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.
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.
So, clearly there are disadvantages to underexposure to bacteria (hygiene hypothesis etc.), but are they so bad that they outweigh the risks of allowing bacterial exposure? In other words, is there any evidence that the optimal level of exposure to bacteria (i.e. the level that minimizes the sum of the risk of pathogenic infection and the risk of cleanliness-related problems like allergies and autoimmunity) is nonzero?
Left to its own devices in a modern America, a human will typically become obese from overeating and eating unhealthy foods (guess how I know!). That doesn't make this behavior adaptive. Humans didn't evolve under an environment of plenty, so their behavior in such an environment does not necessarily maximize survival value. Ditto for an environment where parents don't pay attention to what their infants put in their mouths.
In summary, it's a long, long shot to claim that babies being willing to eat anything constitutes evidence that bacterial exposure is beneficial.
consider that babies rely solely on instincts, whereas our behavior as we get older, depends greatly on factors such as upbringing, our experiences and expectations, media exposure etc.
As someone that grew up on a farm (and a data point of 1), I am pretty damn healthy and very rarely ill.
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.
It's interesting to examine the history of soap and hand-washing: how patients and doctors gradually came to understand its importance.
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.
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.
I like the Taleb way to decide on these choices: if you have a very low return on a new medical thing (eg drug) and is supposed to use it often, the very tiny risk inside becomes actually quickly bigger than the benefit. On the opposite, even there is only 70% chance for it to work, go for the new heart surgery technique because if you don't you die anyway. (I am simplifying)
So in result: say no to antibacterial soap, say yes to whatever Doctor House prescribes you.
Bacterial killing is not inherently valuable since so much of your homeostasis is regulated by native bacterial flora, both on the skin and inside the body. It could be that even beyond the skin damage of anti-bacterial soaps, that regularly wiping out your endogenous bacteria could increase certain infectious susceptibilities.
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.
Bacteria are not completely removed from your skin when you wash.
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 is not only found in antibacterial soaps. It is also found in Colgate's regular and whitening toothpaste (this might be specific to Canada), where it comes into contact with your gastrointestinal tract.
Not in the US it isn't. Not sure about elsewhere. Crest even uses "triclosan free" in some of its advertising.
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.
Care to share your findings? I've already stopped using Listerine (which ended up being the right decision) and I'm growing skeptical even of "hippie" toothpastes. Thinking about moving to just baking soda paste.
I'll raise a weak [citation needed] on the efficacy claim and argue that even generic Listerine tastes far better than salt water (either warm or cold).
I haven't used toothpaste regularly for about 8 years. I've never told my dentists. I have had 3 fillings but I'm not sure if not using toothpaste was a contributor (I used to be really lazy with flossing. I think that's more likely).
Whats your diet? I'm not trying to ignite the traditional HN flamewar about the evils of a science based paleo diet, but I have had a similar experience where not eating grains or sugar none the less results in a relatively tartar free mouth per my dentist. Even though I hate waiting and am impatient and do not visit every 3 months or whatever often its supposed to be.
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.
The average life expectancy for those times factors in infant mortality and severe injury. If you survived your first few years and never got mortally wounded, you could still expect to live to 60-70.
My understanding from what dentists have said to me in the past is that ordinary toothpaste in the abstract is of limited value, especially if you brush often, but it's a useful vehicle for fluoride.
I make my own soaps at home with only organic oils and lye, and I'll be happy to sell you some! :)
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.
The 2nd link is to a small study, with n=~10 for each of the sample groups. Small enough that it's hard to take it to say anything too firm on the subject.
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.
Well the problem is that a lot of antibiotic resistance can be attributed to efflux pumps that literally pump the stuff out of the bacteria. So these are generalized resistance mechanisms that target a broad array of environmental stuff that might ordinarily kill a microbe. Here's a pretty well-cited paper on the issue, though it's rather old: http://aac.asm.org/content/45/2/428.short
I'm not a biologist, but I would assume that bactericides for external use can be much more aggressive than antibiotics that are injected in the organism; they are expected not to kill the patient altogether the bacteria.
I stopped using antibacterial soap when I read stories about how triclosan was being found in children's urine, etc, and that there are no regulations regarding how much should be put into soap, etc. I was fine with soap and water so I don't see how this could make things any better. Finally, my paranoia is vindicated!
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.
As long as I've been responsible for buying my own soap (i.e. since 2009), I've made an effort to buy non-antibacterial soap, primarily to avoid contributing to the antibacterial resistance tragedy of the commons.
You have a natural gut flora; you have a natural skin flora. Screwing around with your gut flora is uncontroversially seen as a bad thing. Screwing around with your skin flora strikes me as a similar argument.
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.
Well, where "screwing around" == killing. Screwing around by taking probiotic supplements, eating fermented foods, etc. is generally considered to be good, or at least harmless.
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.
As an anecdote I gave up antiperspirant and deodorants after suffering rashes and pain in my under arms. I sweat more, but I was surprised to find I actually smell better. Or rather I'm told I smell better. Additionally I discovered that the stains in the underarms of my clothing went away, apparently it's caused by the deodorants. Diet may indeed play a factor, I am vegan. YMMV.
There's definitely a potential for negative impact on your septic system, especially the newer aerobic type, which is much more sensitive.
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.
>It's not food or a drug - you don't put it into your body 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 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.”
The emerging evidence on the body burdens of chemicals in the American people, as well as the new science on how small exposures to these chemicals can add up to harm, suggest that there is no health-based rationale for the difference in regulatory powers between the different FDA divisions.
Here's a link about formaldehyde in hair straighteners:
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.
>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.
If you were to simply argue that regulatory structures sometimes seem arbitrary and inefficient, I don't think you'd get much pushback here. In this case the reality is very simple; the FDA regulates cosmetics by law, and soap is a cosmetic. Pretty obvious.
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?
your argument that the FDA shouldn't be regulating products that are applied directly to the skin takes libertarian dogma to confusing heights
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.
Hmm... so you're just a disinterested observer asking for help in understanding the reasons for which the government classifies some things and not others as cosmetics for regulatory purposes? I'm afraid I can't help you there, and you're right, I'm not really interested.
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.
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.