WASHINGTON — Just short of calling for an outright ban, the American Public Health Associ-ation Nov. 19 urged all hospitals to reduce or eliminate their use of PVC plastics. The APHA declined to respond to repeated telephone inquiries seeking comment on the body's resolution against PVC. APHA represents key leaders in the public health field, including physicians, nurses, social workers and health administrators.
Calls to the 12 individual members of the APHA's Joint Policy Committee, which presented the resolution to the voting members of the association in the group's annual meeting Nov. 17-20, also were unanswered.
The vote came despite intense lobbying by such companies as Baxter Healthcare Corp., Geon Co., the Washington-based Chlo-rine Chemistry Council of the Chemical Manufacturers Associ-ation, and the Vinyl Institute. The vote is considered a setback, according to Robert H. Burnett, executive director of the Vinyl Institute in Morristown N.J.
``This is not good news for the industry or for the medical community,'' Burnett said, but added, ``Their action has no force of law.''
PVC proponents argue that the costs of investigating a tiny amount of dioxin as defined by the Environmental Protection Agency does not equal the value of PVC to the entire medical industry. Further, opponents contend there is no direct proof that incineration of PVC creates dioxins. They point to an American Society of Mechanical Engineers survey released in late 1995 noting that some 1,900 tests at 169 incinerators show no correlation to the chlorine going into incinerators and the dioxin found later.
The APHA call was the latest in a series of nonbinding APHA declarations that have grown out of health-care industry concern about the presence of dioxins in 2,400 medical incinerators nationwide, according to CCC spokeswoman Carolyn Tieger.
Vinyl proponents claim the dioxin problem is not so much with plastics as it is with too-low incinerator temperatures.
APHA bases its resolution on a 1994 EPA dioxin reassessment.
Originally, the resolution had stated dioxins are ``created by the production and disposal'' of PVC. Plastics advocates, including Burnett, hailed a last-minute lobbying campaign for eliminating the word ``production.''
CCC contends that more than 25 percent of medical plastics are PVC, and supporters point out that some products would be difficult and costly to substitute. According to CCC, 18-33 percent of hospital waste is plastic, but only 2-3 percent is PVC that is burned.
The American Medical Associ-ation also has scrutinized PVC in recent months.
Thomas Hobbins, a Maryland physician and a member of the Board of Governors of the Baltimore County Medical Associ-ation, brought the issue of chlorinated plastics, incineration and dioxins before the AMA Board of Governors this past summer.
``I found out earlier this year that our own hospitals are one of and perhaps the greatest sources of dioxins,'' he said. ``I felt the need to alert my fellow physicians.''
Hobbins cited a recently published book, Dioxins and Health by Albert Schecter, as his source.
James Lyznicki, a scientist in the department of preventative medicine and environmental health at AMA headquarters in Chicago, noted a report will be prepared ``at some point, perhaps after the EPA final dioxin assessment report.''
``It doesn't make sense to prepare a report when the EPA still has a report out,'' he said.
According to the June 20 Federal Register, the amount of dioxins allowed by EPA as ``baseline emissions'' from medical incinerators tentatively was set quite low — 150 grams, or about 51/2 ounces from all such medical burning combined. This is the most recent EPA dioxin reassessment. But in 1998, when EPA's final report may be produced, that level is expected to drop to less than 20 grams per year.
The last time APHA went after chlorine was in November 1993, when it resolved to eliminate chlorine used in paper bleaching. It made no mention of plastics.
The AMA report will be written by the Council on Scientific Affairs, a body of 12 elected AMA members. It then would be sent out for peer review after its committee approval, then go through the Board of Trustees, then to the 450-member Board of Delegates, the policymaking arm of the physician group, Lyznicki said.
The council will decide the timeline for the report, he said.
Kip Howlett, CCC managing director and a vice president of the Chemical Manufacturers Association, said, ``AMA is wise to thoroughly review the current science and the significant benefits of PVC medical products and packaging — before the association makes a decision that could seriously impact patient and worker safety, as well as the overall cost of health care in this country.''