A Small Dose of Toxicology Ethics & Prec Prin 05/26/05
A Small Dose of Bioethics
Toxicology, Human Health, andThe Precautionary Principle
Department of Environmental and Occupational Health Sciences
May 26, 2005
Steven G. Gilbert, PhD, DABTwww.asmalldoseof.org LINK
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
A Small Dose of Toxicology
See: www.asmalldoseof.org -- smdose
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
NW Public Health
See: http://healthlinks.washington.edu/nwcphp/nph/
nwph
Public Health and the Precautionary
Principle
By Steven G. Gilbert
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Doubt / Uncertainty
"Doubt is our product since it is the best means of competing with the 'body of fact' that exists in the mind of the general public.“
1969 an executive at Brown & Williamson owned by R. J. Reynolds Tobacco Company
(Doubt Is Their Product by David Michaels in Scientific American, June 15, 2005)
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Current Bioethical Issues
Check the local news paper Stem cells (state, national, international) Genetically Engineered Organisms Knowing your genes In vetro fertilization – choosing your child's
genes and characteristics Global warming Nanotechnology Environmental health Chemicals exposures – human health
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Child Health
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• Vision of Child Health
• Knowledge of Reproductive and Developmental Toxicology
• Policy Approach within an ethical framework• Social responsibilities• No technical solutions• Restriction of freedoms• Precautionary Principle
Convergence of Issues
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
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
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
American Academy of Pediatrics
The APA goes on to state: “To this purpose, the AAP and its members dedicate their efforts and resources.
The vision: 1) to advocate for infants, children, adolescents, and young adults and provide for their care; 2) to collaborate with others to assure child health; and ….
http://www.aap.org/member/memcore.htm
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
“Children can develop and mature in an
environment that allows them to reach and maintain their full
potential.”
Vision for Child Health
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“Conditions that ensure that all living things have the best opportunity to reach and maintain their full genetic potential.”
S. Gilbert (1999)
Environmental & Human Health
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Socially responsible white guys?
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Socially Responsibility
What is social responsibility?
What are our responsibilities to society?
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
"A thing is right when it tends to preserve the integrity, stability, and beauty of the biotic community. It is wrong when it tends otherwise." -
Aldo Leopold, 1949, A Sand County Almanac
The First Bioethicist
---------- 1887 - 1948 ----------
Aldo Leopold
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“An ethic, ecologically, is a limitation on freedom of action in the struggle for
existence”Aldo Leopold
Limits on Freedom
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“The Commons”
The Tragedy of the CommonsBy 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 CommonsBy Garrett Hardin, Science, 1968
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Problems – Solutions?
Lead and kids Fetal alcohol syndrome Nuclear disarmament Bioterrorism Ocean Fisheries Persistent chemicals The Commons
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Lessons Learned
Thalidomide Methylmercury Lead Ethanol (Alcohol) PBDEs
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
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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Fetal Effects of MeHg
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The Mercury Cycle
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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
http://www.doh.wa.gov/fish/FishAdvMercury.htm
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Lead In Homes
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Agency Blood Lead Levels
60
40
3025
2015
10
20
10
20
30
40
50
60
Blo
od
Lea
d (
ug
/dl)
CDC1960
CDC1973
CDC1975
CDC1985
WHO1986
EPA1986
CDC1990
CDC2006?
Agency and Year
Acceptable Childhood Blood Lead Levels
Ethics & Prec Prin 05/26/05 A Small Dose of ToxicologyFAS Child
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
FAS & FAE
Most common preventable cause of adverse CNS development
Fetal Alcohol Syndrome (FAS)4,000-12,000 infants per year in US
Fetal Alcohol Effect (FAE)7,000-36,000 infants per year in US
1 to 3 infants per 1,000 world wide??
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
• 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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Structure of PBDEs
X & Y are number of Bromine atomsCommon Penta, Octa, and Deca
PolyBrominated Diphenyl Ether
O
BrxBry
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PBDEs in House Dust (ppb)
From EWG - Toxic Fire Retardants Contaminate American Homes - http://www.ewg.org/reports/inthedust/summary.php
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
PBDEs in Breast Milk (ppb)
From EWG - Toxic Fire Retardants in Breast Milk from American Mothers - http://www.ewg.org/reports/mothersmilk/es.php
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Developmental Data
2863 above 1 Million pounds
78.2% no data
21.4% some data
12 or 0.4% good data
www.preventingharm.org
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Nearly 12 million children (17%) under age 18 in the US suffer from one or more developmental disabilities
Learning disabilities – 5-10% of kids in public school
ADHD – 3-6% of all school kids, maybe higher
The Consequences
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
The challenge
To develop an individual and societal ethical framework for
decision making that supports the long term maintenance of a globally
sustainable ecology
Genomic and Ecological Bioethics
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The challenge
“the knowledge of how to use knowledge for the social
good”
Knowledgeable Bioethics
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"All scientific work is incomplete - whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have or postpone the action that it appears to demand at a given time. "
Sir Austin Bradford Hill (1965)
Sir Austin Bradford Hill
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
1. Strength of association
2. Consistency of findings
3. Biological gradient
4. Temporal sequence
5. Biologic or theoretical plausibility
6. Coherence with established knowledge
7. Specificity of association
Sir Austin Bradford Hill (1965)
Determining Causation
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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.
Precautionary Principle
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
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)
Safety & Efficacy vs Harm
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• Taking preventive action in the face of uncertainty
• Shifting the burden of proof/responsibility to the proponents of an activity
• Exploring a wide range of alternatives to possibly harmful actions
• Increasing public participation in decision making (environmental justice)
Wingspread Conference, 1998.
Central components
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Improve decision making Promote integrated assessments Promote transparency Promote sharing of information Examine alternatives Examine uncertainties Encourage discussion among
stake holders
Purpose/Objectives
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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 PP working group
Seattle Initiative
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• Seattle Precautionary Principle White Paper (www.asmalldoseof.org)
• Inclusion of PP in Comp Plan Environment Element
(http://www.seattle.gov/dpd/Planning/Seattle's_Comprehensive_Plan/DPD_001178.asp) Link
Result of Effort
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“Protecting Public Health by Adopting the Precautionary Principle as an Approach to Decision Making”
Resolution Submitted to Washington State Public Health Association
WSPHA Resolution
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The citizen toxicologist is a thoughtful advocate for human and environmental health, who strives to share their scientific knowledge with the public, speaking to public interests rather than private or special interests.
Citizen Toxicologist
Socially Responsible Toxicologist
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• Testifying
• Writing review papers
• K-12 class room teaching
• Adding expertise to community groups
• Education
• Mentoring
• Speakers Bureau
Socially Responsible Actions
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• Forum in which to discuss the ethical implications of results from our science as well as the resulting legal and social implications.
• 2005 SOT meeting – workshop on Conflict of Interest
SOT - ELSI Specialty Section
http://www.toxicology.org/memberservices/specsection/specsection.html
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
• 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
Knowledge - Responsibility
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The Potential of Children
A Small Dose of Toxicology Ethics & Prec Prin 05/26/05
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)
Garrett Hardin - The Tragedy of the Commons (Science, 1968)
Ethics and Environmental Health – Mini Monograph - Environmental Health Perspectives (November 2003)
Ethical, legal, and social issues: our children's future. Steven G. Gilbert. Neurotoxicology, in press, 2005
A Small Dose of Toxicology Ethics & Prec Prin 05/26/05
Ethics and the Precautionary Principle
Questions or Comments?
Download Presentation from www.asmalldoseof.org
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Authorship Information
For Additional Information ContactSteven G. Gilbert, PhD, DABT
E-mail: [email protected]: www.asmalldoseof.org
This presentation is supplement to “A Small Dose of Toxicology”
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Socially Responsible
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
Scientific Process
VariabilityUncertainty
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• Statistical
• Model
• Fundamental
Types of Uncertainty
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• Easiest to examine & reduce
• Not knowing the exact value of a variable (inter and intra subject variance)
• Sample size
Statistical Uncertainty
Reducing Variability
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• Not fully understanding the relations between variables (mechanism of action)
• Which variables are most important (high dose vs low dose)
Model or System Uncertainty
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• Not knowing the right questions to ask
• Most sensitive end point
• “we don’t know what we don’t know”
Fundamental Uncertainty
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• Dose Response Issues
• Higher metabolic rate
• Different nutritional requirements
• Rapidly dividing & migrating cells
• Immature organs
Susceptibility of Children
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"Biology combined with diverse humanistic knowledge forging a
science that sets a system of medical and environmental
priorities for acceptable survival.“Global Bioethics (1988)
Bioethics
-------- 1911 - 2001 --------
Van Rensselaer Potter
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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??
CharacteristicsGrowth deficiency
Learning dysfunctionNervous systems disabilities
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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
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
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
Ethics & Prec Prin 05/26/05 A Small Dose of Toxicology
1) Respect - for the needs and rights of this and future generations as well as others who cannot speak for themselves
2) Humility - towards the natural world and our ability to understand it through science
3) Democracy - giving people a voice in matters that affect their lives
4) Responsibility - government’s public trust responsibility to manage the commonwealth for this and future generations.
- Individuals’ including industry, obligation to take responsibility for their actions in the world.
Values of the precautionary principle