Commentary

Real “Health Care Without Harm”

People go to hospitals to get healthy. But a new study from the U.S. Agency for Healthcare Research and Quality figures that medical injuries at hospitals kill more than 32,000 patients a year.

There obviously is no sense to making hospitals more dangerous. Yet the group Health Care Without Harm is campaigning against medical products made of polyvinyl chloride (PVC).

Health Care Without Harm has made particular inroads with some religious institutions, such as Catholic Health Care West, which has pledged to phase out the use of PVCs. Moreover, the state of California has just included the additive DEHP to the Proposition 65 list of chemicals believed to cause birth defects or reproductive harm.

Yet scientific studies consistently find that PVCs pose no risk to the vast majority of patients. Discarding vinyl would eliminate use of some of the most important health care devices, ranging from IV bags to surgical gloves; patients would be at greater risk.

The use of PVCs is the sort of esoteric issue vulnerable to misguided public relations campaigns by activist organizations pursuing ideological agendas. The result is almost always bad policy, however good the politics.

Vinyl-based products account for about one-fourth of medical goods, ranging from building materials to dialysis equipment.

Observed former Surgeon General C. Everett Koop: “Without DEHP, a wide range of lifesaving medical devices —such as blood bags, cardiac and urinary catheters and a variety of surgical instruments and gadgets — would lack either the flexibility, transparency, or shelf life to be of much use.”

However, Health Care Without Harm, a coalition of 350 groups, ranging from environmentalist to labor to religious, is campaigning against PVCs. There hardly seems to be any theological issue at stake, and HCWH has won support in part because its objectives are superficially appealing.

Obviously, no one wants harmful health care. But none of the complaints about PVCs stand up to analysis. Although incineration of vinyl products generates the carcinogen dioxin, emission levels, already very low, are falling and incinerators are disappearing — without banning the product.

Fears have been expressed about the effects of using vinyl products on humans, but PVC products have been used for more than five decades and are estimated to account for 7 billion to 9 billion patient days of acute use, and 1 billion to 2 billion patient days of chronic use, with no evidence of ill effects.

Despite early concerns that DEHP might be a carcinogen, scientists have since concluded otherwise. Three years ago, the World Health Organization formally downgraded DEHP from a possible carcinogen to one “not classifiable as to carcinogenicity to humans.”

Some animal studies have suggested that DEHP might cause reproductive problems. However, rodents absorb more chemicals than do primates, and test doses far exceeded common patient exposure.

Thus, medical and regulatory agencies such as the U.S. Food and Drug Administration and Health Canada have expressed concern only about uniquely vulnerable populations facing uniquely high exposure, primarily premature babies and critically ill infants.

The appropriate policy is obvious: reduce unnecessary contact in these groups, while not sacrificing the significant benefits of using PVC products to care for the vast majority of patients.

Although this represents good scientific practice, HCWH advocates applying the “precautionary principle” to ban products without evidence of harm since there is always a possibility of harm. Applied rigorously, this principle would halt all innovation.

Warns science analyst Ron Bailey, “Proponents of the precautionary principle are trying to smuggle in a default position: The environment trumps all other values.”

Moreover, the same analysis should be applied to any materials used in place of PVC. And there is less experience with such products — which means they, too, would be banned under HCWH’s reasoning.

Observes Dr. David Feigal of the FDA, “We would need to see substantial amounts of testing to make sure we weren’t moving from a product with good characteristics to one that we didn’t know much about.”

Creating more significant risks in an attempt to eliminate very small or theoretical ones is extraordinarily bad, and arguably even immoral, policy.

Further, the medical cost of not using vinyl must be balanced against its obvious advantages. That means using the product where the risks are theoretical and de minimus, while looking for cost-effective alternatives in the few cases where there is greater reason for concern and where treatment would not suffer from switching products.

New technologies are not without risk, but they have done much to improve the well-being of humankind. Patients should come first, affirming the importance of human life and dignity over abstract ideology antagonistic to technology. Only in this way will we achieve the laudable goal of “health care without harm.”

Doug Bandow is a senior fellow at the Cato Institute and a nationally syndicated columnist.