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Comparing Risks – Eating Fish
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Comparing Risks – Eating Fish

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Submission at the at the Workshop on Risk Assessment in Regulatory Policy Analysis (RIA), Session 10, Mexico, 9-11 June 2014. Further information is available at …

Submission at the at the Workshop on Risk Assessment in Regulatory Policy Analysis (RIA), Session 10, Mexico, 9-11 June 2014. Further information is available at http://www.oecd.org/gov/regulatory-policy/

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  • 1. Comparing  Risks  –  Eating  Fish     In  2004,  the  U.S.  Food  and  Drug  Administration  (FDA)  and  the  U.S.  Environmental   Protection  Agency  (EPA)  issued  an  advisory  about  the  risks  of  methylmercury   (MeHg)  in  fish  and  shellfish1.    The  goal  was  minimizing  the  likelihood  that  women  of   childbearing  age  would  ingest  excessive  MeHg  while  still  benefiting  from   consumption  of  fish.    MeHg  is  a  potential  developmental  neurotoxicant,  causing   cognitive  deficits  in  children  exposed  in  utero  and  may  have  other  adverse  effects   including  heart  attacks  in  men.    At  the  same  time,  fish  consumption  provides  a  rich   source  of  omega-­‐3  fatty  acids.    Omega-­‐3  fatty  acids  are  linked  to  a  number  of  health   benefits  including  reduced  risk  of  heart  attack  and  stroke  (primarily  in  older  men)   and  improved  cognitive  function  in  infants.         EPA  and  FDA  did  not  conduct  a  formal  analysis  of  the  magnitude  of  the  benefits  (and   disbenefits)  that  might  occur  from  the  advisory.    The  impact  of  the  advisory  on  fish   consumption  by  women  of  childbearing  age  and  the  rest  of  the  population  was   unknown.      Evidence  for  MeHg  harm  to  the  developing  fetus  comes  from  prospective   epidemiologic  studies  for  populations  with  high  fish  consumption  in  New  Zealand,   the  Faroe  Islands  and  the  Seychelles  Islands.    The  studies  reach  different   conclusions  with  the  NZ  and  Faroe  Island  studies  finding  subtle  cognitive  deficits  in   the  children  of  mothers  with  the  greatest  MeHg  exposure  and  the  Seychelles  study   finding  no  effects.    Some  epidemiology  studies  link  MeHg  to  heart  attacks,  although   the  findings  are  mixed.    The  benefits  of  omega-­‐3  fatty  acids  are  based  on  both   epidemiologic  studies  and  clinical  trials  (for  the  benefit  to  infant  cognitive  function).     The  results  are  quite  consistent  across  studies.     If  you  were  asked  to  conduct  an  impact  assessment  of  a  fish  consumption  advisory2:     • How  would  you  decide  which  health  outcomes  to  include  and  which  to   exclude?     • Would  it  matter  to  you  that  some  health  outcomes  have  consistent  evidence   for  causality  and  some  do  not?    If  so,  how  would  you  incorporate  this  into   your  analysis?     • How  would  you  think  about  quantitatively  comparing  very  different  health   outcomes  like  heart  attacks,  strokes  or  cognitive  effects  in  infants?     • Does  it  matter  that  different  populations  bear  the  risks  or  get  the  benefits  of   fish  consumption?                                                                                                                       1  http://www.fda.gov/food/resourcesforyou/consumers/ucm110591.htm   2  Cohen,  J.T.  ,  Bellinger,  D.,  Connor,  W.E.,  Kris-­‐Etherton,  P.M.  ,  Lawrence,  R.S.  ,  Savitz,  D.S.  ,  Shaywitz,  B.   ,  Teutsch,  S.M.  ,  Gray,  G.  (2005)  A  Quantitative  Risk-­‐Benefit  Analysis  of  Changes  in  Population  Fish   Consumption.    American  Journal  of  Preventive  Medicine  29:325-­‐334