(Beyond Pesticides, June 2, 2017) According to a new study, levels of triclosan spike in the bodies of children after they brush their teeth or wash their hands. Triclosan, a controversial antimicrobial, is frequently added to consumer care products. Last year, the Food and Drug Administration (FDA) banned the use of triclosan in hand soaps, but it is still allowed in toothpaste and numerous plastic and textile products regulated by the U.S. Environmental Protection Agency (EPA). Many companies had previously decided, due to consumer pressure, to remove triclosan from hand soaps years ahead of the FDA decision. Researchers collected and tested the urine of 389 mothers and their children –three times during pregnancy, and then took between 1-6 samples from children between the ages of 1 and 8 years old. The researchers found triclosan in over 70% of samples taken. In the group of 8 year olds, they report that levels were 66% higher in the children that used hand soap. For those that wash their hands over five times a day, the levels increase more than four times in comparison to children who wash their hands once or less per day. For toothpaste, researchers find that children who had […]

(Beyond Pesticides, May 12, 2017) Researchers from the University of California San Diego, School of Medicine, in collaboration with scientists from Ecuador and Minnesota, have found that exposure to heavy pesticide use during peak periods can impact neurobehavioral performance in children. The study focused on exposure to organophosphate pesticides, which have been associated with a broad range of diseases in both children and adults. The study, published in NeuroToxicology, involved 308 non-worker Ecuadorian children between the ages of 4 and 9. Neurobehavioral performance for each child was tested once between 63 and 100 days after the Mother’s Day flower harvest, which is a period of high pesticide use in Ecuador. The researchers found that children examined sooner after Mother’s Day had lower scores than children who were tested later. “Children examined sooner after the flower harvest displayed lower performance on most measures, such as attention, self-control, visuospatial processing (the ability to perceive and interact with our visual world) and sensorimotor (eye-hand coordination) compared to children examined later in a time of lower flower production and pesticide use,” said Jose R. Suarez-Lopez, MD, PhD, and lead author of the study, to ScienceBlog. Dr. Suarez-Lopez continued, “This discovery is novel because it […]

(Beyond Pesticides, May 9, 2017) Last month, San Juan Capistrano (SJC) became the latest community in Orange County, CA to pass an organic landscaping policy for city parks and open spaces. The city’s move follows the passage of an organic land care policy in nearby Irvine, CA last year, and like Irvine, was brought forward by a strong contingent of local advocates, health practitioners, and city officials working together to safeguard public health and the environment. By a vote of 4-0-1, San Juan Capistrano’s City Council put the community on the cutting edge of local changes to pesticide use that are taking place across the country. SJC’s policy is the result of persistent pressure and engagement by community group Non-Toxic San Juan Capistrano with city officials. A change.org petition hosted by the group, which received over 300 signatures, detailed the discussions and responses the group received from local leaders. At the time the City Council took up the issue at a mid-April meeting, Mayor Kerry Ferguson made a strong statement indicating that, “Chemical pesticides and herbicides have been proven to be toxic to children, pets, and the general public.” Mayor Ferguson further said, “While [chemical pesticide] use is somewhat limited […]

(Beyond Pesticides, March 31, 2017) On Wednesday, Scott Pruitt, the new head of the Environmental Protection Agency (EPA), rejected the conclusions of EPA scientists, and independent scientific literature, and reversed a tentative decision from 2015 to revoke food residue tolerances of chlorpyrifos due to the chemical’s neurotoxic impacts. This would have effectively banned chlorpyrifos from agriculture. This decision stemmed from a petition and lawsuit filed by the Natural Resources Defense Council (NRDC) and Pesticide Action Network North America (PANNA)  ten years ago, calling for EPA to revoke all chlorpyrifos tolerances and cancel all registrations. A Federal Appeals court mandated that EPA take final action by March 31, 2017. Mr. Pruitt’s decision leaves the door open for continued neurotoxic dangers for humans, especially children, who have been shown to be especially vulnerable to chlorpyrifos. Chlorpyrifos is part of the organophosphate (OPs) class of pesticides, which were used in World War II as nerve agents. As potent neurotoxicants, organophosphates are extremely harmful to the nervous system, given that they are cholinesterase inhibitors and bind irreversibly to the active site of an enzyme essential for normal nerve impulse transmission. The scientific evidence of neurotoxic dangers associated with chlorpyrifos exposure is extensive and consistent. Epidemiological data also […]

(Beyond Pesticides, March 2, 2017) On Tuesday, the European Commission (EC) refrained from voting on proposed scientific criteria that would have identified endocrine disrupting chemicals (EDC) and led to regulation on their use in EU countries. This sends the Commission back to the drawing board on the proposal, on which they hope to eventually take a formal vote. The failure to move forward with defined criteria on these hazardous chemicals, which are present in pesticides, biocides, and self-care products, is still largely due to the disagreements of voting member states over the rules reflecting hazard or risk-based criteria. There have been several other meetings of the member states on this proposal, including a meeting in December which highlighted the inadequacies of the criteria. After this meeting, according to Bas Eickhout, of the Greens-European Free Alliance, “Under the Commission’s criteria, it is likely that not a single substance would be identified as an endocrine disrupter, and they would effectively escape specific regulation.” This all follows on the weak regulations issued by the EC in June 2016 to regulate endocrine disruptors in pesticide products, which ultimately undermine the precautionary legal standard that governs pesticide usage in Europe. Many scientists and advocacy organizations criticized […]

(Beyond Pesticides, January 31, 2017) A tentative ruling last week by Fresno County Superior Court Judge Kristi Culver Kapetan moves California closer to listing glyphosate (Roundup) as a carcinogen under the state’s Safe Drinking Water and Toxic Enforcement Act of 1986 (Proposition 65). Monsanto, a leading manufacturer of glyphosate under its Roundup brand, sued California to stop the listing, as it would require cancer warning labels be placed on its end-use product. The company indicates it will challenge the tentative ruling. California’s proposed to list glyphosate as a carcinogen after a 2015 determination of the International Agency for Research on Cancer, a United Nations body under the World Health Organization, that the chemical is a cancer-causing agent for humans based on laboratory studies. Monsanto refutes these claims, and since the determination has worked directly, and through proxy organizations, to discredit and attack IARC, as well as individual scientists that have participated in its decision-making process. Shortly after IARC’s Monograph on glyphosate, the German Federal Institute for Risk Assessment (BfR), a Monsanto-supported group, released a report dismissing glyphosate’s link to cancer. In October of last year, the U.S. House of Representatives’ Committee on Oversight and Government Reform, led by Rep. Jason Chaffetz […]

(Beyond Pesticides, December 23, 2016) The Environmental Agency (EPA) has finalized a proposal to ban 72 inert (or secret hazardous) ingredients from use in pesticide formulations following a long fight with environmentalists who, in 2006, asked that pesticide product labels disclose any of 371 inert ingredients that could be in products. While this finalization is a step in the right direction, ultimately the move is viewed by advocates as inadequate. The original petition, submitted by Northwest Coalition for Alternatives to Pesticides, along with Beyond Pesticides, Physicians for Social Responsibility, and nearly 20 other organizations, called on the agency to require disclosure of inerts. To put the announcement in perspective, EPA is acting on 72 inert ingredients that are no longer being used, such as turpentine oil, and nitrous oxide. An inert ingredient is defined as any ingredient that is “not active,” or specifically targeted to kill a pest. According to a 2000 report produced by the New York State Attorney General, The Secret Ingredients in Pesticides: Reducing the Risk, 72 percent of pesticide products available to consumers contain over 95 percent inert ingredients and fewer than 10 percent of pesticide products list any inert ingredients on their labels. The report also found […]

(Beyond Pesticides, December 21, 2016) A California Department of Pesticide Regulation (DPR) report of all pesticide related illnesses in the state in 2014 identifies 1,685 cases “potentially involving health effects from pesticide exposure,” combining exposures from agricultural and non-agricultural use. Of the 798 cases associated with non-agricultural use, 18% of them (146 cases) involved exposure in children under 18 years old. The exposure rates are alarming, and only strengthen efforts by local activists in counties like Tulare to protect children from pesticide exposure. According to the report, Tulare County has the highest number of reported illnesses related to pesticide exposure at 78, followed by Santa Cruz County with 67. The report, Summary of Results from the California Pesticide Illness Surveillance Program 2014, provides a summary of illnesses identified by the Pesticide Illness Surveillance Program (PISP), a program under DPR. Of the 1,685 cases potentially involving health effects from pesticide exposure reported, DPR epidemiologists determined that 1,073 of those cases were “at least possibly associated” with pesticide exposure, representing a 5% decrease from 2013. However, even though the number of associated cases decreased in 2014, PISP did see a 14% rise in the number of associated episodes, defined as “an event in which a single source […]

(Beyond Pesticides, December 20, 2016) A long-awaited and contentious scientific meeting convened by the U.S. Environmental Protection Agency (EPA) on the carcinogenic properties of glyphosate wrapped up its review last week, with the 15-member scientific advisory panel split on their determination,  and some considering a “suggestive evidence” classification. The panel’s charge was to evaluate EPA’s recent proposal that the widely used herbicide should be considered “not likely to be carcinogenic to humans,” despite a 2015 determination from the International Agency for Research on Cancer than glyphosate is “probably carcinogenic” with “sufficient evidence of carcinogenicity” based on laboratory studies.  The panel now has roughly three months to provide a final recommendation to the agency, which is likely to influence EPA’s final classification of the herbicide. The meeting was split into four days, with one and a half days committed to the panel receiving public comments. As veteran reporter Cary Gillam notes in The Huffington Post, representatives from Monsanto were allotted over three hours to provide evidence against a cancer determination, while public health advocates including Beyond Pesticides and allies were only allotted between 5-15 minutes to make their case. [Read Beyond Pesticides’ comments to the Glyphosate Review Panel here.] Monsanto, for its […]

(Beyond Pesticides,  November 7,  2016) In a letter  last week on the widely used weedkiller  atrazine, Rep. Ken Buck (R-CO) and 105 of his colleagues told Gina McCarthy, administrator of the U.S. Environmental Protection Agency (EPA), that, “It would be irresponsible to greatly restrict one of the safest and most trusted herbicides on the market.” The  letter was triggered by EPA’s release in June of its  draft  Ecological Risk Assessment on atrazine, which found levels of concerns exceeded by as much as 200-fold for some organisms. Lawmakers indicated that the draft assessment in its present form, “Would have a significant impact on farmers and rural communities nationwide.” Despite a wealth of information to the contrary, they claim that restricting the use of atrazine would put an unnecessary financial burden on farmers. Atrazine, produced by Syngenta,  is the second-most widely used pesticide in the U.S., with over 73 million pounds applied each year. While Rep. Buck claims that atrazine is a safe chemical, years of research shows that the chemical poses unacceptable risks to human health and the environment.  Once applied, the chemical often washes into surface water and leaches into groundwater. Water contamination issues spurred community water utilities  across the […]

(Beyond Pesticides, November 4, 2016) After withdrawing in January its registration approval for the toxic herbicide mixture Enlist Duo, for use in genetically engineered (GE) crops, the Environmental Protection Agency (EPA)  announced  this week that it is not only reapproving  the chemical combination, but it is proposing to expand the number of crops and states in which it can be used. The expanded registration will allow the use of Enlist Duo on GE cotton and extend use to GE corn, soybean, and cotton from 15 states to 34 states. This follows an EPA review triggered by manufacturer claims that Enlist Duo ingredients have synergistic effects, which EPA had not evaluated. According to EPA, its latest review of the data found no synergistic effects. Ironically, this EPA-proposed expansion of pesticide use in GE crops across the U.S. comes on the heels of a front page Sunday New York Times exposé  that concludes “genetically engineered crops fail to increase yields and reduce pesticide use,” despite continuing claims to the contrary. Developed by Dow AgroSciences (Dow), Enlist Duo is an herbicide that incorporates a mix of glyphosate and a new formulation of 2,4-D, intended for use on GE Enlist-Duo-tolerant corn and soybean crops. […]

(Beyond Pesticides,  November 3, 2016) Beyond Pesticides and the Organic Consumers Association (OCA), represented by Richman Law Group, filed a lawsuit yesterday in Superior Court in the District of Columbia against Sioux Honey Association, for the deceptive and misleading labeling of its Sue Bee and Aunt Sue’s honey brands. The suit follows news that Sue Bee honey products labeled “100% Pure” and “Natural” tested positive for glyphosate residue. Glyphosate, a known endocrine disrupter and, according to the World Health Organization, a probable human carcinogen, is the active ingredient in Monsanto’s Roundup ® herbicide. “A consumer seeing the words ”˜Pure,’ ”˜100% Pure’ or ”˜Natural’ on a honey product would reasonably expect that product to contain nothing other than honey,” said OCA International Director, Ronnie Cummins. “Regardless of how these products came to be contaminated, Sioux Honey has an obligation to either prevent the contamination, disclose the contamination, or at the very least, remove these deceptive labels.” Jay Feldman, Executive Director of Beyond Pesticides, said: “We join and support those beekeepers who are working to stop hazardous pesticides uses that cause widespread contamination of crops, including honey. Until U.S. regulatory agencies prohibit Monsanto and other manufacturers of glyphosate from selling pesticides that […]

(Beyond Pesticides, October 25, 2016) Last week, a study,  Exposure to endocrine-disrupting chemicals in the USA: a population-based disease burden and cost analysis,  published in The Lancet  journal, concludes  that exposure to pesticides and other chemicals found in common household items, such as toys, makeup and detergent, costs the U.S. more than $340 billion annually in  health care costs and lost wages. The chemicals in question, endocrine disruptors (EDCs), interfere with the body’s hormone system, which can lead to a variety of health problems. According to Environmental Health News, the researchers estimate the costs by looking at exposure data and then projecting 15 medical conditions that are linked to endocrine disruptors and their associated health costs and lost wages. The findings came from calculations made by the Endocrine Society, the World Health Organization, and the United Nations Environment Program. A group of flame retardant chemicals called polybrominated diphenyl ethers (PBDEs) were the worst offenders in the U.S., accounting for nearly two-thirds of estimated health problems. These chemicals were estimated to annually cause about 11 million lost IQ points and 43,000 additional cases of intellectual disability, costing around $268 billion. Pesticide exposure, the second most costly chemical group in the U.S., […]

(Beyond Pesticides, September 16, 2016) Tell EPA to ban all uses of atrazine in the United States! Atrazine, widely used on food and feed crops, golf courses, and residential lawns, is a potent endocrine disruptor that is  strongly associated with birth defects, cancer, sex reversal and hermaphroditism in many different animals. The European Union and other countries have banned atrazine, however EPA continues to put U.S. citizens and the environment in harm’s way, allowing nonstop use of this toxic chemical. Sign Beyond Pesticides’ petition to ban atrazine by October 5, 2016. Atrazine is the second-most widely used pesticide in the U.S., with over 73 million pounds applied each year. Atrazine has washed into surface water and leached into groundwater, spurring community water utilities  across the U.S. to file class-action lawsuits to remove the pesticide from drinking water supplies. Even at levels established as “safe” or acceptable by EPA drinking water standards, atrazine is linked to endocrine-disrupting effects. EPA is not adequately assessing the effects of atrazine by using high dose testing models, which are not appropriate for hormonally-active substances  that  often show effects at minute doses. Studies by Tyrone Hayes, Ph.D., University of California, Berkeley,  and others have shown that […]

(Beyond Pesticides,  September 6, 2016) “The Food and Drug Administration (FDA) decision today to remove the antibacterial triclosan, found in liquid soaps (toothpaste use will remain), is a long time coming,” Jay Feldman, Executive Director of Beyond Pesticides, said today. He continued: “The agency’s failure to regulate triclosan for near two decades, as the law requires, put millions of people and the environment at unnecessary risk to toxic effects and elevated risk to other bacterial diseases. Now, FDA should remove it from toothpaste and EPA should immediately ban it from common household products from plastics to textiles.” Many companies had decided under consumer pressure to remove triclosan from its liquid soap products years ahead of the FDA decision today. FDA’s announcement today indicates that soaps containing the antibacterial ingredient triclosan do not have substantiated germ-killing health benefits. Beyond Pesticides raised concerns about the health effects of triclosan in 2004 in its piece The Ubiquitous Triclosan, and petitioned the agency to ban the chemical in 2005. In 2015, triclosan was banned in the European Union. For nearly two decades, scientific studies have disputed the need for the chemical and linked its widespread use to health and environmental effects and the development […]

(Beyond Pesticides, August 10, 2016) In a letter, submitted by the Soil Association, leading bread producers and supermarkets in the United Kingdom (UK) are being urged to cease stocking and selling bread products that  contain traces of the herbicide glyphosate. Glyphosate, the active ingredient in Monsanto’s Roundup, has been classified as a probable human carcinogen by the World Health Organization (WHO) and is linked to numerous other environmental and human health concerns. Glyphosate residues have already been detected in bread, beer, and wine. The Soil Association, a UK organization that campaigns for healthy, humane and sustainable food, farming and land use, is concerned that glyphosate is used on crops immediately before harvest, and subsequently makes its way into food. According to the letter and a spokesperson for the group, “Using glyphosate, and glyphosate-based products, as a pre-harvest treatment is fundamentally wrong, and we are calling for an end to it with our campaign.  Wheat harvest will start in the next few weeks, and we are asking bread companies to act now and put a stop to glyphosate as a pre-harvest desiccant in their supply chains. The EU has just advised glyphosate use as a pre-harvest spray on food crops should […]

(Beyond Pesticides, June 21, 2016) New regulations issued by the European Commission (EU) last week to regulate endocrine disruptors in pesticide products are being criticized by public interest groups and scientists as undermining the precautionary legal standard governing pesticide use in Europe. Previous  investigations and reports  have uncovered  industry’s attempt to quash efforts to enact robust protections from these harmful chemicals, despite their likely contribution to billions of dollars in lost revenue due to health effects. EC’s new rules endorse the World Health Organization’s definition of endocrine disrupting chemicals (EDC). The WHO defines an endocrine disruptor as “an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny, or (sub)populations,” However, the proposed regulations go little beyond defining the term. “The WHO definition is not a criteria, it is just a definition,” said Andreas Kortenkamp, PhD to The Guardian. “In effect, the commission has decided to place the burden of deciding how to regulate endocrine-disrupting chemicals onto the assessors on a case-by-case basis.” Of concern is the level to which the rules reflect a hazard or risk-based criteria. While EC asserts that its rules will follow […]

(Beyond Pesticides, April 27, 2016) The  European Union (EU)  has placed a moratorium on two endocrine-disrupting herbicides that are linked to thyroid cancer, infertility, reproductive problems and fetal malformations. The chemicals, amitrole and isoproturon, will be banned as of September 30, 2016, after the European Commission voted unanimously, for the first time, to ban the two endocrine disruptors. Earlier this month, the European Commission’s Standing Committee on Phytopharmaceuticals voted to ban the uses of amitrole and isoproturon in accordance with 2009-EU pesticide rules,  which state that endocrine disrupting pesticides should not be allowed on the European market. The committee finds that amitrole is capable of causing malformations in offspring and inducing thyroid cancer, while isoproturon can cause adverse effects to reproduction and lower fertility. In 2013 amitrole was voluntarily cancelled by the registrant, while isoproturon is not registered for use in the U.S. According to the Guardian, amitrole is widely used in 10 EU countries, including the UK, in industrial farming. But  a European Food Safety Authority (EFSA) analysis concluded  that it was an endocrine disruptor that could damage unborn children, and have toxic effects on the thyroid and reproductive organs. Similarly, EFSA recommended classifying  isoproturon as toxic for reproduction […]

(Beyond Pesticides, April 26, 2016) A study published last month finds that exposure to endocrine-disrupting chemicals (EDC) plays an important role in the development of certain female reproductive disorders, and ultimately results in significant economic costs to society. The study, published in the Journal of Clinical Endocrinology &nMetabolism, and authorized by a team of scientists from New York University School of Medicine and Washington State University’s School of Molecular Biosciences, looked at the monetary impact of EDC-attributed female reproductive disorders in the European Union (EU). This economic valuation is part of series of analyses undertaken by the research team, which determined last year that over €150 billion ($162 billion) in yearly health care costs in the EU are attributable to the loss of brain function induced by EDCs. “There are substantial human and toxicological studies (in mice and other lab animals) that suggest that exposure to these endocrine-disrupting chemicals, many of which are increasing in use, are contributing to female reproductive conditions,” said study co-author Leonardo Trasande, MD, associate professor of pediatrics at NYU School of Medicine to CNN. The study found that the strongest data linking EDCs to female reproductive disorders was exposure to diphenyldichloroethene (DDE) resulting in fibroids, […]

(Beyond Pesticides, January 4, 2016) A study published by the U.S. Geological Survey (USGS) and U.S. Fish and Wildlife Service (FWS) found large-scale evidence of intersex in smallmouth and largemouth bass in the Northeast United States, an indicator of endocrine disruption. The study, published in the journal Ecotoxicology and Environmental Safety, looks at 19 U.S. National Wildlife Refuges and is the first reconnaissance survey of this scope. The study found that the prevalence of testicular oocytes across all samples was 85% and 27% for male small- and largemouth bass, respectively. Intersex occurs when one sex develops characteristics of the opposite sex. In the case of this study, researchers found testicular oocytes ””female eggs found inside male testicles””in male smallmouth and largemouth bass. The study explains, “The presence of oocytes in the testes of male gonochoristic fish has been used as an indicator of estrogenic exposure.” The source of the estrogen is hard to pinpoint, but pesticides are often cited as a cause given that they widely pollute waterways that  fish populate. Those chemicals have properties that disrupt the endocrine system and affect the reproductive system, causing development issues such as testicular oocytes. According to USGS, “Intersex is a global issue, […]

(Beyond Pesticides, December 18, 2015) One of the most likely causes for the population decline of smallmouth bass in the Susquehanna River are endocrine-disrupting compounds and herbicides, concludes a multi-agency, multi-year study of one of the most complex river systems in Pennsylvania. The Pennsylvania Department of Environmental Protection (DEP) and the Pennsylvania Fish and Boat Commission (PFBC), along with nearly 50 participants and six partner agencies, released findings on Monday that narrow the likely causes from an initial field of 14 candidates to two. PFBC also found that pathogens and parasites are probable contributing factors. Following a smallmouth bass (SMB) population crash in 2005, and additional observed maladies, such as tumors and lesions on SMB, the team used ground-breaking monitoring strategies to collect more than 30,000 water quality records annually, along with review of existing research to isolate the possible causes keeping young-of-the-year (YOY) SMB from growing to adulthood. The study provides evidence to what Beyond Pesticides suspected back in May, when PFBC confirmed that a rare malignant tumor was found for the first time on a SMB caught by an angler back in the summer of 2014. Though the findings at the time did not point to a specific […]

(Beyond Pesticides, November 10, 2015) Exposure to organochlorine chemicals, such as DDE and PCBs, is linked to increased rates of sperm abnormalities that may lead to fertility problems, according to a new study published in the journal Environmental Health Perspectives. This is the latest study in a long line of research implicating endocrine (hormone)-disrupting chemicals in reproductive diseases. Researchers investigated this issue by observing the blood serum and sperm quality of 90 men, aged 22-44, participating in health studies in the Faroe Islands, an archipelago under  Denmark’s control that is  located between Iceland, the UK and Norway. Faroe islanders consume a high seafood diet that often consists of pilot whale, integral historically as a  food source for the Faroese people. However, this practice exposes the Faroese to higher than average levels of environmental contaminants. For the study, data on umbilical cord blood and blood serum at age 14 was available for 40 of the participants, allowing a researchers to measure lifetime impacts. Faroese participants were screened for sperm aneuploidy, a condition which usually involves an abnormal number of X or Y chromosomes in sperm, and is suspected as contributing to congenital abnormalities and up to 50% of early pregnancy losses. […]

(Beyond Pesticides, November 6, 2015) New York State Senator Tim Kennedy (D-NY) has called for a statewide ban on triclosan, one of the most prevalent antibacterial compounds found in common household products. Minnesota is the only state to have passed a triclosan  ban. If passed, the New York Bill (Bill S6070) would prohibit the sale of cleaning products containing triclosan, triclocarban, or derivatives of similar antibacterial compounds, and mark a clear victory for human health and safety interests within the state. Triclosan has been used for over 30 years in the U.S., mostly in a medical setting, but more recently in consumer products. Beyond Pesticides has generated extensive documentation  of the potential human and environmental health effects of triclosan and its cousin triclocarban, called on manufacturers to stop using triclosan in its products and retailers to stop carrying these products, and previously petitioned the Environmental Protection Agency (EPA) for the cancellation of registered products that contain the antibacterial pesticide. In May 2015, EPA issued its long-awaited response to the Citizen Petition filed by Beyond Pesticides and Food & Water Watch, denying the request. When introduced to the market in 1972, triclosan was confined to hospital and health care settings. Since […]