1. Small Dose of Lead and Mercury A Small Dose of Toxicology A Small Dose of Pb or Hg An Introduction To The Health Effects of Lead & Mercury

2. A Small Dose of Toxicology Small Dose of Lead and Mercury Child Health

3. A Small Dose of Toxicology Small Dose of Lead and Mercury “Conditions that ensure that all living things have the best opportunity to reach and maintain their full genetic potential.” Steven G. Gilbert, 1999 Environmental & Human Health

4. A Small Dose of Toxicology Small Dose of Lead and Mercury “The Commons” The Tragedy of the Commons By Garrett Hardin, Science, 1968

5. A Small Dose of Toxicology Small Dose of Lead and Mercury 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

6. A Small Dose of Toxicology Small Dose of Lead and Mercury Problems – Solutions?  Lead and kids  Fetal alcohol syndrome  Nuclear disarmament  Bioterrorism  Ocean Fisheries  Persistent chemicals  The Commons

7. A Small Dose of Toxicology Small Dose of Lead and Mercury Key Words of Toxicology Hazard + Exposure = Risk Individual Susceptibility Dose / Response

8. A Small Dose of Toxicology Small Dose of Lead and Mercury Lead In Homes

9. A Small Dose of Toxicology Small Dose of Lead and Mercury Lead in Families

10. A Small Dose of Toxicology Small Dose of Lead and Mercury  6500 BC. - Lead discovered in Turkey, first mine.  500 BC-300 AD.- Roman lead smelting produces dangerous emissions.  100 BC. - Greek physicians give clinical description of lead poisoning. Ancient Awareness

11. A Small Dose of Toxicology Small Dose of Lead and Mercury "Lead makes the mind give way." Ancient Awareness Greek Dioscerides - 2nd BC

12. A Small Dose of Toxicology Small Dose of Lead and Mercury “If we were to judge of the interest excited by any medical subject by the number of writings to which it has given birth, we could not but regard the poisoning by lead as the most important to be known of all those that have been treated of, up to the present time.” Historical Awareness Orfila, 1817

13. A Small Dose of Toxicology Small Dose of Lead and Mercury Public Health Service - L. Sullivan, 1991 “Lead Poisoning remains the most common and societal devastating environmental disease of young children. ” L. Sullivan, 1991

14. A Small Dose of Toxicology Small Dose of Lead and Mercury Lead Based Paint Products

15. A Small Dose of Toxicology Small Dose of Lead and Mercury Lead Based Paint 1887 - US medical authorities diagnose childhood lead poisoning 1904 - Child lead poisoning linked to lead-based paints 1909 - France, Belgium and Austria ban white-lead interior paint 1914- Pediatric lead-paint poisoning death from eating crib paint is described 1921 - National Lead Company admits lead is a poison 1922 - League of Nations bans white-lead interior paint; US declines to adopt 1943- Report concludes eating lead paint chips causes physical and neurological disorders, behavior, learning and intelligence problems in children 1971- Lead-Based Paint Poisoning Prevention Act passed

16. A Small Dose of Toxicology Small Dose of Lead and Mercury Lead In Gasoline 1854 - Tetraethyl lead discovered by German chemist 1921 - Midgley discovers that tetraethyl lead curbs engine knock 1922 - Public Health Service warns of dangers of lead production, leaded fuel 1923 - Leaded gasoline goes on sale in selected markets 1936 - 90 percent of gasoline sold in US contains Ethyl 1972 - EPA gives notice of proposed phase out of lead in gasoline. 1986 - Primary phase out of leaded gas in US completed 1994 - Study shows that US blood-lead levels declined by 78 percent from 1978 to 1991 2000 - European Union bans leaded gasoline

17. A Small Dose of Toxicology Small Dose of Lead and Mercury InvestigatorDateBlood Findings Dioscerides2nd BC100"Lead makes the mind give way." B. Franklin1763100"Dry gripes" A.J. Tuner189480Childhood plumbism R. Byers194380Long-term sequelae CDC197340Undue lead exposure CDC197530Undue lead exposure CDC198525Undue lead exposure WHO198620Undue lead exposure EPA198615Undue lead exposure Fulton et al.198715IQ Deficits Hansen et al.198715IQ Deficits CDC199010Undue lead exposure History Of Lead Toxicology

18. A Small Dose of Toxicology Small Dose of Lead and Mercury Agency Blood Lead Levels

19. A Small Dose of Toxicology Small Dose of Lead and Mercury Health Effects Encephalopathy Colic Frank Anemia Hemoglobin Synthesis Peripheral Neuropathies Infertility (MEN) Systolic Blood Pressure (MEN) Nerve Conduction Velocity Erythrocyte Protoporphyrin DEVELOPMENTAL TOXICITY IQ, Memory, Learning Growth

20. A Small Dose of Toxicology Small Dose of Lead and Mercury Common Lead Uses  Lead acetate (Pb (C2H3 O2)2· 3H2O) White, crystalline substance Sugar of lead has a sweet taste Paint  Lead tetraethyl (Pb(C2H 5)4) antiknock compound added to gasoline significant contributor to air pollution

21. A Small Dose of Toxicology Small Dose of Lead and Mercury Sources Of Lead Lead Paint Dust, Soil Water Industry Hobbies Traditional Ethnic Remedies

22. A Small Dose of Toxicology Small Dose of Lead and Mercury California, 1998 Lead poisoning in furniture workers and their families Father 46 µg/dL 18-month-old child BLL 26 µg/dL 4-month-old daughter BLL 24 µg/dL two refinishers BLLs of 29 and 54 µg/dL, the four carpenters BLLs of 46, 46, 47, and 56 µg/dL. Take Home Lead Exposure MMWR - April 06, 2001 / 50(13);246-8

23. A Small Dose of Toxicology Small Dose of Lead and Mercury Herculaneum, Missouri Doe Run – Lead smelter 160,000 tons of lead per year One of the largest lead smelters in US Past over 800 tons of lead released into the environment as part of the smelting process. Reduced to 81 tons in 2001 Target is 34 tons in 2002. Lead Contaminated Town NY Times, Jan 19, 2002

24. A Small Dose of Toxicology Small Dose of Lead and Mercury 1990 – lead removed from Gasoline Between 1976 and 1994, the mean blood lead concentration in children dropped from 13.7 mcg/dL to 3.2 mcg/dL One of the major public health triumphs of the 20th century Lead Out of Gasoline

25. A Small Dose of Toxicology Small Dose of Lead and Mercury Lead - Absorption Orally Consumed Lead Absorbed In Place of Calcium CHILDREN – 30-50% OF LEAD ADULTS – 5-10% OF LEAD Increased During Pregnancy

26. A Small Dose of Toxicology Small Dose of Lead and Mercury Lead - Nutrition NUTRITIONAL DEFICIENCIES INCREASE ABSORPTION (high fat diets, iron, calcium) VITAMIN D (from sun) INCREASES

27. A Small Dose of Toxicology Small Dose of Lead and Mercury 25 DAYS -- BLOOD 40 DAYS -- SOFT TISSUE 20 YEARS -- BONE Half-life Of Lead

28. A Small Dose of Toxicology Small Dose of Lead and Mercury Children Vulnerability CHILDREN are more vulnerable exposure than ADULTS Size Consume More Food Inhale More Air Developing Nervous System Increased need for Calcium

29. A Small Dose of Toxicology Small Dose of Lead and Mercury Needleman, NEJM, 1979

30. A Small Dose of Toxicology Small Dose of Lead and Mercury 150 10 20 30 40 50 100 Death Encephalopathy Nephropathy Frank Anemia Colic Hemoglobin Synthesis Vitamin D Metabolism Encephalopathy Frank Anemia Decreased Longevity Hemoglobin Synthesis Nephropathy Peripheral Neuropathies Infertility (MEN) Systolic Blood Pressure (MEN) Hearing Acuity Erythrocyte Protoporphyrin (Women) Hypertension (?) Nerve Conduction Velocity Erythrocyte Protoporphyrin Vitamin D Metabolism(?) DEVELOPMENTAL TOXICITY IQ HEARING GROWTH Transplacental Transfer Blood Lead (ug Pb/dl) - Low birth weight - Miscarriages, Stillbirth - Premature birth CHILDREN ADULTS

31. A Small Dose of Toxicology Small Dose of Lead and Mercury WOMEN lead crosses the placenta low infant birth weight retarded mental development miscarriages premature birth stillbirth MEN decreased sex drive impotence sterility altered sperm-birth defects Reproductive Effects Of Lead

32. A Small Dose of Toxicology Small Dose of Lead and Mercury -- LONG TERM PROBLEMS -- LOW GRADES ABSENTEEISM READING DISABILITY HIGH SCHOOL DROP OUT Childhood Lead Exposure

33. A Small Dose of Toxicology Small Dose of Lead and Mercury Increased risk of not graduating from high school (rr 4.8) Poorer reading scores Increased evidence of depression Higher rate of hard drug use Increased risk for attention deficit disorder Increased risk for antisocial behavior Academic & Social Costs Of Lead Exposure

34. A Small Dose of Toxicology Small Dose of Lead and Mercury 16% of all American children Children with blood leads above 15 UG/DL 7% of economically favored white children 55% of African American children in poverty source: The nature and extent of lead poisoning in children in the US: a report to Congress - ATSDR Children Affected

35. A Small Dose of Toxicology Small Dose of Lead and Mercury Mechanisms Of Lead Toxicity Lead-Calcium Interactions Lead-Protein Interactions Lead-Dopamine Systems Interactions Lead-Opioid Systems Interactions

36. A Small Dose of Toxicology Small Dose of Lead and Mercury EDTA, Bal, Succimer EDTA In Use For 48 Years Little Knowledge Of Benefits Or Hazards Of These Drugs The Treatment Is Removing The Source Of Lead Lead Chelating

37. A Small Dose of Toxicology Small Dose of Lead and Mercury Lead In Ethnic Remedies RemedyUseLead Content Azarcon (Mexico) Digestive problems 76-86% Greta (Mexico) Digestive problems 4-90% Surma (India) Cosmetic to improve eye sight 23-26% Tibet Improve slow development 1-3%

38. A Small Dose of Toxicology Small Dose of Lead and Mercury California Suing Major Retailers Over Lead in Jewelry Allegations California is suing 13 major retailers alleging they broke state law by not warning customers that some of their jewelry contains lead. Private lawsuits containing similar allegations have been filed against a further 11 retailers. Named in the state's suit were Macy's, Target, Wal- Mart, Kmart, J.C. Penney, Mervyn's, Nordstrom, Ross, Sears, Express, Claire's, Toys "R" Us and Burlington Coat Factory, along with some of their affiliates and parent companies, according to The San Jose Mercury News. (June 24, 2004) Lead in Jewelry

39. A Small Dose of Toxicology Small Dose of Lead and Mercury Lead in Jewelry http://www.leadinspector.com/

40. A Small Dose of Toxicology Small Dose of Lead and Mercury Test siblings Find the source Reduce risky behaviors Education about the hazards Education about nutrition Why Screen For Lead Exposure

41. A Small Dose of Toxicology Small Dose of Lead and Mercury Environmental Pollutants and Disease in American Children: Estimates of Morbidity, and Costs for Lead Poisoning, Asthma, Cancer, and Developmental Disabilities, by Landrigan, P. et al. EHP, 110, July 2002, 721-728. Cost of Childhood Lead Assumptions in calculating costs All lead is harmful and from environment Blood lead of children age 5 – 2.7 ug/dl (CDC) 5-year old boys (1,960,200) and girls (1,869,800) 1 ug/dl of lead = 0.25 IQ point reduction Cost – boys $27.8 and girls $15.6 Billion Total Costs $43.4 Billion

42. A Small Dose of Toxicology Small Dose of Lead and Mercury Agency Blood Lead Levels

43. A Small Dose of Toxicology Small Dose of Lead and Mercury Water Quality at Seattle Public Schools http://www.seattleschools.org/area/facilities/WaterQuality/water_qu ality_update_nov5.htm Lead entering schools < 1 ppb Max found 1600 ppb EPA standard for schools 20 ppb Lead in Water – Seattle Schools

44. A Small Dose of Toxicology Small Dose of Lead and Mercury “What are the legal limits regarding lead and drinking water? Lead and copper are regulated by a treatment technique that requires systems to control the corrosiveness of their water. If more than 10% of tap water samples exceed the action level of 15 parts per billion, water systems must take additional steps to reduce corrosivity.” EPA - http://www.epa.gov/safewater/lead/leadfacts.html#concerned Lead in Water - regulation

45. A Small Dose of Toxicology Small Dose of Lead and Mercury Recycling Lead

46. Small Dose of Lead and Mercury A Small Dose of Toxicology Truth and Lead “How long a useful truth may be known and exist, befort it is generally receiv’d and practis’d on” Benjamin Franklin

47. A Small Dose of Toxicology Small Dose of Lead and Mercury Mercury the Metal

48. A Small Dose of Toxicology Small Dose of Lead and Mercury Methyl Mercury (MeHg) Hg CH 3

49. A Small Dose of Toxicology Small Dose of Lead and Mercury Hg - Inorganic & Organic Hg CH 3 Inorganic – Quick Silver Hg Organic – Methyl Mercury

50. A Small Dose of Toxicology Small Dose of Lead and Mercury Hg Facts & Uses Quicksilver 13.6 times the weight of water Evaporates at room temperature Bacteria change to Methylmercury Amalgam Many Industrial uses (thermometers, chemical reactions, gold mining)

51. A Small Dose of Toxicology Small Dose of Lead and Mercury Hg – Like Water

52. A Small Dose of Toxicology Small Dose of Lead and Mercury Hg – Solid Enough to Sit On

53. A Small Dose of Toxicology Small Dose of Lead and Mercury Alchemy Medicine - cure syphilis? Egyptian tomb -1500 BC Ancient Awareness

54. A Small Dose of Toxicology Small Dose of Lead and Mercury Greek God Mercury “For then she bare a son, of many shifts, blandly cunning, a robber, a cattle driver, a bringer of dreams, a watcher by night, a thief at the gates, one who was soon to show forth wonderful deeds among the deathless gods...” Description of the birth of the Greek God Mercury

55. A Small Dose of Toxicology Small Dose of Lead and Mercury Occupational Exposure Gold mining. Hatters in the felt industry. Historical Events

56. A Small Dose of Toxicology Small Dose of Lead and Mercury Historical Awareness

57. A Small Dose of Toxicology Small Dose of Lead and Mercury Polluting with HG Discharge in Minamata Bay

58. A Small Dose of Toxicology Small Dose of Lead and Mercury Fetal Effects of MeHg

59. A Small Dose of Toxicology Small Dose of Lead and Mercury Life-Long Effects of MeHg

60. A Small Dose of Toxicology Small Dose of Lead and Mercury Planting Seed with Mercury

61. A Small Dose of Toxicology Small Dose of Lead and Mercury Iraq Mothers with Bread

62. A Small Dose of Toxicology Small Dose of Lead and Mercury Iraq Infant - Effects of Mercury

63. A Small Dose of Toxicology Small Dose of Lead and Mercury Coal Fired Plants – Hg Emissions

64. A Small Dose of Toxicology Small Dose of Lead and Mercury Outbreaks of MeHg Poisoning PlaceYearCases Minamata1953-601000 Nigata1964-65646 Guatemala1963-6545 Ghana1967144 Pakistan1969100 Iraq1956100 Iraq19601,002 Iraq197140,000 On-going2001???

65. A Small Dose of Toxicology Small Dose of Lead and Mercury Inorganic - elemental mercury vapor Hg 0 Biotransformation Organic - Methylmercury - CH 3 Hg + Bioaccumulatio n Mercury to Methyl Mercury

66. A Small Dose of Toxicology Small Dose of Lead and Mercury Mercury Release 50-75% mercury of released in the environment related to human activities

67. A Small Dose of Toxicology Small Dose of Lead and Mercury Atmospheric Hg

68. A Small Dose of Toxicology Small Dose of Lead and Mercury Ambient Water Sediments Edible Fish Inorganic Mercury Methyl- Mercury In Humans Biomethylation Bioaccumulation Exposure Discharge Biotransformation of Mercury

69. A Small Dose of Toxicology Small Dose of Lead and Mercury Natural Degassing of the earth Combustion of fossil fuel Industrial Discharges and Wastes Incineration & Crematories Dental amalgams Hg 0 Hg 2+ CH 3 Hg + Environmental Sources of Mercury

70. A Small Dose of Toxicology Small Dose of Lead and Mercury The Mercury Cycle

71. A Small Dose of Toxicology Small Dose of Lead and Mercury Blindness - Deafness Cerebral Palsy - Seizures Abnormal reflexes & muscle tone Retarded motor development Visual and Auditory Deficits Delayed motor development Altered DRH performance Neurobehavioral Effects

72. A Small Dose of Toxicology Small Dose of Lead and Mercury Decrease in Brain Size Cell loss Disorganization of cells Cell migration failures Effects On The Brain

73. A Small Dose of Toxicology Small Dose of Lead and Mercury  MONKEY - 25 µg/kg - LOAEL  RAT - 10 µg/kg - LOAEL  RAT - 50 µg/kg - replicated Animal - Risk Assessment

74. A Small Dose of Toxicology Small Dose of Lead and Mercury  2.5 µg/kg - NOAEL (animals)  0.25 µg/kg - Human  0.025 µg/kg - Sensitive populations Animal - Risk Assessment (the rule of dividing by 10)

75. A Small Dose of Toxicology Small Dose of Lead and Mercury 10-20 ppm hair - LOAEL 40-80 ppb blood - LOAEL 0.645 µg/kg 0.06 µg/kg - RfD Human - Risk Assessment

76. A Small Dose of Toxicology Small Dose of Lead and Mercury Mercury Fishing Advisories  In 2000, 41 States have over 2000 fish consumption advisories  An increase form 27 in 1993  Pregnant women, nursing mothers, women who intend to have children, and children under 15

77. A Small Dose of Toxicology Small Dose of Lead and Mercury Reduce environmental release Restrict global production and sale Advise women of child bearing age Research mechanisms of action Assess neurodegenerative effects Recommendations

78. A Small Dose of Toxicology Small Dose of Lead and Mercury MeHg Consumption Limits US EPA – 0.1 ug/kg-day US FDA – 1 ppm (mg/kg) in tuna

79. A Small Dose of Toxicology Small Dose of Lead and Mercury 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

80. A Small Dose of Toxicology Small Dose of Lead and Mercury WA State Mercury Chemical Action Plan Reduce Hg in fish Reduce Hg release into the environment 4-5 tons of Hg released in WA Educating consumers about Hg in home WA State Hg CAP http://www.ecy.wa.gov/biblio/0303001.html http://www.ecy.wa.gov/programs/eap/pbt/mercuryplan.html

81. A Small Dose of Toxicology Small Dose of Lead and Mercury U.S. EPA Produced “First-Ever Rule to Reduce Mercury Emissions from Power Plants” Last 15 years no drop in Hg emissions from power plants Is Cap and Trade appropriate for a demonstrated neurotoxic compound? Hg CAP and Trade

82. A Small Dose of Toxicology Small Dose of Lead and Mercury Mercury A Global Issue Mercury distribution and exposure is a global problem

83. A Small Dose of Toxicology Small Dose of Lead and Mercury Precautionary Principle "When an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." - Wingspread Statement on the Precautionary Principle, Jan. 1998

84. A Small Dose of Toxicology Small Dose of Lead and Mercury Alice’s Adventures “Everything’s got a moral, if you can only find it” Lewis Carroll in Alice’s Adventures in Wonderland

85. A Small Dose of Toxicology Small Dose of Lead and Mercury 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

86. Small Dose of Lead and Mercury A Small Dose of Toxicology Mercury or Lead Questions or Comments?

87. Small Dose of Lead and Mercury A Small Dose of Toxicology Additional Information - Pb  Web Sites  U.S. EPA http://www.epa.gov/opptintr/lead/index.html  CDC Childhood Lead Poisoning Prevention Program http://www.cdc.gov/nceh/lead/lead.htm  “A Small Dose of Toxicology” – A Small Dose of Lead – http://www.asmalldoseof.org/toxicology/lead.htm

88. Small Dose of Lead and Mercury A Small Dose of Toxicology Additional Information - Hg  Web Sites  World Health Organization - global prospective on mercury health effects. http://www.who.int/water_sanitation_health/ GDWQ/Chemicals/mercuryfull.htm  US EPA - Main site on Mercury. http://www.epa.gov/mercury/  The Mercury Policy Project (MPP). - works to raise awareness about the threat of mercury contamination - http://www.mercurypolicy.org/  www.asmalldoseof.org

89. A Small Dose of Toxicology Small Dose of Lead and Mercury Authorship Information For Additional Information Contact Steven G. Gilbert, PhD, DABT E-mail: smdose@asmalldoseof.org Web: www.asmalldoseof.org This presentation is supplement to “A Small Dose of Toxicology”