 Environmental researcher/writer Sandra Steingraber, Ph.D., signs copies of her books at the Society of Teachers of Family Medicine Annual Conference. Steingraber was a featured speaker at the meeting. |
BY CINDY BORGMEYER
There's no denying the truth of the adage, "Good things come in small packages." One glance at the enrapt face of a woman cuddling her newborn proves that.
Unfortunately, bad things also can come in small packages. Take traces of mercury in the infant's bloodstream, for example. That's a reality family physician Stephanie Brundage, M.D., of Greenville, S.C., deals with daily. Brundage directs the Appalachia II Public Health District, which encompasses Greenville and Pickens counties in South Carolina.
"We issue warnings to people who go fishing in certain lakes that they shouldn't be eating more than X number of largemouth bass because of the mercury content," Brundage said. "If a patient is pregnant and I know she has a husband who goes fishing a lot, I can tell her that certain species of fish contain higher levels of mercury than others and that could pose a risk to the pregnancy."
FP Leigh Beasley, M.D., of Central, S.C., takes a similar tack with her patients. Beasley is associate director of the Appalachia II health district, overseeing the Pickens County Health Department. She, too, warns her pregnant patients about consuming the local "catch of the day" and advises against eating locally harvested deer meat because of toxoplasmosis concerns.
"Dose makes the poison"
Brundage and Beasley embody the environmental awareness Sandra Steingraber, Ph.D., Distinguished Visiting Scholar in Interdisciplinary and International Studies at Ithaca College in Ithaca, N.Y., hopes all physicians espouse.
Steingraber described in glittering detail some of the hazards posed by environmental toxins Sept. 21 during the 36th Society of Teachers of Family Medicine Annual Conference in Atlanta. Her remarks fit hand-in-glove with the conference's theme, "Healthy People, Healthy Communities: Defining Family Medicine's Role."
Sixteenth-century Swiss physician and alchemist Paracelsus laid down the guiding principle of toxicology, Steingraber told family medicine educators at the conference. That principle: "The dose makes the poison."
"Now the evidence shows that it's the timing that makes the poison, as much if not more than the dose," she said. "There are windows (during human development) in which we are exquisitely sensitive to the effects of toxins."
Research suggests that during breast development in young girls, for example, exposure to even tiny amounts of ionizing radiation presents a risk of subsequent breast cancer, said Steingraber. Therefore, some clinicians avoid giving dental X-rays to girls during this developmental period. But problems can begin much earlier, said Steingraber. (See "Preconception, prenatal exposures can have lasting effects.")
Know local health risks
The prospect of keeping up-to-date with all potential environmental threats may seem overwhelming. Best to start in your own backyard, said Brundage.
"Family physicians really have to know what the particular risks are in their own communities," Brundage said. "Their major role is to translate health information for their patients, to help them understand what might affect them."
Right questions, right answers
Beasley said she had little difficulty gauging her patients' environmental risk. Most of them work in the textile mills, industrial plants or fast-food joints that form the lion's share of the local economy. A few well-considered questions about work and diet typically are all that's needed to elucidate potential toxic exposures. "I'm not saying we're all going to become occupational doctors," she said. "I'm just saying we need to know what mills or plants are in the area and know what the hazards are."
Providing reassurance and education can go a long way toward allaying patients' fears, Beasley has found. For example, patients frequently misunderstand the concept of possible versus probable risk, she said. "People are scared to get an epidural, for example, because the consent form lists 'death' as a possible side effect. I break it down by talking about the risks of driving, of being injured or killed in a car accident. Everybody understands about those risks and yet we're all going to go outside, get in our cars and drive home."
Some of this misunderstanding may stem from a paucity of reliable patient information about the risks posed by environmental pollutants. What's needed, Beasley mused, is a way to translate existing technical resources -- such as the material safety data sheets developed by the Occupational Safety & Health Administration on hundreds of hazardous substances -- into patient-friendly materials ready for posting online or handing out to patients.
Any takers?
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
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