Document jNVvw13z0MzQ5LVEYE7832apN

L.cP'-i i o ^ -sa IWUlf THE NEWSMAO\ZNE OF MEDICINE /, MARCH 3Q198) PCBs sour some on mother's milk lAMtlNP, mat--Growing concern that America's littkit inhabitant* may be bearing the biggest burden of environmental contamination i* leading health author!tie* to reluc tantly reweigh the ri*kt and bene fit* of breutfceding. In the wake of a University of Michigan report demonctrating that contamination with the induatrial poflutant polychloride biphe nyl (PCB) i* ubiquitous and nurs ing mother* may b* endowing their infanta with heavy doaaa of the lipophilic chemical--mobiliied from what toxicolcgiit* call "the vast link of body fat"--the elate health department here convened a elect panel on PCB*. The expert* concluded that "the vast majority" ef Michigan mother* needn't wor ry, but a few may have to reduce or even atop auckling. "We aapport a* much breast feeding a* possible," lay* Dr. Laursnoe Flnberg, a pediatries profes sor at Albert Einstein College of Medicine in New York City. "But we're also concerned about toxin* that would contraindicate it" Dr. Finbsrg, chairman of the Ameri can Academy of Pediatrics' enviroamontaJ-haiardo committee, was one of those called bar* by Dr. John L loblstor, head of environ mental epidemiology in Michigan. This oolect group decided only women with PCB level* over 10 parts per million should discontin ue breastfeeding. It advised thorn having between 5 and 10 ppm to discuss with their physicians the possibility of decreasing the fre MCDCAl WOULD NCWS/Mrcb 30, 1931 quency or duration of nursing ses sions, which normally are nutri tionally and immunologically su perior to bottle feeds. Such women are few, said the panel's report, and their "unusual exposure" is likely to have come about through occupational contact with PCBs, as in the manufacture and servicing of oil-filled power transformers. High levels may also be found among women exposed to accidental releases of the chemical or those who regularly eat fish from the Great Lakes and other heavily contaminated waters. But most women don't need to have their breast milk tested, panelists stressed; the state makes no provi sion for such screening anyway. Michigan wants no PCB stigma. An episode of human and livestock poisoning here in the early 1970* was traced to animal feed tainted with the PCBs' next of chemical kin, polybrominated biphenyls (PBBs). "But PCBs aren't unique to Michigan," Dr. Isbister told mm. "They're widespread." Very likely, though Ann Arbor researchers detected them in all 1,067 samples of breast milk sub mitted by women in this state for PCB snd PBB testing. In Febru ary's American Journal of Public Health, the team reported most of the mothers had PCB levels of 1 to 2 ppm, though the range ran up to 6.1 ppm. The study's median of 1.35 ppm means that half the study population had "a level nearly equal to or above the present FDA tolerance limit for PCBs in cow's milk." It also means 36% of their infants would have a body burden of 1 ppm or more at nine months But no one knows whether such concentrations are harmful. The investigators consider a maternal load of 2.3 ppm--a full standard deviation above their mean--"ele vated" and the signal for decreased breastfeeding. Just over a year ago, Wisconsin health officials asked physicians to send in milk samples from lariat ing women who may have been exposed to such PCB levels But s sharp rejoinder in the journal Pediatrict reminded those doctors -onWaarf HONS 015540 7 i that th* baaodta of broaatfaading iff wall tahHMwd while th* haa- ard* of PCB iaftion an not mi w lu tboy'v* oohmittod baraly a demon opedmoii*. "Pediatrician* claim then have batn no cam report* of frank illoeee [from PCB*} in the U.S.," sot** Ttwmaa M. Wleklxar, a raaaarth mandate at the Uniroroity if Waahiagton School of Public Health In Seattle and a former raeoarch aaaiatant at Ann Arbor. "Bat I worry about aubtle affect* oo the narvoua ayatam and aacoodary probiami from liver toxfdty. Moreover, we don't know the interactive affect* of the chemi cal*" Ho further erarn* that the level of biphenyl* in braatt milk i* only half the haiard, the other half being it* fat content. PCB*, like DDT and other biologically penitent organochloride compound*, an evented in the fat component of milk, and thia varie* among women and according to the time of day. "A mother with twice aa much milk fat tranamits twice aa much chemical contamination," Wickiaar point* out Aleo often ignored ia the fact that infanta aren't PCB virgin* at birth. Tmaaplacental tranamiaaien ian't generally appreciated," ohaarva* pediatrician Maaon Barr, teratology director at the Univenfe ty of Michigan. "The depoeition of PCB* in certain fetal tiaaue* i* *n ana of concern." In 1976 and 1977, he and hie colleague* found PCBrelated PBB* in the brain* of etillborn infanta, a finding "we haven't purauad," he told nm. But other reeearchete are pureuiag euspickma that breaat-milk PCB* may be affecting th* behav ior and health of normal-appearing babiee. Further, recent studiee mggeat that aome PCB iaomera more toxic than ocher* may preferen tially accumulate in breaat tiaaue. The only known epiaod* of human PCB intoxication occurred in 1968 in Japan. Surviving chil dren born to women who'd ingeeted heavily contaminated rice oil there were found to be neurotogieally and developmentally impaired nine year* after th* poiaoning. Only recently have phyxicians begun to meaaure the health effect* of low-level chronic PCB expoaure from breaat milk. In North Carolina (mm, Feb. 5,79, p. 72) and Wiecomin. doctor* are monitoring the development of matched act* of breaat- and bottlefad infant* but their reaulta are at leaat a couple of year* off. How ever, Univeraity of Wlecowm re- earehen have noted growth lag* and learning doddt* among rheaua monkey* born to mother* who cea- umed 2.5 to 5 ppm during preg nancy and lactation. Dr. David P. RaB, director of the National Inatitpta of Environmen tal Health Science*, told mm that in on* atudy not a* yet rvpiieatad, children with large amount* of PCB-related PBB* in body fat did not perform a* well a* thee* with lower level*. In hi* own ttudiat of rata, he added, moderate dcae* of PBB* have derreeeed neurobahav- ioral rraponaei. And at th* envirnamental- Riencea laboratory hooded by Dr. Irving J. laBhaff at Mount Stoai Medical Center in Now York, phy- aiciana have long baia boapfeg taka on PBB level* among Mlrtdgon rea- ident* "All paopie there ham men- aurable amount* in thoir timua," Dr. Selikoff told mm.' "And ife likely PBB* will appear in braaat milk." Th* danger? H* mid hia team ha* evidence that "iiaiaiaaia to infection ia dorroaeod, and poeai- bly reoiatanc* to cancer." Still, pediatrician Finburg of New York City ohaervea, "Thor* are lot* of unknown* aad th* ia*B* remain* open." a Companies find tMOs don't cut costs MDUtO MRt CMM. --Cowtpaaua that have added aa HMO optian to their werkara' benefit program* art ladiag that th* dual ehaico approach loot euttiag thoir haelth- ear* coat*-aad in aom* caaaa may b* booatiag them. Fully 68* of aanior axacutivo* of Bra* offoring omployooa either HMO coverage or standard health iaauraae* foal giving thia alterna tive haa had no effect--up or down--o* expoaoee, according to a corny by Untie Harria aad Aaao- datoa. Though 13% of th* remain ing cfllcinla my coat* have bean lowered. ld% believe HMO cover age h*a led to higher eoatn The mrvey, done for th* Henry J. Kaiaer Family Foundation hero, in beeed on intorvienc with 964 oAdah roughly half in charge of benedti aad half cfaiaf oxecutivea, in 684 email to oaadinm-aaad eompaaim ecrca* th* nation. About two thbda of th* oompaniaa h*v* axporienc* with HMO*. Th* Keieer family, of eoorae, aet up what is today th* large* HMO, KnimrPormenenu. Harrie eoncedet the survey shows little cawvioiou amoug aa-- ployer* that th* HMO option law-' era haalth-baaafit casts, tvaa though HMO* an widely toatod aa cheaper than tradWaaal eaeonga. But Harria term* "pooitiv*" tha finding that at Imit omphyura already offoring tha HMO aptiea gmaralhr don't view it m an addad expanse; ha roaaono thia dmdd *U*y th* fear of oompaaiao not MEDCM. WOULD WWS/Mvtft SO. lt*l MONS 0X5541 B