Child Development and Social Responsibility

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Child Development and Social Responsibility
A Small Dose of Toxicology
ENVH 517a Childrens Environmental Health
Department of Environmental and Occupational
Health Sciences, University of Washington April
19, 2004 Steven G.Gilbert, PhD,DABT
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Child Health
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Convergence of Issues

• Vision of Child Health
• Knowledge of toxicology
• Policy Approach within an ethical framework
• Social responsibilities
• No technical solutions
• Restriction of freedoms
• Precautionary approach

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WHO Vision for Child Health

• A World Fit for Children
• Promoting healthy lives
• Providing quality education
• Protecting against abuse, exploitation and
  violence
• Combating HIV/AIDS.

http//www.unicef.org/why/why_worldgoals.html
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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?id0900f3ec8000e044
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American Academy of Pediatrics
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
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University of Washington

• The Child Health Institute (CHI) promotes
  interdisciplinary collaboration
• 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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Vision for Child Health
Children can develop and mature in an
environment that allows them to reach and
maintain their full potential.
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Vision of Environmental Health
Conditions that ensure that all living things
have the best opportunity to reach and maintain
their full genetic potential.
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Susceptibility of Children

• Dose Response Issues
• Higher metabolic rate
• Different nutritional requirements
• Rapidly dividing migrating cells
• Immature organs

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Vision of Child Health
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Life Potential Harm

• All life depends on reproduction and development.
• 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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Three Areas

• Reproduction issues associated with the egg and
  sperm
• Pregnancy the critical environment of early
  development
• Development of the infant.

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Ancient Awareness

• Many ancient cultures had fertility goddess
• 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

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Historical Awareness

• 15th-16th centuries malformations caused by the
  devil, mother and child killed
• 1830s - Etienne Geoffroy Saint-Hilaire
  experimented with chicken eggs
• 1900s began acceptance of malformations related
  to genetics
• 1940s - Josef Warkany environmental factors
  affect rat development

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Historical Events

• 1941 Human malformations linked to rubella
  virus
• 1960s Thalidomide (a sedative and anti-nausea
  drug) found to cause human malformations
• 1950s Methylmercury recognized as
  developmental toxicant
• 1970s Alcohol related to developmental effects
  Fetal Alcohol Syndrome (FAS)

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Human Reproductive Facts

• 50 of pregnancies end in miscarriage or
  spontaneous abortion often before pregnancy is
  recognized
• 15 of couples of reproductive age are infertile

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Reproductive Endpoints

• Fertility
• Menstrual cycle
• Sperm count and viability
• Sexual behavior

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Reproductive Toxicants

• Endocrine disruptors
• DDT, Dioxin
• Heavy metals
• Lead (decreased sperm)
• Organic Solvents
• Toluene, benzene
• Drugs
• Alcohol

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Pregnancy Effects the Women

• Cardiovascular
• 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)

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Developmental Endpoints

• Teratology (physical malformations)
• Birth weight
• Growth
• Neurobehavioral
• Decreased intelligence
• Decreases learning and memory

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Chemicals/Radiation

• Chlorobiphenyls
• Solvents (Toluene)
• Endocrine disruptors
• DDT, PCBs
• TCDD
• X-rays (therapeutic)
• Atomic fallout

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Infections/Medical Conditions

• Rubella virus
• Herpes simplex virus
• Toxoplasmosis
• Syphilis
• Diabetes

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Plants

• Skunk cabbage (Veratrum californicum) sheep
  cattle
• Parasites (frogs)

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Medical Drugs

• Antibiotics (tetracylines)
• Anticancer drugs
• Anticonvulsants (Valproic Acid)
• Lithium
• Retinoids (Vitamin A)
• Thalidomide
• Diethylstilbestrol (DES)
• Anticoagulants (Warfarin)

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Recreational Drugs

• Alcohol (ethanol)
• Tobacco
• Cocaine
• Solvent abuse

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Case Studies

• Thalidomide
• Ethanol (Alcohol)
• Methylmercury
• Lead

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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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Polluting with HG
Discharge into Minamata Bay
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Fetal Effects of MeHg
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Life-Long Effects of MeHg
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Hg - Inorganic Organic
Hg
Inorganic Quick Silver
Hg
CH3
Organic Methyl Mercury
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The Mercury Cycle
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Mercury Toxicology
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Atmospheric Hg
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WA State Advisory
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.
http//www.doh.wa.gov/fish/FishAdvMercury.htm
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WA State Advisory
Washington State Mercury Chemical Action Plan
http//www.ecy.wa.gov/biblio/0203016.html
Legislature saves effort to tackle toxic flame
retardants http//www.ecy.wa.gov/../news/2004news/
../2004news/2004-051.html
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Alcohol
(CH3-CH2-OH)
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Effects of Prenatal Alcohol
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FAS Child
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Ethanol (Alcohol)

• The common preventable cause of adverse fetal
  development
• Fetal Alcohol Syndrome (FAS) first described in
  1970s
• 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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Fetal Alcohol Syndrome (FAS)
Most common preventable cause of adverse CNS
development 4,000-12,000 infants per year in
US Characteristics Growth retardation Facial
malformations Small head Greatly reduce
intelligence
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Fetal Alcohol Effect (FAE)
Milder form of FAS 7,000-36,000 infants per year
in US 1 to 3 infants per 1,000 world
wide?? Characteristics Growth deficiency Learning
dysfunction Nervous systems disabilities
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Policy Approaches

• 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

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Lead History

• 6500 BC. - Lead discovered in Turkey, first mine.
  
• 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
"Lead makes the mind give way."
Greek Dioscerides - 2nd BC
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Lead In Homes
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Lead in Families
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Agency Blood Lead Levels
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Lead Health Effects

• Children more vulnerable than adults
• 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
• Childhood effects
• Decreased intelligence (lower grades)
• Hyperactivity (higher school dropout rate)
• Growth retardation
• Effects at blood lead levels of 10 µq/dl

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Recycling Lead
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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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Risk of What?
Obvious Death, Cancer, Acid burn, Birth defect,
asthma, Subtle Decreases in learning and
memory (lead), Sensitivity of the individual
(child)
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Risk Management
Policy developed to deal with hazards identified
through risk assessment Process of evaluating
alternative regulatory options and selecting
among them
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The Commons
The Tragedy of the Commons By Garrett Hardin,
Science, 1968
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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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Problems Solutions?

• Lead and kids
• Fetal alcohol syndrome
• Nuclear disarmament
• Bioterrorism
• Ocean Fisheries
• Persistent chemicals
• The Commons

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Freedom?
Hegel Freedom is the recognition of necessity
Restriction of Freedom?
The Managed Commons?
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Business Goals

• Grow
• Reduce Costs
• Increase Revenue

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Adam Smith
The Wealth of Nations - 1776
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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Socially responsible white guys?
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Scientific Process
Variability Uncertainty
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Human Epidemiological
Human Studies Does the chemical or agent causes
adverse effect in human populations?
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Pros and Cons - Humans

• Advantages
• Yields information in humans
• Yields associations relevant to real world
  exposures

• Disadvantages
• Can be very expensive (large N, many years)
• Lack control relative to lab
• Many confounding variables

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Human Variability

• Human Subject Variability
• Lifestyle risk of exposure to .
• Occupation risk of exposure to .
• Breathing digestion uptake of chemicals
• Metabolism kidney function elimination
• Age, gender disease susceptibility to toxicity

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Examples of Variability

• Occupational exposure to multiple chemicals
• 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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Uncertainty

• Measurements error in experiments
• Extrapolation from animal studies to human
• Sample sizes for animal and human studies
• Selection of endpoint
• Intra and inter subject variability

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Precautionary Principle
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.
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Safety Efficacy vs Harm

• FDA regulations of Drugs (1938)
• 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)

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A Tool

• 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.

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Central components

• 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.

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Purpose/Objectives

• Improve decision making
• Promote integrated assessments
• Promote transparency
• Promote sharing of information
• Examine alternatives
• Examine uncertainties
• Encourage discussion among stake holders

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Seattle Initiative

• 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.

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Advantages of Initiative

• Broad philosophical statement
• Provides common decision making platform across
  government departments
• Something many groups can unite behind
  Collaborative on Health and the Environment
  (CHE-NW)

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Knowledge - Responsibility

• 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

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Socially Responsible Actions

• Testifying
• Writing review papers
• K-12 class room teaching
• Adding expertise to community groups
• Education
• Mentoring
• Speakers Bureau

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The Potential of Children
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Socially Responsible
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ELSI of Toxicology and Kids
Questions or Comments?
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Additional Information

• The Science and Environmental Health Network
  (SEHN) (www.sehn.org)
• Late lessons from early warnings the
  precautionary principle 1896-2000 European
  Environment Agency (free)
• (http//reports.eea.eu.int/environmental_issu
  e_report_2001_22/en)
• Garrett Hardin - The Tragedy of the Commons
  (Science, 1968)
• Ethics and Environmental Health Mini Monograph
  - Environmental Health Perspectives (November
  2003)

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Authorship Information
Steven G. Gilbert, PhD, DABT Director, INND 8232
14th Ave NE Seattle, WA Ph 206.527.0926 Fx
206.525.5102 E-mail sgilbert_at_innd.org
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Biomedical Ethics

• Respect for Autonomy
• Nonmaleficence
• Beneficence
• Justice

Beauchamp and Childress, 1994