E X P E R T R O U N D T A B L E

PHYSICIANS AND SCIENTISTS

TALK FRANKLY ABOUT PESTS, PESTICIDE SAFETY
AND PROTECTING KIDS
FROM THE MODERATOR:

W
hen I was asked to organize a blue-ribbon panel of experts to provide independent answers to some pretty
frank questions about pesticide safety, it didn’t take a lot of convincing. As a physician who works at one of
the nation’s busiest poison control centers, I have a lot of first-hand experience with public concerns – real
and unsubstantiated – about the pest control products used in our homes, our yards, our workplaces and our schools.
And, while I spend most of my time in academia teaching toxicology or conducting research, I have enough contact with
consumers to know that there’s a lot of serious misinformation out there.

Some of the confusion is understandable. Common sense tells us these can be harmful products if used foolishly. But,
regrettably, pesticides have become targets for creating alarm – which is unfounded and plainly irresponsible. We all
potentially lose when an invaluable public health tool such as pesticides is portrayed as a net public health risk. My
experience and study have convinced me that the real threats are the pests – the rats, stinging insects, mosquitoes and
cockroaches that can infest our homes and schools, causing serious injury and disease, putting children especially at risk.

However, if you have doubts, concerns or questions about the safety of pesticides, please read this publication. You’ll see
the frank views of some of the most well-informed physicians, pediatricians, toxicologists, public health experts and
asthma specialists in America. I’ve included brief summaries of their credentials.

Ultimately, the key to making good decisions about pesticides gets down to knowing the facts, controlling the risks,
establishing strong safeguards and acknowledging their very real benefits in a world in which the public health risks from
disease-carrying pests will surely increase.

Sincerely,

Scott Phillips, M.D., F.A.C.P., F.A.C.M.T.

Scott Phillips, M.D., F.A.C.P., F.A.C.M.T., serves as associate clinical professor of medicine in the division of clinical
pharmacology and toxicology at the University of Colorado Health Sciences Center. He is also an attending physician at
the Rocky Mountain Poison and Drug Center. He chairs both the Science and Technology Committee of the American
Academy of Clinical Toxicology and the Occupational Toxicology Committee of the American College of Occupational
and Environmental Medicine. He also provides consulting services in Denver, Colo., through Toxicology Associates,
Professional LLC.
PESTICIDE POISONINGS to serious public health consequences such as increased
risk of insect-borne and rodent-borne diseases.

Scott Phillips, M.D., F.A.C.P., F.A.C.M.T.: Among the Phillips: Are there important things that schools should do to reduce
obvious concerns the public has about pesticides is the potential for the likelihood of a problem?
poisonings. How serious a problem is pesticide poisoning in terms of
both its prevalence and how seriously people and children are hurt? Goodman: Certainly, and they are quite simple.
Potentially effective measures may include avoiding
Robert Krieger, Ph.D.: I understand storage of pesticides on school property and scheduling
the public’s concern, but the fact is pesticide application when students and staff are not
poisoning from pesticides is a very rare present.
event because of the way they are used.
Data from the American Association of Krieger: Schools should develop and implement a well-
Poison Control Centers show that in conceived integrated pest management plan that makes
2000, 920 deaths were caused by poisonings, including by clear the conditions for pesticide use. This will permit
drugs, medicines, carbon monoxide, mushrooms, snakes, schools to respond promptly when pest problems occur
wasps and bees, shellfish and other commonly recognized and will provide assurance that there is no needless
agents. Compare that to the 20 people who died from exposure.
pesticide poisonings in 2000, 17 of whom were intentional
ingestions. Two of the unintentional deaths were in
children who ingested pesticides not typically used in and PESTICIDE SAFETY
around schools or buildings; the other, an adult who died
from an unknown pesticide. Obviously, we don’t want any
Phillips: We’ve addressed the issue of poisoning but beyond that, are
of these deaths. But the numbers clearly indicate the
pesticides a health threat to children? Should parents and public
health threat of pesticide poisoning is usually substantially
officials be worried about health problems resulting from even minute
overestimated. There is a very low likelihood people can
levels of pesticide exposure?
be overexposed to these products by normal use.
James Lamb, Ph.D., D.A.B.T.: As a
Michael Goodman, M.D., M.P.H.: I
toxicologist, I can tell you that properly
agree with Dr. Krieger. I’d just like to
used pesticides pose no more than
add that the data indicate parents often
minimal everyday risks to adults and
contact the poison control centers
children. As with any product,
expressing concerns regarding
improper use of pesticides can be
children’s exposures to pesticides.
dangerous. They need to be handled with appropriate
However, 90 percent of these exposures do not require any
respect and care to ensure that they are used safely.
medical intervention, the numbers of serious poisonings
are very small and they are the result of serious and often Goodman: High levels of pesticide exposure are
intentional misuse. unacceptable and potentially dangerous. However, there is
no indication from studying years of scientific and medical
Phillips: Are these poisonings, however rare, enough of a problem to
evidence that appropriate safe use and handling of
curtail pesticide use in the schools or elsewhere?
pesticides pose a health threat to children.
Krieger: I don’t know of any poisoning or health issues
Krieger: Let me just add that over-the-counter pesticides,
resulting from normal use of pesticides in schools.
available to homeowners, are formulated to meet
Pesticides are probably used more frequently in children’s
consumer needs in homes and schools. When pesticide use
homes than in schools. Children’s exposures represent
results in harmful effects, the cause is almost inevitably
trace amounts relative to toxic levels. Pesticide use in
human failure to heed instructions for use.
schools doesn’t represent a threat to health.

Goodman: While prevention of poisonings in general is

very important, banning pesticides from schools may lead
“ORGANIC” PESTICIDES,
PESTICIDE BANS AND
LEAST TOXICITY PROPOSALS
Phillips: With many so-called “non-toxic” or “organic” pest control
options being promoted to consumers, some people may ask why we
shouldn’t just stop using chemical pesticides altogether?
Goodman: It is true that many pest control options are
being marketed as non-toxic. However, so-called natural
pesticides are not necessarily safer than synthetic ones.
Animal studies indicate that about one-half of all naturally
occurring compounds may be carcinogenic at high doses.
Unless and until a natural product is actually tested for
carcinogenicity, one cannot predict the results based
simply on the fact that it is “natural.” Furthermore, organic
pesticides may be more expensive and less effective than
synthetic pesticides. There is no evidence that banning
pesticides will improve public health and help prevent
diseases. Most toxins ingested by people are natural. For
example, more than 99 percent of the pesticides in our diet
are compounds that are naturally present in plants. Some
of those naturally occurring chemicals have been shown to
cause diseases in laboratory animals at high doses.
Nevertheless, humans are exposed to them at low levels on
a regular basis and without any adverse health effects.
Lamb: I agree with Dr. Goodman. “Organic” and “natural”
are not synonyms for “better” or “safer.” All chemicals,
including natural chemicals, have the potential to cause
harm if they are not properly handled. In some cases,
natural products are more dangerous or less effective than
their synthetic counterparts. Synthetic products have been
designed to improve on nature and to increase
effectiveness or decrease the required dose or side effects
by using the same chemical mechanisms as natural
chemicals to control pests.
Phillips: Okay, but what would happen if pesticides to control pests
in residential settings or schools were banned altogether?
Goodman: Banning pesticides may lead to proliferation of
insects capable of transmitting infectious diseases carried
by rats and mosquitoes.
Lamb: Pesticides are used for a variety of reactions
including protection from pests in homes and schools. The
key is to use such products sensibly and with respect.
Children need protection from pests, and pesticides offer
this protection.
Phillips: But some people are calling for complete bans of pesticides in
schools. Why not be “better safe than sorry”?
William Robertson, M.D.: Let me be
frank. Proponents of the so-called
“precautionary principle” – the notion
that we should ban products and
chemicals even in the absence of
evidence that they cause harm – have
worked very hard to oversell risk. Unfortunately if you
believe this theory, you’d never get out of bed in the
morning or drive your car. Remember there simply is no
certainty of absence or lack of risk in life. Risk can be high
or low — but never totally absent. There are significant
risks in NOT using pesticides that must be considered. If
we are to make sound decisions about pesticides, we
simply must get everyone to put aside their “chemophobia”
and replace it with a more reasonable, realistic mindset.
PESTICIDES AND
HEALTH EFFECTS
Phillips: Could a child develop cancer because of exposure to
pesticides used in a school environment?
Krieger: Based on a number of studies during the past 50
years, pesticides aren’t any more likely than other classes
of chemicals to be potential human carcinogens. It’s also
highly unlikely since exposures are intermittent and far
below toxic thresholds. A child is more likely to get cancer
from the sunshine than from the use of pesticides in
schools and homes. In everyday life, the most significant
environmental cancer risk for children is normal exposure
to sunshine.
Lamb: It is extremely unlikely that normal use of a
pesticide could cause cancer in children or adults. A
substantial amount of safety data is developed and
thoroughly evaluated before the product is approved for
use. Product safety study findings are used to set the
conditions for use, and the exposures to children are
carefully considered in developing the label instructions
for pesticide use. Exposures are limited to minimize risk of
any adverse health effect to children, including cancer.
Robertson: Allow me to add that current scientific
thinking never lets us say never. Instead, science lets us
focus on the “likelihood of an event” — a 10-percent risk
or a 1-percent risk or an infinitesimal risk — at which
point the individual or the society makes a choice. At the
present time, as it has been for the past 30 years, science
agrees that the risk of pesticides causing any cancer in
adults or in children is extremely remote, though such a
“risk” can never be said not to exist.
Phillips: As scientists, we understand the use of laboratory animals to
determine product safety. But what should the public think when it
hears about scientific studies showing that pesticides cause cancer in
laboratory animals?
Lamb: There is no reason for the public to be concerned.
The animal safety studies use high doses for nearly the
entire life of the test animal. The very purpose of the
studies is to create an adverse effect – to determine how
much exposure is necessary to make the animal sick. So,
the exposure levels to these chemicals are immense. In
some studies, the effect may be cancer. Under these test
conditions, even some natural chemicals found in food can
cause cancer and other adverse effects. However, we
should be less concerned about which effects are observed
than about the doses or exposure concentrations that cause
the effects and compare them to the levels to which we
might be exposed. For pesticides, we find that the dose
levels that caused cancer in animals far exceed our
exposure levels.
Krieger: We must use great caution when applying the
results of animal studies to people’s everyday experiences.
Let me stress that the high lifetime dosages used in these
studies are so extreme that they are difficult to relate to
normal living conditions. Pesticides are very unlikely to
contribute to cancer due to the nature and limited extent
of human pesticide exposures.
Phillips: During the past few years, the public has read about a new
theory called endocrine modulation, or endocrine disruption. A 1999
National Academy of Sciences report on the endocrine disruption
hypothesis found little evidence to support allegations about chemicals
and adverse effects in people. Do you think that the use of pesticides can
harm a child’s hormonal system?
Robertson, M.D.: After four years of scientific review and
debate, the National Research Council Committee on
Hormonally Active Agents in the Environment reported
that no conclusions could be drawn about potential health
effects of low-dose exposures to certain chemicals. Many
chemicals have “estrogen-like” effects. In my opinion,
endocrine disruption is simply “much ado about nothing.”
For the most part, humans can tolerate the low level of
pesticides found in their environment without any
immediate or long-term effects. And, remember, public
exposure to naturally occurring, hormonally active
substances are at levels millions of times greater than those
levels that may be associated with chemical exposures. My
bottom line is that it’s a provocative theory that the media
likes to report on but there’s nothing I’ve seen that suggests
people should be concerned about it.
Phillips: Some advocacy groups have raised new charges, not yet
proved through scientific research, that pesticides are a serious threat to
brain development and may cause neurological disorders. What’s the
reaction of the medical community to these reports?
Goodman: The current scientific literature contains
several reports evaluating the relation between
environmental chemical exposures and neurobehavioral
test scores in children. At the present time, none of these
studies has clearly shown an adverse effect of pesticide
exposure on the neurodevelopment of children. With the
exception of lead poisoning, these studies show little
evidence of a consistent adverse effect of chemicals at low
levels of exposure. The problems with these types of
studies stem from their inability to account for other
factors, such as socioeconomic status, childhood disease
and nutrition, and maternal substance abuse or poor
nutrition during pregnancy. Many of these potential
factors are far more powerful predictors of
neurodevelopmental problems than the hypothesized
environmental exposure to chemicals.
PESTS, PESTICIDES
AND ASTHMA
Phillips: I know that some parents have kids who suffer from asthma
or allergies and are concerned about pesticides triggering an attack. Yet,
I also know for a fact that the allergens created by cockroaches, mites
and rodents are also a very real threat with regard to asthma.
Dr. Abramson, as an expert in this area, what does the science tell us
about this?
 Stuart Abramson, M.D., Ph.D.: The
2000 report “Cleaning the Air: Asthma
and Indoor Air Exposures” by the
Institute of Medicine, associated with
the National Research Council, found
no evidence to implicate any particular
pesticide as a causal agent for asthma or as an agent
leading to increased risk for developing asthma. Moreover,
childhood exposure to roach and rodent allergens – hair,
urine and fecal matter – can lead to increased allergen
sensitization and ultimately to increased symptoms of
allergic rhinitis, conjunctivitis and asthma when one is re-
exposed to these allergens. Thus, not only does the
scientific literature suggest that pesticides aren’t a
significant problem in causing asthma, but also that the
pests that these products control actually can be quite
harmful to the asthmatic child. However, there are some
reports implicating certain product formulations as likely
irritants that can cause an asthma reaction in an individual
who already has asthma. In addition, pesticides may have a
significant impact on indoor air quality if used in places
that are not aerated well and if they emit an odor.
Therefore, we need to carefully manage pesticide use by
following the pesticide label so that air quality is not
negatively impacted. The bottom line is there are more
pressing reasons to use pesticides to eliminate pests from
the asthmatic child’s environment than there are to allow
these pests to persist.
PESTICIDE TESTING
AND REGULATION
Phillips: A lot of what we’ve talked about assumes that pesticides are
used properly. What laws and regulations are in place to ensure the
proper formulation, distribution and use of pesticides on the farm, in
homes and in schools?
Lamb: The federal government, through the
Environmental Protection Agency, regulates and enforces
safe pesticide use. States and local governments cooperate
in enforcing federal pesticide laws and regulations and
may also have additional requirements. First, before a
pesticide can be sold or distributed, it must be tested by
the company and approved or registered by EPA. Millions
of dollars of toxicology and chemistry data are typically
required, under extremely demanding conditions. The
primary tool for controlling pesticide use and exposure is
the pesticide label. Once the product is registered for a
specific use, the user must be certain that the product is
approved for the target pest and that the label directions
are followed. Some pesticide products are restricted to use
by certified applicators as spelled out in the EPA
requirements.
Krieger: To add to that, I believe chemicals that are used as
pesticides are probably the most thoroughly tested
chemicals with respect to their potential to have adverse
effects on health or environmental quality. Basic short-
term toxicity testing is performed to help establish
conditions of use. Longer-term studies determine a
chemical’s potential to produce effects such as
teratogenicity, immunotoxicity, carcinogenicity,
mutagenicity and behavioral effects. Possible ecological
effects are also part of pesticide testing programs. Taken
together, a substantial scientific database is available for
regulatory evaluation of pesticide uses.
Phillips: Given everything we’ve discussed, how do pesticides rank in
terms of threats to public health?
Lamb: Relative rankings do not show pesticide exposure to
be particularly high in comparison to everyday risks such
as smoking, riding in a car, exposure to communicable
disease or crossing the street. In fact, the ranking of
pesticide risk when compared to these other everyday risks
is very low.
Robertson: In the opinions of experts and individuals
trained in the world of science, the ranking is
extraordinarily low. Among the general public,
unfortunately, pesticides rank far higher on the risk scale
than they should.
ABOUT THE PANELISTS:
Stuart Abramson, M.D., Ph.D., is an assistant professor of pediatrics and immunology at the Baylor College of Medicine in Houston,
Texas. He is also the associate director for clinical research and health professional education for the Children’s Asthma Center at Texas Children’s
Hospital as well as the chief of the Pediatric Allergy and Immunology Clinic at Ben Taub General Hospital in Houston. Abramson’s research
focuses on new approaches to asthma screening, medical management, self-management and environmental control that can be generalized to
community health providers and schools. He is board certified in pediatrics, allergy and immunology and diagnostic laboratory immunology.
Abramson currently serves as chairman of the regional advisory board for the American Lung Association of Texas, Southeast Region. He has
published more than 80 peer-reviewed articles, abstracts and book chapters in the field of allergy, asthma and immunology.

Michael Goodman, M.D., M.P.H., is a managing scientist in Exponent's health/epidemiology practice, with expertise in the areas of
epidemiology, children's health and international health. He particularly focuses on environmental health and infectious disease issues. Goodman
continues to practice as a pediatrician at the Zachaeus Clinic in Washington, D.C. In more than 10 years of clinical experience, he has practiced
pediatrics at St. Agnes Hospital and Johns Hopkins University Bayview Medical Center in Baltimore, Md., as well as in his native Lithuania.
Prior to joining Exponent, Goodman was a physician epidemiologist for Consultants in Epidemiology and Occupational Health in Washington,
D.C. and a PAHO/WHO consultant for the Ministry of Health in Jamaica. Goodman is based in Alexandria, Va.

James Lamb, Ph.D., D.A.B.T., is a toxicologist and past president of the American Board of Toxicology. Now with the environmental
engineering and consulting firm, BBL Sciences, he formerly served as special assistant to the assistant administrator for pesticides and toxic
substances at EPA. Prior to that position, Lamb was head of the fertility and reproduction group of the National Toxicology Program.

Robert Krieger, Ph.D., is a researcher with the University of California, Riverside, in the department of entomology. He specializes in
extension toxicology and chemical risk assessment. His research has focused on the development and the use of advanced analytical methodology
to identify movement of pesticide residues from environmental compartments to children and adults. Indoor, turf and field settings have been included.
In agriculture, this research has supported development of exposure-based re-entry times, as opposed to adverse effect based re-entry times used prior
to implementation of the risk assessment process. Effective re-entry times require accurate human exposure data and clear definition of work tasks so
that short-term and long-term adverse effects can be considered.

William Robertson, M.D., is a professor of pediatrics at the University of Washington. He is also medical director at the Washington Poison
Center and director of the Seattle Poison Control Center in Seattle, Wash. Robertson is a nationally recognized expert on childhood poisoning. He
has authored the sections of poisoning for the “Merck Manual,” Cecil’s “Textbook of Medicine” and Dreisback’s “Handbook of Poisons” and has
been instrumental in making the Washington Poison Center a model program. As director of the WPC, he takes a lead role in providing
consultation on environmental exposures and seeing patients in the clinic based at Children’s Hospital and Regional Medical Center.