You might not realize how many chemicals you and your kids are exposed to in a lifetime. Yet it’s important to understand where these exposures happen, how they impact your health, and how to best avoid them. In this episode, you’ll hear from Dr. Trasande, an internationally-renowned leader in environmental health, as we dig deeper into hormone-disrupting chemical exposure and what we can do to safeguard our families.
You might not realize how many chemicals you and your kids are exposed to in a lifetime. Yet it’s important to understand where these exposures happen, how they impact your health, and how to best avoid them. In this episode, you’ll hear from Dr. Trasande, an internationally-renowned leader in environmental health, as we dig deeper into hormone-disrupting chemical exposure and what we can do to safeguard our families.
Welcome to raising healthy families with Moms Meet and KIWI. We're giving you the tools to enjoy the beauty and chaos of life with little ones in the healthiest way possible.
Maureen:Hi everyone, I'm Maureen Frost, editorial director and today's host. In this episode hear from Dr. Trasande, an internationally renowned leader and environmental health. We're digging deeper into hormone disrupting chemical exposure for kids and adults and what we can do to safeguard our families. This episode is brought to you by Zahlers. Between family times, school and extracurricular activities, sometimes our children need help to find their calm and stay focused. That's where Zahlers Child Calm comes in. Child Calm is an all natural children's relaxation formula, promoting a calm and soothing effect. It contains a powerful blend of ingredients, such as magnesium, l theanine, lemon balm leaf extract, and more to promote calm a better attention span and a good night's sleep and children. Plus, it's kosher, non GMO, dairy free, soy free, and vegetarian friendly. The chewable tablets come in a great tasting fruit punch flavor that kids love. Today we're joined by Dr. Trasande, the Jim G. Hendrick MD professor, Director of the Division of Environmental pediatrics and vice chair for research in the department of pediatrics at NYU School of Medicine. His research focuses on the impacts of chemicals, on hormones in our bodies. He also has led the way in documenting the economic costs for policymakers of failing to prevent diseases of environmental origin proactively in his book sicker, fatter, poor, the urgent threat of hormone disrupting chemicals to our health and future and what we can do about it, he reveals the alarming truth about how hormone disrupting chemicals are affecting our daily lives and what we can do to protect ourselves and fight back. Thank you so much for joining us today, Dr. Trasande.
Dr. Trasande:It's a delight to be here. Thank you.
Maureen:Great. So let's dive into the questions. To get started. Can you give us just a little bit more background on what – on your work in pediatric environmental health and how you got into this field?
Dr. Trasande:Sure. So I was a medical student in the 1990s. And I would tell you that we didn't have a lot of environmental health as part of the training back then, in fact, the notion of endocrine disruption wasn't in the medical textbooks. The reality was we were taught that only the dose makes the thing a poison. It's like a quote attributed to this guy named Paracelsus, from 500 years ago, Sola dosis facit venenum , and it's akin to everything in moderation, which is common sense. After all, a little bit of this, a little bit of that can't hurt you. But unfortunately, as time goes along, and we see that in science a lot, we find things out that surprised us, and I'll come back to that later. But it was after medical school that I really got into environmental health, I was actually more interested in health care policy. I've gotten a master's of public policy that medical degree, gotten infected with capital fever, if you will, decided to spend a year on Capitol Hill working for then Senator Hillary Rodham Clinton. And I was told to work on children's and environmental health, I figured I had the child health part down. It was the environmental health part, really opened my eyes, it transformed my whole thought process about my career. And so I decided to get some fellowship training in what we call environmental pediatrics, the study of environmental exposures and kids. And I proceeded from there and decided to split devote my career trying to understand what environmental factors are doing to kids and all of us, frankly, and then what we can do about it, ultimately, and trying to make the case for policymakers, and ideally, the general public and not to mention companies to do the right thing. And protect the public from these exposures. So that's a bit of the story of how I got to where I got today.
Maureen:Yeah, that's a very interesting pathway. I love that. That's great story. So much of what we talk about is how environmental factors can affect our hormones in the body. But can you first just for our audience talk a little bit about what the role is of our hormones in our body.
Dr. Trasande:So hormones are basic signaling molecules, and they underlie every basic biological function known to humans. Healthy body temperature, metabolism, salt, sugar, even sex, they're how organs signal to each other. It's like traffic signals or a variety of other signals, if you will. And so, those are natural molecules. And they are crucial to human health and functioning and the effects can run the entire life. Of course, they vary based upon when the hormones are working. But it's when synthetic chemicals that were not designed with hormones in mind and not designed with the human body, for that matter in mind, hack those natural hormonal functions that you have disease and disability arise. And that's really what the research I do focuses on these days. It's what the synthetic chemicals in our environment are doing to hormones, and ultimately our health.
Maureen:So these hormone disrupting chemicals, so what what are they doing and what can they do to the human body once we're exposed to them?
Dr. Trasande:So let's talk first about these exposures which are frankly, in everyday life. So we arguably know the most about five categories of synthetic chemicals. So we're talking about Phthalates, used in personal care products, cosmetics and food packaging, bisphenols used in aluminum can linings and thermal paper seats, pesticides used in agriculture, brominated flame retardants used in electronics and furniture. And then the newest chemicals to come on the scene with really a lot of data are these perfluoroalkyl substances or pfas. You'd have to think Mark Russello in this movie dark waters. And that movie really put these chemicals on the general public consciousness map. They're in oil and water resistant clothing and nonstick cooking materials, and they're in the water supply of 100 million Americans. So when we talk about these exposures, they really are affecting everyone. Then let's pivot to what they do to people. So timing isn't just important, it's the only thing arguably. And when we talk about all of us being affected by these exposures, of course, I'm going to tell you, as a pediatrician, kids are uniquely vulnerable, they have greater intake per pound body weight, they have developing organ systems that are susceptible to long term effects. And they the other factors that are important to, but every one life is a window of susceptibility to endocrine disrupting chemicals. So in early life, we know that brain development is particularly vulnerable. Thyroid hormone is the master growth sector. And you rely as a baby on mom's thyroid hormones for the second trimester of pregnancy. And so if brominated flame retardants get in there and hack thyroid hormone, or pesticides get in there and do that, even in the clinically normal range might choose this isn't something enough obstetrician can detect that oh, your thyroid hormone is off. No, this is normal results. These chemicals do their damage and you shift divert hormone just a little bit. You can have cognitive deficits, autism and attention deficit hyperactivity disorder. So these are permanent, lifelong effects. So moving from the developing brains of young kids, when it comes to metabolism, we used to think yes, diet, physical activity, the major drivers of the obesity, diabetes pandemics that we experienced in the world, right. But what we know is that synthetic chemicals are in a third important underrecognized factor just to take the pfas, for example. In a study of adults who lost weight to healthy diet and physical activity, just as they were finishing up, they drew some blood, measured these pfas and then they follow the weights of these adults over time. And the higher the pfas levels, the more the weight gain. And then when they dug in further, they realized that the metabolism was slowed, the resting metabolic rates were lower. So imagine on a cold winter day it turned the body's thermostat the wrong way and you're shivering right, or you're not even shivering, you're just you feeling cold. That's what happens when the body is told, Oh no, no, don't burn energy store it as fat. And so these PFAs are functionally making adults who are trying to do the right thing for healthy diet and physical activity to gain weight back because it's wrecking metabolism, Phthalates, these plasticizing chemicals I talked about. They are disrupting the the expression of genes that are crucial for fat and protein metabolism. So you talked about getting a good workout in having a good protein meal, and your body is misprogrammed to make those calories into fat as opposed to muscle. And so that's just another example of the kinds of effects that are involved and, you know, we can go further reach out with the heart We know that testosterone isn't just a thing for potency or fertility. Low T is a low testosterone is a marker for or predictor of adult cardiovascular disease. And so we know that that Phthalates don't just contribute to obesity and diabetes, they literally kill adults. In one study we did, we looked at a nationally representative sample of adults and follow them over time, the higher the Phthalates levels 10 years before, the more likely they were to have died, when we were able to assess based on death certificates. And when you looked further at the cause of death, it was cardiovascular mortality, and that was in men and in women. So it's not as though one sexes necessarily more vulnerable, though there are differences by sex because these chemicals do hack sex hormones. Bisphenol are synthetic estrogens, they were considered as a pharmaceutical estrogen back in the 1950s. But they weren't potent enough, well, low level estrogens can do things like contribute to ovarian cancer or ovarian dysfunction, not to mention dysfunction in the uterine lining, and things like endometriosis come to mind as potential effects of endocrine disrupting chemicals. So that leaves aside certain cancers in men that have been linked. So when you really run the gamut from baby's brain damage to obesity and diabetes, in adults and kids to heart disease, cancers, you're really talking about a broad array effects. It's almost just impossible to imagine or inconceivable to imagine. But the fact is, if you were using synthetic chemicals, without the body's hormones in mind, hormones do everything. And so when you're hacking hormones, you're gambling with your health.
Maureen:Yeah. It really is in every area. And so some of these chemicals that you talked about, I know a little bit that we can't ever get rid they're persistent in the body. Is that - what is that? Which chemicals does that pertain to? And can we ever get rid of any of these if we've been exposed to them?
Dr. Trasande:So some persist, some don't. That's the reality. It's just based on whether the kidneys or the liver can excrete, or the skin or other organ systems can excrete these chemicals in the first place. So the brominated flame retardants are best known as persistent chemicals because they tend to find their ways into parts of the body and hide and don't get excreted. diseases take years to get out. The phthalates and pesticides and bisphenols tend to have shorter half lives because they just get excreted more laterally in the urine. And so that doesn't mean they don't have effects. There's this thing called hit and run, you have a vulnerable window of development, especially in kids, but it can be in adults too. And you won't even know what the effects are years later. Because that chemicals left the body and it's replaced by whatever you're being exposed to in your daily living sound as though these chemicals disappear either. It's just you're constantly re exposed to new amounts of chemicals that your body is doing its best and excreting as it goes. So the good news and we should get some good news soon, I hope. They're safe and simple steps to reduce your exposure of many of these chemicals. They do go out at the body quickly. And so if you implement the safe and simple steps, you reduce your exposure and you can have immediate benefits for your health.
Maureen:Yeah, absolutely. So you talked a little bit about exposure and pregnancy and how this can affect hormones do do these environmental toxins can can they affect fertility in women and also in men?
Dr. Trasande:We've talked mostly about male factor infertility thus far, mostly due to the Phthalates. Though pfas and pesticides do appear to also have effects. Most of that is a byproduct of early reproductive development, where studies have actually looked at this anatomic distance called anogenital distances. It's literally the distance from the anus to the base of the of the testis or penis depending on what you're talking about. And shortening in that distance reflects less testosterone and men. Women tend to have longer distances for the equivalent body parts because that's a sign that estrogen has gotten in there and facilitated growth. The anogenital distance in men, the shorter the anogenital distance, the more likely to have lower sperm count, not to mention other consequences. And Phthalates had been associated with reduced anogenital distance in young boys. And that anogenital distance is hard to change over time they've done studies, at least in animals, and the anogenital distance you have at birth is the anogenital distance that you have as an adult, essentially. So, early life is a really crucial window for particularly in fertility men. Now, let's pivot to women, for example. There's a lot we don't know. Some of that is that we haven't developed the tissue assays to really evaluate function in a way that can inform the question at hand is what's driving female factor infertility. But what we know so far, is that pfas, are associated with endometriosis. Endometriosis is not good for fertility, we know that levels of certain chemicals can affect ovarian function. We know that pfas are also associated with polycystic ovarian syndrome. In case control studies, modest. You know, that's a modest frequency and extreme event. But one of the concerns that we all have is that these synthetic chemicals are doing something suddenly to disrupt ovarian and other female reproductive tract function and thereby contribute to female factor infertility as well. You know, it takes two to tango. It takes male factor and female factor to be successful to have a pregnancy.
Maureen:Yeah, absolutely. I mean, as a female, we we talk about those types of things within our circles and with our within our friends and you hear somebody has PCOS or endometriosis or things like that, it's, it's interesting to hear that some of these could be a factor in why, why that's been experienced. And you know, as a woman who's trying to get pregnant, those those are hurdles that you really have to jump over. So it's interesting and scary all at the same time. So when we talk about synthetic chemicals, how many would you say that we are exposed to in our daily lives?
Dr. Trasande:So there are different numbers out there. And the numbers are dizzying when you think about the sheer enormity of the chemical exposure on daily lives, is anywhere from 80 to 140,000, the chemical industry will argue is lower. It depends on how you define it. There's actually even an estimate from an academic group, it's actually 300,000. Without getting into the weeds, these are big numbers of synthetic chemicals. We live in a chemical soup. So the argument of the chemical industry is that well, many of those chemicals have been phased out, we don't use those anymore. And that's why the numbers lower, but there's at least one to 3000 new chemicals introduced in manufacturing each year. And unfortunately, one of the patterns we see is that the chemicals of concern that are already emerging are just getting replaced with siblings, or regrettable substitutes. An example is Bisphenol or BPA. BPA free got huge amount of attention in the late 2000s. It was the banned by the FDA in baby bottles and sippy cups. Then what happened is we had 40 or so artists formerly known as BPA come onto the scene. BPS, one bisphenol S, one example is as estrogenic as persistent in the environment and as toxic embryos. So we've literally whacked the mole. We've replaced one problematic chemical with another. So when you don't have a regulatory framework that tests chemicals before they're used, and doesn't regulate chemicals, by class, I mean, you can guess if one chemical in a group is doing something structure follows function and generally, so you have a situation where one chemical in the same category is likely effects to the other. So you probably should err on the side of regulating by class. But that's fought tooth and nail by the chemical industry.
Maureen:I mean, I do recall hearing that many times that okay, even if you're going to buy something that's BPA free, that doesn't necessarily mean it's safe, and you're out of the woods. If you're if you're buying plastic, so it's it's very hard for consumers to to understand and be educated in all of these different chemical combinations that, you know, we don't really know about is consumer, so it's really tricky. Out there. Absolutely. Let's see. I want to switch gears a little bit to some thing that you mentioned in your intro and talk about the term or the phrase, the dose makes the poison when it comes to chemical exposure, because I hear this so much in the argument that, yes, you might be exposed to something that is could be concerning, but it's at a safe level. So what does that actually mean? Is that true? Shouldn't should we feel safe in that? Or are there still concerns?
Dr. Trasande:It was true. It still is true for some things in our environment. There's a reason why we've had that notion around for 500 years, it worked. It met our observation of human phenomena, right? Unfortunately, now, as we advanced in science, we need to change the paradigm. There are 500 peer reviewed scientific manuscripts that show two types of relationships that violate the rule. And the reason why these violations are important is often we extrapolate from high dose exposures in animals, mostly in tissues, to low dose exposures to humans. So do that unique kind of straight line. The fact is, there are nonlinear relationships, particularly at lower levels of exposure, that's called steeper than linear means the bigger bang for your buck or in the lowest levels of exposure. And that's been known for lead for mer-methyl mercury for pesticides for flame retardants I could go on and on, the beat really does go on there. And then the worst of worst is not just a non linearity is the roller coaster ride relationships called the non monotonic or U shaped exposure response functions. Now, the chemical industry looks at these papers and says that's fake news. But there's science and basic mechanisms that explain it. If you have two competing receptors, one that's upregulated at lower levels of exposures and the other downregulated is think of it as a gas and a brake, right, you're pressing the gas in the brake, you're going to counteract the effect. And you're not going to move as fast drunk and accelerate as fast. Your car might stall too. But that's different discussion. The point being, that that kind of combination can produce effects that are really high at low levels of exposure, they disappear in the middle. And then they come back at the highest reaches of exposure. And so that just isn't as real as endocrinology and action as the science of Endocrinology showing up because we've known this for hormones for basic functioning hormones for years. It's just that the consequences of that relationship for the industry are really big, because it undermines some of the basic assumptions of everything in moderation. And it means that you might have to regulate chemicals out of commerce that has banned them from being used in products. If you find any effects. At any level, we've often assumed that we can quantify risk. The problem is if you have nonlinear your non monotonicity, you violate those Paracelsus enrolls the Paracelsus being wrong phenomenon. By the way, it was only the dose that made the thing of poison that was Paracelsus's accurate quote. The fact is, it's not only, its timing, its other exposures. It's so much more complicated. And that's science telling us this, it's science evolving, it's healthy, it's normal, it just means there are consequences. We have to shift our thinking.
Maureen:Yeah, absolutely. So on a similar note, I want to talk a little bit about bio accumulation. So sometimes you hear oh, you could never eat the amount of that one food ever in your lifetime to reach the amount of levels that it would be unsafe. But what if you're eating that food and 10 other foods, and then you also have air pollution, and then you also have you know, pollution or come into contact from the personal care products that you use. So all of the different ways that these products all get into our system on a regular basis interact with each other? What happens then, that's for as on a personal level, that's what I care about when I say oh, it might be safe in small doses. They might say that, okay, well, what have I been exposed to this over a lifetime? Or what if I'm exposed to to hundreds of different ones and they're all going to interact with each other in the body? So what happens then?
Dr. Trasande:So let me break apart for a minute, break down, bio accumulation is slightly different than what you've been talking about. But what you're talking about is really important. So let's let's and we need to come back to bioaccumulation because it's also important, but it's a slight and slightly slight tangent. Okay, so when you live in a mixture, the fact is, there are many chemicals that tick up estrogen, tick, tick off those metabolic pathways I talked about the lipid and carbohydrate metabolism stuff, they trigger cancers. And the human body works in some mysterious ways where you can have my word I talked about the the brake and the gas, right? Well, you could have two gas pedals in some situations with hormones. And if one chemical categories hitting one gas pedal and another chemical categories, hitting another gas pedal, your acceleration might actually be higher than one plus one equals two, it might be three might be 456. That's called synergy. Not a healthy kind of synergy, mind you, because we usually think a synergy is good. There's also antagonism, you can attack a gas brake combination. But when you live in a chemical world, it might not be your low level of exposure. To any one chemical, it's probably it's just that you are being hit by multiple chemical exposures at the same time. So the effect of that low level of exposure is bigger than what you might observe in an isolated experiment. In the laboratory, because the experience laboratory carefully controlled, they're looking at one exposure at a time, most of them, there are some researchers that are getting really sophisticated and trying to model mixtures. But it's hard to know when they come back to bio accumulation because it is relevant here. Your body may carry a lot of these persistent organic pollutants that may magnify the effects of these newer chemicals that are coming on seat. So we are a mixture of the legacy contamination that we've had. As well as the new contaminations coming out of the seat. We usually get more concerned about bioaccumulating chemicals because they stick around till they show up till you basically stop eating them, they will start getting excreted, because that's what bodies do. They recalibrate or - they don't want too much of any one thing in one place, they spread the wealth. So if you are, let's say, you know, I'm a kid of the 70s. In the 70s, I was getting exposed, probably to polychlorinated byphenols, or PCBs, chemicals that were eventually banned in the 70s. Mind you, as electrical capacitors, they were using electrical equipment. You don't get exposed to those anymore, but I probably excrete a little bit of that, just because of legacy contamination, then you put in, let's just talk about the certain ones that have estrogen capacity, then you get bisphenols coming on the scene, they can work at the same receptor and add up in this new mass, such that the bisphenols may actually tick up, tick off the body more than if it even if it was by itself. But the fact that this bits of PCBs are on the scene means the effects are higher. So bioaccumulation does influence the effects of mixtures. But they are technically different scientific issues. But that doesn't mean they're not, they don't go hand in hand. They go hand in hand.
Maureen:Yeah, that makes sense. Thank you for explaining that. So are there regulations safeguarding the population against these exposures to the hormone disruptors? Or is the onus really on the individual to try to make your exposure as little as possible?
Dr. Trasande:It's more Swiss cheese in the United States than anything else, I think. So let's talk and then we'll talk about Europe. Let's talk about the US for a minute. So when it comes to fragrances in personal care products, it's a gigantic loophole. You don't have to test it you only have to report what's in it. It's a trade secret. See, if you put the fra- chemical in the fragrance and you don't worry about it if you're a manufacturer. Then you have food packaging materials, food additive chemicals have something called generally recognized as safe exemptions or GRAS Exemptions, grass without the extra S at the end. It's not literally grass, but the fact is that chemical manufacturers or the food industry can say this chemicals fine, I think it's fine. I'm signing off on it. You do that? You are creating a brick wall you have to leave to get that chemical regulated and manufacturer if you can get the FDA is attention. So that gras exception has led to a lot of chemicals and food to be added as assumed to be safe and it puts the onus on the consumer. Then you go to the Environmental Protection Agency side of the operation and EPA is the oversight of most of the other chemicals in manufacturing. The exceptions are the FDA has food packaging, materials, and cosmetics, Food, Drug and Cosmetics after all, right. But the fact is that when it comes to the EPA side of the operational, they're made improvements, President Obama signed into law a an update to the Toxic Substances Control Act. But in 2016, that law did not mention endocrine disruption. We're so far behind in testing chemicals for their safety in the endocrine system, we don't even know what we should know. We know of at least 1800 endocrine disruptors, but we've tested less than 5%. So we are way behind, and that combination of events. So it's a depressing amount of weight on the shoulders of the consumer. And this is costly. We haven't talked about this. What we know about endocrine disrupting chemicals suggests it costs the US $340 billion a year billion with a big as 2.3% of our gross domestic product. And that's due to a variety of health consequences. And that was based on less than 5% of endocrine disrupters, a subset of diseases due to the few chemicals we studied, and a subset of costs due to few diseases due to the few chemicals we study. So it was an underestimate of an underestimate of an underestimate. And we're talking about 2% of our gross domestic product due to endocrine disrupting chemicals, that should get people pretty mad.
Maureen:Yeah, I mean, I think that people usually wake up when it comes to that type of conversation. So I mean, it's hard as a parent, as a consumer to always be a label reader and understand everything that you're looking at. I'm standing there in the grocery store, Googling and, like trying to look up what these what these chemicals mean. So it, you know that that's a burden on the consumer. Absolutely. So now I'd like to get into the part where you give us some advice on what we can do as parents, what we can do as consumers to protect ourselves and protect our families. What do you usually tell, you know, what do you do with your family? And what do you usually tell your patients what they can do?
Dr. Trasande:So there are safe and simple steps we can all take to reduce exposure, doesn't require a PhD in chemistry doesn't have to break the bank. Let's go right into it. Avoiding canned food reduces your levels of bisphenols. Say no to that thermal paper cup you get in a coffee shop as we're coming back out of the pandemic here, hopefully. That thermal paper is lined with Bisphenols and you've absorbed them into your skin and into your body. Avoiding microwaving plastic. Frankly, I'd prefer you renegotiate your relationship with plastic period because a lot of chemicals used in plastic are not chemically bound to the plastic. And then if you especially microwave or machine dishwashing them you're asking polymers to break down the monomers and ultimately getting them into your body and absorbing them. They're plastic to avoid period of the recycling numbers 3, 6, and 7. 3 for Phthalates, six is for styria, a known carcinogen and seven are for bisphenols that we've already talked about. Eating organic in high income and low income populations can reduce your pesticide levels. So yes, I appreciate there's a cost I work at Bellevue Hospital flagship, the New York City public hospital system and we advise if families can't eat organic, there are food deserts, are places they can't access. But increasingly as market share has exploded, the cost has come down. And so the big box stores are putting organic side by side with conventional similar price points. Simply opening the window and recirculating the air can get rid of these persistent organic pollutant dusts to some extent that we've talked about. There's also the wet mop that works very well. And when it comes to nonstick chemicals, just why not go to cast iron stainless steel it's harder to get rid of the oil and water resistant clothing, it's going to require regulation ultimately to try to face that you're seeing some companies step up their game. But as consumer attention gets placed on these, you're starting to see companies get this out of furniture. PBDs got out of furniture because of a campaign where literally they met he looked at the label they identified who had it and who didn't because California changed this law and no longer required flame retardents and actually required companies to document the presence of flame retardants. It took a study of just five food packages to get oil and water resistant chemicals out of two major supermarket chains for their buffet style food packaging, just so a little bit goes a long way we sell BPA free, go like wildfire through the baby bottle industry, we have to get better because they're still BPS and pfas in some of those products. And it's, it's hard to know and some of them are testing for it. The power of the consumer is the theme here. It's the change that we seek. There's so much power there by simply asking or changing your purchasing behaviors. Mind you, those specific phased out food packages were not being intentionally sold by supermarkets, they were just buying it from other sources. They are the ones that went up the chain and said, Hey, stop this, I don't like that consumers are yelling about it. So again, that's really the power of the consumer, the power of the pocket book or wallet, to drive the change that we're all seeking. So that's why I'm hopeful. And in climate change has really brought environmental contamination to the public in a way never before especially for the millennials and Generation Z folks out there. And the fact is that fossil fuel production and consumption drive both endocrine disruption and climate change. Now that doesn't mean you're going to get rid of endocrine disruption, if you cool the planet. However, there are co benefits. And the attention that this phenomenon is getting among those demographics really gives me hope every day so you people ask me why I'm why and why I'm not depressed. That's why
Maureen:I appreciate that because it does get hard. It's you hear all of these terrible things. And it's coming at you from every angle every day you read the news, but usually when I talk to an expert in a field such as yours or something, you always seem calmer and more level headed about the situation, then I may just as a parent, feeling overwhelmed by all of this and, and you know, I do appreciate you saying that, you know, there is a lot of control or power in the consumer. And that is why we're so appreciative that you came on here to talk to us today because if we don't know that there should be better and the risks that we should be looking out for then we can't actually go and like you know, demand those changes or make different purchasing choices. So I really appreciate you being here with us today. Dr. Trasande. It was very eye opening and I really appreciate this and I know that our listeners will get a lot out of this. So thank you so much for joining us.
Dr. Trasande:My pleasure. It was great being here.
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