Attachment: Children's Report summary
Discussion Draft of the ‘Food and Drug Administration Globalization Act’ Legislation: Device and Cosmetic Safety
Before the Subcommittee on Health of the Committee on Energy and Commerce United States House of Representatives
Wednesday, May 14, 2008, at 10 a.m.
Submitted for the Record
Mr. Chairman, Ranking Member, distinguished Members of the Committee, thank you for this opportunity to testify on the “Discussion Draft of the ‘Food and Drug Administration Globalization Act’ Legislation: Device and Cosmetic Safety.” My name is Jane Houlihan, and I am the Vice President for Research at the Environmental Working Group (EWG), a nonprofit research and advocacy organization based in Washington, DC and Oakland, California. We appreciate the Committee’s interest in, and commitment to, seriously addressing the regulation of cosmetics for the first time in decades. Unfortunately, the cosmetics industry has enjoyed a largely unwatched and unregulated status that raises serious concerns for public health. Cosmetics, or personal care products, are essentially unregulated under the Federal Food, Drug, and Cosmetics Act (FFDCA). The Act includes 112 pages of standards for food and drugs, but just a single page for cosmetics (Tolchin 1990). This page provides the Food and Drug Administration (FDA) with virtually no power to perform even the most rudimentary functions needed to ensure the safety of an estimated $35 billion of personal care products purchased by consumers annually. Under federal law and regulation, FDA (FDA 1995, 2005):
- Cannot require companies to test cosmetic products for safety before marketing.
- Does not review or approve cosmetic products and cosmetic ingredients before they are sold to the public.
- Cannot regulate cosmetic products until after they are released to the marketplace, and even then the process is extremely cumbersome.
- Cannot require product recalls. The agency must to go to court to remove misbranded and adulterated products from the market
- Cannot require manufacturers to register their cosmetic establishments, file data on ingredients, or report cosmetic-related injuries. Instead, FDA relies on voluntary reporting of ingredients, injuries and establishments.
In the absence of government authority, the safety of personal care product ingredients is evaluated through a voluntary industry program known as the Cosmetic Industry Review (CIR) process. In the words of John Bailey, former head of the FDA’s Office of Cosmetics and Color and now head of the personal care products lobby group’s science division, "In the absence of the CIR program, there would be no systematic examination of the safety of individual cosmetic ingredients" (FDA 1992). This complete absence of accountability to a responsible government agency has not served the American public well. Instead, it has created a culture of ignorance around personal care products, where far too little is known about ingredient safety, while the industry and the FDA steadfastly maintain that all products and their ingredients are safe. In the Committee Discussion Draft, you are taking vital steps to close these gaps by requiring cosmetic facilities to comply with some of the same requirements as other facilities: registration with the US Food and Drug Administration (FDA), requiring cosmetic manufacturers to report all anticipated and unanticipated serious adverse effects to FDA, and requiring good manufacturing practices. These actions are needed to close serious gaps in information on personal care products. My testimony will focus largely on what we do and do not know about cosmetics. Unfortunately, what we do not know is much greater than what we do know. But, we do know enough to urge this committee to act expeditiously on the Discussion Draft. In addition, we look forward to working with the Committee as we move forward on additional efforts to ensure that cosmetics are safe for consumers. The vast majority of ingredients have not been assessed for safety by the CIR, the FDA, or any other publicly accountable body. The regulation of cosmetics is woefully outdated. The basic law regulating cosmetics has not been significantly updated for many decades. For the last 32 years, voluntary programs like the CIR, which companies are free to follow or ignore, have been used to deflect calls for reform and fend off the much-needed expansion of FDA authority to include review of ingredient safety. Through 3 decades the CIR has reviewed only about 11% of the ingredients in products, or 1,400 out of what FDA estimates is a total of 12,500 ingredients in personal care products (FDA 2007). At this pace, it will require another two and a half centuries to review the safety of all the ingredients in use by the cosmetics industry, assuming nothing new is introduced. Companies are free to use almost any ingredient they choose in personal care products, with no proof of safety required. FDA has prohibited or restricted by regulation only 9 ingredients in personal care products (FDA 2000a). The CIR has recommended restrictions on some uses of some additional ingredients, mostly to minimize skin irritation and allergic reactions, but has found only 9 ingredients unsafe for use in personal care products (a different 9 from FDA) (CIR 2006). Companies are free to use any other ingredient they choose in cosmetics. Environmental Working Group’s 2007 survey of products sold in the U.S. found nearly 400 products on the market that contain chemicals prohibited for use in cosmetics in other countries, and over 400 products containing ingredients that industry assessments have found unsafe when used as directed on product labels according to reviews by the CIR and the International Fragrance Association (EWG 2007a). EWG’s assessments of product ingredients reveal:
- A wide range of nano-materials may be common in personal care products (EWG 2007b). The safety of these ingredients is in question and is currently under study by multiple government public health agencies (NNI 2008).
- Phthalate plasticizers linked to birth defects of the male reproductive system and other health problems remain in common use in nail care products (EWG 2008a, EWG 2000, Houlihan et al. 2002).
- Companies still use hydroquinone in skin lighteners, despite FDA’s proposed restrictions and warnings that the ingredient can lead to permanent skin disfigurement and may be linked to cancer and reproductive problems (FR 2006).
- Products contain a wide variety of ingredients derived from animal organs and tissues, including placenta expelled from cows (EWG 2008c), ingredients that raise concerns for the transmission of bovine spongiform encephalopathy (FDA 2007), ingredients restricted in other countries (Health Canada 2007), and “ethically sourced” human placenta (Earthscience 2008).
- Studies show lead contamination in lipstick (CSC 2008) and cancer-causing impurities in children’s products and products labeled as “natural” (OCA 2008, EWG 2007c, Steinman 2007).
Since 2000, EWG has analyzed the safety of personal care product ingredients and the laws and regulations that govern them. We publish the results of this work as a part of our Skin Deep website, a searchable consumer tool that evaluates the safety of ingredients in 29,000 personal care products (EWG 2008b). An EWG analysis of product ingredients against definitive government, industry, and academic databases of hazardous chemicals finds that more than 1 in 5 of all products contain chemicals linked to cancer, 80% contain ingredients that commonly contain hazardous impurities, and 56% contain penetration enhancers that help deliver ingredients deeper into the skin. Cosmetic ingredients penetrate the skin and may pose health risks, particularly for children. Personal care products may be the primary exposure route for many chemicals that raise significant health concerns. Consumers can be exposed through skin absorption, inhalation, and ingestion. A personal care product use survey of more than 2,300 people, conducted by EWG and a coalition of public interest and environmental health organizations, shows that the average adult uses 9 personal care products each day, with 126 unique chemical ingredients. More than a quarter of all women and 1 of every 100 men use at least 15 products daily. The average woman uses 12 products containing 168 unique ingredients every day. Men, on the other hand, use 6 products daily with 85 unique ingredients, on average (EWG 2004). Children are at particular risk from exposures to personal care product ingredients. Their skin is significantly thinner than an adult’s, their ability to detoxify and excrete chemicals can be limited, and at birth the blood-brain barrier that can block chemicals’ access to brain tissue is not complete (NRC 1993, EWG 2007d). In short, their developing bodies are more vulnerable to damage from hazardous chemicals. Yet children’s products are not assessed for their risks to children. In July and August of 2007, EWG surveyed more than 3,300 parents to find out what shampoos, lotions, bath soaps and other personal care products their children use. Based on the specific products named by these parents, we found that children are exposed to an average of 61 different chemical ingredients every day, and that on average 27 of these ingredients have not been found safe for children by the government or the cosmetic industry's expert safety panel (EWG 2007d, see attached Executive Summary). Over the past decade, a steady stream of peer-reviewed scientific studies and reports from the Centers for Disease Control and Prevention (CDC) has documented the presence of chemicals from personal care products in the blood and tissues of most Americans, including young children. Many of these chemicals present serious health risks, and most have not been evaluated by the CIR or any authoritative body. Scientists have found many common cosmetic ingredients in human tissues, including industrial plasticizers called phthalates in urine (CDC 2005), preservatives called parabens in breast tumor tissue and urine (Darbre et al. 2004, Ye et al. 2006), and persistent fragrance components like musk xylene in human fat, blood, and breast milk (Müller et al. 1996, Eisenhardt et al. 2001, Reiner et al. 2007). Scientists at the Centers for Disease Control and Prevention (CDC) detected phthalates in urine samples from all but 12 of 2,790 people tested (CDC 2005), with six or more phthalates found in 84% of people tested. A recent study establishes a link between the use of shampoos and lotions on infants and the presence of a group of chemicals called phthalates in infants’ bodies (as measured in urine). All babies in the study had at least one phthalate in them; 80% had seven or more (Sathyanarayana et al. 2008). Over the past four years scientists have published at least 10 epidemiology studies linking phthalates to birth defects in baby boys, reproductive problems in men, abdominal obesity, increased diabetes risk, thyroid problems, as well as asthma and dermal diseases in children (Stahlhut et al. 2007, Meeker et al. 2007, Huang et al. 2007, Duty et al. 2003a, 2003b, 2004, and 2005, Hauser et al. 2007, Hauser et al. 2006, Wormuth et al. 2006, Marsee et al. 2006, Swan et al. 2005, Bornehag et al. 2004, Lottrup et al. 2006). This evidence joins many dozens of laboratory studies proving phthalates to be potent reproductive toxicants that target the male reproductive system, posing the greatest risks during development (Matsumoto et al. 2008, Gray et al. 2006, Frederiksen et al. 2007). Some phthalates are banned from personal care product use in the EU; none are restricted in the U.S. A 2008 study by the CDC found that 97% of Americans are contaminated with a widely used sunscreen ingredient called oxybenzone that has been linked to allergies, hormone disruption, and cell damage (Calafat et al. 2008b). A companion study published just one day earlier revealed that this chemical is linked to low birth weight in baby girls whose mothers are exposed during pregnancy (Wolff et al. 2008). Oxybenzone is also a penetration enhancer, a chemical that helps other chemicals penetrate the skin. Triclosan, a common ingredient in anti-microbial soaps, was found in the urine of 61% of 90 girls age 6 to 8 by researchers from Mt. Sinai School of Medicine (Wolff et al. 2007). CDC found triclosan in 75% of the U.S. population in a recent study (Calafat et al. 2008a). Triclosan tends to bioaccumulate (Samsøe-Petersen 2003), or become more concentrated in the fatty tissues of humans and other animals. As a result, this chemical has been detected in human breast milk, and in blood samples as well (Adolfsson-Erici 2002; TNO 2005; Allmyr 2008. 2006a,b; Dayan 2007). Higher levels of triclosan in blood and breast milk are linked to use of body care products containing triclosan (Allmyr 2006a). The overwhelming weight of the evidence indicates that chemicals in personal care products may be a serious health threat to the American public, and the FDA does not have the statutory authority or the resources to step in and protect the public. Despite the potential risks, FDA does not even know how many ingredients are used in cosmetics. The FDA does not have a basic understanding of the size and scope of the potential health risks from cosmetic ingredients, in no small part because the agency does not know how many ingredients are in cosmetics. And the cosmetic industry does not seem to know, either. In 2000, FDA stated that, “It has been estimated that consumer expenditures for cosmetics exceed 35 billion dollars annually. It is further estimated that the marketed cosmetics are being produced in more than 1400 domestic manufacturing and repacking establishments and represent more than 25,000 product formulations. About 10,500 different cosmetic ingredients and a similar number of fragrance ingredients are being used by the cosmetic industry” (FDA 2000b). In 2007 FDA altered their estimate of ingredients to 12,500 (FDA 2007). Cosmetics industry officials, on the other hand, have variously estimated that the total number of ingredients used is "probably around 2,000" (Solomon 2004) or "really less than 4,000" (Bender 2005). FDA sources show that the agency has records of 4,066 ingredients, as published in their ingredient dictionary and in the product database FDA has compiled through its Voluntary Cosmetic Registration Program (FDA 2008a, FDA 2008b). EWG has compiled ingredient listings for 29,037 products in our online product database (EWG 2008b), and as of May 12 2008 we find a total of 8,821 unique ingredients in our product database and FDA sources altogether, including 4,755 ingredients for which FDA has no record. Clearly, the industry’s voluntary program for providing FDA with product ingredient listings is leaving FDA with grossly incomplete data on the full scope of ingredients used in products. FDA does not know where and how many companies make and distribute personal care products. FDA cannot require companies to register their cosmetics establishments with the agency, although they encourage companies to do so voluntarily. The absence of mandatory registration is a significant limiting factor in FDA’s ability to ensure that cosmetics are not harming public health. Without the ability to require pre-market safety testing, FDA must rely on facility inspections to assess product safety. A 1990 General Accounting Office study found that facility inspections are FDA’s “primary enforcement tool for overseeing the cosmetics industry” (GAO 1990). Yet without mandatory registration, FDA does not know where and how many companies make and distribute personal care products. It is impossible for FDA to inspect facilities if their existence is not on record. And as the GAO noted, “Because FDA cannot mandate participation, it cannot accurately assess how many companies may be avoiding registration” (GAO 1990). FDA has estimated that marketed cosmetics are being produced in more than 1,400 domestic manufacturing and repacking establishments (FDA 2007), but their registration system for these establishments is purely voluntary. FDA does not know the extent of health impacts from harmful ingredients in cosmetics. Twenty years ago the cosmetic industry staved off the threat of federal regulation with renewed pledges to increase the number of companies reporting adverse health effects from their products to FDA’s voluntary reporting system. At the time, FDA reported that only 3% of distributors were filing injury reports. Though the industry claimed this was sufficient, since large companies with large market shares were participating, FDA noted that without injury data for each specific product on the market, they would be unable to identify all those that present safety problems (GAO 1990). GAO found that voluntary injury reporting will fail: “FDA will never be able to require reporting from all companies, particularly those that may be least likely to report because they have experienced problems with their cosmetics” (GAO 1990). In 2007 the cosmetic trade association launched a renewed effort to boost company participation in voluntary reporting, a program called the Consumer Commitment Code, again staving off renewed interest in stronger federal regulations. By signing the Code, a company agrees, among other things, to calculate “the incidence of adverse health effects in the United States (e.g., number per 100,000 or million units distributed) that have been medically confirmed as caused by the product in question” and to provide this information to FDA for inspection at a “mutually agreed location” when an FDA District Director submits a written request to the company’s CEO or other designated official that is based on an explicit, legitimate, and specific safety concern with regard to the product (PPCP 2008). This agreement might help mitigate the long-standing problem of companies refusing to disclose health information to FDA on their products (GAO 1990). But while better reporting of adverse events is a necessary first step to ensuring product safety, it alone will not give FDA the data it needs to understand the full range of health impacts from harmful cosmetic ingredients, even if the entire cosmetic industry participates and if FDA spends enormous resources sending staff to “mutually agreed locations” to inspect ingredient safety reports. Consumers and their doctors might recognize skin irritation or allergic reactions as linked to particular products. But those cases will be the exceptions. Chronic health effects from chemicals in personal care products, like cancer, reproductive or nervous system effects are driven by genetic susceptibility, the timing of exposures, and aggregate exposures over a lifetime, and can almost never be traced back to individual consumer products. Exposures in the womb or early childhood, for instance, can lead to health problems much later in life (Lau et al. 2004). An injury reporting system that focuses only on acute, immediately observable adverse reactions will never help FDA understand other kinds of health risks. Only mandatory reporting systems, pre-market safety testing, and stronger safety standards for cosmetics will provide the information needed to ensure that personal care products are truly safe. Consumers’ right-to-know is hampered by lack of standards and labeling loopholes. With no required safety testing for products, consumers must rely on labels for clues about a product’s safety. Unfortunately, though, not all ingredients appear on labels, and not all claims printed on products must be backed by proof. There is almost no regulation of marketing terms and other product claims. When FDA tried to establish definitions for the use of terms such as "natural" and "hypoallergenic," its regulations were overturned in court. Companies can use these and many other claims on cosmetic labels “to mean anything or nothing at all” (FDA 1998). EWG’s analysis (EWG 2007c) shows that 35% of all children's products marked as "natural" on the label are not completely natural, but instead contain one or more artificial preservatives linked to allergic reactions, hormone disruption, or nervous system problems in laboratory studies. Four out of five children's products marked as gentle and non-irritating (gentle, soothing, non-irritating, dermatologist approved, or free of harsh ingredients) instead contain ingredients linked to allergies and skin or eye irritation according to government and industry sources. When the cosmetic trade association’s chief scientist was head of FDA’s color and cosmetic office, he noted: "Most cosmetics contain ingredients that are promoted with exaggerated claims of beauty or long-lasting effects to create an image… Image is what the cosmetic industry sells through its products, and it's up to the consumer to believe it or not” (FDA 1992). Likewise, consumers’ ability to make wise purchasing decisions is hampered by significant ingredient labeling loopholes. Federal law requires that all ingredients in a product appear in order of prevalence, but does not require that the ingredients in the “fragrance” added to a product appear on the label. Fragrances are usually complex mixtures of many chemicals. EWG’s research shows that 44% of all products list the word “fragrance” on the ingredient label but fail to list what’s in it (EWG 2008d). FDA has estimated that there are 12,500 ingredients in cosmetics, and an additional 12,500 chemicals used as fragrances (FDA 2007), none of which are required to be listed on product labels. Additionally, nanomaterials do not have to appear as such on product labels. Many ingredients are now produced in both conventional and nano-scale forms that may pose greater potential for exposure and health risks. Because there are no labeling requirements for nanomaterials, consumers have no way to know the difference. Recommendations The cosmetics industry has renewed efforts to boost participation in voluntary programs through its new Consumer Commitment Code. But the industry’s 70-year track record in self-regulation shows that this effort will fail to provide FDA with the information and authority it needs to protect public health. To fill the gaps, states are taking actions to restrict some of the most hazardous chemicals from products, independent certifications programs are increasing in number in attempts to provide meaningful standards for consumers, and groups and coalitions like the national Campaign for Safe Cosmetics are educating consumers on cosmetic safety and working directly with manufacturers to encourage the production of safer products. Until FDA can take enforceable actions when problems arise, the agency will remain unable to protect public health. EWG looks forward to working with the committee to address the following issues to ensure that personal care products are safe, particularly for those most vulnerable to the harmful effects of hazardous chemicals:
- Mandatory registration of facilities. FDA needs to know who is making personal care products, and what products they are making, as a basic first step to protecting the public health.
- Mandatory, public injury reports (adverse event reporting). FDA needs to know exactly which products may be endangering public health so that they can take the appropriate actions.
- Registration of products and ingredients must be mandatory. FDA must know what is in products if it is to protect the public from ingredients that may pose health risks.
- Meaningful and proven labeling. Product claims and marketing terms must be backed up by tests and must meet explicit definitions set by FDA.
- Safety standards for cosmetics and FDA enforcement authority. FDA’s safety standard for cosmetics and its authority over cosmetic safety must be brought up to par with the agency’s authority over pesticides and food and color additives under the Federal Food, Drug, & Cosmetic Act (FFDCA). FDA must have the mandate to ensure that ingredients are safe and the authority to demand the studies that it needs to make this finding. Cosmetic ingredients have been found in cord blood and they pollute the bodies of nearly everyone in the population; they should be as safe as pesticides, and food and color additives that meet safety standards under FFDCA.
Thank you. References Adolfsson-Erici M, Pettersson M, Parkkonen J, Sturve J. 2002. Triclosan, a commonly used bactericide found in human milk and in the aquatic environment in Sweden. Chemosphere. 2002 Mar;46(9-10):1485-9. Allmyr M, Harden F, Toms LM, Mueller JF, McLachlan MS, Adolfsson-Erici M, Sandborgh-Englund G. 2008. The influence of age and gender on triclosan concentrations in Australian human blood serum. Sci Total Environ. 2008 Apr 1;393(1):162-7. Epub 2008 Jan 22. Allmyr M, Adolfsson-Erici M, McLachlan MS, Sandborgh-Englund G. 2006a. Triclosan in plasma and milk from Swedish nursing mothers and their exposure via personal care products. Sci Total Environ. 2006 Dec 15;372(1):87-93. Allmyr M, McLachlan MS, Sandborgh-Englund G, Adolfsson-Erici M. 2006b. Determination of triclosan as its pentafluorobenzoyl ester in human plasma and milk using electron capture negative ionization mass spectrometry. Anal Chem. 2006 Sep 15;78(18):6542-6. Bender, K. 2005. Trend: Health-Conscious Teens Toss Make-Up. Women’s ENews. March 28 2005. Accessed May 11 2008 at http://www.womensenews.org/article.cfm/dyn/aid/2201. Bornehag CG, Sundell J, Weschler CJ, Sigsgaard T, Lundgren B, Hasselgren M, Hägerhed-Engman L. 2004. The association between asthma and allergic symptoms in children and phthalates in house dust: a nested case-control study. Environ Health Perspect. 2004 Oct;112(14):1393-7. Calafat AM, Ye X, Wong LY, Reidy JA, Needham LL. 2008a. Exposure of the U.S. population to bisphenol A and 4-tertiary-octylphenol: 2003-2004. Environ Health Perspect. 2008 Jan;116(1):39-44. Calafat AM, Ye X, Wong LY, Reidy JA, Needham LL. 2008b. Urinary concentrations of triclosan in the U.S. population: 2003-2004. Environ Health Perspect. 2008 Mar;116(3):303-7. CDC (Centers for Disease Control and Prevention). 2005. Third National Exposure Report. http://www.cdc.gov/exposurereport/report.htm. CIR (Cosmetic Ingredient Review). 2006. Ingredients found unsafe for use in cosmetics (9 total, through December, 2006). Available for download at http://www.cir-safety.org/findings.shtml. Accessed May 11 2008. CSC (Campaign for Safe Cosmetics). 2008. A Poison Kiss: The Problem of Lead in Lipstick. Accessed May 11 2008 at http://www.safecosmetics.org/your_health/poisonkiss.cfm. CTFA (Cosmetic Toiletry and Fragrance Association). 2005. Annual Report. Accessed May 11 2008 at www.ctfa.org/Content/NavigationMenu/About_CTFA/Annual_Report/48661a_CTFA_Lowres.pdf Darbre PD, Aljarrah A, Miller WR, Coldham NG, Sauer MJ, Pope GS. 2004. Concentrations of parabens in human breast tumours. J Appl Toxicol. 2004 Jan-Feb;24(1):5-13. Dayan AD. 2007. Risk assessment of triclosan [Irgasan] in human breast milk. Food Chem Toxicol. 2007 Jan;45(1):125-9. Duty SM, Silva MJ, et al. 2003a. Phthalate exposure and human semen parameters. Epidemiology 14(3): 269-77. Duty SM, Singh NP, et al. 2003b. The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay. Environ Health Perspect 111(9): 1164-9. Duty SM, Calafat AM, et al. 2004. The relationship between environmental exposure to phthalates and computer-aided sperm analysis motion parameters. J Androl 25(2): 293-302. Duty SM, Calafat AM, et al. 2005. Phthalate exposure and reproductive hormones in adult men. Hum Reprod 20(3): 604-10. Earthscience. 2008. FAQ. Where do you obtain the placenta in Placentagen Eye and Throat Crème? Accessed May 11 2008 at http://www.earthessentials.com/faq.html. Eisenhardt S, Runnebaum B, Bauer K, Gerhard I. 2001. Nitromusk compounds in women with gynecological and endocrine dysfunction. Environ Res. 2001 Dec;87(3):123-30. EWG (Environmental Working Group). 2008a. 128 Products Containing Dibutyl Phthalate. Skin Deep Cosmetic Safety Database. Accessed May 11 2008 at http://www.cosmeticdatabase.com/browse.php?containing=701929. EWG (Environmental Working Group). 2008b. Skin Deep Cosmetic Safety Database. http://www.cosmeticdatabase.com. EWG (Environmental Working Group). 2008c. 12,798 Products Containing Fragrance. Skin Deep Cosmetic Safety Database. Accessed May 11 2008 at http://www.cosmeticdatabase.com/browse.php?containing=702512. EWG (Environmental Working Group). 2007a. Cosmetics with Banned and Unsafe Ingredients. Letter from Richard Wiles of EWG to Andrew von Eschenbach of FDA. https://www.ewg.org/node/22610. EWG (Environmental Working Group). 2007b. A Survey of Ingredients in 25,000 Personal Care Products Reveals Widespread Use of Nano-Scale Materials, Not Assessed for Safety, in Everyday Products. Comments to U.S. Food and Drug Administration. Docket: FDA Regulated Products Containing Nanotechnology Materials. Docket number: 2006N-0107. https://www.ewg.org/node/21738. EWG (Environmental Working Group). 2007c. EWG Research Shows 22 Percent of All Cosmetics May Be Contaminated With Cancer-Causing Impurity. Accessed May 11 2008 at https://www.ewg.org/node/21286. EWG (Environmental Working Group). 2007d. Safety Guide to Children’s Personal Care Products. Accessed May 11 2008 at http://www.cosmeticdatabase.com/special/parentsguide/summary.php. EWG (Environmental Working Group). 2004. Exposures Add Up – Survey Results. Accessed May 11 2008 at http://www.cosmeticdatabase.com/research/exposures.php. EWG (Environmental Working Group). 2000. Beauty Secrets. Does a Common Chemical in Nail Polish Pose Risks to Human Health? Accessed May 11 2008 at https://www.ewg.org/research/beauty-secrets. FDA (U.S. Food and Drug Administration). 2008a. 9-Digit Code Number Dictionary. Voluntary Cosmetic Registration Program. https://info1.cfsan.fda.gov/vcrp/report/?cmd=cas. FDA (U.S. Food and Drug Administration). 2008b. Voluntary Cosmetic Registration Program. Product and ingredient listings obtained on Feb 4, 2008 via Freedom of Information Act request from Environmental Working Group to FDA submitted on July 7, 2006. FDA (U.S. Food and Drug Administration). 2007. Compliance Program Guidance Manual. Program 7329.001. Chapter 29 – Colors and Cosmetics Technology. Available for download at http://www.cfsan.fda.gov/~comm/cp-toc.html. Accessed May 11 2008. FDA (U.S. Food and Drug Administration). 2005. FDA Authority Over Cosmetics. Accessed May 11 2008 at http://www.cfsan.fda.gov/~dms/cos-206.html. FDA (U.S. Food and Drug Administration). 1998. Clearing Up Cosmetic Confusion by Carol Lewis. FDA Consumer magazine. May-June 1998. Accessed May 11 2008 at http://www.fda.gov/FDAC/features/1998/398_cosm.html. FDA (U.S. Food and Drug Administration). 1995. FDA Authority Over Cosmetics. Accessed May 11 2008 at http://web.archive.org/web/20050207151415/http://www.cfsan.fda.gov/~dms/cos-206.html. Dated February 3 1995. Last archived February 7 2005. FDA (U. S. Food and Drug Administration). 2000a. Prohibited Ingredients and Related Safety Issues. Center for Food Safety and Applied Nutrition. Office of Cosmetics Fact Sheet. March 30, 2000. Accessed May 11 2008 at http://www.healthy-communications.com/fdaprohibitedingredients.html. FDA (U. S. Food and Drug Administration). 2000b. Cosmetics Compliance Program. Domestic Cosmetics Program. Chapter 29 – Cosmetics and Color Technology. July 31 2000. Accessed May 11 2008 at http://web.archive.org/web/20010619050559/http://www.cfsan.fda.gov/~comm/cp29001.html. FDA (U.S. Food and Drug Administration). 1995. FDA Authority Over Cosmetics. Accessed May 11 2008 at http://web.archive.org/web/20050207151415/http://www.cfsan.fda.gov/~dms/cos-206.html. Dated February 3 1995. Last archived February 7 2005. FDA (U.S. Food and Drug Administration). 1992. Cosmetic Ingredients: Understanding the Puffery by Judith E. Foulke. FDA Consumer Magazine. May 1992. Accessed May 11 2008 at http://www.fda.gov/fdac/reprints/puffery.html. FR (Federal Register). 2006. Skin Bleaching Drug Products For Over-the-Counter Human Use; Proposed Rule. August 29, 2006 (Volume 71, Number 167). Page 51146-51155. http://www.fda.gov/OHRMS/DOCKETS/98fr/E6-14263.htm. Frederiksen H, Skakkebaek NE, Andersson AM. 2007. Metabolism of phthalates in humans. Mol Nutr Food Res. 2007 Jul;51(7):899-911. GAO (U.S. General Accounting Office). 1990. Cosmetic Regulations. Information on Voluntary Actions Agreed to by FDA and the Industry. GAO/HRD-90-58. March 1990. Gray LE Jr, Wilson VS, Stoker T, Lambright C, Furr J, Noriega N, Howdeshell K, Ankley GT, Guillette L. 2006. Adverse effects of environmental antiandrogens and androgens on reproductive development in mammals. Int J Androl. 2006 Feb;29(1):96-104. Hauser R, Meeker JD, Singh NP, Silva MJ, Ryan L, Duty S, Calafat AM. 2007. DNA damage in human sperm is related to urinary levels of phthalate monoester and oxidative metabolites. Hum Reprod. 2007 Mar;22(3):688-95. Hauser R, Meeker JD, Duty S, Silva MJ, Calafat AM. 2006. Altered semen quality in relation to urinary concentrations of phthalate monoester and oxidative metabolites. Epidemiology. 2006 Nov;17(6):682-91. Health Canada. 2007. List of Prohibited and Restricted Cosmetic Ingredients. ttp://www.hc-sc.gc.ca/cps-spc/person/cosmet/info-ind-prof/_hot-list-critique/prohibited_e.html. Hotchkiss AK, Parks-Saldutti LG, Ostby JS, Lambright C, Furr J, Vandenbergh JG, Gray LE Jr. 2004. A mixture of the "antiandrogens" linuron and butyl benzyl phthalate alters sexual differentiation of the male rat in a cumulative fashion. Biol Reprod. 2004 Dec;71(6):1852-61. Houlihan J, Brody C, Schwan B. 2002. Not Too Pretty. Phthalates, Beauty Products & the FDA. Accessed May 11 2008 at https://www.ewg.org/reports/nottoopretty. Howdeshell KL, Furr J, Lambright CR, Rider CV, Wilson VS, Gray LE Jr. 2007. Cumulative effects of dibutyl phthalate and diethylhexyl phthalate on male rat reproductive tract development: altered fetal steroid hormones and genes. Toxicol Sci. 2007 Sep;99(1):190-202. Huang PC, Kuo PL, Guo YL, Liao PC, Lee CC. 2007. Associations between urinary phthalate monoesters and thyroid hormones in pregnant women. Hum Reprod. 2007 Oct;22(10):2715-22. Lau C, Rogers JM. 2004. Embryonic and fetal programming of physiological disorders in adulthood. Birth Defects Res C Embryo Today. 2004 Dec;72(4):300-12. Lottrup G, Andersson AM, Leffers H, Mortensen GK, Toppari J, Skakkebaek NE, Main KM. 2006. Possible impact of phthalates on infant reproductive health. Int J Androl. 2006 Feb;29(1):172-80. Main KM, Mortensen GK, et al. 2006. Human breast milk contamination with phthalates and alterations of endogenous reproductive hormones in infants three months of age. Environ Health Perspect 114(2): 270-6. Marsee K, Woodruff TJ, Axelrad DA, Calafat AM, Swan SH. 2006. Estimated daily phthalate exposures in a population of mothers of male infants exhibiting reduced anogenital distance. Environ Health Perspect. 2006 Jun;114(6):805-9. Matsumoto M, Hirata-Koizumi M, Ema M. 2008. Potential adverse effects of phthalic acid esters on human health: a review of recent studies on reproduction. Regul Toxicol Pharmacol. 2008 Feb;50(1):37-49. Meeker JD, Calafat AM, Hauser R. 2007. Di(2-ethylhexyl) phthalate metabolites may alter thyroid hormone levels in men. Environ Health Perspect. 2007 Jul;115(7):1029-34. Müller S, Schmid P, Schlatter C. 1996. Occurrence of nitro and non-nitro benzenoid musk compounds in human adipose tissue. Chemosphere. 1996 Jul;33(1):17-28. NNI (National Nanotechnology Initiative). 2008. NNI Environmental, Health, and Safety Issues. http://www.nano.gov/html/society/EHS.html. NRC (National Research Council). 1993. Pesticides in the Diets of Infants and Children. June 1993. National Academy of Sciences Press. Washington, DC. OCA (Organic Consumer Association). 2008. Carcinogenic 1,4-Dioxane Found in Leading "Organic" Brand Personal Care Products. Press release. Accessed May 11 2008 at http://www.organicconsumers.org/bodycare/DioxaneRelease08.cfm. PPCP (Personal Care Products Council). 2008. The Personal Care Products Council Consumer Commitment Code. Accessed May 11 2008 at http://www.personalcarecouncil.org/Content/NavigationMenu/About_Us/Consumer_Commitment_Code1/Consumer_Commitment_Code.htm. Reiner JL, Wong CM, Arcaro KF, Kannan K. 2007. Synthetic musk fragrances in human milk from the United States. Environ Sci Technol. 2007 Jun 1;41(11):3815-20. Samsøe-Petersen L, Winther-Nielsen M, Madsen T. 2003. Fate and Effects of Triclosan. Danish Environmental Protection Agency. Sathyanarayana S, Karr CJ, Lozano P, Brown E, Calafat AM, Liu F, Swan SH. 2008. Baby care products: possible sources of infant phthalate exposure. Pediatrics. 2008 Feb;121(2):e260-8. Stahlhut RW, van Wijngaarden E, Dye TD, Cook S, Swan SH. 2007. Concentrations of urinary phthalate metabolites are associated with increased waist circumference and insulin resistance in adult U.S. males. Environ Health Perspect. 2007 Jun;115(6):876-82. Solomon GL. 2004. Wash those fears right out. The Washington Times. August 15, 2004. Steinman D. 2007. 1,4-Dioxane in personal care products. Test results. Accessed May 11 2008 at https://static.ewg.org/files/14-dioxane.pdf. Swan SH, Main KM, et al. 2005. Decrease in anogenital distance among male infants with prenatal phthalate exposure. Environ Health Perspect 113(8): 1056-61. TNO. 2005. Man-made chemicals in maternal and cord blood TNO-B&O-A R 2005/129. Apeldoorn, The Netherlands: TNO Built Environment and Geosciences. Tolchin M. 1990. Who’s Monitoring Cosmetics Safety? New York Times. April 14, 1990. Wolff MS, Engel SM, Berkowitz GS, Ye X, Silva MJ, Zhu C, et al. 2008. Prenatal phenol and phthalate exposures and birth outcomes. Environmental health perspectives 116: Available online March 20, 2008. Wolff MS, Teitelbaum SL, Windham G, Pinney SM, Britton JA, Chelimo C, Godbold J, Biro F, Kushi LH, Pfeiffer CM, Calafat AM. Pilot study of urinary biomarkers of phytoestrogens, phthalates, and phenols in girls. Environ Health Perspect. 2007 Jan;115(1):116-21. Wormuth M, Scheringer M, Vollenweider M, Hungerbühler K. 2006. What are the sources of exposure to eight frequently used phthalic acid esters in Europeans? Risk Anal. 2006 Jun;26(3):803-24. Ye X, Bishop AM, Reidy JA, Needham LL, Calafat AM. 2006. Parabens as urinary biomarkers of exposure in humans. Environ Health Perspect. 2006 Dec;114(12):1843-6.