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This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2005.067215v1 95/8/1304-a    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Arnold, S. M. Articles by Middaugh, J. P. Search for Related Content PubMed Articles by Arnold, S. M. Articles by Middaugh, J. P.

Scott M. Arnold, PhD, Tracey V. Lynn, DVM, MS, Lori A. Verbrugge, PhD and John P. Middaugh, MD

At the time of writing, all authors were with the Section of Epidemiology, Alaska Division of Public Health, Anchorage.

Correspondence: Requests for reprints should be sent to Scott M. Arnold, PhD, Alaska Division of Public Health, Section of Epidemiology, 3601 C St, Suite 540, PO Box 240249, Anchorage, AK 99524–0249 (e-mail: scott_arnold{at}health.state.ak.us).

Knobeloch and Anderson assert that the current approach to fish consumption advisories is effective and empowers women to make improved choices. Yet they acknowledge that the public is confused. While the intent of national advisories is laudable, the public health consequences seem unsatisfactory, because there is recent evidence that generic fish advisories may have decreased fish consumption nationwide.¹ Therefore, we do not agree that women are being empowered or that the current approach is consistent with the principle of beneficence.

We do not recommend telling worried people not to worry. Alaska’s fish advisory² was developed through collaboration with many entities after fully considering all available evidence regarding benefits—including nutritional, spiritual, and cultural benefits—as well as potential risks associated with consuming locally caught fish. We believe the current scientific evidence suggests that risks associated with methylmercury exposure from fish consumption are overemphasized, and benefits are not adequately addressed in current US Environmental Protection Agency (EPA) guidelines. We note that Knobeloch and Anderson emphasize potential risks from methylmercury to cardiovascular health, although the evidence is weak and the weight of evidence strongly supports the health benefits of fish consumption.³

Biomonitoring is a tried and true public health tool for targeting populations at risk from exposure to methylmercury in fish. We propose that biomonitoring be used whenever possible to determine actual levels of exposure, not theoretical estimates, and to tailor dietary recommendations that balance benefits and risks.

Local public health authorities are uniquely qualified—indeed, they are the only ones able—to accurately evaluate local risks, populations, and issues. Fish consumption advice should originate from them. The EPA and US Food and Drug Administration national advisories fail to adequately address or account for local circumstances and variations. Only when all members of a community are provided with accurate, balanced information regarding actual benefits and risks are people truly empowered to make good decisions.

References

1. Oken E, Kleinman KP, Berland WE, Simon SR, Rich-Edwards JW, Gillman MW. Decline in fish consumption among pregnant women after a national mercury advisory. Obstet Gynecol.2003;102:346–351.[Abstract/Free Full Text]

2. Bulletin No. 6, June 15, 2001. Mercury and National Fish Advisories Statement from Alaska Division of Public Health, Recommendations for Fish Consumption in Alaska. Available at: http://www.epi.hss.state.ak.us/bulletins/docs/b2001_06.htm. Accessed June 7, 2005.

3. Regulatory Impact Analysis of the Clean Air Mercury Rule. Final Report. P 2-7, C-10. Research Triangle Park, NC: US Environmental Protection Agency. Office of Air Quality Planning and Standards, Air Quality Strategies and Standards Division; March 2005. EPA-452/R-05-003. Also available at: http://www.epa.gov/ttn/ecas/ria.html (PDF file). Accessed June 7, 2005.

This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2005.067215v1 95/8/1304-a    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Arnold, S. M. Articles by Middaugh, J. P. Search for Related Content PubMed Articles by Arnold, S. M. Articles by Middaugh, J. P.