Moving Away from Mercury - Why and How

May 11, 2004
11:42 am US Eastern Time

Background Information/Resources

Call Transcripts

1. Call Moderator - Charlotte Brody, R.N., Executive Director, Commonweal and Health Care Without Harm

2. Science Update:  Pete Myers, Ph.D., CEO, Environmental Health Sciences and Co-Author, Our Stolen Future

I'm sure most of you saw the article "What the World Needs now is DDT," by Tina Rosenberg in the New York Magazine a few weeks ago. She made a statement in that article that those who follow the science of DDT, felt was rather outrageous. In essence, she said, "Surely by now we know everything there is to know about  of DDT."

 A quick look into one journal, Environmental Health Perspectives, over the last few months, reveals how false that assertion is. In the April edition of EHP, with articles that were put online in January, Salazar, Garcia, et. al., studying malaria control workers in Southern Mexico, found that paternal exposure, exposure of men applying DDT to control malaria, was associated with almost a four-fold increase in birth defects in their children. Another study, which just went online in the last few days, looked at residual DDT levels in African American agricultural workers in North Carolina. They found significant reductions in Immuno-Globular G (IGG), in workers with somewhat elevated DDT levels. The immunologists among you will know that IGG plays a crucial part in the body's defense against pathogens. The authors, Cooper, et. al., expressed concern, particularly for infants whose own ability to produce IGG is limited through development, about what the impact of DDT might have on the immuno-competency of infants exposed. In this case, they also commented that while there's a lot of lab work on DDT effects on the immune system, their study is one of only a few studies actually looking at humans and DDT affects on immuno-competence.

So, Rosenberg got it wrong. She would have been well advised to look carefully at a paper by Shannon Rogan, in Emerging Infectious Diseases, which made a very careful effort to look at some of the tradeoffs that are involved in DDT use in malaria control and the effects on mortality.


3. Feature Presentation: "Moving Away from Mercury - Why and How"


4. Welcome: Charlotte Brody, R.N., Executive Director, Commonweal and Health Care Without Harm

Thank you to everybody for joining us today. I'm really pleased that we are able to have this discussion today because mercury is really a metaphor for the work of the Collaborative on Health and the Environment in a couple of ways. One way, as we'll learn from Ted Schettler and Jane Hightower, is that mercury is the kind of toxic substance where we're learning that it's not just occupational exposures in large amounts that matter. We're learning that exquisitely small amounts at the wrong time can be a problem. And it's not just the people who are directly exposed, it can also be a problem for people who live thousands of miles away from the original emission.

We're also going to hear from Jaime Harvey, Lakota Harden and Susan Marmagas, who can give us the other part of the mercury metaphor about this being a problem, that people are figuring out how to solve. We will, for one of the first times on a CHE call, get to hear about the different corporate and public policy opportunities that have taken place and are taking place to do something about the mercury problem.


5. First Speaker: Ted Schettler, M.D., MPH, Science and Environmental Health Network

Mercury is actually a rather complex metal, because it can exist in several different forms. I will talk about three of these forms: metallic mercury, inorganic mercury and organic mercury. Metallic mercury is the kind of mercury that many of us played with in our childhood. It's the silver metal. The problem with this one is that it can volatilize or evaporate so we can actually breathe it in. That is an important pathway of exposure for metallic mercury, which is why mercury thermometers can be a problem if they break in a house. We are also exposed to metallic mercury, to some degree, through the metal fillings that are in some of our teeth. It's not well absorbed from the gastrointestinal tract, but as I mentioned, it can be inhaled. This kind of mercury, elemental or metallic mercury, is readily distributed to the body, easily crosses the placenta and the blood brain barrier, and easily gets into the brain and the developing fetus. When it's metabolized or oxidized to an inorganic form, it doesn't cross the placenta particularly well, but tends to get into organs, and stay there.

This is somewhat different from inorganic mercury, which is slightly better absorbed from the gastrointestinal tract, but it does not cross the placenta or the blood brain barrier quite as easily as metallic or elemental mercury.

Then there's mercury that's released from incinerators and coal-fired power plants. This mercury is released into the atmosphere and when it finally settles onto the surface of the earth, often thousands and thousands of miles from where it was released, it gets into the sediments of water bodies where it's transformed chemically to a third form of mercury called organic or methyl mercury. This form of mercury biomagnifies or bioaccumulates as it moves up the food chain and it contaminates the fish that many of us eat. The fish at the top of the food chain tend to have the highest levels. This is an important pathway for this form of mercury. Organic mercury is rapidly absorbed from the intestine, unlike the other forms. It's stored in a variety of organs in the body. It easily crosses the placenta and it easily gets into the brain of the developing fetus and when it does get into the brain or other organs, it's sometimes converted to one of the other forms of mercury and it's stored there for a long period of time.

Mercury is thus a complex metal with several different forms and the way it behaves in the body varies depending on the form it's in. The developing fetal brain is thought to be the most sensitive endpoint or organ to low levels of exposure.

Considerable research has been done to identify the impacts of low-levels of exposures. These studies were largely triggered by observations of severe damage to developing children whose mothers were exposed to organic or methyl mercury in Minamata Bay in Japan and some poisoning episodes in Iraq where after high levels of exposure, several of the children had cerebral palsy, seizures, mental retardation, blindness, deafness and various kinds of psychomotor delays. In some cases the mothers of these badly injured children showed limited or no impacts. This provided the clue that the developing child is most sensitive, whereas the adult is somewhat more resistant.

A number of studies have been done looking for evidence of low-level effects of methyl mercury exposure to see what the threshold might be and to see what happens in the general population where exposures are generally lower that than they were in these poisoning episodes. Two of the best known are studies that were done in the Seychelle Islands and the Faroe Islands. In the case of the Seychelles, they were eating fish. In the case of the Farrow, they were eating Pilot meat, which is a staple of the diet in that area. There have been other studies that were done in New Zealand and Brazil and elsewhere. In the Faroe Islands study, investigators found impacts as a result of in utero exposure. They found impacts in the developing children on language, attention and memory function. They were able to identify a benchmark dose, where you can begin to see those adverse effects. Based on the results of the Faroe Island study, the EPA established a reference dose, which was later affirmed by the National Toxicology Program.

Many of you are probably aware that the Seychelles study did not find the same impacts on children's neurodevelopment as those in the Faroe's. We could go into a discussion as to why those differences are there, but for now I'll just summarize by saying that some of the hypothesis are that there are either cultural differences and cultural relevance of testing that was used may explain the difference. A technical issue is that the Seychelles children were entered into the study at six-months of age, whereas the Faroe's children were entered at birth and umbilical cord blood-levels of mercury were measured in them. That was a difference in the study design in the two instances. There may also be an important difference in the dosing patterns in the two populations. There may also have been other dietary factors that may have caused this. It's known that other dietary factors like Selenium and various fatty acids can alter the neurodevelopmental impacts of mercury.

Considerable information has been obtained on the mechanisms of toxicity. To summarize, mercury can disrupt a number of different processes that are necessary for normal brain development.

There are other health affects that are associated with mercury besides the impact on the developing brain. These include impacts on blood pressure and heart rate variability in children in the Faroe Islands. Studies have been published showing a correlation between mercury levels and a risk of myocardial infarction in adults. There are also immune system impacts that have been studied and identified in both laboratory animal test and human populations.

Finally I'd like to point out two areas of real controversy where the data are not thoroughly consistent. We still do not know the health impacts of mercy in dental fillings.  We also do not fully understand the implications of the use of Thimerosal, which is a form of organic mercury that is used as a preservative in vaccines, or at least historically.

Many of you are aware of the controversy surrounding these two issues. Some hypotheses have been generated about the relationship between those exposures and, for example, autism in children and a variety of health affects in adults.


6. Second Speaker: Jane Hightower, M.D., Practicing Physician

I'm an internist in San Francisco. I do primary care and diagnostic work-ups. I'm independent from all organizations other than my medical society, and the College of Physicians and Surgeons. I'm sort of a chronic non-joiner. I'm also independent from all insurance companies, therefore I'm not a participator in any of their plans. So no one can really look over my shoulder and say, "no, you can't test mercury." So I had free range of my pen, which made it very easy to check some people.

I stumbled upon this issue when a colleague of mine in dermatology was listening to a radio show in Idaho. People were calling in and saying that their hair was falling out from eating fish from a polluted lake. Of course a dermatologist always wants to look at causes of hair loss, because oftentimes we can't find it. She's in research, so she wanted to test this. The first patient that walked in who had hair loss happened to be one of my patients. My colleague asked if she ate fish. We really didn't know much about what fish, how much, etc. So she tested the first patient, and her level was about four times higher than the reference dose. Now remember, there's a bench-mark dose, which is the Faroes, and there's a reference dose. Those are two different issues, but they happen to be the same number.

So, I re-tested her along with her urine levels. Her urine was negative, her blood was positive. She had various symptoms of trouble thinking, she had passed out, she was having memory loss, stomach upset and muscle aches. Essentially, I realized that I had a number of patients who had similar symptoms. I started looking into the literature on mercury and the Japanese literature and the large epidemiologic studies. Realizing that in San Francisco we do eat a lot of fish, I started testing people. The day that I got my second results from patient one, another patient came in and said, "I swear my house is making me sick.'' Her level was higher than the first patient. Essentially, I realized quickly that this needed to be reported. I informed public health officials, local and state level, my medical society, and I was even connected with folks at US EPA, who flew out to San Francisco to meet me, very early on, to look at charts and confirm that I was documenting these high levels.

So, for one year after meeting with public health, I did a survey of my practice, complete with survey forms. Because I didn't have a grant, I only tested those with medical indication. I used the reference dose as a way to screen and the FDA's lists of mercury contents in fish. If a patient was over on their intake on mercury, not necessarily fish, but mercury, then they got tested. I got Dan Moore on board, who is a biostatistics Ph.D and very capable. We published in Environmental Health Perspectives.

Essentially it's not rocket science. You eat mercury and it goes up in the body, you stop eating mercury and it goes down. I got 67 people to stop eating mercury and their levels went down. Two people did not go down in the initial study. One was lost in follow-up and the other reduced his level to less than five after the study.

Because I did this study myself, I've been educating myself for the last four years and did extensive research on my own. I have also been educated by others including Ted Schettler and the whole gang of mercury researchers, all of which has helped to make me well-versed in the literature, history and biochemistry of mercury.

Subsequent to my study, I re-looked at the charts, because, when looking at symptom profiles such as fatigue, muscle aches, stomach upset, hair loss, those types of things that have been associated with mercury in other studies. I also noticed that I eliminated anybody who had other disease diagnoses. So, I thought I would throw everybody back in the pot and re-look at what they had. What's interesting is that I have a very high amount of those with atherosclerosis. I think we had 15 or 17 people who had coronary artery disease on angiograms and all the subsequent complications, such as strokes. There was also a lot of auto-immune disease represented. So, what Ted Schettler had said, according to the literature, if you increase your mercury even slightly, and that means a hair level of 2.1, you can double your risk of heart attack and triple your risk of death from heart attack, in the men's Finnish studies. Research with toenail mercury and that showed that you also will increase heart-attack levels with minute levels of methyl-mercury and it can negate the good effects of Omega-3s. All I would have to tell the American Heart Association is that we have not met our goals and we need to have some goals on methyl-mercury and that we need to keep it very low.


7. Third Speaker: Jamie Harvie, Institute for a Sustainable Future

I'm just going to give a quick snapshot of where mercury policy is. I think it's instructive to take some of the comments that Ted made in reference to some of the advances in the science in the Seychelles and Faroe studies. I think we need to find out more about mercury, because the more we learn the more policy is enacted.

Around the mid-80's the Great Lake States started to take notice about mercury problems in their lakes. They started doing studies and found mercury in fish and started to enact some policies. These included primarily regulations prohibiting disposal of mercury in waste. As time went on, by the mid-90's there started to be more and more interest and concern about mercury contamination especially in the Great Lake States and Atlantic Provinces. Mercury sources and distribution are primarily air-bourne, which are transported by the prevailing winds. As you go from west to east in the North American continent you are going to have higher concentrations of mercury. Of course there will be some local variations. The New England States started to take notice of mercury because of the studies that they were doing there. By the mid-90's, the New England Waste Managers Association started working to put together some model mercury legislation. By the end of the 90's, we had a mercury ordinance on thermometers that was passed and quickly followed by ordinances in San Francisco, Boston, New Hampshire and a couple of other states. This was really the first mercury product legislation prohibiting sale versus disposal. From the late 90's to present day we've had a number of significant pieces of mercury product legislation put into place. The states that are really taking the lead are these New England states that have been over time have been trying to implement this model mercury legislation. The legislation has passed in Rhode Island, Connecticut and Maine, where to varying degrees, they've been mercury in switches and mercury in measuring devices. The Great Lakes States, the New England States, the Northwest and Californian States really started to get on board in passing mercury legislation.

From the air perspective, which is the largest source of mercury pollution. Coal-fired power plants represent about half to 60% of mercury emissions to the air. At the federal level, during the waning days of the Clinton administration the EPA issued the Clean Air Act (section 1112), where they would call for the reduction of mercury emissions. The intention was to regulate mercury as a hazardous air pollutant, which would require maximum achievable control technologies. Under this rule it would achieve a 90% reduction by 2008. So that would essentially be putting mercury control and cleansing technology on the top of the coal-fired power plants stacks. This was later changed, by the current administration to one that would only require a 70% reduction by the year 2018. So this policy on mercury is currently up for debate.

There are still some flu vaccines which contain Thimerosol. A majority of vaccinations have reduced their use of Thimerosol by going from a multiple dose to single dose vials, thereby preventing cross-contamination of the vial. So where you still see Thimerosol it is because they are still using primarily multi-dose vials.

Mercury has also begun to be restricted in dental offices. Mercury is used in fillings and discharged from filling and amalgam repair. This source now represents up to 40% of the mercury in waste water. What has started to be implemented in several states are requirements, some voluntary, some legislative, for removal technologies. These are screens and pipes that would remove the mercury that comes out of dental offices.

While there is no national ban on the sale of mercury thermometers, essentially 100% of the national chain drugstores, including the major pharmacies have agreed to stop selling mercury thermometers. There are also a couple of sphygmomanometer makers who have stopped their sale of mercury containing blood pressure devices.


8. Comments, Discussion, Questions and Answers


Lakota Harden, International Indian Treaty Council:
I work with the treaty council, which has consultative two status with the UN. We have been looking at indigenous issues for a long time. We were formed in 1974. Currently we have representatives at the third session of the UN's permanent forum in New York presenting this because it's an indigenous women's topic and this definitely affects our women.

Through our work and looking at the environment we started looking at Northern California. In our research, we're finding out that there are over 300 abandoned mercury mines in the California coastal range, that we know about. There are also 1000's of gold mines that we don't know about. Approximately 26 million pounds of mercury were used in gold ore recovery in the Sierra Nevada's and the Klamath Trinity Mountain areas. These are our homelands here. Our people are sedentary tribes and the Olampomo and the Klamath and all the other tribes depend on fish as their way of life. It is not just for subsistence, it's cultural and it's the way that they've existed all these centuries. So this is a very personal issue for us.

At the permanent forum the opening of the third session the UN Secretary General, Kofi Annan, announced that the international community still needs to address this. There is a history of inequality and disproportionately extreme poverty and pollution in our communities. This has been an ongoing thing for us.

We started doing our own research. We've been going out and trying to get information about mercury issues to our communities because the majority of these people don't know, particularly those who are non-English speaking, and other communities as well, including Asian, African-American and Latino communities who may be taking fish from the bay.

We've put together flyers and a booklet that's available on our website. We worked with the Hesperian Foundation to make this booklet accessible to people who are uneducated, as well as to those who aren't. We also have a video called Gold, Greed and Genocide, which looks at the history of how this mercury got there and how it was never cleaned up. People don't want this information out because it depreciates the value of real estate.

We've been working with the Northern communities by educating all the WIC (Women, Infants and Children) who gives out tuna to pregnant women and encourage them to eat more fish. These are often people who live below the poverty line and they depend on these things.

So we need alternatives and we need clean up and that's what we're working towards. One of the ways that we've been doing this is by having these coalitions with other communities and organizations that are looking at this issue. Ultimately what we need is alternatives. We can't tell these people to stop eating their traditional foods without offering them an alternative and educating them.

On an international level, the UN Environmental Program has taken this issue up on what's called the Mercury Global Pollution Problem that we've been a part of. There was a recent conference held and there will be another one in Kenya in 2005.

Our website is www.treatycouncil.org.


Susan Marmagas, MPH, Physicians for Social Responsibility:
I'm going to speak briefly about the Mercury Air Emissions Rule that is currently under discussion across the country and is a proposal by the EPA. CHE Partners can play a role in commenting on this rule, providing input to EPA on this rule and elevating the importance of this rule through the eyes of public health, children's health and women's health. We have helped to lead an effort across the country that has really helped to re-frame the Mercury Air Emissions Rule as fundamentally a public health issue and one that significantly impacts our children. This has involved working very closely with CHE Partners. The Learning Disabilities Association has been working very closely on this issue as well as the Learning and Developmental Disabilities Initiative Working Group (LDDI) that is a part of CHE. In fact, in a couple of weeks when LDDI has their national meeting here in Washington, they are planning to meet with the EPA officials and bring the learning disabilities community actively to the table with Administrator Leavitt.

The message is really a fundamental message about children's health and elevating this issue in the press through the eyes of children so that it's not just another environmental policy story that gets covered as environmentalists versus industry with EPA and the administration in the middle. That has really been a very message that a number of organizations, including CHE Partners have been involved with across the country.

So the question really is how can CHE Partners be more engaged. There are a number of options. The first is that there is a national consensus statement of public health, medical organizations that has been put together. All of you on this call as organizations can join that consensus statement. It is linked to the agenda that Jeanette sent out. If you are interested in signing on you can email me at swest@psr.org.

The second thing is the comment period at EPA is open, it has been extended for two more months and it's open until June 29. So we invite you as organizations and as individuals to submit public comments to the EPA docket. We already have over 500,000 comments to the docket, which is twice as many as has ever been submitted on any EPA rule in its history. It is significant that the public health voice and the public voice is coming out on this issue.

The last thing is that as CHE Partners, you also have a really important role to play with the press. We have found that the press has really covered this story as a public health issue and a kid's issue. If you're interested in working on letters to the editor or op-eds, PSR is here and available to assist you in doing that. We have a number of options that we can certainly help you with if you'd like more information on how to be involved and get your message out in the media arena.


Alison Carlson, Senior Research Fellow, Health & Environment Program, Commonweal:
I read in various chapters in Generations at Risk about inorganic mercury having some effects in menstrual abnormalities and spontaneous abortion. Ted, would you be able to note what the strength of the evidence is for inorganic mercury's effect's on reproductive health?


Ted Schettler: I do know of studies that have been done on dental assistants who have been disproportionately exposed through their occupational work. In some studies, but not all, they have had increases in spontaneous abortion and reproductive problems. As with so many epidemiological studies there are strengths and weaknesses to each of them. That doesn't negate the evidence, but it is a body of evidence that has been gathered from that population.


Diana M. Lee, M.P.H., R.D., Environmental Health Investigations Branch, California Department of Health Services:
I believe also in the health professionals follow-up study, a majority of those participating were dentists and that was one of the cardiovascular studies that looked at mercury as well.

Sandra Miller Ross, Ph.D., Health and Habitat:
Does anyone know a decent digital thermometer? I also hope you will do a discussion like this on fluoride.

Jaime Harvey: All digital thermometers that are sold in the marketplace have to go through the same voluntary testing protocol that mercury thermometers do. So all of those thermometers on the market should meet the standard requirements. There is no specific brand that leaps out as one over the other.

Charlotte Brody: Regarding fluoride, I can tell you that is on the list for discussion.

Pete Myers: The tradeoffs that Shannon Rogan explored have to do with an associated between DDT and a decreased lactation period. Women with higher levels of DDT in their blood breastfeed for a shorter period of time. There are some hormonal feedback loops involved in the control mechanisms. As you all may know, there is also an association between duration of breastfeeding and infant mortality. In fact some important new results came out on that last month on that. So one of the tradeoffs, which they explored in a paper published by the CDC, was while you can decrease infant mortality due to malaria by using DDT in malaria control, the evidence suggests you are also increasing infant mortality via that mechanism. There are several other things including increased chance of pre-term birth associated with DDT. So, it's not clearly a wash one way or the other.

Earl James, Director of Development, New Mexico Environment and Health Coalition, New Mexico Environmental Law Center:
Do you know of any state regulations that apply to crematoria emissions. I'm thinking about mercury emissions specifically. We don't have any in New Mexico, but our air quality bureau is thinking about it, so I'm looking for models.

Jaime Harvey: A number of states in Europe have implemented regulations and I can send more details on that. There are currently no state or federal regulations on crematoria in the US. In Europe they consider mercury emissions from crematoria as the second largest source of mercury to the air.

Alice: Do you have any more information about the midnight protection for vaccine manufacturers?

Jaime Harvey: My understanding is that exemption was removed.

Bill: That is correct. It went back to the Senate Committee and it was overwritten. It's a non-issue right now.

Anna Dillingham, Outreach Associate, Trust for America's Health:
We are working on a new initiative that is very much in the development stages, but it is complementary to what you're working on. We're working on a public education campaign to educate the public about the effects of mercury, along with the importance of Omega 3 and the need for same fish consumption. We're also trying to raise the awareness to create a demand for routine testing of mercury along with Omega 3 levels. As many of you know we've been working on health tracking for many years and we see this as a way to advance the exposure monitoring component of health tracking and working on increasing biomonitoring capacity. We are just starting this but when we have more details we will look forward to collaborating with the work so many of you are doing.

Madeline P. Beery, M.Ed., Mercury Program Manager, Office of Environmental Health Assessment, Department of Health:
Is there a good substitute for a mercury free scoliometer available now?

Jaime Harvey: My understanding is that there is, but I don't remember the name of the manufacturer. If you go to the Sustainable Hospitals website at www.sustainablehospitals.org, I believe there is now information up on the alternative.

Beth: Ted, do you have any more verified information about the risk to dental patients with amalgam fillings? And are there fish consumption guidelines posted anywhere?

Ted Schettler: As far as dental fillings, let me just say that this is an area of enormous controversy. There is a fairly extensive literature that concludes that some patients who have a variety of symptoms, many of which were mentioned by Jane Hightower and others, improve when their fillings are removed. It's a large literature and is often the case, many of the studies are better designed than are others. One of the things that is currently being investigated is whether there are neurodevelopmental problems in children who are treated with dental fillings. This is an ongoing study and the results are not yet in. I want people on the phone to be aware that this is an area of enormous controversy and there are a number of websites with large numbers of studies posted to them. I really couldn't do it justice to try to summarize this right now. This is one of the areas where people have strong feelings. It's an area that needs more investigation, at the same time we put the evidence up against the fact that there are good ways to repair teeth and to provide good dental care. It becomes one of these tradeoff questions that are complex, but which we need to do a better job of engaging.

Susan Marmagas: The FDA and EPA released a joint advisory on fish consumption in the end of March, which just related to fish consumption and the issues of mercury. Many of us in the public health community do not believe that this advisory goes far enough. In fact, in June PSR is releasing a set of guidelines about fish consumption which was originally started by Greater Boston PSR, Ted Schettler and others. We are now working with the Association of Reproductive Health Professionals to do clinical guidelines for the reproductive health and pediatric communities on effective communication materials for patients. So they can provide guidance to their patients and along with that will be materials that they can actually pass out and give to patients in their waiting rooms. So that will be coming out in June. It will be available in hard copy and on-line. It will be linked to our website at www.mercuryaction.org. It doesn't just address mercury, it also addresses PCB's.

Jaime Harvey: The Institute of Agriculture and Trade Policy, an organization based in the Twin Cities, just today released their fish calculator, which allows you to enter your weight and fish species online to give you a recommendation as to how much of that fish you can eat. The fish calculator can be found at www.iatp.org.

Charlotte Brody: This is an important tool, because it allows us to talk about the fact that there are some fish that have much lower levels of mercury.

Bill Ravanesi, M.A., M.P.H., Boston Campaign Director, Health Care Without Harm:
Yesterday we held a New England Fish Advisory Forum.  We brought together scientists, the public health community, health professionals and the regulatory makers from six states. This was put on by the New England Mercury Zero Campaign. In the spirit of disclosure, our funders, The John Merck Fund, who's done a lot on mercury, Health Care Without Harm, Clean Water Action, National Wildlife Federation, Mercury Policy Project and the Environmental Health Strategies all worked together in the six states to bring the regulators together. In the afternoon we put on panels where we attempted to raise for bar for state regulators throughout New England to come out with consistent fish advisories, both in terms of the fish you catch and the fish you buy. So we'll see how successful we are with these six states in the coming months to see if they step up to the plate and ramp up on a consistent communication level. We're feeling at this point that the point of purchase awareness has not been as great as we would like to see it throughout New England and New England eats a lot of fish.

So this forum can be replicated and if you would like to get in the mix on this we'd be happy to send you some information. I can be contacted at Ravenesi@bu.edu.

Madeline Beery: I would like to add that we do have a fish facts brochure that you can all access from our website at www.doh.wa.gov/fish. Our advisors have also gone beyond the recommendations of EPA.

Jane Hightower:  I were to have my choice I would want to have a mercury advisory rather than a fish advisory. There were people in my study who ate 50 meals of fish a month and didn't have nearly the levels of mercury of some of the people who ate five meals a month. So it really depends on the mercury content and that needs to be stressed.

Alison Carlson: Something that really concerns me, that no one has addressed yet is people replacing fish consumption with fish oil pills. Can we trust that those that are supposedly marked PCB or contaminant-free really are?

Jane Hightower: Consumer reports had a wonderful article in the July issue of last year, where they checked 16 different brands and there were only trace levels, so they are distilling out those contaminants. They only drawback is that in the Tampa Symposium, some nutrition people said if you have too much Omega 3 fatty acids you can have stroke and disruption of your immune system. So I still think we can go overboard and over dose on Omega 3 fatty acids.

Charlotte Brody: That is our last comment. I would like to end this call with a welcome and a thanks and I ask all of you to help me to do this. Starting in late June a new Program Coordinator at CHE, Eleni Sotos, will be joining us. We get to keep the wonderful work and fellowship of Jeanette Meyers, who will be stepping down as Program Coordinator, but will still be connecting with many of you as a part-time CHE staff person working especially with health affected groups. So, if you will all help me thank Jeanette for her wonderful work as CHE Program Coordinator and welcome Eleni in the days to come. I think we have great things in store for the future.

Jeanette Meyers: The next CHE Partnership Call is June 30, at the same time, 9 a.m. Pacific / 12 noon Eastern. This call will be one hour and the topic will be Birth Defects. We hope that you will all join us.

Charlotte Brody: Thank you to all of our speakers and to everyone for joining us on this call.