FDA votes 12 to 9: no more nvCJD blood
BSE inquiry evidence to remain secret for 30 years
CJD: falling through the crack
Funeral home preserves cells for posthumous testing
Belgium knowingly poisoned Europe with dioxin-laden eggs and pork
Dioxin and the precautionary principle
Canada: recommendation on donor deferral policy by mid-June
!6 year old in Japan, dura mater
Wed, Jun 2, 1999 By Eileen Murphy, Consumer Affairs Correspondent, PA NewsConfidential evidence containing potential criticisms of the handling of the "mad cow disease" outbreak may not be made public for 30 years, BSE crisis investigators admitted today.
The BSE Inquiry, which began in March 1998, has already taken evidence from more than 300 witnesses and has published more than 400 statements. Statements have been taken from former ministers, scientists, health officials and the families of those who contracted and died from the human form of BSE - new variant Creutzfeldt-Jakob Disease (CJD).
However, the inquiry - which is due to issue its final report by the end of March 2000 - is now entering its second phase which it described as "clarification, conflict and potential criticisms". The inquiry team explained today that letters have been sent to an unspecified number of people involved in the BSE crisis setting out potential criticisms they may face in the final report. The recipients have been asked to respond in writing and, although some replies are still pending, the inquiry is expected to call between 40 and 50 to give oral evidence at London-based hearings later this year.
But an inquiry spokesman explained today that it was possible some may give a reasonable explanation or admission of their actions and not be called upon, or wish, to give oral evidence. He said: "Some of these details may be published as part of the report or they may remain in the Public Records Office for another 30 years."
It was also revealed today that some Government documents which had not previously come to light had now been released by the Ministry of Agriculture following a letter outlining potential criticisms the department may face. The inquiry spokesman said that this was probably due to the turnover of staff at such large Government departments and said civil servants may "through their collective memory have forgotten it was there".
The inquiry will begin hearing oral evidence on June 21 and a full witness timetable will be published before the first hearing. Although it may not determine why people contracted a new form of CJD linked to the BSE outbreak, the final report could have implications for the way future food safety scares are handled.
The inquiry spokesman added: "I think there are questions we are going to be unable to answer." The proceedings were announced in December 1997 to investigate the emergence of BSE and new variant CJD up until March 1996 when the Government announced a possible link between the disease in cows and the degenerative brain disorder in humans. So far, according to Government figures, 40 people have died from new variant CJD although scientists admit they cannot predict its long-term extent.
2 June 99 Associated Press By LAURAN NEERGAARDComment (webmaster): This was an expected step. Now 6 months total visitation to the UK is not science-based but rather designed not to impact blood product exports and elective surgery, sort of like excluding pigs from the downer cow ban. Perhaps 1 month would make more sense.
This should have been accompanied by a call for dramatically increased spending on diagnostic and therapeutic research but it was not according to the story. If the US had spent 5% of its recall budget on research over the years, this disease would now be in the same category as smallpox.
Of course if 23% of the blood donors for the last 15 years have been exposed, what is accomplished with a limited ban now? It sounds like a half-measure along the lines of what England did in the early days. What might be the scientific basis for the panel's reassurances to at-risk donors, "their vote did not mean that frequent travelers to Britain are at risk of getting a fatal illness linked to mad cow disease" -- why exclude them if they are not at risk?
What about existing stocks? Give them out for the next few months until they are used up, even if today they would be excluded? This is what was done with AIDS and hepatitis C.
Next they could think about extending the exclusion to hunters from NE Colorado and SE Wyoming, to people who have eaten sheep from the 39 scrapie-endemic states, to known familial CJD kindreds, and reinstate recalls of blood products from known donors. (Familial kindreds are seldom genotyped back to the stem line though this is easily done on the Internet now.)
One wonders what level of cooperation the US is receiving from Britain. That country obviously knows more about its own situation than it has publicly disclosed. But is that information actually shared? FOIA documents indicate that the US military and embassies had no advance warning about the nvCJD victims until the first 10 cases were announced in the press; indeed, embassy staff and military personnel continued to be served British beef until April of 1996. These people would all be covered by the new exclusionary ban.
Panel members stressed that their vote did not mean that frequent travelers to Britain are at risk of getting a fatal illness linked to mad cow disease -- or of spreading it through their blood.
The problem is that scientists just don't know if the illness can be spread that way. There's never been a human case where that happened. But at issue is a new fatal disease that doctors don't yet understand -- and some scientists have successfully transmitted similar illnesses to animals through blood.
``The day you find out there is (human) transmission, you're years too late'' to protect the blood supply, warned Dr. Linda Detwiler of the U.S. Agriculture Department as the panel voted 12-9 that FDA should forbid some blood donations. The FDA is not bound by its advisers' recommendations, but typically follows them.
If it does so in this case, it must decide how long someone had to stay in Britain to be deemed enough of a risk to refuse their blood. That's crucial because an American Red Cross study found almost 23 percent of recent blood donors had traveled to Britain at least once between 1980 and 1996. If the FDA barred them all, the United States would face a critical blood shortage.
The advisory panel said the concern is not a typical week-long tourist trip. Instead, a majority said Americans must have spent a total of over six months in Britain between 1980 and 1996 before being blocked from donating blood. Some advisers wanted the time extended to over a year, excluding fewer people.
Blood donations are dropping every year even as demand for blood increases, and every summer and during holidays parts of the country experience serious shortages. If the FDA blocks travelers who spent a total of six months in Britain, there will be a 2.2 percent drop in the U.S. blood supply, the Red Cross study said.
A majority of FDA's advisers said even though the risk is only theoretical, it makes sense to be conservative in protecting the public. Some noted that critics say the AIDS epidemic might have been mitigated had doctors taken a more aggressive stand to protect the blood supply in the early 1980s.
At issue this time is an infection that kills by literally eating holes in brain tissue. In cows, this condition is called mad cow disease -- and from the late 1980s through 1996, British cows suffered an epidemic. Mad cow disease also has been found in cattle in certain other countries, but Britain was hardest hit.
About one in 1 million people around the world gets a similar brain disease called Creutzfeldt-Jakob disease, or CJD. Although CJD sometimes is hereditary, usually its cause is not known. The worry about blood stems from Britain's discovery in the mid-1990s that some people caught a new variety of CJD apparently by eating beef infected with mad cow disease. Named ``new variant CJD,'' it has claimed 39 British victims.
There is no known mad cow disease in U.S. cattle, the United States has not allowed importation of British beef for over a decade and no American has caught new variant CJD.
But because these brain diseases can incubate for years without causing symptoms, some scientists say the possibility exists that years from now they will discover a link between blood transfusions and infection. Indeed, doctors are closely watching Britain to see if that happens.
The British government now imports drugs made from blood plasma from other countries, although British researchers told the FDA panel Wednesday that they simply cannot predict the risk, if any. Canadian health officials last month decided they, too, would determine how to block blood donations from certain Canadians who traveled to Britain.
Thursday June 3 6:16 PM ET Yahoo daily newsGAITHERSBURG, MD, Jun 03 (Reuters Health) -- Due to fears about transmission of an agent linked to a mysterious brain disease, Food and Drug Administration (FDA) advisers voted Wednesday to prohibit some people who have lived or traveled in the United Kingdom from donating blood or plasma in the US. The FDA is expected to use the panel's advice to make a new policy on restricting blood donations from some individuals.
Members of the FDA's Transmissible Spongiform Encephalopathies (TSE) Advisory Committee voted 12 - 9 to institute new deferral criteria for whole blood and for plasma donors who lived or traveled in the UK in the period 1980-1996 -- believed to be the peak period when people in Britain may have been exposed to the agent that causes bovine spongiform encephalopathy (BSE), or ``mad cow disease.'' Some experts believe that cases of a degenerative brain disease called new variant Creutzfeldt-Jakob disease (nvCJD) reported in the UK and France may be due to BSE. The bulk of these cases have occurred in the UK. There have also been no cases of BSE or nvCJD reported in the US.
``I am very concerned we may be facing the grave possibility of an epidemic of nvCJD,'' said Robert Rohwer, a consultant to the TSE Advisory Committee. ``It is possible to do something, and we should do it,'' said Rohwer, director of the molecular and neurovirology unit at the VA Medical Center in Baltimore, Maryland.
Panelist Susan Leitman, who voted against deferrals, said, ''There are simply inadequate data on which to base a decision.'' Leitman is chief of the blood services section at the National Institutes of Health's Transfusion Medicine Division.
Blood banking industry representatives argued against a new deferral policy, saying there was no proof that nvCJD is a bloodborne pathogen. They also said that new, replacement donors would have to be found, and that first-time donors generally present more risks to the blood supply.
``Given the present body of scientific and epidemiologic data, and considering the known impact on our nation's blood supply, any deferral at this time for this theoretical risk cannot be justified,'' said Richard Davey, chief medical officer of the American Red Cross Biomedical Services.
There was no consensus among the panel on what length of time spent in the UK should be used as a cut-off to exclude people from donating blood in the US. Seven of the 21 members said those who had lived or traveled for a cumulative period of six months should be barred, while five others said one year should be used as the cut-off. There were also suggestions for 4 months and 5 years.
The TSE committee grappled with the problem of balancing a loss of donors with the potential for an epidemic of a fatal, incurable disease. In December, the same committee heard evidence that these donors could potentially transmit nvCJD through their blood or plasma products, although there have been no such instances reported in the US or in Europe.
At that meeting, the agency asked the blood banking industry to determine the impact on the nation's blood supply if people who had traveled or lived in the UK were deferred.
The American Red Cross and the American Association of Blood Banks randomly polled people who had donated blood in December or January. Alan Williams of the American Red Cross presented data on Wednesday from 8,666 respondents. They were asked about how long they had traveled in England, Scotland, Wales, Northern Ireland, the Isle of Man, the Channel Islands, and the Republic of Ireland between 1980-89 and 1990-96. They were also asked if they had eaten beef while on their visit or within the last year.
For 1980-1996, 22.6% of the respondents had traveled or resided in the UK. Most had been there a month or less. Overall, 72% of had eaten beef during their UK travel, and 96.6% had eaten meat in the past year.
The survey estimated that if one week of travel was used as a cut-off, 16.3% of donors, and 14.9% of the US blood supply would be lost. If one month was used as a cut-off period, 7% of donors, and 6.4% of units would be lost.
Using the TSE panel's suggested 6 months, about 2.2%, or 285,000 units might be lost. The numbers are based on estimates of 11.9 million units donated in the US per year.
Military donors would have higher deferral rates, as they had higher rates of travel than other donors, said Williams.
Thu, 3 Jun 1999 Committee of Ten Thousand Dave Cavenaugh, Government RelationsPublic comment before the FDA's Transmissible Spongiform Encephalopathies Advisory Committee June 2, 1999 Gaithersburg, MD:
"The Committee of Ten Thousand is gravely concerned about industry logic favoring continued use of US donors who have visited the United Kingdom, lest a ban on them would require seeking additional US replacement donors, who may be at higher risk than their intercontinental-traveler, high income and education, theoretically "safe" brethren. This even given the refined survey presented today showing far less impact on the supply than did the "11% of REDS study patients visited the UK so there could be an 11% drop in the supply if we did this" information presented at your last meeting six months ago. Moreover, today's discussion has brought out the valuable point that the committee lacks any data whatsoever on plasma donors travel, and, given the vastly larger quantities harvested from them, the impact of a corresponding loss on supply and risks in replacement."
"We have heard quite a bit today about the likely blood-borne nature of this never-documented entity -- the "prion" -- and its ability to be transmitted by blood. Even the Chair, Paul Brown, indicates now a belief that nvCJD can be blood-borne."
"The link between nvCJD and beef is based largely on proximity; clearly there is such a risk for classical CJD too. Just being in the UK in the late 1980's, at the peak of the BSE epidemic, was sufficient for many of the hundreds of classical CJD cases reported there at that time. Both statisticians presenting this morning demonstrated a clear risk of nvCJD in blood, not even enlarging the scope to classical CJD."
"It is true that there have been no reported cases of nvCJD in the US, to date, but there is plenty of Classical, arguably much more than the 1:1,000,000 rate alleged. Just ask CJD Voice, a family support group which spoke before you 18 months ago. Small then, its numbers have mushroomed. Something's getting transmitted. Can it all be through beef?"
"But most disturbing is the recent news confirming a second mutated form of prions, also causing death within a year. This "doubling" of the number of ways that prions can be malformed, with fatal results, raises our level of concern considerably."
"With an entity so new, so unknown, and so dangerous, the TSEAC should be providing every protection possible, not bowing to arguments of relative risk."
Wednesday, June 2, 1999 BBC NewsThere is concern over the safety of blood supplies The British public should not worry about the safety of blood supplies even though the US is considering a ban on blood donations from thousands of Americans who have visited the UK, says the Deputy Chief Medical Officer.
Concern over the possible spread of BSE - commonly known as mad cow disease - may prompt US authorities to ban blood donations from thousands of Americans who have visited Britain in the last 15 years. The BBC's Stephen Sackur: "What if tainted blood should ever slip through?"No one knows for sure whether the human form of BSE, known as new variant Creutzfeldt-Jakob Disease, can be transmitted through blood supplies, but the United States Food and Drug Administration is loath to take any chances.
An advisory panel of doctors and public health experts has been considering the wisdom of banning blood donations from people with strong British connections for months. Their conclusions will be publicised at a meeting in Maryland on Wednesday.
Dr Metters said although noone could say for certain that there was no theorectical risk, it was far outweighed by the serious risk to life that would result from refusing a blood transfusion where doctors recommended it. Dr Jeremy Metters:
"No one should refuse a blood transfusion." He said: "If a patient is recommended to have a blood tranfusion there should not hestitate because of this very theorectical risk."
Mad cow disease first emerged in Britain in the mid-1980s. Amid much controversy, scientists proved that the brain-wasting disease had been passed on to humans through infected beef products. More than 42 Britons are known to have died from the disease.
He said that would dramatically reduce any theoretical risk of mad cow disease entering the US via a British connection, while at the same time safeguarding supplies of donor blood. Experts reckon that a ban on donations from anyone who has visited Britain, even for a few days, would cut total donations by up to 20%. The FDA could impose new restrictions on blood donors within months, and that might just prompt new questions about the safety of Britain's own blood supplies.
Tandy N Logistical problems of supplying leucodepleted blood components within the national blood service. Transfus Sci. 1998 Dec;19(4):373-4. Smith KJ NBS approaches to the approval of suppliers of leucodepletion systems. Transfus Sci. 1998 Dec;19(4):371-2. Prowse C Operational and research approaches to universal leucodepletion in Scotland. Transfus Sci. 1998 Dec;19(4):367-9. Seghatchian MJ, et al Validation approaches selective/universal leucodepletion: the need for standardised validation strategies. Transfus Sci. 1998 Dec;19(4):363-5. Barrowcliffe TW Universal leucodepletion--practical and regulatory consequences. Transfus Sci. 1998 Dec;19(4):361. Seitz MD International views on universal leucodepletion: the perspective in Germany. Transfus Sci. 1998 Dec;19(4):359-60. Flesland O Perspective on Nordic views on selective/universal leukodepletion. Transfus Sci. 1998 Dec;19(4):355-7. de Wit HC International views on universal leucodepletion: the perspective in The Netherlands. Transfus Sci. 1998 Dec;19(4):353-4. de Sousa G International views on universal leucodepletion: the perspective in Portugal. Transfus Sci. 1998 Dec;19(4):351-2. Murphy W International views on universal leucodepletion: the perspective in NBS, Ireland. Transfus Sci. 1998 Dec;19(4):349-50. Wallington T International views on universal leucodepletion: the perspective in NBS, England. Transfus Sci. 1998 Dec;19(4):347-8. Murphy MF Potential clinical benefits and cost savings of universal leucocyte-depletion of blood components. Transfus Sci. 1998 Dec;19(4):343-6. Turner M The risk of transmission of nvCJD by blood transfusion and the potential benefits of leucodepletion. Transfus Sci. 1998 Dec;19(4):331-2. Wallington T NBA/NBS perspective on nvCJD. Transfus Sci. 1998 Dec;19(4):329-30.
June 1, 1999 Associated PressGREENSBORO, N.C. A funeral home is offering another service to families who have lost loved ones. They will preserve hair, nail and skin samples of the deceased in case they're needed later to solve a family mystery. "What we are trying to do is find ways, better ways, to serve families," said Scott Lineberry, vice president of Hanes Lineberry Funeral Service, which offers the service for $200.
Tests on preserved hair and nails can reveal the level of chemicals in someone's body at the time of death. This can be helpful if the cause of death is questioned long after a person has been laid to rest. The skin sample records a person's individual DNA. This DNA code can help settle paternity suits or alert future generations to genes that might trigger certain ailments or diseases, said Lee Skidmore, president of Youth Cell Technologies in Greensboro.
Youth Cell, through its subsidiary Memory Cell Technologies, has an arrangement with Hanes Lineberry to freeze the tissue samples in cryogenic vaults. The samples are placed in racks that are shrouded in a fog of vaporized liquid nitrogen. Theoretically, the tissue will remain unchanged for hundreds of years. Taking the samples before a person is buried eliminates the need to exhume a body later if scientific questions arise. Digging up someone's grave, especially that of a loved one, can be an emotionally wrenching experience. It can also be costly.
Families who prefer cremation may consider having samples taken "because once the cremation has taken place, the DNA is lost forever," said Chris Webster, a funeral director and embalmer at Hanes Lineberry. Hanes Lineberry has taken samples from bodies on two occasions. David O' Connell, a vice president at Youth Cell, said his company has storage agreements with 16 other funeral homes in North Carolina.
Retrieving tissue for DNA sampling is a relatively new service provided by funeral homes and one that raises some potentially sticky legal questions, said Kelly Smith, a spokesman for the National Funeral Directors Association. For example: Who is liable if a sample is lost or decomposes? Memory Cell assumes liability for any samples taken by Hanes Lineberry, Webster said. Furthermore, only family members are entitled to the results of any testing.
The sample-taking process is pretty simple. It can be performed before or after the body is embalmed, Webster said. At Hanes Lineberry, the embalmer takes five strands of hair with roots attached, a nail clipping from either a finger or toe and a small scraping of skin from behind the ear. The specimens are placed in plastic vials and refrigerated until Memory Cell comes to collect them.
Memory Cell stores the samples in cryogenic containers at its headquarters. The company then contacts the family and sends a certificate stating that the deceased's "final gift" to loved ones is "being preserved for time everlasting at Memory Cell Technologies."
If the family wants tests performed on the samples, Memory Cell will take care of all the arrangements, O'Connell said. "You'll get a printout back saying what they have found ... and probably the bill for it, too," he said.
Britain's mad cow scare has died down, but deaths from eating beef are growing May 5, 1999 Sydney Morning Herald JENNIFER COOKE JENNIFER COOKE is a Herald journalist and the author of Cannibals, Cows and the CJD Catastrophe (Random House) $24.95, which, the story says, last night won the Graphic World Eureka Science Book Prize for 1999. IT'S been two years since the infamous announcement by the British Government that the deaths of 10 young people in Britain from a new strain of the fatal brain disorder, Creutzfeldt-Jakob disease (CJD), was probably caused by food made from mad cows. The story goes on to say that with Australia's CJD Registry, the unit is also monitoring reported cases of classic and accidentally transmitted CJD here for any sign of the beef-related strain. They are seeking evidence of anything resembling a sign of the distinctive brain damage caused by nvCJD in CJD deaths among British migrants, visitors or Australians who may have been infected in Britain in the 1980s when cows were, the story says, being turned into cannibals by eating protein supplements made of rendered-down animals. Early predictions of an epidemic - anything up to 80,000 cases in Britain - have been played down, but the watchers have focused on a worrying sharp rise in the number of nvCJD deaths in the last quarter of last year. Nine of the 40 nvCJD deaths in Britain occurred within that 12-week period. The surveillance unit's consultant neuropathologist, Dr James Ironside, was quoted as saying the deaths could be just a "blip" in the statistics or the start of "something bigger". Professor Colin Masters, head of Australia's CJD Registry, was quoted as saying, "Everyone is very anxiously awaiting developments in the UK," and that the nine deaths are significant because they are a direct result of eating infected beef - a link admitted by John Major's Conservative Government in Britain only on March 20, 1996, after more than a decade of denials that the BSE disease which was decimating the country's dairy and beef herds could cross into humans. As far as researchers are concerned, this nvCJD represents an unknown quantity compared with other forms of person-to-person "accidental" transmission through transplanted organs, human growth hormone injections and early fertility treatments. The death toll around the world from these forms of accidentally transmitted CJD continues to rise and is now 214. These include deaths after at least three corneal transplants, 126 former child recipients dead or dying of CJD from pituitary-derived human growth hormone injections manufactured before 1988 and four Australian women who received a pituitary-derived fertility drug. In addition at least 81 patients of surgical procedures who received grafts of human brain lining called dura mater have died of CJD. The tollclimbs each year, with incubation periods ranging from 18 months to 16 years for contaminated dura mater, eight to 30 years for human growth hormone, and a few years for infected corneas. All cases resulted from human tissue transplanted from CJD-infected cadavers over the past three decades. The story notes that researchers at the Prion Unit and Department of Neurogenetics, Imperial College School of Medicine at St Mary's in London - where the tonsil test was developed - have also found evidence that copper present in the brain may influence the shape of the abnormal prion protein, causing it to switch from one strain (ie, sporadic CJD or nvCJD) to another. This potential link between the metal-binding capabilities of prion protein and strain variations raises the possibility of future therapy from drugs that influence copper metabolism. Other recent research reports have highlighted the bizarre instance of CJD in a husband and wife (there is no evidence of close contact or sexual transmission in any prion disease) within five years of one another, and, within 10 days of one another, prion disease in an Italian man and his cat. Dr Paul Brown, a senior research scientist at the National Institute of Neurological Diseases and Stroke at Bethesda, Maryland, was cited as saying that a handful of comparatively young cases of CJD in deer hunters and/or venison eaters in both Europe and the United States are "under active study". Dr Michael Alpers, an Australian researcher who has lived much of the past three decades in Papua New Guinea, was cited as saying he thought he would be around to chart the last case of kuru, the first prion disease discovered in humans, in 1956. At one stage, kuru threatened to wipe out the entire 12,000-strong cultural and linguistic group known as the Fore in the eastern Highlands. It wasn't until 1968 when the kuru epidemic had markedly declined, that Alpers realised its demise was linked to the outlawing of cannibalism in PNG at the end of the 1950s. Alpers, director of the Papua New Guinea Institute of Medical Research, was further cited as now acknowledging that, with a new case or two of kuru emerging each year, he may be witnessing the slow demise of a disease that has an incubation period as long as the human lifespan. The story says that kuru was the forerunner of accidental person-to-person transmissions of CJD and it provides the benchmark from which incubation periods can be measured in cases caused accidentally through contaminated medical treatments. Instead of the cannibalism of the Fore people, however, the new culprit was high-tech cannibalism of human body tissue. In charting how many people may die of these different types of CJD, the starting point is always kuru. How long has it taken for people to die of kuru since the source of the outbreak was identified and removed? More than 40 years. So far. And if Alpers concedes that kuru will remain incubating in unsuspecting victims into the next millennium, then, the story concludes, the world may be witnessing the start of the upswing in a parabola of nvCJD deaths.
Press releas 3 June 99OTTAWA - The members of Canadian Blood Services' (CBS) Ad Hoc Advisory Committee on New Variant Creutzfeldt Jakob Disease (nvCJD) have been named and will hold their first meeting this week. The Committee was announced May 5, 1999 to recommend to CBS whether or not blood donors who have travelled to or lived in countries where bovine spongiform encepholopathy (BSE) has been found should be deferred. There is a theoretical possibility that blood donors who have been in countries endemic for BSE may be at risk of exposure to nvCJD, the human equivalent of ``mad cow'' disease.
Consisting of 15 people of various backgrounds from blood donors and recipients to ethicists, medical specialists and lawyers, the Committee will provide advice to the CBS Board of Directors and CEO by mid-June.
Chairing the Committee is Dr. John G. Wade, previously Dean of Medicine at the University of Manitoba and Deputy Minister of Health for the province of Manitoba. According to Dr. Wade: ``We have been asked to balance the risk of reducing the supply and availability of blood and blood products against the risk of exposure to nvCJD. We will examine all the issues related to the supply of blood, including the regional impact of various deferral models or options.''
``We would like to thank the members of the Committee for making themselves available. This kind of consultation reflects our commitment to public participation in the management of Canada's blood supply system and their recommendations will play an essential part of our decision-making as we go further in our discussions with Health Canada, Hema-Quebec and other countries,'' said Lynda Cranston, Chief Executive Officer of CBS. ``We would also like to urge all Canadians to continue to donate blood or if they have never done it, to do so for the first time. We rely on the generosity and dedication of donors because the need never stops.''
Canadian Blood Services is a national, not-for-profit, charitable organization whose sole mission is to manage the blood supply in all provinces and territories except Quebec. CBS operates 14 blood centres, two plasma collection centres and countless blood donor clinics.
For further information: Ian Mumford, Vice-President, Communications, Canadian Blood Services, (613) 739-2045 (phone), (613) 739-2099 (fax). Complete list of committee members follows:
Committee Chair: - Dr. John Wade, former Deputy Minister of Health and former Dean of Medicine, University of Manitoba Committee Members: - Dr. James AuBuchon, blood transfusion specialist, U.S. - Professor Mary L Chipman, epidemiologist, University of Toronto - Dr. Edward Crosby, anesthesiologist, Ottawa Hospital - Dr. Paul Greig, surgeon (liver transplants), Toronto Hospital - Dr. Wilbert Keon, Director General, University of Ottawa Heart Institute - Dr. Edward (Ted) Keyserlingk, biomedical ethicist, McGill University - James Kupkee, blood donor, Rothesay, New Brunswick - James McLaren, transplant recipient, Burnaby, B.C. - David Page, Chairperson, Canadian Hemophilia Society Blood Safety Committee - Marion Raycheba, blood donor, Toronto - Dr. Robert Rowher, CJD and prion diseases expert, U.S. - James Smellie, lawyer, Ottawa - Dr. David Sutton, Secretary-General, World Apheresis Association - Dr. David Westaway, Researcher in prion diseases
COMTEX Newswire Mon, Jun 7, 1999Comment (webmaster): The article doesn't say just when the 16 year old had surgery. The last bad batch of dura mater was supposed to have been all used up or recalled by 1986 or so. This raises concerns that dura mater is still being pooled or CJD is much more common that thought, at least at the level sufficient to jumpstart transmission.
TOKYO -- Lawyers filed a lawsuit Monday demanding a total of 320 million yen in damages from the state and two companies for three people who contracted a fatal brain disease from imported dura mater.
The lawsuit filed at the Tokyo District Court says the three people, one of whom has since died, contracted Creutzfeldt-Jakob Disease (CJD) from transplants of dura mater, the membrane surrounding the brain and spinal chord. The six plaintiffs said the state, a German company, B. Braun Melsungen AG, that produced the dura mater, a Tokyo-based importer and its officials are responsible. This suit brings to 10 the number of CJD patients or their relatives demanding compensation at the Tokyo and Otsu district courts, Shiga Prefecture.
The CJD patients in the latest suit are a 16-year-old boy from Sapporo, and a 53-year-old woman from Chiba, east of Tokyo. A 59-year-old man from Usa, Oita Prefecture, died from CJD last month. The two surviving patients received the imported dura mater in transplant operations 14 to 15 years ago. They were diagnosed with CJD last year and are currently hospitalized.
The two are not among 61 patients recognized by the Health and Welfare Ministry as CJD patients who have undergone dura mater transplant operations, they said. One of the lawyers for the plaintiffs said, "As the incubation period is long, there is fear that more patients with the disease will be discovered from now on...We want to aim for an early resolution of the suit."
June 2, 1999 By RAF CASERT Associated PressBRUSSELS, Belgium - Belgium's chicken pollution scandal spread Wednesday, with countries across Europe banning the import and sale of the tainted birds, eggs and byproducts and the European Union ordering their destruction. The scandal, which broke last week, has forced two Belgian Cabinet ministers to resign and left the government open to charges it waited nearly a month to tell the public the chickens and eggs were laced with high levels of the carcinogen dioxin.
"This is completely unacceptable. We reserve the right to take the necessary steps," EU Farm Commissioner Franz Fischler said, accusing Belgium of previously withholding information on the dioxin.
In Belgium, two officials from a major animal feed fat producer were arrested and accused of tampering with the fat that goes into chicken feed. The chickens became tainted when they ate the toxic feed, according to media reports.
The EU's executive commission on Wednesday ordered its member nations to destroy any poultry, eggs, or byproducts produced from Jan. 15 to June 1 by some 400 suspect farms. Authorities in Greece incinerated tons of Belgian poultry and egg products at an Athens landfill and Russian health authorities banned imports and sales of Belgian chickens. The Netherlands, Germany and France already had taken measures against the chickens. Belgium exported about $340 million in chickens and eggs last year.
The EU Commission will now investigate the issue further to see if the dioxin contamination was accidental "or far more serious," said EU Consumer Affairs Commissioner Emma Bonino. "Acute (health) effects appear to be relatively unlikely," she said. But "there are possible long-term effects."
This actually began in January 1999 - Belgian animal feed company economized on a vegetable oil used as a filler by using spent industrial oil. Unfortunately, it contained dioxins 700 times the limit. In February 1999, Belgian government ministers found out but said nothing and did nothing. From February to May 1999, eggs, pate, pork, beef , etc with unsafe levels of dioxins enteree the human food chain. If in doubt about anything in the fridge, throw it out, says minister
2 June 99 London Times BY ROBIN YOUNGTHOUSANDS of products were cleared from British supermarket shelves yesterday as Nick Brown, the Agriculture Minister, advised: "If people are worried about anything in their fridge they should chuck it away." Chocolates made with eggs were taken off sale yesterday Mr Brown admitted that the dioxin scare arising from an animal feed scandal in Belgium was "a serious problem". But he added: "I do not think there is any danger and I do not think this has the potential to become the next BSE."
At a farming conference at the Royal Bath and West Show, he said: "We do not import much of these products." He added that the main retailers would be able "very quickly" to determine whether their products were likely to be affected. British supermarkets were yesterday withdrawing products "as a precaution", though the European Commission had ordered member states to "seek and destroy" anything produced between January 15 and June 1 that might contain even as little as 2 per cent of Belgian poultry products. Belgian pork is also suspect.
Tesco cleared 18 products, including Belgian pate, mayonnaise and croissants. Sainsbury's and Asda followed suit by withdrawing a further five products. A Food Hazard Warning was in force across the country, and the Government called on retailers and local authorities to check all products for ingredients which might have been contaminated. A spokeswoman said that while the chain did not sell fresh or frozen poultry, pork or eggs produced in Belgium, and had been reassured that its pate and chocolates were not affected, it had withdrawn two products "as a precautionary measure". Asda withdrew stocks of three own-brand prepacked meats earlier this week in response to the scare. A spokesman said that while there was no evidence that its garlic and herb chicken, Belgian chargrilled chicken and honey roast chicken were affected, they were being withdrawn as a precaution.
Mr Brown said he was "pretty confident" contaminated products imported into Britain could be traced but added that the failure of the Belgian authorities to notify other nations immediately was "scandalous". The health alert made it clear, though, that there was no way that consumers, or even the Government, can obtain information to ensure absolute safety.
Britain imports 5,000 tonnes of fresh pork from Belgium annually, 3,000 tonnes of processed pork and 8,000 tonnes of pate, containing pork, chicken or both. Few fresh eggs are imported from Belgium but Belgian producers are among the largest suppliers of pasteurised egg and catering egg powders. The Kentucky Fried Chicken chain has withdrawn potentially contaminated chicken from its outlets.
The complexity of tracing what has become of the contaminated products, though, presents an almost insuperable difficulty, because food processing involves long chains of supply and using large quantities of ingredients from many sources often mixed together and seldom kept in discreet batches. A pork and egg pie labelled "produced in the UK" could have been made with Belgian pork, or Belgian egg, and even if both the main ingredients came from Britain, the egg in the pastry, or some of it, might still have have been imported.
Products obviously on the suspect list and already removed by some shops and supermarkets include Belgian and Ardennes pate, Belgian chargrilled chicken dishes and Belgian cake and omelette mixes, pastries biscuits and confectionery. Others whose safety may be in some doubt include Belgian chocolates, though most have no egg content, imported egg pasta, and recipe dishes including chicken or Belgian sausage.
It is known that more than 400 Belgian farms are likely to have received the contaminated feed. No one is sure how many farms in other countries may have been affected. Dioxin is a persistent compound which would not be removed by pasteurisation, conventional processing or cooking. It can cause cancer and devastate the immune and nervous systems. A spokesman for the Institute of Environmental Health said yesterday: "It is frankly impossible for consumers to tell which foods might present a health risk. The contaminated product could turn up almost anywhere."
The Meat and Livestock Commission claimed that its checks had shown the risk of any of the Belgian contaminated feed being imported into Britain as animal feed was "vanishingly small". The British Pig Industry Support Group said British pig producers had been giving a warning for ten months that all imports of pigmeat which failed to meet Britain's rigorous standards should be banned.
An official at the European Commission said: "The contamination appears to have occurred many months ago, and most of the products concerned are perishable. The sad but appalling truth appears to be that the problem has already been eaten."
June 4 1999 Roger Boyes reports from Cologne on hysteria and hygiene patrolsEUROPEAN leaders were eating carefully yesterday as the scare over Belgian chicken and eggs prompted raids on supermarket chains throughout Germany and panic from France to Russia.
European confidence has been sapped by the weak euro, the war in the Balkans and an inert Commission, and the last thing EU leaders needed was another case of food poisoning. Arguments over BSE tore Europe apart, and with Belgian chickens keeling over, two Belgian ministers are already down.
Nowhere is the anxiety more intense than Germany, where a coalition of safety-conscious consumers and populist politicians led to a blockade of British beef imports. "Dioxin!" shouted Bild, the tabloid pulse of the nation. "Meat and eggs from Belgium are everywhere in our country."
Hundreds of hygiene control teams swooped on German supermarkets yesterday. The range of products regarded as suspect extends to mayonnaise, pasta, biscuits and confectionary (although not, apparently, chocolate).
Belgium has ordered a slaughter ban in 500 pig-breeding farms while their feed is checked, and pork too is being removed from German supermarkets. It remained however on the journalists' menu (though not the politicians') at the Cologne summit.
The first hens started to drop on Flemish farms in January, and the contamination period is regarded as between January 15 and June 1. But the Germans are taking no chances. The country's Consumer Affairs Council yesterday urged Germans to destroy any chicken in their fridges or deep-freezers unless the origin of the birds was clearly marked, and bakeries that use liquid egg are to be inspected. The German Health Minister, Andrea Fischer, said that parliament would approve a purchase ban on Belgian poultry, eggs and egg products in the next few days.
Her Green colleague, Baerbel Hoehn, yesterday urged all retailers to ignore safety declarations attached to Belgian products. "I appeal to all retailers and consumers not to trust these statements," she said.
In the state of Hesse, 12 tonnes of Belgian chicken legs have been impounded and throughout yesterday the hygiene police were announcing the discovery of hundreds of kilos of chicken pieces. The French, too, are affected. At least 80 poultry farms in France have been using Belgian seed, and France has imported 20,500 tonnes of eggs and 41,000 chickens from Belgium so far this year. Even Russia is considering an import ban.
For Belgium, "Chickengate" is above all a political problem since it seems to have taken the Belgian authorities a month to report their suspicions to the European Commission.
But for all Europeans who eat chips with mayonnaise - a depressingly large number - and who have a preference for pork schnitzel, these are suddenly hazardous times.
An entire nation wondered what to eat Friday after those foods and more were yanked from supermarket shelves or considered too suspect to eat because of cancer-causing dioxin feared to have spread through the Belgian food chain due to contaminated animal feed. ``No chicken, no pork, no eggs, no beef!'' screamed a banner headline in the daily La Derniere Heure. ``And that jar of mayonnaise? Better not touch it,'' said Health Minister Luc Van den Bossche.
The government advised against eating beef and pork products after it already pulled poultry and eggs from the shelves -- leaving shoppers staring at many empty shelves instead of stocking up on weekend goodies. ``What are you having today?'' Het Nieuwsblad newspapers headlined over an empty plate.
State police were on alert Friday to make sure no poultry, pigs or cattle were slaughtered or transported anywhere until at least Sunday night. Officers went from shop to shop checking that potentially contaminated products had been taken off the shelves. Organic food stores were doing great business and foreign foods were popular to replace discredited local fare.
Belgian farmers were outraged. ``Our consternation is total,'' said Roger Saenen of the Farmers Union. ``All this is so colossal, it is indigestible.''
The scandal broke last week when a television station reported that fat laced with dioxin -- a carcinogenic byproduct of the manufacture of some herbicides and pesticides -- was used to make poultry feed. Belgium's health and farm ministers resigned when it became clear they knew about the dioxin for a month before making it public.
Prime Minister Jean-Luc Dehaene rushed back from a European Union summit and huddled with key ministers to deal with the issue. ``This is extremely serious,'' he said. The 15-nation EU, meanwhile, quickly took measures to contain the food crisis and was looking to add dairy products to the list of restrictions already imposed on produce from suspect farms.
Greece imposed an immediate ban on all imports of Belgian animal products. Britain said it would issue an emergency order to destroy Belgian pork, beef and related products suspected of dioxin contamination.
Spain ordered all Belgian animal products taken off the market. France said it was banning sales and transport from 66 cattle farms that used products containing animal fat provided by a French company that imported part of its supplies from Belgium.
Countries outside the EU were also taking action. The United States held up all imports of chickens, pork and any byproducts from the EU -- a response the EU called ``disproportionate.''
Russia banned the import of Belgian pork and pig fodder. Health authorities confiscated 20 tons of ground turkey in central Russia because of fears of dioxin contamination. Romania imposed a ban on all imports of Belgian livestock and animal products.
Van den Bossche said 175,000 pounds of contaminated animal feed had been distributed to poultry, beef and pig farms early this year. Initial tests showed dioxin levels in some chickens were 1,000 times the accepted limit.
The scandal was limited to poultry until Thursday, when it became evident that pork and beef could also be contaminated. An estimated 140 cattle farms, 500 pig farms and 416 poultry farms have been linked to the contaminated fat.
Two officials of the company who produced the animal feed fat have been arrested on fraud charges. The food crisis was already taking a toll on jobs. The Ter Beke meat company had to temporarily lay off 1,000 of its 1,200 workers. It is Europe's worst food scandal since the mad cow disease in 1996, when the EU Commission imposed a worldwide export ban on British beef.
Reuters Financial Report Sat, Jun 5, 1999 By Nieck AmmerlaanBRUSSELS, - Belgium, facing growing alarm at home and spreading trade curbs abroad over a food contamination scare, announced more measures on Saturday to reassure consumers that it had the crisis under control. Prime Minister Jean-Luc Dehaene's government said pork and beef products that could have been tainted with cancer-causing dioxin found in animal feed would be taken out of circulation, but for now there were no measures for milk and dairy products.
The scare, Europe's worst food scandal since Britain's "mad cow" crisis, has led to tough European Union restrictions on trade in Belgian poultry, pork and beef, and related products. Countries as far afield as the United States and the United Arab Emirates (UAE) closed their borders to Belgian meat. The UAE's official news agency WAM reported that health inspectors in the emirate of Sharjah had seized 1,000 boxes of Belgian chicken.
After a nine-hour cabinet meeting that began on Friday afternoon, Dehaene told a news conference early on Saturday: "There is no general contamination." Officials have said that around 1,000 poultry, pork and beef farms in Belgium may have received feed contaminated with dioxin from a polluted transportation tank. How the toxic chemical got into the tank remains unclear. Chicken, eggs and derived products from suspect farms have already been taken from shelves. Tests on pork and beef had found "no effective presence of dioxins," Dehaene said. But pork and beef products from suspect farms would still be removed gradually from sale.
On Friday the European Commission, still outraged by Belgium's failure to tell it of the poisoning quickly, extended trade curbs on Belgian chickens and eggs to pork, beef and dairy products from farms which might have bought contaminated feed. Germany on Saturday extended its ban on imports of Belgian eggs and poultry to cover pork, beef and dairy products in line with the commission decision. Meat and dairy goods produced on the affected farms since January 15 must be traced and removed from sale. The EU's executive body set a special meeting of veterinary experts for Monday "to examine the matter further."
The Belgian meat trade faced near-collapse as the number of countries steering away from Belgian imports continued to rise. Saudi Arabia on Saturday banned imports of chicken meat and eggs. Switzerland stopped imports of milk, milk products and cheese. Belgian shoppers crossed into France, Germany and England in search of untainted produce for their weekend dinners as selected Belgian towns opened dump sites to residents so that they could drop off suspect goods for destruction. The Belgian army made a barracks complex near the coast available for storing unwanted produce.
Prime Minister Dehaene said any dioxins in pork and beef would be concentrated in fat. While no poison had been found, Belgian products with high-fat content -- such as minced pork, sausages and bacon -- would be removed from sale by Sunday. Belgium also extended a ban on transporting cattle, pigs and poultry by two days until next Tuesday. "It seems to me that the measures are going in the direction of what Europe wants," Health Minister Luc Van den Bossche told the early morning news conference on Saturday. No curbs were set on trade in milk and dairy products since any dioxins would be greatly diluted in huge vats of milk.
Deputy Prime Minister Elio di Rupo acknowledged that restoring confidence in Belgian meat abroad would be "a colossal job." The scandal, initially involving dioxin contamination of chickens and eggs, hit like a bombshell before Belgium's June 13 elections, forcing the resignation of two ministers. Dehaene halted his campaign activities on Saturday as he and top ministers held more crisis talks to tackle issues such as farmers' compensation claims and calls from employers to keep the European Commission from imposing more trade restrictions.
Belgian media have estimated that the crisis could cost the nation some 30 billion Belgian francs ($767 million).
June 3, 1999 Rachel's environment & health weekly #653Two years ago, in 1997, the International Agency for Research on Cancer (IARC) formally concluded that dioxin causes cancer in humans. IARC is a division of the World Health Organization (WHO) and its recommendations carry considerable weight in the world of public health policy.
Dioxin is the name of a family of 219 toxic chemicals, many of them created as unwanted byproducts of numerous industrial processes: incineration of municipal solid waste, hazardous waste and medical waste; the smelting of metals; the manufacture of chlorine-bleached paper; and the production of many pesticides and other toxic chemicals. Basically, any time you have high temperatures and the presence of chlorine-containing chemicals, you have conditions that can spawn dioxins.
Over the years, many studies of laboratory animals have shown that dioxins can cause many different kinds of cancer. However, in reaching its 1997 conclusion, IARC relied on studies of humans, specifically, four studies of workers exposed to high levels of dioxin on the job. The four studies revealed a remarkably consistent effect from dioxin exposure: a 40% increased chance of dying from cancer. In all four studies, the effect was highly statistically significant.
In three of the four studies, data for estimating dioxin exposures was available in 1997. Using the available exposure data, the authors of the three studies were able to observe a clear "dose response relationship" -- as the level of dioxin exposure increased, so did the chances of dying of cancer. Seeing a "dose response relationship" gives researchers more confidence that the relationship they have observed (in this case, between dioxin exposure and cancer) is real.
Now information about dioxin exposures among the fourth group of workers has become available, and a dose-response relationship can be seen in those workers as well. The more dioxin they were exposed to on the job, the greater their chances of dying of cancer.
This fourth group was the largest of them all -- 5132 workers at 12 U.S. industrial plants where they were exposed to dioxin over many years. Researchers at the U.S. National Institute for Occupational Safety and Health (NIOSH) were able to find job histories for 69% of the 5132 workers and thus could categorize them into seven groups according to their dioxin exposures.
The new information appears in the May 5 issue of the JOURNAL OF THE NATIONAL CANCER INSTITUTE. In their report, the NIOSH researchers explain that they saw a 13% increased chance of dying of cancer among the 5132 workers, compared to an unexposed group. Among the highest two exposure groups, they observed a 60% increased chance of dying of cancer.
In sum, we now have four separate studies of groups of humans who have been exposed to dioxin and who are dying disproportionately from cancers. These studies provide support for many previous studies of laboratory animals showing that dioxin causes various cancers.
Does this close the book on dioxin and cancer? Unfortunately, it does not. Every group of humans who have been exposed to high levels of dioxins has now been studied. There aren't any other groups to study. Therefore, the data that are available now are probably the only human data we will ever have. (Of course as time passes these same groups will be studied further, but the results are not likely to change dramatically.)
With today's data, it is still possible to reach conclusions that are 180 degrees out of synch with each other. In an editorial in the JOURNAL OF THE NATIONAL CANCER INSTITUTE May 5, Dr. Robert N. Hoover of the U.S. National Cancer Institute wrote, "My belief, based on the current weight of the evidence, is that TCDD [the most potent dioxin] should be considered a human carcinogen." This is precisely what the World Health Organization concluded two years ago.
In contrast, when the British medical journal LANCET ran a news story reporting the latest dioxin findings from the JOURNAL OF THE NATIONAL CANCER INSTITUTE, they quoted Michael Kamrin, a toxicologist from Michigan State University (East Lansing, Mich. USA) who said the dioxin data is "unconvincing and epidemiologically weak... These data don't suggest to me that there's any health risk from dioxin [TCDD]. I didn't think so before, and I don't think so now," Kamrin told the LANCET.
So the question is, how should ordinary people react to dioxin? When we learn that we and our children are breathing dioxins created by a medical waste incinerator, or a garbage incinerator, or a cement kiln burning hazardous waste, what should we think? Should we accept the opinion of Robert Hoover from the National Cancer Institute that dioxin is probably a cause of human cancers? Or should we accept the words of Michael Kamrin at Michigan State who says there isn't any health risk from dioxin? Experts can always disagree, but citizens must make choices in the best interests of themselves and their families.
It seems clear that science cannot solve this kind of dilemma. There has never been a chemical studied more thoroughly than dioxin. For the past decade the U.S. government has been conducting a detailed analysis of many hundreds of previous studies of the health effects of dioxins (in animals and humans). Furthermore, the government has spent millions of dollars conducting new studies of dioxin's effects on humans (for example, the NIOSH study, discussed above) and animals. In addition, the Chemical Manufacturers Association and the Chlorine Chemistry Council have spent substantial sums of money hiring their own brand of scientist to try to tilt the balance in the direction of "dioxin is no problem." (As you might imagine, there are huge sums of money riding on the outcome of the dioxin debate.)
For most chemicals, we can probably never expect to get data as good as the data we have now for dioxin. Given limited funds for study, and given that there are 70,000 chemicals now in use and 1000 new ones added each year, we cannot realistically expect anything like "thorough" data on the health effects of any particular toxic chemical.
Therefore, how should we, the public, react to dioxin or any other toxic chemical? There are two basic ways of approaching such a question -- risk assessment or precaution.
Risk assessment asks the question, How much damage are we willing to tolerate from dioxin exposure? Risk assessors usually answer this question by saying that it is "acceptable" to kill one in every million people exposed to dioxin. (Sometimes they give a different answer, saying it is OK to kill as many as one in every 10,000 people exposed to chemical A or chemical B, but usually their answer is that one-in-a-million is the acceptable kill ratio.)
Now let us remove our rose-colored glasses for just a moment and be blunt. You rarely find a risk assessor who will say so, but the one-in-a-million formula is, at base, a prescription for legalized murder. The dead person is selected at random and is killed anonymously. But it is still a premeditated, planned death. If "risk assessment science" improved to the point where the victim's identity were known, then everyone would agree that a murder had been committed.
Once the community of risk assessors has accepted that it is OK to kill one-in-a-million citizens by exposing them to dioxin (or some other toxicant du jour), then the mathematicians and toxicologists go to work and develop a formula that says "exactly this much dioxin can be emitted into the community, and no more, if we are to abide by the one-in-a-million limit of 'acceptable risk.'" Then it is up to the engineers to design a machine that will emit just the "acceptable" amount of dioxin or other toxicant and no more. And then the government regulators ratify and enforce the engineer's limit. That is the sum and substance of the "risk assessment" approach to controlling toxic exposures, from dioxin or from any other deadly agent.
A different way to view the problem is to ask, How can we avoid dioxin exposures and so avoid the possibility of killing people with dioxin? This is the approach embodied in the "principle of precautionary action." The precautionary principle says,
"When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context the proponent of an activity, rather than the public, should bear the burden of proof. [See REHW #586.]
"The process of applying the Precautionary Principle must be open, informed and democratic and must include potentially affected parties. It must also involve an examination of a full range of alternatives, including no action."
A precautionary approach to dioxin would look at the available (sometimes conflicting) evidence about dioxin and ask, "If we think it is better to be safe than sorry, shouldn't we avoid dioxin exposures when we can?" And then the search would begin for alternative ways to avoid dioxin exposures. Shutting down incinerators -- or, better yet, not ever building incinerators -- would be one feasible approach. There are numerous alternatives to incineration, and a "better safe than sorry" strategy would examine all of them.
Reducing our use of chlorine-containing chemicals would be a second approach. There are few, if any, uses of chlorinated chemicals that are essential and irreplaceable. Alternatives are available.
In sum, a precautionary approach would not ask "How many dioxin deaths can we tolerate in our society?" -- instead, it would ask, "How can our society avoid making dioxin?"
The risk assessment approach, which has been the "official" approach in the U.S. for the past 25 years, excludes citizens for the most part because they don't have the knowledge to calculate the one-in-a-million kill ratio. Only the "risk experts" are able to do that. In that sense, the risk assessment approach is undemocratic and even anti-democratic. \tab But when it comes time to deciding whether an incinerator is the best way to handle the community's garbage, people can get involved. They can ask citizens in other communities how they are handling THEIR garbage. They can sponsor public discussions in which various groups (including waste companies) send representatives to tell how they would handle the community's wastes. People can ask about the sources of waste in their community and they can demand a "clean production" approach to those sources. (See REHW #650, #651.) Then people can discuss the pros and cons of what they have heard and can make up their own minds about what's best. Unlike risk assessment, the precautionary approach fosters citizen participation and promotes democracy. --Peter Montague (National Writers Union, UAW Local 1981/AFL-CIO)
 Douglas B. McGregor and others, "An IARC Evaluation of Polychlorinated Dibenzo-P-dioxins and Polychlorinated Dibenzofurans as Risk Factors in Human Carcinogenesis," ENVIRONMENTAL HEALTH PERSPECTIVES Vol. 106, Supplement 2 (April 1998), pgs. 755-760.  Robert N. Hoover, "Dioxin Dilemmas," JOURNAL OF THE NATIONAL CANCER INSTITUTE Vol. 91, No. 9 (May 5, 1999), pgs. 745-746.  Kyle Steenland and others, "Cancer, Heart Disease, and Diabetes in Workers Exposed to 2,3,7,8-Tetrachlorodibenzo-p-dioxin," JOURNAL OF THE NATIONAL CANCER INSTITUTE Vol. 91, No. 9 (May 5, 1999), pgs. 779-786.  Marilynn Larkin, "Public-health message about dioxin remains unclear," LANCET Vol. 353 (May 15, 1999), pg. 1681.
Terry S. Singeltary Sr. Listserve 18 May 99"I believe CJD IS on the rise in the U.S. Everything I have ever read, stating the one in a million, the document seems to be 3 or 4 years old, and by the present system set up, and the misdiagnosis of CJD, no autopsie's. There is NO way to give a proper estimate. A good example, a letter just posted through the Voice-list, I will leave names out:"
"It seems that I cannot get CJD added to my husbands death certifcate, because, according to the Doctor who was on call the night my husband died, says, there is NO DOCUMENTED PROOF. He did state that they all knew he had it, but without documented evidence, he could not add it. The only sure way was an autopsy after death. Which we chose not to do, thinking the tests were good enough."
Here is a copy of the statement his Neurologist sent to me personally..."This letter is in reference to your late husband, ________. As you remember I had the courtesy of a neurologic consult while he was at _______ Hospital. I felt at that time he had a dementia which was most consistent with Creutzfeldt-Jakob disease. The clinical course that he had up to his death certainly supports this diagnosis."Is this sufficent to say that he definitely died with the disease? I have been promised to have a copy of his medical records from this hospital in 7 days. Yet the first doctor says nothing is documented on the records he has a copy of. The neurologist says that it is........
How in the world, can there be an accurate statistic on deaths from CJD, with a system, such as this???"