FDA: Antibacterial soaps could pose health risks
usatoday.com
usatoday.com
http://wwwnc.cdc.gov/eid/article/7/2/70-0225_article.htm
Some people are expected to wash their hands a lot. Clinicians, people preparing food, etc. It's important to us that they have clean hands.
Some cleaning routines damage the skin, causing places where risky germs can hide. Sometimes cleaning just moves germs that are safely colonising skin into the air, or onto different parts of the skin.
> "Consumers assume that by using antibacterial soap products they're protecting themselves and their families from illness — but we don't have any evidence that they're better than simple soap and water," Kweder said.
Some people are pretty keen on "The Hygiene Hypothesis" - that over clean environments has caused an increase in illnesses such as eczema or asthma, and that some exposure to dirt helps build a robust immune system. I'm not sure what the research is?
> But many of those images "look like people who have viral illnesses" such as the common cold, she said. Viruses are the most common cause of infections in the United States and antibacterial agents have no effect on them.
See also the marketing for alcohol-based hand cleaners, which don't do much against some bacteria.
It's good that the FDA is asking companies to prove the effectiveness of claimed benefits. It's gently worrying that the companies will do the minimum possible, rather than a collaborative big proper study.
at least for infants/children, the research is in favor of introducing bacteria to the immune system.
Exposure to microbes during early childhood is associated with protection from immune-mediated diseases such as inflammatory bowel disease (IBD) and asthma.
...
These results indicate that age-sensitive contact with commensal microbes is critical for establishing mucosal iNKT cell tolerance to later environmental exposures.
http://www.sciencemag.org/content/336/6080/489.abstract#aff-...
also some interesting info on children delivered by c-sections (which prevents newborns from getting into contact with the diverse vaginal flora):
CS was associated with a lower total microbial diversity, delayed colonisation of the Bacteroidetes phylum and reduced Th1 responses during the first 2 years of life.
http://gut.bmj.com/content/early/2013/07/09/gutjnl-2012-3032...
there's much more info to be found on the topic. these are just the ones i recently stumbled upon.
If you believe that evolution generates behavior to maximize survival value, this fact about babies seems relevant.
In summary, it's a long, long shot to claim that babies being willing to eat anything constitutes evidence that bacterial exposure is beneficial.
My wife on the other hand grew up in a spotlessly clean house, and has a range of allergies, asthma, coeliac disease, allergic to asprin and anaesthetics.
In fact, hand-washing took a really long time to catch on, largely because doctors saw it as an inconvenience. Some surgeons used to pride themselves on wearing lab coats covered with blood; it was the sign of a busy practice.
This story in the New Yorker actually makes a much broader, interesting point, investigating why some innovations take so long to catch on. For example, anesthesia was discovered around the same time as antiseptics, but it caught on about a decade sooner.
http://www.newyorker.com/reporting/2013/07/29/130729fa_fact_...
Scientists say that these chemicals may act as hormone disruptors, pointing to a link between triclosan exposure and allergies.
That's not accurate. It does work, as in, it does kill bacteria.
The question is if this killing has any value. i.e. does it actually prevent illness. It's pretty clear that in a hospital or nursing home setting triclosan is worth it. It's not so clear if it's worth it in the home.
Then there is a secondary question of does it cause resistance in the bacteria, which then causes it to be less effective where it's needed, i.e. medical settings. For that, it might work, but not be worth it for society as a whole.
> That's not accurate. It does work, as in, it does kill bacteria.
It's known to work in vitro, and it's known to work in toothpaste.
It sounds like there is no body of evidence to indicate that it works in things like hand soaps. Considering how often agents like this are found to work under one set of circumstances and not under another, I'd say that suggests that whether the agent works for this purpose is still an unknown.
Even if it does work (as in kill bacteria) on the hand, that doesn't mean it works (as in prevents illness).
And in medical settings it's yet another question: does it work (as in prevent the spread of bacteria), even if it doesn't prevent illness.
You have to be careful about what your goal is.
So in result: say no to antibacterial soap, say yes to whatever Doctor House prescribes you.
This has been seen with C. difficile infections that occur after broad-spectrum antibiotic administration. These infections are 50% fatal when treated with more antibiotics. Use of fecal transplants, aka the poop of a healthy person put it into the c. difficile patient's stomach, seems to drop that fatality rate to less than 1%. The impact appears to be from the reestablishment of bacterial homeostasis in the gastrointestinal tract.
Study is still ongoing on the broad efficacy of this method, but regardless there is at the very least a substantial subset of the population who are demonstrably at risk from the loss of native flora due to bactericidal treatment.
The question is not whether anti-bacterial soaps kill bacteria (they do). The question is whether using them has health benefits or not.
Dousing those removed bacteria with chemicals, to which they could become resistant, makes no sense to me.
Resistance is unlikely as these chemicals are a lot more harsh than antibiotics, because they don't have to go through your bloodstream and kill only bacteria without hurting the host's cells. These are also just everyday bacteria, so only a tiny, tiny fraction of the population will ever get on your hands and become exposed to the chemical, so there isn't significant selection pressure for resistance (though to be fair if we are talking about only bacteria which are dangerous to humans, there might be a larger selection pressure.) And so what if they do become resistant? There are other chemicals and we can always go back to just regular soap. Resistant bacteria are also generally weaker than non-resistant varieties.
Triclosan also has to be declared as an active ingredient in toothpaste, so it's not exactly hidden. Just spend 5 minutes reading some labels at the store.
Archeologically, before people started eating grains and processed "psuedo-food" we mostly died with good teeth and its a stereotypical observation that you can tell when grain agriculture sets in with a people when their teeth start rotting out at a young age.
Off the shelf at a regular store though, it's hard to find soaps (and toothpastes) without these ingredients. Just one more reason to DIY, especially with things that are going in/on your body.
Safer? Probably not. Probably not worth the risks.
The 1st one is a meta analysis of similarly small studies. When you've got a meta-analysis of small studies showing an overall small effect size, there's a good chance that the only thing the meta-analysis actually measures is the file drawer effect.
And of course the needed contact with foreign agents to build immune resistance. Use antibacterial soap when needed: hospitals
http://en.wikipedia.org/wiki/Antiseptic#Evolved_resistance
I'm not sure if there's a relation of resistance between biocides and antibiotics
The agency's proposal comes more than 40 years after the agency was first tasked with evaluating triclosan and similar ingredients. Ultimately, the government agreed to publish its findings only after a legal battle with an environmental group, which accused the FDA of delaying action.
I'm also reminded of another FDA shenanigan: http://en.wikipedia.org/wiki/Stevia#Controversy
I would be interested to know of any summary of dermatology studies on anti-bacterial soaps. I would theorize that much as screwing around with your gut flora leads to all manner of uncomfortable stinkiness, so should screwing around with your skin flora. So people who use overly aggressive decontamination solutions on their bodies should be stinkier and have more and weirder rashes than people using normal stuff.
The stinky hypothesis is interesting, I would think it would require an experiment designed around the use of deodorant soaps (which often contain anti-microbials). We know of course that people who wash very rarely often do have a distinct odor, though there's at least some implication that diet plays a part in exactly how stinky it is.
But where does the FDA get the authority to regulate soap? It's not food or a drug - you don't put it into your body at all. Indeed, the whole point is that it's supposed to NOT directly affect you at all.
facepalm
Do you really think those products you are rubbing around your skin every day and sniffing up your nose don't get absorbed by your skin and lungs!!? I mean they make drugs that can be rubbed on like lotion, as well as medications that can be delivered in patch form and your telling me "well it isn't going in your body so it won't directly affect you."
We don't know yet. There are thoughts that triclosan might cause endocrine disruption. but I don't know and I don't think the science has been done yet. The FDA wants to find out. This is GOOD. The FDA should be doing more to vet the cosmetics industry which is mostly a wild west at the moment.
The Campaign for Safe Cosmetics explains: http://safecosmetics.org/section.php?id=75
The agency charged with oversight of cosmetics, the U.S. Food and Drug Administration (FDA), has no authority to require pre-market safety assessment as it does with drugs, so cosmetics are among the least-regulated products on the market. The FDA does not review – nor does it have the authority to regulate – what goes into cosmetics before they are marketed for salon use and consumer use. In fact, 89 percent of all ingredients in cosmetics have not been evaluated for safety by any publicly accountable institution.
Ironically, most consumers believe the U.S. government regulates the cosmetics industry the same way it regulates food and drugs sold in this country to make sure they're safe. The truth is, no one's minding the store when it comes to shampoo, skin moisturizers, baby products, lipstick or any other personal care product.
The FDA’s own Web site explains its limitations:
“FDA's legal authority over cosmetics is different from other products regulated by the agency .... Cosmetic products and ingredients are not subject to FDA premarket approval authority, with the exception of color additives.”
Here's a link about formaldehyde in hair straighteners:
http://www.scientificamerican.com/article.cfm?id=us-governme...
Josimov began to realize it was her life that was changing. Her progression of symptoms mirrored hundreds of other stylists – the burning eyes and sore throats followed by chronic runny noses. Respiratory infections settled in for months, accompanied by scabby blisters in the nose. With prolonged exposure came the asthma-like wheezing and shortness of breath.
After Arce's exposures, she started getting rashes, headaches and sore throats. Now she coughs up bloody mucous and is on two inhalers. Marino would get nauseated and dizzy, and would have to stick plastic bags in her purse in case she had to throw up in public. She was diagnosed with asthma and sinus infections.
Nice attitude. Remember, you're on HN, not reddit.
Do you really think those products you are rubbing around your skin every day and sniffing up your nose don't get absorbed by your skin and lungs!!?
Aside from the fact that I don't typically snort lotion, it's true that there are plenty of things that come into contact with my body all the time. So maybe you can help me understand where to draw the line.
For example, why is hand soap of interest to the FDA, but not:
- dish detergent, since I'm actually ingesting some small remnant of their content
- laundry detergent, and especially softener, since that's rubbing against my skin for nearly 24 hours/day.
- building materials, whose outgassing I'm inhaling for much of the day
Further, in your quotation above, this part seems pretty much nonsensical: "The FDA does not review – nor does it have the authority to regulate – what goes into cosmetics before they are marketed for salon use and consumer use.". I read this to say that "you can sell any cosmetics you want - as long as you don't try to sell it".
mostly a wild west at the moment.
Is that necessarily a problem? Is there a reason that everything must be regulated? If you're worried about safety, as in your final quotation, then why not settle for warnings while letting the users determine if they've got, e.g., adequate ventilation, or if there's other circumstances that make the risk worthwhile. For example, I typically won't use antibacterial soap myself, but if I've got a cut, or doing something else for which sanitation is important, it may be worthwhile in that special case. Government regulations lead to one-size-fits-all, and that size is the lowest common denominator, with no accommodation for individual circumstances - take their position on experimental drugs for terminal patients, for example.
http://www.fda.gov/cosmetics/productandingredientsafety/Prod...
>Ordinary soap is solely made up of fats and an alkali. In the past, people made their own soap from animal fats and wood ashes.
>Today there are very few true soaps in the traditional sense on the market. You might recognize these soaps as products marketed with characteristics such as "pure." "True" soaps are regulated by the Consumer Product Safety Commission, not FDA, and do not require ingredient labeling.
Also, the second a product claims to be "Antibacterial" it is making a drug claim, and needs to have a drug list on the bottle.
>If a drug claim is made on a cleanser or soap, such as antibacterial, antiperspirant, or anti acne, the product is a drug, and the label must list all active ingredients, as is required for all drug products.
And the other examples you gave all have their own regulatory agencies which in theory should protect the public. The FDA is concerned with food, drugs, and cosmetics. Period. Cosmetics are certainly ingested (think lipstick, lipgloss) as well as absorbed into the body. It makes senses for the FDA to have that under their wing.
But your argument that the FDA shouldn't be regulating products that are applied directly to the skin takes libertarian dogma to confusing heights. Do you think we should allow Tho-Radia cosmetics to still be sold for example?
And warning labels? Really? You realize that warning labels are also imposed by the FDA, right? And besides, exactly how do warning labels protect me from formaldehyde fumes (or radiation, as from Tho-Radia) caused by someone else in my vicinity who chooses to ignore them?
If you go back, you'll see that I never actually said that. I asked a question, I didn't argue against it.
So you're not interested in answering the line-drawing question: why soap, but not fabric softener or dish detergent?
And the problem with lowest-common-denominator solutions remains. Why must I, a terminally ill cancer patient, be subject to the same rules as a healthy person? In bureaucracy, there's no room for anyone to be different.
My personal opinion is that products that are dangerous by their very nature, such as radium-containing makeup, lead paint, and formaldehyde-laden hair products, should be strictly regulated. Given that, I naturally support the existence of regulatory agencies to do the work, by force if necessary.
I don't know enough about triclosan to have a strong opinion about it. I'm a pragmatist by any measure, and I generally lean toward the conservative side in this area. But I'm not so rash that I would question the very existence of all regulations just because said agencies make a decision that I don't like.
Edit: My last sentence reads a bit harshly. I'm not calling you rash, but rather reflecting on my own thought process.
The FDA regulates cosmetics, which, like soap, are supposed to stay outside the body.
What do you call antibiotics, then, if not drugs?