ELSI Children 2/28/04 Child Development and Social Responsibility A Small Dose of Toxicology ENVH 517a – Children’s Environmental Health Department of

PowerPoint PresentationENVH 517a – Children’s Environmental Health Department of Environmental and Occupational Health Sciences, University of Washington
April 19, 2004
Steven G.Gilbert, PhD,DABT
Social responsibilities
Promoting healthy lives
Providing quality education
Combating HIV/AIDS.
CDC Vision for Child Health
“Environmental Health at CDC strives to promote health and quality of life by preventing or controlling those diseases or deaths that result from interactions between people and their environment.”
http://www.cdc.gov/node.do?id=0900f3ec8000e044
Hong Kong --
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Mission and vision
To attain optimal physical, mental and social health and well-being for all infants, children, adolescents and young adults.
http://www.aap.org/member/memcore.htm
Center for Child Environmental Health Risks Research (CHC) – focus on susceptibility to pesticides
http://depts.washington.edu/chc/index.html
http://depts.washington.edu/chiorg/
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“Children can develop and mature in an environment that allows them to reach and maintain their full potential.”
Vision for Child Health
“Conditions that ensure that all living things have the best opportunity to reach and maintain their full genetic potential.”
Vision of Environmental Health
What effects this process and harms a child's potential?
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Terms
Monster – abnormal or strange animal or plant. From Latin monstrum omen, from monere to warn (abnormal infants reflect the future).
Teratology – The study of malformations. From the Greek word for monster – teras.
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Pregnancy – the critical environment of early development
Development of the infant.
Many ancient documentation of malformations
Malformations rich aspect of mythology
6500 BC – Turkey - figurine of conjoined twins
4000-5000 BC – Australia drawings of twins
2000 BC - Tablet of Nineveh – describes 62 malformations and predicts the future
Ancient Awareness
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15th-16th centuries malformations caused by the devil, mother and child killed
1830’s - Etienne Geoffroy Saint-Hilaire experimented with chicken eggs
1900’s began acceptance of malformations related to genetics
1940’s - Josef Warkany – environmental factors affect rat development
Historical Awareness
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1941 – Human malformations linked to rubella virus
1960’s – Thalidomide (a sedative and anti-nausea drug) found to cause human malformations
1950’s – Methylmercury recognized as developmental toxicant
1970’s – Alcohol related to developmental effects – Fetal Alcohol Syndrome (FAS)
Historical Events
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50% of pregnancies end in miscarriage or spontaneous abortion often before pregnancy is recognized
15% of couples of reproductive age are infertile
Human Reproductive Facts
Increased - cardiac output heart rate, blood pressure, blood volume expands
Oxygen consumption increases by 15-20%
Urine volume increases
Gut absorption changes
Increases in iron and calcium (toxic lead substitutes for calcium)
Liver metabolism decreases for some drugs or chemicals (caffeine)
Pregnancy Effects the Women
Parasites (frogs)
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Thalidomide
Introduced in 1956 as sedative (sleeping pill) and to reduce nausea and vomiting during pregnancy
Withdrawn in 1961
Discovered to be a human teratogen causing absence of limbs or limb malformations in newborns
5000 to 7000 infants effected
Resulted in new drug testing rules
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Limit the amount of canned tuna you eat, based on your bodyweight.
Guidelines are: Women of childbearing age should limit the amount of canned tuna they eat to about one can per week (six ounces.) A woman who weighs less than 135 pounds should eat less than one can of tuna per week. Children under six should eat less than one half a can of tuna (three ounces) per week. Specific weekly limits for children under six range from one ounce for a twenty pound child, to three ounces for a child weighing about sixty pounds.
WA State Advisory
WA State Advisory
http://www.ecy.wa.gov/../news/2004news/../2004news/2004-051.html
Fetal Alcohol Syndrome (FAS) first described in 1970’s
Symptoms included facial deformities, growth retardation, sever nervous system effects and reduced intelligence
4,000-12,000 infants per year in US
Fetal Alcohol Effect (FAE) – milder form but still serious nervous system effects
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4,000-12,000 infants per year in US
Characteristics
1 to 3 infants per 1,000 world wide??
Characteristics
1981 - U.S. Surgeon General first advised that women should not drink alcoholic beverages during pregnancy.
1988 - U.S. requires warning labels on all alcoholic beverages sold in the United States.
1990 - U.S. Dietary Guidelines state that women who are pregnant or planning to become pregnant should not drink alcohol.
1998 - 19 states require the posting of alcohol health warning signs where alcoholic beverages are sold
Policy Approaches
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100 BC. - Greek physicians give clinical description of lead poisoning.
1904 - Child lead poisoning linked to lead-based paints.
1922 - League of Nations bans white-lead interior paint; U.S. declines to adopt
1923 - Leaded gasoline goes on sale in selected markets
1971- U.S. Lead-Based Paint Poisoning Prevention Act passed
1923 - Leaded gasoline goes on sale in selected markets
1986 - Primary phase out of leaded gas in US completed
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Ancient Awareness
Orally consumed lead absorbed in place of calcium
CHILDREN absorb 30-50% of oral lead
ADULTS absorb 5-10% of oral lead
Increased absorption during pregnancy
Growth retardation
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Risk Assessment
Process of estimating association between an exposure to a chemical or physical agent and the incidence of some adverse outcome.
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Subtle
Decreases in learning and memory (lead), Sensitivity of the individual (child)
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Policy developed to deal with hazards identified through risk assessment
Process of evaluating alternative regulatory options and selecting among them
Risk Management
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Technical Solutions
“It is our considered professional judgment that this dilemma has no technical solution.”
The Tragedy of the Commons
By Garrett Hardin, Science, 1968
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Ocean Fisheries
Persistent chemicals
The Commons
Another point that Hardin made was that many problems do not have a technical solution – these can range from Tick-tack-toe to disarmament to managing fish stocks and to many of the issues that our panelist will briefly discuss.
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Restriction of Freedom?
The Managed Commons?
“the invisible hand”
“an individual who intends only his own gain is led by an invisible hand to promote … the public interest”
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Human Epidemiological
Human Studies
Does the chemical or agent causes adverse effect in human populations?
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Disadvantages
Lack control relative to lab
Many confounding variables
Metabolism & kidney function – elimination
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Lung function and susceptibility are altered by smoking or asthma
Disease effects liver function
The overall dose-response behavior is subject to both intra-individual and inter-individual variability.
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Sample sizes for animal and human studies
Selection of endpoint
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“When an activity raises threats of harm to human health or the environment, precautionary measures should be take even if some cause and effect relationships are not fully established scientifically.”
Wingspread Conference, 1998.
FDA regulations of Dietary Supplements (Dietary Supplement Health and Education Act of 1994 (DSHEA))
Ephedra present an unreasonable risk of illness or injury (Dec, 2003)
Safety & Efficacy vs Harm
Precautionary Principle is a tool to assist in an integrated assessment of the human health, environmental issues, scientific facts, uncertainty, and alternatives as well as the ethical, legal and social implications of any decisions.
A Tool
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Taking preventive action in the face of uncertainty
Shifting the burden of proof to the proponents of an activity
Exploring a wide range of alternatives to possibly harmful actions
Increasing public participation in decision making
Wingspread Conference, 1998.
Purpose/Objectives
City Comprehensive Plans
Every citizen of Seattle has an equal right to a healthy and safe environment.
Seattle sees the Precautionary Principle approach as its policy framework to develop laws for a healthier and more just Seattle.
Seattle Initiative
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Provides common decision making platform across government departments
Something many groups can unite behind – Collaborative on Health and the Environment – (CHE-NW)
Advantages of Initiative
Children have a right to a safe, fair and healthy environment
Ethical Responsibility to share and use of knowledge
Duty to promote health and well being of children
Thoughtful public health advocate
Education
Mentoring
Questions or Comments?
Late lessons from early warnings: the precautionary principle 1896-2000 – European Environment Agency (free)
(http://reports.eea.eu.int/environmental_issue_report_2001_22/en)
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Director, INND
Ph: 206.527.0926
Fx: 206.525.5102
E-mail: [email protected]
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Documents

ELSI Children 2/28/04 Child Development and Social Responsibility A Small Dose of Toxicology ENVH 517a – Children’s Environmental Health Department of