The Congress That's Hazardous to Your Health: Two More Nasty Little Bills from House Republicans

This week, the Republican leadership of the House Energy and Commerce Committee is planning to continue its war on Americans’ health by passing two more nasty little bills to weaken public health safeguards under the Clean Air Act.  

Over the last 18 months, the Committee and the full House have passed dozens of bills, amendments, and riders to weaken the Clean Air Act and our other environmental laws.  These two bills target the Clean Air Act provisions that, together with the treaty known as the Montreal Protocol, protect the earth’s fragile ozone layer that shields us from dangerous ultraviolet radiation.  By phasing out ozone-destroying chemicals, these safeguards are saving literally millions of Americans from death and disease due to skin cancer, cataracts, and immune diseases. 

The first bill, grandiosely-titled “The U.S. Agricultural Sector Relief Act,” actually caters to a small sliver of growers of strawberries and other specialty crops.  It would slow, or even reverse, the transition away from methyl bromide, an ozone-destroying and toxic pesticide that was supposed to have been eliminated seven years ago.  Ironically, the bill would increase crop losses for other farmers whose crops are being damaged by increased ultraviolet radiation from a weakened ozone layer.

The second bill, called “The Asthma Inhalers Relief Act,” is designed to put back on the market a banned inhaler that contains both ozone-destroying CFCs and a drug that the nation’s top asthma doctors consider ineffective and even dangerous.

After a perfunctory hearing Wednesday morning, the Energy and Power Subcommittee plans to “mark up” both bills on Thursday.  If passed by the full Committee, the bills will then go to the floor of the House.  Update 8/1/12:  The House Energy and Commerce Committee passed both bills today and sent them to the floor.  Fortunately, they have little chance of passing the Senate.

Here’s a summary of the testimony I’ll give on the methyl bromide bill at Wdnesday's hearing (the full testimony is here).  After that, I’ve highlighted testimony from the American Thoracic Society on the inhaler bill.

Protection of the ozone layer is a huge bi-partisan public health success story.  The phase-out of ozone-destroying chemicals, including methyl bromide, is saving literally millions of Americans, and tens of millions of people around the world, from death and disease, from skin cancer, cataracts, and immune diseases.  It is also saving farmers billions of dollars in UV-related crop losses. 

Now is not the time to tamper with the Montreal Protocol and the Clean Air Act.  By slowing or even reversing the transition away from methyl bromide, “The U.S. Agricultural Sector Relief Act” will lead to more skin cancers, more cataracts, more immunological disease.  It will benefit strawberry growers and others who have profited by abusing the “critical use exemption” for almost a decade.  Thousands of other farmers growing other crops will suffer more UV-related crop losses as a result.

Methyl bromide suppliers and users have dragged their feet on replacing this dangerous compound for two decades.  No other industry has had more time and more leeway to transition from dangerous ozone-destroying chemicals. 

The United States is responsible for more than 90 percent of all methyl bromide exemptions.  Every other strawberry- and tomato-growing country with California-like growing conditions – including Italy, Spain, Greece, and Australia – has ended use of methyl bromide.   Mexican growers use less methyl bromide per acre than their California counterparts, and Mexico will end methyl bromide use entirely this year.

California strawberry growers have done very well during the whole experience, according to a recent peer-reviewed economic study.  Strawberry acreage is up 16% and yields are up 14% since 2004 despite significant reductions in methyl bromide allocations.  So are U.S. grower prices and total crop values. 

U.S. critical use exemptions have been coming down.  California strawberries are now the only field use for which the U.S. is still seeking critical use exemptions.  Together with several structural and commodity uses, the total U.S. exemption request for 2014 is down to slightly more than 400 tons.    

The bill would do reckless damage in three major ways:  First, it would permanently define as “critical uses” all of the uses that were labeled critical in 2005, even though the vast majority no longer even use methyl bromide.  Absurdly, the bill would make even golf course turf grass a “critical use.”  It makes no sense to freeze into law an utterly out-dated list of “critical uses.”

Second, the bill relieves applicants of the need to show why they need exemptions.  They could just submit their exemption wish lists without any supporting data.  EPA then would bear the burden of gathering the data to support any reduction.  Absent resources and data, EPA would have little choice but to forward the applicants’ unsupported wish lists to the parties.  This would be foolish even from the growers’ perspective.  It actually helps the U.S. government win approval for exemptions to have shown that it has exercised judgment and discipline in framing its requests, and has is not mechanically asked for everything its domestic applicants may have wanted.

Third, the bill would blast an enormous new loophole into the Clean Air Act and our pesticide safety laws, by allowing any individual user to write his own ticket for up to 20 tons of methyl bromide simply by asserting the existence of an “emergency.”  There could be a hundreds of emergency exemptions per year, totaling up to 2,000 tons per year (the 2011 critical use amount).   

This is a bad and unneeded bill.  It would harm public health, harm other farmers, and indeed even harm the farmers it is intended to help.  The process is working.  This Committee should let well enough alone.

The “Asthma Inhalers Relief Act” is another piece of work.  Note that it is the Inhalers, not the Patients, Relief Act.  That’s because the purpose of this special-interest bill to favor one company by putting back on the shelves a 1960’s-vintage over-the-counter product called “Primatene Mist.”  Primatene Mist contains a drug called epinephrine and ozone-destroying chlorofluorocarbons (CFCs).  Both the Food and Drug Association and the Environmental Protection Agency have determined should come off the market.  Why?  Because epinephrine is no longer considered a safe and effective or essential treatment for asthma. 

After many years advance warning, the deadline for selling Primatene Mist passed on December 31, 2011.  Primatene’s manufacturer apparently misjudged the declining market for its product and found itself with stocks of inhalers on its hands after the deadline.  So now the company is lobbying Congress to pass a special bill to put those stocks back on the market. 

The nation’s leading lung health doctors oppose this bill because they think it actually would be dangerous for asthma patients to put this medicine back on the shelves.  Here’s what Dr. Monica Kraft, professor of Medicine at Duke University and current president of the American Thoracic Society, will say in her testimony on Wednesday:

It is my strongly held view and the view of the American Thoracic Society, that returning epinephrine inhalers to the U.S. market, even for a limited time, would be ill advised. 

This view is shared by several other physician organizations including, the American Academy of Allergy Asthma and Immunology, the American College of Asthma Allergy and Immunology, the American Association of Respiratory Care and the National Association for the Medical Direction of Respiratory Care.

The take away message is that in the majority of cases, asthma can be successfully treated by working with health care professionals to find the right combination of safe and effective medications.

Epinephrine is NOT one of the medications that is considered safe for the treatment of asthma.

For years the medical community has recognized the dangerous side effects of epinephrine for the treatment of asthma and has recommended against it use for asthma. In 1999 the American Medical Association 1) urged that warning labels on over the counter epinephrine inhalers be strengthened to warn patients about the dangers of epinephrine use, 2) encouraged FDA to consider removing inhaled epinephrine from the market and 3) requested studies to determine whether the availability of inhaled epinephrine is a risk factor in asthma morbidity and mortality. The American Medical Association again reaffirmed this position in 2009.

The American Thoracic Society strongly encourages any patient who is using over the counter medications--like Primatene Mist CFC--to treat their asthma to see a healthcare provider who can help the patient develop an asthma management plan and recommend more effective and safer medications to manage the asthma.

If the intent of the legislation is to restore a safe and effective asthma drug to the market place, then this legislative effort is mis-informed. Inhaled epinephrine is not a safe drug for the treatment of asthma. The adverse side effects of epinephrine are serious and well documented.  No current clinical practice guideline for the diagnosis and treatment of asthma recommends the use of epinephrine. In fact, asthma guidelines specifically recommend against inhaled epinephrine for treating asthma. 

The Subcommittee will also hear testimony from Chris Ward, past chairman of the Asthma and Allergy Foundation of America:

Another false assumption is that low income people need these medications because they are low cost. While the price of Primatene Mist may be lower than the total cost of or co-pay for more effective bronchodilators, the relief from these epinephrine devices does not last as long. Thus, the long term cost is actually higher. ...

[O]ver-the-counter bronchodilators can promote self-diagnoses, which is particularly unsafe for the symptoms of asthma. With proper diagnoses and treatment, people can control their asthma symptoms, avoiding high-cost interventions like emergency department visits and hospitalizations. Cutting out care by qualified medical practitioners could be dangerous for the patient and costly to the healthcare system.

Some backer of the Primatene bill surely will profess concern for poor people’s access to asthma treatment.  These are the same folks who voted last week to repeal the Affordable Care Act.

These bills are just more bad news for from the Congress that’s hazardous to your health.