Q&A: Everyday Plastics Are Making Us Sick—and Costing Us $250 Billion a Year in Healthcare

From our collaborating partner “Living on Earth,” public radio’s environmental news magazine, an interview by host Steve Curwood with Dr. Leonardo Trasande, director of New York University’s Center for the Investigation of Environmental Hazards. 

Two hundred and fifty billion.That’s the annual health and economic cost of toxins in plastics in the United States, from the plastics found everywhere—in food packaging, clothing, furniture, cookware and even nail polish. They’ve come to permeate our environment so thoroughly that some have started calling our time the “Plasticene.”

Plastic trash is ugly enough, but the invisible host of chemicals they contain wreak havoc on the hormone systems of the human body, leading to devastating and costly health outcomes.

A recent study published in the Journal of the Endocrine Society found in 2018 alone disease and disability caused by chemicals in plastic cost the U.S. a whopping quarter of a trillion dollars in health and economic losses.

Lead author Dr. Leonardo Trasande is a pediatrician who directs the NYU Center for the Investigation of Environmental Hazards. This interview has been edited for length and clarity. 

STEVE CURWOOD: Your study focused on the costs of just a few of the thousands of chemicals that are used in plastics. What were the chemicals that you included in your study, and how do they threaten our health?

LEONARDO TRASANDE: We started by focusing on brominated flame retardants. Brominated flame retardants are best known to hack thyroid hormones. Babies rely on thyroid hormone through the second trimester of pregnancy; even low levels of thyroid hormone can disrupt brain development in young children, and have consequences that are permanent and lifelong. 

Then we focused on phthalates, chemicals used to soften plastics that not only have effects on metabolism in adults as well as kids, but disrupt sex hormone function and thereby can have effects on fertility. These chemicals may have behavioral consequences not just for attention deficit, but for depression and other mental illnesses. 

We also looked at bisphenols used in polycarbonate plastic and aluminum can linings. Bisphenols are synthetic estrogens; they mess with fat distribution in the body by disrupting how cells in the body develop. Instead of bone or muscle, they become fat. And they disrupt the protective function of proteins that are important for heart function. 

Finally, there are these “forever chemicals,” as they’re called, per- and polyfluoroalkyl substances—nonstick chemicals that are used in oil- and water-resistant clothing, too. 

They contribute to cancers, they disrupt metabolism, they can impair cognitive function. And the reason why these chemicals have such broad effects is they weren’t designed with the human body in mind the way drugs are. You mess with hormones, you have reverberations that cut across all sorts of organ function in the body.

CURWOOD: We have an obesity epidemic in this society. How might exposure to these chemicals and plastics be related to that?

TRASANDE: We used to think simply calories in, calories out. And nothing I’m saying today mitigates the importance of diet and physical activity in the twin pandemics of obesity and diabetes in the U.S. and globally. 

But we know that chemicals can scramble our body’s response to normal dietary cues. Take for example a study that followed a population of adults who had lost weight through healthy diet and physical activity. They drew a blood sample and measured PFAS in that blood sample, and then they saw who gained weight back the fastest. The ones who gain the most weight back are the ones with the highest levels of PFAS. And then they dug in deeper. And they found that the resting metabolic rate of those adults actually slowed down in relationship to the chemicals.Talk about the body’s thermostat being turned the wrong way…

CURWOOD: Your study found that using these chemicals and plastics costs us some $250 billion in U.S. health costs a year. What kind of costs did you include in those calculations?

TRASANDE: Just to start at the basic level, we looked at direct medical care costs: doctor’s visits, prescriptions, emergency room visits, hospitalizations. But you have to dig deeper, because there are downstream costs that are terribly important at a societal level. And we ultimately pay because the chemical industry contaminates us through the products we use in our daily lives and through the chemicals that are used in those products and in particular plastic. 

Just take lost economic productivity. A big driver of our costs was early death from phthalate-induced cardiovascular mortality. That’s mortality during people’s peak productive years. Those are big dollar drivers, often over and above the cost of the medical care that you can count. 

Another example is when a child doesn’t perform well in school, I might not notice as a pediatrician, the mother might not notice, the teacher might not notice. But if 100,000 kids lose an IQ point, the entire economy notices because each IQ point is worth a 2 percent decrease in that child’s ability to perform in the economy. And if somebody makes on average a million dollars over his or her lifetime, 2 percent of a million dollars is a big number, particularly when you multiply that by 4 million births in the U.S. each year.

CURWOOD: Give me some context for this enormous number, $250 billion. How big a deal is that?

TRASANDE: It’s 1.2 percent of the gross domestic product of the United States. The chemical industry profits to the tune of $750 billion a year. So that’s not even a great return on investment. That’s a loss of 1/3 of that economic output as a result of disease and disability. When you put that side by side with U.S. healthcare costs, it’s a bit of an apples and oranges comparison, but it’s about 5 percent. 

In the big picture here, we looked at only maybe 10 or so chemicals used in plastic. There are thousands. And then we only looked at a subset of diseases due to the few chemicals we studied. And a subset of costs due to the few diseases due to the few chemicals we studied, so I’m afraid to say that the costs that we identify here may actually be much, much bigger.

CURWOOD: This number, though, is one of those classic problems of externalities for pollution: Somebody makes products, spews them in the air or distributes them, but somebody else pays for the impact of that. And the plastic-making companies are profiting—let’s face it, they make a lot of money from our addiction to plastics. If we can’t get the companies to pay for these costs, who will? And actually a sub-question of that is, what’s the point of your research if no one’s going to pick up the tab?

TRASANDE: The point of the research is that we all pay the cost of the profit of the chemical industry. And right now, countries across the globe are negotiating a Global Plastics Treaty. It’s a landmark watershed moment in history where we can take on the challenge of the plastic threat to our planet. 

There are some people out there, particularly from the chemical industry, that are pushing very hard to make the plastic pollution threat just a waste threat. They want you to focus on the Pacific Garbage Patch, for example. 

But we all have a little bit of that Pacific garbage patch in our bodies, and it’s harming us, it’s hacking our hormones and contributing to disease and disability. So we not only need to get rid of waste from plastic, we need to reduce our use and production of plastics, period. That’s going to face a lot of resistance from within the U.S. delegation because we produce, as an economy, a substantial amount of plastic, not just for the United States but for the planet. And we’re only recycling 9 percent of plastics on our planet. If we don’t turn off the tap, what will happen is this plastic will accumulate even more in our bodies, and the disease burden that we’re talking about will escalate even further.

“But we all have a little bit of that Pacific garbage patch in our bodies, and it’s harming us, it’s hacking our hormones and contributing to disease and disability.”

CURWOOD: If we were to recycle all of the plastic that’s out there, to what extent will we still be at risk from disease?

TRASANDE: Even more, in an indirect way, because when you recycle plastic, you don’t simply do a basic burn and reuse kind of operation, you add chemicals to it to make the plastic reusable. The few studies that are out there have documented that chemical contamination in recycled plastic, including heavy metals, by the way, is higher than the virgin plastic. And so we need to use the Global Plastics Treaty as a chemicals treaty. A lot of people want to just sweep the chemicals under the carpet. But there are tens of thousands of chemicals used in plastic materials to this day, of which 12 or so have been regulated by existing environmental conventions globally.

CURWOOD: If I’m hearing you correctly, if you were in charge of everything, you would simply get rid of plastics from our society, at least the way that they’re made right now.

TRASANDE: Well, I wouldn’t get rid of essential plastic. There is a distinction here. I use the analogy of the cucumber wrapped in the proverbial plastic tight wrap. That cling wrap has no use. No logical use. During the pandemic, when I started flying again, I would see these trays delivered with an extra two layers of plastic wrap under the guise of, well, I’m trying to prevent COVID by doing this. COVID is transmitted by air particles, not by droplets. It was the biggest plastic theater episode that I have ever witnessed. 

We seem to have gotten into the mindset that plastics are the future. Plastics have definitely provided crucial innovations to our life as a society. But the pendulum has swung way too far. We are excessively focused on profiting from finding any potential use of plastic in our life.

CURWOOD: The U.S. Environmental Protection Agency recently included PFAS chemicals in the definition of “hazardous waste” under the Resource Conservation and Recovery Act, RCRA. What’s the state of regulations for these chemicals right now? How far do we have to go to keep these chemicals out of unneeded everyday products?

TRASANDE: We’ve generally failed, particularly when it comes to the Food and Drug Administration. Take BPA, or Bisphenol A, for example. We knew that it was a problem back in 2008. The FDA banned it in baby bottles and sippy cups, but didn’t ban it in any other plastic materials. Let’s go to phthalates now. The Consumer Product Safety Commission banned eight phthalates in toys, or restricted them to a very low level. The Food and Drug Administration has only limited two of those eight. Talk about a logical inconsistency. It’s not as though kids don’t eat food from packaging the same way they play with toys.

CURWOOD: To what extent is dealing with this problem a bit of whack-a-mole? Because when one type of chemical is taken off the market, let’s say Bisphenol A, industry comes up with Bisphenol S. How safe are the alternatives that industry has been putting forth when certain chemicals were identified as problematic?

TRASANDE: Unfortunately, the little we see is that these are not safer. Bisphenol S is a prototype example. It’s as estrogenic, as toxic to embryos and as persistent to the environment. Bioplastics are often proposed as a whole other alternative. But what little we know about bioplastics, which you would assume are naturally derived and safe, right? Nope. They are as endocrine active and endocrine disrupting as the chemically based plastic. 

There are safe materials. It’s just that we have become aware of the many different ways in which things that we thought were safe are actually not.

CURWOOD: So people who are concerned about this, what steps can they take to protect themselves and our society as we wait for some sort of response from the politicians that govern our regulations?

TRASANDE: There are safe and simple steps we can take in our lives to reduce our plastic footprint and protect ourselves. If you need to use plastic, particularly don’t machine wash or microwave plastic. The chemicals in some cases are not covalently bound to plastic, and the harsh ingredients and high temperatures can lead to degradation and eventually absorption of those chemicals into food more readily. 

Also, avoiding certain recycling-number plastics is important. Three is for polyvinyl chloride, which typically adds phthalates. Six is polystyrene, which breaks down into styrene, a known carcinogen. And seven is typically for polycarbonate plastics, which include bisphenols. But more generally, we can reduce our use of plastic. People use plastics in our daily lives when they actually could save money and save grief by using glass or stainless steel.

CURWOOD: It’s so overwhelming that it’s costing people in this country a trillion dollars every four years for the health effects from plastics. It’s a huge number. What gives you hope?

TRASANDE: What gives me hope is we’ve seen decreases in levels of these chemicals of concern over the past two decades. BPA levels, for example, have declined as attention to BPA-free materials has come into vogue. That’s come with some unfortunate consequences; there are some replacements of BPA that are starting to come on the scene and are detectable in people. 

But the awareness has fundamentally changed. And the more we keep growing awareness of this issue, people will use the power of the pocketbook or wallet to drive the change they seek. Ultimately, these companies are accountable to the consumer. It’s the consumer that gives me hope—not to mention the fact that with the attention to climate change, particularly among Generation Z, you have a spirit of awareness that hasn’t been there before.