# No Iron Clothing and Skin Irritation



## SouthernLiveOak (Dec 12, 2010)

Has anyone here experienced an allergic reaction to non-iron clothing (shirts or pants)? Conducting some very unscientific research. Thanks in advance for your input.


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## Topsider (Jul 9, 2005)

Not an allergy so much as an aversion.


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## sbdivemaster (Nov 13, 2011)

I haven't myself, but I have no doubt that it happens:

https://www.nytimes.com/2010/12/11/your-money/11wrinkle.html?pagewanted=all


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## phyrpowr (Aug 30, 2009)

My LLBean no-irons are pretty comfortable, and I'm picky about such


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## P Hudson (Jul 19, 2008)

No. I think they have improved a lot over the years. I have some non-irons from BB that are hard to distinguish from an untreated shirt, but I also have some that are close to horrible.


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## RM Bantista (May 30, 2009)

No, Sir, I have not, but I do always wear a cotton tee beneath shirts of all sorts of materials. Personally, one should not share too much information about these things. But lined pants, comfortable undergarments; no problems.
good day to you all,
rudy


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## Taken Aback (Aug 3, 2009)

I think things have improved across the board compared to years ago. The worst I've encountered as of late were some tartans from LE and AL that rustled at the touch.


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## Starch (Jun 28, 2010)

No reaction here.


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## dks202 (Jun 20, 2008)

Not so much a reaction but they sure are hot! Kinda stiff too. I tried a couple and dumped them after a couple of wearings.


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## nlieb (Mar 20, 2012)

They give the workers who make them Leukemia, I heard, because they're made with formaldehyde and formaldehyde is a carcinogen. I wouldn't wear them for that reason, the moral aspect. Plus I'm not too hot on having a carcinogen on my skin. Skin irritation though? Not so much. I've heard it's quite rare and mostly occurs in people who have previously been sensitized to formaldehyde.


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## Oldsarge (Feb 20, 2011)

I've never heard any reports that non-iron shirts caused leukemia in the workers. I'd like a citation for that, please, otherwise I will treat it as one more internet rumor. Personally, my skin is sufficiently insensitive that almost nothing bothers me so as far as I'm concerned, ironing is something that happens to other people. YMMV.


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## nlieb (Mar 20, 2012)

Oldsarge said:


> I've never heard any reports that non-iron shirts caused leukemia in the workers. I'd like a citation for that, please, otherwise I will treat it as one more internet rumor. Personally, my skin is sufficiently insensitive that almost nothing bothers me so as far as I'm concerned, ironing is something that happens to other people. YMMV.


Got it from this article: https://www.straightdope.com/column...n-shirts-made-by-soaking-them-in-formaldehyde

I suppose you could contact the author if you wanted to read the study...

I'll do some more research to see if I can dig it up


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## nlieb (Mar 20, 2012)

https://www.cancer.gov/cancertopics/factsheet/Risk/formaldehyde

More reliable source

Also references the study

Still can't find it, though


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## nlieb (Mar 20, 2012)

Here it is

(don't know if you can see it without the university-grade journal subscriptions I have, so I'll post the text in a couple seconds)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740723/pdf/v061p00193.pdf


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## nlieb (Mar 20, 2012)

Can't select it in the pdf. Anyways, here's a related article on increased incidence of leukemia in embalmers working with Formaldehyde - it's not as if this is an isolated study, there _is_ a demonstrated coorelation:

"
Abstract
Background
Excess mortality from lymphohematopoietic malignancies, in particular myeloid leukemia, and brain cancer has been found in surveys of anatomists, pathologists, and funeral industry workers, all of whom may have worked with formaldehyde. We investigated the relation of mortality to work practices and formaldehyde exposure levels among these professionals to address cancer risk in the funeral industry.

Methods
Professionals employed in the funeral industry who died between January 1, 1960, and January 1, 1986, from lymphohematopoietic malignancies (n = 168) or brain tumors (n = 48) (ie, case subjects) were compared with deceased matched control subjects (n = 265) with regard to lifetime work practices and exposures in the funeral industry, which were obtained by interviews with next of kin and coworkers, and to estimated levels of formaldehyde exposure. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by use of logistic regression. All statistical tests were two-sided.

Results
Mortality from myeloid leukemia increased statistically significantly with increasing number of years of embalming (_P_ for trend = .020) and with increasing peak formaldehyde exposure (_P_ for trend = .036). Compared with subjects who performed fewer than 500 lifetime embalmings, mortality from myeloid leukemia was elevated among those who performed embalmings for more than 34 years (OR = 3.9, 95% CI = 1.2 to 12.5, _P_ = .024), who performed more than 3068 embalmings (OR = 3.0, 95% CI = 1.0 to 9.2, _P_ = .057), and those whose estimated cumulative formaldehyde exposure exceeded 9253 parts per million-hours (OR = 3.1; 95% CI = 1.0 to 9.6, _P_ = .047). These exposures were not related to other lymphohematopoietic malignancies or to brain cancer.

Conclusion
Duration of embalming practice and related formaldehyde exposures in the funeral industry were associated with statistically significantly increased risk for mortality from myeloid leukemia.


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CONTEXT AND CAVEATS
Prior knowledge More deaths than expected among anatomists, pathologists, and funeral industry workers have been attributed to lymphohematopoietic malignancies, in particular myeloid leukemia, and brain cancer. Individuals in these fields may have worked with formaldehyde.

Study design In a case-control study in a cohort of deceased funeral industry workers, those who died from lymphohematopoietic malignancies and brain tumors were compared with control subjects. Lifetime work practices and exposures to formaldehyde were obtained by interviews with next of kin and coworkers.

Contribution The number of years of embalming practice and related formaldehyde exposures in the funeral industry was associated with statistically significantly increased mortality from myeloid leukemia. No associations were observed with other lymphohematopoietic malignancies. Associations with brain cancer were unclear.

Implications Further studies are warranted to investigate the risk of leukemia in relation to specific embalming practices and exposures and to investigate this risk in other groups of professionals who are exposed to formaldehyde and have an increased risk of leukemia (ie, anatomists and pathologists).

Limitations Exposures to formaldehyde were obtained from interviews with next of kin and coworkers. There were relatively few deaths from myeloid leukemia among case subjects. There was a considerable amount of missing data that required imputation for analyses.
From the Editors

In recent decades, more than 2 million US workers are exposed to formaldehyde (1), including anatomists, pathologists, and professionals who are employed in the funeral industry and who handle bodies or biological specimens preserved with formaldehyde. Surveys of causes of death in these professions have shown excess numbers of lymphohematopoietic malignancies (-), in particular nonlymphocytic leukemia (3-6), and brain cancer (-6,9-) among these groups. However, specific work practices and exposures were not characterized in these studies (-)-three of which (4-6) used length of licensure to approximate duration of employment and obtained inconsistent results. Recently, some studies (,13-15) of industrial workers exposed to formaldehyde noted excess numbers of deaths from lymphohematopoietic malignancies. One of these studies (15) used quantitative exposure estimates and observed an association for peak formaldehyde exposure, which is consistent with formaldehyde being a causative agent for lymphohematopoietic malignancies.
A recent review by the International Agency for Research on Cancer classified formaldehyde as a human carcinogen (group I) because of its genotoxic characteristics, because of experimental observations of nasal cancer in rodents, and because of epidemiological evidence showing excess numbers of patients with or deaths from nasopharyngeal cancer among exposed groups (16,17). The evidence on occupational exposure to formaldehyde and leukemia was considered strong, but it was not sufficient to establish causality.
To follow-up leads from mortality surveys, we investigated the relationships of lifetime work histories, work practices, and predicted formaldehyde exposure levels in the funeral industry to risk for leukemia, other lymphohematopoietic malignancies, and brain cancer. Nasopharyngeal cancer was also of interest but, as expected, few deaths from this rare disease were identified.


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Participants, Materials, and Methods

Identification of Case and Control Subjects
In previous mortality surveys in the US funeral industry, inactive or deceased funeral directors and embalmers were identified from registries of the National Funeral Directors' Association (NFDA), as well as licensing boards and state funeral directors' associations (n = 6651) (3), the New York State Bureau of Funeral Direction (n = 1678) (4), and the Division of Funeral Directors and Embalmers in the California State Department of Health (n = 5665) (). We used subjects in these studies and determined their vital status and, if deceased, cause of death by searching state vital statistics offices. We obtained death certificates for 6808 embalmers and funeral directors who died between January 1, 1960, and January 1, 1986. Death certificates were coded for underlying and contributing causes of death according to the rules in effect at the time of death and assigned codes according to the _International Classification of Diseases, Eighth Revision_ (_ICD-8_).
In this study, we included all deaths with an underlying or contributory cause identified as lymphohematopoietic malignancies (n = 168; _ICD-8_ 200-209; 85% assigned as underlying cause of death), brain tumor (n = 48; _ICD-8_ 191, 192, 225, or 238.1; 92% underlying cause of death), and nasopharyngeal cancer (n = 4; _ICD-8_ 147; 100% underlying cause of death). In three case subjects, more than one disease of interest occurred among the underlying and contributing causes of death; for the analysis, these were coded to the underlying cause of death. For lymphohematopoietic malignancies, risks were assessed for malignancies of lymphoid (n = 99; _ICD-8_ 200-204) or nonlymphoid (n = 48; _ICD-8_ 205, 206, 208, or 209) origin and, as a separate rubric, myeloid leukemia (n = 34; _ICD-8_ 205). Because there were only four deaths from nasopharyngeal cancer, these subjects were only briefly described.
Control subjects (n = 265) were randomly selected from individuals in the funeral industry whose deaths were attributed to other causes, excluding cancers of the buccal cavity and pharynx (_ICD-8_ 140-149), of the respiratory system (_ICD-8_ 160-163 or 231), and of the eye, brain, or other parts of the nervous system (_ICD-8_ 238). Control subjects were stratified to be similar to the case subjects with respect to data source (NFDA, New York State Bureau of Funeral Direction, and California State Department of Health), sex, and dates of birth and death (5-year intervals).

Interviews
Interviews were carried out with next of kin and coworkers by interviewers who were blinded with regard to the cause of death of the study subject and who used a structured questionnaire to obtain information on the funeral home and work practices of the study subjects and on demographic characteristics and tobacco use, with at least one next-of-kin interview per subject and multiple coworker interviews per subject to cover the working life of the study subject in the funeral industry. Next of kin typically do not know details about the workplace, but the funeral industry is unusual in that many funeral homes are family operated and the next of kin often works and lives with the embalmer in the funeral home. In addition, we asked detailed workplace questions of only those next of kin who had worked in the funeral home with the study subject. The work history component of the questionnaire covered items such as whether the subject had embalmed, the number of intact and autopsied embalmings done by decade for each job held at least 5 years, and the effectiveness of the ventilation system (no fan, poor, moderate, or excellent) and its date of installation. Work practices, including embalming duration for intact and autopsied corpses (<1, 1-2, >2 to 3, or >3 hours) and the frequency of spills (>1 per week, a few times per month, a few times per year, or never), were queried as an average over a subject's lifetime. During 1990-1992, we interviewed at least one next of kin for 220 (96%) of the 228 eligible case subjects and for 265 (94%) of 282 eligible control subjects. We conducted 1221 interviews, averaging 1.5 next-of-kin interviews and 1.1 coworker interviews per case subject and 1.4 next-of-kin and 1.1 coworker interviews per control subject. The study was approved by the National Cancer Institute's institutional review board, and all interviewed subjects provided informed consent.

Exposure Assessment
We linked the questionnaire responses to measurement data from an exposure-assessment experiment carried out at the Cincinnati College of Mortuary Sciences, as described previously (18). We assigned formaldehyde exposure levels during embalming to case and control subjects by use of a predictive model that was based on the exposure-assessment data, considering the effect of ventilation rate, concentration of the formaldehyde solution, whether an intact or autopsied corpse was embalmed, and measured covariates (19). After the final model was selected, its validity for estimating retrospective formaldehyde levels was evaluated on the basis of measurements from independent embalmings. The model overestimated the measured formaldehyde intensities by an average of 35% with a precision (variation of predicted values around the average bias) of 0.53 parts per million (ppm). The estimated accuracy was similar to the expected variability of repeated measurements of identical embalmings. We modified the approach of Hornung et al. (19) to consider the geometric mean by refitting the model as exp(1.976 − 0.092_x_[SUB]1[/SUB] − 0.488_x_[SUB]2[/SUB] − 0.894_x_[SUB]3[/SUB] + 0.4592/2), where _x_[SUB]1[/SUB] is the number of air changes per hour, _x_[SUB]2[/SUB] is equal to 1 for an intact corpse and 0 for an autopsied corpse, and _x_[SUB]3[/SUB] is equal to 1 if no spill and to 0 if a spill occurred, and 0.4592/2, which was used to estimate the arithmetic mean, is one half of the variance. The model explained 74% of the variability. Further, we calculated peak exposure level as the maximum of moving averages of any series of measurements covering 15 minutes (90 measurements, with one measurement every 10 seconds), with peak levels estimated according to the formula exp(2.354 − 0.0708_x_[SUB]1[/SUB] + 0.0913_x_[SUB]2[/SUB] − 0.344_x_[SUB]3[/SUB] + 0.5312/2), with _x_[SUB]1[/SUB], _x_[SUB]2[/SUB], and _x_[SUB]3[/SUB] as above. The model for peaks explained 44% of the variance. The peak model could not be validated because independent real-time measurements were not available for the validation embalmings.
For time periods with multiple interview reports, the average covariate value across reports was used, with interview responses for categorical variables converted to the midpoint of the range. Whenever any one respondent reported embalming for a given year, we assumed the study subject indeed embalmed in that year. If data were missing for a year, information available for other years for the same job was used; if those data were not available, the mean for the same 10-year age group and decade of work among control subjects who ever embalmed was imputed.
For each subject, job- and year-specific formaldehyde exposure estimates were derived with conversions in the predictive model as follows. Fan effectiveness was converted to 1.1, 5.5, and 13.3 air changes per hour to correspond to the responses of poor ventilation or no fan, moderate ventilation, and excellent ventilation, respectively. Duration was converted to 0.75, 1.5, 2.5, and 3.5 hours for less than 1, 1-2, more than 2 to 3, and more than 3 hours, respectively. Spill frequency was converted to 96, 36, 8, and 0 times per year to correspond to more than one spill per week, a few times per month, a few times per year, and never, respectively.
Using the predictive model, we calculated the estimated formaldehyde intensity during embalmings for each combination of characteristics (intact or autopsied corpse, spills, and ventilation) under which embalmings were performed during a given year. After multiplying each intensity estimate by the number and typical duration of each type of embalming, the products were added to yield the cumulative formaldehyde exposure for each year. Nonfuneral home and nonembalming jobs were assigned an intensity estimate of zero. Lifetime cumulative formaldehyde exposure was calculated by summing yearly estimates over the entire job history. Average formaldehyde intensity while embalming was calculated by dividing cumulative exposure by the number of hours of embalming. The 8-hour time-weighted average formaldehyde intensity was calculated by dividing cumulative exposure by the number of years of embalming and by 1950 hours/year (ie, the assumed number of hours worked per year). Lifetime peak formaldehyde exposure was predicted as the maximum 15-minute average intensity ever experienced over all embalmings over all years. We also calculated the lifetime number of embalmings that were associated with predicted peaks exceeding a certain level.

Completeness and Quality of Data
Reported work histories covered 18 534.5 (97%) of the 19 104 person-years between the start of the first and the end of the last reported job. Virtually all reported jobs (99.7% of person-years) were characterized by study respondents as being in a funeral home or not, and, for all jobs in funeral homes, it was reported whether the job included embalming. Reports were frequently unavailable for number of embalmings (2466 [32%] of 7806.5 person-years in embalming jobs for control subjects and 2364.5 [32%] of 7424 person-years for case subjects) and the number of autopsied embalmings (3524.5 [45%] of 7806.5 person-years for control subjects and 3272.5 [44%] of 7424 person-years for case subjects). Frequency of spills and duration of embalming an intact or an autopsied corpse were queried over a subject's lifetime. For those three variables, the proportions of control and case subjects for which none of their respondents reported a value were 43%, 43%, 45%, and 37%, 37%, 40%, respectively. A single value for those variables was available for 17%, 17%, and 17% of control subjects and 11%, 11%, and 13% of case subjects. Thus, although the duration of working in jobs with embalming could be calculated for all subjects, information was frequently missing on at least one of several characteristics used in the calculation of cumulative and average intensity of formaldehyde exposure (4143 [53%] of 7806.5 person-years with embalming for control subjects and 3701 [50%] of 7424 person-years for case subjects) and peak formaldehyde exposure (4014 [51%] of 7806.5 person-years for control subjects and 3578 [48%] of 7424 person-years for case subjects), although the exposure metric for the corresponding person-years may still have been based primarily on observed data. Of all person-time with multiple reports for a particular variable, 14% was discordant for whether embalmings were performed, with no differences between control subjects and case subjects. With discordance for continuous variables defined as a difference of more than 20% from the calculated mean across reports, 2219 (42%) of 5338 person-years with multiple reports were discordant for the number of any embalmings among control subjects, compared with 2848 (44%) of 6506 person-years among case subjects. Corresponding numbers for the number of autopsied embalmings were 1599 (37%) of 4315 person-years for control subjects and 2166 (42%) of 5177 person-years for case subjects, and those for the level of ventilation were 1918 (42%) of 4541 person-years for control subjects and 1951 (34%) of 5706 person-years for case subjects. Where more than one respondent reported frequency of spills or duration of embalming an intact or autopsied corpse, disagreement by more than one category was 5%-10%.

Statistical Analysis
Odds ratios (ORs) were calculated for categories of exposure metrics, with a 2-year lag that was based on unconditional logistic regression adjusted for calendar year of birth (1905 or before, 1906-1914, 1915-1923, or after 1923), age at death (≤56, 57-66, 67-74, or >74 years), sex, data source (NFDA, New York State Bureau of Funeral Direction, or California State Department of Health), and smoking status (ever or never). Continuous exposure metrics described above were grouped for analysis in four categories: nonexposed and by approximate tertiles of exposed control subjects. Tests of trend for categorical variables were based on the estimated slope of the original continuous variable (Wald test). All statistical tests were two-sided at a 5% statistical significance level. We evaluated various lag intervals from 2 to 15 years and found that odds ratios and goodness of fit did not differ substantially. Where we observed associations, we performed nonparametric modeling with generalized additive models (20) to appraise the underlying functional form of the exposure-response relationship. The patterns were adequately described by the category-specific odds ratios and so no results are shown. A sensitivity analysis was performed for each exposure metric by excluding subjects with 30% or more of their work history missing and therefore whose exposure level could not be calculated from reported data without any of the required variables missing.


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Participants, Materials, and Methods
Results
Discussion
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Results

Demographic characteristics, source of data, employment in funeral homes, and overall history of embalming were generally similar between deceased case subjects and deceased control subjects (Table 1). Years of birth ranged from 1876 to 1959 and years of death ranged from 1960 to 1986. The study population (n = 485) was predominantly male (n = 244 [92%] of control subjects and n = 209 [95%] of case subjects) and white (n = 235 [89%] of control subjects and n = 198 [90%] of case subjects), and a history of tobacco use was common (n = 207 [78%] of control subjects and n = 176 [80%] of case subjects). Approximately 75% (n = 356) of the 485 study subjects were identified through the NFDA, and most subjects (n = 196 [74%] of control subjects and n = 175 [80%] of case subjects) had attended a school of mortuary science. Most subjects began to work in a funeral home before 1950 when they were aged 28 years or younger, and many had worked in funeral homes beyond age 65 years.


*Table 1*Characteristics of the study population by case group[SUP]*[/SUP]




Among the 265 control subjects, interview respondents reported that 55 (21%) did not perform embalmings during their employment in the funeral industry. Compared with those who embalmed, these 55 control subjects were more frequently women (16 [29%] nonembalmers vs n = 5 [2%] embalmers), were older at death (mean age at death, 68.1 vs 63.3 years, respectively), were less frequently smokers (n = 32 [58%] vs n = 175 [83%], respectively), had less often attended mortuary science school (n = 13 [24%] vs n = 183 [87%], respectively), had started working in a funeral home later (mean age, 37.2 vs 25.2 years, respectively), and were older when they last worked in a funeral home (mean age, 63.5 vs 57.2 years, respectively). Among the 220 case subjects, 32 never embalmed, including six (13%) of 48 with brain tumors, 18 (18%) of 99 with lymphohematopoietic malignancies of lymphoid origin, four (8%) of 48 with lymphohematopoietic malignancies of nonlymphoid origin, and one (3%) of 34 with myeloid leukemia. We refer to these subjects who never embalmed as nonexposed. Characteristics of embalming practice and formaldehyde exposure among those who embalmed are shown by study group in Table 2.


*Table 2*Characteristics of embalming practices and formaldehyde exposure among subjects who embalmed by case group[SUP]*[/SUP]




Lymphohematopoietic Malignancies of Nonlymphoid Origin
Having ever embalmed was not associated with risk for all lymphohematopoietic malignancies (OR = 1.4, 95% CI = 0.8 to 2.6), but it was associated with a borderline statistically significantly increased risk for lymphohematopoietic malignancies of nonlymphoid origin (OR = 3.0, 95% CI = 1.0 to 9.5, _P_ = .059) (Table 3). Increasing years of embalming practice, compared with having never embalmed, were associated with statistically significantly increasing risks for lymphohematopoietic malignancies of nonlymphoid origin (_P_ for trend = .046; eg, among those who embalmed for more than 20 years, OR = 3.5, 95% CI = 1.1 to 10.9, _P_ = .034, data not shown). As other metrics of formaldehyde exposure increased, risk associated with lymphohematopoietic malignancies of nonlymphoid origin also tended to increase, although not always monotonically, with statistically significant increased risk being associated with the highest levels of exposure for cumulative formaldehyde exposure, 8-hour time-weighted average intensity, and peak exposure. Risk was not associated with increasing number of embalmings during which peaks in the highest category of peak intensity occurred (ie, exceeding 9.3 ppm; data not shown).


*Table 3*Associations of embalming, compared with no embalming, and risk for all lymphohematopoietic malignancies (LHPM) (_ICD-8_ 200-209; n = 168), LHPM of lymphoid (_International Classification of Diseases, Eighth Revision_ [_ICD-8_] 200-204, n = 99) and (more ...)



In a sensitivity analysis for the association of number of embalmings with lymphohematopoietic malignancies of nonlymphoid origin, we excluded subjects with missing data for 30% or more of their work history, and then compared the results for the highest category of number of embalmings with 27 exposed case subjects after exclusions with the full subject series of 44 exposed case subjects. The risks associated with the number of embalmings tended to be elevated in the sensitivity analysis (OR = 2.3, 95% CI = 0.7 to 7.9, vs OR = 3.9, 95% CI = 1.2 to 12.8; Table 3), although there were fewer exposed subjects in the analysis. For modeled formaldehyde exposure estimates, sensitivity analyses excluding subjects with 30% or more of their work history missing (so that the metric could be computed without imputation) were based on only 16 exposed case subjects. In the sensitivity analysis, risks associated with cumulative formaldehyde exposure tended to be elevated (OR = 2.2, 95% CI = 0.6 to 8.5 vs the full subject series of 44 exposed case patients, OR = 4.0, 95% CI = 1.2 to 13.2) as did those associated with average formaldehyde intensity while embalming (OR = 1.7, 95% CI = 0.4 to 6.9 vs OR = 2.9, 95% CI = 0.8 to 9.7) and for 8-hour time-weighted average formaldehyde intensity (OR = 2.0, 95% CI = 0.4 to 8.9 vs OR = 3.4, 95% CI = 1.0 to 11.8). The risk associated with peak formaldehyde exposure was more strongly attenuated (OR = 1.2, 95% CI = 0.3 to 5.3 vs OR = 3.8, 95% CI = 1.1 to 12.7).
Embalming was most strongly and statistically significantly associated with risk for myeloid leukemia (OR = 11.2, 95% CI = 1.3 to 95.6, _P_ = .027). Statistically significant trends were observed with number of years of embalming (_P_ = .020) and peak formaldehyde exposure (_P_ = .036) (Table 3), although there was no evidence that risks increased with the number of embalmings involving peaks in the highest category of peak intensity (ie, exceeding 9.3 ppm; data not shown). When we compared the 27 case subjects who embalmed 20 or more years with the seven case subjects who embalmed for a shorter period, a statistically significant association between embalming and risk for myeloid leukemia was observed (OR = 4.1, 95% CI = 1.6 to 10.7, _P_ = .004; data not shown). The overall pattern was similar when women were excluded from the analysis or when subjects with more than 30% of their work history unavailable for the metric of interest were excluded, although numbers of subjects were substantially reduced (13-19 vs 33 exposed case subjects, depending on the metric; data not shown). When myeloid leukemia was excluded from the analysis of lymphohematopoietic malignancies of nonlymphoid origin, embalming was not associated with risk for the remaining diseases (ie, monocytic leukemia, polycythemia vera, or myelofibrosis, including 11 exposed case subjects and three nonexposed case subjects; OR = 0.8, 95% CI = 0.2 to 3.3; data not shown).
Because there was only one case subject with myeloid leukemia in the reference group of nonembalmers, we also evaluated risks for this condition by considering subjects who performed fewer than 500 lifetime embalmings (to include five case subjects) as the reference group. With this larger referent, increased risk for myeloid leukemia was associated with high-level exposures of more than 34 years of employment in embalming (OR = 3.9, 95% CI = 1.2 to 12.5, _P_ = .024), more than 3068 embalmings (OR = 3.0, 95% CI = 1.0 to 9.2, _P_ = .057), and more than 9253 ppm-hours of cumulative formaldehyde exposure (OR = 3.1, 95% CI = 1.0 to 9.6, _P_ = .047) (all subjects in these high-level exposure groups had carried out more than 500 embalmings) (Table 4). These represent more conservative but probably more reliable risk estimates for high-level exposure than those shown in Table 3.


*Table 4*Associations of embalming, compared with performing fewer than 500 embalmings, and risk for lymphohematopoietic malignancies (LHPMs) of nonlymphoid origin (_International Classification of Diseases, Eighth Revision_ [_ICD-8_] 205, 206, 208, and 209; n=48), (more ...)



Among the 34 deaths from myeloid leukemia, 20 were acute, 12 were chronic, and four (including the one death in the nonexposed group) were unspecified. When the extended reference group of fewer than 500 embalmings (including three case subjects with acute myeloid leukemia in the referent) was used to assess association with acute myeloid leukemia, the strengths of associations between these factors and risk for acute myeloid leukemia were similar to those for all myeloid leukemias combined (Table 4).

Lymphohematopoietic Malignancies of Lymphoid Origin
We found no association between embalming practice or estimated formaldehyde exposure level and risk of lymphohematopoietic malignancies of lymphoid origin (odds ratios in the highest exposure categories ranged from 0.6 to 1.2) (Table 3). Data and goodness of fit were very similar when subjects with more than 30% of their work history details incomplete for the metric of interest were excluded. When ever embalming was compared with never embalming, no associations were observed for non-Hodgkin lymphoma (OR = 0.9, 95% CI = 0.4 to 2.1), multiple myeloma (OR = 1.4, 95% CI = 0.4 to 5.6), and all lymphoma including chronic lymphocytic leukemia (OR = 1.0, 95% CI = 0.5 to 1.9) nor for any of the exposure metrics. Detailed analyses were not feasible for Hodgkin disease, because there were only eight case subjects. However, there was no evidence of an association with ever vs never embalming (OR = 0.5, 95% CI = 0.1 to 2.6) and we observed low average exposure levels among case subjects compared with control subjects for all exposure metrics.

Brain Tumors
Embalming was not statistically significantly associated with risk for brain tumors (OR = 1.9, 95% CI = 0.7 to 5.3), and there was little evidence of increasing risks with increasing number of years in jobs with embalming or with other metrics of exposure (Table 3). Associations were somewhat attenuated when subjects with more than 30% of their work history details incomplete for the metric of interest were excluded. Patterns that were similar to those for all brain tumors were observed for the subgroup of malignant brain tumors, which excluded the two subjects with benign tumors (_ICD-8_ 225) and the eight subjects who died from brain tumors of unspecified origin (_ICD-8_ 238.1).

Nasopharyngeal Cancer
Four case subjects died from nasopharyngeal cancer, but only two had embalmed (OR for ever embalming = 0.1, 95% CI = 0.01 to 1.2). Average exposure levels of the two exposed case subjects with nasopharyngeal cancer were, however, equal to or higher than the corresponding levels among exposed control subjects for most exposure metrics.


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Abstract
Participants, Materials, and Methods
Results
Discussion
Funding
References

Discussion

This study was the first epidemiological investigation, to our knowledge, to relate cancer risk to duration of employment, work practices, and estimated formaldehyde exposure levels in the funeral industry. We observed an association between embalming and death from myeloid leukemia, with the greatest risk among those who practiced embalming for more than 20 years. Deaths from myeloid leukemia were also related to greater estimated formaldehyde exposure, which was based on exposure models. The association was specific to myeloid leukemia, with no evidence for an association with deaths from other lymphohematopoietic malignancies. Other studies have also found a greater than expected number of deaths from lymphohematopoietic malignancies in the funeral industry (3-,8,), with the most consistent pattern being observed with cell-type groupings that include myeloid leukemia [(3-) and as reviewed by Zhang et al. (21)]. Reports (6,9,10) of mortality among pathologists and anatomists also indicated that these groups may have a higher number of deaths from lymphohematopoietic malignancies than expected, but studies among these professional groups also had not considered risks in relation to specific work practices (6,,9,10,). Two recent assessments (,15) of formaldehyde and cancer risk in industrial workers also noted a potential relationship between formaldehyde and death from myeloid leukemia, although this relationship was not observed in another industrial study (). In our study, the findings for brain cancer are inconclusive, which is consistent with the literature on this topic. A meta-analysis () found a statistically significant 50% excess of brain cancer deaths in studies among funeral industry professionals, pathologists, and anatomists; however, none of the large industrial cohort studies in the formaldehyde industry observed such an association (,,23).
The biological mechanism of formaldehyde as a leukemogen has not been elucidated. Leukemia develops in pluripotent stem and progenitor cells in the bone marrow (21). Formaldehyde reacts rapidly on contact with upper respiratory tract mucosa, and increased blood levels of formaldehyde have not been reported after the respiratory system has been exposed to formaldehyde (). Respiratory exposure to formaldehyde is related, however, to lymphocyte genotoxicity and damage to other peripheral blood cells (17), potentially including circulating pluripotent cells in the blood vessels of the highly vascularized tissue of the nasal and olfactory mucosa (21).
The associations with death from myeloid leukemia that we observed in our study were unlikely to have been the result of confounding exposures. Our analysis in one relatively homogeneous industry allowed us to compare causes of death of subjects who differed by exposure but were similar with respect to most other important factors. Embalming fluids and other embalming products contain numerous agents in addition to formaldehyde, including isopropanol, ethylene glycol, methanol, phenol, and glutaraldehyde; however, none of these have established leukemogenic properties. In contrast, ionizing radiation, exposure to benzene, and cigarette smoking have been related to risk for myeloid leukemia (25). Although exposure to ionizing radiation may occur during the embalming of corpses containing radioactive isotopes (26), the frequency of such embalmings and the resulting levels of radiation exposure are not likely to be sufficiently great to explain the observed association. Benzene is not used in embalming practice, and two surveys found that benzene could not be detected (18) or was present in only trace amounts (ie, <0.1 ppm) (27). Finally, smoking was not related to embalming practice or formaldehyde exposure in our study. We adjusted our analyses for tobacco use (ever or never), and almost identical results were found after adjustment for the number of cigarettes per day (data not shown). In addition, the similarity of the findings in this study to those in two industrial cohort studies (,15) is notable, in that embalmers and industrial workers share high levels of exposure to formaldehyde but have few other workplace exposures in common. We observed relatively similar associations between several exposure metrics and death from myeloid leukemia, including metrics that were not correlated with years of embalming practice or number of embalmings, for example, average formaldehyde intensity while embalming. These independent indicators provide support for the overall association of embalming practice and formaldehyde exposure with increased risk of myeloid leukemia.
Because of the absence of a known mechanism of formaldehyde carcinogenesis, we evaluated several exposure metrics that were derived directly from the questionnaire data (ie, ever embalming, duration of working in jobs with embalming, and number of embalmings) and others that relied on predictions derived from external measurements, and we observed relatively similar associations for myeloid leukemia. In formaldehyde industry-based studies, duration of work in jobs with exposure may not be the best estimate of delivered dose because of the many different jobs and tasks and because of assumptions of constant exposure levels across different jobs over time. In our study, however, the variability in exposure levels was likely to be lower than that in industry-based investigations because we studied only one type of job and therefore the number and type of sources and possible variations are more limited than those in other industries. Thus, duration may better approximate the delivered dose in the funeral industry than in most industry-wide studies. Myeloid leukemia was associated with higher model-derived peak exposure levels of formaldehyde but was not associated with frequency of such exposure, perhaps because of the uncertainty involved in predicting both level and frequency of peak exposures or because of the limited resolution of our peak prediction, with a range of predicted peak formaldehyde concentrations of 3.7-12.3 ppm.
This study has several limitations. Surrogate respondents (ie, next of kin and coworkers) may or may not accurately report exposure-related information, depending on the type of information and type of surrogate (-33). We addressed this concern by including multiple surrogates (next of kin and coworkers) for each study subject. Indeed, the high concordance rates between multiple respondents for the same subject with respect to the number of years worked in the funeral industry (93%) and the number of these years during which embalming was practiced (86%) increase confidence in the accuracy of these variables. Because we used surrogates for both case and control subjects, exposure misclassification was likely to be nondifferential, so that any resulting bias would be toward the null and thus would tend to underestimate risk. In addition, if any systematic positive bias were to occur, it would be expected to affect all cancer types equally. Therefore, the specificity of the association with myeloid leukemia but not with other leukemias was noteworthy.
Under the assumption that formaldehyde exposure is causally linked with myeloid leukemia death, one might have expected stronger associations for the formaldehyde exposure metrics than for duration of embalming. However, the uncertainty in estimating the lifetime formaldehyde exposure may have attenuated estimated risks, despite the prediction model that explained a large fraction of the variation in measured formaldehyde concentrations during embalmings that were performed at various times and by following various protocols. In this context, trend tests that were based on categories were less influenced by extreme values of exposure metrics than those that were based on continuous values, which was the method that we selected a priori. For example, category-specific associations between exposure and death from myeloid leukemia (eg, 8-hour time-weighted average intensity) were statistically significant if ordinal scores (1, 2, 3, and 4) were used as a continuous variable (_P_ for trend = .021) but not if continuous exposure was used (_P_ for trend = .396) (Table 3) (trend tests that were based on ordinal scores gave _P_ = .012 for number of embalmings and _P_ = .023 for cumulative formaldehyde exposure; data not shown). The observation that associations between formaldehyde exposure metrics and myeloid leukemia were generally similar to those for duration of embalming or number of embalmings supports the possibility that formaldehyde may be involved in the greater than expected number of deaths from myeloid leukemia among embalmers.
A major limitation of our study is the relatively small number of deaths from myeloid leukemia, although the numbers of case subjects with myeloid leukemia were roughly similar in our study (n = 34) and in the largest industrial cohort (n = 48) (15). To address small numbers for myeloid leukemia, we carried out additional analyses that combined never and low-frequency embalmers as a referent group and found results that were similar to those in the main analysis. There were also considerable missing exposure data requiring imputation and, when subjects whose work history was more than 30% incomplete were excluded, the strength of the associations decreased. However, because the missing data did not differ substantially between case and control subjects, we believe this decrease can be attributed to smaller numbers of subjects and to chance. The strongest associations were with ever embalming and number of years of embalming, the variables in which we have the most confidence.
Our study also has some unique strengths compared with other studies of formaldehyde exposure (,15,). In industrial cohort studies (15,), exposure is usually assessed for thousands of different job types, and every subject is assigned the same exposure for a given period and job. These studies often rely on aggregated information for plants and departments to estimate job-specific exposure levels and so measurement data, particularly historical data, are limited. In contrast, we studied only one exposed job type (embalming) and individual exposure levels were estimated by use of study subject-specific information from questionnaires combined with statistical models that were based on high-quality measurement data.
This study adds supporting and complementary data to other epidemiological evidence of an association between formaldehyde exposure and risk of myeloid leukemia. When we compared this study in the funeral industry with the National Cancer Institute cohort study of formaldehyde industries (15), we found that funeral home workers who embalm tended to have longer duration of formaldehyde exposure and higher cumulative levels of formaldehyde exposure but lower 8-hour time-weighted average intensity. Peak exposure levels of greater than 4 ppm, the lower bound of the highest exposure category in the analysis of the industrial cohort study, appear to be more common among embalmers (ie, 77% of control subjects) than among industrial workers (ie, 25% of workers). Our study assessed work in the funeral industry approximately through the early 1980s and so the work patterns and estimated exposure levels of deceased control subjects may not be entirely representative of current practice in the funeral industry. However, the average estimated formaldehyde intensity while embalming among control subjects (1.7 ppm, SD = 0.7 ppm; Table 2) was generally consistent with levels that were reported previously (17) in limited surveys of funeral homes, which tend to show average exposure levels in the range of 1 ppm.
The absolute impact of exposure to formaldehyde on death from myeloid leukemia in the general population is difficult to assess on the basis of data in this study, which are not population based. However, if formaldehyde exposure is causally related to myeloid leukemia, then from the best linear approximation of the exposure-response relationship in this study, US-wide formaldehyde exposure at an equivalence of a decade of employment in an embalming job would roughly increase the age-adjusted mortality from myeloid leukemia in the United States (ie, 3.4 deaths per 100 000 person-years [34]) by approximately 36% (ie, by 1.2 more deaths from myeloid leukemia per 100 000 person-years). Within the limits of this quantitative exposure assessment, the number of additional deaths from myeloid leukemia associated with an additional average formaldehyde intensity of 1 ppm would be 1.7 per 100 000 person-years. Because of the case-control design of this study and the limitations discussed above, these exposure estimates should be used with caution in quantitative risk estimation.
In summary, this is the first study, to our knowledge, to specifically relate number of years of embalming practice and related formaldehyde exposures in the funeral industry to mortality from myeloid leukemia. No associations were observed with other lymphohematopoietic malignancies, and associations with brain cancer were unclear. Further studies of leukemia risk in relation to specific embalming practices and exposures, as well as similar specific exposure studies in other professional groups that are exposed to formaldehyde and that have an increased risk of leukemia (ie, anatomists and pathologists), should help to clarify our understanding of cancer risks related to formaldehyde. This study adds to the accumulating evidence from studies of industrial workers that increased exposure to formaldehyde is associated with increased risk of myeloid leukemia.
"


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## nlieb (Mar 20, 2012)

And a follow up of the textile worker study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740723/?tool=pubmed


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## Bjorn (May 2, 2010)

Yuck for non-iron then.


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## AJLP (Oct 12, 2007)

Can't say it is a true allergic reaction but the shirt collars irritate my neck. Trousers have not presented a problem at all.


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## cdavant (Aug 28, 2005)

"Results: Mortality from all causes (2206 deaths, standardised mortality ratio (SMR) 0.92, 95% CI 0.88 to 0.96) and all cancers (SMR 0.89, 95% CI 0.82 to 0.97) was less than expected based on US mortality rates. A non-significant increase in mortality from myeloid leukaemia (15 deaths, SMR 1.44, 95% CI 0.80 to 2.37) was observed."

Cheer up. In this study formaldehyde exposure reduced your risk of death. If the risk were high, every medical student in the 90's and before got such a heavy dose in the anatomy lab we'd all be dead by now. Big doses over a long time may have increased one type of leukemia in embalmers, the exposure from wearing a non-iron is minimal after just one washing.


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## Topsider (Jul 9, 2005)

cdavant said:


> In this study formaldehyde exposure reduced your risk of death.


Well, it is a preservative, after all. 



> the exposure from wearing a non-iron is minimal after just one washing.


You're probably more likely to die from chafing.


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## Cowtown (Aug 10, 2006)

AJLP said:


> Can't say it is a true allergic reaction but the shirt collars irritate my neck. Trousers have not presented a problem at all.


I had the same problem when I wore a non-iron shirt I received as a gift several years ago. I didn't like the feel of the fabric at all and thought it wore hot. I will stick with must iron.


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## nlieb (Mar 20, 2012)

"Increasing years of embalming practice, compared with having never embalmed, were associated with statistically significantly increasing risks for lymphohematopoietic malignancies of nonlymphoid origin"

I don't think you can say exposure to formaldehyde is good for you.

The point isn't that it will give you cancer, but that you're basically insuring that other people will get cancer by buying these shirts. We're using comparative advantage (in an economic sense) and convenience to justify killing people. I just don't think that's right.


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## Oldsarge (Feb 20, 2011)

You're a lot more likely to ensure cancer if you and your deceased relatives are embalmed rather than cremated. The way I interpret the statement is that any correlation between work in the textile industry and rare cancers was due to the deceased having been in the industry years ago when the processes were far less sophisticated than they are now. That's the trouble with cancer. It takes a long time to develop and by the time you've figured out what the possible cause is, society has moved on . . . probably to other potential carcinogens!


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## Atterberg (Mar 11, 2012)

No irritation, but it doesn't breathe as well.


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## nlieb (Mar 20, 2012)

Oldsarge said:


> You're a lot more likely to ensure cancer if you and your deceased relatives are embalmed rather than cremated. The way I interpret the statement is that any correlation between work in the textile industry and rare cancers was due to the deceased having been in the industry years ago when the processes were far less sophisticated than they are now. That's the trouble with cancer. It takes a long time to develop and by the time you've figured out what the possible cause is, society has moved on . . . probably to other potential carcinogens!


Well maybe we should all forgo being embalmed. Your corpse is just a thing after your dead, why hold onto it forever? As for me, when I die, I plan on being cryogenically frozen .

Somehow I doubt they have sufficient controls on safety in Cambodia and Bangladesh or wherever our clothes are made these days. I don't know about Bangladesh, but when I was in Cambodia I saw a woman give birth on the side of a road that smelled of excrement. They show a remarkable lack of concern about safety there (probably because for years due to the civil war between the central government and the Khmer Rouge people didn't know whether they would live to see another day regardless of whether they looked both ways when they crossed the street). I'm sure part of the low cost of manufacture in these country is insufficient safety practices. Workers' safety costs money, after all. The incentive is _not_ to ensure safe working conditions.


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## cdavant (Aug 28, 2005)

It's human nature to worry about rare and unlikely but serious things like cancer from formaldehyde and ignore real and common hazzards like the loss of fingers and hands in third world workers. Malnutrition in a worker's family will kill many more people should they have no job at all than chemical exposure will. Must iron shirts are made from cotton that also undergoes processing with many chemicals along the way to you. You don't want to know.
While I buy American when I can, when I can't I know I am contributing at least a few crumbs to feed someone who might otherwise starve. If I don't, even realizing that the lion's share doesn't go to the worker, the lion won't starve. The possibly exploited worker almost surely will.


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## Oldsarge (Feb 20, 2011)

+1 Thanx for so clearly articulating what I was trying to compose.


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## RM Bantista (May 30, 2009)

Good thread, Gentlemen,
Awareness of conditions where things are made should be a consideration for us as ethical and morally intelligent persons. This is a consideration, and if one wishes to promote good work well paid for skills applied, there is a cost to the end user for their price. As we are able, it is morally imperative to empower others to have a life of freedom and opportunity to attain some semblance of aspiration and security in their persons and families. However, it is also not entirely a thing we may exercise comprehensive authority to influence in every instance. All things are not certain and certainly not settled. Some statistical survey studies and research is just to generate doctorates and some is valid; some are just matters of adjustment of practice to find a statistically significant measure of exposure and determine if there is also any level of acceptable risk and method of insurance against unnecessary exposure. These are very complex interactions that are not absolute positive correlations. A great many papers are written based on very slim premises. The funeral directors and embalmers have directed the law in this matter. The funerary practices that are required for burial and preparation of bodies have been institutionalized at their guidance as the experts in practices. Forensic science and medical best practices have also influences on the laws in most states. Hydrologists have influenced legislation in these areas as well.
The things we imagine we know are more than we may be certain that we know. This is why we have intuition, reflection, and projection of potential into paths we may wish to experience. It is very possible that what has been seen to be the best practice for stopping contagious diseases from the exposure to corpses as well as eliminating the need to worry about being buried alive were not the best choices that might have been made. Someone made money from enforcing this in legislation. There were once bells in graveyards with lanyards inside the coffins to prevent the still living and now awakened from death after coma, What could be sadder than exhumation of a body where the inside of the casket has bloody fingernails embedded in the lid.
Kill Bill to the side, one cannot survive without assistance if buried alive. This does not happen these days, because we drain the blood and flood the bodies with a poisonous preservative as the bequest of the funeral directors.
What is the ethical and moral posture in this question? Very slippery ground here.
Hikers beware.
Regards to you and good fortune on these holy days,
rudy


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## nlieb (Mar 20, 2012)

cdavant said:


> It's human nature to worry about rare and unlikely but serious things like cancer from formaldehyde and ignore real and common hazzards like the loss of fingers and hands in third world workers. Malnutrition in a worker's family will kill many more people should they have no job at all than chemical exposure will. Must iron shirts are made from cotton that also undergoes processing with many chemicals along the way to you. You don't want to know.
> While I buy American when I can, when I can't I know I am contributing at least a few crumbs to feed someone who might otherwise starve. If I don't, even realizing that the lion's share doesn't go to the worker, the lion won't starve. The possibly exploited worker almost surely will.


Your logic is faulty:

The way I understand your argument, you're asserting that:
a) Not buying non-iron shirts will put third world workers out of work
b) It doesn't matter that textile workers are exposed to formaldehyde because they're exposed to other nasty chemicals instead.

The second point is demonstrably false: if it were true, than studies such as the one I quoted (the one looking at statistics for actual textile workers working with actual formaldehyde) would have shown no increase in mortality in workers exposed to formaldehyde. So while textile workers are no doubt exposed to many noxious chemicals we don't know about, we do know that this chemical is demonstrably shortening their lifespan.

The first is wrong because of simple economics. Non-iron and iron shirts are complimentary goods. If consumers do not buy non-iron shirts, it almost certainly means they are buying conventional shirts instead. The alternative, I suppose, is that they are replacing their wardrobe of need-to-iron clothing, and if there are a sizable number of people who do this, then yes, people might get fired. But I suspect the majority of people would be replacing their shirts anyways. If this is the case, the shirt-maker, not being idiotic, will pick up on this trend, if it is large enough to matter, and produce more normal shirts and less non-iron shirts. Nobody loses their jobs.

Gentlemen, I know none of you want to iron your own shirts. It's tedious, tedious work and it's easy to ruin expensive clothes through scorching. I'm sure many of you find it annoying that I am pointing out that the alternative is giving people cancer. You don't want to accept that I might be right because it would be...inconvenient. But just because what I'm saying is annoying doesn't mean it isn't right. Come on, give me more points to refute - I'm having great fun.


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## Oldsarge (Feb 20, 2011)

1. You have yet to establish that formaldehyde is used in non-iron clothing.

2. You have yet to establish a definite link between non-iron clothing and cancer.

3. You have yet to clearly establish the rate of cancer in the textile industry that can be definitively correlated with non-iron clothing.

4. If this is your idea of fun perhaps you should work for Concerned Scientists.


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## nlieb (Mar 20, 2012)

Oldsarge said:


> 1. You have yet to establish that formaldehyde is used in non-iron clothing.
> 
> 2. You have yet to establish a definite link between non-iron clothing and cancer.
> 
> ...


If you'd read the articles I'd cited you'd have noticed that I established all of the above.

I'm not sure what you have against concerned scientists. Maybe you don't like concern? Maybe you don't like science?


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## nlieb (Mar 20, 2012)

Also, what I get a kick out of is a good argument. It doesn't particularly matter that I happen to be on the "good" as opposed to the "evil" side of the fence. My entire family are lawyers (with the exception of me), thus I was brought up with the idea that a good argument is worthwhile in and of itself. Not that it doesn't help when I'm so clearly on the winning side, as I am now.


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## nlieb (Mar 20, 2012)

Also, sorry to be an obnoxious *****. I just hate it when people act as if they know something when they haven't taken the time to inform their self.


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## nlieb (Mar 20, 2012)

One final point before I hand over the floor to the honorable curmudgeon: if I were arguing the other side of this argument, I might have pointed out that there was another study done in Australia that found no correlation in textile workers between formaldehyde exposure and leukemia. 

I wouldn't try this line of reasoning, though, since I could refute this by pointing out that Australia is a first world country with (likely) first-rate safety protocols.


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## nlieb (Mar 20, 2012)

But wait: one more thing: an abstract of yet another study:


A retrospective cohort mortality study of workers exposed to formaldehyde in the garment industry.Stayner LT, Elliott L, Blade L, Keenlyside R, Halperin W.
SourceDivision of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati OH 45226.

AbstractIn order to assess the possible human carcinogenicity of formaldehyde we conducted a retrospective cohort mortality study of workers exposed for at least three months to formaldehyde in three garment facilities which produced permanent press garments. A total of 11,030 workers contributing 188,025 person-years were included in the study. Vital status was successfully ascertained through 1982 for over 96% of the cohort. The average (TWA) formaldehyde exposure at the three plants monitored in 1981 and 1984 by NIOSH was 0.15 ppm but past exposures may have been substantially higher. In general, mortality from nonmalignant causes was less than expected. A statistically significant excess in mortality from cancers of the buccal cavity (SMR = 343) and connective tissue (SMR = 364) was observed. Statistically nonsignificant excesses in mortality were observed for cancers of the trachea, bronchus and lung (SMR = 114), pharynx (SMR = 112), bladder (SMR = 145), leukemia and aleukemia (SMR = 113), and other lymphopoietic neoplasms (SMR = 170). Mortality from cancers of the trachea, bronchus and lung was inversely related to duration of exposure and latency. In contrast, mortality from cancers of the buccal cavity, leukemias, and other lymphopoietic neoplasms increased with duration of formaldehyde exposure and/or latency. These neoplasms also were found to be highest among workers first exposed during a time period of high potential formaldehyde exposures in this industry (1955-1962). However, it should be recognized that these findings are based on relatively small numbers and that confounding by other factors may still exist. The results from this investigation, although far from conclusive, do provide evidence of a possible relationship between formaldehyde exposure and the development of upper respiratory cancers (buccal), leukemias, and other lymphopoietic neoplasms in humans.

PMID:3389362 [PubMed - indexed for MEDLINE]


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## nlieb (Mar 20, 2012)

> In contrast, mortality from cancers of the buccal cavity, leukemias, and other lymphopoietic neoplasms increased with duration of formaldehyde exposure and/or latency. These neoplasms also were found to be highest among workers first exposed during a time period of high potential formaldehyde exposures in this industry (1955-1962).


And there we go.


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## nlieb (Mar 20, 2012)

Also, this article in the NYT confirms that formaldehyde is used in the making of non-iron fabrics.

https://www.nytimes.com/2010/12/11/your-money/11wrinkle.html?pagewanted=all


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## Oldsarge (Feb 20, 2011)

That's better. However, those are studies of non-iron garments made some time ago, like fifty years? Things have changed a lot, even overseas. I still haven't seen what the actual incidence _was_ then nor is there anything about what it is now. I've had stats and 'statistical significance' which I used in my grad work can be as little as one percent. More data, please.


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## Oldsarge (Feb 20, 2011)

And of course, wash any washable garment before wearing it. That's always been my policy.


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## Trip English (Dec 22, 2008)

No matter what your occupation, in what country, what year, what conditions, you are at a higher risk for some ailment than those outside of your occupation. Then there's the common store of risk like falling down stairs, choking, being involved in an auto accident, etc. To choose one microcosmic example and use it as a deed to a moral high-ground just sounds a little absurd. It's like saying I'm going to avoid owning or operating a car because I won't cause some poor factory worker to develop carpal tunnel syndrome. My own occupation has a special set of risk factors and while I appreciate the role of the regulation and oversight that keeps me _relatively_ safe and healthy in the context of my profession, I certainly wouldn't want to be advocated for to the point of unemployment.

Without making this thread interchange-bait, this is often the breakdown between the two political ideologies in the west. Do we want to be able to choose some dangerous work or do we want those avenues shut off to us by those who know better? There are sound arguments for both societal constructs and we're probably more conditioned to the former here in the USA, but just as you frame the safety in terms of what's available to a first-world nation like Australia verus a developing nation like Cambodia, you also have to address the concomitant economic conditions that might affect the calculation someone could make to risk the possibility of cancer in order to secure some means of financial independence.


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## Bjorn (May 2, 2010)

I think in fact, if we find evidence of a chemical being carcinogenic, we simply don't allow workers being subjected to that within the area which is subject to 'western' legislation, including the US. There is hardly an argument to be made against that, in fact it is not possible to operate such a business due to the possibility of civil litigation (government agencies aside) in the western world. 

It is then not a very handsome argument to say that simply because we CAN buy these goods from elsewhere, we should, to support the economies of workers and businesses in the third world. 

Non-iron shirts are cotton that has been soaked in chems. Whether the ever-remaining residue is enough ppm to give us cancer, dermatitis, or any number of other discomforting or fatal things is, if you simply google it, 'a matter of ongoing research'. However, I'm sure I ingest or am otherwise subjected to any number of different chemicals every day that I can do little about. 

As far as non-iron shirts, I can. I'll stick with shirts that have to be ironed. It reduces risk.


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## Trip English (Dec 22, 2008)

Wearing must-iron shirts certainly reduces the risk of wearing non-iron shirts, if nothing else.


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## sbdivemaster (Nov 13, 2011)

Oldsarge said:


> And of course, wash any washable garment before wearing it. That's always been my policy.


I can attest to the necessity of this. Washing all new clothing before wearing is my general rule; however, a few years back, after getting some new socks, I thought they were so soft and nice that I would wear them without washing first - big mistake. After only a few hours, my feet started itching... when I finally removed the socks, my feet had a wicked rash with oozing blisters. A few hours of pleasure took weeks to heal.

Jerry Lewis I am not. (see #3)


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## nlieb (Mar 20, 2012)

Trip English said:


> No matter what your occupation, in what country, what year, what conditions, you are at a higher risk for some ailment than those outside of your occupation. Then there's the common store of risk like falling down stairs, choking, being involved in an auto accident, etc. To choose one microcosmic example and use it as a deed to a moral high-ground just sounds a little absurd. It's like saying I'm going to avoid owning or operating a car because I won't cause some poor factory worker to develop carpal tunnel syndrome. My own occupation has a special set of risk factors and while I appreciate the role of the regulation and oversight that keeps me _relatively_ safe and healthy in the context of my profession, I certainly wouldn't want to be advocated for to the point of unemployment.


I think maybe you're misunderstanding my argument. I'm not saying that it's immoral to wear shirts, I'm saying it's immoral to wear non-iron shirts. I'm not saying we shouldn't patronize third-world textile workers, I'm just saying we shouldn't expose them to any more risks than they are already in, if we don't have to. Not buying non-iron shirts is a way we _know_ we can (if enough people do it to affect market share) encourage safer working practices. Dipping shirts in formaldehyde based resins is not essential to making shirts: it is essential to making _non-iron_ shirts.


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## nlieb (Mar 20, 2012)

Oldsarge said:


> That's better. However, those are studies of non-iron garments made some time ago, like fifty years? Things have changed a lot, even overseas. I still haven't seen what the actual incidence _was_ then nor is there anything about what it is now. I've had stats and 'statistical significance' which I used in my grad work can be as little as one percent. More data, please.


Admittedly, I can't find any such studies. I don't think they're necessary, though, to demonstrate a correlation. All you have to do is calculate that the results you get are more likely to have occured had your hypothesis been correct than not. But I'm sure you know all of that, since your graduate studies included statistical surveys.


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## cdavant (Aug 28, 2005)

This is what happens when science meets sociology--God forbid politics and religion get added to the mix. It's easy to forget that even scientists have agendas and these agendas may have a heavy influence on what gets studied. Then there is something called "Publication Bias." Studies showing second hand tobacco smoke is very harmful easily get published. Another very well done study that found little influence was turned down by every major American journal before a British journal finally accepted it. We seem to be seeing the same thing with "Climate Change."

To pull an older quote:

There are lots of chemicals in regular shirts as well: "During the conversion of cotton into conventional clothing, many hazardous materials are used and added to the product, including silicone waxes, harsh petroleum scours, softeners, heavy metals, flame and soil retardants, ammonia, and formaldehyde-just to name a few (8). 

Many processing stages result in large amounts of toxic wastewater that carry away residues from chemical cleaning, dyeing, and finishing. This waste depletes the oxygen out of the water, killing aquatic animals and disrupting aquatic ecosystems (8). 

The North American Organic Fiber Processing Standards prohibits these and similar chemicals. 


Cotton uses approximately 25% of the world's insecticides and more than 10% of the pesticides (including herbicides, insecticides, and defoliants.). (Allan Woodburn) 


Approximately 10% of all pesticides sold for use in U. S. agriculture were applied to cotton in 1997, the most recent year for which such data is publicly available. (ACPA)"

My niece didn't have a clue where the electricity that recharges hybrid cars comes from-- mostly good old coal. Everything is made up of "chemicals." Some are toxic. Some like H2O are not (in small doses). It largely depends on the dose, duration of exposure and so on. I'd bet 90% of the "chemicals" that are remotely potentially toxic are gone from both iron and non-iron shirts after the first washing and 99% after a couple more. The above quote comes from people who grow "organic" cotton and want to use the public's fear of "chemicals" to push their product--which will, of course, have to be treated with chemicals like dyes, bleaches, softeners to be useable for making shirts.

Had nlieb remembered his statistics studies he'd know that his "more likely than not" standard could mean there's more than a 49.9% chance his hypothesis is flat out wrong. Even using the 95% confidence level we consider "statistically significant" means one out of twenty studies reached a conclusion by chance alone. And many researchers "cherry pick" results. Look for the incidence of fifty diseases in men who wear shell cordovan shoes and it's a virtual statistical certainty that some will be higher than "average." Others will surely be lower. Correlation does not prove causality.
Irons burn people. Irons left unattended set houses afire. There are no free lunches. There are, unfortunately, those ill-informed but well-intentioned folks untrained in critical thinking who immediately accept any statement that fits their mind set and world view without considering that the alternative may be equally bad.

I'm spending my time worrying about the asteroid that's going to hit us this December. Will we still be able to find shoe polish? God knows, that must be toxic anyway. Should I stock up now? Should I stop polishing shoes now to reduce my risk of dieing from fumes before the Maya are proved right? Sorry, I was trying to keep religion out of this...


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## Bjorn (May 2, 2010)

Is the alternative really as bad? 

I mean, come on. Just use the old iron. That's what this is all about. You don't want to.


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## nlieb (Mar 20, 2012)

Bjorn said:


> Is the alternative really as bad?
> 
> I mean, come on. Just use the old iron. That's what this is all about. You don't want to.


Really, you'd think I was explaining the socioeconomic implications of cocaine production on Latin American countries to crack addicts. Maybe no iron shirts are covered with tiny little hypodermic syringes that inject their wearers with heroin for positive reinforcement.


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## nlieb (Mar 20, 2012)

Let me explain, line by line, why cdavant is wrong in virtually everything he has just said.



cdavant said:


> This is what happens when science meets sociology--God forbid politics and religion get added to the mix. It's easy to forget that even scientists have agendas and these agendas may have a heavy influence on what gets studied.


 What, and you don't have an agenda here?


> Then there is something called "Publication Bias." Studies showing second hand tobacco smoke is very harmful easily get published. Another very well done study that found little influence was turned down by every major American journal before a British journal finally accepted it. We seem to be seeing the same thing with "Climate Change."


 Being in the sciences (I am a Physicist) I agree with you that this is a problem. Many good theories get thrown out or never submitted for publication at all because consensus would ridicule them. I would also note that that is entirely unrelated to what is under discussion. There is no pressure, political or otherwise, for scientists to find a correlation between formaldehyde exposure in textile workers and cancer. How many times have you heard this issue come up? It is simply not a hot-button issue in the same way as those you mentioned because both liberals and conservatives wear non-iron shirts. As I pointed out, some studies have shown no correlation between Formaldehyde exposure and rare cancers. I discounted these papers on the basis that their sample groups came from first world countries with proper safety practices. But if there was pressure on scientists to make an issue out of non-iron clothing, would you expect these counter-points to make it to us?



> To pull an older quote:
> 
> There are lots of chemicals in regular shirts as well: "During the conversion of cotton into conventional clothing, many hazardous materials are used and added to the product, including silicone waxes, harsh petroleum scours, softeners, heavy metals, flame and soil retardants, ammonia, and formaldehyde-just to name a few (8).


I responded to this point above. Perhaps you're not reading what I'm saying?



> Many processing stages result in large amounts of toxic wastewater that carry away residues from chemical cleaning, dyeing, and finishing. This waste depletes the oxygen out of the water, killing aquatic animals and disrupting aquatic ecosystems (8).
> 
> The North American Organic Fiber Processing Standards prohibits these and similar chemicals.


 Good for them! I'm not entirely sure why you brought this up, though.


> Cotton uses approximately 25% of the world's insecticides and more than 10% of the pesticides (including herbicides, insecticides, and defoliants.). (Allan Woodburn) Approximately 10% of all pesticides sold for use in U. S. agriculture were applied to cotton in 1997, the most recent year for which such data is publicly available. (ACPA)"


Once again, I'm not entirely sure what you're trying to say. 10% of the world's pesticides and 25% of the world's insecticides are huge numbers. Perhaps they seem small to you, but consider that cotton farming accounts for only 2.5% of arable land usage. Are you saying that organic cotton doesn't make a difference? I'd remind you that organic cotton uses 0% of the world's pesticides and 0% of its insecticides.



> My niece didn't have a clue where the electricity that recharges hybrid cars comes from-- mostly good old coal.


 The point is not that hybrid cars don't use energy generated from fossil fuels, it is that the distributed generation model allows the efficiency with which fossil fuels are used to be higher than if we used smaller individual internal combustion engines. Know your science.


> Everything is made up of "chemicals." Some are toxic. Some like H2O are not (in small doses). It largely depends on the dose, duration of exposure and so on.


 Under discussion are "toxic chemicals," not chemicals _a nomine_ (yes, I know latin, I'm an intellectual, deal with it).


> I'd bet 90% of the "chemicals" that are remotely potentially toxic are gone from both iron and non-iron shirts after the first washing and 99% after a couple more.


 But they're not gone when the shirts are being handled by textile workers.


> The above quote comes from people who grow "organic" cotton and want to use the public's fear of "chemicals" to push their product--which will, of course, have to be treated with chemicals like dyes, bleaches, softeners to be useable for making shirts.


 So your point is...that because we use toxic chemicals in shirts anyways, we should feel free to use as many and any toxic chemicals we want? Why don't we just f-ing spray all our shirts with plutonium dust while we're at it, just for shits and giggles.


> Had nlieb remembered his statistics studies he'd know that his "more likely than not" standard could mean there's more than a 49.9% chance his hypothesis is flat out wrong.


 So in other words, there is at least (really greater than, as we will see later) a 51.1% chance that the hypothesis is correct? Why don't we all play russian roulette with a revolver with only two chambers? Bravo, sir, you've just made my point.


> Even using the 95% confidence level we consider "statistically significant" means one out of twenty studies reached a conclusion by chance alone. And many researchers "cherry pick" results.


 So in other words, there's a 19 in 20 chance that the studies did _not_ reach their results by chance alone. I applaud you again :icon_cheers:!


> Look for the incidence of fifty diseases in men who wear shell cordovan shoes and it's a virtual statistical certainty that some will be higher than "average." Others will surely be lower. Correlation does not prove causality.


 Do you know what statistically significant means?


> Irons burn people. Irons left unattended set houses afire. There are no free lunches. There are, unfortunately, those ill-informed but well-intentioned folks untrained in critical thinking who immediately accept any statement that fits their mind set and world view without considering that the alternative may be equally bad.
> 
> I'm spending my time worrying about the asteroid that's going to hit us this December. Will we still be able to find shoe polish? God knows, that must be toxic anyway. Should I stock up now? Should I stop polishing shoes now to reduce my risk of dieing from fumes before the Maya are proved right? Sorry, I was trying to keep religion out of this...


 This is just silly. I won't even bother responding to this rambling attempt at derision.


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## cdavant (Aug 28, 2005)

Ah, a Physicist. That explains the superficial acquaintance with biochemistry and biostatistics. I was concerned I'd found myself in a battle of wits with an unarmed man.


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## sbdivemaster (Nov 13, 2011)

Clean up on aisle 6!


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## nlieb (Mar 20, 2012)

cdavant said:


> Ah, a Physicist. That explains the superficial acquaintance with biochemistry and biostatistics. I was concerned I'd found myself in a battle of wits with an unarmed man.


 If you knew anything about physics you'd know that statistics is an essential and necessary part of physics research. And if you knew anything about biochemistry you'd know it has nothing whatsoever to do with what is under discussion. Are we debating the _means _by which formaldehyde causes cancer? No, but I could if you wanted to, because my knowlege of chemistry is far from superficial. I suspect yours is, though, for you have repeatedly demonstrated a remarkable lack of knowlege of how science works in general and therefore could not possibly be a specialist. Skepticism is welcomed (Freeman Dyson's stance on global warming comes to mind), but willful ignorance is just annoying. Realize that this isn't so much a battle of the wits as me dancing on your bloodied corpse.


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## Bjorn (May 2, 2010)

nlieb said:


> If you knew anything about physics you'd know that statistics is an essential and necessary part of physics research. And if you knew anything about biochemistry you'd know it has nothing whatsoever to do with what is under discussion. Are we debating the _means _by which formaldehyde causes cancer? No, but I could if you wanted to, because my knowlege of chemistry is far from superficial. I suspect yours is, though, for you have repeatedly demonstrated a remarkable lack of knowlege of how science works in general and therefore could not possibly be a specialist. Skepticism is welcomed (Freeman Dyson's stance on global warming comes to mind), but willful ignorance is just annoying. Realize that this isn't so much a battle of the wits as me dancing on your bloodied corpse.


That's a tad much, I think we should wrap this up now 

To each his own, ymmv etc. Onwards to more clothing related matters...


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## Topsider (Jul 9, 2005)

I think the participants have, at least, demonstrated that non-iron shirts can be irritating.


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## nlieb (Mar 20, 2012)

Bjorn said:


> That's a tad much, I think we should wrap this up now
> 
> To each his own, ymmv etc. Onwards to more clothing related matters...


I did get carried away, didn't I...


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## Atterberg (Mar 11, 2012)

Is there anyone who actually _likes _non-iron shirts? I have a few pairs from BB and compared to their original polo which requires ironing, I kinda like the convenience of being able to hang it and not worry about it and the slight sheen due to the chemical pressing. Sacrilegious? Perhaps, but I'm still a poor graduate student and even the non-iron shirts are a novelty and step up for my wardrobe.


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## RM Bantista (May 30, 2009)

Atterberg said:


> Is there anyone who actually _likes _non-iron shirts?
> Yes! But as stated they are always a compromise in some way. As one always wears high quality cotton tees, it is not much of a compromise.
> Plus, no ironing.
> I have a few pairs from BB and compared to their original polo which requires ironing, I kinda like the convenience of being able to hang it and not worry about it and the slight sheen due to the chemical pressing. Sacrilegious? Perhaps, but I'm still a poor graduate student and even the non-iron shirts are a novelty and step up for my wardrobe.


When one may, almost any washable item may be dried flat between cotton towels and a firm surface with a flat above of some sort for pressing. This will not always work, but it will work sometimes. Just as hanging in good hangers helps and brushing with good brushes help various items so that they do not require professionals, it is also so that many items may be preserved in better condition with less laundering and more air and sun drying as well as sensible pressing with as little effort as possible; not to mention stress on the fabrics that may be very delicate in some cases.
But a good non-iron shirt is not evil though it is a compromise without argument. If one can iron shirts, that is best. My mother ironed all our shirts without teaching any of us how to carry on without her expertise. She also darned socks and sewed buttons on garments. One would wish for that knowledge to carry forward into the future. Ladies once could do all these things and many more without a thought about it. Men have always left the skilled work to women and rested on their ability to earn a salary for some particularity of education. We should perhaps be somewhat more expansive in our aspirations, but it has not been so in many instances in other days.
Imagine, girls made silk braces for their fiances as a usual thing at one time... Does anyone know a girl who could or would attempt such a thing? One very much doubts so. But, when and how you may, it is better to know how to iron and darn and sew buttons than not. I promise. Ladies at times have made all the clothing for their households from raw cotton, wool, and leather.
Regards,
rudy


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## Austinii (Sep 15, 2011)

Yes is the short answer, my skin has become blotched with dime sized red areas since I started wearing non iron shirts a few months ago. At first I thought it was due to the lambswool pullovers I had been given at Christmas, but now that the warmer weather is here the cause is clearly the shirts. In my ignorance I had bought a dozen of them since they really look smart, but you never look sharp if you're constantly scratching!
As others have found these shirts are too hot and breathe badly.


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## RM Bantista (May 30, 2009)

Wash and wear. The irritants may wash out, or not. Somethings become permanent with exposure for some and not for others. As stated, "...always a compromise". sometimes a compromise that should not be made as with exposure to latex or food items or medicines. Allergies happen for individuals. These become complex chemical/biological interactions which have uncertain outcomes. Always best to be cautious, but white cotton shirts are not without environmental impact. Certainly non-iron shirts are as bad or worse. These things we do have consequences and responsibility belongs to all in some portion: the designer, the maker, the chemical companies, and the end user. Best to remember but not dwell on the deaths that may result. There is always an unseen toll for anything.
you may think as you please about this, but this is where I live. People died to make the things I have. And things are just things but people are uniquely precious.
One treasures what one has and remembers that these things cost more than we ourselves have paid, whatever we paid...
Good fortune be with you, Gentlepersons,
rudy


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## Atterberg (Mar 11, 2012)

I wore a non-iron collar for about sixteen hours and experienced itching and a red ring of irritation around my neck. From now on I'll be wary of wearing them for longer than ten hours... or at least unbutton the neck later in the day.


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## RM Bantista (May 30, 2009)

Atterberg said:


> I wore a non-iron collar for about sixteen hours and experienced itching and a red ring of irritation around my neck. From now on I'll be wary of wearing them for longer than ten hours... or at least unbutton the neck later in the day.


Sixteen hours. One should have a plan to change everything and take a break. It is not a sound practice to work so many hours without a chance to rest and restore the mind and body. (I know this was a common practice for children in other times and still is for people in some industries; such as film making, commercial fishing, truck driving, etc..) Dirty Harry said in the movie, "a man has to know his limitations.", and this is so. We also have to make room for them in the day to day by thinking like a cub scout and always be prepared...
And always leave the camp better than when we arrived.
It is not my intent to be obscure: plan for the expected, the unexpected, and the catastrophic; and plan to have survived these in the variety of states that may remain should certain kinds of things transpire. And also plan for the circumstance that you survive but others do not. This is almost as bad as it gets. Doesn't bear thinking about.
Sixteen hours? What was so important to you to do so? Just a question, not requiring an answer should you not wish to give one. It all depends on the consequences of the mission. One may always go beyond the usual in preserving life and protection of the nation. When the President asks one to do something, one should if it is not illegal nor immoral make every effort to serve.
Do as thou wilt is the whole of the law.
rudy


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## Atterberg (Mar 11, 2012)

It was just a long day -- travel followed by an impromptu social gathering once I returned home. I didn't have time to change, so I just continued wearing what I had on.


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## trgolf (Jun 24, 2011)

I get a buring sensation and slight rash when I wear one of these shirts. I often wondered if it was due to the chemicals.


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## RM Bantista (May 30, 2009)

trgolf said:


> I get a buring sensation and slight rash when I wear one of these shirts. I often wondered if it was due to the chemicals.


Sir, that is an allergenic response, and these generally only become more severe with continued exposure. Please try to avoid that very brand of shirt in future. Doesn't matter what brand it was. The safest course is always the must iron, best quality, long-fiber fabric, well woven. Or linen is an option for some, which is supposed to be a bit rumpled. But please do avoid non-iron shirts of that type/process (the manufacturer may be queried as to the exact composition, though they will likely avoid disclosure); next time you may get hives. 
Be well, live long, do good work well.
rudy


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