Kaiser Health News
FDA’s Plan to Ban Hair Relaxer Chemical Called Too Little, Too Late
Ronnie Cohen
Thu, 08 Feb 2024 10:00:00 +0000
In April, a dozen years after a federal agency classified formaldehyde a human carcinogen, the Food and Drug Administration is tentatively scheduled to unveil a proposal to consider banning the chemical in hair-straightening products.
The move comes at a time of rising alarm among researchers over the health effects of hair straighteners, products widely used by and heavily marketed to Black women. But advocates and scientists say the proposed regulation would do far too little, in addition to being far too late.
“The fact that formaldehyde is still allowed in hair care products is mind-blowing to me,” said Linda Birnbaum, a former director of the National Institute of Environmental Health Sciences and the National Toxicology Program. “I don't know what we're waiting for.”
Asked why it's taking so long to get the issue on the FDA's agenda, Namandjé Bumpus, the regulatory agency's chief scientist, told KFF Health News: “I think primarily the science has progressed.”
“Also,” she added, “the agency is always balancing multiple priorities. It is a priority for us now.”
The FDA's glacial response to concerns about formaldehyde and other hazardous chemicals in hair straighteners partly reflects the agency's limited powers when it comes to cosmetics and personal-care products, according to Lynn Goldman, a former assistant administrator for toxic substances at the Environmental Protection Agency. Under the law, she said, the FDA must consider all chemical ingredients “innocent until proven guilty.”
Critics say it also points to broader problems. “It's a clear example of failure in public health protection,” said David Andrews, a senior scientist at the Environmental Working Group, which first petitioned the agency to ban formaldehyde in hair straighteners in 2011 and sued over the issue in 2016. “The public is still waiting for this response.”
Mounting evidence linking hair straighteners to hormone-driven cancers prompted Reps. Ayanna Pressley (D-Mass.) and Shontel Brown (D-Ohio) last year to urge the regulatory agency to investigate straighteners and relaxers.
The FDA responded by proposing to do what many scientists say the agency should have done years ago — initiate a plan to eventually outlaw chemical straighteners that contain or emit formaldehyde.
Such a ban would be a crucial public health step but doesn't go nearly far enough, scientists who study the issue said. The elevated risk of breast, ovarian, and uterine cancers that epidemiological studies have recently associated with hair straighteners is likely due to ingredients other than formaldehyde, they said.
Formaldehyde has been linked to an increased risk of upper respiratory tract cancer and myeloid leukemia, Bumpus said in a video announcement of the proposed ban on X, formerly known as Twitter. But Kimberly Bertrand, an associate professor at the Boston University Chobanian & Avedisian School of Medicine, and other scientists said they were unaware of any studies linking formaldehyde to the hormone-driven, or reproductive, cancers that prompted recent calls for the FDA to act.
“It's hard for me to imagine that removing formaldehyde will have an impact on the incidence of these reproductive cancers,” said Bertrand, an epidemiologist and lead author on a study published in December, the second linking hair relaxers to an increased risk of uterine cancer.
Hair products targeted to African Americans contain a host of hazardous chemicals, said Tamarra James-Todd, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health who has studied the issue for 20 years.
Studies have shown that straightener ingredients include phthalates, parabens, and other endocrine-disrupting compounds that mimic the body's hormones and have been linked to cancers as well as early puberty, fibroids, diabetes, and gestational high blood pressure, which is a key contributor to Black women's outsize risk of maternal mortality, James-Todd said.
“We have to do a better job regulating ingredients that people are exposed to, particularly some of our most vulnerable in this country,” she said. “I mean, children are being exposed to these.”
The first study linking hair relaxers to uterine cancer, published in 2022, found that frequent use of chemical straighteners more than doubled a woman's risk. It followed studies showing women who frequently used hair relaxers doubled their ovarian cancer risk and had a 31% higher risk of breast cancer.
Bumpus praised the studies as “scientifically sound” and said she would leave to epidemiologists and others questions about whether straightener ingredients besides formaldehyde might be contributing to an elevated risk of hormone-driven cancers.
She could not offer a timeline for a formaldehyde ban, except to say the agency was scheduled to initiate proceedings in April. The schedule could change, she said, and she did not know how long the process of finalizing a rule would take.
Brazilian Blowouts and similar hair-smoothing treatments sometimes use formaldehyde as a glue to hold the hair straight for months. Stylists usually seal the product into the hair with a flat iron. Heat converts liquid formaldehyde into a gas that creates fumes that can sicken salon workers and patrons.
In addition to cosmetics, formaldehyde is found in embalming fluid, medicines, fabric softeners, dishwashing liquid, paints, plywood, and particleboard. It irritates the throat, nose, eyes, and skin.
If there are opponents to a ban on formaldehyde in hair straighteners, they have not raised their voices. Even the Personal Care Products Council, which represents hair straightener manufacturers, supports a formaldehyde ban, spokesperson Stefanie Harrington said in an email. More than 10 years ago, she noted, a panel of industry-paid experts deemed hair products with formaldehyde unsafe when heated.
California and Maryland will ban formaldehyde from all personal-care products starting next year. And manufacturers already have curtailed their use of formaldehyde in hair care products. Reports to the California Department of Public Health's Safe Cosmetics Program show a tenfold drop in products containing formaldehyde from 2009 to 2022.
John Bailey, a former director of the FDA's Office of Cosmetics and Colors, said the federal agency often waits for the industry to voluntarily remove hazardous ingredients.
Cheryl Morrow co-founded The Relaxer Advocates late last year to lobby on behalf of California Curl, a business she inherited from her father, a barber who started the company, and other Black hair care companies and salons. “Ban it,” she said of formaldehyde, “but please don't mix it up culturally with what Black people are doing.”
She insisted the relaxers African Americans use contain no formaldehyde or other carcinogens and are safe.
A 2018 study found that hair products used primarily by Black women and children contained a host of hazardous ingredients. Investigators tested 18 products, from hot-oil treatments to anti-frizz polishes, conditioners, and relaxers. In each of the products they found at least four and as many as 30 endocrine-disrupting chemicals.
Racist beauty standards have long compelled girls and women with kinky hair to straighten it. Between 84% and 95% of Black women in the U.S. have reported using relaxers, studies show.
Black women's often frequent and lifelong application of chemical relaxers to their hair and scalp might explain why hormone-related cancers kill more Black women than white women per capita, Bertrand and other epidemiologists say. Relaxers can be so habit-forming that users call them “creamy crack.”
As a public health educator, Astrid Williams, director of programs and initiatives at the California Black Health Network, has known the health risks associated with hair relaxers for years. Nonetheless, she used them from age 13 until two years ago, when she was 45.
“I felt I had to show up in a certain way,” she said.
A formaldehyde ban won't make creamy crack safe, she said. “It's not even a band-aid. The solution is to address all chemicals that pose risk.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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By: Ronnie Cohen
Title: FDA's Plan to Ban Hair Relaxer Chemical Called Too Little, Too Late
Sourced From: kffhealthnews.org/news/article/hair-relaxers-straighteners-formaldehyde-carcinogen-fda/
Published Date: Thu, 08 Feb 2024 10:00:00 +0000
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Kaiser Health News
Union With Labor Dispute of Its Own Threatens to Cut Off Workers’ Health Benefits
Phil Galewitz, KFF Health News
Fri, 26 Jul 2024 09:00:00 +0000
The National Education Association, the nation's largest union, is threatening to cut off health insurance to about 300 Washington, D.C.-based workers on Aug. 1 in an effort to end a bitter contract dispute.
It's a tactic some private employers have used as leverage against unionized workers that has drawn scrutiny from congressional Democrats and is prohibited for state employers in California. Experts on labor law say they've never seen a union make the move against its own workers.
“This is like a man-bites-dog situation where the union is now in a position as the employer,” said Paul Clark, a professor of labor and employment relations at Penn State University. “It's not a good look for a union.”
NEA workers with pressing health needs are worried but say they won't fold. Joye Mercer Barksdale, a writer on the NEA's government relations team, said she needs coverage for a medical procedure to address atrial fibrillation, a cardiac disorder. “This is insane for the NEA to use our health benefits as a bargaining chip,” she said.
But Barksdale said the threat isn't enough to force her to agree to an unacceptable contract. “I am not ready to give in,” she said.
The NEA Staff Organization, the union representing workers at the NEA's headquarters, launched a strike on July 5 in Philadelphia, during the union's annual delegate assembly. It was its second walkout this summer as the two parties negotiate a new contract, navigating sticking points such as wages and remote work.
In response, the NEA ended the conference early. President Joe Biden was supposed to speak at the event but withdrew, refusing to cross the picket line. The NEA on July 24 endorsed Kamala Harris for president.
On July 8, the day after the conference had been scheduled to end, the NEA locked out workers. In a letter the day before, the NEA informed its unionized workers that they would not be paid, effective immediately, and their health benefits would expire at the end of July unless a new deal were reached.
“NEA cannot allow NEASO to act again in a way that will bring such lasting harm to our members and our organization,” Kim Anderson, the NEA's executive director, wrote in the letter, obtained by KFF Health News. “We are, and have always been, committed both to our union values and to the importance of conducting ourselves as a model employer.”
Democrats in Congress, including Sens. Sherrod Brown of Ohio and Bob Casey of Pennsylvania, introduced legislation last year to protect striking workers from losing their health benefits, after several large companies, including General Motors, John Deere, RTX (formerly Raytheon Technologies), and the maker of Kellogg's cereals, threatened to or did cut off coverage during labor disputes.
“Workers shouldn't have to choose between their family's health and a fair contract,” Brown said in a statement to KFF Health News.
The legislation was endorsed by large labor unions including the Service Employees International Union and United Steelworkers, according to a press release from Brown's office. The NEA wasn't among them.
“This tactic is immoral, and it should be illegal,” United Steelworkers' president at the time, Thomas Conway, said in the release.
Officials at the NEA, which represents teachers and other administrators, declined an interview request. In a statement, the organization's president, Becky Pringle, said “we are making every effort to reach an agreement as quickly as possible” with its staff union.
“As union leaders who have been on strike, we recognize the significance and impact of these important decisions on a personal and family level. We truly value our employees and look forward to continued collaboration with NEASO to develop a new contract that benefits us all,” she said.
Kate Hilts, a digital strategist who works for the NEA, said she fears losing her coverage will leave her unable to afford treatment for a rare autoimmune disease that attacks her kidneys. Her next treatment was slated for August.
“I wake up every day and can't believe this is happening,” she said. “You would expect this from an employer that is antiworker or has a terrible labor record, but I am totally flabbergasted that a labor union would do this that bills itself as pro-worker, pro-family, pro-education, and pro-children.”
The NEA staff union has filed multiple charges with the National Labor Relations Board this year, including allegations that the NEA withheld holiday overtime pay and failed to provide information on the outsourcing of millions of dollars in bargaining unit work.
California is one of the only states that protect striking workers from losing health coverage. The state legislature passed a law in 2021 that blocks the tactic from being used against public employees and another law in 2022 that allows any striking workers who lose their insurance to immediately get heavily discounted coverage through the state's Affordable Care Act marketplace.
If they remain locked out, the NEA workers would be eligible for coverage under COBRA, a federal program that allows people who are fired or laid off to maintain their employer-sponsored insurance for 18 months.
But the coverage can be a financial hardship, as individuals often must pay the entire cost of their insurance premiums, plus a 2% administrative fee.
Another option for workers would be coverage through the Affordable Care Act marketplace, though that also could be costly. And it may be unclear how soon that coverage would begin or whether insurers would cover their existing doctors.
“I'm hoping the NEA will be so ashamed of what they are doing that, at the very least, they will not take away our health benefits,” Barksdale said.
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By: Phil Galewitz, KFF Health News
Title: Union With Labor Dispute of Its Own Threatens to Cut Off Workers' Health Benefits
Sourced From: kffhealthnews.org/news/article/nea-national-education-association-union-threatens-health-insurance-benefit-lockout/
Published Date: Fri, 26 Jul 2024 09:00:00 +0000
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Kaiser Health News
The CDC’s Test for Bird Flu Works, but It Has Issues
Arthur Allen and Amy Maxmen
Fri, 26 Jul 2024 09:00:00 +0000
The Centers for Disease Control and Prevention says a glitch in its bird flu test hasn't harmed the agency's outbreak response. But it has ignited scrutiny of its go-it-alone approach in testing for emerging pathogens.
The agency has quietly worked since April to resolve a nagging issue with the test it developed, even as the virus swept through dairy farms and chicken houses across the country and infected at least 13 farmworkers this year.
At a congressional hearing July 23, Rep. Brett Guthrie (R-Ky.) asked about the issue. “Boy, that rings of 2020,” he said, referring to when the nation was caught off guard by the covid-19 pandemic, in part because of dysfunctional tests made by the CDC. Demetre Daskalakis, director of the CDC's National Center for Immunization and Respiratory Diseases, responded that the agency rapidly developed a workaround that makes its bird flu test reliable.
“The tests are 100% usable,” he later told KFF Health News, adding that the FDA studied the tests and came to the same conclusion. The imperfect tests, which have a faulty element that sometimes requires testing a sample again, will be replaced soon. He added, “We have made sure that we're offering a high-quality product.”
Still, some researchers were unnerved by the news coming four months after the government declared a worrisome bird flu outbreak among cattle. The CDC's test is the only one available for clinical use. Some researchers say its flaws, though manageable, underscore the risk of relying on a single entity for testing.
The problem came to light in April as the agency prepared to distribute its test to about 100 public health labs around the country. CDC officials detected the issue through a quality control system put in place after the covid test catastrophe of 2020.
Daskalakis said the CDC's original test design was fine, but a flaw emerged when a company contracted by the agency manufactured the tests in bulk. In these tests, one of two components that recognize proteins called H5 in the H5N1 bird flu virus was unreliable, eliminating an important safeguard. By targeting the same protein twice, tests have a built-in backup in case one part fails.
The agency developed a fix to ensure a reliable result: If only one of the two parts detected H5, the test was considered inconclusive and would be run again. With the FDA's blessing, the CDC distributed the tests — with workaround instructions — to public health labs.
Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories, said the results of the tests have not been ambiguous, and there is no need to discard the tests.
Still, the agency has asked a different manufacturer to remake the faulty component so that 1.2 million improved tests will be available soon, Daskalakis said. Some of the updated tests are already in stock at the CDC, but the FDA hasn't yet signed off on their use. Daskalakis declined to name the manufacturers.
Meanwhile, the outbreak has grown. Farmworkers continue to lack information about the virus and gear to protect them from it. Rural clinics may miss cases if they don't catch a person's connection to a farm and notify health officials rather than their usual diagnostic testing laboratories.
Those clinical labs remain unauthorized to test for the bird flu. Several of those labs have spent months working through analyses and red tape so that they can run the CDC's tests. As part of the licensing process, the CDC alerted them to the workaround with the current test, too.
But outside select circles, the news was largely overlooked. “I'm totally surprised by this,” Alex Greninger, assistant director of the University of Washington Clinical Virology Laboratory, told KFF Health News this week. Greninger's lab is developing its own test and has been trying to obtain CDC test kits to evaluate.
“It's not a red alarm,” he said, but he's worried that as the CDC and the FDA spend months developing and evaluating an updated test, the only one available relies on a single component. If the genetic code underlying that fragment of the H5 protein mutates, the test could give false results.
It's not uncommon for academic and commercial diagnostic labs to make mistakes and catch them during quality control checks, as the CDC did. Still, this isn't the agency's first mishap. In 2016, well before the covid debacle, CDC officials for months directed public health labs to use a Zika test that failed about a third of the time.
The CDC caught and worked to remediate the situation far more quickly and effectively in this case. Nonetheless, the mishap raises concern. Michael Mina, chief science officer of the telemedicine company eMed.com, said diagnostic companies may be better suited to the task.
“It's a reminder that CDC is not a robust manufacturer of tests” and lacks the resources that industry can marshal for their production, Mina said. “We do not ask CDC to make vaccines and pharmaceuticals, and we do not ask the Pentagon to manufacture missiles.”
The CDC has licensed its updated test design to at least seven clinical diagnostic labs. Such labs are the foundation of testing in the U.S. But none have FDA clearance to use them.
Diagnostic labs are developing their own tests, too. But that has been slow-going. One reason is the lack of guaranteed sales. Another is regulatory uncertainty. Recent FDA guidance could make it harder for nongovernmental laboratories to issue new tests in the early phase of pandemics, said Susan Van Meter, president of the American Clinical Laboratory Association, in a July 1 letter to the FDA.
Transparency is also critical, scientists said. Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University, said as a public agency the CDC should make its protocol — its recipe for making the test — easily accessible online.
The World Health Organization does so for its bird flu tests, and with that information in hand, Pinsky's lab has developed an H5 bird flu test suited to the strain circulating this year in the U.S. The lab published its approach this month but doesn't have FDA authorization for its broad use.
The CDC's test recipe is available in a published patent, Daskalakis said.
“We have made sure that tests are out there, and that they work,” he added.
As the CDC came under fire at the July 23 congressional hearing, Daniel Jernigan, director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases, noted that testing is just one tool. The agency needs money for another promising area — looking for the virus in wastewater. Its current program uses supplemental funds, he said: “It is not in the current budget and will go away without additional funding.”
——————————
By: Arthur Allen and Amy Maxmen
Title: The CDC's Test for Bird Flu Works, but It Has Issues
Sourced From: kffhealthnews.org/news/article/bird-flu-test-cdc-flaws/
Published Date: Fri, 26 Jul 2024 09:00:00 +0000
Kaiser Health News
KFF Health News’ ‘What the Health?’: Harris in the Spotlight
Thu, 25 Jul 2024 18:45:00 +0000
The Host
Julie Rovner
KFF Health News
Julie Rovner is chief Washington correspondent and host of KFF Health News' weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
As Vice President Kamala Harris appears poised to become the Democratic Party's presidential nominee, health policy in general and reproductive health issues in particular are likely to have a higher profile. Harris has long been the Biden administration's point person on abortion rights and reproductive health and was active on other health issues while serving as California's attorney general.
Meanwhile, Congress is back for a brief session between presidential conventions, but efforts in the GOP-led House to pass the annual spending bills, due by Oct. 1, have run into the usual roadblocks over abortion-related issues.
This week's panelists are Julie Rovner of KFF Health News, Stephanie Armour of KFF Health News, Rachel Cohrs Zhang of Stat, and Alice Miranda Ollstein of Politico.
Panelists
Stephanie Armour
KFF Health News
Rachel Cohrs Zhang
Stat News
Alice Miranda Ollstein
Politico
Among the takeaways from this week's episode:
- President Joe Biden's decision to drop out of the presidential race has turned attention to his likely successor on the Democratic ticket, Vice President Kamala Harris. At this late hour in the campaign, she is expected to adopt Biden's health policies, though many anticipate she'll take a firmer stance on restoring Roe v. Wade. And while abortion rights supporters are enthusiastic about Harris' candidacy, opponents are eager to frame her views as extreme.
- As he transitions from incumbent candidate to outgoing president, Biden is working to frame his legacy, including on health policy. The president has expressed pride that his signature domestic achievement, the Inflation Reduction Act, took on the pharmaceutical industry, including by forcing the makers of the most expensive drugs into negotiations with Medicare. Yet, as with the Affordable Care Act's delayed implementation and results, most Americans have yet to see the IRA's potential effect on drug prices.
- Lawmakers continue to be hung up on federal government spending, leaving appropriations work undone as they prepare to leave for summer recess. Fights over abortion are, once again, gumming up the works.
- In abortion news, Iowa's six-week limit is scheduled to take effect next week, causing rippling problems of abortion access throughout the region. In Louisiana, which added the two drugs used in medication abortions to its list of controlled substances, doctors are having difficulty using the pills for other indications. And doctors who oppose abortion are pushing higher-risk procedures, like cesarean sections, in lieu of pregnancy termination when the mother's life is in danger — as states with strict bans, like Texas and Louisiana, are reporting a rise in the use of surgeries, including hysterectomies, to end pregnancies.
- The Government Accountability Office reports that many states incorrectly removed hundreds of thousands of eligible people from the Medicaid rolls during the “unwinding” of the covid-19 public health emergency's coverage protections. The Biden administration has been reluctant to call out those states publicly in an attempt to keep the process as apolitical as possible.
Also this week, Rovner interviews Anthony Wright, the new executive director of the consumer health advocacy group Families USA. Wright spent the past two decades in California, working with, among others, now-Vice President Kamala Harris on various health issues.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: NPR's “A Study Finds That Dogs Can Smell Your Stress — And Make Decisions Accordingly,” by Rachel Treisman.
Alice Miranda Ollstein: Stat's “A Pricey Gilead HIV Drug Could Be Made for Dramatically Less Than the Company Charges,” by Ed Silverman, and Politico's “Federal HIV Program Set To Wind Down,” by Alice Miranda Ollstein and David Lim.
Stephanie Armour: Vox's “Free Medical School Won't Solve the Doctor Shortage,” by Dylan Scott.
Rachel Cohrs Zhang: Stat's “How UnitedHealth Harnesses Its Physician Empire To Squeeze Profits out of Patients,” by Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence.
Also mentioned on this week's podcast:
- States Newsroom's “Anti-Abortion Researchers Back Riskier Procedures When Pregnancy Termination Is Needed, Experts Say,” by Sofia Resnick.
- KFF Health News' “Louisiana Reclassifies Drugs Used in Abortions as Controlled Dangerous Substances,” by Rosemary Westwood, WWNO.
- The New York Times' “Biden and Georgia Are Waging a Fight Over Medicaid and the Future of Obamacare,” by Noah Weiland.
Credits
Francis Ying
Audio producer
Emmarie Huetteman
Editor
To hear all our podcasts, click here.
And subscribe to KFF Health News' “What the Health?” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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This story can be republished for free (details).
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Title: KFF Health News' ‘What the Health?': Harris in the Spotlight
Sourced From: kffhealthnews.org/news/podcast/what-the-health-357-kamala-harris-campaign-health-policy-july-25-2024/
Published Date: Thu, 25 Jul 2024 18:45:00 +0000
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