EPA tightens health standard for airborne lead
By DINA CAPPIELLO
Associated Press Writer
WASHINGTON (AP) _ Three decades after removing lead from gasoline, the Environmental Protection Agency is slashing the amount of the toxic metal that will be allowed in the nation’s air by 90 percent.
EPA officials, under a federal court order to set a new standard by midnight Wednesday, said the limit would better protect public health, especially for children. They can inhale lead particles released from smelters, mines and waste incinerators and ingest it after it settles on surfaces.
Exposure to even low levels of lead early in life can affect learning, IQ and memory in children. Lead can cause cardiovascular, blood pressure and kidney problems in adults.
“Our nation’s air is cleaner today than just a generation ago, and last night I built upon this progress by signing the strongest air quality standards for lead in our nation’s history,” the EPA chief, Stephen Johnson, said Thursday. “Thanks to this stronger standard, EPA will protect my children from remaining sources of airborne lead.”
The new limit, 0.15 micrograms per cubic meter, is the first update since 1978, when the government helped phase out leaded gasoline. It is 10 times lower than the old standard, 1.5 micrograms per cubic meter.
The EPA estimates that 18 counties in a dozen states will violate the new standard. That means state and local governments must find ways to further reduce lead emissions.
The new limit is in the lower end of a range recommended in May by the agency’s independent scientific advisory panel. By contrast, the Bush administration did not follow its own staff’s advice or its science advisers when it set health standards for smog and soot that were less stringent than recommendations.
The EPA also said it would require lead to be measured in 101 cities and near sources that release at least 1 ton of lead per year.
A representative for the Association of Battery Recyclers said the new standard would be difficult to meet. Several members of the group, which represents 14 facilities that recycle lead from car batteries, met two weeks ago with White House and EPA officials to seek a less stringent standard.
“We have put in the best controls and we are going to still have compliance problems,” said Robert Steinwurtzel, a lawyer for the group. “We explained to them our concerns that if the standard was promulgated at lower end of EPA’s range it would threaten viability of industry.”
Environmentalists hailed the move but said the agency could have done more to monitor emissions and ensure the standard is met.
“We commend EPA for taking a giant step in the right direction, but they need to greatly expand the lead monitoring network if they hope to enforce this standard,” said Dr. Gina Solomon, a senior scientist with the Natural Resource Defense Council.
The EPA will designate areas that fail to meet the new standard by October 2011. Based on air quality data from collected from 2005-2007, 18 counties in Alabama, Colorado, Florida, Illinois, Indiana, Minnesota, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee and Texas would fail to meet the standard.
The EPA said the cost of the reductions would be between $150 million to $2.8 billion, but the standard would produce economic benefits of $3.7 billion to $6.9 billion. In calculating the benefits, the agency assumed that children would be smarter and earn more money as a result of less lead in the air.
The government was under a court order to review the standard after a 2004 lawsuit by the Missouri Coalition for the Environment on behalf of two former residents of Herculaneum, Mo., the home of the last lead smelter in the U.S. The smelter repeatedly has violated the older health standard for lead in recent years. Blood taken from children in the area in 2002 showed elevated concentrations of the toxic metal.
The Doe Run Co., which operates the Herculaneum smelter, said the facility is now in compliance with the current standard. Dan Vornberg, the company’s vice president for environmental affairs, said the new standard “will have a significant impact on our operations” and will require exploring options such as new technologies and process adjustments.
The suit charged that the EPA had failed to review the lead standard every five years as law requires. Since 1990, more than 6,000 studies have examined the effects of lead on health and the environment, according to the agency.
“They still have to enforce it,” said Kathleen Logan Smith, executive director of the coalition. “But it is there. It is a start.”
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On the Net:
EPA lead site: www.epa.gov/air/lead
Doe Run. Co.: http://www.doerun.com/
Copyright 2008 The Associated Press.
www.lead-info.com
Food allergies increasing in US kids, study says
By MIKE STOBBE
AP Medical Writer
ATLANTA (AP) _ Food allergies in American children seem to be on the rise, now affecting about 3 million kids, according to the first federal study of the problem.
But experts said that might be because parents are more aware and quicker to have their kids checked out by a doctor.
About 1 in 26 children had food allergies last year, the Centers for Disease Control and Prevention reported Wednesday. That’s up from 1 in 29 kids in 1997.
The 18 percent increase is significant enough to be considered more than a statistical blip, said Amy Branum of the CDC, the study’s lead author.
Nobody knows for sure what’s driving the increase. A doubling in peanut allergies — noted in earlier studies — is one factor, some experts said. Also, children seems to be taking longer to outgrow milk and egg allergies than they did in decades past.
But also figuring into the equation are parents and doctors who are more likely to consider food as the trigger for symptoms like vomiting, skin rashes and breathing problems.
“A couple of decades ago, it was not uncommon to have kids sick all the time and we just said ‘They have a weak stomach’ or ‘They’re sickly,'” said Anne Munoz-Furlong, chief executive of the Food Allergy & Anaphylaxis Network, a Virginia-based advocacy organization.
Parents today are quicker to take their kids to specialists to check out the possibility of food allergies, said Munoz-Furlong, who founded the nonprofit in 1991.
The CDC results came from an in-person, door-to-door survey in 2007 of the households of 9,500 U.S. children under age 18.
When asked if a child in the house had any kind of food allergy in the previous 12 months, about 4 percent said yes. The parents were not asked if a doctor had made the diagnosis, and no medical records were checked. Some parents may not know the difference between immune system-based food allergies and digestive disorders like lactose intolerance, so it’s possible the study’s findings are a bit off, Branum said.
However, the study’s results mirror older national estimates that were extrapolated from smaller, more intensive studies, said Dr. Hugh Sampson, a food allergy researcher at the Mount Sinai School of medicine.
“This tells us those earlier extrapolations were fairly close,” Sampson said.
The CDC study did not give a breakdown of which foods were to blame for the allergies. Other research suggests that about 1 in 40 Americans will have a milk allergy at some point in their lives, and 1 in 50 percent will be allergic to eggs. Most people outgrow these allergies in childhood.
About 1 in 50 are allergic to shellfish and nearly 1 in 100 react to peanuts, allergies that generally persist for a lifetime, according to Sampson.
Some people have more than one food allergy, he said, explaining why the overall food allergy prevalence is about 4 percent.
Children with food allergies also were more likely to have asthma, eczema and respiratory problems than kids without food allergies, the CDC study found, confirming previous research.
The study also found that the number of children hospitalized for food allergies was up. The number of hospital discharges jumped from about 2,600 a year in the late 1990s to more than 9,500 annually in recent years, the CDC results showed.
Also, Hispanic children had lower rates of food allergies than white or black children — the first such racial/ethnic breakdown in a national study.
The reason for that last finding may not be genetics, said Munoz-Furlong. She is Hispanic and said people in her own family have been unwilling to consider food allergies as the reason for children’s illnesses. “It’s a question of awareness,” she said.
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On the Net:
The CDC report: http://www.cdc.gov/nchs
Copyright 2008 The Associated Press.
Parents press states for autism insurance laws
By CARLA K. JOHNSON
Associated Press Writer
CHICAGO (AP) _ In Washington state, Reza and Arzu Forough pay more than $1,000 a week for behavior therapy for their 12-year-old autistic son.
In Indiana, Sean and Michele Trivedi get the same type of therapy for their 11-year-old daughter. But they pay $3,000 a year and their health insurance covers the rest.
Two families. Two states. Big difference in out-of-pocket costs.
If autism advocates get their way, more states will follow Indiana’s lead by requiring health insurers to cover intensive and costly behavior therapy for autism.
In the past two years, six states — Texas, Pennsylvania, Arizona, Florida, South Carolina, Louisiana — passed laws requiring such coverage, costing in some cases up to $50,000 a year per child.
The powerful advocacy group Autism Speaks has endorsed bills in New Jersey, Virginia and Michigan and is targeting at least 10 more states in 2009, including New York, California and Ohio.
Other states, including Illinois, have similar bills in the works but aren’t working directly with Autism Speaks.
“This is the hottest trend in mandates we’ve seen in a long time,” said J.P. Wieske, a lobbyist for an insurance coalition that argues that these state requirements drive up insurance costs for everyone. “It is hard to fight them.”
For lawmakers, voting against these measures means voting against parents who are struggling to do the best for their children.
Parents tell moving stories about how behavior therapy works better than anything they’ve tried. In two states, bills got nicknames like “Steven’s Law” and “Ryan’s Law,” so voting against them was tough.
Arzu Forough of Kirkland, Wash., who is pushing a bill in her state, credits behavior therapy for teaching her son Shayan, at age 3, to make a sound to ask for a drink of water. Now 12, he is learning to converse about his favorite food and music, and to talk about his frustrations rather than throw tantrums.
Trained therapists, using principles of applied behavior analysis (ABA), created a system of rewards to teach Shayan these skills. As a preschooler, he got a piece of cheese when he said “bubba” for water. Now a therapist rewards him with tokens when he responds in conversation. He uses the tokens to “buy” privileges like going for a car ride.
Shayan’s improvements are a welcome relief to his mother, who once called for police help with her out-of-control son while she was driving.
“I pulled over to the side of the road,” she said. “I had to call the police to drive behind me so I could drive safely home.”
The Foroughs have health insurance, but it doesn’t cover Shayan’s therapy. Although they both work full time, they must live rent-free with her elderly mother to be able to afford his treatment.
Meanwhile, the Trivedi family of the Indianapolis suburb of Carmel, get 25 hours a week of behavior therapy for 11-year-old Ellie. They contribute co-pays and a deductible, totaling about $3,000. Insurance pays the rest, about $47,000 a year.
Michele Trivedi is an autism activist. She fought for years after a vaguely worded 2001 Indiana law required coverage but insurers still refused to pay for ABA. Finally in 2006, she helped convince the state’s insurance commissioner to issue a bulletin spelling out what was expected of insurers.
“It’s no longer acceptable that blatant discrimination against people with autism occur,” Trivedi said.
Autism is a range of disorders that hinder the ability to communicate and interact. Most doctors believe there is no cure. An estimated 1 in 150 American children are diagnosed with it.
Supporters say behavior therapy has decades of research behind it and can save money in the long run by keeping people out of institutions. Researchers agree, but say much remains unknown about which therapy works best for autistic kids, whether long-term gains can be claimed, and whether it works with older children.
Some states require behavior therapy coverage up to age 18 or 21. But the scientific evidence for ABA is strongest for the youngest, ages 2 to 5. Some researchers have reported on individual children with autism who no longer appeared disabled when they reached school age.
The most rigorous studies, though, show mixed results. A study published in 2000 showed that preschoolers who got intensive behavior therapy had greater gains in IQ than children who didn’t get the therapy. But there was little difference in the two group’s language development or the intensity of behavior problems. And the children most severely affected by autism showed no comparative gain.
Another study in preschoolers, published in 2005, showed little difference between an intensive ABA-based program run by therapists and less-intensive therapy from parents; children in both groups improved.
When it comes to older children, the research is sparse, said Tristram Smith of the University of Rochester Medical Center in New York, who co-authored the 2000 autism study.
“You could make a decent case for the little kids up to 6 or 7 that (insurance mandates) would be appropriate,” Smith said. “I think it would be hard to make that case for older kids.”
Another autism researcher, Laura Schreibman of the University of California at San Diego, said “fly-by-night” behavior therapists could defraud insurers with ineffective therapy.
“I would like to see insurance cover this kind of intervention because it’s documented to be effective,” she said. “But insurance companies have every right to monitor whether it’s working. If it’s been two years and there are no gains, an insurance company should be saying, ‘What are we paying for here?'”
The Council for Affordable Health Insurance, the industry lobbying arm, estimates autism mandates increase the cost of insurance by less than 1 percent by themselves, but when combined with other requirements make insurance less affordable.
Susan Pisano, a spokeswoman for America’s Health Insurance Plans, said the industry has been wary of laws ordering a specific treatment because when new scientific evidence emerges, the mandate remains frozen. And she questions whether behavior therapy is medical or educational.
The American Academy of Pediatrics includes ABA therapy in its clinical report on autism, but describes it as an “educational intervention.”
“There has been an effort to transfer the response to autism from school systems to the health care system,” Pisano said.
Nevertheless, some big companies and the U.S. military are providing ABA-based autism therapy as a benefit.
The U.S. military’s Tricare health insurance program not only covers up to $2,500 a month for the therapy, but also recently expanded the definition of who can provide it to make it more accessible. And some self-insured companies, including Microsoft and Home Depot, pay for autism behavior therapy.
Gaining insurance coverage state by state is the top lobbying priority for Autism Speaks.
“It’s the No. 1 thing we hear from parents,” said Elizabeth Emken, the group’s vice president of government relations. “What’s more difficult than knowing there’s an effective treatment for your children, but you can’t afford to offer it to them because it’s not covered by insurance?”
A new federal law requiring insurers to make coverage for mental health conditions equitable with other health coverage was tacked onto the recent financial industry bailout package.
Autism Speaks applauds the law, but says autism is not a psychological condition and that the insurance industry has refused to cover autism treatments in states with mental health parity laws on the books.
“We hope it sets the stage for the Congress and the next president to continue this effort to end discrimination in the health insurance marketplace,” Emken said. “Whichever party is elected, autism will be on the table and be a major point of discussion. There may have to be a federal mandate.”
Copyright 2008 The Associated Press.
Pediatricians double vitamin D recommendations
By LINDSEY TANNER
AP Medical Writer
CHICAGO (AP) _ The nation’s leading pediatricians group says children from newborns to teens should get double the usually recommended amount of vitamin D because of evidence that it may help prevent serious diseases.
To meet the new recommendation of 400 units daily, millions of children will need to take daily vitamin D supplements, the American Academy of Pediatrics said. That includes breast-fed infants — even those who get some formula, too, and many teens who drink little or no milk.
Baby formula contains vitamin D, so infants on formula only generally don’t need supplements. However, the academy recommends breast-feeding for at least the first year of life and breast milk is sometimes deficient.
Most commercially available milk is fortified with vitamin D, but most children and teens don’t drink enough of it — four cups daily would be needed — to meet the new requirement, said Dr. Frank Greer, the report’s co-author.
The new advice is based on mounting research about potential benefits from vitamin D besides keeping bones strong, including suggestions that it might reduce risks for cancer, diabetes and heart disease. But the evidence isn’t conclusive and there’s no consensus on how much of the vitamin would be needed for disease prevention.
The new advice replaces a 2003 academy recommendation for 200 units daily.
That’s the amount the government recommends for children and adults up to age 50; 400 units is recommended for adults aged 51 to 70 and 600 units for those aged 71 and up. Vitamin D is sold in drops for young children, capsules and tablets.
The Institute of Medicine, a government advisory group that sets dietary standards, is discussing with federal agencies whether those recommendations should be changed based on emerging research, said spokeswoman Christine Stencel.
The recommendations were prepared for release Monday at an academy conference in Boston. They are to be published in the November issue of the academy’s journal, Pediatrics.
Besides milk and some other fortified foods like cereal, vitamin D is found in oily fish including tuna, mackerel and sardines.
But it’s hard to get enough through diet; the best source is sunlight because the body makes vitamin D when sunshine hits the skin.
While it is believed that 10 to 15 minutes in the sun without sunscreen a few times weekly is sufficient for many, people with dark skin and those in northern, less sunny climates need more. Because of sunlight’s link with skin cancer, “vitamin D supplements during infancy, childhood and adolescence are necessary,” the academy’s report says.
Recent studies have shown that many children don’t get enough vitamin D, and cases of rickets, a bone disorder often associated with malnourishment in the 1800s, continue to occur.
Greer, a University of Wisconsin pediatrician, acknowledged that most studies suggesting vitamin D may play a much broader role in disease prevention have been observational, not the most rigorous kind of medical evidence.
Nonetheless, many doctors consider the research compelling and many have begun to offer patients routine vitamin D testing.
Adrian Gombart, a vitamin D researcher at Oregon State University, said the new recommendations are safe and conservative but that 400 units “is probably not enough.”
Gombart’s lab work in human tissue has shown that vitamin D helps increase levels of a protein that kills bacteria. He said many experts believe that between 800 and 1,000 units daily would be more effective at helping fight disease.
Several members of an academy committee that helped write the guidelines have current or former ties to makers of infant formula or vitamin supplements.
___
On the Net:
Academy: http://www.aap.org
Institute of Medicine: http://www.iom.edu
Copyright 2008 The Associated Press.
States ask baby product companies to avoid BPA
HARTFORD, Conn. (AP) _ Attorneys general from three states are asking 11 companies that make baby bottles and baby formula containers to stop using the toxic chemical bisphenol A.
Letters signed by attorneys general from Connecticut, New Jersey and Delaware call the chemical, known as BPA, potentially harmful to infants.
The letters are being sent to baby bottle manufacturers Avent America Inc., Disney First Years, Gerber, Handicraft Co., Playtex Products Inc. and Evenflo Co., and formula makers Abbott, Mead Johnson, PBM Products, Nature’s One and Wyeth.
BPA is used in lightweight, durable plastics. Products include some baby bottles, sippy cups and reusable food and drink containers.
Copyright 2008 The Associated Press.
Child Safety: Facts about drowning
It is estimated that for each drowning death, there are 1 to 4 nonfatal submersions serious enough to result in hospitalization. Children who still require cardiopulmonary resuscitation (CPR) at the time they arrive at the emergency department have a poor prognosis, with at least half of survivors suffering significant neurologic impairment. – American Academy of Pediatrics
19% of drowning deaths involving children occur in public pools with certified lifeguards present. – Drowning Prevention Foundation
A swimming pool is 14 times more likely than a motor vehicle to be involved in the death of a child age 4 and under. – Orange County California Fire Authority
Children under five and adolescents between the ages of 15-24 have the highest drowning rates. – U.S. Centers for Disease Control and Prevention
An estimated 5,000 children ages 14 and under are hospitalized due to unintentional drowning-related incidents each year; 15 percent die in the hospital and as many as 20 percent suffer severe, permanent neurological disability. – National Safety Council
Of all preschoolers who drown, 70 percent are in the care of one or both parents at the time of the drowning and 75 percent are missing from sight for five minutes or less. – Orange County, CA, Fire Authority
The majority of children who survive (92 percent) are discovered within two minutes following submersion, and most children who die (86 percent) are found after 10 minutes. Nearly all who require cardiopulmonary resuscitation (CPR) die or are left with severe brain injury. – National Safe Kids Campaign
For information on how you can prevent infant drowning, visit http://www.infantswim.com/
To find out how infants and toddlers can learn to survive in potentially deadly drowning situations, there is an excellent video at: http://www.childdrowningprevention.com/index.html
Drug companies: No cold medicines for kids under 4
By RICARDO ALONSO-ZALDIVAR
Associated Press Writer
WASHINGTON (AP) _ Children under 4 should not be given over-the-counter cough and cold remedies, drug companies said Tuesday in a concession to pediatricians who doubt the drugs do much good and worry about risks.
The voluntary change in advice to parents comes less than a week after federal health officials said they also saw little evidence that the drugs work. But government officials were afraid that taking the medicines off store shelves might prompt parents to give their children adult medicines.
The drug makers said they will also add a warning that parents should not give antihistamines to children to make them sleepy. These are allergy-relief medications often found in medicines that combine several ingredients to treat a variety of symptoms.
The new measures “reflect industry’s overall commitment to the continued safe and appropriate use of children’s oral OTC cough and cold medicines,” Linda Suydam, president of the Consumer Healthcare Products Association, said in announcing the changes on behalf of the companies.
“We are doing this voluntarily out of an abundance of caution,” she added. The new instructions will appear on products distributed for the coming cold season. Last year, the companies pulled medicines for babies and tots under 2 from the market.
Pediatricians, who have been calling for a ban on OTC cough and cold remedies for children under 6, welcomed the industry’s latest shift.
“It’s a huge step forward,” said Dr. Joshua Sharfstein, Baltimore’s health commissioner. “There is no evidence that these products work in kids, and there is definitely evidence of serious side effects.”
Problems with OTC cough and cold medicines send some 7,000 children to hospital emergency rooms each year, with symptoms including hives, drowsiness and unsteady walking. Many kids overdose by taking medicines when their parents aren’t looking.
Since a majority of the problems involve 2- to 3-year-olds, the industry’s new instructions, if followed by parents, should help.
“The 2- and 3-year-olds are definitely the highest risk,” said Sharfstein. “More than 50 percent of the problem is with these kids. “If they don’t have this stuff around the home, they’re less likely to grab it and ingest it.”
Pediatricians still support recalling the medicines for children under 6, and the Food and Drug Administration is studying their effectiveness for children under 12. But federal health officials said at a public hearing last week that it could take them a year or more to make a final decision and order changes.
Leading cough and cold brands include Dimetapp, Pediacare, Robitussin, Triaminic, Little Colds and versions of Tylenol that have ingredients to treat cold symptoms. U.S. families spend at least $287 million a year on cold remedies for kids, according to Nielsen Co. statistics that do not include Wal-Mart sales.
The industry also said it is expanding an educational campaign aimed at getting parents to be more careful about giving their kids cough and cold medicines.
Parents should never:
—Give adult medicines to a child.
—Give two or more medicines with the same ingredients at the same time.
—Give antihistamines to make a child sleepy.
Parents should:
—Give the exact recommended dose, using the measuring device that comes with the medicine.
—Keep OTC medicines out of sight and out of reach.
—Consult their doctor if they have any questions.
Colds usually clear up by themselves after a few days, and many doctors say rest and drinking plenty of fluids are all that’s needed.
___
On the Net:
Consumer Healthcare Products Association statement: http://tinyurl.com/4bzj2f
Copyright 2008 The Associated Press.
Fan use linked to lower risk of sudden baby death
By CARLA K. JOHNSON
Associated Press Writer
CHICAGO (AP) _ Using a fan to circulate air seemed to lower the risk of sudden infant death syndrome in a study of nearly 500 babies, researchers reported Monday.
Placing babies on their backs to sleep is the best advice for preventing SIDS, a still mysterious cause of death. Experts also recommend a firm mattress, removing toys and pillows from cribs, and keeping infants from getting too warm.
Such practices helped slash U.S. SIDS deaths by more than half over a decade to about 2,100 in 2003. But SIDS remains the leading cause of death in infants ages 1 month to 1 year.
“The baby’s sleeping environment really matters,” said study senior author Dr. De-Kun Li of the Kaiser Permanente Division of Research in Oakland, Calif. “This seems to suggest that by improving room ventilation we can further reduce risk.”
SIDS is the sudden death of an otherwise healthy infant that can’t be attributed to any other cause. These babies may have brain abnormalities that prevent them from gasping and waking when they don’t get enough oxygen.
The new study, published in October’s Archives of Pediatrics & Adolescent Medicine, offers another way to make sure babies get enough air.
More research is needed, said Dr. Fern Hauck of the University of Virginia in Charlottesville, but she said that because fan use is in line with theories, it may be worth considering.
“This is the first study that we know of that has looked at this issue,” said Hauck, a member of the American Academy of Pediatrics SIDS task force.
Researchers interviewed mothers of 185 infants who died from SIDS and mothers of 312 infants of similar race and age. Moms answered dozens of questions about their baby’s sleeping environment.
Researchers took into account other risk factors and found that fan use was associated with a 72 percent lower risk of SIDS. Only 3 percent of the babies who died had a fan on in the room during their last sleep, the mothers reported. That compared to 12 percent of the babies who lived.
Using a fan reduced risk most for babies in poor sleeping environments.
The study involved infants in 11 California counties. It was supported by grants from the National Institutes of Health.
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On the Net:
Archives: http://www.archpediatrics.com
Copyright 2008 The Associated Press.
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