EPA’s Asthma Miasma

EPA’s Asthma Miasma

On Point No. 5
April 01, 1998

Is the Environmental Protection Agency a friend or enemy of asthmatic children?

It all depends on which issue the agency is peddling. Last year, in justifying its controversial new ozone and particulate matter (smog and soot) standards under the Clean Air Act, the agency played the role of the nations’ pediatrician, asserting that the existing air rules need to be tightened in order to protect kids with asthma. EPA Administrator Carol Browner said that the costly new standards would prevent "hundreds of thousands of cases of significantly decreased lung function in children and cases of aggravated asthma."

Lacked Scientific Support. What Browner’s heavily publicized claims lacked in scientific support – even EPA’s own panel of experts had concluded that the new standards will do very little to help asthmatics – they more than made up for in emotional power. Indeed, recent congressional efforts to reduce the economic impact of the rules fell flat, due in large part to the perceived political dangers of seeming insensitive to the needs of sick children, especially in an election year.

Meanwhile, on a separate regulatory front, EPA is trying to get rid of the most popular and effective types of metered dose inhalers (MDIs) relied upon by millions of those very same asthmatic kids. MDIs, the small containers that deliver medications into the lungs during asthma attacks, use chlorofluorocarbons (CFCs) as propellants. CFC production and use has been severely restricted, due to concerns that these compounds deplete the ozone layer. New production of CFCs is forbidden in the U.S., except for use in MDIs. Now, EPA has teamed up with the Food and Drug Administration (FDA) in an attempt to eliminate this exemption in the near future.

10,000 Negative Comments. Their proposal, announced last year, was met by an unexpectedly large backlash. Nearly 10,000 negative comments, many from health care professionals and asthma support groups, poured in to the regulators’ offices. Numerous medical societies raised concerns that the wide variety of CFC inhalers currently in use will be replaced with a handful of unproven substitutes that may be inadequate for some patients. Others focused on the cost of these new inhalers, which are likely to be considerably higher than the generic

CFC versions now available. Cost is of particular concern given the disproportionate incidence of pediatric asthma among poor minority children.

For an agency accustomed to exploiting children’s health concerns in order to get its way, EPA now finds itself on unfamiliar ground, squared off against groups with names like the American Academy of Family Physicians, and facing tough questions about reducing treatment options and pricing poor kids out of needed medications.

Playing This One Down. But the agency with a history of cynically playing up such issues has proven itself equally adept - and dishonest - in playing this one down. EPA has hawked the one non-CFC MDI that has been approved for use as a near cure-all, even going so far as to assist its manufacturer in marketing it to health care providers. The agency also says that other non-CFC inhalers are in development, and insists that the proposed ban will not take effect until federal regulators determine that comparable alternatives are available. But those who are actually responsible for the care of asthmatic children are not convinced. In congressional hearings, Rep. Tom Coburn (R-OK), who is also a pediatrician, stated that he considers the current proposal "insufficient for a lot of my patients."

EPA justifies the proposed ban on the grounds that it will help in "preventing dangerous pollution and protecting the environment." However, it is not clear whether the old CFC inhalers are bad for the environment, or that the new ones are benign. The amount of CFCs used in MDIs is too small to have an appreciable effect on the ozone layer, according to atmospheric scientists. Current data indicate that the annual CFC contribution from inhalers is approximately one three-thousandth of what is already in the atmosphere. Thus, an additional 5 years of CFC-inhaler use will add only 0.1 to 0.2 percent to the atmospheric burden of this gas. In addition, EPA has neglected to point out that its favorite new inhaler uses a compound called HFC-134a, which it has implicated as a greenhouse gas. Indeed, EPA is already in the process of banning HFC-134a in other uses, because of its "potential to contribute to global warming." Thus, if the ban on CFC-inhalers succeeds, their replacements could become the next regulatory target, leaving asthmatics with still fewer treatment options.

Obvious Inconsistencies. EPA seems to spend half its time overstating some threats, and the other half understating or ignoring others. Despite the obvious inconsistencies, there is a common theme here. The agency will say and do anything to advance its regulatory agenda. If it means hyping false scares about air pollution and asthmatic children, EPA will do it. If it means ignoring real concerns over the impact on those same children of banning the most effective MDI’s, the agency will do that as well. For its part, FDA is nearly as hypocritical, apparently willing to go along with EPA’s crusade despite the public health implications.

With a "friends" like EPA and FDA, asthmatic kids could use some real help in Washington. Fortunately, Congress has introduced several bills (H.R. 2221, H.R. 2627, H.R. 2968, S. 1299) to rein in these agencies and ensure that CFC-inhalers are available as long as they are needed.

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1 Testimony of Carol M. Browner, Administrator, U.S. Environmental Protection Agency, Before The Committee On Agriculture, U.S. House Of Representatives, September 16, 1997.2 362 Federal Register 10,242 (March 6, 1997).3 Hearing Of The Health And Environment Subcommittee Of The House Commerce Committee, July 30, 1997.4 63 Federal Register 5,491 (February 3, 1998).