Excerpt. © Reprinted by permission. All rights reserved.
Chapter 1
In Case of Emergency
Chemicals in the Not-So-Friendly Skies
Mary stopped the beverage service cart in the aisle and nudged the brake on with her foot. Smiling, she leaned toward the passenger by the window and took in a breath before asking them if they would like anything to drink.
At that moment, she started to choke, and buried her face in the elbow of her navy-blue jacket as she continued to hack. Gathering herself, she apologized profusely, poured herself some water, and continued with some effort to serve drinks. After she managed to finish the service, she stood in the back galley, wondering what the heck was going on. Lately, she had been coughing all the time, even though she had no other symptoms of a cold or flu. It was the spring of 2011, almost a decade before the Covid pandemic started making its way around the world in airplane cabins.
Mary (not her real name, to protect her job) was otherwise healthy and active. She had a gym membership and liked to go hiking in the verdant mountains that rise thousands of feet above Seattle, where she lives and where Alaska Airlines, the company she works for, is headquartered. Well, she hiked when she had time. Mary had a hectic work schedule, flying six days a week all over the US. Sometimes she would work fourteen days in a row, which lasted anywhere from six to twelve hours, with just enough time for a quick dip in the hotel pool and a sleep during her layovers. But by and large, she loved her job. "I drank the Kool-Aid," she said later. "I thought I mattered. I thought I was part of the family."
Mary, along with her twenty-eight hundred colleagues, had received a box from Twin Hill containing her new Alaska Airlines uniform a few months before, in late December 2010. When she pulled out about a dozen plastic-wrapped pieces, she judged it a big improvement over the old frumpy, bulky wool uniform made by M&H, an American uniform maker. These new pieces had a modern cut and were made with a sleek, polyester-wool blend fabric. What she didn't know is that while pure wool is naturally flame retardant, the new uniform's flame retardancy was provided by a chemical finish-and the fabric came with many other performance-enhancing chemicals, such as stain-proofing provided by Teflon.
Mary had heard senior attendants complaining that the new uniforms were giving them a rash. "I thought, these people are just mad because they don't like change," she told me a decade later. She was having her own breathing problems, but said, "I had not put two and two together. No one had ever heard of being poisoned by clothes before."
One of those senior attendants who was complaining the most was John, an attendant with twenty-five years of experience who lived in Long Beach, California, near his base of LAX. Back in 1986, John was a fifth-degree, black belt tae kwon do instructor when a friend invited him along for an interview to be a flight attendant at a small airline. He'd gone just for fun, but when he was offered the job, he took it and never looked back. The very next year, the airline was bought and absorbed into Alaska Airlines. By his midfifties, John had softened a bit around the middle but still had a handsome, boyish charm, with a square jaw, dimpled chin, and short brown hair.
According to his partner, Marco, John was low-key, even reserved, on the ground. But when he donned his Alaska Airlines uniform, he took on a different persona: gregarious, silly, charming. If he noticed a colleague was feeling down, he would go out of his way to make them laugh. At fast-food restaurants, he would order kids' meals so he could give the toys to fussy children on flights. He celebrated his colleagues' birthdays and put on funny hats for holidays.
John was a hard worker, and loved his job. When Alaska's insufficient maintenance of an older plane led it to crash off the California coast in 2000, killing everyone on board, John went right back to work. "It's just like getting thrown off a horse-you need to get right back on, otherwise you won't do it again," he told Marco.
John and Marco had met during one of John's layovers in San Francisco. They made it official with a domestic partnership in 2007, before it was legal for two men to be married in the US. John kept his home near LAX but, as an attendant with seniority, would select as many layovers in San Francisco as possible so that he had to spend only a few days a week away from Marco, who lived in the Bay Area.
"He wanted to keep working as long as possible. He loved his job," Marco told me by phone in 2021. "That all changed in 2010, when they issued those uniforms."
On a cool December day, John pulled the new uniform pieces out of the box and started trying them on in front of the mirror. Within the next two days, his whole upper body flushed with a rash, and he had trouble breathing, according to complaints he submitted later to the flight attendant union. He wore the outfit to work in January, before Alaska communicated the official rollout date, and he landed in the emergency room with severely compromised breathing and blisters on his arms. He came away from that ER visit with a $4,900 bill and a diagnosis of bedbug bites. Few had heard of a piece of clothing being toxic before. Rashes? Sure. That can happen when the pH balance of fabric is off. But landing in the emergency room from a blazer? The doctors had nothing to offer.
In fact, this wasn't the first time something like this had happened. In 2009, Transportation Security Administration (TSA) employees-the people who work the security checkpoints in airports across the US-started telling the American Federation of Government Employees that their uniforms gave them rashes, light-headedness, red eyes, swollen and cracked lips, and runny or bloody noses.
A TSA representative downplayed the issue. Less than 1 percent of the fifty thousand TSA workers were complaining, after all. And the Nashville-based manufacturer of their uniforms, VF Solutions, had the uniforms tested and said all substances, including formaldehyde, were below "acceptable limits."
"It's not a new fabric," VF Solutions' vice president for safety told the Washington Post. Just a typical cotton-polyester blend. There was no reason for these reactions to kick up now. But TSA agents were offered the option of 100 percent cotton alternatives. We don't know if John, his doctors, or even anyone at Alaska Airlines had heard about the TSA uniforms-I heard about them from another attendant who had done hours and hours of research.
All Alaska Airlines flight attendants were required to report to work in their new uniforms by February 23, 2011. Within days, Judith Anderson, an industrial hygienist in the Department of Safety, Health, and Security at the Association of Flight Attendants (AFA), started receiving emails and calls from members about the new uniforms and nasty reactions.
Anderson is slender and pale, with green eyes and straight, light-brown hair she keeps in a conservative sideswept crop. She has the air of a preschool teacher, with a soft voice that emanates both concern and gentle authority. Like the attendants she represented, Anderson tended to wear a conservative skirt suit and tights-with the addition of a perky scarf; you might find yourself asking her for soda water and pretzels.
In 1993, when Anderson graduated from college with a degree in chemistry and biopsychology, she started looking around for a master's program that would allow her to work in public health and have a real-world impact. When she learned about the field of industrial hygiene, it seemed like a great fit.
Anderson's second job out of school-after a stint in cancer research in British Columbia-was at George Washington University, helping the Center to Protect Workers' Rights assess chemical exposure of maintenance workers at a paper pulp mill. She remembers putting on steel-toed boots, walking inside a giant chemical digester, and seeing people welding without any respiratory equipment.
"It was appalling to see the conditions that some people work under," she told me by phone from her home office in Seattle in early 2022. She felt compelled to use her education and relative privilege to advocate for laborers.
So in 1999, when she saw a job posting at the Association of Flight Attendants-the largest flight attendant union in the world, representing tens of thousands of people from more than a dozen different airlines, including US Airways, Alaska Airlines, Hawaiian Airlines, and United Airlines-she was intrigued. But Anderson was also unsure that it would offer the kind of challenge and advocacy work she was looking for. "I thought, How dangerous could this job be?" she said. Sure, flight attendants work hard, and the struggles of working with the public in a stressful environment have been well documented, especially in recent years. But were their jobs and their working environments actually toxic in the literal sense? She wasn't so sure. "I had this glossy image of what it is to be a flight attendant," Anderson confessed to me.
But she quickly found out that flight attendants-and to a lesser extent, passengers-are often surrounded by a cocktail of toxic chemicals on the plane. And because they float above earth in workplaces not covered by the Occupational Safety and Health Administration, flight attendants actually need more advocacy from someone like Anderson, not less. She took the job and threw herself into the interesting, engaging work. It's a job she still holds today.
As an industrial hygienist working inside the airline industry, Anderson supports not just the airline employees but in effect, the traveling public as well. For example, on cold days, the smell of de-icing fluid infiltrates the airplane cabin. Anderson has also worked on airborne illnesses, including SARS and COVID-19, and the simple danger of it being dangerously hot or cold in the airplane cabin.
And the AFA has been fighting since the 1970s to reduce the quantity and toxicity of pesticides that are sprayed up and down planes during stopovers to countries like Australia and India that have policies requiring it. In 1979, after some passengers experienced anaphylactic shock, the CDC stopped requiring routine disinfection on flights to Hawaii. In a small win in 2001, the AFA managed-with the help of the California Board of Health-to convince a large airline to stop spraying pesticides directly on the attendants' bunk beds in the large planes that do overnight flights to Australia. (Often the beds and passenger seats would still be wet when boarding started.)
But the "fume events" were what shocked and alarmed Anderson the most. That's when the jet engines start leaking hot oil into the air exchanges that run past the engines, and toxic fumes fill the cabin. Anderson receives weekly reports from crew members about "dirty sock smells" and smoke so thick it makes them cough, then develop headaches, brain fog, dizziness, and fainting.
Over the years, Anderson had developed close working relationships with the flight attendants from a dozen different airlines, from the young idealistic women working puddle-jumping commuter flights between small American cities to the seasoned attendants who serve champagne on jumbo jets to exotic destinations. If an attendant suspected they might have been poisoned on the job, Anderson was often the only sympathetic ear they could find.
Now, in 2011, pictures appeared in her inbox from Alaska attendants, of red patches of skin, swollen eyelids, and eyes crusted with pus. Unbeknownst to Anderson or the flight attendants, Alaska Airlines' customer service representatives were also having trouble with the uniforms. They filed a complaint with the Department of Labor & Industries in Washington State, where the airline is headquartered. The agency sent a letter to Alaska Airlines on March 3, describing the reactions.
In early March, John put on his uniform, and again, within minutes, he broke out in hives and couldn't breathe. It was clearly an ongoing problem. His manager encouraged him to see a worker's comp doctor, and he got one month of paid leave.
Alaska started demanding answers from Twin Hill, who had the uniforms tested and sent a memo to Alaska Airlines saying there were "no foreign chemicals" in the uniforms, meaning that everything that was on there had been put there on purpose. The oxford shirts contained formaldehyde at 24 parts per million (ppm), below the most stringent limit of 75 ppm, in Japan. They also had a Teflon coating, which made the uniforms stainproof. (That's the stuff on nonstick frying pans.)
By fall 2011, when several of Alaska's senior executives had a meeting with the AFA, the story had changed. Judith Anderson recalls them explaining that a few bolts of fabric had been contaminated during transit from Turkey to China with a chemical called TBP, or tributyl phosphate. She immediately recognized the name. Also known as phosphoric acid tributyl ester or tri-n-butyl phosphate, it's an ingredient in almost every hydraulic fluid used in the aerospace industry.
It also had shown up in fume events-something she was all too familiar with.
In work settings, TBP can cause skin problems; if inhaled, it can cause respiratory problems. It's also a potential endocrine disruptor, which means it could interfere with hormones and thyroid functioning. What the heck is TBP doing in clothing? Anderson wondered.
She started doing research and found out that, far from being accidental contamination, TBP is often used as a wetting agent and solvent in textile manufacturing. Greenpeace found it in a sample of polluted water issuing from a textile manufacturer into the Yangtze River delta during its explosive 2010 investigation into toxic runoff from apparel factories.
Alaska Airlines tried to assuage attendants' concerns by painting the TBP found in their uniforms as perfectly normal. It purchased uniforms by other brands and got them tested to show they also had TBP, albeit at much lower levels. And it offered $135 to all the flight attendants for dry cleaning. But experts told Anderson that dry cleaning wouldn't get rid of it. By July, Twin Hill's story had changed again. Now it was telling Alaska Airlines that the fabric had been contaminated in Turkey, and that the brand had severed its relationship with the Turkish fabric mill responsible. But these clothing reactions didn't seem to be isolated incidents-Anderson was getting emails from bank and hotel employees who were also having reactions to their own Twin Hill uniforms.
The thing was, Anderson couldn't find an official limit for TBP on textiles. Only Levi's specifies a limit for tributyl phosphate in garments: 50 ppm. The uniforms contained between 10 and 57 ppm, but Twin Hill didn't have to conform to another brand's voluntary and arbitrary standard. Instead, it hired a consulting company, Environ, which said the levels of TBP in the uniforms did not explain the symptoms that flight attendants were reporting.
So why were so many people getting sick?
Fashion’s Dirty Secret
Judith Anderson was starting to discover the dirty secret of thefashion industry. In the United States, outside of California, there are no legally enforceable standards that limit what kind of chemicals can be put on fabrics and then sold to adult consumers—or forced on employees. There are only voluntary guidelines put together by private companies, industry groups, and a few multinational brands like Nike, Levi’s, and H& M. And how do they determine what chemicals to look for and at what level they’re safe for human health? Hard to say. Rarely are the limits based on robust research. More often they are the result of a few studies, sometimes on rats, sometimes on unfortunate employees at factories who are exposed to the chemical day in and day out. Sometimes, the limits are arbitrary best guesses or just industry "best practice."
That means someone at the fashion brands has guessed that the performance attributes of a chemical are worth any potential sideeffects to the wearer.
One day in May, Mary woke up with a rash spreading across her chest. She covered it with makeup and headed down to have breakfast in the hotel dining room with an older colleague.
"What’s all this?" the senior attendant said, pointing to Mary’s chest. Mary shrugged.
"You need to quit wearing the uniform, and you need to quit wearing it right now," the senior flight attendant said.
Mary protested, but the attendant fixed her with a stare usually reserved for an unruly passenger. "Take it from someone who’s been here for a while and knows the route," Mary remembers him saying. "You’re nobody. You’re just a number. And you need to quit listening to what the company is telling you, get rid of that uniform, and go buy your own clothes." When Mary revealed thats he had been coughing and getting migraines, the older attendant told her to get a notebook so she could start keeping track of hersymptoms.
So Mary did. It took only a few weeks of notes to realize that her cough only showed up when she was at work, in her uniform. She went out and bought her own navy-blue suit pieces and white button-down shirts. At the time, her supervisor was sympathetic and helpful.
That would soon change.
