Modern clothing is a technological marvel — it’s brighter than ever, more flame-resistant, more water-repellent.

It’s also often toxic. The properties we’ve come to know and expect stem from fossil fuel-derived chemicals that, according to a growing body of research, are making people sick.

There are the brominated azobenzene disperse dyes, which give polyester clothes their bright colors but can cause skin inflammation. There are the per- and polyfluoroalkyl substances, also known as PFAS or “forever chemicals,” which make clothes waterproof but are linked to thyroid disorders and cancer. There are carcinogens like formaldehyde, used for bleaching or to prevent mold, and hormone disruptors like NPEO, used as a cleaning agent. 

And then there are the hundreds, if not thousands, of chemicals that we know vanishingly little about. Paltry funding and patchy oversight from the Environmental Protection Agency and the Consumer Product Safety Commission, an independent federal agency, mean the U.S. government isn’t checking most of the clothes we buy for toxicity. When problems do arise for people — when they suspect that their clothing is behind their pesky rash, their wheezing cough, their splotchy skin — they are often disbelieved and offered little to no recourse from manufacturers, whether in the form of reimbursed medical bills or monetary damages.

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This all-too-familiar story played out in a big way during the 2010s, when flight attendants at four major airlines began reporting severe reactions to new uniforms made from synthetic fabrics. Headaches, dizziness, loss of memory — even being near other flight attendants who had the clothes on seemed to cause symptoms, in a few cases. For some employees, the reactions were so bad they had to be hospitalized. Others began limiting their time on the plane, and some eventually quit — or were fired for taking too many unexcused absences. 

Usually, it’s hard to pin symptoms precisely on clothing, but the flight attendants had all begun wearing the uniforms at the same time and were consistently keeping them on for long periods in a small, enclosed space. This suggested that it was the uniforms, and not another factor, that was causing their symptoms. Public health researchers at Harvard University later analyzed contemporaneous survey data and found a significant increase in the prevalence of rashes, itchy eyes, sore throats, shortness of breath, and other health complaints after Alaska Airlines introduced its new uniforms. (Three of the airlines, including Alaska, eventually ordered new uniforms, but without admitting the old ones had caused health problems.)

Alden Wicker, a sustainable fashion writer, documents the story in To Dye For, her new book on the fashion industry’s toxic underbelly. Hazardous substances have been used in clothes for centuries, she told Grist, but with the advent of fossil fuel-based chemistry, the dangers have multiplied, growing alongside the number of unpronounceable chemicals available to today’s clothiers. Many of these chemicals act in concert with each other: toxic on their own, but potentially even worse when mixed together on the same piece of fabric. Scientists know alarmingly little about how these chemical combinations affect human health.

“We’re just immersed in this miasma of chemicals that researchers know are toxic, and nobody’s protecting us,” Wicker said. Out of the up to 60,000 chemical substances and polymers currently registered for use in various industries, the U.S. only bans three from textiles, and that’s only for children’s products. 

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Grounded in the firsthand experiences of those flight attendants — some of whom are still fighting for their symptoms to be recognized by their airlines, doctors, and insurance companies — To Dye For reveals how the fashion industry got here and what needs to change to keep people safe.

This Q&A has been edited and condensed for clarity and length.

Q.People tend to think that exposure to toxic substances and chemical pollution in the textile industry primarily happens “over there” in developing countries. But chemicals don’t stay put. How is this a global problem?

A.A lot of the chemicals that people hear about being used in garment factories, not all of them are effectively washed off during the process of creating, dyeing, and finishing fashion. Some can be left behind as residues. More importantly, some are deliberately applied and are meant to stay on for a long period of time — like dyes for things like polyester. Recent research out of Duke has shown that those dyes are ending up in our house dust from the polyester textiles we bring into our homes. And we’re breathing them in or touching them or ingesting them.

Q.There have been toxic ingredients in clothing for a long time, but things seem to have gotten particularly bad over the past century or so. What happened?

A.Fashion has been toxic for hundreds of years. Before the advent of fossil fuel chemicals, it was mostly heavy metals, the sorts of things that would make you sick with undefinable symptoms over a period of years — things like mercury or arsenic, where they build up in the body and it can be hard to identify what’s happening. With fossil fuels, though, we’ve been able to create — and are still creating — thousands and thousands of chemicals.

Now there can be at least 50 individual chemicals on a textile, if not more than that. So if you imagine a textile, you have 50, 100, 1,000 chemicals all layered on it. And then you’re also wearing multiple pieces of clothing, and there’s a lining, and there’s buttons. How are the chemicals mixing on the textile, and how are they working together when they get into the body? These are things we don’t have answers for.

Q.What is the U.S. doing to protect us from these chemicals?

A.Nobody is protecting us.

While the European Union has banned over 30 chemicals specifically for use in textiles, the U.S. has only banned three, and only in children’s products. And the Consumer Product Safety Commission is severely underfunded. As long as it’s from a legitimate company and it’s not a counterfeit, nobody is checking to make sure that these products are free from known hazardous substances. Consumers are just being hung out to dry.

Q.At least there are some industry-led efforts to keep toxics out of clothes, right?

A.I have a lot of respect for ZDHC [Zero Discharge of Hazardous Chemicals], the industry group that has come up with a “manufacturing restricted substance list.” The problem is that it’s voluntary. There’s a bunch of big brands in there, but if you look at them in terms of their market share, they’re not covering much. We can’t rely on brands to take care, to do their research, to require testing, to invest in good partnerships with their manufacturers. We have to make this the baseline for the industry or else this is going to keep happening.

Q.On a systemic level, what needs to change to keep people safe?

A.We are long overdue for an overhaul in this country of the way chemicals are evaluated and regulated. I think the first step is transparency — getting ingredient lists. If people actually saw the long list of deliberately applied dyes and finishes, I think people would be really, really shocked. And then watchdogs and journalists can leverage that information to push for more legislation.

We should also definitely be regulating chemicals by class. There are at least 12,000 different types of PFAS, and we are not going to be able to evaluate every single one for its toxicity. If a chemical is known to be extremely hazardous, we should just ban or regulate or restrict everything in that same class. Same thing for phthalates. Also, we need more funding for research.

Q.On a personal level, how do we protect ourselves from these chemicals?

A.The first thing I would tell people is to always avoid ultra-fast-fashion brands. If you’ve never heard of the brand, if it’s too cheap to be true, if it has a gibberish name, it’s very risky to shop that brand. I would also say look for labels such as Oeko-Tex, Bluesign, or GOTS [Global Organic Textile Standard], which are not perfect, but they indicate that the brand has had things tested. And always wash your clothes before you wear them, with fragrance-free laundry detergent.