Book Review

Pesticides in the Diets of Infants and Children

N Engl J Med 1994; 330:443-444February 10, 1994

Article

Pesticides in the Diets of Infants and Children
By a committee of the National Research Council. 386 pp. Washington, D.C., National Academy Press, 1993. $47.95. ISBN: 0-309-04875-3

The title of this book is bound to stimulate the interest of a diverse spectrum of readers. All of us take an interest in the quality of food fed to our children and its potential risks. Most of us have assumed that our food is free of risks posed by pesticides but have heard some uncomfortable allegations to the contrary, usually in the lay press. Many physicians have been confronted with such concerns from patients, with little in the way of objective scientific data related to the issue. This report of the Committee on Pesticide Residues in the Diets of Infants and Children, a committee of the National Research Council of the National Academy of Sciences, is a careful and dispassionate assessment of our present understanding of such risks. It is also an excellent exposition of the gaps in our knowledge and the problems with the present methods of regulating the use of pesticides on foodstuffs.

It is tempting to read only the executive summary, which is excellent and clearly outlines the salient points and the clear recommendations of this expert panel. This temptation is reinforced by the style and content of much of the rest of the text, which is sometimes difficult or tedious and repetitive reading. A careful reading of the complete document is a rewarding experience, however, for several reasons. First, this book uniquely summarizes the many programs of state and federal governments that affect the regulation of pesticides in food. It highlights clearly the deficiencies in the present confusing and somewhat poorly coordinated systems. In an eye-opening fashion it demonstrates basic conceptual deficiencies in the system, including the lack of a true health-based standard for the regulation of pesticides in our food supply. Any reader not already familiar with these systems will be greatly enlightened by this discussion.

Second, this is perhaps the most readable discussion available of some of the basic elements of risk assessment that are or can be used to evaluate hazards to health from toxic materials in our environment. For the reader who has always wondered how risk is estimated, the clear and succinct descriptions of some of the methods available are illuminating. For the reader who has accepted without question risk estimates reached by the government and others, it is troubling to learn of the pitfalls and inherent inaccuracies and inconsistencies of the present systems. For the expert in this area, this book may offer some new or relatively new approaches to assessing risks to children. Certainly, any reader should benefit from these discussions.

Since it was written by a diverse committee, this report unfortunately suffers from substantial variations throughout in style and content. The general reader will probably be particularly disappointed by errors in the descriptions of normal growth and development, metabolism, dietary requirements, and the physiology of infants and children. These sections would have benefited considerably from improved peer review by pediatricians expert in these areas.

Despite some obvious weaknesses, this report, overall, is an excellent assessment of current knowledge and regulations related to pesticides in the diets of children. It presents a workable approach to improving the process of assessment and regulation. It provides clear and direct guidance to those involved in protecting children from the hazards described. Finally, it serves the generalist physician as an excellent resource with which to respond to the concerns of parents. It is worthy of the attention of any person interested in potential hazards in the diets of children.

J. Routt Reigart, M.D.
Medical University of South Carolina, Charleston, SC 29425