
FDA: Antibacterial soaps could pose health risks - brianmartinek
http://www.usatoday.com/story/news/nation/2013/12/16/fda-antibacterial-soap/4038907/
======
DanBC
The US CDC has a nice document called "When is Clean Too Clean?"

[http://wwwnc.cdc.gov/eid/article/7/2/70-0225_article.htm](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.

~~~
enkephalin
> I'm not sure what the research is?

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._

[http://www.sciencemag.org/content/336/6080/489.abstract#aff-...](http://www.sciencemag.org/content/336/6080/489.abstract#aff-1)

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._

[http://gut.bmj.com/content/early/2013/07/09/gutjnl-2012-3032...](http://gut.bmj.com/content/early/2013/07/09/gutjnl-2012-303249)

there's much more info to be found on the topic. these are just the ones i
recently stumbled upon.

~~~
rcthompson
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?

~~~
jblow
Left to its own devices, a baby will stick pretty much everything into its
mouth.

If you believe that evolution generates behavior to maximize survival value,
this fact about babies seems relevant.

~~~
rcthompson
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.

~~~
enkephalin
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.

~~~
rcthompson
I don't see how that's relevant or detracts from my point.

------
hawkharris
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.

[http://www.newyorker.com/reporting/2013/07/29/130729fa_fact_...](http://www.newyorker.com/reporting/2013/07/29/130729fa_fact_gawande)

------
aresant
TL;DR: Core ingredient in most anti-bacterial soaps, triclosan, may or may not
work. FDA asking manufacturers to prove it works.

Scientists say that these chemicals may act as hormone disruptors, pointing to
a link between triclosan exposure and allergies.

~~~
ars
> may or may not work

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.

~~~
bunderbunder
> > may or may not work

> 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.

~~~
ars
That's the wrong question.

Even if it does work (as in kill bacteria) on the hand, that doesn't mean it
works (as in prevents illness).

And in medical settings it's yet another question: does it work (as in prevent
the spread of bacteria), even if it doesn't prevent illness.

You have to be careful about what your goal is.

------
nathan_long
I never buy "antibacterial" soap. All soap is antibacterial in the sense that
it removes bacteria from your skin. That's all that matters.

Dousing those removed bacteria with chemicals, to which they could become
resistant, makes no sense to me.

~~~
Houshalter
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.

------
solox3
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.

~~~
npsimons
It's in a _lot_ of toothpastes, and a _lot_ of soft soaps. I've had to look
hard to find brands that don't include it.

~~~
lukifer
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.

~~~
simoncion
What's wrong with Listerine?

~~~
adrr
Alcohol can inflame your gums which can lead to gum disease. Best to use non
alcohol versions.

~~~
simoncion
In that case, one should warn others away from drinking vodka and whiskey.
Best to stick to beer, I guess. :-)

------
aestra
Antibacterial soaps have been shown to be _slightly_ more effective at
removing bacteria than non-anti bacteria soaps.
([http://dx.doi.org/10.4315/0362-028X.JFP-11-122](http://dx.doi.org/10.4315/0362-028X.JFP-11-122)
[http://dx.doi.org/10.1128/AEM.02405-07](http://dx.doi.org/10.1128/AEM.02405-07))

Safer? Probably not. Probably not worth the risks.

~~~
bunderbunder
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.

------
raverbashing
Not to mention increased resistance from bacteria

And of course the needed contact with foreign agents to build immune
resistance. Use antibacterial soap when needed: hospitals

~~~
jcampbell1
Is there any evidence for this? Generally speaking, one would expect biocide
resistant bacteria to be less antibiotic resistant.

~~~
JunkDNA
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](http://aac.asm.org/content/45/2/428.short)

------
steven2012
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!

------
tocomment
Why are they doing this now? What has changed?

~~~
scoot
This?

 _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._

~~~
jere
Just imagine if they gave 23andMe the same head start.

I'm also reminded of another FDA shenanigan:
[http://en.wikipedia.org/wiki/Stevia#Controversy](http://en.wikipedia.org/wiki/Stevia#Controversy)

------
rcthompson
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.

------
VLM
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.

~~~
blacksmith_tb
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.

~~~
sten
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.

------
CWuestefeld
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.

~~~
aestra
>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 Campaign for Safe Cosmetics explains:
[http://safecosmetics.org/section.php?id=75](http://safecosmetics.org/section.php?id=75)

 _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:

[http://www.scientificamerican.com/article.cfm?id=us-
governme...](http://www.scientificamerican.com/article.cfm?id=us-government-
has-little-authority-to-stop-unsafe-cosmetics)

 _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._

~~~
CWuestefeld
_facepalm_

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.

~~~
nate_meurer
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?

~~~
CWuestefeld
_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.

~~~
nate_meurer
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.

------
tlow
Just another reason I like my all natural biocide soap which doesn't cause
resistance[1]. It is made in SF and organic and called Cleanwell.

[1][http://en.wikipedia.org/wiki/Cleanwell#Active_Ingredient](http://en.wikipedia.org/wiki/Cleanwell#Active_Ingredient)

------
ck2
If it is bad on your hands, imagine what it is doing in many toothpastes now.

------
kimonos
Very helpful info! Thanks for sharing!

------
ffrryuu
Learn to co-exists. Otherwise you are just putting evolutionary pressure for
the bacteria to become super bacteria.

