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Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.

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Becoming Advocates for Prevention

By Martha Dina Arguello

This essay is in response to: How can we set science-based policies in the face of scientific uncertainty?

One of the biggest challenges in doing advocacy around emerging chemicals of concern or on any toxics issue is the question of scientific uncertainty and causation. From climate change to the debate on the safety of BPA, there is an ongoing tension between the need of regulator and government agencies for certainty and the inevitability of scientific uncertainty.

The case of birth defects in Kettleman City, California, is a perfect example of the limits of science. It also shows us how the voices of alert practitioners can be critical in supporting precautionary actions and policy directions. Kettleman City is a town of 1,500 in California’s San Joaquin Valley. Activists expressed concerns about the number of birth defects among its mostly low-income Latino residents. Residents and many environmental health and justice advocates believe that the cumulative effects of the local toxic waste dump, poor air quality, and the heavy use and exposure to pesticides may be to blame.

When the state presented the data their preliminary finding was that “since 1987, the overall number of birth defects is not higher than expected and so far, nothing indicates a pattern in the birth defects.” In 2008 there were five children born with birth defects and that appears to be one more than what would be a normal population distribution. But questions have arisen among community members about how the data was classified and what years have been studied. The data seems to fly in the face of the reality in this small community. We have no way of telling this community what are the effects of living with multiple stressors and toxic exposures.

I am not trying to suggest that the epidemiology applied to this situation was false. But it was flawed. It addressed a limited time period, and a limited set of outcomes, and led to a collective shrugging of shoulders. Instead, we should be raising our voices as health professionals to point out that the waste dump should not be expanded, and that we should figure out ways to clean it up. As healthcare professionals we understand that avoiding exposures is a key component of prevention. Our public policy choices must be based in prevention. Waiting for certainty will mean that we unnecessarily expose people to dangerous chemicals.

I recall a hearing before the California assembly agricultural committee. I was providing testimony along with an ER physician. He was asked by a member of the committee, “Have you in your practice seen someone who got cancer from a pesticide?” The doctor tried to answer but stumbled -- and again the assemblyman asked, “Have you seen one single patient in your office that got cancer from a pesticide?” The doctor said, “No, I cannot say that I have.” With that, the assemblyman ended testimony. Our pesticides in schools bill died in the agriculture committee.  

We did not get a chance to say that our assemblyman was asking the wrong question. Our current science cannot give us that kind of certainty, particularly with regard to cancer. Instead we need to be asking: What is the weight of evidence? Who is funding the studies? How is the science being used?

Doctors, nurses, and other healthcare professionals could really help communities in shaping what kinds of questions to ask. We need to have an ethic of prevention that extends beyond our clinical practice into our lives as citizens. We need to talk about this – to be advocates for prevention, on the policy level. And we need to do it in the context of the limitations of science. Lack of data does not mean lack of harm.

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