INTRODUCTION: A World of Toxic Threats

Steve Osborn

You are what you eat--and drink, and breathe, and otherwise absorb. That is one of the underlying themes of this issue of Marin Medicine, which investigates environmental health. Physicians as diverse as internists, radiologists, pediatricians, public health officers and pulmonologists address the environmental risks within their particular area of expertise, emerging with a composite portrait of a world filled with human-made dangers to human health.

Dr. Sridhar Prasad, a pulmonologist at Kaiser San Rafael, identifies the major pollutants in the air we breathe and then details their respiratory consequences, which include asthma, lung cancer, heart disease, and death. “The combustion of flammable substrates, so vital for our economy,” he writes, “leads to the elaboration of a host of different gases into the atmosphere, with far-reaching climate and health-related outcomes.”

Cars and factories are often blamed for poor air quality, but readers might be surprised to learn that another main culprit resides in their living rooms, either as an open fireplace or a woodburning stove. Ina Gotlieb, the program director of Families for Clean Air, notes that wood smoke is just as toxic as diesel exhaust or tobacco smoke, and that it accounts for up to half the wintertime particulate pollution in the Bay Area. Factory exhaust may be difficult to regulate, but this version is well within the individual homeowner’s control.

Wood smoke pollution coming out of a chimney is clearly visible, but contaminants in our drinking water are harder to see. That clear water running from your tap could contain one or more of the hundreds of chemicals known to cause cancer and other diseases. A key problem, according to Dr. Jason Eberhart-Phillips, the former public health officer for Marin County, is that we don’t know much more than “could contain” because so many of these chemicals are unregulated and unmeasured. Of the tens of thousands of chemicals released into the environment, he observes, the EPA regulates only 91.

Chemicals may also be the culprit for the recent dramatic rise in neurobehavioral disorders, writes Dr. Alice Brock-Utne, a pediatrician who used to work for Marin Community Clinics. She recommends that parents reduce their children’s exposure to these environmental toxins by watching what their family eats, avoiding insecticides and herbicides, advocating against flame retardants, spending time outdoors and staying vigilant against toxic threats.

Ironically, medicine itself is the source of another toxic threat, in the form of medical imaging. Despite their obvious benefits, x-rays, mammmograms and particularly CT scans can increase the risk of cancer. Drs. Marc Gelman and Prasad Murthy, an internist and radiologist at Kaiser San Rafael, describe the scope of the problem and offer specific suggestions for reducing radiation risk, from using alternative tests to tracking each patient’s total radiation exposure.

Environmental concerns are also evident in the interview with new MMS President Dr. Irina deFischer, a family physician who lives in Marin and works at Kaiser Petaluma. Among other topics, she discusses the role of organized medicine in promoting healthy eating and creating pedestrian-friendly environments.

The interview touches as well on the continuing growth of physician groups. One of those groups, the Marin-Sonoma IPA, has been much in the news of late, as they expand northward into Sonoma County. Larkspur cardiologist Dr. Mark Wexman, chairman of their board, describes the next expansion--an accountable care organization (ACO) that they hope to form with local hospitals. A key element of the Affordable Care Act, ACOs may be the wave of the future.

Marin County has long been home to gifted physician writers, including Mill Valley psychiatrist Dr. Jean Shinoda Bolen. Her latest book is Like a Tree, an homage to a Monterey pine that used to grace her neighborhood before the homeowner’s association cut it down. As a “tree person,” she uses the incident as a springboard for exploring the biology and beauty of trees.

Another local plant of interest is the ubiquitous grapevine. Dr. Miguel Delgado, a Novato plastic surgeon, describes his decades-long quest to create great wine, beginning in a storm drain behind his house and ending in a Carneros vineyard.

We close with a book review by Greenbrae internist Dr. Anne Cummings and a report on the new ED at Kaiser San Rafael by physician-in-chief Dr. Gary Mizono.

As always, we welcome your comments or article proposals. Marin Medicine is sent to every physician in Marin County, and there is much to report.

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Mr. Osborn edits Marin Medicine.

Email: sosborn@scma.org