Jewish World Review Jan. 9, 2004 /15 Teves, 5764
Drs. Michael A. Glueck & Robert J. Cihak
A new plastic phobia?
From time to time (actually, rather often) we've written of the real and
potential baleful effects of a bad idea known as the "Precautionary
Principle" - the notion that unless an activity can be shown to be
completely safe, it should not be undertaken. By this standard, few of us
would even get out of bed in the morning.
However, the Precautionary Principle is now an article of faith among
environmental activists, whom, one wishes, would apply this reasoning to
their own activities ... and stay in bed.
But the Precautionary Principle alone is not the source of all the
environmental mischief, meddling and malaise that these people attempt to
inflict upon the rest of us. Several decades or so ago, a bunch of academics
with time on their hands came up with a notion called "The Social
Construction of Reality."
At certain levels, reality is indeed socially constructed. Table manners,
speed traps, the bills in your mailbox: These are indeed socially
Then the belief that reality is what we think it is got into science.
When feminists denounced the law of gravity as a male chauvinist construct,
it was merely amusing. But when the Social Construction of Reality melds
with the Precautionary Principle, it produces a curious phenomenon: people
who do enormous harm while believing, in the face of overwhelming scientific
evidence, that they're actually doing good.
Example du jour: a coalition that styles itself "Health Care without Harm"
(HCWH) and whose crusade against the medical use of polyvinyl chloride (PVC)
products could harm patients by the millions (yes, millions) without doing
any ecological or human good whatsoever.
But when no level of perceived risk is acceptable, and when reality is what
you say it is ... what does it matter? PVCs are plastics - sturdy, nonporous
and cheap - used in many medical products, from blood bags to surgical
instruments. Without PVCs, bacterial sterility would be harder to achieve,
many medical instruments and tools would be too stiff to do their medical
jobs well, and the shelf life of many products would be lessened.
These benefits notwithstanding, HCWH, a coalition of over 350
environmentalist, religious and other groups, wants a total ban on medical
PVCs because they contain the additive DEHP, claimed to cause birth defects
and to do reproductive damage. HCWH wants them banned both because of their
alleged direct effects and because, they claim, incineration releases
The problem with this argument is twofold. First, no scientific study has
ever demonstrated that PVCs have actually harmed any patients. Logic
suggests that patients should receive special consideration and not be used
as an excuse to ban entire classes of useful products.
Also, there is no scientific consensus on the harmful effect of incinerating
DEHP. In fact, the World Health Organization has downgraded DEHP from a
"possible carcinogen" to one "not classifiable as to carcinogenicity in
But this hasn't slowed down HCWH, because they cling to a wrongly
interpreted theory of toxicity. As doctors have known for millennia,
everything is toxic - and nothing is toxic. It all depends on how much, how
concentrated and how quickly. Exposure is measured by time as well as by
For example, 100 aspirin, taken all at once, would kill me. But I've been
taking 1/4 tablet daily for years, to reduce the likelihood of blood clots,
and others say I seem to still be alive.
However, groups such as HCWH hold to an absolutist "linear dose/response"
gospel: Toxicity accumulates over time. In some rare cases, this may be
true. But in the vast majority of instances, toxicity does not accumulate
because human beings, and all living things, are dynamic systems,
self-cleansing and regenerating.
Nor does HCWH deign to measure the direct harm that a PVC ban would do to
patients, i.e., nearly all of us at some time or other. How many would die
or suffer because of a ban that would produce only the most minuscule
medical and environmental improvements, if any?
No one has an absolute answer to that question, but HCWH doesn't even ask
it. Unlike many HCWH claims, decisions in reality always involve trade-offs
- trade-offs which HCWH ignores.
Editor's Note: Robert J. Cihak wrote this week's column.
Michael Arnold Glueck, M.D., is a multiple award winning writer who comments
on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute
Senior Fellow and a past president of the Association of American Physicians
and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists.
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