Monday’s guest post by Chandra Rogers about how her Aquaphor-laden clothes started smoldering (and could have caught on fire) got me thinking: Were there any other reported instances of Aquaphor catching on fire? After we published Chandra’s post, I did a quick Google search for “Aquaphor combustion” and saw a scientific study published about the use of Aquaphor in high-oxygen environments such as neonatal intensive care units.
Reading through that article and reviewing some of the products and other literature cited in it led me down a very odd path. So today I’m writing not just about fire-safety issues and Aquaphor (an issue near and dear to our heart since we use a lot of Aquaphor), but also how Jennifer and I evaluate and assess scientific publications, the marketing of creams and lotions, and other assertions of reliability in our daily lives.
Or, put another way: Ichthyosis care? Check. Evaluating science? Check. Internet marketing/media issues? Check. Sure sounds like a Confetti Skin blog post to me!
As of today, the top Google hit for “Aquaphor combustion” is Chandra’s guest post on our blog about her laundry. The second hit is an article named, “Topical Products and Fire Safety in Neonate High Oxygen Environments” which was produced by a company named McCord Research. The paper compares the combustibility of petrolatum-based Aquaphor to the silicone-based Nutrashield™ and Skin Repair Cream™ from Medline Industries.
The very colorful graph on the right-hand page of that study shows that the silicone-based products have an “acceptability index” over a thousand times that of Aquaphor. The article also helpfully points out that Aquaphor’s “heat combustion value” is somewhere between gasoline and mineral oil, and that the silicone-based products are much more “compatible” with an oxygen-rich environment.
The implication of McCord’s article appears to be that the use of (combustable) Aquaphor in an oxygen-rich NICU environment “may impose significant risks associated with ignition”.
Another PDF hosted at McCord Research is called ,”Neonate Skin Products Used in Oxygen-Enriched Environments May Pose Risks Associated with Flammability and Skin Breakdown“. The linked PDF has the header, “Accepted for publication in Advances in Skin & Wound Care,” and it cites some fairly alarming information about fires in oxygen-rich environments.
Dr. Darlene McCord and her co-authors go into a bit more detail in this article:
Petrolatum-based skin care emollients such as Aquaphor are composed of highly flammable hydrocarbons…Each year numerous medical centers report fires caused by ignition in an oxygen-enriched environment. Sheffield et al. confirmed that enclosed fires occur in enriched oxygen atmospheres and in the presence of abundant, flammable substances. In summary, the application of petrolatum based emollients to preterm infants in oxygen-enriched systems may endanger neonate survival.
And furthermore, the authors point to the toxicity of Aquaphor: “the toxic impurities of petrolatum provide strong evidence against the application of petrolatum-based products to sensitive neonatal skin.”
So should we be screaming, “Stop the presses”?
Well, no. I certainly don’t think so. I don’t have a Ph.D, but reading through the published article, I couldn’t help but notice that the footnotes to Dr. McCord’s citations regarding the flammability of Aquaphor and similar products referred either to dictionaries or publications which only talked about the flammability of petrolatum-based products in general, or general ignition hazards in oxygen-rich environments. None of the cited references appear to cite an actual instance of the ignition or combustion of a petrolatum-based product in a NICU. And the footnotes to the assertion about “toxic impurities”? The citations are to articles about crude oil’s effect on fish embryos and how mineral oil is carcinogenic. (Mineral oil link is to the 2011 version online; cited version was from 2002.)
I’m really hesitant to extrapolate studies about crude oil or mineral oil to draw a conclusion about the toxicity of Aquaphor. So, that’s hardly a resounding condemnation in our opinion.
But as I read more, the plot thickened. Dr. McCord’s published article in “Advances in Skin & Wound Care” regarding flammability is from 2008, and bears a different title: “The selection of skin care products for use in hyperbaric chamber may depend on flammability acceptability indices score.” See Adv Skin Wound Care. 2008 Feb;21(2):79-84. doi: 10.1097/01.ASW.0000305409.20232.af.
The published article’s conclusion is, “The [autogenous ignition temperature] results indicate that all products in 99.5% oxygen concentration under pressure will ignite and that a pattern based on the absence or presence of petroleum-based ingredients does not seem to exist.”
My interpretation of this conclusion is that in 99.5% oxygen under pressure, everything ignites — so it wouldn’t matter one bit whether you use more-flammable Aquaphor or a less-flammable silicone-based ointment. And while there’s certainly an argument that a petrolatum-based ointment might burn more intensely than a silicone-based ointment, the study didn’t appear to cite any evidence that a petrolatum-based ointment has ever ignited in the first place.
At the same time, I took a look at the silicone-based ointments being compared to Aqupahor. If you remember, the first McCord study I discussed compared Aquaphor to Nutrashield™ and Skin Repair Cream™ from Medline Industries. It appears to us that it’s talking about Medline’s Remedy Nutrashield and Remedy Skin Repair Cream.
And there’s an undisclosed connection. Dr. McCord’s current LinkedIn biography states, “Dr. McCord’s most current commercialized skin and wound care product offering is the best selling hospital-based product line in the United States and is sold under the Remedy brand distributed by Medline Industries.” (Emphasis added.) (Her biography at www.darlene-mccord.com says, “Dr. Darlene McCord’s most recent success in the skin and wound care product field is the Remedy brand. The Remedy brand lind (sic) is distributed by Medline Industries and it is based on a proprietary blend of small molecules called Olivamine™ that provide corneotherapeutic support for diseased skin.”)
So as best as I can tell, here’s the syllogism. “Aquaphor is petrolatum based, and catches on fire easily. Fires happen really easily in oxygen-rich NICUs. Therefore Aquaphor shouldn’t be used in oxygen-rich NICUs. (But use this alternate product instead, which I developed.)”
But I can’t find a single reported instance of Aquaphor combustion in a NICU.
Back in 2007, Ian, the nurse who blogs at impactednurse.com, blogged about the use of petroleum-based products in combination with oxygen. Ian wrote, “I cannot find a single case of a patient actually suffering burns to the face from either ignition of a lip balm or spontaneous combustion of a lip balm or petroleum based product.” And while a few nurses chimed in that they had heard that people were worried about this happening, they did not report any evidence that it has actually ever occurred.
While researching this blog post, I also read a bit about Olivamine, the key ingredient in Dr. McCord’s Remedy line. These products are apparently sold through Pinnaclife’s multi-level-marketing (MLM) framework — here’s an example of one of the sites — and I found it interesting that the entire website there disclaims, “Pinnaclife products do not diagnose, treat, cure or prevent any diseases and no such claims are approved by Pinnaclife, LLC.” But at the same time, the website also asserts, “The key ingredient in Olivamine, Hydroxytyrosol, comes from the Green Olive and has been Scientifically proven to Extend the life of Human Cells 20%.” (Capitalization in original.)
On a related note, I also found it interesting that in some publications, Dr. McCord is listed as being the “2009 Global Humanitarian Award Winner of The United Nations”. (Emphasis added.) The “Miracle Olive” blog links to a YouTube video posted by “MyPinnaclife” whose caption talks about Dr. McCord “receiving the 2009 Global Humanitarian Award at the Airline Ambassadors Event in the UN.”
A quick check on the “Airline Ambassadors” site suggests to me that on December 3, 2009, the Airline Ambassadors organization hosted, in the United Nations Delegates Dining Room in New York, a “Children of the World” fundraiser where they honored recipients of their “Global Humanitarian Award“.
In my mind, this is slightly different from receiving the “2009 Global Humanitarian Award from the United Nations” as is narrated in the “Pinnaclife – Olivamine Miracle” video. (I also got a good laugh over the shot of the Washington, DC skyline at 3:35 in the video with the caption, “Such as Michigan State University”.) Bottom line, I think it’s pretty clear that Dr. McCord received the Airline Ambassadors’ award at a reception hosted at the United Nations in 2009, and I also think that it stretches things to say that she received the award from the United Nations (especially when the video displays the UN logo while the narrator says that). (It looks like renting the Delegates Dining Room at the United Nations is relatively straightforward.)
Bottom line, researching “Aquaphor combustion” led me down a very interesting path. Many people within the ichthyosis community were skeptical about the clothes-catching-on-fire story, and that skepticism led to further investigation until we arrived at a first-hand, credible account that lined up with our understanding of science and the way the world work.
But that inquiry itself led us to further assertions, made by seemingly reputable and credible sources. It wasn’t until I dug in further, scrutinizing footnotes, checking PubMed citations and verifying facts, that I was able to arrive at my own conclusions regarding the likelihood of validity of the claims. And as part of that investigation, I came across even more shiny and colorful marketing materials and videos with difficult-to-assess claims.
We live in an interesting world, don’t we?
POSTSCRIPT: As we’ve disclosed from the start in our “About Us” page (and elsewhere), we participate in Beirsdorf’s free Aquaphor program.