Thursday, February 24, 2005

First, Kill The Caregivers (and their unborn children)

So you've got a bunch of well-known cancer-causing chemicals and a group of America's most beloved and needed workers -- nurses and other health care workers -- being exposed. Aside from a few alerts and fact sheets, not much has been done about it, even though there are indications that the fact sheet and alerts aren't working very well. Nurses are getting exposed and probaby getting cancer.

What would you do? Issue regulations preventing exposures? That might make sense. Or at least conduct a few good studies to see who is getting exposed to what and how much? Makes even more sense.

But welcome to Bushworld, where none of that makes sense and every extra penny is being dedicated to tax cuts for those who don't need them, and wars against bad people with weapons of mass destruction who don't have them, and destroying the social security system, which has been working quite well, thank you very much.

The chemicals are chemotherapy drugs -- drugs designed to fight cancer. But human and animal studies have shown they have the potential to cause cancer or reproductive problems such as miscarriage, low birth weight, infertility and birth defects when they are inhaled or absorbed through the skin.

Sounds serious? Nah!
Last March, the federal government issued an unusually detailed alert to the nation's 5.5 million health care workers: The powerful drugs used in chemotherapy can themselves cause cancer and pose a risk to nurses, pharmacists and others who handle them.

Four years in the making, the alert was issued by the National Institute for Occupational Safety and Health (NIOSH). Officials with the institute -- part of the Centers for Disease Control and Prevention (CDC) -- and members of a hazardous-drug advisory panel saw the document as a long-overdue first step toward addressing what could be a serious workplace health problem.

A NIOSH Alert, issued last March, warned health care workers of risks from contact with chemo drugs. The drugs are usually administered to patients intravenously, right.

The next step was to be a study of actual exposures at three hospitals, operated by the universities of Maryland, North Carolina and Texas. The plan was to take blood and urine samples from about 50 pharmacists, nurses and pharmacy technicians at the hospitals and look for signs of drugs such as cyclophosphamide (usually administered intravenously to treat lymphoma, leukemia or breast cancer) and ifosfamide (also an IV drug, often used on lung, cervical and ovarian cancers).

But the study, formally proposed in July 2002, is on hold. Twice the CDC submitted the proposal to the Office of Management and Budget (OMB). Twice it was withdrawn, after the OMB raised questions. It has yet to be resubmitted.

OMB spokesman Chad Kolton would say only that the CDC withdrew the paperwork "to address ongoing technical concerns relating to the scope of the proposed study design." CDC spokesman Fred Blosser said, "Traditionally, we don't go into detail on pending discussions or reviews with OMB."

Study proponents, meanwhile, say that precious time is being lost
Unfortunately, this article appeared in the Washington Post's health section last week, instead of where it should have been -- at the top of the front page. It was written by Jim Morris, deputy editor for Congressional Quarterly. In a past life at the Houston Chronicle, Morris was the author of a hard-hitting series about the chemical industry's efforts to cover up evidence that one of its major products -- vinyl chloride -- caused cancer and other health problems.

It's not hard to be exposed to these drugs, according to the unions that represent health care workers:
"People have exposures every day," said Bill Borwegen, occupational health and safety director for the Washington-based Service Employees International Union, which represents about 875,000 health care workers. "If you're piercing an IV bag and get a drop [of a drug] on your finger, you could be over the safe level."

And a housekeeper who dumps the contents of a bedpan into a toilet might not realize that the waste is toxic. "Sometimes, 80 percent of the active ingredient [in a drug] goes right through the patient's system," said Borwegen, who also served on the NIOSH work group.
And it's not a newly discovered problem:
Beginning in the 1980s, researchers in the United States and Europe found that nurses, pharmacists, veterinarians, housekeepers and others took few precautions when preparing, administering or cleaning up the drugs. As a result, they were routinely exposed to toxic aerosols, powders and liquids.

The Occupational Safety and Health Administration (OSHA) first issued handling guidelines for hazardous drugs in 1986, calling for, among other things, the use of gloves, gowns and biological safety cabinets or respirators with high-efficiency filters. These were voluntary measures, however, not rules. OSHA still has no regulatory standards for cancer-fighting drugs and NIOSH says adherence to the guidelines is spotty.
Anything to be done about it? Maybe more fact sheets or possibly an alliance with a hospital association? Europeans seem to have solved the problem the old fashioned way -- regulations:
As a rule, European countries have moved more aggressively than the United States, requiring hospitals to monitor employees and keep even minuscule amounts of the drugs from being spilled or aerosolized.

"In Holland, we've seen a decline in contamination. Most workers don't have [drugs] in their urine anymore," Paul Sessink, a chemist in the Netherlands who runs a consulting firm called Exposure Control, said in a telephone interview.
Sessnink is shocked at the conditions that exist in American hospitals:
Over the past six years, chemist Sessink has analyzed "wipe samples" -- residue collected from counters, floors and other surfaces -- from about 30 U.S. hospitals. The results indicated that drug-handling at two-thirds of the hospitals was sloppy and employee exposures were "far higher than we have here [in Europe]," he said. He would not identify the hospitals.

Sessink said he finds it "rather amazing" that the U.S. government took so long to warn workers about the dangers. He wonders if pharmaceutical manufacturers and hospitals -- mindful of possible liability -- had something to do with the delay.
Yeah, I wonder too.

Meanwhile, health care workers continue to be exposed while the federal government continues to count beans.
The study can't begin soon enough for Borwegen, the union official.

"These products are produced under very pristine conditions by drug manufacturers, but once they leave the facility the controls aren't really in place," he said. "Most [health care] workers are clueless about how toxic these agents are."
And according to OSHA and OMB, ignorance is bliss -- until the big C comes calling.