Document RrqXroXMQ1R5vRp6EgOndLOa

. V- -t ' ' -* V ' XT, l#3 : . .V`V'. ~ . ' ... . To Xtrfitto of tlx loolth ad h(i<7 CoalttMi ... K*o aolncn tad X tboajit yon *ooid t* IstorMtod U Prank Prlnet'o o mUm* tiKMlot of tlx yrcMst Mr pollution pad honlth altaatton. Tory truly ytarii ' i  .v:>siF .-dM '**( *' " ?JMp; -ci-mm:' Wm '.- * aJ '?,*. vS.;vjVV;' .4 ,} f> -if * % * &%itf v# $*: * Sfr >'*. VI tfl . VC '^lr.v; . _* % | |. t' Vf&S&ti'ZiqM.. _ t-i- -- i - Ml ATVOintnuc HTCixvt-iruwci JAMA, He* U. ISM nml to the knowledge of atmospheric hygiene moat be btrd on u mUt concept! of health to trrrn of physiological rwrtMty, and oot on Uto pian (MCfpU of kcUl wctftrg. n*yiiok>tcwl}y, maa li a reactive organism. Any stimulus will produce a phyW*kgyca) reaction. This ffKlioa iMy b* (ompcouimy or adapthf, It nuy he iDMWauJtr aad fad to otfer adequate protection to Mmil tissue (uncVoniH, or M may b# over* protective, and this very overreactivity may to and of itself produce Uiiur iluiup and physiologic baoreuk)'. Three 9 are the ffeuh of any t)w of revuwimrflUl intrusion on rie tepfr im, tnetlat it be dontcsl, physical, or bacterial Concept* of the bndtb state must, therefora, ule Into fSMklmtoa Ctnaoii* qwcpt of borneost*. sk and Dubos'* concept of adaptability. to add*- tkm to the efforts produced by our duacrc to social sttKidn, brag and wurhtng habits, drop, food, and industrial environment, ad if which in* turner. to one way or another, both fewer pat* tom and persona) attitudes. Any one of these changr* is fifioft to mm, both to tmns of its degree of importance and As influence on the populartun. Collectively, their im pact cannot he determined by conjecture and crash research programs, la fact, ft Is entsrely pnmfhle that the only reasonable de&nitsnn of health would be one that would vary from individual to indi vidual or from group to group. Since health atth tudes are an personal to nature, ft h unlikely that any drgntttoo will ever be acceptable to all Nano* thrlcss. Socrates* ddnttka, "llewhl* rskts when the organ!tm h to harmony wfth its environment,* catia* Sea pbysioiogiaaj criteria and #stel4ul>n a point f departure from which one can drteraune when a disease state etbt*. Since harmony denotes a state of equilibrium, this de&aftioa may be re worded to trad a state of 'dynamic pbysiolugkw! iquiUrtan' fWgardlns of the lack of tprci&cfty of this friaitiua, ft is useful to the understanding of normal physiological processes and to aa un derstanding of those degrees <f abnormality known at disease. It abo drhms the fact that tlirre la a variability la the health state aad that health la not a static phenomenon. Coftiama aad intensive research Is required to the study of attmapheric poDuUntt and their rela tionship to health aad disease. The con&rmatiua of a point of view or a speculation Is neither re search nor to the interest (f the public. Advances hi medical understanding depend, ultimately, on general advances to physiology and hknlwenitlry, and In the development of new knowledge earning the metabolism of a variety of sulwtances, both Intrinsic and ostHnitc. to (la body. This re search ft laborious, tfene-coneuming, and naern aartfy repetitive. TU current marhnsl literature on air pollution has become overwhelming and persuasive. By implication. tha nractld&g physician It sdvised that reipplis^ and death-dealing disease Is being products!, on all sides. by both known and urn innwa clwmloab la the atmosphere. These ar ticle* all seem to share Certain common characleriirtci; they are written as reviews of rtiuing diteases (many of thrm norwpectfic aad of otascure etiology), they are vigorous and even pmskmate to nature, they relate cause and elect statistically (or rptdrfiftolofkwDy, depending upon the author! nod they are written by persons whose bttmft seems to be rrUtrvefy new. Statement* from one* of tlaae most recent artirta are typical: "One of tit* most Important problems to medicine today b the low4rvel but chronic poisoning of our at mosphere by doeras of chemical processes char acteristic of aa advancing cfvfluatton. a poisoning which has ks effect owe the course of many years, but nhkh Dom-thelms torsorably cripples and Villa. .. . Although a connect*** between air poflotkm and nmwnahgn iat respiratory riureses can only be proposed teoiutfulj, the connection between air pollution and cancer of the respiratory tvstra Is aa sure aa statistical studies can nuke ft/ Tbh cuy be totevesttog rending, but it Is direct ly opposed to the opmioa of one of the best known and snt outstanding beahh ngtoen of the petsrat century. Dr. Abel Wolmsn has slated:" "Th# iotuitrvp assumptions that a polluted atmosphere Is ant cruKhttri* to (be bret health ftiS lack efther strong statistical or epidnutolugicul support The me of auggrstion. a* a mask tor scircfttftc ignaeBnrc, and of baplkatkm. aa a substitute for ph drmWtogk evidrnrr. are great temptatiom for bolstering budge*, for focusing public attention, and prwtding action even ft tfhdrdurd. To the scien tist this route is highly suspect To the politician ft is a rich method of raising papular interest and hence 'getting something done/ To the col umnist oa the prowl for lie dramatic and plauafble. if ao* the accurate, the route Is fruitful." Another highly respected engineer* who baa devoted hi* life to the study of the tsvimoni and ft* rrlatioaship to health bar quoted one of bis contemporaries as follows; *1 have dimmed these nrublrm* many ttoses with Dr. Morris W. CohlbLtt of Britain, a toskologtel of worId-wide rrpntsiion and an authority on enretongeniefty. By Srst hand tovratigattom he knows a tot about aft pollution tnuhln. fie told me that ha bebated there ft no evidence that chronic disease of the eye, or la the ebrst or rUrwhre# has been angmtbvrd by Los Angeles smog. II# even went further and said that three is no evidence that plM*ocfirmkwl smog la Los Asttln) ha* been respomihle for the Incident# of lung cancer to Camornte/ Dr. Drinker* cuntlodes; "Thera Is aa convincing evident# that aft polhition is presently endangering the public heekh to th# United State#/ r O V.J 1st, * ATMOUItEftfC HYCICXI--IHDCCI It ihiy be argued, bktoricofly, (bat Semmel- wrks and Potrur were right when the experts were wrong. But cither the protdems nor the situstfcms are analog**** la fad, almost the r* verse k true. la a recent line of Tit* Jix ma I, the prohtom has been hrouglit weO Into focus by a ocnr*W amusing, but extmnely accurate, edi* tcrWj' coocmdng fsllout: "When the new* media and the bureaucratic hubblrbeads state that you nay devriup abnormalities ta tl<e fifth fmerattoa or the sixth or even the seventh, thk k true. U mey also omit fa tlie riebih frorrstua, but ms the E.'ble pn only unto the seventh. You can't argue with thk kind of Ingle. You my fall of a trud tomorrow and UQ yourself, but you may sot You is#y die of heart disease while you are read* tog tbis editorial, but you may not Also, you may &Cancer from drinking cranberry Juke. Thk I of political tlogaaty--"you mey develon ... ,* "you may be aficcted by ... ,* ' you may become . * resembles the advertising stogaitfyi "If you have leprosy and need salicylic acid, take aspirin.* Thk k the worst bad of deception breaues tt trill the truth. So better example of thk type of deception . exhti In the current literature than statements* based on rvtov-Ua concepts that imply that any measurable physiological reaction Is ortrlertous. The fact k that these iavestigatioas demonstrate merely (hat a stimulus will provoke a reaction. TUs k indeed a physiological fad and Is not nee. amerdr evidence of injury. Aside from these basic physiologic eonsidren* tksu, it k to consider, also, what wc really know about the materials in the atmosphere. The term "air poQutkm* may be descriptive, but it has no etiotocic significance. Without adequate drfiotttott of the airborne materials that ars thought to produce disease, and without adequate definition yf the disease that k produced. It k fato* ous to attempt citlwr to diagnose or prevent dk* ease-the primary purpose of *D health worker*. Aa outstanding example f thk situation Is the priorwt confusion cuonnkf chronic bronchitis. The disease k not only poorly defined, there k also cunfusioa cuncernfog its cause. Far yean, to* bacro smoking tinutitix, postnasal drip, alcohol* In* infection, organic and inorganic irTHants, and so forth have beep regarded as causative agents la Its production. It k said to be characterised by changes la the epithelial mucus* of lie tTh-hro* UmltUl tree, and by the rxpectoraMn* of In* creating amounts of sputum of varislde crrntk* lemy. Yet, even thk common definition is Inter* 1 ptv*ed diKrcmtiy by diflrreot observers. Regardless of the difierencre of opinio* corn corning the diagnosis or severity of bronchi'k, the application of snow* ttimtilc principles to the study of thk disease wiU clarify the problem and result to Improvement The knpbcoltan, however. that all dusts, fumes, and gases produce bronchitis will further confuse, frighten, and fall to reduce rite incidence of (tie disorder, it may, in fact, whfk attempting to reduce one evd, real or bnagtoed, result in more serious health problem*. "Without adequate means of comparing behavior*) and physical dborder* quantitatively. It b Impossible to say, in the sum total of human ailments, which cause* the more actual Incapacity, psychic or or* ganlc Influence*." WWW coniideriog the effects of atmospheric contaminants cm health. It might bo well to consider the effects of air pothitioo propa ganda m Health. To suggest merely that the incidence of a dis ease or disease conditka k rrUied mathematical* )y to the increase I* soot-fall or lower visibility It aot helpful to either patients ir physicians. The substance ia the air that k under u(4ckm most be examined critically from the point of view of both chemical and phytic*! characteristics. When the coapoumt hst Wn Identified and ctastified, its effects must the* be measured both to tb* at mosphere and to the laboratory. If the finding la one do not confirm these to the other, one should pause and rvfirct o* ocher tofiuendng factor*. Thrrc are time* when laboratory results are not confirmed to environmental exposure*, and vie* mu A remarkable example of thk type of oc currence Is that acrolein and formaldehyde do not account for off eve Irritations ta sang, although they appear to do so to staple laboratory sy** Irma.** , At the opposite pots ef unidentified tntcHti ' out and undefined disease entity rc thorn atmos pheric hazards where the agent k known and un derstood precisely, and Its effect has bren studied for many yean. Lead k such a cos*. There k a pro* oral impression that kttto k known about tho ab sorption of lead nod Its physiologic*) consequence* to th' e organism. P" er`haipps nI o dW ci ` subsume has received more detailed investigation and study. TW* tiros and symptoms of Intoxication by thk material have uodergooe long study and observation, aad are reported accurately to most textbooks of Industrial hygiene, toxicology, nr #0* cupaitonal dkeasar. Despite thk fact, medical Jour- tok continue to publish articles stating that laadod gasoline Is mpunsfbte for headache, dry noaa, colitis, kidney akturbaneex. rlrmulic signs, trem or, Hching of the skin, rearms. temporary vkual bnpsirment, backache, vrgrtotive dystonia, and in- fiammalUm erf the nose with abscess formation.** With thk appalling array of symptoms and dk* easca to consider, k tt soy wonder that that* Ir concern about dw trvsls of Wad to urben atnsoa* pherm wise* tha amount of vehicular traffic com tinum to tmeeaeof Yat, detailed studtos * of at Waal oua urban in* (Onrinnsti) over a period of 10 yean haw shown that tha tm*d of concentration of Wad to the ok -mm mnaasmmsiamnjmnuyumm^^ --i. ... .T.i.-':: ' ' -"xVifr" -* 'y- - _'r..,, ; ' >5~.' ^-'V - At o i nJ 1 " i (4 ATXIMniCMC IITCIOC-rilLta 1AMA. ,-te. I*. IMS tnofjihrrc lui lireo steadily dowwin], derptte tl*s Increase In n*toe vehicles aad gasoline cocounip* ttoo. li b obvious, l)*rrrfof, that ooe cannot lft>ply that tliere arc greater levels at lead la the air merely because of Increased use of the compound, since other unmeasured factors ouy trod to reduce what might be considered reasons for Incrtam In concentration. In estimating the deR/ee of any environmental hazard, direct mswinnsot of the environment U essential. In industry, the allowable concentration of lead la the atmosphere that b (cotklmd safe for work er* b 900 mkeopams nrr cubic meter. It might be .postulated that since ne working week iryewoU almost 90% of the total week, a safe concentration In the ambient atmorpltero would bn 60 niem prr cubic meter. Thb might be true If the were simply n oonreactKe receptacle, and cause and effect were a stnsightUoe function. But, since thb is not true, and since rates of absorption, nrtibolun, and excrebon are important, such a igure might be either too high or too low. la fad, the subject cf lead actibolha Hu been discussed extensively." M and the evidence b ckb that the amounts of lead in the atmoapherr (taking taro consideration concent/adon. particle aim. slaotp tbm, and metabolism) are not hazardous. Perhaps It b stgu&caat that load la the atmosphere of Los Atgrln has been reported at lerli an high as 41 inkTopsM pee cube meter without evidence of tocieawd lead abaarpttaa or i&nrm. Perhaps the moat rational attitude toward the problems of atmospheric hygiene wan brat an-' pressed by Prtndle.'* in 1561; "At prevent we do not have enough facts to make completely rmtamal dedakwa in the area of health and air pollution-- not enough facts to know when to ad what proCferly lo lake action agshw*. and to what drfbtr purpose. Lord we do, we can recommend only that the public take herd of the nineteenth cen tury* progress in drafting up Ekb through prag. matte experience.* These are wbr words, indeed, and when drtaliww or comfort are die factors that are heiog affected, Htiaby sQ means of rid of the offending agents, bat 1st as not haply that tier# b a throat to life where there It only an off#me to our comfort and pleasure. la addition, M would be woO to discuss the true (acts when reporting economic loss from air pollu tion. When M b reported that the beehh effects of ah pollution have resulted is bifttooa of dollar* (n health and economic coats, let us be prepared to show the data that demonstrate these conclusions, or be prepared fur satires "* dial demonstrate diet only a lew of the talwim}4ic coaduikm will add up to una-Utud of tlw gross national product. I^taOjr important It the fact that in legislating cartain materials out of nU*M, we run (ho risk of producing even peeler measurable loan Finally, the ability to control the anvtiuwmerit must be weighed Carefully against t!*c fruit* of such cootrol Though the gmeral problem b of great bnprtAnte, them b no sudden rmergrocy, and the problems that do niit can await clear thinking and thoughtful In vestigation. It (* truly anomalous that, although it has been noted * that dental cartes, one almost uni versal disease related to environmental factor*. Is susceptible to the manipulation of die mrirwaang by adding fluoride to water, a Urge body of pobbo opinion b opposed to thb prophy lactic measure. About one year ago the steps essential to deck live statramanahip la die held of atmospheric hygiene were luted as foHow.'* (a) A precise state ment of the essential characteristics of the soslroo mental problem; (b) Aa appr. val by competent . professional groups of the real and apparent health aspect* of the various factor* toiohtd; (c) The development of suitable standardized methods for the analysis of c y o Ck chemical*, (d) The design and nromulgatioe of criteria of health, safety, ami coo/orl in the eoviruusnrat; and (e) The tmicologk cal effects of the substances Ending their way into the toiinwnroi tm*st be assessed on a coBtifwhg bssii by prtfnikmd groups, preferably rooted In swluaUry health agencies rather than |p*imuwaL The practicing physician must braoevnn) with the immediate (tmnUot) of hk nabroL He knows that some persons miy greater degrees of isnctlw by than others, not only to the cnwwmwig. bat to food, brvrragr*. and to forth. In the prevent period , of oonfuason and duagrecBarnt, he not realtor that there ate specific criteria lor the dlagnrob of the effects of laun tuHsUaces lie wiS >mJi these out b* the proper medical tradition, and he cnooot afford to assume that some httherto un known disease entity has been produced by oposure In and abtorpoon of some unknown com pound or combinetioa of compounds. When ho does smpret the influence of emlrungunul tlolngtc factors, he will msauh with hb coDrspoi who are recognized specialkta In the apprabal of the environment and in the study of mi iruninm tally.produced diseases. Above aQ else, the hbtoey of biology nod mrdk cine point out the necessity for bearing cWHjr In miad oar own Ignorance of the optimum. Although It has been possibly to control many factors to the --UcnuiH**t. and It may be asnanrrf that R wfB be possible to modify many others, Dwbas ** hai ob served that: "There are other factor* that cannot be controlled so readily, and perhaps not at alb namely- (1) Those that are built into the toreditary faUie of man, hb biological cycles and perhaps hk futwLmmial emotional response*. () Certain onfwedKlahle natural (mu s and. ms Important parU*(w. dw unpeecUtoble effect* of techaofegioal dvlhsatJon.* These are the facts of life as we have ahwtya known them. Thb b not a phfloooplnr of despair, but, rather, aa awairnrss of our own (imHartom of