More Problems of Communication
Last month, we focused our attention on problems communicating science to the public occur by the Centers for Disease Prevention and Control (CDC). We noted that although we have great admiration for CDC as the world’s premiere government epidemiological agency and for its work hunting down the causes of a myriad of threats to the public’s health, it often falls short explaining to the public what it does and what it has found.
This month, we continue this theme by looking at examples of two other U.S. federal science agencies that traditionally do cutting-edge work protecting the public’s health and safety but nevertheless also sometimes leave that same public confused about the meaning of their findings. We highlight the Food and Drug Administration’s (FDA) recent sunscreen study and the findings by the Environmental Protection Agency (EPA) about a weed killer called glyphosate.
Does It Mean We Should Stop Using Sunscreen?
The agency we now know as the FDA was created in 1906, making it the country’s oldest consumer protection agency. It was first officially called the FDA in 1930 and over the last more than a century has worked diligently to ensure the safety of what we eat and the medications we take. It is true that there have been occasions when harmful drugs, like Darvon and Vioxx, have passed through the FDA system and later had to be recalled. Overall, however, the FDA has done a remarkable job at screening out potentially dangerous medications, while approving new drugs that have good safety and efficacy properties.
The science that the FDA does in its regulatory capacity is, therefore, generally first rate. Its problem, however, is how it explains that science to us. This paradox emerged recently when the agency decided to find out if any of the ingredients in the sunscreen products on the market get into the human bloodstream.
FDA has a policy that toxicology studies should be conducted for any sunscreen that is absorbed into the bloodstream over a certain concentration (0.5 ng/ml). It recently tested four sunscreens in a group of volunteers and found that when applied to the skin, all four exceeded that lower limit. In a paper published last May in the Journal of the American Medical Association (JAMA), FDA scientists concluded that these findings support “the need for further studies to determine the clinical significance of these findings”.
Of course, this finding was picked up by the media and introduced to the public with headlines like “Sunscreen enters bloodstream after just one day of use, study says” (CNN) and “Sunscreen seeping into you blood? This is the safest kind to use, experts say” (USA Today). But what is someone about to be exposed to the sun supposed to do with this information? We all know that the sun’s ultraviolet rays increase the risk for skin cancer and that dermatologists strongly recommend we use sunscreen to block them. But is the risk of getting sunscreen in the blood greater than the risk of getting skin cancer from sun exposure? The FDA did very little to anticipate and address the fact that most people do not read JAMA and are going to panic from these headlines. It should have realized this would happen and taken responsibility for giving non-scientists some direction as to whether or not to use sunscreen.
Consumer Reports Steps Up
The non-profit organization Consumer Union did a better job of public communication about the sunscreen study. In its July 2019 Consumer Reports, author, Sally Wadyka asked the question “Is Your Sunscreen Safe?”. “For the first time in 20 years,” she writes, “the Food and Drug Administration has proposed new ways for sunscreen to be regulated.” Wadyka goes on to explain that the FDA has not explicitly determined that any of the 12 ingredients commonly found in sunscreens are dangerous when they enter the bloodstream. Of these 12 ingredients, however, one—oxybenzone—mimics the effects of some of the body’s own hormones. Therefore, the American Academy of Pediatrics has advised parents not to use sunscreen products that contain oxybenzone on their children. That’s at least some authoritative guidance, but hardly enough to help us determine whether it is okay to use most sunscreen products.
Consumer Reports tests sunscreens itself and provides some interesting information:
- Many sunscreens “fell short of their advertised SPF”
- To protect against the sun’s carcinogenic effects, a sunscreen must block both UVA and UVB rays, but the SPF ratings do not reflect UVA blocking actions accurately.
- Mineral-based sunscreens that are sometimes referred to as “natural” products and may be less harmful to coral reefs don’t actually work very well to block ultraviolet radiation from the sun or prevent sunburn.
These points are again helpful, but Consumer Reports does not represent a federal regulatory agency with the authority to determine what products are safe and effective for us to use. We now have two clear-cut scientific findings: exposure to the sun’s ultraviolet rays increases our risk for skin cancer and the chemicals in most sunscreens that block those rays enter the human circulation We do not know in detail if those chemicals are toxic when the internal organs of the body are exposed to them.
It is probable that even the FDA cannot answer the basic question about how safe sunscreens really are. The next step will be a series of toxicology studies that will shed some light on that issue. But that does not mean that the FDA is off the hook for explaining to us what is going on and giving us some guidance about whether we should continue to use sunscreen. We suspect that if they were pressed for an answer, they would say that the risk of getting skin cancers, including the sometimes deadly type called malignant melanoma, outweighs any conceivable risk for sunscreen exposure. We believe the experts would tell us to keep using sunscreen as part of the steps we should take to limit exposure of skin to sunlight. But Critica isn’t a medical authority either; we want the FDA to tell us and not leave us guessing.
A Federal Agency Compromises its Public Trust
A second example of the breakdown of communication between a federal scientific regulatory agency and public understanding of the science it does is perhaps even more concerning. In the case of the FDA and sunscreen, we have a relatively limited problem that does not undermine our fundamental faith that the FDA is protecting the public’s health and safety.
In the case of the Environmental Protection Agency (EPA), however, there are concerns about whether the entire organization is looking after our best interests.
The EPA issued a news release on April 30 declaring that the weed killer (herbicide) glyphosate (brand name: Roundup) does not cause cancer in humans. This is consistent with previous findings from many scientific organizations and laboratories. Critica’s own assessment of the data is that glyphosate is not a carcinogen, despite the fact that juries keep on making awards to people who claim to have gotten cancer from it.
The problem here is that the current administration has pursued a policy of decreasing the size and scope of the EPA, including decreasing its scientific capacity.
The EPA was created in 1970 by President Nixon and charged with protecting the public from dangerous exposures like pollution in the air we breathe and toxic chemicals in the water we drink. It is charged with using scientific evidence to enact regulations that American corporations are required to follow. Right now, however, many of these regulations are increasingly seen as hostile to business and “job-killers” and an aggressive policy of trying to roll back many EPA regulations is being pursued . Critics assert that the administration is using “fuzzy math” to rewrite regulations and exaggerating the costs of cleaning up the nation’s air and water.
A big company (Bayer) makes Roundup. Given the claim that the present administration favors business interests over environmental protections, is the public wrong to worry that the EPA’s findings are motivated by a desire to protect the company’s profits? While we continue to believe that glyphosate is safe, we get it that people are having an increasingly hard time believing what the EPA tells us. Here is another case, then, in which the science seems solid—glyphosate is probably not a carcinogen—but the public communication is amiss.
We will continue to advocate for all federal and state scientific agencies to develop and use evidence-based approaches to communicate their findings to their non-scientist consumers. CDC, FDA, and EPA have exemplary traditions of doing groundbreaking science that has saved lives and improved the public’s health. They fall short, however, in explaining to us what they do, allaying our fears, and helping us decide what steps we need to take to protect our health and safety.