(Beyond Pesticides, October 24, 2019) Fish and fruit are undoubtedly healthy foods, but modern-day contamination is leading scientists to caution pregnant mothers and young children to stick within current dietary guidelines, or switch to organic, in order to avoid adverse health effects. This new public health message is based on research published in the journal Environmental Health Perspectives by scientists from University of Southern California (USC) and several European Countries, finding that overconsumption of fish and fruits leads to higher levels of contamination with toxic persistent chemicals. “During gestation and early development, the fetus and the child, respectively, are vulnerable to the effects of environmental chemicals, said Lida Chatzi, MD, associate professor of preventive medicine at the Keck School of Medicine of USC. “A balanced diet during these periods is also critical for optimal nutritional status, but what to eat, and how much, are critical questions.” Scientists studied a cohort of 1,288 children (between 6 and 11 years) and 818 pregnant mothers from six European countries, who were provided questionnaires to assess their weekly diet. Blood levels of a range of environmental toxicants, including organochlorine compounds like PCB, PFHSs, PFOS, PFOA, pesticides like DDT and DDE, and heavy metals including […]

(Beyond Pesticides, October 2, 2019) New data gleaned from the Kuakini Honolulu Heart Program — a longitudinal study of men of Japanese descent living on Oahu — demonstrate that occupational exposure to high levels of pesticides can increase risks for cardiovascular disease (CVD) in the forms of coronary heart disease (CHD) or stroke (CVA, or cerebrovascular accident). Further, researchers determined both that workers who experience high-level exposures may not experience such effects for years afterward, and that the maximum subsequent effects were seen within a decade of exposure. The study’s conclusion highlights the importance of pesticide applicator use of protective gear when handling toxic pesticides. These risks and harms could be eliminated through a transition to non-chemical means for pest control in agriculture, land management, and home and personal practices. The Kuakini Honolulu Heart Program, after enrolling more than 8,000 Japanese-American men, 45–68 years old and living on Oahu, Hawaii between 1965 and 1968, has continued to examine and interview these subjects, and document morbidity and mortality among them. This study, which performed statistical analyses on 7,557 of the subjects, is the longest longitudinal study of cardiovascular disease and any association with chronic occupational pesticide exposure, taking into account epidemiologic risk […]

(Beyond Pesticides, September 24, 2019) In 2016, Canadians and Americans residing in Havana reported symptoms of headaches, dizziness, nausea. They described hearing strange buzzing and high-pitched sounds – some woke in the middle of the night fumbling for alarm clocks that were not going off. Media used the term “Havana syndrome” to describe the illness. Diplomats, scared by symptoms that seemed to only hit them in their hotel rooms or at home, speculated that a sonic weapon was being used against them. The Trump administration accused Cuban leaders of misconduct and removed all but essential employees. Later, some suspected that the diplomats could have experienced “mass hysteria.” A new Canadian study provides a more likely explanation to this mysterious illness that impacted diplomats in Havana: neurotoxic pesticide exposure. Researchers conducted testing on 14 individuals who had resided in Havana and a control group of 12 that had never lived there. Some of the experimental group had been recently exposed while others, tested 19 months after their return, were classified as “remotely exposed.” Tests included brain imaging and self-reported symptom questionnaires. They analyzed blood samples for routine biochemistry, kidney, liver, and metabolic functions. Individuals that showed symptoms of brain injury went […]

(Beyond Pesticides, August 30, 2019) The indictment of organophosphate pesticides gained more traction with the publication, in the Proceedings of the National Academy of Sciences, of a new research study out of the University of California, Berkeley. The research, among the first to use advanced brain imaging to assess cortical activation, shows altered brain activity, during tasks that call on executive function, in teenagers from California’s Salinas Valley (the site of significant organophosphate use) whose mothers were exposed prenatally. The UC Berkeley study underscores the slow-motion calamity of the Trump administration Environmental Protection Agency’s (EPA’s) failure to ban the use of this class of pesticides, and of chlorpyrifos in particular, which compounds carry extreme risks for children. The effects of this prenatal exposure continue to unfold during children’s critical developmental periods. Researchers used fNIRS (functional near-infrared spectroscopy) imaging to monitor blood flow in the brains of the teens, 15–17, born and raised in the Salinas Valley. They used data from the California Pesticide Use Reporting program (which documents locations and times of pesticide spraying) to estimate the subjects’ mothers’ proximity to organophosphate (OP) applications during pregnancy. The subject adolescents — estimated to have relatively high levels of prenatal exposure to organophosphates — […]

(Beyond Pesticides, August 22, 2019) In early August, experts from European Union (EU) member states and staff members of the European Food Safety Authority (EFSA) announced their conclusion that chlorpyrifos fails to meet criteria for renewed approval for use, potentially moving the EU a step closer to an outright ban. This ends the green light that chlorpyrifos (and its structurally close cousin, chlorpyrifos-methyl) have enjoyed at the EU level since 2006. That permitting is set to expire in January of 2020, although eight member states — Germany, Ireland, Finland, Denmark, Sweden, Latvia, Lithuania, and Slovenia — had already either banned or never authorized chlorpyrifos use in their countries. In the U.S., states are picking up the slack on efforts against chlorpyrifos use as, in the tenure of the current administration, the Environmental Protection Agency (EPA) has chosen to protect industry rather than human health and the environment. The step EFSA took was unusual in that the agency does not typically publish findings before ongoing peer reviews are completed. EUObserver.com reports that EFSA’s public statement was triggered by a July 2019 EU request for information “on the available outcomes of the human health assessment in the context of the pesticides peer […]

(Beyond Pesticides, August 15, 2019) An article in the journal Plos One, “An assessment of acute insecticide toxicity loading (AITL) of chemical pesticides used on agricultural land in the United States,” shows that recent shifts in insecticide use—from organophosphates and carbamates to synthetic pyrethroids and neonicotinoids—have made a large contribution to the ongoing insect apocalypse. This shift to insecticides that target insects based on both selective toxicity and delivery method occurs within a context of shrinking habitat and biodiversity. The study, by Michael DiBartolomeis, PhD, Susan Kegley, PhD, Pierre Mineau, PhD, Rosemarie Radford, and Kendra Klein, PhD, presents a measure of acute insecticide toxicity loading that incorporates acute toxicity, quantity used, and the rate at which the insecticide degrades. Goulson et al. applied a similar measure in Great Britain that did not incorporate the rate of degradation. Both studies use the median lethal dose (LD50) to honey bees as a measure of acute toxicity and calculate the potential number of bee deaths based on the number of lethal doses of various insecticides applied in the field. In both cases, researchers used toxicity estimates for honey bees because they are widely available. Other insects may be more or less sensitive. The […]

(Beyond Pesticides, July 30, 2019) Earlier this month, the U.S. Environmental Protection Agency announced a decision to register new uses for the bee-toxic pesticide sulfoxaflor. The decision closely followed a USDA announcement halting the Honey Bee Colonies Survey, combining blows to already suffering beekeepers. According to the nonprofit Bee Informed, this past winter tallied the most colonies lost in a decade—an estimated 37% between October 1, 2018 and April 1, 2019. “Proposing to register sulfoxaflor for use on bee-attractive crops, in the midst of an ongoing pollinator crisis, is the height of irresponsibility,” said Drew Toher, community resource and policy director for Beyond Pesticides in an interview for Bloomberg Environment. “When all of the available data points to significant risks to pollinators from use of this chemical we must face the facts: EPA is working towards the protection of pesticide industry, not the environment,” he said. Sulfoxaflor is a systemic insecticide whose mode of action is the same as neonicotinoid pesticides. After application, the chemical is absorbed and distributed throughout the plant, including pollen and nectar. These insecticides are selective agonists of insects’ nicotinic acetylcholine receptors—they bind to the receptor and cause it to activate. The impact on foraging bees […]

(Beyond Pesticides, July 22, 2019) The U.S. Environmental Protection Agency (EPA) will permit the continued use of a known neurotoxic insecticide on the food the Americans eat, the agency announced yesterday in response to a lawsuit filed by public health groups. Health advocates say the move to continue chlorpyrifos use is the latest example of the agency working to protect the profits of industry over the health of Americans. “By allowing chlorpyrifos to stay in our fruits and vegetables, Trump’s EPA is breaking the law and neglecting the overwhelming scientific evidence that this pesticide harms children’s brains,” said Patti Goldman, an attorney for Earthjustice. “It is a tragedy that this administration sides with corporations instead of children’s health.” Under a lawsuit filed in the 9th Circuit US Court of Appeals, EPA had 90 days to provide a justification for why the pesticide should remain on the market. EPA denied the petition yesterday, and rather than providing positive justification for continued use of the chemical, attacked the sound science claimants urged the agency to consider as “not…valid, complete, and reliable.” In the absence of EPA action, several states are leading in the protection of their residents by rejecting the agency’s determination regarding […]

(Beyond Pesticides, July 11, 2019) Pregnant mothers with higher concentrations of pesticide metabolites (breakdown products) in their urine are more likely to have children who develop symptoms of Attention Deficit/Hyperactivity Disorder (ADHD), according to research conducted by the University of Southern Denmark and Odense University Hospital. The results of this study are consistent with past findings from Rutgers University and Cincinnati Children’s Medical Center, indicating a need for researchers to determine causality, and pesticide regulators to rein in toxic insecticide use. The pesticides investigated by researchers were breakdown products of the organophosphate chlorpyrifos, and the synthetic pyrethroid class of insecticides. The residue of these chemicals are frequently detected on conventional, industrially farmed food products. Although chlorpyrifos is banned from residential use in the U.S., most household bug sprays such as RAID contain high amounts of synthetic pyrethroids. Among the 948 pregnant Danish women tested, 90% had some level of chlorpyrifos metabolites (3,5,6-trichloro-2-pyridinol) detected in their urine, and 94% were positive for the generic pyrethroid metabolite (3-phenoxybenzoic acid). Scientists continued to follow up with pregnant women’s children through the first five years of life. A child behavioral check list was completed to determine the relative level of ADHD symptoms. Concentrations of […]

(Beyond Pesticides, July 9, 2019) Teens and adolescents living in agricultural areas and exposed to organophosphate insecticides are at higher risk of depression, according to the findings of a new study in the International Journal of Hygiene and Environmental Health. As rates of depression and suicide rise for teenagers in the US and throughout the world, public health researchers are working to find out why by investigating potential triggers. Toxic pesticide use represents a risk that can be addressed head on, protecting children and their families from a range of diseases that threaten public health. Jose R. Suarez-Lopez, MD, PhD, at the University of California San Diego School of Medicine, has been studying children living in the Ecuadorian Andes since 2008. His team assessed 529 individuals aged between 11 and 17 for their blood levels of acetylcholinesterase (AChE), an enzyme necessary for the proper functioning of nerves in the body. Exposure to organophosphate insecticides like chlorpyrifos and malathion have been shown to lower levels of AChE in the body. An assessment was also given to the children to fill out, in order to determine the severity of depressive symptoms or anxiety. Results showed that children with lower levels of AChE […]

(Beyond Pesticides, June 26, 2019)  “We were drooling excessively. My eyes would not stop watering,” Kaylynn Knull said to Denver ABC7, after she and her boyfriend filed suit against a Dominican Republic resort they claimed poisoned them with toxic pesticides. This year, the same resort, the Grand Bajia Principe, has had three Americans die on its premises. This is not the first time an island resort has been implicated in improper, potentially illegal pesticide use. In 2015, a family of four was poisoned by Terminix after the highly toxic fumigant methyl bromide was applied in a nearby room seeped in while they slept. Ms. Knull told ABC7 that the couple’s symptoms began after rejecting a time share offer at the resort. “As soon as we came back to the room, we noticed it smelled like somebody had dumped paint everywhere. I was having the worst intestinal cramping I have ever experienced. It felt like a chainsaw going through my gut.” The couple booked the first flight off the island, and went to a doctor, who diagnosed them with “Likely Organophosphate poisoning.” Organophosphates are acutely toxic insecticides that bind to and block the transmission of the acetylcholinesterase, an enzyme important to […]

(Beyond Pesticides, June 19, 2019) To mark National Pollinator Week (June 17-23), more than 10,000 people across the country are joining to demand that Kroger (NYSE: KR) help stop the extreme decline of pollinators. Customers are delivering letters to stores asking the nation’s largest conventional grocery store to eliminate pollinator-toxic pesticides from its food supply chain and increase domestic organic food offerings to help stop the catastrophic decline of pollinators and other insects. Pollinators and other insects could go extinct within a century, threatening a “catastrophic collapse of nature’s ecosystems,” the first comprehensive global meta-analysis of insect decline states. This is largely due to the widespread use of neonicotinoids and other toxic insecticides in industrial agriculture. “Systemic neonicotinoid insecticides and the broad range of pesticides that harm people and pollinators have no place in our food supply,” said Drew Toher, community resource and policy director at Beyond Pesticides. “Kroger customers are asking the company to be part of the solution to the pollinator crisis by eliminating hazardous pesticides and expanding organic options.” “To avoid the ‘bee apocalypse’ it is critical that Kroger immediately commit to stop selling food with pollinator-toxic pesticides,” said Tiffany Finck-Haynes, pesticides and pollinators program manager at […]

(Beyond Pesticides, June 6, 2019) Pesticide use eliminates pest predators and permits mosquito populations to flourish, according to research conducted in Costa Rica by scientists at Utah State University. The new study, “Adaptation to agricultural pesticides may allow mosquitoes to avoid predators and colonize novel ecosystems,” highlights the dangers of human intervention through broad scale pesticide applications, and the urgent need to consider ecosystem-wide impacts before allowing chemicals to be placed on the market. As lead study author Edd Hammill, PhD, told National Geographic, the investigation got its start after he observed higher numbers of mosquitoes in orange groves he was visiting, when compared to other, non-agricultural areas. “We felt like we were getting a lot more mosquito bites in plantations than in pristine areas and started to wonder why,” noted Dr. Hammill. The study focuses first on the role that bromeliads, a tropical flowering plant that grows on tree branches, play in affecting mosquito populations. Mosquitoes use the water that these plants catch in between their leaves to lay eggs. Many other species are found to lay eggs within the leaves, including the top-level predator in this system, the damselfly. Dr. Hammill’s team looked at community composition within bromeliad […]

(Beyond Pesticides, June 4, 2019) A class-action lawsuit is accusing Starbucks stores in New York of misusing a highly toxic, carcinogenic pesticide near food, putting the health of customers and employees at risk.  “Stores throughout Manhattan have for many years been permeated with a toxic pesticide called Dichlorvos [DDVP], which is highly poisonous and completely unfit for use in proximity to food, beverages and people,” the suit reads. According to the lawsuit, Hot Shot brand No Pest Strips were placed in food areas in violation of labels that prohibit the pesticide’s use in “the food/feed areas of food/feed processing or food/feed manufacturing or food/feed service establishments.” A pest control operator found the illegally placed products on a number of separate occasions, hidden under bagels or in pastry display cases, during a five year period from 2013 to 2018. This was not at only one location, but appeared to be a common occurrence at nearly every one of the 100+ stores serviced by the pest control operator. The case brings to light a number of issues with the use of synthetic pesticides. The unsanitary conditions permitted to persist within Starbucks stores, per the pictures provided in the suit (see page 14), […]

(Beyond Pesticides, May 28, 2019) In yet another attack by the Trump administration on science, public health, and children and families, as well as another wink and nod to industries whose products harm, the U.S. Environmental Protection Agency (EPA) and the National Institute of Environmental Health Sciences (NIEHS) are planning to end their support for research centers that do important scientific investigation related to children’s health. Tell Your Congressional Representatives to Insist on Funding for Children’s Environmental Health Centers. EPA has announced that it will no longer renew its grants to these centers. As of July, they will lose a huge portion of the funding that has allowed them to deploy hundreds of scientists — in genetics, toxicology, and neurodevelopment — on unusually comprehensive and longitudinal studies of what factors in children’s experiences and communities impact their health. The work of these centers has been critical in uncovering the relationships between children’s exposures to toxic chemicals, including pesticides, and diseases and health anomalies later on in their developing years. According to Tracey Woodruff, PhD, who runs the University of California, San Francisco Pregnancy Exposures to Environmental Chemicals Children’s Center: When EPA weighs the harms of a chemical against its benefits, ignorance “works out perfectly for industry. . . If EPA doesn’t […]

(Beyond Pesticides, May 23, 2019) Glyphosate weed killers may be contributing to the growing worldwide epidemic f non-alcoholic fatty liver disease (NAFLD), a condition that causes swelling of the liver, and can eventually lead to cirrhosis, cancer, or liver failure. Researchers at the University of California (UC) San Diego found that higher levels of glyphosate detected in urine corresponded significantly with individuals that have also been diagnosed with NAFLD. Advocates are urging lawmakers at every level to respond to the accumulating science on the danger of glyphosate herbicides, ban their use, and adopt policy changes that put into place organic land management practices. “There have been a handful of studies, all of which we cited in our paper, where animals either were or weren’t fed Roundup or glyphosate directly, and they all point to the same thing: the development of liver pathology,” said Paul J. Mills, PhD, professor and chief in the Department of Family Medicine and Public Health at UC San Diego School of Medicine in a press release. “So I naturally thought: ‘Well, could it be exposure to this same herbicide that is driving liver disease in the U.S.?’” Dr. Mills and his team received urine samples from […]

(Beyond Pesticides, May 20, 2019) The bans of chlorpyrifos in three important agricultural states show the support for a ban of the chemical nationwide. Hawai’i banned chlorpyrifos a year ago with a unanimous vote of the legislature. New York and California banned it this month. States have been pursuing bans since the Environmental Protection Agency rescinded its proposed ban in 2017. Tell Your Governor to Ban Neurotoxic Pesticides and Support Organic; Send Thanks to Your Governor in Hawai’i, New York, and California Like other organophosphate pesticides, chlorpyrifos has been linked to damaging and often irreversible health outcomes in workers, pregnant women, and children. A widely used pesticide, agriculture companies annually spray six million pounds on crops like citrus, apples, and cherries.  In the same family as Sarin gas, the substance was initially developed prior to World War II as a chemical weapon. It can overstimulate the nervous system to cause nausea, dizziness, and confusion. With very high exposures (accidents or spills), it can cause respiratory paralysis and even death. When applying the chemical to fields, workers must wear protective garments such as respirators. Workers are then blocked from entering the fields from 24 hours up to 5 days after application due to the chemical exposure risk. A group of leading toxics […]

(Beyond Pesticides, May 17, 2019) After two decades of co-sponsoring and co-funding research centers that do important scientific investigation related to children’s health, the U.S. Environmental Protection Agency (EPA) and the National Institute of Environmental Health Sciences (NIEHS) are planning to end their support. EPA has announced that it will no longer renew its grants to these centers. As of July, they will lose a huge portion of the funding that has allowed them to deploy hundreds of scientists — in genetics, toxicology, and neurodevelopment — on unusually comprehensive and longitudinal studies of what factors in children’s experiences and communities impact their health. The work of these centers has been critical in uncovering the relationships between children’s exposures to toxic chemicals, including pesticides, and diseases and health anomalies later on in their developing years. This announcement represents yet another attack by the Trump administration on science, public health, and children and families, as well as another wink and nod to industries whose products harm. Says Tracey Woodruff, who runs the University of California, San Francisco Pregnancy Exposures to Environmental Chemicals Children’s Center: When EPA weights the harms of a chemical against its benefits, this “works out perfectly for industry. . . […]

(Beyond Pesticides, May, 7, 2019) Last week, the New York State legislature voted to phase out and eventually ban the use of the neurotoxic insecticide chlorpyrifos. The vote, 44-18 in the state Senate and 94-50 in the Assembly, is still awaiting the Governor’s signature, who is expected to sign the measure. As evidence of harm continues to accumulate, scientists have called for a ban, and a legal case works its way through the courts, pressure is mounting on the U.S. Environmental Protection Agency (EPA) to once and for all remove this harmful pesticide from use. New York’s legislation sets implementation dates that leapfrog a similar law banning chlorpyrifos that passed in Hawai’i last year. Although Hawai’i’s law takes effect beginning in July of this year, the state may provide temporary use permits for the chemical until December 2022. New York also phases in restrictions, first prohibiting aerial applications beginning January 2020, then prohibiting all use except on apple trees starting January 2021. The chemical will be completely banned for use in New York in December 2021. Chlorpyrifos is a highly toxic insecticide that has been linked to damaging and often irreversible health outcomes, particularly for pregnant mothers and their children, […]

(Beyond Pesticides, March 28, 2019) A set of documents obtained by the Center for Biological Diversity reveals that the Trump administration has known for over a year – and actively concealed – that the organophosphate insecticide chlorpyrifos jeopardizes the existence of 1,399 endangered species. Top officials at the U.S. Department of the Interior, including Acting Secretary David Bernhardt, were privy to and prevented the release of a “biological opinion,” completed by the Fish and Wildlife Service (FWS) in 2017, which contains a full analysis of the extensive environmental impacts wrought by three organophosphate insecticides. While chlorpyrifos is the worst of the three, the censored biological opinion includes similarly concerning findings for two other organophosphate pesticides, malathion and diazinon, which are currently jeopardizing 1,284 and 175 species, respectively. The U.S. Environmental Protection Agency (EPA) has determined that that all organophosphates have a common mechanisms of effect and therefore the multiple exposures to these pesticides lead to a cumulative risk. “It’s outrageous that Trump, Bernhardt and the industry hacks inhabiting this administration are speeding the extinction of nearly 1,400 endangered species by refusing to take any action on chlorpyrifos,” said Lori Ann Burd, environmental health director at the Center for Biological Diversity […]

(Beyond Pesticides, March 27, 2019) Exposure to commonly used pesticides in the womb and during the first year of life is linked to a higher risk of developing autism, according to the study, “Prenatal and infant exposure to ambient pesticides and autism spectrum disorder in children: population based case-control study,” published in the journal BMJ last week. Although the study does not reveal a causal link, it adds to previous literature highlighting autism risks from pesticide exposure, and reinforces calls to limit pesticide exposure during early life critical windows of vulnerability. The authors note their findings “support the need to avoid prenatal and infant exposure to pesticides to protect the developing child’s brain.” Researchers used data from California’s records of autism disorder diagnosis and birth rates from 1998 to 2010. Roughly thirty-five thousand healthy patients acted as a control, while scientists identified nearly three thousand patients with an autism diagnosis, of which 445 also displayed a co-occurring intellectual disability. Data was then drawn from California’s pesticide use recording database, and eleven pesticides (glyphosate, chlorpyrifos, diazinon, acephate, malathion, permethrin, bifenthrin, methyl bromide, imidacloprid, avermectin, and myclobutanil) were analyzed for their use within 2000 meters (1.25 miles) of the homes of those […]

(Beyond Pesticides, March 26, 2019) In a study investigating the carcinogenic effects of pesticide exposure by analyzing data on 316,270 farmers and farmworkers in the U.S., Norway, and France, researchers have identified elevated risk for non Hodgkin lymphoma (NHL) and some subtypes, linking glyphosate and large B-cell lymphoma. Other pesticides linked to the disease include the pyrethroid deltamethrin and chronic lymphocytic leukemia/small lymphocytic lymphoma; and terbufos and NHL overall. Researchers also found “inverse associations of NHL overall with the broader groups of organochlorine insecticides and phenoxy herbicides, after adjusting for exposure to other pesticides”; such inverse associations were not found with active ingredients within these groups. The research underscores how complex the science of pesticide impacts on human health, and on cancer incidence, can be. To wit: in evaluating 14 different pesticide categories and 33 individual, active chemical ingredients, Maria E. Leon, et al., conclude that associations of pesticides with the development of NHL appear to be (NHL) subtype- and chemical-specific. Published in the International Journal of Epidemiology in mid-March, the study, “Pesticide use and risk of non-Hodgkin lymphoid malignancies in agricultural cohorts from France, Norway and the USA: a pooled analysis from the AGRICOH consortium,” uses data from three large cohort […]

(Beyond Pesticides, March 1, 2019) The costs of pesticide use extend far beyond the invoices farmers pay for purchase of the chemicals to use on their crops. The real costs related to pesticide use and exposure include those of health care, lost productivity and income, and environmental damage (loss of environmental services and biodiversity; compromised air, water, and soil quality). There has been relatively little research focused on those real and extensive costs; this Daily News Blog turns its attention to several that have made the attempt. January 2019 saw the publication of a new book, Sicker Fatter Poorer: The Urgent Threat of Hormone-Disrupting Chemicals to Our Health and Future … and What We Can Do About It, by Leonardo Trasande, MD, MPP, which examines how some chemicals — including organophosphate and organochlorine pesticides — disrupt human endocrine (hormonal) function, and damage health, sometimes irreparably. The book further investigates the economic costs of associated diseases and other health problems to the U.S. economy — on the order of 2.3% of GDP (gross domestic product), or $340 billion, annually. As Dr. Trasande notes, “The reality is that policy predicts exposure, exposure predicts disease and disease ultimately costs our economy.” Dr. Trasande is […]