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Physicians’ Perspective: Looking to the Future of Health Care in America By Rick Bayer, M.D.

Physicians' Perspective: Looking to the Future of Health Care in America By Rick Bayer, M.D.

Rick Bayer, M.D.Physicians' Perspective In Harm's Way: Toxic Threats to Child Development by Rick Bayer, M.D.

Last year, Greater Boston Physicians for Social Responsibility (GBPSR) issued a very important report: In Harm’s Way: Toxic Threats to Child Development (http://www.preventingharm.org/).

Its summary states, “This report examines the contribution of toxic chemicals to neurodevelopmental, learning, and behavioral disabilities in children....Toxic exposures deserve special scrutiny because they are preventable causes of harm.”

GBPSR reports an epidemic of learning, developmental, and behavioral disabilities for 17% of American children. Attention deficit hyperactivity disorder (ADHD) affects 3 to 6% or more of school children and treatment with Ritalin (methylphenidate) is increasing. Learning disabilities affect 5 to 10% of public school children and the incidence is rising. Whether new or newly recog-nized, this is a staggering epidemic among American children.

GBPSR notes that animal & human studies demonstrate that a variety of chemicals commonly encountered in industry and the home can contribute to developmental, learning, and behavioral disabilities. The chemicals include lead, mercury, manganese, nicotine, dioxin, PCBs (poly-chlorinated biphenyls), pesticides, and solvents. Damage to children includes ADHD, learning disabilities and lower IQ, and birth defects with mental retardation.

Neurotoxics are not merely a “potential” threat to children. In some instances, adverse impacts are seen at current exposure levels. These include exposure to mercury-laden fish from contaminated water like the Willamette River, dioxins concentrated in breast milk, and interior lead paint in older houses.

In the case of lead poisoning, risk factors include young age (1 to 2 years old), poverty (Medicaid), and old housing (esp. pre-1950). Though Oregon Pediatrics Society maintains, “Childhood lead poisoning in Oregon is a non-issue”, the Oregon Health Division reports an average incidence in NE Portland of 1 to 3% (compared to 4% national average). Our own clinic in NE Portland, which is co-sponsored by Physicians for Social Responsibility and Coalition of Black Men, reported an incidence of over 3% in otherwise healthy persons, but the risk for lead poisoning is as high as 8% in some Oregon zip codes. Because of old housing, Multnomah County ranks 48th among 3,000 US counties for risk of elevated lead levels in infants.

One senior public health official told me that prevention of childhood lead poisoning in Oregon is not a priority because it is not as common in Oregon as other parts of the USA, and that losing 5 IQ points may not be very important in the overall scheme. The above excuses account for the fact that Oregon practitioners perform blood lead tests on only 5 to 10% of infants on Medicaid (Oregon Health Plan) compared to national avg. of 20% compliance.

Oregon remains woefully behind because of complacency in our Department of Human Services, and other alleged leaders in children’s health, who don’t understand or prioritize environmental justice issues. Recent data indicate brain damage from lead at levels previously considered “safe” because, in truth, there is no “acceptable range” for human blood lead levels. It is a toxic industrial chemical that doesn’t belong in the body. And, while a loss of 5 IQ points may be marginally important from a public health standpoint for one affected individual with a normal IQ, a shift in 5 IQ points in an affected population of 260 million Americans increases the numbers of functionally disabled by 50% (from 6 to 9.4 million) and decreases the numbers of gifted by 50% (from 6 to 2.4 million). Numbers aside, is there any parent who wants their child to incur preventable toxic brain damage at all?

Protecting our community’s children from preventable and potentially harmful exposures requires a precautionary policy that can only occur with basic changes in the regulatory process. A “precautionary policy” means that when there is evidence for serious, widespread and irreversible harm, as described by In Harm’s Way, or by the Alliance to End Childhood Lead Poisoning (www.aeclp.org) and others, then residual scientific uncertainties should not be used to delay precautionary actions. Science and industry must prove that a product is safe before introducing it rather than using it and waiting to see if damage occurs.

If young children represent the equivalent of the “canary in the coal mine” to provide early warning of environmental disaster, it is time we listened and put the burden of proof for safety on those who make the profits. If we don’t, we can expect only further environ-mental degradation at the expense of our community’s children.

Rick Bayer, MD is a board certified internal medicine physician who lives in Portland, Oregon.

Alternatives Magazine - Issue 17

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