BAD MEDICINE: THE DANGERS OF VINYL HOSPITAL SUPPLIES.

When Hollie Shaner's 14-year-old son needed surgery last year, she requested that glass intravenous (IV) bottles and special tubing be used instead of the usual polyvinyl chloride (PVC) equipment. Shaner, a registered nurse, wanted to prevent her son from getting an unintentional dose of phthalates, a family of chemicals that the Environmental Protection Agency, classifies as "probable carcinogens." She and others have grown concerned about the use of phthalates in medical products, after scientists found their use in PVC toys to be a health risk.

PVC bags, tubing and catheters contain a phthalate chemical additive to make the PVC pliable. The softening chemical, di-2-ethyl-hexylphthalate (DEHP), does not chemically bond with PVC, so it easily seeps into the fluids inside IV bags, or from PVC tubing into the air breathed by vulnerable patients using respirators, as medical manufacturers have discovered.

Why the concern? Scientific studies have shown that phthalates, including DEHP, cause cancer, liver and kidney damage, birth defects and damage to reproductive systems. At particular risk are newborns, pregnant women and people who require frequent transfusions or dialysis.

One study found that infants who were ventilated through PVC respiratory tubes developed unusual lung disorders. In another, seven of 12 autopsy lung samples from patients who had received blood transfusions contained elevated levels of DEHP.

Still, medical professionals disagree on how great the risk is to patients. Eric Juzenas of the American Public Health Association says his group "supports using non-PVC alternatives where they are available," but stresses that in cases where PVC is used short-term, patients shouldn't worry. "If there is a risk, it's likely to be pretty small," he says. However, Health Care Without Harm's Jackie Hunt Christensen says her group advises against using vinyl medical products whenever possible, as "a precautionary principle."

Safer alternatives that cost the same as PVC bags are already available from two of the top three U.S. medical suppliers. Polyolefin bags and tubing do not contain phthalates, and studies have demonstrated their safety.

Some hospitals have already agreed to start phasing out PVC medical products for a different reason: The production and later incineration of PVC products create dioxins, persistent chemicals that are known to cause cancer and highly toxic effects at low doses. The movement against PVC seems to be growing. "We shouldn't risk cancer and potential reproductive effects in people who are already sick," says Christensen. CONTACT: Health Care Without Harm, PO Box 6806, Falls Church, VA 22040/[phone]; American Public Health Association, 1015 15th Street NW, Suite 300, Washington, DC 20005/[phone].