Physicians in Congress Committing Malpractice on Millions

Physicians in Congress Committing Malpractice on Millions

The sun setting behind a thick layer of air polution. (Photo: D'Arcy Norman / Flickr)

What would you think if your physician told you, “Keep smoking because quitting would kill tobacco and health care jobs.” Or, “Don't take your high blood pressure medicine, you can't afford it.” And, “Don't lose weight, no one has proven obesity is bad for you.”

That's exactly the quality of medical advice we are getting from the 18 Republican physicians currently serving in Congress. Some of the most well known are the father and son team of Rep. Ron Paul and Sen. Rand Paul, and Sen. Tom Coburn. Almost all of these physician/Congressmen have been key soldiers in the Republican war on the Environmental Protection Agency (EPA), calling it a “job killer,” pronouncing relevant health science “unproven,” claiming we “can't afford” their regulations.

In the last ten years, over 2,000 scientific studies published in the mainstream medical literature have revealed that air pollution has much of the same physiologic and disease consequence as first- and second-hand cigarette smoke.(1, 2) Those studies show that just as there is no safe number of cigarettes a person can smoke, there is no safe level of air pollution a person can breathe. Even pollution at “background” levels still causes health consequences, including increased mortality rates.(3, 4)

Air pollution contributes to and/or exacerbates, virtually every lung disease known, in every age group, from newborns to the elderly. The connection is as solid as that between smoking and lung cancer; in fact, air pollution also causes lung cancer. But air pollution damages much more than the lungs. It causes a systemic low-grade arterial inflammation,(5) impairing and increasing the disease potential of virtually every organ system, especially the heart, lungs, brain and placenta. Heart attacks, strokes, sudden death, poor birth outcomes, higher infant mortality rates, autism, Alzheimer's, diabetes and breast cancer are just some of the many diseases found to occur in significantly higher rates among people who breathe more air pollution. Even people who are otherwise healthy are harmed. Air pollution accelerates the aging process, increases the average person's blood pressure and shortens life expectancy even if it causes no obvious symptoms.(6, 7, 8, 9, 10)

Particulate air pollution, the primary focus of EPA regulations, can travel from the lungs to the arteries and eventually penetrate any cell in the body. For example, the chemicals and heavy metals within particulate pollution can actually penetrate brain tissue, causing loss of intelligence and memory and learning impairment in children.(11, 12, 13, 14, 15, 16)

Pollution particles can even penetrate subcellular structures like the cell nucleus where the all-important chromosomes lie. Particulate air pollution can alter and damage chromosomes, especially serious if occurring during early embryonic development. By causing chromosomal dysfunction, air pollution can even impair the health of future generations.(17, 18, 19, 20, 21)

The nation's premier pollution and health experts, the Clean Air Scientific Advisory Committee (CASAC) regularly review all new medical research and advise the EPA on updating the national air pollution standards. Every time the CASAC has made that review, they have called for making those standards more strict, as they are doing right now and have been since 2006.

Supporting the CASAC in calling for standards even stricter than what Republicans are bludgeoning the EPA for, is virtually every major medical and public health organization in the country, specifically, the American Medical Association, the American Thoracic Society, the American Lung Association, the American Academy of Pediatrics, the American College of Cardiology, the American Heart Association, the American Cancer Society, the American Public Health Association and the National Association of Local Boards of Health. Indeed, there is no reputable health group that disagrees with the CASAC's recommendations.(22, 23) because they understand and accept new research, apparently unlike our physician/Congressmen.

Every study not funded by fossil fuel industries has shown economic and health benefits of controlling air pollution far exceeding the costs of implementing those controls, even if pollution levels are already low. In fact, the benefits average 30 times greater than the costs, and those benefits create jobs, not kill them.(24) That kind of rate of return on investment should be impressive, even to someone who works for Bain Capital. (By the way, someone should tell Mitt Romney, he could do a leveraged buy out of the EPA.)

Being on the front lines of patient care, in a specialty where the margins between life and death can be very thin, I'm reluctant to accuse other physicians of malpractice. However, it is obvious these lawmakers have let political fealty co-opt their medical judgment. Moreover, their malfeasance has the potential to sabotage the health of millions, not just a handful of their own patients. This is malpractice on a grand scale.


1. Peters, A. “Air Quality and Cardiovascular Health: Smoke and Pollution Matter,” Circulation. 2009: 120:924-927

2. Eugenia E. Calle and Michael J. Thun C. Arden Pope, III, Richard T. Burnett, Daniel Krewski, Michael Jerrett, Yuanli Shi. Circulation. 2009; 120:941-948. “Cardiovascular Mortality and Exposure to Airbourne Fine Particulate Matter and Cigarette Smoke.”

3. Elliott CT, Copes R. “Burden of mortality due to ambient fine particulate air pollution.” (PM2.5) in interior and Northern BC. Can J Public Health. 2011 September-October;102 (5):390-3.

4. Peters, A, and Pope, CA III Editorial, Lancet. Vol 360, Oct 19, 2002.

5. American College of Cardiology.(2008, August 14) “Air Pollution Damages More Than Lungs: Heart And Blood Vessels Suffer Too.”

6. Urch B, Silverman F, Corey P, Brook J, Lukic K, Rajagopalan S, Brook R. “Acute Blood Pressure Responses in Healthy Adults During Controlled Air Pollution Exposures.” Environ Health Perspect. 2005 August; 113 (8): 1052–1055.

7. Sérgio Chiarelli P, Amador Pereira LA, Nascimento Saldiva PH, Ferreira Filho C, Bueno Garcia ML, Ferreira Braga AL, Conceição Martins L. “The association between air pollution and blood pressure in traffic controllers in Santo André, São Paulo, Brazil.” Environ Res. 2011 May 11. (Epub ahead of print.)

8. Brook RD, Shin HH, Bard RL, Burnett RT, Vette A, Croghan C, Thornburg J, Rodes C, Williams R. “Exploration of the rapid effects of personal fine particulate matter exposure on arterial hemodynamics and vascular function during the same day.” Environ Health Perspect. 2011 May;119 (5):688-94.

9. Adar SD, Klein R, Klein BE, Szpiro AA, Cotch MF, Wong TY, O'Neill MS, Shrager S, Barr RG, Siscovick DS, Daviglus ML, Sampson PD, Kaufman JD. “Air Pollution and the Microvasculature: A Cross-Sectional Assessment of In Vivo Retinal Images in the Population-Based Multi-Ethnic Study of Atherosclerosis (MESA)” PLoS Med. 2010 November 30;7 (11):e1000372.

10. Pope, CA III, Ezzate, M., Dockery, D. “Fine-Particulate Air Pollution and Life Expectancy in the United States.” NEJM. Vol. 360:376-386 January 22, 2009, Num. 4.

11. Calderon-Garciduenas, L. et al. (2002) “Air pollution and brain damage.” Toxicol. Pathol. 30, 373–389

12. Calderon-Garciduenas, L. et al. (2003) “DNA damage in nasal and brain tissues of canines exposed to air pollutants is associated with evidence of chronic brain inflammation and neurodegeneration.” Toxicol. Pathol. 31, 524–538 .

13. Mateen F, Brook R. “Air Pollution as an Emerging Global Risk Factor for Stroke,” JAMA. 2011;305 (12):1240-1241.doi:10.1001/jama.2011.352.

14. Morgan TE, Davis DA, Iwata N, Tanner JA, Snyder D, Ning Z, et al. 2011. “Glutamatergic Neurons in Rodent Models Respond to Nanoscale Particulate Urban Air Pollutants In Vivo and In Vitro.” Environ Health Perspect : doi:10.1289/ehp.1002973.

15. Gackière F, Saliba L, Baude A, Bosler O, Strube C. “Ozone inhalation activates stress-responsive regions of the central nervous system.” J Neurochem. 2011 April 6. doi: 10.1111/j.1471-4159.2011.07267.x. (Epub ahead of print.)

16. Calderón-Garcidueñas L, D'Angiulli A, Kulesza RJ, Torres-Jardón R, Osnaya N, Romero L, Keefe S, Herritt L, Brooks DM, Avila-Ramirez J, Delgado-Chávez R, Medina-Cortina H, González-González LO. “Air pollution is associated with brainstem auditory nuclei pathology and delayed brainstem auditory evoked potentials.” Int J Dev Neurosci. 2011 March 31. (Epub ahead of print.)

17. Bocskay K, Tang D, Orjuela M, et al. “Chromosomal Aberrations in Cord Blood Are Associated with Prenatal Exposure to Carcinogenic Polycyclic Aromatic Hydrocarbons.” Cancer Epidem Biomarkers and Prev. Vol. 14, 506-511, February 2005.

18. Perera F, Tang D, Tu Y, “Biomarkers in Maternal and Newborn Blood Indicate Heightened Fetal Susceptibility to Procarcinogenic DNA Damage.” Environ Health Persp Vol 112 Number 10 July 2004.

19. Pilsner JR, Hu H, Ettinger A, Sanchez BN, et al. “Influence of prenatal lead exposure on genomic methaylation of cord blood DNA.” Environ Health Persp, April 2009.

20. Baccarelli A. “Breathe deeply into your genes!: genetic variants and air pollution effects,” Am J Respir Crit Care Med. 2009 March 15;179 (6):431-2.

21. Baccarelli A, Wright RO, Bollati V, Tarantini L, Litonjua AA, Suh HH, Zanobetti A, Sparrow D, Vokonas PS, Schwartz J. “Rapid DNA methylation changes after exposure to traffic particles.” Am J Respir Crit Care Med. 2009 April 1; 179 (7):523-4.

22. Letter from the CASAC to EPA Administrator Stephen L. Johnson, September 29, 2006.

23. Letter from 1,882 physicians and health care professionals to Congress, February 9, 2011.

24. EPA report “The Benefits and Costs of the Clean Air Act: 1990 to 2020.”