Apples, Arsenic, and Risk - Part 17: Generated Incredulousness

Remember this:

It remains very unlikely that you have done any harm to yourself or to your children through the drinking of apple juice. 

Russell H. Greenfield, MD, Clinical Assistant Professor of Medicine, UNC Chapel Hill School of Medicine makes that statement on the Dr. Oz "Taking Action: Arsenic and Our Children" web page. Dr. Greenfield is a medical doctor.  I only play one on TV or when I sleep at a Holiday Inn Express.

So, where to start,,,oh yeah, you know what really grinds my gears?...

Let me pose a series of questions here.  First off:

Should parents of apple juice drink'n kids be "incredulous?"

"The findings raise significant health concerns for us and for our children, and have generated incredulousness that this could happen in our country."

Should these parents be "concerned?"

"Should you be concerned? Yes."

Should these parents be "angry?":

"Should you be angry? Yes,"

Dr. Greenfield, MD, tells parents they should be incredulous, concerned, and angry.  Those are his comments on the Dr. Oz web page.

And if I asked Dr. Greenfield, MD, "why," he would most assuredly tell me - as he wrote - because:

"The findings raise significant health concerns for us and for our children."

And if I asked "what findings?" he would tell me:

Dr. Oz "found high levels of arsenic in some apple juice products."

So if high levels of arsenic in some apple juice products raise "raise significant health concerns for us and for our children," then it wouldn't make any sense to then tell us:

It remains very unlikely that you have done any harm to yourself or to your children through the drinking of apple juice.

You see if we have not "done any harm to yourself or to your children through the drinking of apple juice" then there is no "significant health concerns for us and for our children" to be raised.

Why is that?  Because the reason to be "incredulous," "concerned," and "angry" is because of the "significant health concerns" based on the "high levels of arsenic in some apple juice products."  Those same levels which Dr. Greenfield, MD, tells us "remains very unlikely that you have done any harm to yourself or to your children through the drinking of apple juice."

This is the same strange logic - or lack thereof - that Mike Judge was trying to make in his movie "Idiocracy:"

Secretary of Energy: "Yeah, it's got electrolytes."
Joe: "What are electrolytes? Do you even know?"
Secretary of State: "It's what they use to make Brawndo."
Joe: "Yeah, but why do they use them to make Brawndo?"
Secretary of Defense: "'Cause Brawndo's got electrolytes."

Or in this case...

Me: "So we should be be incredulous, concerned, and angry?"
Dr. Greenfield, MD: "Yeah, the apple juice has arsenic."
Me: "And the arsenic in the apple juice is harming us and our children?"
Dr. Greenfield, MD : "No, it remains very unlikely that you have done any harm to yourself or to your children."
Me: "So why should we be incredulous, concerned, and angry?"
Dr. Greenfield, MD : "'Cause the apple juice has arsenic."

I have written 16 posts - not including this one - trying to show how the amount of arsenic found in apple juice is no where near the health concern that Consumer Reports, Dr. Oz, and the rest of these MDs and PHds have been trying to make.

Now let me get this out there - once again - in case my posts are being construed as "pro-arsenic."  Less is better.  Less inorganic arsenic consumption is better.  Period.

That being said, the amount of arsenic found in the 85 apple juice samples tested by Consumer Reports does not:

"raise significant health concerns for us and for our children." (1)

"suggest that chronic exposure to arsenic even at levels below water standards can result in serious health problems." (2)

What is being reported by Consumer Reports and Dr. Oz concerning the arsenic they detected in the apple juice is missing one of the basic caveats of toxicology and risk assessment:

We assume that there is a "daily exposure to the human population (including sensitive subgroups) that is likely to be without an appreciable risk of deleterious effects during a lifetime." (3)

We call this "daily exposure" the the "oral Reference Dose" or "RfD" and it is based on the assumption that thresholds exist for certain toxic effects.  The RfD expressed in units of mg/kg-day and is an estimate (with uncertainty spanning perhaps an order of magnitude) of an acceptable daily dose.

When we are at - or below - the acceptable daily dose, we can say things like:

"It remains very unlikely that you have done any harm to yourself or to your children through the drinking of apple juice." 

The amount of arsenic that is acceptable in our drinking water is based on  RfD that has been established for arsenic.  It allows us to draw a line in the sand and state that at a level of 10 ug/L is the "daily exposure to the human population (including sensitive subgroups) that is likely to be without an appreciable risk of deleterious effects during a lifetime."

Dr. Greenfield, MD, seems to understand this, look at what he writes:

"The 10 ppb level is simply as close as we can reasonably get considering our natural exposure to arsenic in the environment and other limitations. At that level, almost all experts agree our drinking water is quite safe." (4)

So if "it remains very unlikely that you have done any harm to yourself or to your children through the drinking of apple juice" and "at that level [10 ug/L], almost all experts agree our drinking water is quite safe," why does he also say that the 4 ug/L of inorganic arsenic in apple juice raises "significant health concerns for us and for our children."

For the life of me I cannot figure this out.  If a child drank two liters of apple juice a day instead of water they would consume less than the MCL of 10 ug/L (ppb) for arsenic that he says "almost all experts agree...is quite safe."

Where is the connection being missed here?  It is - and always will be - about the dose:

"All substances are poisons; there is none which is not a poison. The right dose differentiates a poison…." Paracelsus (1493-1541)

Once more: "The Dose Makes the Poison:"

A substance can produce the harmful effect associated with its toxic properties only if it reaches a susceptible biological system within your body in a sufficient concentration (a high enough dose). The toxic effect of a substance increases as the exposure (or dose) to the susceptible biological system increases. For all chemicals there is a dose response curve, or a range of doses that result in a graded effect between the extremes of no effect and 100% response (toxic effect). All chemical substances will exhibit a toxic effect given a large enough dose. If the dose is low enough even a highly toxic substance will cease to cause a harmful effect. The toxic potency of a chemical is thus ultimately defined by the dose (the amount) of the chemical that will produce a specific response in a specific biological system. (5)

That's from Yale by the way.  But I'll bet you dollars to donuts I could find researchers there who would conclude that arsenic in the apple juice raises "significant health concerns for us and for our children."  Heck, I wrote a bunch of posts on how three public health professionals made the claim that using laundered shop towels posed a risk to employees,  Barbara D. Beck PhD went to Harvard which is in the same league as Yale and she produced two papers that exaggerated the risk of heavy metal exposure.

Where is the connection being missed by these well educated professionals?

Next Post: Apples, Arsenic, and Risk - Part 18: The China Syndrome


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