Musings: Looking for Answers

I recently wrote a post that questioned the current politicized approach to dealing with agricultural pesticides on Kauai, and noted that blood and urine tests can reveal the presence of agricultural chemicals in the body. I asked why none of these tests were being done to offer proof of pesticide exposure from the chem/seed companies. 

I received this comment from Pat Gegen, which I think is worthwhile to share:

Regarding the testing of the 75 chemicals you referenced - tests are available to test for specific or groups of chemicals and the metabolites they produce but they are very costly and not covered by health insurance. A basic test I am aware of that covers approximately 75% of the chemicals identified in the Waimea lawsuit used by Pioneer costs over $750.00. A test to determine the level of glyphosate in a person's system by it self cost me just under $100.00. Those are large amounts to spend on testing for individuals.



The doctor who expressed concerns that some birth defects may be 10 times the national average and need to be studied was Dr. Raelson who works out of KVMH. This was based on babies just delivered by himself and a few other providers on Kauai (study size was approximately 750 births if I recall correctly) - This does not include folks who may live on the westside but delivered somewhere else due to higher risk situations. His letter is in the public realm as it was submitted as testimony during deliberations of 2491.

I recognize that lab tests are expensive — though I'm not sure that none are covered by insurance if a doctor thinks they are needed — but still, why haven't some of the ant-GMO groups funded even a few such tests?  Hawaii SEED has spent tens of thousands of dollars bringing speakers here -- money that could've been used to accumulate some data and give worried families some answers. And what about the plaintiffs in the case against Pioneer?  Hasn't even one family paid out of their own pocket to find out for sure? I am not saying it is the responsibility of westsiders to prove they are being poisoned by pesticides, but still, hasn't even one person checked?

I also found an "open letter" from Dr. Jim Raelson, which I am reprinting here so that people can see for themselves what he really said:

Several people have asked about comments I made regarding birth defects (specifically cardiac defects) at the meeting we had a couple weeks ago with Kauai County Council members. I would like to clarify what I said at that meeting and share my thoughts on the issue. Dr. Chatkupt and I have for some time commented to each other on what we felt were an unusual number of certain birth defects in the population delivering at KVMH. Putting our heads together we seem to have a cluster of complex congenital heart defects. A few comments though about that:

1. There is no good data. I have learned that there has been no active Hawaii Birth Defects surveillance since 2005. In my verbal phone conversation with the director of the program I learned that due to administrative issues and the change of the program from UH to DOH there has been a lapse of the registry. DOH recognizes this deficiency and importance of having the data and has started an effort to resurrect data going back to 2005. A very informative complete report of hawaii birth defects broken down by year, type, county was published for the years 1986-2005:



Hawaii Birth Defects Registry



but there is no reliable data after 2005. 

The only numbers that Dr. Chatkupt or I have is from our involvement the last 7 years with most of the significant cases of birth defects and our recollections. Some of our mothers deliver in Lihue and some in Oahu; we would not know about cases we had no clinical involvement. Also many serious birth defects including cardiac defects result in 1st and 2nd trimester spontaneous Ab's; which often would not be diagnosed.

2. Health Events clusters. Like cancer clusters, birth defects clusters need to have epidemiological evaluation to determine if the observed unusual incidence in a population is statistically significant or could occur by statistical chance alone. Because the population of our westside deliveries is so small I think this would require quite some time (years) to prove statistical significance. Certainly however DOH does have responsibility to collect and look at the data and do the epidemiological studies.

That being said, of particular concern is the incidence of serious cardiac malformations; particularly those that result from early embryogenesis defects that have occured in our population the last three years. We have had 5 major cardiac defects that have required early extensive surgical repair in San Diego the last 3 years: 2 cases of Transposition of the Great Vessels, 1 Hypoplastic left heart, 1 Hypoplastic Right heart with heterotaxy and 1 severe pulmonary stenosis. 

The transposition cases and hypoplasia cases are considered defects that occur in early first trimester. While cardiac birth defects are the most common birth defects these particular types of lesions are rare. 

Recent CDC statistics puts transposition at 1/3300births, hypoplastic Left heart at 1/4344 births and hypoplastic right at 1/17000 births. In the last 3 years we have had about 750 deliveries ; this gives us an incidence of 53/10,000 births for these 4 defects. National US data shows an incidence of 5.5/10,000 births, so we have 10 times the national rate. 

Interestingly, the report published for Hawaii's numbers from 1986 to 2005 showed an overall small downward trend over these years in total birth defects but with an increasing trend in transposition of the great vessels and pulmonary atresia.



The point I tried to make to Council members was that we don't know for sure if we truly have a problem of true clusters because it has not been adequately studied but as clinicians we are seeing suspicious clusters of disease. We also don't know about cause and effect but if we are seeing a true cluster of a disease that has been linked to low level exposure by good studies done elsewhere then that in itself is grounds for real concern that we are seeing serious health problems. One of the things to advocate for is tfor CDC and DOH to do the unbiased epidemiology studies and to do bio-monitoring. As an example CDC recently did a study in central Washington of the birth defect anencephaly because they were seeing a fourfold increase in that defect over national data. 

So as I've written before, has anyone, like Gary or the anti-GMO groups, asked the CDC to do such a study? Instead of pursuing the EPHIS, which as currently designed will be a highly-politicized and expensive process unlikely to deliver reliable, respected data, why not ask a qualified outside agency to come in?

Also, if you take the time to look at the birth defects registry, you will see that factors such as inadequate pre-natal care, very young mothers and drug and alcohol use are the most frequent causes of birth defects in Hawaii. When you consider also that drug overdose — both prescription and illegal — is the most common cause of accidental death in Hawaii, is it possible that the ice and oxycontin epidemic in Hawaii could be playing a role if there is indeed a birth defect cluster?

Yes, it could be pesticide exposure, but it could be due to other factors, or a combination of things. I've often wondered how many people on the westside have heavy metal poisoning due to the lead paint and arsenic in the canec drywall used in the old plantation homes.

I personally got very, very sick from such exposure while renting an old home in Anahola. I paid out of my own pocket for medical tests that verified high levels of lead and mercury, and also for tests that documented elevated lead levels in my house. As a result of those tests, I got the proper treatment and I moved.

I am not trying to minimize any real health concerns that are taking place on the westside or elsewhere. My point is only that we need more information. I feel it's irresponsible for politicians to be blaming one possible source and stoking people's fears, without any real evidence. Responsible politicians and activists would be seeking answers, not court rulings and media coverage.