Q: In France, most receipts have printed on their backs “Papier garanti sans bisphenol et sans phenol.” Apparently, these two substances are toxic and make it dangerous to touch the ink on receipts.
Do receipts printed in the U.S. still contain these chemicals, and if so, is anything being done to protect workers and customers from it?
A: Many cash registers in the U.S. rely upon heat-sensitive paper to print receipts. It is the paper, not the ink, that contains bisphenol A (BPA). This chemical and similar compounds have been linked to a wide range of health problems because they mimic the hormone estrogen.
A study in the journal Environmental Health Perspectives (Aug. 25, 2015) determined whether handling cash-register receipts might impact levels of bisphenol in cashiers. The investigators found that amounts were higher after a worker’s shift than before, and that thermal receipt paper represents a source of exposure to bisphenol compounds.
Whether such receipts pose a risk to consumers remains controversial. Bisphenol also is found in the lining of many aluminum cans, food packaging containers and plastic medical equipment. So far, the Food and Drug Administration has not banned this substance.
Q: I have been unable to tolerate most medicines without experiencing bad side effects. My doctor does not believe me. She prescribes medications with names I don’t recognize, and I react badly to them. My mother and daughter have the same problem.
Just to illustrate, children’s cough medicine with codeine put me in the emergency room with a drug overdose. Antihypertensive drugs dropped my blood pressure to 40/30. Prilosec gave me horrible abdominal pain. It seems the list is endless. Is this an actual condition?
A:We are shocked that your physician does not seem to be aware of the reason for your super-sensitivity to codeine. There is a very good likelihood that you metabolize drugs differently than many other people, which would account for the overdose you experienced.
Codeine is converted to morphine in the body, but this requires an enzyme called CYP2D6. Some people are ultrarapid metabolizers, which means they quickly transform codeine into morphine, which in turn can lead to overdose. This is especially dangerous in vulnerable children and has led to accidental deaths.
The fact that your mother and your daughter also are highly susceptible to drug side effects suggests that you all have a similar genetic profile. Prescribers should take this into account and modify doses accordingly.
Q: I suffer from asthma and osteoporosis. I am concerned that the asthma medicines that I take (Flovent and Xopenex) have side effects that are affecting my osteoporosis and my essential tremor. Are there any alternatives for my condition?
A: Flovent contains fluticasone, a cortisonelike drug that has been linked with bone thinning and osteoporosis. Other asthma inhalers that contain corticosteroids (Advair, Pulmicort, QVAR, Symbicort) also may pose a similar risk.
That does not mean you can stop your inhaler, as such drugs represent a mainstay of asthma treatment. You may find a book by David Hahn, M.D., M.S., of interest. He discusses an alternative antibiotic approach in “A Cure for Asthma? What Your Doctor Isn’t Telling You - and Why” (published by People’s Pharmacy Press).
In their column, Joe and Teresa Graedon answer letters from readers. You can email them via their website at www.peoplespharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”
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