WHO KNOWS
Dr. J. Routt Reigart is a professor of Pediatrics and director of General Pediatrics at the Medical University of South Carolina. Kimberly M. Thompson, Sc.D., is assistant professor of Risk Analysis and Decision Science at the Harvard School of Public Health and director of the Kids Risk Project.
Are children more susceptible to environmental pollutants than adults?
Routt Reigart: The answer clearly is yes and no. Under some circumstances children are more resistant to environmental injury, and under others they are more susceptible. However, if I had to generalize I would say children are more susceptible than adults. Virtually all environmental toxicants will have a greater effect on a developing child than on a mature adult. Children also are more affected by elements like lead and mercury.
Kim Thompson: Sometimes, but not always. Adults can be more sensitive in some instances. With acetaminophen, which is a common ingredient in pain medications such as Tylenol, it turns out that kids are less susceptible. Kids can't metabolize acetaminophin as well as adults and it's the metabolite that is harmful. In terms of children being more susceptible, most people are familiar with the dangers of lead exposure in children. It's really important to appreciate that kids are different from adults, and that they face different risks as they develop into adults.
Do current standards adequately protect children?
RR: In many cases, no. The air standards are under the most scrutiny right now people are concerned with indoor and outdoor air pollutants that may contribute to asthma. There is also particular concern about the effects of certain pesticides on children. In these cases, we need to set standards that are specifically protective of children.
KT: The question you have to start with is whether current standards adequately protect humans. I think there is some question about how we set standards: whether we go far enough in some cases and too far in others. For carcinogen risk assessment, standards usually take into account lifetime risk of getting cancer from an exposure, so children should be adequately protected in this case. There is a question, however, about how well these cancer standards were set to begin with, and whether they are appropriate for both children and adults. There might be some non-cancer health risks that would need extra protection for kids, as is the case for lead.
There tends to be a lot of uncertainty about the effects that many environmental exposures have on children's health. There is debate about whether we should act on issues of concern before that uncertainty is resolved.
RR: Clearly, you will never remove all uncertainty in every situation. But erring on the side of protection is preferable to waiting 20 to 30 years for certainty. The classic example is the lead story-it was pretty clear going into the 1900s that lead was injurious to children in many countries, but the United States waited for more perceived certainty about the child health risks. Australia got rid of lead in paint 70 year before the United States. As a result, many millions of children were unnecessarily affected by lead. Whenever there is reasonable cause to suspect injury or potential injury, it's better to protect than to wait for scientific certainty, which may never be established.
KT: There is always uncertainty; we always try to do our best with the information that we have. We should act on issues of uncertainty by evaluating all our choices, getting better information when we can, using risk analysis to make better decisions, and reassessing as we go along. We shouldn't pass up cost-effective ways to reduce risk just because there is uncertainty. However, it's important to realize that action to reduce one type of risk might require a trade-off. If you are looking at risks in isolation, you might not see how reducing one risk might increase others.
How do we balance risks of health outcomes with costs of preventing exposures?
RR: The policy of the American Academy of Pediatrics is that we need health-based standards to protect children, meaning that if we know something is a risk, we need to fix it almost without regard to cost. Our experience is that when industries say it will cost too much to address a risk, the actual cost often is 10 or 20 times lower and the benefits are much higher. One of the classic examples was getting lead out of gasoline. The petroleum and automotive industry said it would cost too much, but we did it, and the benefits far outweigh the cost.
KT: The question boils down to how we set priorities-what are the most important things to invest in for our kids? I think we do a horrible job in this area. Most states have very little idea how much money they spend on kids and what the pay-off is for their investment. We need to evaluate programs better so we can invest in the things that are working.
What can state legislators do to help ensure that children are adequately protected?
RR: The states have a role because many environmental problems are not national in scope and the states know better than anyone else what's going on in their state. What state legislators can do is educate themselves about the risks to children. A few states, have state commissions or boards that look at children in the environment and make recommendations to legislators. These panels of experts give legislators a new perspective on the risks to children. Legislators might not be able to pick up this kind of information if they rely on things they hear or read here and there.
RT: Legislators should pay attention to how kids are doing in the state, not just in the environment but in health overall. Kids don't vote, so they don't have a lot of political power. In some respects, they are certainly an underrepresented community. That makes it more challenging to make sure people are truly representing their interests and not just putting a "kids" spin on an issue to give it more political force.
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