlated that fracking leads to toxins in the water and air of the surrounding area. Yet, I believe and have said this in letters to the editor and to politicians, set that aside for now. Fracking takes a huge amount of water out of the water supply and it cannot go back as it is poisoned with the fracking chemicals. We can ill-afford to waste our water on this environmentally destroying  retrieval process. Water is very dear and the droughts and fights over water supply will continue to show this. The developers say the same things they have said for years on other issues – you cannot prove there is a causal relationship between fracking and the toxins. Yet, we can prove you are taking a lot of drinking, bathing and sewage water away from people. And, the data is very compelling on the toxins as well.

This brings us back to the Precautionary Principle. We should reverse the equation. OK, Mr. Developer, since you want to make a ton of money and pay off people to frack beneath their land, YOU prove that fracking is NOT toxic to people or environment before you dig one hole. You prove that this is the best use of our dear water supply. And, you keep testing after you start digging. I have known many developers in my day and the last thing they want to do is hold off on doing something. They want to make their money and leave the problems for someone else. If we reverse the equation, they will have to do more homework beforehand and throughout. That is a good thing.

The dilemma we face as a planet is there is a lot of money to be had in developing energy and chemical products from fossil fuels. As a result, the industry supports a lot of politicians with a lot of money and lobbying efforts. Yet, we must diminish our reliance on fossil fuels, we must understand the impact of petro-chemicals on our environment and people and we must put the burden of proof that an activity is not harmful on the purveyor of that activity beforehand and throughout. In the meantime, if anyone says we should do away with the EPA, for you, me and our children, tell them that is the dumbest idea you have ever heard and would be poor stewardship of our planet. Please help advocate the Precautionary Principle as well.

Environmental Crisis – Raising all of our Elijahs (a reprise)

The following post was written in 2012, but requires repeating. We have made some progress, but not near enough. The children are starting to pay more attention about the world they are inheriting, as evidenced by Greta Thunberg’s popularity.

Earlier this week, I had the distinct pleasure to hear Dr. Sandra Steingraber speak on the significant environmental crisis that has been with us for some time and the impact past, current and future events will have on the environment and us in the future. I say pleasure, but in fact, she scared the crap out of me and everyone in attendance which was her purpose. Dr. Steingraber is an ecologist, author, cancer survivor* and mother of two. Her most recent book about her son is called “Raising Elijah – Protecting our Children in an Age of Environmental Crisis” and it follows her earlier book called “Living Downstream: An Ecologist’s Personal Investigation of Cancer.” She is a frequent public speaker and has testified in front of Congress, the United Nations and the European Parliament to name a few. Her first book has been made into a film by The People’s Picture Company of Toronto.

She tells her stories from each of her lenses, but her most impactful lens is the one told as a mother of two. I am currently reading “Raising Elijah” and would encourage each of you to read it and tell others about it. I will move onto her first book after this one. She attests that when you speak of these issues as a mother (or parent), it resonates with everyone as we all wish for our children to live healthy lives. She notes she has been able to bring pro-life and pro-choice believers together on these issues.

In her mind, there are two types of crises with the environment – the toxic crisis and the climate change crisis. The toxic crisis has been with us for some time and decisions and exposures from many years ago are still affecting people now. The climate change crisis is very real and, in addition, to the other issues it creates, it heightens the impact of the toxic crisis even more. Elevated temperatures and the impact on the ozone will only make current matters worse. From a mother’s perspective, the impact on our children is worse than it is on adults. She notes the obvious, but children are closer to the ground where many of the toxins reside, they have a much higher degree of mouth breathing meaning they will take in more air per pound, they put their hands in their mouth about ten times an hour plus they will be exposed for longer periods due to their age than adults to toxins. A few facts that will heighten the issue

– 1 out of 8 US children are born prematurely which is traceable to the environment; early births mean the lungs are not fully created, so life long breathing issues will result;

– 1 out of 11 US children have asthma (1 out of 4 in Harlem);

– 1 in 10 US children will have a learning disability;

– 1 in 110 US children will have some form of Autism; and

– 1 in 10 US white girls and 1 in 5 US black girls will have breast development before the age of 8, which translates into menopausal and other issues.

I wish to tell you these numbers are made up, but they are well-grounded. And, the higher propensity can be traced to toxins that have been allowed to exist in the air, water and even playgrounds. The latter will make you furious, but the pressurized wood we have in many of our playgrounds is loaded with arsenic, copper and chromium, so our children and adults with our pressurized decks, are exposed to these chemicals. Adding to that, it  is measured that 60% of Americans live in areas where the air is unhealthful. So, from her perspective, “an investment in green energy is also an investment in cancer prevention.”

I went to hear her speak as she is one of the biggest opponents of hydro-fracturing or fracking to release and harvest natural gas. What I expected to hear is the impact fracking has on the nearby water where the chemicals used to fracture the shale gets in the water table. I also expected to hear about the significant increase in earthquakes in areas where fracking is done. These are a problem. Yet her major concern is what is released into the air and its impact on many today and in the future. Air pollution is what is causing the conditions in children and adults.

She notes the US is now doing and promoting Four Extreme Measure of Fossil Fuel Extraction – (1) mountain top removal, (2) tar sands, (3) deep-sea oil drilling and (4) fracking. All of these impact our environment greatly, but fracking gives her the most alarm. She advocates we must have a strategy to cease all new fossil fuel extraction now and invest in renewable forms of energy. Her point is any change will not impact the climate change for about 15 years, so we must divorce ourselves now from new fossil fuels.

What can we do? Reading from “Climate Change and Your Health – Rising Temperatures, Worsening Ozone Pollution,”  by the Union of Concerned Scientists, we should be doing the following (here in 2020, many of these are now being done, but they need to be accelerated):

– investing in more fuel-efficient cars and reducing the miles driven;

– developing fuels that are less carbon-intensive;

– providing good public transit and other commuting/ travel alternatives;

– increasing energy efficiency at industrial and commercial facilities;

– developing and retrofitting homes and buildings to be more efficient;

– using more renewable energy resources – such as wind, solar and geothermal – to generate electricity; (looking from 2020, I would add tidal as well; note wind and solar are now more cost effective than coal)

– ensuring that ozone and carbon-reduction standards are strong enough to be truly protective of public health; and

– working collaboratively with global partners to reduce carbon emissions from other countries.

The issues and solutions require concerted effort and input from all parties. And, once you read Dr. Steingraber’s book I hope you have a better grasp that we need a concerted effort now to save our children – our Elijahs. While other issues are important – none of them will matter if we don’t fix these problems. The human and economic cost will dwarf any of these issues.

*Note: Steingraber is a bladder cancer survivor. Bladder cancer is a bellweather cancer meaning it is most often environmentally caused. She and a few other family and extended family members got bladder and other types of cancer, as they lived between four manufacturing plants. And, as Steingraber notes, she is adopted, so her cancer was not hereditary.