Editor's note: This is the third in a series of periodic articles exploring health issues that have been underreported or have seen new advances in the treatment of care.
      In this story - the third of three parts - reporter Amy Yannello looks at the medical establishment's response to the possible connection between dioxin exposure and the use of tampons.

      If you have questions or concerns regarding the long-term safety of a product you're using, do you expect your government to provide answers? What about your doctor or nurse practitioner?
      Although a variety of women's organizations and a U.S. congresswoman have called attention to the possible link between the use of many conventionally-produced tampons and dioxin exposure, response from the government has, so far, been spotty. And reaction from the traditional medical establishment ranges from unawareness to skepticism.
      "I'm not concerned," said Dr. Linda Birnbaum, acting director for the national health and environmental effects research laboratory of the Environmental Protection Agency.
      "As scientists, I don't think we've ever had any overarching concerns, because as a (delivery) source, tampons are less important than other sources, like our primary food supply. Also, the function of (tampons) is to soak up things, not release them, so I'm doubtful that all the dioxin that is contained in a tampon is being released."
      But that is just one of many specific questions that remain unanswered in the debate over exposure to dioxin - a known carcinogen, long-linked to cancer and suspected in diseases like endometriosis and Toxic Shock Syndrome.
      Following an investigation by The Press-Tribune, the following questions remain either unanswered or so surrounded by conflicting evidence that no clear answer has emerged:
      nHow many of the conventionally-produced tampons and sanitary pads contain levels of dioxin?
      nAt what level does dioxin produce negative health effects in humans, specifically women?
      nOf the tampons produced by Playtex (the only manufacturer whose products have been tested privately), how much of the .7 picograms of dioxin contained in each tampon actually gets released into a woman's body?
      nWhat does the development of endometriosis in monkeys and mice that have been fed dioxin-laden food mean for women who are exposed to dioxin both in their daily diet and through their tampon use?
      nWhy does the FDA require manufacturers of such products as shampoo and nail polish to list ingredients, but no such requirement exists for tampon manufacturers?
      nWhy are so many doctors and nurses unaware of the possible link between tampon use and dioxin exposure?
      Some women's health educators and health professionals think these questions are worth exploring, while others - typically toxicologists working for the EPA and large universities - believe there's nothing more to study. Still others are completely unaware that questions even exist.
      "I think there's reason for concern, especially since tampons have been shown to cause retrograde bleeding - one of the leading theories on the cause of endometriosis," said Gillian Ford, a hormone educator working with the Center for Hormonal Health in Roseville and author of "Listening to Your Hormones."
      "Endometriosis is a horrible, horrible ordeal for many women and unfortunately, many OB/GYNs don't tend to take the pain very seriously. However, when you're talking about links that haven't been proven and why doctors aren't responding, I think you'll find that many of them are reading standard medical literature and this (new) information is coming more from the grassroots level.
      "It's sort of like smoking ... it's been hard to prove in the scientific community that it's linked to lung cancer, even though most of us would say that it's obvious. The point here is that here you have a factor - dioxin - that is a known link and it's something you can control. So women should have the information available so they can make an informed choice."
      Megan Seely, outreach coordinator for Women's Health Specialists, said, "There's a general avoidance around talking about vaginal health and a culture of shame around our bodies.
      "That makes talking about any of this very difficult and something not likely to happen unless someone really presses their doctor. In addition, we have a history in this country of not giving women a lot of information about their bodies and not giving much weight to their concerns in the medical establishment," said Seely, whose non-profit center provides family planning and reproductive health services to women in Placer and Sacramento counties.

Many doctors are unaware
      An informal survey of doctors and nurses in several area hospitals and clinics showed that few knew that some conventionally-made tampons contained dioxin. Nor did they know that dioxin exposure had been linked to the development of endometriosis in Rhesus monkeys.
      "I've certainly never heard of that and I checked with (a couple) of our OB/GYNs and they're not aware of that either," said Carol Gann, spokeswoman for the University of California at Davis Medical Center. "But I imagine that if it were true, we would have heard something."
      Julie Jennings, a nurse practitioner for Planned Parenthood in Roseville, said that although she had "never heard of it" she didn't feel it was "fair to comment without first reading some studies" on the issue.
      "Our family practice physician, Dr. Steve Uzelac, has also never heard that there is dioxin in tampons or that there's anything to worry about (on that front)," Jennings said.
      A toxicologist from the poison control center at U.C. Davis Medical Center, noted that while he would expect to be apprised of any public health threat by the FDA, he also knew that "the news media oftentimes gets wind of something before we do."
      Before reading the recent series in The Press-Tribune, Marsha Montbriand, a nurse practitioner for Sutter Women's and Children's Services, said she, too, was unaware.
      "I've been in this field for 30 years and continue to educate myself, so I was definitely surprised that I hadn't heard about this issue before. But I believe that there's enough questions to warrant more scientific studies," Montbriand said.
      The debate itself is frustrating to EPA's Birnbaum.
      "I get frustrated because it's a testable hypothesis. You could take mini tampons, made for mice, lace them with dioxin and see, first of all, if the (chemical) does in fact leach out."
      "But again, from what I've read, dioxin levels (in tampons) are going down anyway, and I think the levels - whatever they are - are still dwarfed by the exposure we get in our daily diet," Birnbaum said.
      EPA scientist Mike DeVito, who evaluated the results of a test done by MAXIM Technologies on 10 Playtex Super-Plus Absorbency tampons, confirmed that they contained between .6 to .7 picograms of dioxin each. According to DeVito, a woman who is normally exposed to 150 picograms of dioxin in her daily diet, would get an additional 5.6 picograms per day, during a typical five-day menstrual cycle. In other words, 3.5 percent of her daily exposure would come from her tampon use.
      While spreading that exposure out over a month's time would significantly reduce that figure (to .93 percent), DeVito added that "If you're exposed to 1 picograrn of dioxin today, in 11 years, you'll still have half a picogram in you."
      To many women, that's enough of a question mark to cause concern.

Research is 'new'
      "Much of this research is only six years old, so I wouldn't be surprised that doctors don't know about it or are skeptical," said Mary Lou Ballweg, executive director of the International Endometriosis Association.
      "Some might also think it has to do with toxicology and so therefore isn't a gynecological issue ... that's a strange mindset to me, but it's how many of them think. They also might think 'I didn't learn about this in medical school, so how important could it be?' Of course, it is important and it does matter and that's what we have to get out there," she said.
      Montbriand agreed.
      "Like a lot of issues, the more publicity this receives, the more consumers become aware and then there will be a cry from the public to do something. I think women need more information so they have what they need to determine their own health needs."
      "So much of medicine is education and this new information will probably lead me to bring this up to my patients in my education of them," Montbriand said, adding that while she doubts that dioxin exposure will be found to be the single cause of endometriosis - a disease whose cause is still unknown - she feels that it could "prove to be a missing part of the puzzle."

Here are all the local links at this site "Ruth's Page - Endometriosis and Dioxin"
Who Is Ruth B? | Ruth's Blog | Hidradenitis Suppurativa  | Veterans | Coalbed Methane | the Press-Tribune | Tampon Survey | H.R.2900 | POP's Treaty | Endometriosis | | Fibromyalgia | Environmental Issues | Voice Your Opinion | Contact the Media | Just for Fun | | Endo-Links | Fibro-Links | Traditional Treatments | Alternative Treatments | Tampons | | Acupuncture | Herbs | Progesterone/ Wild Yam Creams | Ruth's Opinion | Teens "Our Future" | Discussion Board | Petition Corner | Playtex Tampons Tested for Dioxin | Get Politically Involved! |
Copyright © 1997-2004 Ruth's Page - Endometriosis & Dioxin - http://www.frontiernet.net/~ruthb.
The information on this page may not be reproduced, republished or mirrored on another webpage or website without prior written consent.