Mad Hatters: Saving the WorldOr: Potential applications of strategies from an institutional mercuryreduction campaign to develop a national public health initiative for

reducing human exposure.

Captain Edward H. RauDivision of Environmental ProtectionOffice of Research FacilitiesNational Institutes of HealthBethesda, MD 20892-5746

U.S. Department of Health and HumanServices

Howard Fawcett Award Acceptance Speech

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A Tip of the Hat*

I am deeply, deeply honored to be the recipient of this award.

The Mad as a Hatter? Mercury Free Campaign initiated at theNational Institutes of Health has received recognitions fromseveral sources, including a citation from the Governor ofMaryland.

But none are as important to me as this award, bestowed by myfriends and colleagues in the American Chemical Society’sDivision of Chemical Health and Safety.

*The speaker was in costume

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Speaker’s Disability DisclaimerSome of you may not know why our mercury reduction campaign

was named after the Mad Hatter from Lewis Carroll’s classic storyof Alice in Wonderland, written in 1865.

Demand for these tall hats became so big in the mid 1800s thathatters started making them out of less expensive materials likewool instead of beaver fur.

To make the hats stiff and shiny, hatters used secret chemicalrecipes in the forming process, which was called secretage orcarroting.

At one time, the recipe used camel urine,* but later this ingredientwas replaced with mercurous nitrate.

The new recipe created good hats, but it made the hatters forgetful,sleepless, confused, distracted and gave them tremors.

Since many of the hat factories were located around Danbury,Connecticut the hatters’ disability was sometimes called theDanbury Shakes.

*This ingredient is still scarce around Connecticut, but severe mercury pollution from thefactories is still present in 2005.

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Opening Words

As immortalized by Carroll in his classic tale, I’llbegin with a quote from another famoushatter, an acquaintance of Alice who washaving a bit of trouble trying to recite asimple rhyme:

"Twinkle, twinkle, little bat!How I wonder what you're at!“"Up above the world you fly,‘’Like a tea-tray in the sky.Twinkle, twinkle--"

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Was this just…

A failed attempt to by the Hatter to remember andrecite a nursery rhyme correctly?

Lines written for a fictional character to fit a story line?

---Or symptoms of something else.

Maybe it should be interpreted as one of two warnings aboutthe effects of mercury exposure that can be heard in Alice’sstory.

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A Second Warning fromWonderland?

You better listen this time - it’s about all of you…

"In that direction," the Cheshire Cat said, waving its rightpaw round, "lives a Hatter: and in that direction," wavingthe other paw, "lives a March Hare. Visit either you like:they're both mad."

"But I don't want to go among mad people," Alice remarked.

"Oh, you can't help that," said the Cat: "we're all mad here.I'm mad. You're mad."

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Today, the Cat May be Right

All of you may be going mad…

Releases of mercury to the environment are 5 to 6 times higher than theywere before the industrial era.It’s bioaccumulating in wildlife - not just the fish – even the song birds ofVermont according to a recent study.CDC data show about 10% of women of childbearing age have bodyburdens that may be unsafe for the developing fetus, resulting in learningdeficiencies and delayed mental development.Mercury may have an association with the increased incidence of autism.New information suggests there may be other impacts on adults as well –subtle neurological changes, insomnia and associations withcardiovascular disease.

---This is what our campaign platform is about:

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Campaign BeginningsMost of you attended the 2003 CHAS meeting in New Orleanswhere I presented the campaign and its decommissioning andpublic outreach initiatives so I won’t repeat all that detail here.It began as a voluntary initiative at the National Institutes ofHealth, in Bethesda, MD with primary goals of encouragingemployees to use mercury-free devices and reagents to reducepotential for spills, occupational exposures and pollution. Soonall of NIH joined. And then some other agencies.Community outreach was originally intended as a minorelement of the campaign, part of our campaign kick-offcelebration event.But my theme and messages proved more popular with thepublic than even a Mad Hatter could imagine.Probably set a precedent for an institutional Chemical Healthand Safety program going public!

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Campaign Accomplishments

Since 2003 ACS DivCHAS meeting:Tens of thousands more participants: website visitors,attendees at health fairs, presentations, thermometerexchanges, pledges made.Mercury spills have been a huge problem in schools throughoutthe land, so we hosted a national video webcast workshop onmercury reduction and pollution prevention in schools inpartnership with EPA, Maryland environmental and educationalagencies, and universities.We shared campaign tools with the UN EnvironmentProgramme (UNEP) mercury initiative. A campaign summarypresentation is on the UNEP website.Completed several major laboratory facility decommissioningprojects involving mercury decontamination - working with MIT,Harvard, HHMI to develop consensus standards.

Some Lessons Learned fromMy Campaign

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Lesson #1 (Most Important)

Hatters Are Good Teachers

OUR FIRST STUDENTS WERE JUST SLOW LEARNERS:

1860 - the first of several major studies confirmed mercury waspoisoning us.

1865 - Alice (of Wonderland) had a tea party and noticed somethingwas wrong with the Hatter but didn’t know what it was.

1925 - Another Alice (Hamilton) knew what was wrong and devoted anentire chapter to the hat industry in her classic work, IndustrialPoisons in the United States.

1941 - Use of mercury in hat making was finally banned by the U.S.Public Health Service.

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Lesson #2:

Think Out of the HatboxChemical Health and Safety professionals shouldn’t spend all oftheir prevention efforts on occupational exposures ininstitutional environments such as labs (and hat factories).

A more holistic approach as practiced in the campaign is neededto protect employees from health and safety hazards of chemicalslike mercury because:

Unlike most lab chemicals, there are sources of significant acuteexposure outside occupational setting – in homes, schools etc.

Everyone has some level of chronic exposure from dietary intake -for a significant fraction of the population it is already an over-exposure.

Mercury uptake is cumulative and toxic effects occur at very lowlevels.

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Lesson #3:

Don’t Rely on Occupational

Standards – They May Not BeProtective

Better to Use Risk-Based Exposure Standards Established for theGeneral Population:

OSHA regulations, exposure guidance by NIOSH and others are based on old data,

assume that workers are “healthy”, exposed only at work, and that they work only a

40 hour work week.

Workers in academia, health care and research often work longer hours than that –

they live in their labs.

Workers are not “healthy” - we know that about 1 of every 6 female workers of child

bearing age reports to work already overexposed to mercury.

Our built environment also houses patients, visitors and research animals who may

be much more sensitive to mercury than workers.

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Lesson #4:

Proactive Approaches by Institutions are

Required to Cope with New Limits

`I can't go no lower,' said the Hatter: `I'm on thefloor, as it is.'

Allowed exposure and emissions limits for mercury are going lower and willcontinue to drop in response to evidence of health and environmentalimpairment at current limits.

A most extreme example: the discharge limit for wastewater from POTWsin EPA Region 5 has been lowered to 1.5 parts per trillion.

POTWs that cannot meet these limits will be required to impose controls onupstream sources, and labs will be specifically targeted in guidance fordeveloping required reduction plans.

Developing institutional strategies to meet these new limits will require aproactive, long term approach and major commitments of resources.

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Lesson #5: Consider Impacts of Mercury Contamination

on the Facility’s Mission Activities

We are justifiably focused on the impacts of chemicals on health and safety in theworkplace. But what has been almost completely overlooked are potentialimpacts of contaminants on the activities occurring in that environment – likelearning, experimentation and research.

Example: biomedical research, with its recently increasing emphasis oninfectious diseases and vaccine development.

Studies suggest that low levels of mercury are present as a contaminant inmany biomedical research laboratories – in the air, on surfaces ofequipment, casework and floors, and reagents in like methanol.

It can be a potent immunostimulant and suppressant, depending onexposure dose and individual susceptibility and may increase susceptibilityto parasitic, bacterial, and viral infections.

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The Lesson is Confirmed byLab Mice…

The immunotoxic effects of mercury – its capability to alterimmune responses in animals is the lowest dose/effect yetdescribed (0.4 µg/kg).

Example - subtoxic exposures to mercury have recently been shown toenhance susceptibility and impair murine responses to parasitic diseasessuch as leishmaniasis and Plasmodium yoelii infection.

In fact, it has been theorized that the resurgence of malaria (caused byanother species of Plasmodium) noted in Amazonia may be a result ofincreased mercury emissions associated with mining activities in theregion.

Mercury may interfere with biological processes at extremely lowlevels and thus could alter the outcome of experiments performedin mercury contaminated lab environments.

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And Dormice?

But what did the Dormouse say?' one of the juryasked the Hatter. He couldn’t remember or didn’tknow.

--Like that Hatter, we may not know what thelab mice are saying.

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What’s Next:Hatter’s New Campaign Platform

1. Use successful community outreachapproaches developed here as tools insimilar national and internationalcampaigns to reduce public exposure.

2. Focus the expanded campaigns on twoprimary sources of exposure:

SpillsExcessive dietary uptake.

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Prevent Acute Exposures to Vaporsby Eliminating Sources of Spills

Improve public awareness of mercury-containingitems and the hazards they pose.Encourage replacement of mercury devices at work,in schools and homes.Facilitate proper disposal Household hazardous waste collection sites. Community thermometer exchanges.

Provide guidance on proper spill clean up methodsand links to resources for spill detection,decontamination and disposal.

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Reduce Chronic Exposure byIncreasing Awareness of Healthy Diet

Regardless of the pollution prevention approaches we employ,significant reductions in mercury emissions and concentrationsin the food chain will take years to achieve.Exposures can be reduced now by changing consumptionpatterns of fish, the primary source of mercury exposure.This will require delivery of a complex health educationmessage to: Attain health benefits of eating more fish Yet reduce risk of excessive mercury exposure by careful selection of

caught and purchased fish with lower mercury content.

Campaign methods Direct public to campaign website Provide links to latest EPA-FDA dietary guidance and State and local fish advisories (46 states affected)

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Campaign Expansion:How would it work?

Use the same methods as the NIH institutional campaign: Copy and translate materials and methods from this and other

similar campaigns. Methods are adaptable and easily scalable. Use volunteers, public service ads and the Internet to deliver

the message.

No national public health problem of this magnitude has everbeen addressed for such a minimal investment: Little additional funding required. No new drugs need be developed. No new regulations to be promulgated.

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Continue Focus On Protecting Children(Hatter’s Helpers)

WHY? The unborn and very young children are at highest risk of

toxic effects from very low levels of exposure.

With its interesting properties and bright shiny appearanceolder children are enticed to play with it. Getting themercury safety message to teachers, parents and childrenis critical.

Most reported spills in the U.S. are in schools. Spills are difficult to clean up, may result in school closures

and extremely high clean-up and disposal costs. Schools have limited funds and expertise for clean up. Spills are easily preventable by eliminating mercury.

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To be Successful I Need Your Help

As CHAS professionals you are uniquely qualified to leadthese efforts. Take the Hatter’s Pledge for the NewCampaign:

Get involved. Build and reinvigorate partnerships - with public agencies,

non-governmental organizations, private sector. Share limited resources more efficiently – your expertise,

case studies, mercury detection equipment, websites andpublicity tools. Maybe even costumes.

Work with school programs - Teach the teachers.

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Closing WordsWe must succeed in these efforts so our children can recite the rhyme

as it should be:

Twinkle, twinkle, little star,How I wonder what you are.Up above the world so high,Like a diamond in the sky.Twinkle, twinkle, little star,How I wonder what you are.

With senses and intellect unimpaired,

Let them experience all the Wonder.

And discover what they are…

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Hatter’s Final Privilege

Howard Fawcett Awardees have the privilege to invite aspeaker to the CHAS Awards symposium.I invited Dr. Leo Trasande of the Center for Children’s Healthand the Environment at the Mount Sinai School of Medicine,and an NIH grantee to present a summary of researchconducted by his team on the public health and economicconsequences of methylmercury on the developing brain.You will find that the magnitude of just one impact of a singlemercury compound is astounding.And it’s why my new campaign platform is so important andurgent.

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World