What Do You Really Need to Keep Your House Clean and Avoid Disease?

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http://bulletin.aarp.org/yourhealth/healthyliving/articles/what_do_you_really_need_to_keep_your_house_clean_and_avoid_disease_.1.html

By: Q. Stranahan

April 15, 2010

What Do You Really Need to Keep Your House Clean and Avoid Disease?

America’s obsession with germ-free cleanliness may be misplaced

Last year, more than 300 new beauty and household-cleaning products—all touting their ability to kill germs—were introduced to U.S. consumers, joining thousands of similar products already on the market. Americans are now spending more than $1 billion annually on this growing arsenal of bacteria fighters, intent upon lathering, scrubbing, wiping and spraying their way to a healthier environment.

But are they? Or, in their quest to achieve extreme clean, are consumers tinkering with Mother Nature in ways that might be causing more harm than good?

“Hygiene is a good thing,” says Betsy Foxman, professor of epidemiology at the University of Michigan School of Public Health. “The issue is, how clean do you have to be, and what do you want to use to clean things with? That’s the two-edged sword.”

New products vs. old standbys

Antibacterial household products are no more effective than soap and water or traditional cleaning agents such as bleach or alcohol in removing germs, according to a number of studies. They also are indiscriminate killers, destroying good bacteria with bad.

But advertising seems to have convinced consumers that the old standby cleaners aren’t powerful enough to keep homes and families safe from germs. “It does play on people’s fears,” says Foxman. “It’s a good marketing tool.”

New products, new risks?

What consumers may not be aware of, however, is what molecular biologist Stuart B. Levy calls “the big P—the potential for risk.”

Bacteria exhibit strong survival tendencies. When attacked, bacteria protect themselves by changing, throwing up defenses against the chemicals that are attacking them. Levy, professor of medicine at Tufts University and president of the Alliance for Prudent Use of Antibiotics, calls the process “one big sink-or-swim training camp,” with the strongest bacteria surviving to live another day because they develop a resistance to the attacker. The bacteria can also pass along that resistance to other bacteria, creating new, resilient strains.

Over the years, improper use of prescription antibiotics may have created dangerous new strains of drug-resistant bacteria, including deadly “superbugs” and certain drug-resistant types of tuberculosis found in hospitals. Although antibacterial consumer products contain extremely low levels of germ-killing chemicals, Levy and others believe that their indiscriminate use could eventually produce the same results in homes. Although evidence of this has appeared only in laboratory settings, some experts agree it’s only a matter of time before these products increase the number of drug-resistant bacteria in kitchens and bathrooms.

Limits on antibacterial cleaners

So, if there is no real benefit derived from antibacterial products—and the potential for creating a new strain of drug-resistant bacteria exists—is there any reason to keep using them?

There isn’t, said experts convened by the U.S. Food and Drug Administration and the American Medical Association. But the FDA has taken no action—even though a 2005 panel concluded the potential for creating drug-resistant bacteria is significant enough that continued widespread use of the products by consumers is not worth the risk. The agency is still reviewing the panel’s 2005 conclusions, an FDA spokeswoman says: “We are working as expeditiously as possible” to come up with a proposed rule. Additional scientific data may be needed before a final rule is issued, she says.

Foxman’s concerns are much broader. She believes that in our haste to kill germs, we are indiscriminately killing off or altering the beneficial “bugs” that keep us disease-free. “There are many good microbes, and we wouldn’t be as healthy without them,” she explains. “They prime our immune systems, create essential vitamins, keep the balance of pH that we like—things that make you feel good.”

Bacteria are microscopic, single-cell entities that live by the tens of trillions inside and outside our bodies. They have co-evolved with humans and often protect us from the microbes that can hurt tissue or cause illnesses such as food poisoning, pneumonia, strep throat or meningitis. The role they actually play in health is only now being studied as part of the National Institute of Health’s Human Microbiome Project.

Manufacturers respond

The development of antibiotics in the 1940s has saved countless lives. The first antibacterial consumer product—Dial soap—followed a short time later, unleashing what ultimately has become a flood of agents promising a “cleaner” clean. Triclosan, the most common ingredient in these products, was introduced in health care settings in the 1960s.

Somewhere along the way, the line between hospital clean, shower clean and kitchen clean has been blurred.

Today, small quantities of triclosan are present in everything from liquid soaps to deodorants to kitchen-counter cleaners, all of which carry the promise to fight germs, odors and all sorts of other nasty things. And unlike soap and water or bleach, antibacterial chemicals remain in the environment—on countertops, hands, baby furniture and in waste water—long after they are applied, continuing to kill or transform bacteria.

The manufacturers of antibacterial products say critics like Levy are making much ado about nothing. “There is no real-world evidence linking the use of antibacterial soaps and cleaning products to antibiotic resistance,” says Sansoni of the Soap and Detergent Association, a trade group with 100 members, based in Washington. It may happen in the lab, but not in the home, he says. “They’re telling a ghost story, but there’s no ghost.”

Soap, water, bleach

Levy counters that there is no evidence demonstrating the beneficial use of antibacterial consumer products, either. He has coauthored research showing that homes using antibacterial products are no healthier than those using soap, water and other traditional cleaning agents.

He contends the use of antibacterial products should be limited to places where they clearly are necessary—to hospitals and health care facilities. They are not warranted for the general population, he says.

Foxman also believes the risks are too great. “I just don’t think there’s any added value to this extra level [of cleaning]. We don’t want to be without microbes.”

Antibacterials and swine flu

At the moment, however, consumers are voting with their dollars. A 2007 market survey showed that nearly three-quarters of American adults who do some or all of the household cleaning said they preferred antibacterial and germ-killing products. Much of that demand is driven by media attention to public health threats and disease, says Sansoni of the manufacturers’ association. “For us, you can sum up 2009 with four symbols: H1N1.”

In reality, however, antibacterial products—and antibiotics—are largely ineffective against the flu and the common cold, which are caused by viruses. But the public often makes no distinction, nor do advertisers.

“Let’s face it,” says Sansoni, “all this talk about us living in too-clean environments is utopian. What’s the real threat we face? There’s not enough common-sense hygiene.” For Sansoni, a common-sense hygiene routine includes antibacterial products.

For Foxman, however, it means something else: lots of plain soap and water.