Watching Our Health Go Up in Smoke

The medical waste incineration industry was given birth to in the late 1980s by the confluence of two high profile media circuses: one – the HIV hysteria – and two – multiple media accounts of bags of syringes, needles, plasma bags, IV tubing, bottles of pills and even body parts washing up on the shores of some of the most popular resort beaches on the East Coast stretching from Maine to Florida. In 1987, in Indianapolis, Indiana, 12 children were found playing with HIV-infected vials of blood that came from an unsecured dumpster used by a medical clinic.

In a classic case of the cure being worse than the disease, the knee-jerk response was a widespread call to burn hospital waste so that the various avenues of incompetence, corruption and profiteering that led to dirty needles washing up on exclusive beaches could be closed down through a back door. Little thought was applied to the consequences of incineration, until plumes of black clouds began billowing from hospital complexes. Neighbors complained, air pollution research showed that those emissions were indeed dangerous and the Environmental Protection Agency (EPA) became involved.

Eventually the number of incinerators contracted dramatically, but in part because “centralized” incinerators became an easy solution. Hospitals washed their hands of the matter by allowing their waste to be burned in someone else’s backyard.

As a result, Stericycle, headquartered in Lake Forest, Illinois, became the king of the medical waste incineration industry, operating six large incinerators throughout the country, including one of the largest medical incinerators west of the Mississippi in the heart of the most heavily populated part of Utah, the North Salt Lake subdivision of Foxboro, a few miles from my house. Stericycle now receives the medical waste of eight surrounding states there.

The relationship between Stericycle and Foxboro has always been tense. Efforts to shutter Stericycle were launched as long as 10 years ago by a handful of citizens concerned about the toxic brew that billows out of Stericycle’s short smokestack. It’s no surprise that burning medical waste, just like burning fossil fuels or just about anything else, creates a pollution potpourri of hazardous chemicals and gases, heavy metals and particulate matter.

Indeed, citizens’ concerns are validated by hundreds of studies showing multiple adverse health outcomes among people exposed, including higher rates of cancers like childhood leukemia and adverse pregnancy outcomes that I have written about in a previous essay.

The repercussions of the toxic incinerator emissions are made even more disturbing when adding the realization that the medical waste incineration industry was born on a false premise – that hospital pathogens must be incinerated. An EPA report dating back 25 years cites numerous studies showing hospital waste presents no more risk of spreading infection than household waste – which harbors virtually all the same viruses and bacteria. In fact, according to the Society for Hospital Epidemiology of America, “Household waste contains more microorganisms with pathogenic potential for humans on average than medical waste.” So why single out medical waste? Scalpels and needles can be shredded without incineration.

Many of the toxic chemicals and heavy metals in hospital waste are not destroyed by incineration. In fact, burning medical waste is the worst possible way to manage it.

While merely landfilling is a less than perfect solution, the possibility of contamination of usable groundwater is theoretical, not a certainty. Whereas with incineration, the emissions enter the air shed we all breathe from, guaranteeing public exposure, especially for those closest to the incinerator. The ash left over from incineration may be a smaller volume than the original waste, but it is much more toxic, and eventually has to be landfilled anyway.

Incineration does not prevent disease; it actually spreads disease. Incineration not only does not remove toxins; it actually creates new ones and concentrates, mobilizes and redistributes existing ones. Emissions from incinerators are probably the most toxic type of air pollution there is, contaminated with the deadliest compounds known to science, designated by the EPA as “HAPs” (hazardous air pollutants), which includes dioxins, benzene, PAHs (polycyclic aromatic hydrocarbons), furans, heavy metals and radioactive elements. Medical incinerators have even more deadly compounds not found in any other source, like residuals from chemotherapy drugs and even prions, the highly infective proteins that cause the 100 percent fatal human “Mad Cow” disease (which are much more common in human tissue than previously realized, and not reliably deactivated by incineration).

State health departments and environmental agencies are fond of claiming that toxicology assessments of the concentrations of many of these toxins are small enough to be written off as “safe.” The Utah State Health Department measured dioxin levels in the soil around Stericycle and declared the levels to be below any threshold of concern. If the devil is often in the details, in this case, the devil lies in the ignorance of the details.

Those toxicology assessments ignore the biologic complexity of the exposure. Many of these toxins are bioaccumulative, meaning they build up in the human body insidiously over time, and in even higher concentrations in certain critical organs and tissues.

Lipophilic (fat-like) toxins like dioxins highly concentrate in human breast milk. Nursing infants consume 10 to 20 times as much dioxin as the average adult. No toxicology assessments are ever based on the amount of dioxins in the human breast milk of people who live near incinerators, yet that undoubtedly is where dioxins wreak their greatest havoc on public health. Nor do those assessments consider the consequences of lipophilic toxins crossing the placenta that will primarily end up in the developing fetal brain because fat comprises about 60 percent of brain structural matter, and is the primary fat reservoir in the fetus.

Recently a new documentary was released that significantly raises the stakes in the long and sorry saga of this dying industry whose flagship corporate villain is Stericycle. The film features an undercover interview with an anonymous former Stericycle employee giving a credible, extraordinarily detailed account of fraudulent, illegal management practices far beyond what prompted the criminal investigation by state and federal law enforcement. The whistle-blower alleges shocking disregard for public and employee safety by Stericycle management – including directing employees to ignore the Geiger counter giving radioactive readings of the waste and to burn it anyway. Furthermore, he stated, the Geiger counter didn’t work much of the time.

While radioactivity is an inherent part of hospital waste, one of the few appropriate provisions in Stericycle’s permit is a prohibition of burning anything radioactive, and with good reason. No amount of radiation exposure is safe. Quoting from an article in the New England Journal of Medicine, “Mutagenic effects theoretically can result from a single molecular DNA alteration . . . every molecule of a carcinogen is presumed to pose a risk.” (1)

In fact, the medical community is now much more cautious about the radioactive burden of many of our common diagnostic tools, like CAT scans, because of this growing recognition. Even low dose radiation exposure can damage chromosomes, alter gene expression and lead to cancer, brain diseases, immune disorders, birth defects and miscarriages – all of which North Salt Lake residents believe they have experienced in excess in their neighborhoods.

The ex-employee described management deliberately rigging the company scales and ignoring their permitted weight limit, a likely reason the state caught them exceeding their dioxin limit by 400 percent. Add to this the revelation that Erin Brockovich’s investigative team found dioxin concentrations in Foxboro homes to be inversely proportional to the distance from the incinerator. The home closest to Stericycle had 17 times the level of dioxins in its attic that would be considered average for an industrial area.

Incineration is widely recognized by international health organizations as an unnecessary, dangerous means of handling waste. Over 98 percent of medical incinerators have closed in the last 15 years – leaving a handful of communities like Foxboro to take most of the “hits for the team.” Utah’s governor, Gary Herbert, could close Stericycle on the basis of necessary public health protection, but he is loath to do so because he functions under the fog of the conservative mindset, that protection of business inherently has priority.

The whole medical incineration industry was a huge mistake right from the start, but Stericycle seems to have achieved immortality simply because someone is making money from it. The gnawing outrage of Stericycle is just a microcosm of the endemic failure of countless public policies held hostage to capitalism. Science, common sense, proportion, justice and human decency get thrown under the bus initially by fear and ignorance, and held there in perpetuity by ideology, exploitation and greed. We watch the same play over and over again with a different cast, be it gun control, the wealth gap, ISIS, our war addiction, GMO labeling, chemical and pesticide dysregulation, factory farming – and of course, the climate crisis. It makes me wonder whether we are not already living on the planet of the apes.

Watch the full documentary on Stericycle.

Moench’s essay does not represent the official position of UCS or PSR.

1. Bernard D. Goldstein, M.D., Howard J. Osofsky, M.D., Ph.D., and Maureen Y. Lichtveld, M.D., M.P.H.The Gulf Oil Spill N Engl J Med 2011; 364:1334-1348April 7, 2011