Essential Reading: For medical professionals and others serious about understanding the Kauai pesticide/birth defect situation

Below is a comment pulled from The Garden Island comment section, that was attached to the "Pesticides and Birth Defects - Who do you believe?" story published on 11/29/2017 (and republished on this blog, below this blog piece).This is important to read if you are seriously interested in this topic.  The State Department of Health (SDOH) has struggled with updating the Hawaii Birth Defect registry and the most recently posted report is dated 2005.The SDOH continues to insist that "there is no problem" as to increased incidence of birth defects on Kauai, even though several local physicians based in the main hospital that serves the community most impacted by high levels of pesticide applications in the nearby fields, - continue to believe there is a problem.  Dr. Raelson explains below the source of his concerns regarding the reliance on the SDOH data.  Here is a link to his original email explaining how he and colleagues came to the conclusion that the Kauai Veterans Memorial Hospital (KVMH) appeared to have 10X the national rate of certain rare heart defects in new borns.  https://tinyurl.com/y7djq7t2Jim Raelson November 29, 2017 11:08 pmReplyI am one of the physicians that Mr. Hooser refers to above and in fact am responsible for raising the concern re: a cluster of certain birth defects on the Westside. The Joint Fact Finding Study released May/2016 does an excellent job of summarizing what we know and don’t know and should be read carefully by those expressing opinions. In regards to birth defects and neurodevelopment problems on the Westside the study clearly and carefully states that there is not accurate data to answer the question. The claim by Uncleania and others that the data show no evidence of increased incidence of birth defects or health problems is just not true. The Joint Fact Finding Study made specific recommendations re: getting accurate birth defects information. DOH and Dr. Pressler have made efforts since then to improve birth defects data gathering but still have not conducted the type investigation that would be required. The problem is with case ascertainment. HBDP and DOH data relies on ICD9/10 case identification primarily. There are multiple problems with this approach which I have raised with the Fact Finding Group:1. There are multiple different EHR systems in hospitals, clinics and private physician offices that don’t interchange data and many DOH does not have access to. 2. ICD9/10 coding is driven by billing concerns not epidemiology needs and as such accurate coding of birth defects does not exist; coding at one hospital in question is not even done by physicians or clinicians but by billing clerks. 3. Many birth defects are not diagnosed at birth but later after leaving the birth hospital 4. Many birth defects do not ever require inpatient care and won’t show up in Hospital ICD9/10 data sets. I was asked to meet with and help DOH with their data by adding cases that “I was aware of”. I declined based on the adage that “no data is better than bad data”. Producing data based on individual clinician recall, mining inaccurate incomplete ICD 9/10 data sets produces bad data. And the problem with bad data is that people will use it for their own biased agenda; there does not exist any accurate data saying there is or there is not an increase in birth defects or neurodevelopment problems on the Westside of Kauai.Accurate data is attainable but it would be very manpower and time intensive and so would be very expensive. 1000 births, 5 years of Westside births could be studied by pulling records of Hospitals and the primary pediatricians records, phone calls to parents, and analyzing by trained epidemiologists would do it. Epidemiologists know that the magnitude of affect of a drug or toxin determines the number of births that would need to be studied in order to show a statsitcally significant finding. I do not want to disparage Dr. Pressler and her colleagues. Maternal and Child Health Title V Block Grant Report released 7/17/17 shows the great work they are involved in and the priorities and demands on their limited resources. I don’t know if the Westside of Kauai families bear the burden of more birth defects because of pesticides and I am sure no one else knows either. But I do know that in other locations with larger populations good studies have shown a correlation between birth defects and neurobehavioral problems with pesticides. I do understand the importance of jobs and a healthy economy for the health of families. But I know many Westside families and none would trade the health of their treasured children for a job if they knew a risk existed. All use of pesticide on Kauai is a risk to our children not just from seed company use. But I think we are going at this all wrong. We know these chemicals have potential toxicities. Why do we as citizens, why do our government agencies have to bear the burden and cost of proving they are harmful? Why don’t we demand that the users of pesticides follow the Fact Finding Report and pay for the good studies, pay for biologic sampling and prove to us that they are safe?