AmyTuteurMD

AmyTuteurMD
Bio
Dr. Amy Tuteur is an obstetrician-gynecologist. She received her undergraduate degree from Harvard College and her medical degree from Boston University School of Medicine. Dr. Tuteur is a former clinical instructor at Harvard Medical School.

NOVEMBER 9, 2009 8:21AM

Toxicophobia, fear of poisoning

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Believers in pseudoscience appear to suffer from a free floating fear. What unites vaccine rejectionsists, organic food devotees, and consumers of “alternative” health? They are united by a pervasive fear of being poisoned. And not poisoned accidentally, either. They are united by a fear of being poisoned surreptitiously, deliberately, and as part of a giant conspiracy perpetrated by Big Pharma and Big Farma. They suffer from toxicophobia, the irrational fear of being poisoned.

It is axiomatic among vaccine rejectionists, organic food devotees and consumers of “alternative” health that vaccines, conventionally grown food and the water supply are filled with “toxins.” Sometimes these toxins are named; often they are not. In all cases, though, there is no evidence that anyone is actually being harmed by “toxins,” but, of course, proof is not a requirement in the fantasy world inhabited by pseudoscience believers.

Vaccines supposedly contain “toxins” that cause autism. (N.B. Toxins always and only cause diseases and syndromes whose etiology is still unknown. No one ever claims that toxins cause strep throat, or sickle cell anemia, or gallstones.) Our food supply is purportedly contaminated by toxins too numerous to even bother mentioning by name. Our water supply is supposedly contaminated by the toxins in pesticides. And, of course, all medications produces by Big Pharma have myriad secret and toxic side effects.

That all pervasive fear would be disabling enough on its own. Apparently, pseudoscience devotees imagine themselves navigating a world pervaded by an unseen toxic miasma. What’s worse, though, is that the entities responsible for creating this toxic miasma know all about it, did it deliberately to make money, and are engaged in a vast conspiracy to keep it secret from the rest of us. Oh, it is a nefarious world indeed!

Big Pharma deliberately adds toxins to its vaccines. Sounds like overkill to me, since vaccine rejectionists also claim that the vaccines themselves are toxic. And vaccine manufacturers know all about this and do it to make more money. And the government knows all about it, too, and insists that we take more and more vaccines every year. And the government pays for it. And the government has granted vaccine makers indemnity from prosecution. It is a wicked world.

Big Farma covers our fruits and vegetables with toxins, and, if that weren’t enough, adds toxins in the guise of preservatives to everything else. And these toxins cause cancer! What kind? Don’t ask, no one knows, and why would that matter anyway? Cancer is cancer. And if all that weren’t bad enough, Big Farma now wants to flood our food supply with … genetically modified food. Horror of horrors, genetically modified foods (they modified the GENES, for chrissakes) are sure to be filled with unnamed toxins of all sorts. And if that weren’t bad enough, Big Farma wants to irradiate our food to kill harmful bacteria (they’re going to expose our food to RADIATION, for chrissakes). Next thing you know we’ll all be gigantic and super-powerful. Oh, wait, maybe we’ll all be stunted and weak. It doesn’t matter; regardless of what they do you can be sure it will “weaken” our immune systems.

We are facing a big problem. Contrary to what the food and medicine toxicophobes believe, it is not the deliberate contamination of our food and pharmaceutical systems. The problem is a sociological problem. Large segments of the populations are suffering from the delusion that industry and the government are colluding to deliberately poison them.

To be clear, I’m not suggesting that medications don’t have side effects or that pesticides or preservatives are theoretically incapable of being harmful. Everything has potential side effects, but there’s a big difference between “potential” and “real.” Vaccines, for example, are known to cause brain damage and death in a tiny proportion of children who are vaccinated. That is real. But vaccines don’t cause autism. That’s fantasy.

What is the source of this toxicophobia? In part it stems for Americans’ apparent inability to understand risk. Americans are so obsessed with side effects that they forget about effects. They vastly overestimate the real risk of side effects and vastly underestimate the effects of the treatment in question. That tendency to overestimate side effects is directly related to the sense of control that Americans do or do not feel. Just as Americans routinely underestimate the risks of driving, they routinely overestimate the risk of plane flight. They believe themselves to be in control while driving, yet they develop irrational fears about the risk of an unforeseen and unforeseeable plane crash.

So Americans obsess over the risk of side effects from medication and the theoretical risk of side effects from agricultural methods that have made the food supply larger and safer. They are consumed with anxiety by the belief that they are secretly being poisoned.

This obsession is magnified by the belief that Big Pharma and Big Farma know about all these side effects and are hiding them. Do large corporations hide damaging information from the public? Yes, unfortunately, they do. But Big Pharma and Big Farma are no different from other large corporations. Yet no one has stopped driving because they fear the auto industry has designed cars that will blow up at the slightest provocation (even though that actually happened with the Ford Pinto) and no one has stopped crossing bridges for fear that shoddy construction will lead them to collapse (even though that has actually happened, too).

Simply put, there is no basis in reality for this pervasive toxicophobia, suggesting that it may be serving a psychological function. I’m going to go way out on a limb here, and raise the possibility that American toxicophobia is psychosomatic. Americans are not being poisoned, but they imagine they are because it is a way to channel their fear of being left behind in an increasingly technological world, and their anger at being so easily manipulated by large corporate entities like banks and other special interests, and their frustration at their perceived powerlessness. Toxicophobia projects this fear, anger and frustration onto medications and food. Unfortunately, rather than being protective, toxicophobia diverts attention from the real problems onto imaginary ones. And, paradoxically, toxicophobia doesn’t improve health, it puts health at risk.

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Have you heard of Norman Borlaug? They say he was one of the greatest people in history, he saved more than a BILLION lives with his research into genetic modification of wheat to grow more quickly with higher yields. He was a believer that organic farming hurts the world food supply and helps no one but the super rich and privileged. People starving all over the world need food, and to grow that food we need to use pesticides to keep the supply alive, and genetic modification to grow more food at higher yields. Plus, having higher yield foods decreases deforestation, so we can grow more on less.

His work is fascinating. I'm sure a lot of the Western organophiles revile him, after all he genetically modified food and used "toxins." I'll bet the billion people he saved directly through his work don't care quite so much.
Ignorance and fear are powerful motivators. For example, the "Baby Boom" generation, the first to benefit from antibiotics, is the first generation whose parents could reasonably expect to live to adulthood. Those vaccines people are so afraid of led to the virtual elimination of infantile paralysis (as polio was called) in the developed world.

Come to think of it, most of the "toxiphobes" probably wouldn't be alive without some of the things they're so afraid of. And without fertilizers and pesticides, they'd be darn hungry.
kathleendsm:

"People starving all over the world need food, and to grow that food we need to use pesticides to keep the supply alive, and genetic modification to grow more food at higher yields. Plus, having higher yield foods decreases deforestation, so we can grow more on less."

The problem with toxicophobia is that it exists in contradiction to the most basic facts. Partly that's because organophiles, vaccine rejectionists and believers in "alternative" health long for an idyllic past that never actually existed. As I have written in the past: There was a time when all food was organic, all remedies were natural, and in that glorious time the average lifespan was ... 35 years.
Scribblenerd:

"Come to think of it, most of the "toxiphobes" probably wouldn't be alive without some of the things they're so afraid of. And without fertilizers and pesticides, they'd be darn hungry."

And yet, they don't seem to realize it.
I wouldn't be surprised that some toxins in some food harm some people, but I've always been drawn to the point that you make, and I paraphrase; If all of this stuff is so bad for us why do we keep living longer?
Roger:

"If all of this stuff is so bad for us why do we keep living longer?"

The irony is that the healthier we get, the more obsessed we are with our health and the more convinced we are that our health faces greater threats than every before.
I find the anti-vax crowd to be the toughest to deal with on a personal level. I've been told that I'm being irresponsible and indirectly told that I'm "borderline abusive" towards my children for choosing to vaccinate. I'm pregnant and trying to get my hands on an H1N1 vaccine right now, and have received tremendous grief for "making a choice for my unborn child" that could have "horrible life-long ramifications". Really? What about the ramifications if I get sick with H1N1??

Interestingly, all these loud anti-vaxers are women I met in a breastfeeding support group. I'm not sure why pro-breastfeeding and anti-vax go hand in hand - but it does with this group. I'm not breastfeeding my 14 month old any longer (which is also a point that many frown upon, but that's another topic) but I still sometimes go to their cookout functions or playdates. More and more, I'm thinking I'll just stop going. I don't need adult interaction THAT badly.

Great post!
Slightly off-topic, but I was listening to an episode of Skeptoid last night, http://skeptoid.com/episodes/4166, which shattered some of my own warm fuzzy feelings about organic foods.

What I took away from it was:
1. the same gigantic agricultural conglomerates who produce conventional foods do the bare minimum to achieve "organic" labeling on some of their products and reap huge profits from the more expensive retail pricing;
2. diverting resources to organic farming actually reduces the food available to starving people;
3. organic fungicides in wine production, for example, require more frequent application, thus increasing the carbon footprint due to tractor soil compaction, diesel exhaust, increased use of fuel, etc.
3a. organic fungicides, fertilizers, etc have the exact same chemical composition as conventional agricultural chemicals and may actually increase environmental impacts as above, but also because they limit the products that can be recycled into fertilizers and other stuff.

Food for thought.
Appreciated your comments, Anthropologist Underground - I think its really important to separate the effect of organic foods on human health (v. little data to support) versus the effect of organic farming on the health of the planet (much more data on this, but much of it clouded by political ideology).
Amy, do you have pointers to studies of the effects of ethyl mercury on the brain?
Thanks Aliquot. I had one more general though about organic foods. My observation is that dedication to organic ideology can be a powerful way to assert (or fake) economic status.
Amy: "Partly that's because organophiles, vaccine rejectionists and believers in "alternative" health long for an idyllic past that never actually existed."

Do you have any evidence to support this claim?
CrankToIt11:

"I'm not sure why pro-breastfeeding and anti-vax go hand in hand - but it does with this group."

They don't always go hand in hand. Many women who are pro-breastfeeding are not anti-vax. However, virtually every mother who is anti-vax is pro-breastfeeding.
Anthropologist Underground:

"Food for thought."

Yes, there's a real truth in labeling problem with organic food.
Amy: "However, virtually every mother who is anti-vax is pro-breastfeeding."

How are you defining "virtually"? And do you have any data to support this assertion?
I would also like to point out that organics are not necessarily fringe science. UC Davis, Cornell, OSU and many other top research universities conduct methodological, well-controlled studies of the outcomes of organic farming (including factors like the food supply and environmental health). Interpretation of these findings by corporations in order to make claims for profit from the 'organic' label is a completely separate issue, and is perhaps the source of much of the public's beliefs about organics.
Hot off the press for you, Douglas! Let me know if you'd like a PM with full text, or any other articles.

Cell Biol Toxicol. 2009

Induction of metallothionein in mouse cerebellum and cerebrum with low-dose thimerosal injection.

Minami T, Miyata E, Sakamoto Y, Yamazaki H, Ichida S.

Department of Life Sciences, School of Science & Engineering, Kinki University, 3-4-1 Kowakae, Higashi-osaka, Osaka, 577-8502, Japan, minamita@life.kindai.ac.jp.

Thimerosal, an ethyl mercury compound, is used worldwide as a vaccine preservative. We previously observed that the mercury concentration in mouse brains did not increase with the clinical dose of thimerosal injection, but the concentration increased in the brain after the injection of thimerosal with lipopolysaccharide, even if a low dose of thimerosal was administered. Thimerosal may penetrate the brain, but is undetectable when a clinical dose of thimerosal is injected; therefore, the induction of metallothionein (MT) messenger RNA (mRNA) and protein was observed in the cerebellum and cerebrum of mice after thimerosal injection, as MT is an inducible protein. MT-1 mRNA was expressed at 6 and 9 h in both the cerebrum and cerebellum, but MT-1 mRNA expression in the cerebellum was three times higher than that in the cerebrum after the injection of 12 microg/kg thimerosal. MT-2 mRNA was not expressed until 24 h in both organs. MT-3 mRNA was expressed in the cerebellum from 6 to 15 h after the injection, but not in the cerebrum until 24 h. MT-1 and MT-3 mRNAs were expressed in the cerebellum in a dose-dependent manner. Furthermore, MT-1 protein was detected from 6 to 72 h in the cerebellum after 12 microg/kg of thimerosal was injected and peaked at 10 h. MT-2 was detected in the cerebellum only at 10 h. In the cerebrum, little MT-1 protein was detected at 10 and 24 h, and there were no peaks of MT-2 protein in the cerebrum. In conclusion, MT-1 and MT-3 mRNAs but not MT-2 mRNA are easily expressed in the cerebellum rather than in the cerebrum by the injection of low-dose thimerosal. It is thought that the cerebellum is a sensitive organ against thimerosal. As a result of the present findings, in combination with the brain pathology observed in patients diagnosed with autism, the present study helps to support the possible biological plausibility for how low-dose exposure to mercury from thimerosal-containing vaccines may be associated with autism.

J Appl Toxicol. 2007 Sep-Oct;27(5):511-8.
Thimerosal distribution and metabolism in neonatal mice: comparison with methyl mercury.

Zareba G, Cernichiari E, Hojo R, Nitt SM, Weiss B, Mumtaz MM, Jones DE, Clarkson TW.

Department of Environmental Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA. grazyna_zareba@urmc.rochester.edu

Thimerosal, which releases the ethyl mercury radical as the active species, has been used as a preservative in many currently marketed vaccines throughout the world. Because of concerns that its toxicity could be similar to that of methyl mercury, it is no longer incorporated in many vaccines in the United States. There are reasons to believe, however, that the disposition and toxicity of ethyl mercury compounds, including thimerosal, may differ substantially from those of the methyl form. The current study sought to compare, in neonatal mice, the tissue concentrations, disposition and metabolism of thimerosal with that of methyl mercury. ICR mice were given single intramuscular injections of thimerosal or methyl mercury (1.4 mg Hg kg(-1)) on postnatal day 10 (PND 10). Tissue samples were collected daily on PND 11-14. Most analysed tissues demonstrated different patterns of tissue distribution and a different rate of mercury decomposition. The mean organic mercury in the brain and kidneys was significantly lower in mice treated with thimerosal than in the methyl mercury-treated group. In the brain, thimerosal-exposed mice showed a steady decrease of organic mercury levels following the initial peak, whereas in the methyl mercury-exposed mice, concentrations peaked on day 2 after exposure. In the kidneys, thimerosal-exposed mice retained significantly higher inorganic mercury levels than methyl mercury-treated mice. In the liver both organic and inorganic mercury concentrations were significantly higher in thimerosal-exposed mice than in the methyl mercury group. Ethyl mercury was incorporated into growing hair in a similar manner to methyl mercury. The data showing significant kinetic differences in tissue distribution and metabolism of mercury species challenge the assumption that ethyl mercury is toxicologically identical to methyl mercury. (c) 2007 John Wiley & Sons, Ltd.
Amy,

I agree with most of this post. The paranoia surrounding vaccination is really quite difficult to understand. While I believe, like you do, that there is no large-scale conspiracy being engineered by the government and U.S. pharmaceutical and agricultural businesses, there is some understandable fear associated with these mysterious "toxins" in our food and water.

I hope that I will not be misunderstood. I am not an organic food cheerleader and I don't mind my food being irradiated to kill bacteria, but there are some real environmental and human health concerns with modern farming. Since 1950, the world population has more than doubled, and more people require more food. Consequently, the amount of CAFOs (Confined Animal Feeding Operation; a "factory farm") has increased dramatically.

These farms can produce as much urine and fecal waste as a moderately sized city, without many elements of a modern city's sanitation system. Runoff from these farms is a serious environmental hazard and can lead to dangerously contaminated groundwater, rivers, and ponds. Also, keeping animals in such close quarter causes more insecticide to be used in and around the CAFO to control harmful pests. This insecticide, like many environmental toxins, can and does accumulate in the animals prior to slaughter and sale.

Here in Michigan, mercury and PCB runoff into the inland and Great Lakes is concentrated in the fish. The larger predatory fishes (walleye, salmon, pike, etc.) accumulate enough of these substances to be considered unsafe to eat more than once a week.

Anyway, I have never heard of anyone dying or getting mercury poisoning from a fish, and I enjoy eating them, but there are some agricultural practices that do have a significant impact on human health and can cause drinking water and food to contain "hidden" toxins.
Aliquot: Based on numerous studies, I am dubious as to the tendency to compare the results from ethyl mercury and methyl mercury. While studies seem clear that both ethyl mercury and methyl mercury cross the blood-brain boundary, it also seems clear that the body flushes the former much more quickly than the latter, helping to prevent toxic buildup. I think the methodology using the toxicity of the one to indicate possible (or lack of) toxicity of the other is clearly obsolete.

This is why I've asked Amy to please provide pointers to studies of the effects of ethyl mercury on the brain. Can't continue to educate myself if I don't have the data. All I've found so far are studies similar to the one you quoted from above, which seem to boil down to, "ethyl mercury is much less toxic than methyl mercury, and since we've based our guidelines on the toxicity of the latter, we must be ok." I'd like more directed studies than that.

So Amy, at the risk of repetition, do you have pointers? I would appreciate it.

(And just out of curiosity, why are the injecting lipopolysaccharide in combination?)
A C,

I don't mean to imply that every chemical and every farming practice is safe. When scientific evidence alerts us to a danger, we should address that danger.

I'm stuck by a sociological observation: vaccine rejectionism, devotion to organic farming, and belief in "alternative" are seem to flourish in conjunction with a free floating anxiety about being poisoned by unknown and unseen toxins, and an irrational belief that government and industry are colluding to knowingly and deliberately poison the population.
Douglas:

"do you have pointers?"

No.

In the course of defending a particular post I may provide additional scientific references, but I don't have enough time to do research for individual questions that are not directly on point.
Dr. Amy,

I understand. I haven't encountered many people (except, it seems, on the internet) that truly believe that large pharmaceutical companies and agribusiness are conspiring to against us and that our government is at best complicit and at worse cooperating with them.

What I find more interesting is that there is fairly clear scientific evidence that supports the following general conclusions: vaccines are safe; organic food is not demonstratively better for you; alternative medicine is not as effective as (for lack of a better word) normal medical practices.

However, people do not believe this stuff for whatever reason. Why? Do they not understand science? Is this considered acceptable in society? I studied math in college, and when people asked about my major, a common response was a laugh and "Oh, I suck at math." Most people know some history and have read many of the same books, and take the time to read about current events, etc. Never reading any Shakespeare would be odd for an adult. Not knowing about photosynthesis or how to do polynomial long division wouldn't. I find this very troubling, and am not sure why scientific literacy seems to be valued so little by a society dependent on science and technology.
Amy: "In the course of defending a particular post I may provide additional scientific references, but I don't have enough time to do research for individual questions that are not directly on point."

Well, the reason I ask is that you have a lot to say about vaccines, thimerosal, ethyl vs. methyl mercury, and related topics. It comes up in your posts fairly frequently. In your last 10 posts, for example, you have mentioned related topics in 6 of them (7, if you count the dentist parody). That's a durn high percentage. One would presume you have access to, or at least knowledge of, a lot of research in this topic area. As such, it seems both reasonable and on-point to ask for pointers. Not asking you to do my research for me; I'm simply asking for pointers.

Or to put it another way, if you asked me for pointers to topics on, say, Layer 2 networking, I could provide you with a dozen or so in as many minutes. It's my topic area, and so I have those pointers at my fingertips. Since you post so frequently about this topic area, it doesn't seem unreasonable to me for you to have similar access to pointers on thimerosal, ethyl mercury, and methyl mercury studies. I mean, geez, you post on it all the time, Amy; you must have studies handy. (If they're hard-copy, the titles would be fine.)
Amy: "I'm stuck by a sociological observation: vaccine rejectionism, devotion to organic farming, and belief in "alternative" are seem to flourish in conjunction with a free floating anxiety about being poisoned by unknown and unseen toxins, and an irrational belief that government and industry are colluding to knowingly and deliberately poison the population."

What is your evidence (preferably non-anecdotal) to support that assertion? Or is it just "one woman's opinion," as the saying goes?
Dr. Tuteur,

You claim:

"The irony is that the healthier we get, the more obsessed we are with our health and the more convinced we are that our health faces greater threats than every before."

The healthier we get? Uhhh...am I grossly misinformed about the current rates of Obesity, Diabetes, Heart Disease, and etc.? I thought all were increasing or at least quite high.

If all you're saying is "we are healthier than our paleolithic ancestors and third world countries" well, that's not a very strong claim!

Regards,
-David Logan
David Logan:

"Uhhh...am I grossly misinformed about the current rates of Obesity, Diabetes, Heart Disease, and etc.?"

For most of human existence, the average life expectancy was 35 years. As recently as 1900, American life expectancy was 48 years; now it is 77.8.

Of course heart disease, cancer and diabetes are rising. Diabetes used to be uniformly fatal and cancer and heart disease are diseases of old age. They can only rise when other more deadly disease have been vanquished. The reality is that we are healthier than we have ever been, live longer than we ever have done, and have a better quality of life while doing so.
Attention "Organophobes":

You need to specify precisely what it is you are referring to when you condemn "organics" (as many of you have).

I buy "organic" foods from local farming cooperatives in Lincoln, Nebraska. The prices are NOT higher, as some of you claim, and there is NO advertising (local family farms can't afford to advertise!). If ya'll (that's country speak) are so distrustful of advertising and big business (or so went several of your arguments against organics and specifically label claims) wouldn't that distrust be just as strong against the giant ag-companies?

IF your posts are only condemning large, corporate, "organic" outfits (and really, they only could be) you need to MAKE ABSOLUTELY CLEAR which companies and which label claims are bothersome. But your blanket statements against "organic farming" and "toxins" only show you to be ignorant of who's growing food out there, and ignorant of the complexity at hand (I'm a "toxiphobe"? which "toxins"? at what exposure? who is being exposed? Which foods were tested and how much and how long (and how many times replicated)? Or is this thread a blanket denial that "toxins" exist or could ever affect people for all spaces/times/universes?)

Nobody I know from co-ops wants to universalize "organic" farming methods (and so the first poster's argument is a straw man). The food at local cooperatives tastes much better to me, and I get it at a lower cost to myself, all while supporting surrounding farmers and the local economy (and I've never seen people shopping at a co-op as a "status symbol"--ever seen a bunch of sweaty Nebraskans at a co-op?) What the hell is wrong with that?

Only a "city mouse" would make the types of comments ya'll make.

Best,
-David Logan
Dr. Tuteur,

Thank you for the response. I have not noticed the trends you've mentioned amongst my family, friends, or classmates (a great many seem to be sick or depressed, with fairly low quality of life) but that is merely anecdotal. I assume that others notice the same, which is why I posted that first comment.

It's a drag that I only post on your threads when I disagree with something (and I DO AGREE with you re: vaccine rejectionism, and many others...) But such is the nature of the internet :)

Best,
-David Logan
Please don't lump all "consumers of 'alternative' health" together, and especially not with the anti-vax and obsessive organic folks. I'm sure you're aware that some "alternative" modalities are being increasingly accepted as complementary to Western medicine, and I'd wager that far more people use some combination of old and new medicine than avoid Western medicine altogether. As a quadriplegic with chronic nerve pain, pressure sores, and nutritional challenges, I've found great success in blending acupuncture, chiropraxis, massage therapy, etc with my more mainstream treatments, and with the blessing of my Western doctors.

I'm completely rational and not "toxicophobic," but I *am* a "consumer of alternative health," and I found it difficult to read your article when I was attacked right out of the gate. I understand the point you're trying to make, but unless you only want to preach to the choir, softening your language towards the rest of us would go a long way!