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FDA To Decide Fate of Triclosan, Commonly Used In Antibacterial Soaps 223

Posted by samzenpus
from the washing-their-hands-of-it dept.
kkleiner writes "The FDA is finalizing its review of the antibacterial agent triclosan common to many soaps and other health/household products after four decades of use. Recent studies suggest the chemical may be harmful to animals and could interfere with the human immune system along with increasing the proliferation of antibiotic-resistant bacteria. The agency has been slow to cast a verdict, to much criticism considering its widespread use."
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FDA To Decide Fate of Triclosan, Commonly Used In Antibacterial Soaps

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  • by fuzzyfuzzyfungus (1223518) on Monday May 20, 2013 @12:42PM (#43774927) Journal

    As if millions of hypochondriacs cried out in terror and suddenly went to check WebMD.

    • by 0racle (667029) on Monday May 20, 2013 @12:52PM (#43775001)
      Not looking forward to listening to the sister-in-law and father-in-law if they do anything other than give it a huge thumbs up.

      Not that SIL and FIL are right, but damn they're loud about being wrong. So damn wrong.
      • by noh8rz10 (2716597) on Monday May 20, 2013 @12:54PM (#43775021)
        there is no purpose for antibacterial soap. it is just a gimmick and fud that has bad implications because bacteria build up resistance over time. regular soap kills bacteria just fine. you know how a drop of soap will break up grease? the outside of a bacteria cell is just lipids, so the regular soap has the same effect on them. Good for FDA for limiting the explosion of antibacterial products. next step, eliminate antibiotics in farm food.
        • by h4rr4r (612664)

          While I agree with you, your next step will not happen. They will not give up antibiotics for farm animals. Hell, I would be glad to buy such a product and pay more for them. Producers however will never want to make that trade.

          • by Belial6 (794905)
            If you want meat that is antibiotic free, you can certainly get it. You will just have to go to a much smaller producer. You will probably have to pay a lot more for it too. It is available though.
            • by h4rr4r (612664)

              As far as I can tell this is just not true in my area.
              I drive about 2 hours for the pork, if my parents did not live nearby I would never do that. If I have to drive farther for meat, I might as well just buy factory farmed crap or skip the meat.

              • by poetmatt (793785)

                farmers markets and CSA's exist for a reason, and exist everywhere. it's more common the more rural you are. That's all you have to find. I'd be shocked to find an area of the USA where there isn't a CSA or farmers market within 20-40 miles.

                • by h4rr4r (612664)

                  I live in an urban area, and there is a farmers market ~20 miles away. They sell very little meat, and it goes fast. So if you want to get up at 8am on Saturday you do that. I would rather sleep and eat less meat. I will admit I am lazy.

                  • Exactly. People don't understand that farmer's markets and other sources of fresh produce don't exist everywhere.
                • farmers markets and CSA's exist for a reason, and exist everywhere.

                  Next time you go to a farmers Market, show up 30 minutes early and watch the "farmers" peeling the "Produce de Mexico" stickers off their fruit. Half the stuff they sell isn't even in season locally.

              • by quetwo (1203948)

                Just about every farmer's market that I've been to in the last four or five years in the midwest have had at least ONE vendor who offers anti-bacterial, "organic" meats. Heck, I don't live in a very large metropolitan area and there are at least 6 different farmer markets within a 25 minute drive each weekend. I'm sure most of the normal grocers in this area don't carry any of this type of food, but that's why I don't go out of my way to shop there either...

          • Producers however will never want to make that trade.

            Large producers won't but smaller ones do. The critters I eat come from such farms and it is cheaper than buying from the grocery store. Then again those critters also aren't knee deep in their own shit or eating nose to nose like the ones at factory farms and feed lots.

            • by h4rr4r (612664)

              I have a source for pork like that but no other animals.

              Beef locally is available, but they admit to using growth hormones and antibiotics. So I might as well go with factory farmed meat then.

              I have never seen it cheaper than a grocery store. For example the pork I spoke of is more than $4/lb for the meat. The price appears lower at first, but once the butchering is done there is substantial loss.

              • I don't know about the hormone additives but eating anti-bacterial free meat now will do nothing for you, you might as well eat it if its cheaper than the other stuff. Heeding the lessons of food additives in this generation can only benefit our children's children. Its already too late for us. All you're doing is spending more money for your food, it will be no safer for you.
              • by Bob the Super Hamste (1152367) on Monday May 20, 2013 @01:56PM (#43775551) Homepage
                For beef last year I split 1/4 of a cow with my father and it came out to just over $4 a pound with processing and the farmer is one of my dad's long time friends. For pork my neighbor's brother raises hogs so I will split a quarter of a hog with him and that comes out to just under $3.50 a pound. Strangely the two farmers live about a mile apart and know each other. In both cases I end up paying the farmers directly and the processor for the bulk processing. Chickens I have to butcher and pluck them myself but they are small enough that it isn't a long job and I can pick one up on the way home from work for $5 as it is only about a mile out of my way. I get my deer processed at the same place as the hogs and cattle as they do a really good job and have won tons of state, regional, and national quality and cleanliness awards. They charge by finished weight $1/lb for steaks, chops, and roasts, and $0.25/lb to grind the trimmings into burger with sausages carrying extra fees depending on what you want done to cover the additional costs. Unlike some places the critter you bring in is the one you get back which seems to happen a lot with places that process venison. The other nice thing is since I know the farmers I have seen what the critters are fed, how the live, and how they are treated and know if they have been given hormones or antibiotics. It seems that there is a much stronger flavor from these critters when compared to the store bought ones probably because they aren't so over processed (treated with ammonia and packed in CO2) and fed a diet of something other than empty calories and hormones.
          • If you live in the U.S., this type of meat is named "organic" and already on the shelves.

            Hell, I would be glad to buy such a product and pay more for them.

            You can do that already -- unless you object to the use of antibiotics on animals with an infection. Even organic labelling allows that. It's the non-therapeutic use of antibiotics that is prohibited.

            • by h4rr4r (612664)

              I cannot find organic beef regularly. I can never find organic irradiated ground meat. I like the irradiated as I eat burgers far too rare for good sense. If you are going to suggest cooking them, forget it. I would rather not eat a burger than eat a cooked one.

              I actually do object to that use. Antibiotics should be reserved for humans and pets. Farm animals should be quarantined and if they do not recover, destroyed.

            • by heypete (60671)

              My understanding is that antibiotics are permitted to treat infection, but the meat from that animal cannot be sold as "organic" for as long as they're taking the medication and for a certain period of time afterwards to allow for the medication to be excreted from their bodies.

          • Why not just feed soap to the cows, since it kills bacteria?

        • You are correct that the soaps should be limited. Even though I am dependant on them. I have a long history of skin infections and nothing made it better until my doctor suggested using antibacterial soap. I am now almost free from them now. If they were banned hopefully I could get a prescription for the soap.

          As for the farm animals most use antibiotics because of feeding corn to cows, or the crowded way chickens and pigs are kept. This use could be eliminated but food prices would go up.
        • by interval1066 (668936) on Monday May 20, 2013 @01:52PM (#43775509) Homepage Journal

          regular soap kills bacteria just fine.

          No it doesn't. Soap just serves to make the surface of your skin slippery enough to shed the little buggars. If we all really felt the need to kill germs sans anti-bacterial chemicals we should be washing with bleach, but since that's not really a good idea for your skin our military-industrial complex came up with "anti-bacterials". By the way- researchers were warning us about the rise of superbugs becuase we started down this stupid path 30 years ago. I guess as usual we all refused to listen. Now we have a huge, hideous, monster of a problem looming. Good job, humanity.

          • Strictly speaking soap just traps the natural oils in your skin in which a great many bacteria live which allows your hands to be much cleaner than otherwise. It doesn't make the bacteria directly "slip off" but it makes it so that you can get the nasty oil off of your hands. Also, washing with alcohol would likely be as effective or possibly more so, but the downside is dryness. Bleach, as you said is bad for your skin for multiple reasons.
            • by Lehk228 (705449)
              I keep a bottle of low test (50%) isopropyl next to my sink just for that purpose.

              it also removes "permanent" ink from surfaces and cloth (although cloth tends to smear around rather than come completely out)
    • Only the ignorant hypochondriacs. The better informed ones are more concerned about triclosan affecting their epigenetics and giving them multiple drug resistant hand-ebola bacteria.

      Source: I am an over-informed hypochondriac. I cringe when I have to touch receipts. [nih.gov]
  • Toothpaste (Score:2, Insightful)

    by G-News.ch (793321)
    Personally, I find the thought that we put that stuff in our mouths every day much more worrying than the use in soaps. It's also in fabrics, clothing, plastic tools etc.
    • by guttentag (313541) on Monday May 20, 2013 @12:48PM (#43774969) Journal

      Personally, I find the thought that we put that stuff in our mouths every day much more worrying than the use in soaps.

      Perhaps you just need a brand in a shinier box? I suggest you try the new Crest 4D White toothpaste. It has every bit as much fluoride as 3D White, but comes in a new extra-shiny with sparklies box. Those matte boxes will make your teeth rot.

      • by Synerg1y (2169962)

        lol Crest... how is that crap not banned by the FDA? Your teeth will go longer without it.

  • by alen (225700) on Monday May 20, 2013 @12:43PM (#43774933)

    always works, especially older women

    GERMS. OMG, GERMS. my wife used to buy this crap and i refused to use it because there was literature in the 90's about how it made you sicker in the end by screwing up your immune system

    • Anecdote:

      I started life as a dirty hippy. There are quite a few photos, by the instamatic standards of the late 60s, of me crawling around naked in river beds next to the campgrounds we lived in or sitting in mud puddles splashing about. In one photo, I'm sitting in the dry part of a riverbed chewing on a stick I must have picked up, smiling like an idiot smile while some dirt and drool seep out of the corner of my mouth.

      Anyway, I almost never get sick and the only thing I have an allergy to is acetaminophen. I do shower almost everyday now though.

      • by Maximum Prophet (716608) on Monday May 20, 2013 @01:11PM (#43775179)
        You're tough, you didn't die, you've lived to post about it.

        Every kid that was killed by weird diseases caused by picking things up, isn't posting.
        • by bussdriver (620565) on Monday May 20, 2013 @01:22PM (#43775235)

          Is it not nature that the unhealthy do not pass on their genes? We evolved too, not just the bacteria... except we stopped. Insensitive? no, realistic - stop living in a dreamworld you can't ever completely win against nature. It is one thing to take precautions by not swimming in your shit pool and quite another to wage an expensive a war against nature.

          • They shouldn't wage an expensive a war against nature.

            You shouldn't spend too much just to stay alive.

            I will spend whatever it takes to stay alive and comfortable.

            Substitute anyone for "They", "You", and "I".
          • by DarkTempes (822722) on Monday May 20, 2013 @01:53PM (#43775515)
            Just because it's what has worked so far for "nature" doesn't mean that it's the best way or the way that we have to do things.

            Ideally we'd figure out what bacteria are in dirt that we need to expose some kids to for healthy immune system development and we'd use that knowledge to more directly influence immune system development. "Nature" can't do that but luckily we might just be rational conscious entities with that potential.

            We can afford to keep the "weak" alive as a species and I posit that it's better overall for community emotional, moral, and intellectual health.

            I put nature in quotes because it's an idea that we made up and does not necessarily reflect reality (but it might).
          • by tlambert (566799) on Monday May 20, 2013 @02:43PM (#43775941)

            Is it not nature that the unhealthy do not pass on their genes? We evolved too, not just the bacteria... except we stopped. Insensitive? no, realistic - stop living in a dreamworld you can't ever completely win against nature. It is one thing to take precautions by not swimming in your shit pool and quite another to wage an expensive a war against nature.

            What about insulin for diabetics? What about glasses for myopic or presbiopic people, or publishing anything at all in Braile, along with the manufacture of white sticks? What about Erucic acid for Adrenoleukodystrophy? What about cyanocobalamin/hydroxocobalamin injections for pernicious anemia? What about iron supplements for women?

            There are plenty of us who would be dead now, had we been born in the 1200's; insulin dependent diabetics (type I diabetes) were pretty much dead until the 1920's, and later than that, if they couldn't afford the private manufacturing costs for ongoing treatment - assuming they were even correctly diagnosed in time.

            We've been "preventing" natural selection ever since we first started dabbling in medicine in prehistory, and earlier than that, if you include appointing "minders" to keep the tribes near-sighted oral history from walking off a cliff.

            Would it be great if we could all be genetically perfect? Yeah. But I'm not willing to buy into the idea of some eugenically managed "naturalist" utopian ideal to get there.

          • In which countries do people live longer?

            A) Third world countries with human waste management issues, lack of clean water, etc,....
            or
            B) First world countries where there is proper sanitation?

            You can exclude non-disease-related deaths if you want, even.

        • by ceoyoyo (59147) on Monday May 20, 2013 @01:47PM (#43775455)

          There is evidence, including a large Finnish study, that the more variety of microbes you're exposed to as a child, the healthier your immune system as an adult and the less likely you are to have autoimmune diseases.

          • Probably not a good idea to take that too far though.

            I mean, you can feed your kid raw chicken to expose him to a "variety of microbes" if you want, but I think Im gonna opt out of that.

    • by dkleinsc (563838) on Monday May 20, 2013 @01:28PM (#43775301) Homepage

      Sadly, this is a common marketing strategy, for several reasons:
      - Women are a lot more likely to be homemakers than men, so they're easier to bombard with advertising.
      - Women are slightly more likely than men to make decisions using emotion rather than logic (everyone uses both ways of deciding, but where they conflict men are about 60-40 in favor of logic while women are about 60-40 in favor of emotion).
      - Women do most of the shopping in most households.
      - Women are significantly more socialized than men to give presents to each other to cement social bonds.

      All this adds up to advertisers targeting women for common household products, particularly women who grew up before the rise of Second-wave Feminism. And although this is changing a bit, most ads for cleaning supplies, food, diapers, paper towels, etc feature those products being used by women rather than men.

      • by ceoyoyo (59147)

        "feature those products being used by women rather than men."

        Lots of products aimed at men feature women too. If you want to sell something to women, put a woman on it. If you want to sell something to men, put a woman on it. We just all like to look at women, rather than men.

        • by dkleinsc (563838)

          That's why I focused on who was using the product rather than just who was on the screen. For instance, Axe body spray ads have lots of women in them, but none of those women are actually using it. By contrast, ads for breakfast cereal are much more likely to show a mom serving it than a dad doing the same thing.

  • SOAP (Score:5, Informative)

    by stanlyb (1839382) on Monday May 20, 2013 @12:48PM (#43774975)
    There is only on kind of soap that works, the one that ALL the doctors are using, the plain, simple, normal SOAP. No artificial ingredients, no strawberry scent (who wanna to eat soap!!!) nothing.
    • by fl!ptop (902193)

      plain, simple, normal SOAP

      How simple [frontierfreedom.com] are you talking about?

      • by stanlyb (1839382)
        Actually, the site got it wrong, originally it was not animal sacrifices, but human ones.... Nevertheless, that's the only ingredients you need: fat, water,lye. Is there anything more simple than this formula!
    • Re:SOAP (Score:5, Informative)

      by evilviper (135110) on Monday May 20, 2013 @01:02PM (#43775097) Journal

      There is only on kind of soap that works, the one that ALL the doctors are using, the plain, simple, normal SOAP. No artificial ingredients, no strawberry scent (who wanna to eat soap!!!) nothing.

      While most medical staff do indeed use plain soap, surgeons at least, are required to use antibacterial soap.

      • by G00F (241765)

        There is only on kind of soap that works, the one that ALL the doctors are using, the plain, simple, normal SOAP. No artificial ingredients, no strawberry scent (who wanna to eat soap!!!) nothing.

        While most medical staff do indeed use plain soap, surgeons at least, are required to use antibacterial soap.

        I thought surgeons scrubbed with iodine.

        • by evilviper (135110)

          Iodine is the most common antibacterial agent in surgical soap solution, but no, surgeons aren't pouring the standard liquid form of povidone-iodine on their hands. It wouldn't lather, and would leave a horrendous stain on their skin.

        • No, you're thinking that because of their personalities.

          (Iodine has been deprecated for most things. It's not terribly effective.)

          • by evilviper (135110)

            (Iodine has been deprecated for most things. It's not terribly effective.)

            Iodine is quite effective (though not the best), but it's relatively expensive. Chlorine & Alcohol are much cheaper, so they've replaced Iodine in a number of places.

    • Im fairly certain that adding strawberry scent to soap does not remove its properties as a soap.

      • by evilviper (135110)

        Im fairly certain that adding strawberry scent to soap does not remove its properties as a soap.

        That depends... Are you using it to wash strawberries?

    • by Teun (17872)
      That's the remarkable part in this story, these soaps are outside of the US generally only used in the medical profession.

      What is it Americans are so much more adverse to bacteria than at least as healthy Europeans, Japanese or Australians?

      I know part of it is our European laws are very much for the protection of the consumer, not to advance the income of manufacturers.

      Working in an international industry I've seen how US companies set up a canteen here in Europe and hung up anti-bacteriological soaps an

  • Unless your sick you should not take antibiotics as it raises your resistance to them. Save them for when you need them and they will work much better.

    • Well, yes. Livestock that are given antibiotics, even when not sick, gain weight faster. We don't know why.

      People are getting fatter...
    • by PCM2 (4486)

      Unless your sick you should not take antibiotics as it raises your resistance to them.

      Why would you want to succumb to antibiotics? Or, if you had no resistance to them, why would you swallow them?

      • by PCM2 (4486) on Monday May 20, 2013 @01:18PM (#43775215) Homepage

        Actually, on a more serious note, TFA is not talking about antibiotics. The word used is antibacterial, which refers to things that can kill bacteria while not being harmful to humans. For more clarity, a better term would be antimicrobial soaps, because they can also work on a variety of other microbes. But there is no real relationship between these agents and the kinds of antibiotics that come in pills.

        • by ceoyoyo (59147)

          "But there is no real relationship between these agents and the kinds of antibiotics that come in pills."

          Wrong.

          http://www.ncbi.nlm.nih.gov/pubmed/16922622 [nih.gov]

        • Well, that definition would also apply to your classical 'antibiotic'. It appears from the Wikipedia site that Triclosan is not a generic antimicrobial in that it won't affect viruses, protozoa or Scientologists.

          At in-use concentrations, triclosan acts as a biocide, with multiple cytoplasmic and membrane targets.[16] At lower concentrations, however, triclosan appears bacteriostatic and is seen to target bacteria mainly by inhibiting fatty acid synthesis. Triclosan binds to bacterial enoyl-acyl carrier protein reductase enzyme (ENR), which is encoded by the gene FabI. This binding increases the enzyme's affinity for nicotinamide adenine dinucleotide (NAD+). This results in the formation of a stable ternary complex of ENR-NAD+-triclosan, which is unable to participate in fatty acid synthesis. Fatty acids are necessary for reproducing and building cell membranes. Humans do not have an ENR enzyme, and thus are not affected. Some bacterial species can develop low-level resistance to triclosan at its lower bacteriostatic concentrations because of FabI mutations, which results in a decrease of triclosan's effect on ENR-NAD+ binding, as shown in Escherichia coli and Staphylococcus aureus.[17][18] Another way for these bacteria to gain low-level resistance to triclosan is to overexpress FabI.[19] Some bacteria have innate resistance to triclosan at low, bacteriostatic levels, such as Pseudomonas aeruginosa, which possesses multi-drug efflux pumps that "pump" triclosan out of the cell.[20] Other bacteria, such as some of the Bacillus genus, have alternative FabI genes (FabK) to which triclosan does not bind and hence are less susceptible.

    • by alen (225700)

      antibiotics are given for a short time
      these antiobiotic soaps are used all the time which is what creates the resistant strains
      with normal antibiocs they kill enough bacteria for your body to finish the job

    • by Artraze (600366) on Monday May 20, 2013 @01:59PM (#43775577)

      The awfulness of this post is pretty remarkable. Sidestepping the wrong "your":
      *) This antibiotic isn't for "taking", it's for things that aren't edible like soap and toothpaste
      *) Overuse of antibiotics doesn't "raise your resistance to them", at best it increases the bacteria's resistance to them, but in actually it just increases the chance of creating an antibiotic resistance strain. Almost all of the time, however, any resistant bacteria that may develop are killed by other means (like your immune system) and don't live on.
      *) One should never save antibiotics, but rather take them when prescribed and as prescribed. While your post could be construed as saying that, the reality is that antibiotics generally require a prescription so it's unlikely anyone will have any to save unless they were sick but are feeling better halfway through the prescription. Saving them at that point is the worst possible thing you can do; not taking a full regimen is what is primarily responsible for resistance.

      All that being said, the first point is the most important: this is an external antibiotic. Since it's not applying evolutionary pressure while the bacteria are in your body, there isn't a combined force to make deadly resistant bacteria: ones that survive the antibiotic may not be as effective in the body and thus no one cares. Further, even if that is not the case, the mechanism of action is not the same as other antibiotics so it can still be killed off effectively. For instance, MRSA which is resistant to basically every internal antibiotic can be killed by Triclosan (the chemical in question).

      It's very important to understand that not all antibiotics are the same. Something like a blast furnace will kill bacteria and they will never develop a resistance to it, period. However, it will also kill all of humanity so it's not a fantastic treatment for infection. Ditto with chemicals like ethylene oxide or other physical means like gamma rays. Something like bleach is also very effective at killing bacteria, and can even do so on human skin, but obviously doesn't leave the skin doing so well on longer exposure. There are many many things that kill bacteria. The only ones that are really 'special' and need careful use are the ones that can kill bacteria without killing people. Triclosan kind of falls in the middle and while it deserves some consideration, that 'ZOMG RESISTANCE" response isn't really appropriate either.

  • So if they ban it in soap, will people start washing their hands with Colgate's Total toothpaste? I'm sure there are already people who rub Colgate's "Optic White" in their eyes to whiten their vision.
  • after 4 decades of profit? Not likely.

    • by Tailhook (98486)

      Phosphates are being removed from detergents after who knows how many decades of profit. Will that fact impact your distorted world view? Not likely.

  • by WillAdams (45638) on Monday May 20, 2013 @01:02PM (#43775093) Homepage

    where it is markedly better than anything else, though I wouldn't object to seeing it prescription only.

    All other usages should be discontinued.

    Further, _all_ anti-biotics should be on a rotating schedule, and only used for a period of time brief enough that it's unlikely bacteria will develop resistance, then some other similar anti-biotic rotated in, repeat as necessary, and new anti-biotics are added into the rotation schedule (and only used when prescribed by a doctor, or injected by a veterinarian).

    This could be easily enforced by manipulating the expiration dates of anti-biotics.

    William

    • by omnichad (1198475)

      Further, _all_ anti-biotics should be on a rotating schedule

      All of medicine already does it. Except for a longer time - and when the patent expires, the medicine never goes back into rotation.

    • by Burz (138833)

      If you want a long-term antibiotic type effect in your mouth, eat foods or supplements that are rich in vitamin K2. It is chemically/structurally similar to vitamin K, but the 'small' difference makes it play an almost entirely different role in the body. K2 (especially the MK4 and MK7 variants, used with vitamin A/cod liver oil) has a moderating/managing effect on calcium uptake and tooth/bone health and somehow prevents plaque buildup (to the point where I wonder sometimes if I should bother brushing my t

    • by iroll (717924)

      Actually, toothpaste is one of the first places that it should be banned, since toothpaste with triclosan loads your body more heavily than any other triclosan containing personal care product.

      When you brush your teeth, you scuff your gums up and the triclosan goes directly into your blood, from where it ends up in your fatty tissues and hangs around much longer than you would like it to. The best part is when nursing mothers end up feeding it to their newborns. This is hardly the case with soaps, unless yo

  • by Nethemas the Great (909900) on Monday May 20, 2013 @01:34PM (#43775351)
    It isn't just the immune system that it affects. It has been shown to decrease muscle strength [sciencenews.org]--including the heart. It also readily reacts with the chlorine in household tap water to form chloroform [acs.org], a recognized carcinogen [wikipedia.org].
  • In soap really there isn't any evidence that it has a positive effect. Soap itself is a disinfectant, and triclosan isn't known to improve the effect. There is no reason to have triclosan in soap.

    However triclosan in toothpaste really does prevent gingivitis.

    The question is whether or not there are unintended consequences. I'm skeptical - too many of these studies are not reproducible, such as in the case of bisphenol-a.

    http://munews.missouri.edu/news-releases/2013/0102-previous-studies-on-toxic-effects-of- [missouri.edu]

  • Ok, I admit to being a bit older than most slashdotters, but once upon a time, there was hexachlorophene. Although I think the possibility of hexachlorophene being carcinogenic was the cause of its ban, I seem to recall concerns regarding bacteria becoming resistant to it as also mentioned.
  • According to this: http://cid.oxfordjournals.org/content/45/Supplement_2/S137.long [oxfordjournals.org] -
    "Soaps containing triclosan within the range of concentrations commonly used in the community setting (0.1%–0.45% wt/vol) were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands."

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