Transcription of Doug Dransfield, M.D. for the show Pure and Simple #61
Dr. Lisa: This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour & Podcast show number 61, Pure and Simple, airing for the first time on November 11th 2012 on WLOB and WPEI Radio, Portland, Maine.
Today’s guests include Children’s Health Advocate Elisa Boxer; Steve Taylor, the program manager for the Environmental Health Strategy Center in Portland; and Dr. Doug Dransfield, board member of the Maine Chapter of Physicians for Social responsibility.
Environmental health has been one of my interests as a physician for many years. After being a family medicine resident, I went to the University of Massachusetts and studied Preventive Medicine and got a Master’s in Public Health. Part of public health is the health of the environment and we talked a lot about clean air, clean water and having a clean and healthy place to grow up.
Things have evolved and changed. We have seen people become more and more aware of things like bisphenol A and plastics, lead in our groundwater and on the paint on our houses. I think they’re still far to go, but I’m glad that people are paying attention now and I want people to be able to pay attention without feeling scared. There are substances in the environment and substances that do impact our health, but on the other hand people are working on the problem. There are ways that you can get involved yourself, so we hope you’ll take a moment to listen to Elisa, Steve and Dr. Doug Dransfield, as they talk about this pure and simple idea and give us very specific ways that we can make sure that our environ is as healthy and safe for our growing children and ourselves as possible.
The Dr. Lisa Radio Hour & Podcast is pleased to be sponsored by the University of New England. As part of our collaboration, we offer a segment we call Wellness Innovations. This week’s wellness innovation comes from the National Institute of Environmental Health Sciences.
The environment plays a role in 85% of all diseases. New science is showing that the effects of exposure to chemicals at low doses and in combination can have an impact on human growth and development. Some chemicals, pollutants, foods and other behavioral changes that may have minimal adverse effects on adults may impact the developing fetus and have a long-lasting effect on a child’s health even into adulthood.
Results from studies conducted at the Breast Cancer and Environmental Research Center in Cincinnati have added to widespread concern that girls are increasingly entering puberty at an earlier age. These investigators have found the positive association between the early onset of puberty and increased risk of developing breast cancer.
For information on this innovation, visit d, o, c, t, o, r, lisa dot org. For information on the University of New England, visit une.edu.
Dr. Lisa: It’s always particularly interesting for me to sit across the microphone from a fellow physician and especially thrilled to have a physician that I trained with when I was a family medicine resident many years ago. At least our paths crossed somewhat and it’s exciting to know that there are doctors who are going out in the world and thinking about health in a bigger way that way that I like to think about health.
Today, I have with me Dr. Doug Dransfield, who is a retired pediatrician and neonatal specialist and a board member on the Maine Chapter for Physicians for Social Responsibility. Thanks for coming in and talking with me about this today.
Doug: Thank you for having me.
Dr. Lisa: There seems like a radical departure. I remember you in your role in the NICU, in the Neonatal Intensive Care Unit, and I remember you dealt with very tiny babies and there were a lot of technical aspects to your work and it’s not an easy job. Being a neonatologist is not an easy job. Now you’re out there and you’re dealing with health in a really different way. What drew you to be part of the Main Chapter of the Physicians for Social Responsibility?
Doug: I was originally drawn to it because of the issue of nuclear weapons and that actually is the founding principle for PSR, Physicians for Social Responsibility. The chapter formed. There are actually three chapters at one time in Maine they formed in the early ’80s. It was in response to the fact that the Cold War had increased the number of nuclear weapons to such extreme numbers and also the continuing effort to try to educate the public that there was no medical response possible for nuclear weapons.
Basically, the theme was that physicians have to recognize that when you have something you can’t treat you have to prevent it and that was the organizing theme for PSR for a number of years. As we had increasing success with nuclear weapons although there are still a lot to talk about nuclear weapons and there are still some big problems there, the organization began to realize they had other responsibilities in the same way or other issues that we didn’t have cures for that we really only had prevention for.
The issues of climate and environmental changes were first and then we added to that the issues of toxins. Our own local chapter got very involved in domestic violence education although that isn’t as much of an issue as of the national PSR group, but certainly the toxins have grown. The importance for the work at the local chapter and PSR is one of the members of the Alliance for Clean and Healthy Maine along with another organization I belong to, which is the American Academy of Pediatrics, the Maine Chapter, and that coupled with the efforts to the Maine Medical Association increasingly in these areas for me is the basis for why I think we think we need to do this.
It is a big departure from what I did as a neonatologist. As a neonatologist, I was very concerned about really almost micromanaging physiologic issues with babies that were physiologically terribly unstable because they’ve been born very early because they had congenital malformations in some cases because they were sick with diseases. I was trying to bring a lot of cure to that, didn’t spend much time dealing with prevention, but in my life as a father and as now a grandfather I think I have a lot of interest in the other side of medicine which is the public health side of medicine and therefore I was attracted in retirement to give much more energy to PSR and trying to do much more to promote these messages of prevention.
Dr. Lisa: It is related in a way because we know that the environmental, some people call them toxins, some people call them contaminants. But they are chemicals in the environment and they do impact babies and they impact children and they impact them to a much greater degree than we think that they impact adults. It may not seemed like it’s a drug relationship but there likely is.
Doug: I think there is and I certainly feel very prepared to think about these issues and to further my learning about these issues because of the background I have in developmental medicine and in pediatrics. Absolutely, there’s a tremendous difference in how one molecule would act in a fetus as to how it would might act in a 2-year-old or how it would act in me as a 65-year-old. Those are tremendously different issues.
Basically, my own professional life has been trying to learn about more things because I graduated in the middle ages. I graduated in 1973 so there’s a lot of medicine that’s been learned since then and particularly about genetics and control of biology through genetics. How vulnerable that can be to disruption by molecules that are in some way, not apparently most of the time but in some way, surprisingly similar to natural molecules that are in our own body and they end up having disruptive effects.
Dr. Lisa: That’s a good segway I guess into BPA and the work that’s being done with BPA in the state. Talk to us a little bit about that and your experience with it.
Doug: Bisphenol A is a material that’s in plastics and as I understand it is used to hardened plastics. It is pretty universally present and it is one of a group of molecules, chemicals, toxins, depending on how you’re talking about them, that have the ability to disrupt the function of normal hormones in the human body. Particularly that molecule, BPA, interferes with the actions of estrogen in the body.
It’s a complex relationship because it’s not like when I was taught about poisons and toxins and things that made you sick, there were chemicals in medical school. It was this very linear relationship where you could tolerate a little bit, but if you build up the dose it would make you sicker and sicker, and it was very much a dose-dependent relationship where something became a poison at a point where you exceeded a certain amount.
So a lot of toxicology thinking was all around what’s the safe limit, how much. Of course we’re going to have these things around us, how much can we tolerate. For instance, Tylenol, a lot of people take Tylenol. Tylenol, very safe, very effective, wonderful drug in the right dose. You get up to a high dose, it’s a poison. It knocks your liver off. It can kill you. This thinking of dose-response relationship where a little bit might be safe and a lot may be harmful was the basis for legislation in the past in 1976, which was the Toxic Substance Control Act, TSCA.
Since 1976, we’ve come to understand that there are these unique molecules like BPA and they behave in a very different way. What we know about BPA is that it actually has the ability to bind to sites in the body they’re called hormone receptors. Just to back up a little bit, the way hormones work in the body is that there is a very small amount of chemical material called the hormone that’s produced at a particular place in the body and then released in the bloodstream and has actions at different sites.
It has actions at different sites because those different sites have a place for that molecule to go and to lock on to. When it locks on to that site, the receptor site at the cell level, it then causes changes within that cell that cause the DNA messages, the controlling messages of that cell, to either become active or to get turned off and influence how that cell acts subsequent to that.
It’s a problem if you have a molecule that enters the body for no reason other than the fact that it happened to be in the plastic container that you’re drinking from or the lining of the can you ate from or something. It finds its way in your body and it latches on the receptor that’s really meant for estrogen and has other effects. It was that realization that there were these endocrine disruptor materials that begin to change the way we started to think about toxins, and because BPA, bisphenol A, was so universally present and because it has such potentially dangerous relationships with estrogen action in the body that became one of the early ones it was focused on.
In Maine, I think the people in Maine should be reassured and pleased with the fact that there was a recognition of this and that agencies like Physicians for Social Responsibility, like the Maine Medical Association, like the American Academy of Pediatrics joined in this coalition for a clean and healthy Maine, and resulted in legislation that limited this product in Maine in products sold in Maine. That’s really just the beginning of how we need to think about our relationship with our chemical world.
It’s a very different way of thinking about it. It’s not at all something that is intuitive or is it something that’s easy for people to understand that something could have a profound effect at the low level than not much of an effect at the mid level and may be a different effect at the high level. We’re always used to thinking about certainly like how you use your gas range. You had a little bit of heat. You turn it up, you got a lot of body heat and that’s the same analogy with chemicals. A little bit you probably can tolerate that, a lot of it you can’t tolerate, but it turns out that there’s a lot of chemicals that just don’t being that way.
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Dr. Lisa: I remember listening to Dr. Helen Caldicott back when I was a grade schooler come and talk about. I know this is dating me, but nuclear war and I remember being terrified by the movie that she showed in our school and there was a lot of attention paid to that. I remember Dr. Caldicott being somewhat viewed as a little fringy. It was very polarizing. Did you experience any of this as a physician working with the Maine Chapter of Physicians for Social Responsibility when you started?
Doug: I think there was yes, skepticism. She was so much the face and voice of PSR in those years. She really became the lightning rod for people that wanted to criticize thinking this way, so I didn’t experience anything near what she experienced.
Dr. Lisa: How did other physicians accept you or respond to you, I guess, when you first started this whole process?
Doug: I guess I don’t know really to be quite honest if not. I have good friends that I don’t talk about this with much and I have other friends that are very involved in it. It’s like a lot of things that can potentially be divisive, whether it’s religion or politics or sexual preference or whatever. Sometimes you just go along to get along a little bit and you downplay things, but that doesn’t mean that the values that you hold there are really not important values to you or things that you feel strongly about, but just choose the time when you make the thing you’re defining yourself with.
Dr. Lisa: What have you learned from your experience working with this?
Doug: Excellent question. I’ve learned a great deal about the public health aspects of the environmental issues and the chemical issues. Those were things that I like most people in my generation were pretty naive about. We were brought up in the ’50s and ’60s, where every day there seemed to be some new chemical thing that was great that science was sweeping us forward and there were all these advances, whether it was Jiffy Pop or going to the moon. It was great. It was always something new.
That’s been human experience right along that you do things and you explore things and you learn things and then there are some consequences to what we’re doing and may be we need to look at this in a different way. We’re in that reexamination period and it’s harder to get the message through, I think, to people that started out thinking about things in one way and now we’re being asked to think about things in a different way.
My delight is that as young people come along. Gosh, I feel like so old saying that. Look at my grandchildren, for instance, they are very attuned to the fact that things are very interactive in their world. Of course, you need to think about possibly not apparent effects of things and that just like there are hidden things in their video game that they can discover. There are hidden things in world they can discover and just because things appear to act in a certain way it doesn’t mean that that’s actually how in fact the sum total of how they’re acting.
Dr. Lisa: How can people learn more about the Physicians for Social Responsibility Maine Chapter?
Doug: Very easily. The executive director for our group would want me to say right now, “Look for us on Facebook.” I’m a Facebook newbie and I know nothing about Facebook, but PSR does have a Facebook presence there and you can find us there. Then more traditionally for me is the internet, so you can look for psr.org, which is the national organization. There’s a pull-down button screen there for chapters and you’ll find the Maine Chapter and you can see all that what we’re up to.
If you friend us on Facebook, every couple of days you’ll get something that has to do with the environment or with toxins or other things that PSR is very involved in, not necessarily things that we’re doing directly but links to things that are important to know about.
Dr. Lisa: It has been a pleasure for me to spend time with you, Dr. Doug Dransfield, who is the on the Board of Directors for the Maine Chapter of Physicians for Social Responsibility and also somebody who had a hand in my teaching as a family medicine resident, a colleague of my fathers previously at the Maine Medical Center, so lots of different Maine connections going on. I value the time you’ve taken to be here today.
Doug: Thank you.