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Just One Word - Plastics

One of the most popular movies ever made was “The Graduate,” which hit the big screen in the late 1960s and made well over $100 million. The movie starred Dustin Hoffman as Ben Braddock, a recent college graduate looking for something to do with his degree. His parents host a graduation party for him where he is pulled aside by a family friend who offers him some career advice. “I just want to say one word to you Ben, just one word…plastics.” It was probably good advice since plastics and plastic-based products have pretty much taken over our immediate gratification and instantly disposable way of life. It’s not much of an exaggeration to say that plastics changed the world.

The age of plastics dawned in 1907 when Leo Baekeland, a Belgian chemist, invented the first fully synthetic plastic while trying to find a varnish substitute. It didn’t take long to realize the new material was highly versatile and cheap as well as durable, flexible, light, and didn’t conduct electricity. Manufacturers started using it in almost everything such as radios, cars, clothes, and appliances. In the 1930s and 1940s, new forms of plastics including polyester, nylon, Styrofoam, and Plexiglas came along that pushed its use even further into our lives and, not appreciated at the time, into our planet’s ecosystem. Plastic production exploded in the 1950s. A Life magazine story from 1955 titled “Throwaway Living” cheered the spread of disposable items, such as single-use plastics, as a godsend for housewives drowning in chores. It all sounded great at the time, but the problem is that this stuff all gets thrown out and never goes away; it just gets beaten down into smaller and smaller pieces ending up as “microplastics (MP)” and “nanoplastics (NP)” - little particles less than 5 mm in size.

The world generates about 353 million metric tons of plastic waste a year, almost a million metric tons every day. The durability of plastic molecules contributes to their staying power and scientists believe that all the plastic ever made, except for what has been incinerated, is still around in a form that can’t degrade naturally. Trying to get rid of it by burning plastic doesn’t help as it releases toxic chemicals and heavy metals into the air. To date, microplastics have been found in 1,300 species, including us. They’re in the water we drink, the food we eat, the clothes we wear, and the air we breathe. They’ve pervaded every ecosystem in the world, from coral reefs to Antarctic ice, and they’ve infiltrated the human body, lodging themselves in everything from brain tissue to reproductive organs.

The environmental impact of this overdose of plastics is huge. Even with all the efforts to recycle plastic waste like those blue garbage bags, Wednesday “recycle pick-up days,” and dedicated recycle garbage bins, we recycle only about 5% of discarded plastic. Most of it ends up in “landfills” and garbage mounds that emit methane that’s more than 25 times more potent as a greenhouse gas than CO2 alone. Still more concerning, recent estimates are that about 2.5 million tons of discarded plastics enter our oceans every year. More than half of it is less dense than the water and just floats on the surface, where it pollutes the aquatic environment. It persists on the sea surface and is transported offshore by converging currents, with all those tons of garbage finally accumulating in giant floating junk heaps. There is a junk pile floating in each of the five oceans; the largest offshore plastic accumulation zone is known as the “Great Pacific Garbage Patch“ and is located in the Pacific Ocean halfway between California and Hawaii. It covers an estimated surface area of 1.6 million square kilometers (620,000 square miles), an area twice the size of Texas or three times the size of France. It’s so big it can be seen from space.

Two-thirds of the plastic waste in the Pacific come from China and Japan alone (the U.S. contributes about 5%), and once these plastics enter the gyre, they don’t’ leave. The stuff just breaks up into those small microplastics that are absorbed by sea life and enter the ocean food chain and ultimately make their way into our bodies in the food we eat. Freshwater ecosystems also exhibit significant MP contamination in stream and lake fish that are a big part of our diet like salmon, walleye, trout, and bass. The effects of microplastics on our health and longevity are becoming better understood as our imaging and diagnostic capabilities improve. The US Food and Drug Administration is “formulating an approach” to regulation, but rules and regulations from the federal level are slow to come by.

Even if the government is slow to act, the medical community is very concerned about the risks these MPs pose to our health and longevity. A recent review paints a bleak picture: “The escalating global presence of microplastics (MPs) and nanoplastics (NPs) in ecosystems, especially within food systems, represents a critical 21st-century environmental and public health concern. The existing scientific evidence overwhelmingly demonstrates the ecological and toxicological impacts of these particles; they bioaccumulate, disrupt physiological processes, and act as vectors for co-contaminants, exacerbating overall toxicity.” That’s a mouthful, but confirmation of these concerns came from a Stanford University Medical School Study: “MP particles have been found in multiple human organs and tissues, including the brain, testicles, heart, stomach, lymph nodes and placenta. They’ve also been detected in urine, breastmilk, semen and meconium, which is a newborn’s first stool, that indicates we start off life with plastics already in our system.”

A huge health alarm is the impact of MPs on atherosclerotic disease, “hardening of the arteries,” which we’ve talked about here numerous times, the cause of heart attacks and strokes. A study published last year in the New England Journal of Medicine found MPs and NPs in almost 60% of atherosclerotic plaque removed from patients’ arteries at surgery, certainly raising the possibility that MP contamination led to plaque formation. Following these patients for even a short time after surgery showed a “four times higher risk of myocardial infarctions (heart attacks), strokes, and death from any cause at 34 months of follow-up than those in whom MPs were not detected.” The plaque material from these patients was studied in the lab with electron microscopy and “revealed visible, jagged-edged foreign particles among plaque macrophages (clean-up cells) and scattered in external debris.”

We’ve also talked in these pages about the role of inflammation in multiple diseases. Studies show that the presence of these particles in our body correlates with inflammation leading to other health issues, such as hormonal imbalances, cancer, and developmental diseases. This has very real-world consequences; just take breast cancer (BC) as one example. Breast cancer is the most common cancer both here in the United States and around the world.  BC rates are rising at alarming rates among all age groups, but rising fastest among younger women. The annual percent increase in BC rates among women aged 15−29 is now more than double that of any older age group. This has direct links to the chemicals in plastics as a recent study says: “The highest concentration of chemicals that have been shown to increase the risk of breast cancer mostly consisted of petrochemicals used in plastic manufacturing.”

There are some commercially available tests that can measure your body microplastics with a mail-in kit that screens urine, and there are a few available tests that measures levels in the blood. It might be nice to know, but it’s unclear how the amount of microplastics measured with these tests correlates with health risks. Dissolving plastics is one way to clean up the environment, and some private vendors have developed solvents that selectively dissolve the plastic polymers that can then be purified and processed back for reuse in manufacturing. Another option being explored in Japan is engineering plastics that dissolve in the saline environment of the sea and degrade to benign by-products.

It’s impossible to eliminate plastics and plastic breakdown products from our lives, but we can reduce some of our exposure, especially single-use plastics, and change our habits to reusable containers and bags. Everything that impacts our health impacts our safety in the air, so be smart, avoid as much of this stuff as you can, and as always, FLY SAFE!
Kenneth Stahl, MD, FACS
Kenneth Stahl, MD, FACS, is a surgeon who is triple board-certified in cardiac surgery, trauma surgery/surgical critical care and general surgery. Dr. Stahl holds an active ATP certification and is a 25-year member of the AOPA with thousands of hours as pilot in command in multiple airframes. He serves on the AOPA Board of Aviation Medical Advisors and is a member of the Federal Aviation Administration Aeromedical Innovation and Modernization Advisory Board. He is an expert in principles of aviation safety and has adapted those lessons to healthcare and industry for maximizing patient safety and minimizing human error. He also writes and teaches pilot and patient safety principles and error avoidance and is a published author with numerous peer reviewed medical journal and textbook contributions. Dr. Stahl practices surgery and is also active in writing and industry consulting. He can be reached at [email protected].

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