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Do we need

aD these chemicals?

by Dr Jenny Pronczuk de Garbino

Associate Professor of Clinical Toxicology, Universidad de la Republica, Montevideo, Uruguay

T

he headlong expansion of science and tech- nology is constantly pro- viding human society and the environment with more and more new substances.

Different molecules are being created, tested, discarded or commercialised according to their usefulness or economic advantage. But little or no attention is being paid to the conse- quent risks for human or environ- mental health.

It is neither practical nor economically feasible to evaluate the short- and long-term effects of the vast numbers of chemicals which are being invented - and re-invented! The objec- tives of this dynamic creativity are usually beneficial: to protect crops, to increase food stocks, to simplify house- hold chores, to protect our health and hygiene. But . . . are all those new chemicals really indispensable? Does mankind really need to be swamped by so many new chemical compounds?

What used to be "chemical develop- ment" - the production of highly useful pharmaceuticals, anilines, anti- septics and pesticides - turned into a

"chemical revolution", and is now well on the way to becoming "chemical chaos." Too many substances and compounds are entering our homes, our working place, our environment and our bodies without our really knowing their risks and benefits, with- out a true evaluation of their useful- ness and - worse still - without complete studies of their harmlessness for other forms of life.

Examples of the poisonings and chemical disasters that have resulted are legion. It took many years to realise that industrial and domestic use of fluorochlorocarbon propellants in aerosols were contributing to the depletion of the ozone layer, with all its environmental consequencs. Pro- longed use of asbestos fibres have

The angular geometry of a big chemical refinery in Europe.

WORLD HEALTH, January-February 1990

caused malignant mesotheliomas (tumours) in exposed workers. Clinical studies of patients who took high doses of analgesics showed that certain renal insufficiencies were due to those apparently innocuous phar- maceuticals. All too late did medicine link the drug thalidomide with the birth of children with deformed arms and legs. And the indiscriminate use of pesticides is still causing a high toll of morbidity and mortality in some rural areas of developing countries. Long- term "hidden" tragedies such as Mina- mata disease in Japan or explosive chemical disasters such as Bhopal in India are other examples where a large human group falls victim to uncon- trolled chemicals.

Most countries, especially the industrialised ones, have special units located within universities or public health services that deal with toxico- logical matters. Called Poison Control Centres (PCC) or Toxicology Units, their main objective is to provide advice on how to manage a clinical

case of poisoning, or what should (or should not) be done, how to deconta- minate the victim or the area, which antidote should be given, what clinical and analytical controls are required, or whether further studies are needed.

Since they began more than 30 years ago, PCCs recognised the need to respond to more and more toxico- logical problems. The developed coun- tries had the social and financial conditions that permitted the creation of these specialised medical units. We must recognise and honour those first clinicians and information scientists who pioneered them with enthusiasm and dedication. They acknowledged a responsibility with reference to toxico- logical problems and public health, and they found an answer. But in developing countries there has been a certain Jag: they have been hindered by financial, political, social and edu- cational considerations, and over- whelmed by other medical priorities such as malnutrition or infectious diseases. In most of those countries the population has not received any information on toxicological risks, and some specific groups may become innocent victims of this lack of information and instruction.

Toxic exposure

Among the high-risk population are factory and farm workers, pregnant women and children - most of them unaware of the care they should take to avoid toxic exposures and protect their health. Doctors too may not have access to up-to-date toxicological information, or - even worse - they may have no access to health authori-

13

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Do we need all these chemicals?

ties who can recognise the impact of poisons on public health. Fortunately, a number of motivated international bodies are helping those countries to initiate poison control programmes that include prevention and treatment of poisonings.

How can chemical poisonings be prevented? Firstly, any kind of activity in this area should be preceded by an evaluation of the most used chemicals and the impact they may have on populations at risk. Secondly, different methods of information and education should be carefully prepared, adapted and disseminated at professional and non-professional levels: to schools, community groups, labour unions and universities. The mass media have an important role to play in this field.

Longlasting PCBs

I

t will take up to 20 years to dispose of the PCB com- pounds that have accumulated worldwide since they first came into use in 1929. according to Or Alistair Hay, a specialist in chemical pathology at Leeds University, UK .. And a techni- cally foolproof method of destruction has not yet even been found. Or Hay believes that incineration of polychlori- nated biphenyls is the best option. but he has doubts about the efficiency of existing incin- erators. Released largely from factory chimneys and from the open-air burning of plastic wastes. PC Bs are suspected of causing cancer in animals and of affecting their repro-

duction. •

Thirdly, preventive activities should be repeated periodically so as to maintain public awareness of toxico- logical risks. Poison prevention cam- paigns by radio and television have been run for a whole week, once a year, in some countries and have proved very useful. At university level, toxicology courses taken by students of chemistry, agronomy, biology, medi- cine and paramedical careers provide both scientific knowledge and aware- ness of how to promote the prevention of poisonings.

Chemical spraying is a valued weapon against locusts; but has enough atten- tion been paid to potential risks to human or environmental health?

14

In the highly specialised area of treatment, we can safely say that common sense is as essential as the advice of an experienced toxicologist.

Decontamination of the victim (for instance by vomiting, or washing affected skin) and life-saving . pro- cedures such as artificial respiration or external cardiac massage may be per- formed anywhere by a well-informed person. But the guidance of poison centres or consultation with toxicology services is indispensable for appro- priate management of clinical cases (and also for epidemiological reporting purposes). It is important to know whether a gastric lavage can be per- formed, which kind of clinical compli- cations to expect, whether an artificial kidney is needed, or if antidotes are available and how they should be administered. Such management problems require the advice of an experienced clinician.

As we have seen, prevention and treatment of poisonings require information on chemicals, and well- trained personnel in medical and paramedical areas. Not all countries have reached the optimal situation of having a Poison Control Centre (to serve, say, five million inhabitants), good communications, up-to-date information sources and clinical toxico- logy units in their main hospitals. In fact, many countries have an absolute lack of toxicology centres, and have

not even recognised poisonings as specific medical situations. The inter- national activities undertaken by such bodies as the International Programme for Chemical Safety (jointly conceived by UNEP, ILO and WHO), the World Federation of Poison Control Centres and Clinical Toxicology Centres, as well as regional toxicology associations, have encouraged the recognition of common problems and needs, as well as the value of inter-centre coop- eration amongst countries.

Although these realities are sus- pected or known by scientists, health authorities and the layman, not much has been accomplished. The struggle of the sensible, informed citizen against uncontrolled chemical development is an uneven one. Scientific progress is certainly a need in such areas as medicine, food technology, agriculture and energy. But do we really need such an array of household products just to keep our homes clean and fragrant? Do we really need hundreds of variegated cosmetics in order to look good?

The more chemicals we have around us, the higher the risks of falling victim to them. We have to consider all the social, cultural and educational factors related to each episode of poisoning. A molecule by itself, a drug in a flask or a pesticide in a tank may be totally innocent. The risk starts when too many molecules

WHO/FAO

WORLD HEALTH. January-February 1990

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Fishy casualties of the chemicals boom.

Too many substances are entering our homes, workplace and environment before we have truly evaluated their harmlessness.

appear, when too many drugs are being used or when tons of pesticides are applied indiscriminately. Poison·

ings result from a "surplus" of chemicals in our society, coupled with a lack of information, respect and discretion in their use.

As clinical toxicologists, we are often astonished by cases of intoxication provoked by the most unexpected products under anomalous circum·

stances. Immigrants or tourists, for instance, are sometimes poisoned by foreign medications, cosmetics or herbs that are not registered or known locally. Or trouble arises from pes·

ticides which are introduced illegally into a country for application to crops and whose composition is totally un·

known. Not long ago, a clinical case of malaise followed by respiratory distress in a middle-aged factory worker, after he cleaned up a spill, turned out to be a case of exposure to a highly toxic chemical that was being used as tissue

Ten years of IPCS

I

PCS - the International Pro- gramme of Chemical Safety- celebrates its first decade of existence in April this year. The brainchild of three UN sister agencies. ILO. UNEP and WHO, the Programme involves 27 countries and 67 participating institutions in the work of chemical risk evaluation and the safe management of

chemicals. •

softener. We were surprised to discover that the product - dimethyl- sulfate - had been proposed years ago as a warfare agent! Scientists specialised in toxicology should be prepared for such surprises.

In this era of chemical sophisti- cation, new products risk getting out of hand like the broom and pail of the

"sorcerer's apprentice." On the other

hand, learning to identify the problems and find solutions, the community is better aware of the effects of poisons and pollution, and the author·

ities are more ready to admit their responsibility. Everybody knows that chemicals recognise no frontiers and @

should be dealt with by international .~

cooperation. The best antidote of all is

13

... prevention. • 0::

WORLD HEALTH. January-February 1990

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