Do health systems need the precautionary principle

Should the precautionary principle be expanded into the injury and preventative medical fields?

I B Pless from the Montreal Children's Hospital (check www.injuryprevention.com ) calls for expanding the precautionary principle into preventative medicine.

Generally, the medical field relies on epidemiology, where actual events are the basis for further study.  Typically, diseases or injuries arise, and then the causes are determined and preventative measures are put in place to prevent further disease and injury.  Pless comments that maybe we should be using the precautionary principle as a good public health initiative by focusing on primary prevention and a recognition that unforeseen circumstances and unwanted consequences are not unusual with human activities.

Now even a trip to the beach involves precautionary principle dilemna

Here in Australia, we are just starting up our summer.  Give that almost all of our population lives on the coastal fringe, this inevitability means trip to the beach.  Our cancer council pushes us to slip slop slap (slip on a shirt, slop on sunscreen and slap on a hat) to protect from the sun.

Well now modern sunscreens use nanoparticles of titanium or zinc oxide as an active part of the protection, and there may be some uncertainty as to the safety of these particles.  Does this sound familiar?  New technology, benefits in one particular area, but uncertainties about future health issues, need for more research?  Sounds like time to call up precautionary –principle-man to the rescue

Well this is where it gets messy.  The Friends of the Earth (FoE) organisation has taken up cudgels against nanotechnology.  FoE, which claims to be the largest federation of environmental organisations in the world, can be reasonably classified on the dark green side of the environmental debate.  They see serious questions about health, environmental, social and political impacts associated with nanotechnology.

FoE are calling for the application of the precautionary principle to nanotechnology.  They quote various governmental bodies and the avoidance of anything like a precautionary approach in the handling of nanotechnology.  FoE give three reasons why the PP is out:

1.       Money.  The gold rush mentality associated with nanotechnology means delaying applications while further investigations and tests are carried out means those countries will fall behind in the competitive stakes to commercialise nanotechnology.

2.       Ideology:  All the conservative governments in the developed world are pushing back on social and environmental issues.

3.       Fear:  Nanotechnology pundits have seen the mess GM foods have made over social acceptance.  So why start a fight when you don’t need to?  Let’s get nanotechnology out there before anyone has a chance to protest and stir it up.

The possible health effects from nanoparticles follow from their extremely small size and ability to enter the bloodstream and develop cancer causing (linked?) free radicals.

Here is the FoE link, and it includes a link to nice safe sunscreens, so your day in the sun will only be spoilt by the possible sun cancer you develop from the sun’s burning UV radiation.

http://nano.foe.org.au/node/186

Precautions with Sharks this Summer

It’s warming up in Australia as we move into summer.  That means bouncers and beaches.  (bouncers being the cricketing term for a ball that bounces up near a batsman’s head).

Already our media are in a burley induced feeding frenzy on shark attacks.  A girl was saved just recently by a hero who tugged a shark’s tail while it was attacking the girl.  It’s a pity he didn’t tug the Current Affairs reporter’s tail and save the girl from an interminable interview.

Of course the media are not there for a rational discussion about the risk of shark attack.  You are more likely to be bitten by a New Yorker than by a shark. On average, one person has died from shark attack in Australia per year, a remarkably steady number considering our population increase of 5 million in less than 20 years.  You are 80 times more likely to die in a drowning accident, 11 times more likely to die by being struck by lightning, and 3 times more likely to die from bee stings.

So I would like to apply the precautionary principle to swimming at the beach.  In the face of uncertain events (shark attack), precautions should be taken to prevent the occurrence of the events:

1.     Always swim with someone tastier than you.  A bit of fish guts in their budgie smugglers will divert attention away from you.

2.     Never swim with dogs.  Scientists may claim the dog paddle actually attracts sharks, but in reality, would you prefer a mouthful of fur or a delicate human rump?

3.     Swim at Cronulla.  The Cronulla Sharks haven’t attacked anything for 6 seasons.

4.     Don’t ask a white pointer for directions.

Stats gleaned from: http://www.thepunch.com.au/articles/the-monstrous-shark-and-other-myths-of-the-sea/?referrer=email&source=Punch_nl&emcmp=Punch&emchn=Newsletter&emlist=Member

Maybe the fat people will have to go back to riding a bike

The New York Times reports The Food and Drug Administration rejected another new diet pill on Thursday, a decision that sharply diminished the already scarce number of options available to overweight Americans amid the nation's obesity epidemic.

 

http://www.nytimes.com/2010/10/29/health/policy/29drug.html?emc=na

 

The rejected drug, called Qnexa, is the third weight loss drug to suffer a significant setback this month because of concerns about safety, as federal regulators seem to have heightened their scrutiny of diet pills that could pose risks to the heart or other organs. Last week, the F.D.A. declined to approve another new drug, lorcaserin, and earlier in the month it forced the withdrawal of Meridia from the market after 13 years, citing the risk of heart attacks and strokes for certain patients.

The precautionary principle is out there, making sure obese people have a smaller chance of heart disease from diet pills, but then again increasing the chance of heart disease through obesity.

It seems doctors in the USA prefer the old ways of losing weight , so rather than popping a pill, get on your bike.

Murray-Darling Basin bogs down on hidden precautionary principle

The Sydney Morning Herald reported today (27 October 2010) on the Murray-Darling Basin Plan getting tied up in legal wrangling.  And guess what has caused the wrangling?  Yes, our little friend the precautionary principle.  But just like a NSW Labour right numbers man, you have to look for the invisible hand.

Link here: http://www.smh.com.au/environment/water-issues/basin-plan-gets-bogged-down-in-legal-wrangling-20101026-172eq.html

Federal Water Minister, Tony Burke, wants to reassure angry farmers he can give social and economic factors equal weighting with environmental imperatives when formulating a new water plan for the Murray-Darling Basin.

However constitutional lawyer and University of NSW law professor George Williams said the advice, released by the minister yesterday, actually confirms that the water plan has to ''faithfully implement'' the international environmental conventions upon which the 2007 Water Act is based.

''It says they have to give primacy to the environment and then they can give consideration to social and environmental effects,'' Professor Williams said.

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''If the plan does anything else, if it is incompatible with the environmental conventions, then it will be unconstitutional, because it is the conventions that the Howard government relied upon to get constitutional power for the Water Act.''

The The Water Act is based on the convention on biological diversity.  It is an international legally binding treaty that entered into force on 29 December 1993.  Here's the wiki link: 

http://en.wikipedia.org/wiki/Convention_on_Biological_Diversity

The precautionary Principle is mentioned in the Preamble to the Convention on Biological Diversity. link: http://www.cbd.int/convention/articles.shtml?a=cbd-00 , but not by name (cunning little principle)

It seems Mr Burke intends to use a weak version of the principle, and Professor Williams the strong version (see my previous post about the differences).  The weak version allows other factors outside of the purely environmental, while Mr Williams Wants the environment to be the overriding concern.

The pity is that the time and cost spent in legal wrangling and spin doctoring could pay for some serious scientific horsepower to really investigate the Murray-Darling basin problems.

Deep Green Precautionary Principle

Greens bid to ban pesticide in Tasmania

Tim Morris is the Greens water spokesman in Tasmania.  He has released a press statement (see above) about the use of the pesticide Atrazine.  Again we see the precautionary principle being used in its deep green strong hue.

He quotes a recent study titled Atrazine reduces reproduction in Fathead Minow undertaken by the United States Geological Survey.


The study's principle author’s Donald E Tillett concludes: 

"the reproductive effects observed in this study warrant further investigation and evaluation of the potential risks posed by atrazine, particularly in wild populations of fish from streams in agricultural areas with high use of this herbicide".

Morris claims there have been over 139 reported contamination detections of atrazine in Tasmania including the contamination of ground water supplies however under the current self regulatory system none of the atrazine contamination events are illegal.

Morris called on The Tasmanian parliament to enact the precautionary principle and ban triazines in Tasmania in the interests of protection both human and environmental health.

This is a classic strong PP application:  Uncertainty, action to be taken, exclusive of any other information about the benefits of triazine herbicides in agriculture and a call for a ban.

How do you take your Precautionary Principle: Weak or Strong?

The precautionary principle comes in two main flavours; weak and strong.

The Weak PP is the least restrictive and allows preventive measures to be taken in the face of uncertainty, but does not require them.  The requirement to justify the need for action generally falls on those advocating action.

The Strong PP requires precautionary measures.  It is a strong form of "polluter pays", with the responsible party liable for the environmental harm. The burden of proof shifts to those proposing the activity that it will not cause significant harm.  The public will not accept any risk, no matter what economic or social benefits may arise.

Weak:

• Pragmatic
• Take action especially if the costs are moderate
• Costs and benefits assessed
• Inclusive
• Proof on protester
• Politically correct

Strong

• Fundamentalist
• Take action no matter what the costs
• Exclusive
• Proof on developer
• Outright bans

The Queensland gas development mentioned in my earlier post is a graphic demonstration of the weak PP in action.  The costs and benefits of the gas development (jobs, gas sales, investment v water pollution, toxic chemicals) were weighed, and the government agreed to the proposal.