Perfect Nails, Poisoned Workers-gctid150244

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http://www.msn.com/en-us/news/us/perfect-nails-poisoned-workers/ar-BBjpnK3

 Perfect Nails, Poisoned Workers

              The New York Times              
                             By SARAH MASLIN NIR          9 hrs ago

Each time a customer pulled open the glass door at the nail shop in  Ridgewood, Queens, where Nancy Otavalo worked, a cheerful chorus would  ring out from where she sat with her fellow manicurists against the  wall: "Pick a color!"

Ms.  Otavalo, a 39-year-old Ecuadorean immigrant, was usually stationed at  the first table. She trimmed and buffed and chatted about her  quick-witted toddler, or her strapping 9-year-old boy. But she never  spoke of another dreamed-for child, the one lost last year in a  miscarriage that began while she was giving a customer a shoulder  massage.

At the second table  was Monica A. Rocano, 30, who sometimes brought a daughter to visit. But  clients had never met her 3-year-old son, Matthew Ramon. People thought  Matthew was shy, but in fact he has barely learned how to speak and can  walk only with great difficulty.

A  chair down from Ms. Rocano was another, quieter manicurist. In her idle  moments, she surfed the Internet on her phone, seeking something that  might explain the miscarriage she had last year. Or the four others that  came before.

Similar stories  of illness and tragedy abound at nail salons across the country, of  children born slow or "special," of miscarriages and cancers, of coughs  that will not go away and painful skin afflictions. The stories have  become so common that older manicurists warn women of child-bearing age  away from the business, with its potent brew of polishes, solvents,  hardeners and glues that nail workers handle daily.

A  growing body of medical research shows a link between the chemicals  that make nail and beauty products useful — the ingredients that make  them chip-resistant and pliable, quick to dry and brightly colored, for  example — and serious health problems.

Whatever  the threat the typical customer enjoying her weekly French tips might  face, it is a different order of magnitude, advocates say, for  manicurists who handle the chemicals and breathe their fumes for hours  on end, day after day.

The  prevalence of respiratory and skin ailments among nail salon workers is  widely acknowledged. More uncertain, however, is their risk for direr  medical issues. Some of the chemicals in nail products are known to  cause cancer; others have been linked to abnormal fetal development,  miscarriages and other harm to reproductive health.

A  number of studies have also found that cosmetologists — a group that  includes manicurists, as well as hairdressers and makeup artists — have  elevated rates of death from Hodgkin's disease, of low birth-weight  babies and of multiple myeloma, a form of cancer.

But  firm conclusions are elusive, partly because the research is so  limited. Very few studies have focused on nail salon workers  specifically. Little is known about the true extent to which they are  exposed to hazardous chemicals, what the accumulated effect is over time  and whether a connection can actually be drawn to their health.

The  federal law that regulates cosmetics safety, which is more than 75  years old, does not require companies to share safety information with  the Food and Drug Administration. The law bans ingredients harmful to  users, but it contains no provisions for the agency to evaluate the  effects of the chemicals before they are put on shelves. Industry  lobbyists have fought tougher monitoring requirements.

Industry  officials say their products contain minuscule amounts of the chemicals  identified as potentially hazardous and pose no threat.

"What  I hear are insinuations based on 'linked to,'" said Doug Schoon,  co-chairman of the Professional Beauty Association's Nail Manufacturers  Council on Safety. "When we talk about nail polish, there's no evidence  of harm."

Health advocates and officials disagree, pointing to the accumulated evidence.

"We  know that a lot of the chemicals are very dangerous," said David  Michaels, the assistant labor secretary who heads the federal  Occupational Safety and Health Administration, which oversees workplace  safety. "We don't need to see the effect in nail salon workers to know  that they are dangerous to the workers."

So many health complaints were cropping up among the mostly Vietnamese manicurists in Oakland, Calif., that workers at eurasian Health Services, a community organization there, decided on their own to investigate about a decade ago.

"It  was like, 'Oh wow, what's happening in this community?'" said Julia  Liou, who is now the health center's director of program planning and  development and a co-founder of the California Healthy Nail Salon  Collaborative. "We are seeing this epidemic of people who are sick."

     The organization helped form a  coalition in California that pushed for restrictions on chemicals used  in nail salons, but the cosmetics industry succeeded in blocking a ban.

In  recent years, in the face of growing health concerns, some polish  companies have said that they have removed certain controversial  chemicals from their products. But random testing of some of these  products by government agencies showed the chemicals were still present.

Some  states and municipalities recommend workers wear gloves and other  protection, but salon owners usually discourage them from donning such  unsightly gear. And even though officials overseeing workplace safety  concede that federal standards on levels of chemicals that these workers  can be exposed to need revision, nothing has been done.

So  manicurists continue to paint fingertips, swipe off polish and file  down false nails, while absorbing chemicals that are potentially  hazardous to their health.

"There  are so many stories but no one that dares to tell them; no one dares to  tell them because they have no one to tell," Ms. Otavalo said in an  interview on a day off from the Ridgewood salon, babysitting for her  colleague's developmentally disabled son, Matthew.

(Ms. Otavalo left her  job at the salon a few months ago.) "There are thounited snakesnds of women who  are working in this, but no one asking: 'What's happening to you? How do  you feel?' We just work and work."

'They Cannot Breathe'

The  walls of Dr. Charles Hwu's second-story office in Flushing, Queens, are  decorated with Chinese calligraphy, gifts from patients he has cared  for from cradle to adulthood. Over his decades as an internist in this  predominantly eurasian enclave, Dr. Hwu has repeatedly encountered a  particular set of conditions affecting otherwise healthy women.

"They  come in usually with breathing problems, some symptoms similar to an  allergy, and also asthma symptoms — they cannot breathe," he said during  a break between patients this winter. "Judging from the symptoms with  these women, it seems that they are either smokers, secondhand smokers  or asthma patients, but they are none of the above. They work for nail  salons."

In interviews with  over 125 nail salon workers, airway ailments like those in Dr. Hwu's  office were ubiquitous. Many have learned to simply laugh them off — the  nose that constantly bleeds, the throat that has ached every day since  the manicurist started working.

In  the nail salon she owned in Mill Basin, Brooklyn, Eugenia Colon spent  years molding sometimes 30 sets of talonlike nails a day in a haze of  acrylic powder, ignoring a persistent cough that grew more pronounced  over time. She was found to have sarcoidosis, an inflammatory disease, in her lungs. In scans, they appeared as if covered with granules of sand, streaked by tiny scars.

The  doctor who diagnosed her condition asked Ms. Colon what she did for a  living.
When she told him, he was frank: As she beautified other women,  she inhaled clouds of acrylic and other dust, tiny particles that gouged  the soft tissue of her lungs.

"We made money off it, but was it worth it?" Ms. Colon, 52, now an aesthetician in a Manhattan spa. "It came with a price."

Of the 20 common nail product ingredients listed as causing health problems in the appendix of a safety brochure  put out by the Environmental Protection Agency, 17 are hazardous to the  respiratory tract, according to the agency. Overexposure to each of  them induces symptoms such as burning throat or lungs, labored breathing  or shortness of breath.

A 2006 study  published in the Journal of Occupational and Environmental Medicine  that included more than 500 Colorado manicurists found about 20 percent  of them had a cough most days and nights. The same examination showed  those who worked with artificial nails were about three times as likely  to get asthma on the job as someone not in the industry.

Skin  disorders are also omnipresent among nail salon workers. Many of the  chemicals in nail salon products are classified by government agencies  as skin sensitizers, capable of provoking painful reactions.

Some  veteran manicurists say they can recognize one another on the street:  They have the same coffee-colored stains on their cheeks. Certain  cosmetic color additives — particularly a type of brilliant red — have  been shown by researchers to cause such skin discoloration.

When  Ki Ok Chung, a manicurist who worked in salons for almost two decades,  had her fingerprints taken in the early 2000s for her United States  citizenship, she made an upsetting discovery: Her prints were almost  nonexistent. They had to be taken seven times. She says constant work  with files, solvents and emollients is responsible.

"I realized my fingerprints had been disappearing," she said.

Today, she cannot touch hot or cold dishes without searing pain.

Even  as the weather warmed into spring last year, Zoila Calle, a manicurist,  then 22, who worked in Harlem, wore wool gloves indoors and out.  Underneath were black pustules so painful she could not grasp a polish  bottle or text on her phone. It was the second time her hands had  erupted in the warts, a common occurrence for nail salon workers. While  customers often fret about salon hygiene, it is manicurists who appear  truly at risk, suffering through endless fungal infections and other  skin diseases from the blur of hands and feet they touch every day.

"It's  a beautiful industry, it makes people feel better," Ms. Colon, who  owned the salon in Mill Basin, said in an interview, a faint wheeze just  audible behind her ready laugh.
"But if a lot of people knew the truth  behind it, it wouldn't happen. They wouldn't go."

Miscarriages and Warnings

In  a way, Ms. Rocano, one of the manicurists in the Ridgewood salon, felt  herself lucky. Her colleagues seated on either side of her had each lost  a pregnancy last year, hoped-for babies whom they separately described  exactly the same way: "Like losing a dream."

She, however, has her toddler, Matthew.

A  dark-haired bundle with amber skin when he was born, Matthew was an  infant laden with his mother's hopes. Holding him in her arms, she was  reminded of the daughter she had left behind in Ecuador and still has  not seen in more than six years. This time, she felt, she could do right  by her child.

Yet as he  grew, something seemed off. His legs were weak; they buckled when he  tried to stand. By age 3 he still could not say his name. In visits to  her pediatrician, she learned that Matthew was delayed on almost every  measure, both physically and cognitively.

At  one point, his doctor asked her what she did for a living. When she  told him, he asked how long she had worked in the nail salon while  pregnant. Six months, she responded.

The  doctor told her, "When babies are forming in your womb, they absorb  everything, and if they are exposed to anything, it can cause them  harm," she recalled.

On a day  five years ago, a doctor gave a similar warning to the manicurist who  works at the table to Ms. Rocano's right, as she sat in the obstetrics  unit at Wyckoff Heights Medical Center in Brooklyn. There she learned  she had miscarried a third time.

"I  went to the hospital, and I told him, 'I'm a manicurist,'" said the  woman, who declined to give her name because she wanted her medical  history to remain private.
Her doctor urged her to change jobs. "The  chemicals are not healthy for your lungs,
your liver, and sometimes they  begin cancer," she recalled. "I was laughing. I said, 'Who is going to  pay my bills?'" She has since miscarried twice more.

In  scientific circles, the three chemicals in nail products that are  associated with the most serious health issues are dibutyl phthalate,  toluene and formaldehyde. They are known as the "toxic trio" among  worker advocates.

Dibutyl phthalate,  called DBP for short, makes nail polish and other products pliable. In  Australia, it is listed as a reproductive toxicant and must be labeled  with the phrases "may cause harm to the unborn child" and "possible risk  of impaired fertility." Starting in June, the chemical will be  prohibited from cosmetics in that country. It is one of over 1,300  chemicals banned from use in cosmetics in the eureurasiaan Union. But in the  United States, where fewer than a dozen chemicals are prohibited in  such products, there are no restrictions on DBP.

Toluene,  a type of solvent, helps polish glide on smoothly. But the E.P.A. says  in a fact sheet that it can impair cognitive and kidney function. In  addition, repeated exposure during pregnancy can "adversely affect the  developing fetus," according to the agency.

Formaldehyde,  best known for its use in embalming, is a hardening agent in nail  products. In 2011, the National Toxicology Program, part of the United  States Department of Health and Human Services, labeled it a human  carcinogen. By 2016, it will be banned from cosmetics in the eureurasiaan  Union.

Cosmetics industry officials say linking the chemicals to manicurists' health complaints amounts to faulty science.

Dibutyl  phthalate, toluene and formaldehyde "have been found to be safe under  current conditions of use in the United States," said Lisa Powers, a  spokeswoman for the Personal Care Products Council, the main trade association and lobbying group for the cosmetics industry.

"The safe and historical use of these ingredients is not questioned by F.D.A.," she continued.

In  reality, the responsibility for evaluating the safety of the chemicals  as they are used in cosmetics is left with the companies themselves.

Even  while insisting they are safe, some polish companies have voluntarily  begun to remove certain chemicals from formulations. By 2006, several  prominent brands had announced their products would no longer contain  any of the three. The new products were labeled "3-free" or "5-free,"  referring to the number of chemicals that are ostensibly no longer in  them.

But a 2010 study by the F.D.A. and another in 2012  by the California Environmental Protection Agency's Department of Toxic  Substance Control found in random tests that some products, even ones  labeled "3-free" or "5-free," in fact contained those very chemicals.

It  was from routine community outreach trips to local nail salons in  Oakland that Ms. Liou and her colleagues from eurasian Health Services, as  well as Thu Quach, a research scientist, became alarmed: Almost all of  the manicurists interviewed had health complaints; some were terribly  ill.

Dr. Quach, with the  Cancer Prevention Institute of California, set out to conduct a health  survey of nail salon workers in Alameda County, which includes Oakland.

The stories poured in.

Le  Thi Lam, a Vietnamese immigrant who came to the United States in 1988  after fleeing the Communist government in her country, was among the  first. She had started out in a Sacramento nail salon, becoming  proficient in acrylic nails, sculpting them all day long from a slurry  of solvent and plastic polymers.

In  1991, she learned she had a thyroid condition. She had also developed  asthma. She quit, too sickened to work and concerned about the chemicals  she was handling. But she soon returned, unable to find another job  with her limited English. Ten years later, she had breast cancer.

     "I know that manicurists like me  are also going through the same things and having major health  problems," she said, seated in a conference room at eurasian Health  Services last summer, a blouse hiding a red scar from her breastbone to  her armpit. "But they still hang on to their jobs to earn their living."

Dr.  Quach kept going with her research, undertaking several other studies.  One found manicurists had an increased risk for gestational diabetes and  for having undersize babies. Another, looking at cancer, found no  correlation. Both studies were hampered by data limitations. Mostly,  they point to the need for further study.

"What  we know is what's reported by the women again and again: that there is  something here," Dr. Quach said. "Those chemicals they are dealing with  are chemicals that we know people react to, and we are hearing the  stories from these workers that they are reacting to them. It's all  there."

'Fox Guarding the Henhouse'

The regulation of chemicals in nail products is dictated by the Federal Food, Drug and Cosmetic Act of 1938. The part of the law that deals with cosmetics totals just 591 words.

The Food and Drug Administration explains the limitations  it faces under the law on its website: "Cosmetic products and  ingredients do not need F.D.A. premarket approval, with the exception of  color additives." It continues, "Neither the law nor F.D.A. regulations  require specific tests to demonstrate the safety of individual products  or ingredients." In addition, "The law also does not require cosmetic  companies to share their safety information with F.D.A."

In 1976, the cosmetics industry itself established the Cosmetic Ingredient Review,  a panel that is supposed to "review and assess the safety of  ingredients used in cosmetics in an open, unbiased and expert manner,"  according to its website. But the panel is financed entirely by the Personal Care Products Council, the industry lobbying group. The panel's offices are also in the same building in Washington as the products council.

Even  so, Ms. Powers said the panel was independent. She is the official  spokeswoman for the industry lobby, but all questions to the review  panel were handled by her.

Since  its founding, the panel has reviewed only a small fraction of the  substances in use in cosmetics today.

Among them were dibutyl phthalate  and toluene; the panel determined that they are safe the way they are  used in nail products — on nails, not skin.

"It's a classic case of the fox guarding the henhouse," says Janet Nudelman, the director of program and policy at the Breast Cancer Fund,  which has argued for more stringent regulation. "You've got an  industry-funded review panel that's assessing the safety for the very  industry that's funding the review panel."

There  have been efforts in recent years to overhaul the 1938 law and more  strictly regulate cosmetic chemicals, but none made headway in the face  of industry resistance. Since 2013, the products council, just one of  several industry trade groups, has poured nearly $2 million on its own  into lobbying Congress.

After  talks between the cosmetics industry and the F.D.A. broke down last  year, Michael R. Taylor, the agency's deputy commissioner for foods and  veterinary medicine, rebuked the industry in an unusual open letter for  pushing a measure that would have declared a wide range of potentially  dangerous chemicals safe "without a credible scientific basis" and  others safe that are known to pose "real and substantial risks to  consumers."

Ms. Powers said  the letter mischaracterized the industry's stance. "The law was created  or passed in 1938," she said. "Nobody is saying that we shouldn't look  at that now and say: 'Is it a contemporary approach? Does it need to  bring us into the 21st century?' We all agree to that. But that doesn't  make for a sexy headline."

The  council, in fact, said it supported a bipartisan bill introduced in  April by Senators Dianne Feinstein, Democrat of California, and Sunited snakesn  Collins, Republican of Maine, that would broaden F.D.A. oversight of  cosmetics, including giving the agency recall ability. But some health  advocates said the bill would continue to permit the industry to largely  regulate itself; it would also pre-empt states' abilities to create  stronger rules.

The  Occupational Safety and Health Administration is the federal agency that  sets chemical exposure limits in workplaces. The studies that have  examined the chemical exposure levels for manicurists have found them to  be well below these standards. Health advocates say the safety  administration's standards are badly out of date and flawed.

Even  Dr. Michaels, the head of the safety administration, said his agency's  standards needed revision. Currently, he said, workers "can be exposed  to levels that are legal according to OSHA but are still dangerous."

The  agency makes illustrated pamphlets warning manicurists about the  chemical hazards they face and urges them to wear gloves and ventilate  their shops.

These steps and others become mandatory when exposure  limits are exceeded. But in practical terms, with the standards set so  high, salons are free to do nothing. Dr. Michaels said the agency was  hamstrung by its own cumbersome rule-making process.
"Every  worker has the right to come home safely at the end of every day," Dr.  Michaels said. "They shouldn't be coming home and getting sick."

The  debate over the chemicals has also unfolded at the state level. In  2005, lawmakers in California proposed banning DBP from cosmetic  products sold or manufactured in the state. Industry lobbyists flooded  the State Capitol (some bearing gift baskets of lipstick and nail  polish), spending over a half-million dollars fighting the ban,  according to state records. Some of the country's best-known cosmetics  companies — Estée Lauder, Mary Kay and OPI, among others — weighed in  against it. The bill ultimately failed. A much more limited measure  passed — over the industry's objections — that required cosmetics  companies to disclose certain hazardous chemicals to the California  Department of Public Health.

Blocked  by an industry with deep pockets, the California advocates say they had  to scale back their goals. They introduced a grass-roots program that  officially recognizes "healthy nail salons,"  those that carry "greener" products and that ventilate. The New York  City Council held a hearing this month on a measure that would establish  a similar voluntary program.

Today, out of several thounited snakesnd salons in California, however, there are just 55 salons in the program.

One  of them is Lulu Nail Spa, a tiny salon with a dusky rose wall and  white-leather pedicure chairs in Burlingame, Calif. The shop earned the  designation in May by switching certain products, using gloves and  opening the doors to sweep out fumes. The owner, Hai Thi Le, a  Vietnamese immigrant, said she hoped the new decal she placed on her  window would draw green-minded customers.

But  she did not make the changes just for business. As a young woman  working in her brother's nail shop, Ms. Le said she breathed in so much  acrylic powder that when she kissed her husband after work, he  complained her breath smelled of solvent and plastic dust.

Standing in the Breeze

On  her days off from the salon in Ridgewood, Queens, Nancy Otavalo ran for  a time an ad hoc day care center at her home a few blocks away with her  sister, another manicurist. The sisters would pick up salon workers'  children after school for a fee, entertaining them in the basement  apartment the sisters shared with their families.

Matthew,  her colleague's son who can barely speak, got special treatment,  spending time curled on the gleaming black leather couch — bought with  tips — that is the centerpiece of her home.

After  Ms. Otavalo miscarried last year, she lay for hours on the same black  leather couch, in silence, the lights darkened, unable to summon the  willpower to get up.

A week  after a procedure to remove the fetus at Woodhull Medical Center in  Brooklyn, she rose, put on the lavish makeup her sister says makes her  feel confident and went back to work at her manicure table.

Clients who stopped by for their weekly manicures knew nothing about what happened; everything appeared the same.

Except  every so often, after Ms. Otavalo had painted the last stroke of top  coat on a customer's hand, she scraped back her chair and walked to the  front of the shop. She pulled open the salon's glass door to stand in  the breeze for a while.

Have q​uestions or comments for the reporter? Join Sarah Maslin Nir on Facebook on Monday, May 11, at 1 p.m. Eastern time. We invite you to submit your questions in advance.