Hormonal Chaos:
The Scientific and Social Origins of the
Environmental Endocrine Hypothesis 

by Sheldon Krimsky Reviewed by Arnold Schecter, MD, MPH / JAMA 8nov00

Books/Environmental Health

Hormonal Chaos: The Scientific and Social Origins of the Environmental Endocrine Hypothesis  by Sheldon Krimsky, 256 pp, $35.95, ISBN 0-8018-6279-5, Baltimore, Md, Johns Hopkins University Press, 2000. Reviewed by Arnold Schecter, MD, MPH / JAMA 8nov00

Hormonal Chaos presents a synthesis of science, policy, the media, and the personalities in the controversial new area of environmental health known as "endocrine disruption," including the natural and synthetic chemicals involved.

The author, Sheldon Krimsky, PhD, is a professor in the Department of Urban and Environmental Policy at Tufts University. His book is well written and a delight to read. It is ideal for a health care provider on vacation who wishes to know more about endocrine disruptors, key scientists and other players, media coverage, and the reaction of Congress to this perceived new health hazard. It is not meant for the health care professional who wishes an in-depth toxicologic or endocrinologic review of this topic.

Endocrine disruption refers to endocrine responses noted in laboratory animals and humans from some synthetic and naturally occurring compounds. These include dioxins and dioxin-like chemicals, such as polychlorinated biphenyls (PCBs), other chlorinated organics such as DDT, and naturally occurring compounds such as phytoestrogens.

Among scientists whose contributions are described is Theo Colburn, PhD, the Rachel Carson of our time. Dr Colburn, an "outsider-scientist," contributed the dual insights that various adverse effects--population decline, reproductive effects, immune suppression, tumors, and others--occurred mainly in predators and offspring of animals in the Great Lakes exposed to pollutants. She brilliantly synthesized and communicated the work of other scientists, including work dealing with similar human effects associated with diethylstilbestrol exposure, and put together a series of science and policy conferences, which produced consensus documents of enormous impact.

Political realities are well described. The book explains how much of science is funded and how the best and brightest of our researchers will bend their interests when money is involvedyet their research can lead to major advances in science and medicine.

The failure to mention some key research teams and their work is disappointing, for instance, the University of Wisconsin team headed by Dr Richard Peterson, and Drs Linda Birnbaum, Michael DeVito, and colleagues at US Environmental Protection Agency in North Carolina. The demonstration that one dose of dioxin to a pregnant rodent could lead to permanent feminization of male offspring, when first presented by Peterson and colleagues,1-4 was electrifying to those of us working in the field. Dutch pediatricians followed with studies demonstrating changeslower birth weight, changes in thyroid hormone and sex hormone levelsin children born to women from the general population in the highest quintile of exposure to dioxins and polychlorinated biphenyls.5-8 Birnbaum and DeVito's elegant calculations showing that, although populations may have smaller daily intakes of some synthetic endocrine disruptors such as dioxins than of plant or phytoestrogens, the dioxins' very long half lives lead to a far higher tissue dose than that of the short lived natural plant estrogens.

The book presents scientific studies and the ensuing reactions in the professional literature and lay media. For instance, it recounts a controversy over an editorialist for the New England Journal of Medicine, who commented in 1997 on an article that revealed no link between environmental estrogens and breast cancer.

In short, this book is fun. It is not comprehensive but makes for easy and enjoyable reading, with a little science and medicine, a bit of policy, a review of media reactions (whose seeming unpredictability has a foundation that the author analyses), and a candid and insightful description of some journals, their editors, and their policies. I would recommend Hormonal Chaos as a unique resource for readers wishing an overview of these disparate topics. Physicians and others seeking an in-depth scientific monograph on the theory of endocrine disruption have many ponderous and exhaustive reviews available elsewhere.

AUTHOR/ARTICLE INFORMATION  Arnold Schecter, MD, MPH University of Texas-Houston School of Public Health at Dallas

REFERENCES

1. Mably TA, Moore RW, Bjerke DL, Peterson RE. The male reproductive system is highly sensitive to in utero and lactational 2,3,7,8-tetrachlorodibenzo-p-dioxin exposure: Banbury Report 35. In: Gallo MA, Scheuplein RJ, van der Heijden KA, eds. Biological Basis for Risk Assessment of Dioxins and Related Compounds. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory Press; 1991:69-78.

2. Mably TA, Moore RW, Peterson RE. In utero and lactational exposure of male rats to 2,3,7,8-tetrachlorodibenzo-p-dioxin, 1: effects on androgenic status. Toxicol Appl Pharmacol. 1992;114:97-107.

3. Mably TA, Moore RW, Goy RW, Peterson RE. In utero and lactational exposure of male rats to 2,3,7,8-tetrachlorodibenzo-p-dioxin, 2: effects on sexual behavior and the regulation of luteinizing hormone secretion in adulthood. Toxicol Appl Pharmacol. 1992;114:108-117.

4. Mably TA, Bjerke DL, Moore RW, Gendron-Fitzpatrick A, Peterson RE. In utero and lactational exposure of male rats to 2,3,7,8-tetrachlorodibenzo-p-dioxin, 3: effects on spermatogenesis and reproductive capability. Toxicol Appl Pharmacol. 1992;114:118-126.

5. Koopman-Esseboom C, Weisglas-Kuperus N, de Ridder MAJ, Van der Paauw CG, Tuinstra LG, Sauer PJ. Effects of polychlorinated biphenyl/dioxin exposure and feeding type on the infant's mental and psychomotor development. Pediatrics. 1996;97:700-706.

6. Koopman-Esseboom C, Huisman M, Weisglas-Kuperus N, et al. Dioxin and PCB levels in blood and human milk in relation to living areas in The Netherlands. Chemosphere. 1994;29:2327-2338.

7. Koopman-Esseboom C, Morse DC, Weisglas-Kuperus N, et al. Effects of dioxins and polychlorinated biphenyls on thyroid hormone status of pregnant women and their infants. Pediatr Res. 1994;36:468-473.

8. Koopman-Esseboom C, Huisman M, Weisglas-Kuperus N, et al. PCB and dioxin levels in plasma and human milk of 418 Dutch women and their infants: predictive value of PCB congener levels in maternal plasma for fetal and infant's exposure to PCBs and dioxins. Chemosphere. 1994;28:1721-1732. Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor; adviser for new media, Robert Hogan, MD, San Diego.