The Physician's Role in the Pesticide Problem BERNARD E. CONLEY and JAMES R. WILSON
Downloaded by UNIV OF MICHIGAN ANN ARBOR on May 12, 2018 | https://pubs.acs.org Publication Date: January 1, 1950 | doi: 10.1021/ba-1950-0001.ch015
American Medical Association, Chicago, III.
The host of new synthetic organic pesticides presents a variety of problems to the practicing physician because of the lack of basic fundamental information on these chemicals. The American Medical Association has organized a committee on pesticides to consider the following problems of economic poisons and to coordinate information and make it available to physicians and other interested persons or groups: safe standards of use, development of prophylactic and antidotal measures, voluntary industry controls, standardization of nomenclature, and professional and public education.
T h e introduction of the newer economic poisons has created potential health hazards which, although not entirely new, are of such magnitude that the practicing physician must give serious consideration to them i n order to safeguard the public welfare. T h e seriousness and extent of these problems are reflected i n the increasing amount of attention which is being devoted to them over the radio and i n the press. Unfortunately some of this publicity has been ill-advised and not always i n accordance with the facts. Consequently, i n this atmosphere of misinformation and misunderstanding, considerable confusion on the part of physicians, as well as the general public, regarding the safety of these materials has resulted. This confusion, if allowed to go unattended, may jeopardize the benefits to the health and economic welfare of the country which a more enlightened attitude would ensure. Since chemists have played such a prominent part i n the development of pesticides, the public health problems associated with this situation and the approach undertaken by the medical profession to assist i n their resolution may be of interest.
Practitioner's Problems The bewildering host of new synthetic organic chemicals presents a variety of complex problems to the medical practitioner, many of which are entirely new to h i m . The basis for these problems lies i n the lack of essential information about the many ways i n which pesticides seem to influence physiologic function and the apparent indifference and carelessness with which many of these new and untried compounds are handled and used. Frequently the physician is called upon to render professional advice or service on health problems involving these toxicants, only to find that there is little or no information upon which to base a rational conclusion. I n other instances, he must piece together facts from a variety of widely scattered sources. Too often this information is of a limited nature and not applicable to the situation at hand or is so controversial and inconclusive i n character as to render a reliable judgment impossible. A s a consequence, the physician must resort to symptomatic measures which are often unsatisfactory because of the difficulty of relating symptoms to causative agent. A t the same time, he is 61
AGRICULTURAL CONTROL CHEMICALS Advances in Chemistry; American Chemical Society: Washington, DC, 1950.
62
ADVANCES IN CHEMISTRY SERIES
faced with the problem of warning the public without alarming it about the dangers inherent i n these materials. These and related problems are being encountered by the practicing physician with increasing frequency because of the wider and oftentimes injudicious use of the newer pesticidal toxicants. The need for information has been apparent for some time. H o w ever, the equal need for the coordination and integration of the existent information, so that it may become readily available to all who should have it, has not received adequate attention to date.
Downloaded by UNIV OF MICHIGAN ANN ARBOR on May 12, 2018 | https://pubs.acs.org Publication Date: January 1, 1950 | doi: 10.1021/ba-1950-0001.ch015
Toxicology Problems The wide gaps i n present knowledge of the physiologic and phytologic properties of the new organic toxicants are all too apparent to anyone familiar with these poisons. Physicians need fundamental information on the mechanism of action, rate of destruction or excretion, and the long-term effects of the compounds on tissue structures. M e d i cal practitioners have little information on secondary biological factors such as diet, susceptibility of age groups, individual sensitivity, and the presence of pre-existing organic changes i n relation to their influence on the ultimate toxicity of these chemicals. I n addition, many factors other than the acute or chronic toxic properties of the basic ingredient must also be evaluated. Such factors as the toxicity of the carrier, diluents and other so-called inert ingredients, the existence of additive or potentiating activity of these materials i n combination with the basic ingredient, particle size i n the case of aerosols, and the intrinsic dangers of different types of application demand further study. U n t i l this information is available, the medical profession will take a d i m view of those preparations which have labels implying that the product may be used with relative freedom and safety, but at the same time carry a disclaimer which states, i n part, that the buyer assumes a l l the risks of handling and use whether i n accordance with directions for use or not. That much of this information is actively being sought i n private, industrial, state, and governmental research laboratories is to the credit of those individuals who have recognized the need and are actively seeking solutions to these pressing questions. The medical profession recognizes that the orderly accumulation of information of this nature is both time-consuming and expensive. However, it also recognizes that i n most instances the acquisition of this information should have preceded, rather than followed, the release of the chemical. Undoubtedly many of the toxicologic problems which have been encountered could not have been anticipated. Nevertheless, the absence of such information should have tempered the enthusiasm with which some of these materials were introduced. In common with other aspects of the toxicology problem, physicians are embarrassed by the absence of adequate information to guide them i n the assessment of the hazards of food contamination. Untried agents of complex composition have been rapidly introduced i n a multitude of different formulations for agricultural purposes. Oftentimes these preparations were employed i n excessive amounts far beyond the indications for use set forth by the manufacturer. This resulted i n a series of economic misadventures which caused a wave of hysteria and overrestrictive legislation. Exaggerated claims for usefulness by some salesmen and distributors have compounded the initial harm to a point where the potential usefulness of the newer agricultural chemicals is being seriously threatened. The medical profession views with equal alarm the abuses that have occurred with these materials and the retaliatory measures which threaten overregulation. These abuses have compelled food processors to reject fruit and vegetable crops which have been treated with certain of the newer materials. I t has also prompted health officials to confer with government and technical workers on means of establishing measures for the protection of the public. The economic and health significance of this problem is so acute that immediate control measures are imperative. What the nature of control measures should be can AGRICULTURAL CONTROL CHEMICALS Advances in Chemistry; American Chemical Society: Washington, DC, 1950.
Downloaded by UNIV OF MICHIGAN ANN ARBOR on May 12, 2018 | https://pubs.acs.org Publication Date: January 1, 1950 | doi: 10.1021/ba-1950-0001.ch015
CONLEY AND WILSON—THE PHYSICIAN'S ROLE IN THE PESTICIDE PROBLEM
63
only be determined by the willingness with which all groups enter into the solution of the problem. Voluntary control should and can be the measure of choice provided standards for the development, release, and distribution of pesticides are adopted which offer the same type of protection to the consumer that exists for drugs and other inherently dangerous substances. Uniform standards for the pretesting of new compounds which would thoroughly evaluate their relative safety and effectiveness under all circumstances of ordinary use must be established. Factors such as the effects on nutritive value, appearance, palatability, and storage qualities of food products, acute and chronic toxicity, practical methods for the detection and decontamination of residues, and the medicolegal aspects of quality control, labeling, and tolerances must be investigated. Advertising claims and promotional activities should be confined within the limits that the available information indicates are justifiable and reasonable. This type of control should extend not only to agricultural chemicals but for all types of bulk and packaged preparations which are offered for sale as pesticides. N o better standard than the old, well worn axiom, " i t ' s better to be safe than to be s o r r y / ' could be used by the pesticide industry i n the development and distribution of its products.
Education of the Public Aside from the apalling lack of basic toxicologic information on pesticides, the need for public enlightenment i n these matters is one of the most pressing problems which confronts the practicing physician. The education of the consumer, be he farmer, industrial handler, or domestic user of economic poisons, to their intrinsic toxic properties is of immediate importance. The consumer must be psychologically conditioned to the fact that he is using inherently dangerous compounds. Individually, he must be trained to read labels and follow directions for use to avoid unnecessary risks i n handling or application i n the home or i n his work. H e must be educated in order to discount the claims of overenthusiastic salesmen and certain newspaper scientists' reports of new worlds conquered. H e must also be informed that new compounds are not "miracle workers" or "wonder drugs," but highly selective chemicals which are specific i n their action. Lastly, the consumer must be told where to seek reliable information when questions about use confront h i m . The problems of educating the public i n such matters are many and diverse. I t will require not only the support of medical people but that of all individuals who have a social conscience. The interest and sincere efforts of all scientific workers are needed to simplify and hasten this much needed program of public education.
Committee on Pesticides The practicing physician, because of his unique position i n community life, has the opportunity to create a -better understanding of the uses and limitations of these pesticides. Recognizing the physician's responsibility i n this aspect of the problem, the A m e r i can Medical Association has held two meetings at its headquarter offices to determine i n what way the association and its membership can best make a contribution. A conference on the health hazards of pesticides was called on November 3, 1948, to assess the health hazards created b y the newer economic poisons and to exchange ideas and i n formation relative to the public health problems they have created. About forty individuals attended this meeting representing government agencies, academic centers, trade associations, manufacturers, toxicologic laboratories, and state public health departments. It was exceedingly apparent from this meeting that there is much to be learned about the uses and limitations of pesticides. However, i t was more apparent that an equal need exists for the coordination and integration of the existent information so that i t may become readily available to physicians and others. T o fill this gap and to provide this much needed service, a committee on pesticides was proposed. A n exploratory meeting of this committee was recently held to determine i n what AGRICULTURAL CONTROL CHEMICALS Advances in Chemistry; American Chemical Society: Washington, DC, 1950.
ADVANCES IN CHEMISTRY SERIES
64
Downloaded by UNIV OF MICHIGAN ANN ARBOR on May 12, 2018 | https://pubs.acs.org Publication Date: January 1, 1950 | doi: 10.1021/ba-1950-0001.ch015
manner i t could best serve physicians and the public. worthy for immediate consideration:
The following projects seemed
1.
PROMOTION OF S A F E STANDARD OF U S E .
I t becomes increasingly apparent that
2.
FOSTER DEVELOPMENT
3.
STIMULATE V O L U N T A R Y CONTROL.
4.
ASSIST IN STANDARDIZATION OF N O M E N C L A T U R E .
5.
A C C U M U L A T E AND E V A L U A T E N E W INFORMATION.
6.
U N D E R T A K E A N INTENSIVE EDUCATIONAL PROGRAM.
the criteria of safety b y which the older pesticides were judged do not always hold for the newer preparations which have been introduced. New methods of application, new fields of usefulness, and more frequent use b y untrained individuals have increased the need for establishing standards for the measurement of the immediate and long-term hazards to the user of pesticides. Considerable concern has been expressed i n government and medical circles about the expanded use of the newer pesticides without a full knowledge of their potential dangers. Consequently, i t is imperative that the areas of probable health hazards be outlined and precautions broadcast relative to their use under these circumstances. OF PROPHYLACTIC AND ANTIDOTAL M E A S U R E S .
The
stimulation of laboratory and clinical research on prophylactic and treatment measures for many of the newer economic poisons is much needed at the present time. Considerable laboratory and animal work remains to be done before investigations can be undertaken. The therapeutic trials committee of the Council on Pharmacy and Chemistry of the Α Μ Α has had considerable experience i n the organization of impartial clinical trials on remedial agents, and its knowledge and facilities would be offered freely i n such matters. H o w ever, at the present time, the field of study is so broad that these investigations must be restricted to individual agents which show promise of wide acceptance and use. A S previously indicated, v o l u n t a r y control is
the desired method for regulating problems which have their roots i n industry. I t is de sired that this approach be undertaken and its many possibilities exhausted before resort is made to other measures. Sincere efforts i n this direction will win the cooperation and support of a l l other interested groups. The committee will aid and encourage this a p proach b y bringing health problems to industry's attention and will suggest possible ways for their correction. T h e profusion of trade names,
initials, numbers, and combinations thereof for pesticides contributes to misuse and errors i n the handling of these preparations. T h e coining of common or generic names for pesticides is a recent and commendable innovation i n this field of science. I t presents many problems which require the services of many groups. The many years of experi ence of the Council on Pharmacy and Chemistry i n the development of generic names for drugs is at the disposal of the committee i n its consideration of nomenclature problems. T h e compilation and appraisal
of new information bearing on the health aspects of pesticides w i l l be undertaken b y the committee. I n this phase of its work i t w i l l keep i n close contact with state and government health services i n an effort to establish comprehensive records of poisonings and the circumstances of their occurrence; i t w i l l suggest means to avoid recurrence. The assembled information w i l l be available to a l l who have a use for such data. A program of information
on health benefits derived from the wise use of pesticides and the health hazards associated w i t h their misuse is greatly needed. The educational facilities of the American M e d i c a l Association, consisting of ten professional journals and the lay publication, Today s Health, w i l l be available to the committee. I n addition, the inquiry service which is conducted b y the various departments, councils, and bureaus of the American Medical Association w i l l be coordinated i n order that letters of committee interest will receive their mutual attention. 1
Preliminary work on several of these projects has already been i n progress for over a year. These initial efforts will be expanded and intensified when the committee on pesti cides becomes activated i n the near future. However, pursuance of this program will require the support and cooperation of all segments of science and industry. Advisory bodies from the various interested groups will be called upon for recommendations and suggestions on problems which fall within their field. I n turn, the assistance of this committee will be available, not only to the medical profession, but to all other groups i n any direction i n which the committee may be useful.
AGRICULTURAL CONTROL CHEMICALS Advances in Chemistry; American Chemical Society: Washington, DC, 1950.
