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IHW Training Materials Frequently Asked Questions

The purpose of this document is to:

  • Provide additional background information for presenters who wish to present the In Harm's Way materials to a variety of audiences.
  • Refer presenters to reference material in the In Harm's Way report or in the notes and references of the In Harm's Way 80-slide PowerPoint presentation.

General Introduction

The 80-slide In Harm's Way PowerPoint presentation is based on the peer-reviewed report In Harm's Way: Toxic Threats to Child Development released by Greater Boston Physicians for Social Responsibility in May 2000. The report was endorsed by leading researchers and academics and has been cited and referenced in numerous journal articles and other publications. The presentation was created in 2001 and updated in the Fall of 2002 with new information and references as well as modifications based on feedback from attendees and faculty at CME training sessions held 2001-02 at the New York Academy of Medicine, Stanford University School of Medicine, Boston University School of Medicine, and University of Minnesota Medical School. It is intended that the presentation will be reviewed and updated as necessary, approximately annually.

The notes and references to the slides provide considerable additional information on the issues that may be raised. We will not duplicate the information in the In Harm's Way report, or in the notes and references, in this FAQ. Instead, we will refer to the appropriate sections for more information. We recommend that all presenters familiarize themselves with the report and the notes in order to understand the evidence and rationale used to create the key points of the slides. For more detailed information, please refer to the cited references, most of which can be accessed on-line.

Modification of the slides could result in mischaracterization of the information and the authors do not grant general permission to modify the slides. If you need to shorten the presentation, please contact GBPSR for guidance or explicitly acknowledge modification for which GBPSR is not responsible.

The full presentation requires about 90 minutes. Shorter (about an hour) and modified presentations are available through SF Bay Area PSR and also David Wallinga MD. (Contact information at end of FAQ.)

Consider Your Audience

As audience level of education and understanding varies, we have broken this FAQ into two sections: one for health care providers and scientists, and one for non-health professionals. There is some overlap, but you may want to at least briefly review this whole document. We start off each section with some "Common Concerns and Issues" that have been raised regularly, followed by more specific questions.

Some presenters have chosen to create and include additional slides at the end of the presentation that outline specific actions that can be taken to address prevention of exposures. Because the presentation was originally created to address the medical and scientific communities, the authors decided not to include this in the standard presentation, reasoning that presenting credible evidence on this topic was challenge enough. To augment the science sections, a series of associated "Out of Harm's Way" fact sheets has been created that provide prevention information for health care providers and patients as well as additional resources. (See www.igc.org/psr.)

We recommend that for most academic audiences, when time is limited, you focus on making the scientific case, and refer audience members to the fact sheets for specific activist steps for those so inclined. When time permits, of course it is always useful to discuss potential responses to the information.

Frequently Asked Questions (FAQs)

Health Professional Audience

Common Concerns and Issues

Most of the questions raised by health providers relate to the nature of the scientific evidence supporting facts and conclusions that are presented. Common questions often address, for example, the evidence for apparent increases in disabilities, including autism and ADHD, as well as the evidence for the linkages between chemicals and specific disabilities. In some cases, audience members will tend to read more into what is being presented than is actually there, and leap to unwarranted conclusions or interpretations. The report goes into considerable detail about these issues and should clarify many of the questions you or others may have. Please be assured that the utmost care was used in the creation of this report and slide show. The literature review for the report included nearly 500 articles and publications, with many more reviewed to create the PowerPoint presentation.

 Questions on Evidence

Q: Can environmental toxicants be linked to disabilities such as autism and ADHD?

A: This question requires additional attention to the explanation of traits vs. syndromes. Audiences not infrequently confuse the two because the developmental disorders they have experience with are commonly grouped under clinical syndromes comprising disabilities such as autism, Attention Deficit Hyperactivity Disorder (ADHD) etc. However, researchers conducting tests on the possible effects of environmental toxicants on humans (toxicants such as lead, mercury, PCBs, pesticides), look for effects on specific behavioral and cognitive "traits" that make up clinical syndromes. The traits might include memory problems, executive function impairment, inattentiveness, learning deficits, speech problems, or aggressive behavior. Scientific evidence allows us to link traits to environmental toxicants, but may not directly link these same toxicants to the syndromes. The distinction between traits and syndromes and the conclusions we draw about traits are a critical point of understanding within this presentation.

Orange arrow pointing right See slides #19, #20 and pages 45-46 in the report for more detail.


Q: Can you show that the increase in autism in California is not attributable to increased surveillance, increased reporting, or changing diagnostic criteria?

A: This is a difficult question to answer with certainty. Considerable ongoing attention to autism trends nationwide is obvious from the appearance of frequent articles in the medical literature. The 1999 California Department of Social Services report referenced in slide #6 showing a 210% increase in autism and a 273% increase in autism spectrum disorders over a 10-year period was critiqued by the University of California, Davis M.I.N.D. Institute in 2002 (1). The latter study concluded that this increase cannot be explained by changing diagnostic criteria, past misclassification of autistic children as mentally retarded, or autistic children moving into California from other states. In other words, the researchers concluded that these increases represent real increases in the disease. The Davis study concluded that "some, if not all of the observed increase represents a true increase." A study subsequently reported in JAMA (2) shows that the incidence of autism is higher than previously thought but cannot conclude that it is actually an increase because there is no reliable baseline data, Notes to slides # 5-7, and pg. 11 of the report explain this in greater detail, noting that, while the annual rate of autism reporting in California regularly increases, reporting for cerebral palsy, epilepsy, and mental retardation has remained stable or increased only slightly. This observation suggests that the increases in autism reporting cannot be attributed solely to families moving to California in order to avail themselves of special services. A more recent analysis of autism prevalence within birth cohorts supports the conclusion that the increase is real. (3)

Orange arrow pointing right References:

1. Byrd R. et al. Report to the Legislature on the Principal Findings from The Epidemiology of Autism in California: A Comprehensive Pilot Study, M.I.N.D. Institute, University of California, Davis, Sacramento, CA, Oct. 2002.
http://www.ucdmc.ucdavis.edu/mindinstitute/

2. Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C. Prevalence of autism in a US Metropolitan Area, JAMA 289(1); 49-55, 2003.

3. Blaxill, M, Baskin D, Spitzer W. Commentary: Blaxill, Baskin, and Spitzer on Croen et al. (2002). The changing prevalence of autism in California. J Autism Devel Disorders 33(2):223-226, 2003.


Q: How would you propose improving surveillance of autism, learning disabilities, and ADHD to figure out if the rates really are changing over time?

A: There is no comprehensive, systematic national tracking of developmental disabilities or other chronic disorders. For several years, Physicians for Social Responsibility (PSR) has been advocating for a national health tracking system for environmental exposures and chronic health problems, including developmental disabilities. Recently, the US Centers for Disease Control began to issue grants to states to begin building capacity for state-level tracking, as well as conduct pilot programs on both outcome and exposures.

Orange arrow pointing right References:

PSR at www.psr.org

Trust for America's Health at http://healthyamericans.org/


Q: Can you attribute the apparent rise in autism rates and learning disabilities to environmental exposures?

A: Genetic, environmental, and social factors interact in complex ways to determine how the brain develops and functions. For autism, twin studies show that the concordance rates for identical twins varies from about 50% to 95% with a mean of approximately 75% in various studies. Interestingly, even in affected identical twins, the expression of neurobehavioral symptoms may vary considerably, suggesting that environmental factors influence genetic expression. In all likelihood, the syndrome of autism is actually a heterogeneous mixture of conditions with varying genetic and environmental contributions. Any true increases in the incidence of autism are almost certainly attributable primarily to environmental causes, and this is the subject of considerable research interest.

Genetic, social, and environmental factors also play important roles in the origins of learning disabilities. Some neurodevelopmental toxicants unequivocally cause impairments of specific domains of learning. The extent to which each factor is responsible for population-wide trends is unclear. It is clear that a number of chemical compounds can interfere with normal brain development. Since environmental exposures are preventable, precaution would dictate that we try and minimize or eliminate exposures to known toxicants whenever and wherever possible.

Orange arrow pointing right See slide #18 and pgs. 1, 49-57 in the report for more detail.


 Questions on Specific Chemicals and Substances

Q: Is mercury harmful for adults as well as fetuses and children? I read an article in the newspaper that said mercury can harm adults as well.

A: The data indicate that adults can tolerate far higher levels of exposure than fetuses or infants. However, serious health effects can occur in adults if they are exposed to enough mercury. Symptoms of methylmercury poisoning in the adult may include behavioral changes, memory loss, headaches, sleep disturbances, hair loss, tremors, numbness and tingling of the fingers, toes, and lips, and constriction of visual fields ("tunnel vision"). These symptoms have been reported in adults who eat large predator fish (such as shark or swordfish), or contaminated freshwater fish, almost on a daily basis.

Metallic mercury poisoning is almost exclusively confined to the occupational setting. However, some cases have been reported among people who use mercury for various hobbies, such as gold panning, where mercury is added to the pan to amalgamate to the gold and is subsequently boiled off. Signs and symptoms of metallic mercury poisoning include pneumonitis, excessive salivation, gingivitis, tremors, and nephrotic syndrome. In addition, inorganic mercury can cause Erethism, or "Mad Hatters syndrome", which includes memory loss, excitability, delirium, personality changes, and shyness.

Recent data from several large cohort studies indicate that methylmercury may increase the risk of cardiovascular disease. Adult males with higher levels of mercury in their bodies may have double the risk of myocardial infarction (heart attack) compared to their peers with lower mercury levels. Researchers have concluded that mercury may seriously detract from the beneficial cardiac effects of omega-3 fatty acids from fish.


Q: I ate canned tuna fish all the time/painted the house/worked in a nail salon, etc. during my pregnancy. Did I hurt my baby? Can I do anything about it now? (This is a question a patient might ask.)

A: We are all exposed to many chemicals during our daily lives - through the air we breathe, the water we drink, and the food we eat. Because of these cumulative exposures, and the difficulties associated with linking specific exposures to specific health effects, we can never really answer this question. What we do know, however, is that there are many easy and proactive steps we can take now to protect ourselves and our families. For what you can do personally, see the "Out of Harm's Way" fact sheet "Creating a Healthy Environment for Your Child's Development." For community and political actions that are necessary to institute health-protective policies, see the resources listed in the fact sheet.


Q: What is your position on mercury in vaccinations and the link to autism?

A: Two hypotheses address a potential link between vaccines and autism. One relates to the observation that thimerosal (ethylmercury), an organic mercury compound historically added to vaccines as a preservative, may damage the developing brain of children, causing neurobehavioral symptoms that may resemble autism. This hypothesis arises because organic mercury is a known neurodevelopmental toxicant and some parents and health care providers report that apparently normally developing children have suddenly shown signs of developmental regression following vaccination. The other hypothesis relates to the measles-mumps-rubella vaccine (MMR). According to this hypothesis, children with autism or a predisposition to autism have potentially abnormal immune systems as well as abnormal gastrointestinal permeability, and MMR vaccination triggers an immune response with neurobehavioral components that resemble autism.

The Institute of Medicine at the National Academy of Sciences has reviewed available data and concluded that there is currently no evidence to support either of these hypotheses. However, they also noted that there is a biological basis for these concerns and that additional research will help to clarify the questions.

Because of the known neurodevelopmental impacts of methylmercury and the assumption that the health risks from ethylmercury are similar, in July 1999 the Public Health Service (PHS) agencies, the American Academy of Pediatrics (AAP), and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure and to reduce exposure to mercury from all sources. Accordingly, all recommended childhood vaccines contain either no or only trace amounts of thimerosal. As long as health care providers are using these newer vaccine products, parents should be assured that potential mercury toxicity from childhood vaccinations is no longer a matter of practical concern for children who are due for vaccination according to recommended guidelines.

However, the flu vaccine does still contain thimerasol. People who are concerned could avoid the flu vaccine in pregnancy or in infancy.

Orange arrow pointing right More information can be found at the following websites: For the AAP position on thimerosal in vaccinations, visit http://www.aap.org/advocacy/archives/julvacc.htm

Orange arrow pointing right For further information from CDC and NIH, visit the following websites:
http://www.niaid.nih.gov/factsheets/thimerosalqa.htm
http://www.cdc.gov/nip/vacsafe/concerns/thimerosal/default.htm

Orange arrow pointing right For an editorial on the subject in the Journal of the American Medical Association, visit: http://jama.ama-assn.org/cgi/content/short/282/18/1763


Q: What about mercury in dental amalgams?

A: Although multiple mercury amalgams can be a significant source of inorganic mercury exposure, the potential neurodevelopmental impacts of that form of mercury have not been well studied. At the present time, there is no evidence linking mercury amalgams to abnormal neurological development, but ongoing research may help to resolve uncertainties or fill data gaps. Avoidance of mercury exposure from any source during pregnancy is, however, prudent.


Q: What do I tell my patients to do with their mercury thermometers?

A: Patients should be encouraged to replace their mercury thermometers with non-mercury alternatives. Most importantly, they should not dispose of the thermometers in the garbage, as the mercury will wind up in a landfill or will be incinerated, ultimately contaminating the environment. Instead, people should take mercury thermometers to a household hazardous waste collection facility. Many state or local agencies operate these facilities as permanent or seasonal collections. Typically, the service is free. Many hospitals and schools now hold thermometer exchanges, where individuals receive mercury-free thermometers when they bring in their mercury ones. If you break a mercury thermometer in the house, do NOT vacuum the mercury droplets since this will assure that mercury vapor will be widely dispersed indoors. Collect as much of the spilled mercury as possible by sweeping and sealing in a closed jar.

Orange arrow pointing right For more information about mercury spills and mercury thermometer exchanges, see Health Care Without Harm's website at http://www.noharm.org/.


Q: If the levels of lead, PCBs have decreased over the past couple of decades, why are we still so concerned?

A: Lead exposure remains a significant problem for some individuals because of sources such as lead-containing house paint in older homes and soil contamination from historic industrial activities. A significant number of children still have lead levels of concern, despite interventions such as removing lead from most kinds of gasoline and fuels and eliminating lead from house paint. Moreover, research shows that lead has neurodevelopmental impacts at extremely low levels, once thought to be "safe".

Similarly, although manufacturing of PCBs was banned in the US in 1977, approximately 2/3 of the total amount of PCBs ever produced has not yet been released into the environment because it is still bound up in products. Because PCBs are persistent in the environment, this is a problem that will not be resolved soon. Adverse impacts of PCBs on neurodevelopment are documented at current exposure levels.

In addition, there are newly-recognized neurological toxicants that have been increasing in our environment. The polybrominated diphenyl ethers (PBDEs) are PCB-like chemicals that have been rising dramatically in human fat and breast milk samples in the U.S. and Europe since the 1970's. (Sweden is one example where regulatory action to restrict manufacturing of PBDE's has corresponded with a decline in PBDEs in tested breast milk- see slide 51). In addition, because so few chemicals in widespread use have been tested to see if they have effects on the developing brain, it is possible that there are other harmful toxicants in our environment that are still unrecognized.

Orange arrow pointing right See slides #31,50, 51-52 and report pgs. 15, 77.


 Questions on Specific Slides

Q: In Slide 52 - PBDE Levels in Humans - How can you compare PBDE levels in fat, serum, blood and milk? Wouldn't you have to use the same type of sample in order to make an accurate comparison?

A: Notice on the y-axis that the values are expressed as ng/gm fat. That means that the values are PBDE levels per gram of fat in the tissue--whether it's blood, milk, or adipose tissue. When you express the values as "lipid-corrected" like this, you account for the fact that there may be different amounts of fat in various tissues. So this compares PBDE levels in a gram of fat in milk, or in adipose tissue, or in blood. And a gram of fat in milk will have roughly the same concentration of PDBE as a gram of fat in blood or adipose tissue in the same person.


 Anticipatory Guidance

(These questions refer to recommendations made on the companion "Out of Harm's Way" fact sheets)

Q: What is the advice around fish consumption, when you weigh the risks of PCBs and mercury up against the benefits of fish consumption and the benefits of Omega Fatty acids?

A: Fish is nutritious, often providing cardiovascular or other important health benefits. However, fish also can be contaminated with toxic pollutants such as mercury, PCBs and dioxin that persist in the environment and accumulate in fish flesh or fatty tissue, and potentially in people eating these fish. People consuming fish, and health care providers advising about fish consumption, should carefully consider the health impacts of this contamination. PSR and GBPSR are preparing a detailed primer for the health care provider entitled Reducing Risks from Toxic Pollutants in Fish: Guidelines for Good Nutrition in a Contaminated World.

People should contact their local or state health agency for specific information and guidance on the consumption of locally caught fish.

Orange arrow pointing right See"Out of Harm's Way" fact sheet series.


Q: What do I tell my patients after they have just read something that tells them that there are chemicals in breast milk?

A: Despite concerns about pollutants in breast milk, all available scientific evidence abundantly demonstrates that breastfeeding is by far the best form of nutrition for the baby. To date, no harmful effects have been demonstrated from typical chemical exposures from breastfeeding. Because chemicals can build up in the bodies of breastfed children, however, it is advisable that women reduce their exposure to environmental chemicals. Choosing a diet low in animal fats and eating more fruits, vegetables, beans, grains, and low-fat or nonfat animal products provides high quality nutrition and reduces body burdens of toxic chemicals.

While it is beneficial for women to take steps to reduce their exposures, reducing/ending the production of harmful chemicals is the key to protecting breast milk from the threat of chemical contamination. This message may reassure a woman that the burden does not rest exclusively with her, but is a larger societal issue. Negative feelings associated with breastfeeding could affect a woman's milk supply and her ability to breastfeed successfully.

Orange arrow pointing right For more information, see GBPSR's "Out Of Harm's Way" fact sheet, "Why Breast-feeding is Still Best for Baby."


Q: How do I incorporate these issues into my already limited time with my patients?

A: Most environmental questions can be easily incorporated into a standard history. Please see the "Out of Harm's Way" Health Care Provider fact sheet for more on this topic.


Q: This seems hopeless - What am I supposed to do? What is practical? Does it really make a difference?

A: Although this may seem overwhelming, there are many things each of us can do at the personal, community and policy levels to help make a difference. Examples of personal actions, with further references to organizations that can help you become involved in community and policy changes, can be found in the "Out of Harm's Way" fact sheet "Creating a Healthy Environment for Your Child's Development."




Non-Health Professional Audience

Common Concerns and Issues

The questions from the lay audience (parents, teachers etc.) seem to revolve more around what they can do to prevent/treat these disabilities. They include questions about how to limit/control exposures to toxicants, the evidence on dangers of mercury in vaccines, evidence on value of nutritional therapies to mitigate disabilities. In addition, questions about poorly-studied but widely used substances frequently arise, such as the health effects of fluoride and food additives. Someone also usually asks about radiation issues or some other substance or chemical and why these are not covered in the report.


 Questions on Disabilities

Q: What is the difference between a disability and a disorder?

A: The words are used interchangeably to refer to a physical or mental impairment that limits a major activity.


Q: Aren't other health outcomes also of concern?

A: There are certainly other health outcomes associated with exposure to environmental chemicals that are of concern. Because they are important, they require a separate analysis and review, which we do not attempt to do here. GBPSR and PSR have reference materials on a wide variety of other health outcomes related to chemical exposures, including endocrine disruption, reproductive health and birth defects, cancer, etc.

Orange arrow pointing right See GBPSR and PSR web sites at www.igc.org/psr and www.psr.org.


 Questions on Prevalence of Disabilities

Q: Why are some findings measured as prevalence and some as incidence? What is the difference?

A: Prevalence and incidence are used in epidemiology to measure disease frequency. Prevalence refers to the proportion of the population that has a disease at a point in time. Incidence refers to the rate of occurrence of new disease during a specified period of time. Prevalence measures are useful to health care providers so they can assess the public health impact of a specific disease in a community and project medical care needs. Incidence measures can be used to help determine causes of disease.


 Questions on Specific Chemicals and Substances

Q: What do I do with my mercury thermometers?

A: Replace your mercury thermometer with non-mercury alternatives such as digital. Do not dispose of thermometers in the garbage, as the mercury will wind up in a landfill or will be incinerated, ultimately contaminating the environment. Instead, people should take mercury thermometers to a household hazardous waste collection facility. Many state or local agencies operate these facilities as permanent or seasonal collections. Typically, the service is free. Many hospitals and schools now hold thermometer exchanges, where individuals receive mercury-free thermometers when they bring in their mercury ones. If you break a mercury thermometer in the house, do NOT vacuum the mercury droplets since this will assure that mercury vapor will be widely dispersed indoors. Collect as much of the spilled mercury as possible by sweeping and sealing in a closed jar.

Orange arrow pointing right For more information about mercury spills and mercury thermometer exchanges, see Health Care Without Harm's website at http://www.noharm.org/.


Q: Isn't there mercury in my cavity fillings? Is this bad for my health, and should I have my fillings removed?

A: Although multiple mercury amalgams can be a significant source of inorganic mercury exposure, the potential neurodevelopmental impacts of that form of mercury have not been well studied. At the present time, there is no evidence linking mercury amalgams to abnormal neurological development, but ongoing research may help to resolve uncertainties or fill data gaps. Avoidance of mercury exposure from any source during pregnancy is, however, prudent.


Q: Is mercury harmful for adults as well as fetuses and children? I read an article in the newspaper that said mercury can harm adults as well.

A: The data indicate that adults can tolerate far higher levels of exposure than fetuses or infants. However, serious health effects can occur in adults if they are exposed to enough mercury. Symptoms of methylmercury poisoning in the adult may include behavioral changes, memory loss, headaches, sleep disturbances, hair loss, tremors, numbness and tingling of the fingers, toes, and lips, and constriction of visual fields ("tunnel vision"). These symptoms have been reported in adults who eat large predator fish (such as shark or swordfish), or contaminated freshwater fish, almost on a daily basis.

Metallic mercury poisoning is almost exclusively confined to the occupational setting. However, some cases have been reported among people who use mercury for various hobbies, such as gold panning, where mercury is added to the pan to amalgamate to the gold and is subsequently boiled off. Signs and symptoms of metallic mercury poisoning include pneumonitis, excessive salivation, gingivitis, tremors, and nephrotic syndrome. In addition, inorganic mercury can cause Erethism, or "Mad Hatters syndrome", which includes memory loss, excitability, delirium, personality changes, and shyness.

Recent data from several large cohort studies indicate that mercury may increase the risk of cardiovascular disease. Adult males with higher levels of mercury in their bodies may have double the risk of myocardial infarction (heart attack) compared to their peers with lower mercury levels. Researchers have concluded that mercury may seriously detract from the beneficial cardiac effects of omega-3 fatty acids from fish.


Q: How come you don't cover radioactive materials (or insert your chemical of choice that we didn't cover) in your report?

A: There is a vast body of information on many different chemicals and health outcomes. For In Harm's Way we have chosen to focus on a specific health outcome (neurodevelopmental) and on chemicals and substances for which we have at least some evidence of toxicity. This does not mean we are not concerned about other substances or health problems, but we just can't address all the topics at once.


Q: How bad is fluoride?

A: This is a topic that needs further study. Studies suggest that fluoride may have adverse effects on the developing brain, and because there is such widespread exposure through drinking water, more research into health effects is needed.

Orange arrow pointing right See report pgs. 90-91.


Q: What about food additives?

A: The degree to which food additives contribute to attentional and behavioral disorders is uncertain.

Orange arrow pointing right See report pgs. 92-93.


 Questions on Prevention of Exposures

Q: I ate canned tuna fish all the time/painted the house/worked in a nail salon, etc. during my pregnancy. Did I hurt my baby? Can I do anything about it now?

A: We are all exposed to many chemicals during our daily lives - through the air we breathe, the water we drink, and the food we eat. Because of these cumulative exposures, and the difficulties associated with linking specific exposures to specific health effects, we can never really answer this question. What we do know, however, is that there are many easy and proactive steps we can take now to protect ourselves and our families. For what you can do personally, see the "Out of Harm's Way" fact sheet "Creating a Healthy Environment for Your Child's Development." For community and political actions that are necessary to institute health-protective policies, see the resources listed in the fact sheet.


Q: We understand that there is a problem, but what can we do about it?

A: Solutions require changes at all levels of society, from government and business policies to personal choices about product use. Get involved and start to work for changes and make healthy choices that prevent pollution - in your community, at work, and at home. And make sure you let your elected representatives know that you want public policies that protect public health.


Q: Is the food chain like the food pyramid?

A: The food chain is not the same as the food pyramid. The food chain is a hierarchy of eating where one organism uses another, usually a lower member, as a food source. Chemicals can concentrate up the food chain to animals higher up, including humans. In contrast, the food pyramid was developed by the US Department of Agriculture and is used as a guide for planning a balanced diet. It is based on six food groups and the guide recommends the appropriate number of servings from each group.

Orange arrow pointing right See slide #28 or report page 77.


 Questions on Testing/Diagnosis/Treatment

Q: Can I get my breastmilk tested for toxicants?

A: If you believe that you have been exposed to unusually high levels of chemicals, either from occupational exposures, or from a diet extremely high in contaminated fish, discuss this with your health care provider. Before you consider getting your breast milk tested, however, it is important to consider that to date, no harmful effects have been demonstrated from typical chemical exposures from breast-feeding. (There is no routine testing of breastmilk available in the United States at this time. However, private laboratories may be able to test your milk for a range of chemicals, for a hefty price.)

Orange arrow pointing right See fact sheet "Why Breast-feeding is Still Best for Baby."


Q: How can I get my child tested for mercury levels?

A: Although testing for mercury can be done, preventing exposures to mercury is the most important health measure you can take. As a society we need to be working to reduce emissions of mercury from coal-burning power plants, incinerators and other sources in order to prevent exposures.


Q: I've heard that chelation can remove toxic chemicals from my body. What is it and should I ask to have this done if I think I've been exposed?

A: Chelation is a process in which a specific drug that binds to a specific toxicant is given to a patient in order to facilitate the excretion of that toxicant from the body. Chelation is usually used only in very serious cases of poisoning. For lead, the only case well studied, there is no evidence that chelation for even moderate levels results in an improved outcome. Chelation may mobilize mercury from body compartments that are not causing a problem and allow migration of the metal to the brain where it may be a problem. So it may be not helpful but also dangerous. It's important to know that once a chemical is removed from the body, chelation cannot reverse any damage that may have been done. In addition, chelating agents can't reach all areas in the body where a chemical may be stored. The best advice is to review the Out of Harm's Way fact sheets on how to reduce your exposure to harmful chemicals. If you do think you've been exposed to a chemical, contact your doctor and follow his/her individual advice.

10/15/03


Many thanks to the following people who provided input on this document:

Michelle Gottlieb MEM, Robert Gould MD, Mark Miller MD MPH, Marybeth Palmigiano MPH, Ted Schettler MD MPH, Julie Silas JD, Gina Solomon MD MPH, Maria Valenti, David Wallinga MD MPA


For more information, contact:

Greater Boston Physicians for Social Responsibility (GBPSR)
727 Massachusetts Ave., 2nd floor
Cambridge, MA 02139
617-497-7440
psrmabo@igc.org
www.igc.org/psr/

For information on shorter modified presentations:

San Francisco Bay Area PSR (SF PSR)
2288 Fulton Street, Suite 307
Berkeley CA 94704-1449
510-845-8395
mailto:info@sfbaypsr.org
http://www.sfbaypsr.org/

David Wallinga, MD MPA
Antibiotic Resistance Project Director
Institute for Agriculture and Trade Policy
2105 First Avenue South
Minneapolis, MN 55404
612-870-3418
dwallinga@iatp.org
http://www.iatp.org/