Beached Syringes and the Invention of Medical Waste
The syringe tideswaves of used hypodermic needles, washing up on landterrified beachgoers of the late 1980s. Their disturbing lesson was ignored. T he first tide of syringes washed ashore on Thursday, August 13, 1987. Hundreds of unmarked hypodermic needles spilled out of the surf that afternoon, accompanied by vials and prescription bottles, along a 50-mile stretch of New Jersey beaches during peak tourist season. By the next morning, New Jersey Governor Thomas Kean, an environmentalist Republican with national ambitions, was aloft in a helicopter surveying the floating slick of medical waste and other garbage that now stretched from Manasquan to Atlantic City. Disembarking onto Island Beach State Park for a press conference, Kean vowed in front of a huddle of news cameras that New Jersey would join legal action to sue in federal court to have the guilty party pay every penny of damage that this tide of garbage has caused. New Jersey officials pointed eastward, across the water, toward Staten Islands Fresh Kills landfill, the 2,200-acre disposal site whose mounds of garbage by then ranked among the largest man-made structures in history. Perhaps an inbound barge filled with trash had spilled. Perhaps a Gotham crime syndicate was luring hospitals into an illicit dumping scheme. Federal officials, including Samuel Alito, then the U.S. attorney for New Jersey, began preparing legal action . But New York Citys mayor, Ed Koch, said there wasnt any proof that the needles had washed over from his jurisdiction. New York, the Koch administration insisted, was not missing any garbage. The legal battle ended a few months later, with a cash settlement and a technological fix. New York agreed to deploy a $6 million superboom with a 15-foot curtain in the water near the Fresh Kills landfill, to prevent its waste from floating over to New Jersey. But the settlement only skimmed the surface of a deeper panic. Some of the beached syringes had visible residues of blood and other bodily fluids. A few tested positive for hepatitisor for what was known then only as the AIDS virus. In October, Senator Frank Lautenberg of New Jersey welcomed his colleagues to a special Senate hearing in Atlantic City at which more syringes were on display, along with the evocative story of a 3-year old boy whose foot was punctured when he stepped on one, leading to weeks of shots to stave off possible infection. From their first appearance in the U.S., the syringe tides were a ready-made tabloid sensation, and a shocking visualization of the perils of a throwaway society. In the years that followed, major efforts would be taken to reduce Americans solid-waste production and protect its shores. But the steel-and-plastic flotsam raised a more specific warning, too, about the increasing and deliberate wastefulness of the American health-care system. That concern went unheeded at the time. Nearly four decades later, its implications are harder to ignore. The long-term ecological costs of single-use medical devices can now be seen on a planetary scale. T he disposable syringe was a relatively new form of waste in the 1980s, and a new kind of environmental threat. Sure, a busted sewer main could put bacteria in your drinking waterbut you could always boil your water just to be safe. Aerosolized dioxins from an incinerator might lead to pulmonary diseasebut those with means could make sure they lived in a nice neighborhood that wasnt anywhere near the exhaust plume. A hypodermic needle, however, is designed to violate the barriers that keep you separate from the outside world, regardless of income, race, and ethnicity. It is engineered to transgress, to deliver contents from the outside in. When the syringe tides struck, they brought the anxiety that the contents of another persons body might spill over into and contaminate your ownor perhaps your childsthrough a sudden prick on a sunny day. When the syringe tides struck again in the summer of 1988like a terrible blockbuster sequelthe consequent media event spread fear even more effectively than the original. New York Citys superboom had failed and shorefalls of used syringes were now spreading north and south, devastating coastlines from Massachusetts to North Carolina, with regular beach closings all summer. Newspaper coverage called to mind the tagline for Jaws 2 : Just when you thought it was safe to go back in the water ... The disposable syringe became an object of terror, a mechanical viper hidden in the sand. In the late 1980s, AIDS was still understood to be a universal death sentence, and one tied directly to the bodies and bodily fluids of other people, especially other kinds of people: homosexuals, heroin users, Haitian immigrants, hemophiliacsthe infamous 4-H Club of at-risk populations. Syringes could now be understood as vessels for their germs, and a man-made vector for increased transmission. If at first officials thought the seaside syringes had originated through the negligence of hospitals and clinics, now they wondered if the tides could be blamed on junkies, whose used, discarded needles had been flushed out into the ocean via the sewer system. When 39 syringes washed up on the beaches of Monmouth County in the first week of June, the Asbury Park Press described the glass vials that appeared alongside them as the kind associated with crack drug use. After New York City closed down two beaches in the lead-up to a 99-degree weekend that July, local health officials said theyd come to understand that beached syringes were to be expected, given prevailing social conditions in the city. As The New York Times put it , The repeated discoveries of waste had made them realize that needles were becoming as common on beaches as jellyfish and cracked seashells. Perhaps the syringe tides were just another threat that we would need to learn to live with, like nuclear war. We now understand that needles on the beach are part of the ecology of New York, just as crack vials in Washington Square, New York Citys health commissioner told the Times . Read: The lost nurdles polluting Texas beaches The CDC tried in vain to reassure the American public that this new normal wasnt all that bad, because medical waste is no more infectious than residential consumer waste. Representatives from the American Hospital Association had already testified at the Senate hearing in Atlantic City the year before that the risk of contracting AIDS from the rising tides of medical waste was overblown. And the chief of environmental protection at the National Institutes of Health had agreed: Although the washing up of syringes on New Jersey beaches by barge accident is deplorable, he told the lawmakers, a sea voyage would be a fairly hostile environment for most human pathogens to survive. From early in the crisis, then, these experts had agreed that widespread fear of beach-syringe-borne viruses was ultimately more dangerous than the syringes themselves. Theyd also pointed out that the disposable syringe was best understood as a tool to stop the spread of infectious diseases, especially among health-care workers and intravenous-drug users. Several first responders to the AIDS and hepatitis epidemics had been infected with these fatal conditions via needle sticks throughout the early 80s, leading to a call for safer, disposable technologies. Meanwhile a cadre of harm-reduction activists was switching from a strategy of helping intravenous-drug users disinfect their needles with bleach to one of maintaining a supply chain of fresh needles and syringes. The supply chain was evolving to meet these goals. Syringes were no longer made of glass but of plastic, and steel needles that previously were sharpened between uses were now designed to end up in a landfill or an incinerator. The new system didnt just equate hygiene and safety with disposability; it promised new modes of efficiency as well. Hospital managers favored single-use medical devices because they were cheaper and easier to manage than the skilled employees who were needed to sterilize reusable equipment. Shifting the architecture of the health-care sector toward disposable technologies entailed other, longer-term costs, but they werent visible. At least, not yet. N ot all objects thrown away remain thrown away. In the syringe tides, thousands of them were now returning. More than 2,000 pieces of medical waste landed on New York beaches in July 1988 alone. By the end of the tides second summer, they were even showing up in the Midwest, dotting the shores of the Great Lakes. After hundreds of used needles washed up on the coast of Lake Erie in August, Cleveland hosted a follow-up to the original Atlantic City Senate hearing. As Representative Dennis Eckart of Ohio welcomed colleagues from Washington, D.C., to his home district, he complained that junkies in the city were rummaging through Dumpsters trying to find hypodermics, and, by implication, that their reused needles were the ones that ended up littering the shores. As long as a needle and a syringe is recyclable, it becomes a tool for self-destruction, he said. In other words, the problem was that the disposable syringe wasnt disposable enough . The EPA chief J. Winston Porter agreed that the health-care industrys move toward a system where everything is thrown away had probably helped safeguard patients and providers while creating new dangers elsewhere: first for the intravenous-drug users who recycled those supposedly single-use syringes, and then for anyone else who might come across one after it had washed up on a beach. The disposable syringe had transformed from a public-health innovation into a public-health crisis. Lawmakers now asked how the crisis could be reversed. Two federal laws, the Ocean Dumping Ban Act and the Medical Waste Tracking Act, would be passed and signed by President Ronald Reagan in the months to come. The first sought to eliminate our use of the ocean as landfill. As the U.S. changed its approach to dumping into bodies that drained into the ocean, so did the rest of the world, with a substantial effect in reduced shorefalls of trash. It was, quite literally, a watershed moment. The second reconceptualized medical waste as a particular kind of refuse that carried a particular set of hazards. New monitoring systems, implemented first in New York and New Jersey and then copied elsewhere, followed and documented medical waste from its creation to the place of its eventual disposal. By singling out medical waste as a special category of refuse, the Medical Waste Tracking Act also had the effect of making medical waste a more expensive form of garbage. The cost that hospitals would now pay for red-bag trash was more than 10 times that of regular sanitary disposal, even though less than 20 percent of medical waste from hospitals was understood to be pathogenic. These changes, the New York Daily News reported, could mean a boom for the medical-waste-disposal industry. Read: Animals are migrating to the Great Pacific Garbage Patch If the syringe tides came to symbolize, for the public, the horrors of runaway waste, the health-care sector would learn a very different lesson. Media coverage of syringe tides led everyday consumers to question their wasteful habits: to reduce, reuse, recycle. But hospital managers came to understand that their wasteful habits should be formalized, if not spruced up. By 1991, former Surgeon General C. Everett Koop and colleagues declared that the epidemics of AIDS and hepatitis, and epidemics to come, necessitated better single-use health-care technologies. The development and widespread production of a syringe truly designed for one-shot use could break chains of infection dependent on syringe reuse, they wrote in a joint statement. It is possible to make disposable syringes truly disposable. Here lies the paradox of the syringe tides: The solution to the crisis of medical waste would lead to the creation of more medical waste. Wheel of Fortune , Sally Ride, heavy metal suicide Foreign debts, homeless vets, AIDS, crack, Bernie Goetz Hypodermics on the shore, Chinas under martial law Rock and roller, cola wars, I cant take it anymore Sandwiched between AIDS, crack, Bernie Goetz, and the Tiananmen Square crackdown, the syringe tides were one of 11 admittedly arbitrary selections that Billy Joel used to commemorate the 1980s in his triple-platinum chronicle of the Boomer era, We Didnt Start the Fire. At the time the song emerged, in September 1989, the tides had just receded. Only a handful of syringes had been found on the New York and New Jersey shores in the preceding summer, with barely a beach closing. By the following year, the syringe tides seemed a thing of the past. Looking back at a few decades remove, however, a more subtle point was missed. The media spectacles of 198788 helped build political pressure for addressing the buildup of solid waste in general, but they had the opposite effect on medical waste. In effect, they served to valorize and naturalize the increasing production of medical trash, and to separate it out from all other garbage in a special category that, by design, could never be reduced, reused, or recycled. We have lived quietly with the consequences ever since, accepting health care as a sector of the economy that is necessarily wasteful for our own good. The paradox of disposable medical technology as both a solution to and a cause of the threat of contagion became visible again in the supply-chain crises of the coronavirus pandemic. Countries around the world struggled first to obtain, and then dispose of, thousands of tons of masks, gowns, and other forms of personal protective protective equipment, as well as plastic test kits and vaccine syringes. Recognizing with alarm that nearly one of every three health-care facilities around the globe lacked the capacity to handle waste under normal circumstanceslet alone the added mountains of disposable devices needed to contain the pandemicthe World Health Organization official Maria Neira declared , COVID-19 has forced the world to reckon with the gaps and neglected aspects of the waste stream and how we produce, use and discard of our health care resources, from cradle to grave. By 2020, the health costs of climate change, which Neiras division of Environment, Climate Change, and Health could enumerate all too easily, were compounded by the climate impacts of a disproportionately wasteful health-care system. If the global health-care industry were treated as a single country, it would have the fifth-largest carbon footprint in the world. Biomedical industries and health-care complexes are among the leading contributors to nondegradable plastics in landfills, incinerators, and oceansespecially the microplastics now seemingly found in every living thing. The uncritical embrace of single-use medical devices in the global health-care sector has become, in all meanings of the word, unsustainable. Now, in these heady times, syringe-strewn beaches are making headlines once again. In early 2020, as the coronavirus was just emerging, dozens of syringes and bloody medical plastics were discovered on a beach in Dakar, Senegaldiscarded there because a nearby hospitals incinerator had broken down. In July 2021, beaches in Monmouth County were very briefly closed after large numbers of home-use disposable syringes washed up to the sand, on the same shores where the first syringe tide made landfall in the 1980s. A similar event had occurred just a few years earlier, in the summer of 2018. As we are only now realizing, those New York City health officials who long ago likened hypodermic needles to jellyfish and cracked seashells in the ecology of the late-20th-century seashore may well have been correct. It will take even more work today to ensure that syringe tides do not remain our new normal .