Apples, Arsenic, and Risk - Part 20: 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).

I hate to keep whipp'n that dead horse, but that's what is missing in these discussions on the arsenic that has been found in apple juice.  Let's look at what Russell H. Greenfield, MD says on the Dr. Oz website regarding arsenic in apple juice:

The 10 ppb level [arsenic MCL for drinking water] 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.

Shouldn't the same goal or, at the very least, similar science-based exposure guidelines, be in place for the juices we commonly give to our children?

What goal would Dr. Greenfield want to see?  Consumer Reports thinks "the standard should be 3 ppb" and the FDA, on December 15, 2008, issued a memo on research they had done regarding arsenic in the juice:

In conclusion, the chronic consumption of apple juice products containing over 23 µg/L (ppb) inorganic arsenic would represent a potential health risk.

The FDA in 2008 says 23 ug/L is the maximum total arsenic in apple juice that would not pose a potential health risk.  That 23 ug/L is based on the actual dose a child would take in (uptake) based on how much apple juice is normally consumed.  That's the way it is supposed to be done, that's the way the FDA did it in 2008, so why does Consumer Reports, Dr. Oz, Dr. Greenfeild, and good ol' Chuck Norris think the FDA has dropped the ball on this?

Let's look at how the FDA came up with that:

Consumption estimates were based on average consumption over two days for individuals who consumed apple juice (eaters only) and were calculated for two population groups: Males and females (MF) from birth to 2 years of age and MF 2 years of age and older.  

The estimates included foods codes for products that were 100% apple juice, including infant apple juice; juice blends that included apple juice as an ingredient were not included.

Relying on results of the more recent 2003-04 NHANES, consumption of apple juice by MF birth to 2 years was estimated to be 16.7 and 36.2 g/kg body weight/day at the mean and 90th percentile, respectively, compared with previous estimates of consumption for all juices of 19.1 and 43.4 g/kg body weight/day.  

For MF 2+ years, consumption of apple juice was 6.0 and 12.9 g/kg body weight/day at the mean and 90th percentile, respectively, compared with the previous estimates for all juices of 6.0 and 13.0 g/kg body weight/day. 

Since consumption estimates from both surveys are similar, the level of concern (LOC) that was calculated for the previous assessment (23 ug/L, or ppb) can be applied in the case of apple juice. 

The 23 ug/L is for inorganic arsenic and is based on the dose a child would take in drinking apple juice.  The reason that number is higher than the 10 ug/L for arsenic in drinking water is that the dose from drinking water is estimated to be 20 ug at the 10 ug/L MCL.  This is because the MCL is based on drinking 2 liters of water per day.

What that means is this:

A 30 kg child (66 pounds) drinking 36.2 grams of apple juice per kilogram of body weight consumes 1086 grams of apple juice which is 1.1 liter.  That's the amount that will deliver the dose of arsenic.  That quantity of apple juice is the 90th percentile highest amount of apple juice estimated to be consumed.  A child drinking that much apple juice would receive 25.3 ug of total arsenic at a maximum FDA acceptable concentration of 23 ug/L.  The highest anticipated "daily dose" for this 30 kg child is 25.3 total arsenic from drinking apple juice.

For drinking water, that same child would consume 2 liters of water at the MCL of 10ug/L for a total daily dose of 20 ug.  That's what the EPA considers a safe dose.

So normal apple juice consumption will see less than 25.3 which is equivalent to what would be consumed if drinking two liters of water at the MCL for arsenic of 10 ug/L.

Drinking apple juice at a total arsenic concentration of less than 23 ug/L is the same as drinking water at the MCL 10 ug/L for arsenic.  The dose is based on the amount consumed per unit of fluid.  You drink less apple juice per day then water so apple juice can contain more ug/L of arsenic and still be considered safe.

Sounds counter intuitive, especially when you are talking about toxicity. We are concerned with the amount of the toxin - dose - received not the amount of the toxin found.  This is why you cannot compare the MCL for drinking water to the concentration of arsenic found in apple juice.  The MCL has been established for a dose based on consuming 2 liters per day.  You therefore need to compare the dose the receptor is anticipated to receive with the maximum dose - mg/kg body weight - established as "safe."

This is how it works.   It is - and always will be - about the dose when describing toxicity.

23 ug/L of total arsenic presents less dose than a drinking water MCL of 10 ug/L and is based on the assumptions of how much of each is consumed.  As long as the daily dose does not exceed 20 ug for a 70 kg person - or - 0.28 ug arsenic/kg body weight - we will not expect to see any short term or long term potential health risks over a 70 year lifetime!

That's why Dr. Greenfield states on the Dr. Oz website:

At that level [10 ug/L], almost all experts agree our drinking water is quite safe.

Even ol' Chuck Norris agrees with that, although I am pretty sure he has no idea that he does:

At the very least, the FDA should not allow more arsenic in apple juice than it allows in Americans' drinking water.

"Not so fast!" Yells our hero Chuck Norris, "tell them about the cover-up!"  No, Chuck, you tell them:

Tragically teetering on a huge U.S. health cover-up, the FDA posted eight "previously undisclosed test results" for apple juice samples from across the country that had arsenic levels that superseded even its own "level of concern" for inorganic arsenic. Two of those eight samples had an arsenic level of 27 ppb. One had a level of 42 ppb, and two others were at 45 ppb.

Tragically teetering?  Oh chuck, you are such the drama queen!  Here is what the FDA discloses in another memo dated November 21, 2011:

In July 2011, we issued an Import Bulletin to significantly increase the number of juice products sampled and analyzed for arsenic under the Toxic Elements program. Importantly, of the 74 samples collected as a result of this import bulletin, all were from China. Of these:

• 1 sample was above 23 ug/L total arsenic
• 1 sample was 10 ug/L total arsenic
• 2 samples were 11 ug/L total arsenic
• The remainder, (almost 95 percent), were below 10 ug/L total arsenic.

 Compare that to the arsenic levels reported by Consumer Reports.  But wait, there is more:

[we] now have a total of 160 apple juice samples collected from 2005 to 2011. These include 70 samples posted by FDA on September 27, 2011 and an additional eight samples that were part of this data set. These eight samples, which had not been previously posted, all have total arsenic levels greater than 23 ppb and were in the process of being further verified.

The data set also includes 82 new samples collected in the latter part of 2011 for which the data have just now become available. Of these 160 apple juice samples:

• Almost 88 percent had fewer than 10 ppb total arsenic
• 95 percent had total arsenic levels below 23 ppb total arsenic.

Okay...anything else from the lyin' stinkin' covern' up FDA?

Similarly, from the Total Diet Study program:

• Nearly 77 percent of the 134 composite apple juice samples tested from 1991 to 2009 (including baby food and general consumption samples) had total arsenic levels below 10 ppb.
• 95 percent had total arsenic levels below 23 ppb.

Cover-up?  C'mon Chuck, this ain't nothin' different than what Consumer Reports found.  How many samples do you need to have analyzed to get you to understand that we're not in any danger.  I mean, really Chuck?

Until then, tides of arsenic will continue to flow from foreign produce fields into American bloodstreams.

Tides of arsenic?  Chuck, Chuck, Chuck...

I have written 20 posts on this topic.  I have tried to show how many of these statements from Consumer Reports, Dr. Oz, and Chuck Norris are not substantiated.

As much as I believe we should consume food that is grown locally and with little to no pesticides, I cannot say that the reason for doing so is because foreign grown apple juice contains more arsenic than American. The Consumer Reports data shows that it does not.

I cannot support lowering the inorganic arsenic level to 3 ug/L.  There is no evidence to support that.  None.  Period.  The FDA's level of concern of 23 ug/L appears to be prudent, justified, and can be supported by the same data used to produce the drinking water MCL for arsenic at 10 ug/L.  And at that level, one more time courtesy of Dr. Greenfield:

"almost all experts agree our drinking water is quite safe."

It is - and always will be - about the dose received and not the amount detected.  You cannot compare the ug/L established for water with the ug/L found in apple juice.  This is no different than comparing a one pound ingot of lead with a one pound feather pillow.  They both weigh the same but one of them you would not want dropped on your head.

Let me sum it all up.  Here is how it works, it only works this way.

If little 2 year old Johnny weighs 66 pounds (30 kg) and he drinks the upper most amount of apple juice the FDA research found, 1.1 liters (36.2 g/kg body weight/day), and that apple juice contains the highest amount of total arsenic the FDA says is safe - 23 ug/L - he would consume 25.3 ug of total arsenic each day he drank 1.1 liters of apple juice.

That's a pretty big two year old and that's a lot of apple juice to drink, but that's a potential and I'm trying to force a "worst-case" scenario to illustrate my point.

25.3 ug for a 30 kg child comes out to 0.84 ug arsenic/kg body weight.  0.84 ug is 8.4E-4 mg/kg.

The IRIS reference dose (RfD) for inorganic arsenic is 3.0E-4 mg/kg-day.  Now before you say "whoa! That's more than double" remember this:

In general, the RfD is an estimate (with uncertainty spanning perhaps an order of magnitude) of 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.

Little Johnny will not drink more apple juice per body weight when he gets older, in fact, the FDA reports that after two years of age, a child drinks about half of that amount per body weight.  And as their body weight increase towards 70 kg, the dose of arsenic received per body weight gets less and less each day they consume apple juice.  So that at the end of 70 years, the dose of arsenic is around 3.0E-4 mg/kg-day based on a max of 23 ug/L.

Oh, and that worst-case amount of arsenic, 8.4E-4 mg/kg-day, is for total arsenic.  Looking at the Consumer Reports data, inorganic arsenic is about 30% less than that.

Nevertheless you may say, this worst case mega-heavy-baby little Johnny is consuming more than the IRIS RfD of 3.0E-4 mg/kg-day of inorganic arsenic based on these FDA estimates and calculations.

True that, but I have another little bit of information that will let me know everything will come out OK.  Even if little Johnny were to drink 1.1 liters of apple juice with 23 ug arsenic every day and never weigh more than 30 kg, the estimated dose of total arsenic - 8.4 mg/kg-day - is just barely above the NOAEL (No Observable Adverse Effect Level) of 8.0E-4 mg/kg-day listed by IRIS for inorganic arsenic and well below the LOAEL (Lowest Observable Adverse Effect Level) of 1.4E-2!

So is the FDA correct in identifying 23 ug/L arsenic in apple juice as a level of concern?  Yes.

Can the FDA substantiate their claim that:

...the chronic consumption of apple juice products containing over 23 µg/L (ppb) inorganic arsenic would represent a potential health risk.

Yes.

Is Dr. Russell H. Greenfield, MD correct when he says:

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

Yes.

Can you and your kids drink apple juice despite all of the misinformation and assumptions made by Consumer Reports, Dr. Oz, and Chuck Norris?

Yes.

Everything in moderation.

Now, how do you like them apples!


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Apples, Arsenic, and Risk - Part 19: Like Dysentery, Only Sweeter

Ubiquitous = Everywhere

Consumer Reports tells us:

Arsenic is a naturally occurring element that can contaminate groundwater used for drinking and irrigation in areas where it’s abundant, such as parts of New England, the Midwest, and the Southwest. (1)

If we water our apple trees with ground water that is naturally contaminated with arsenic, or groundwater that is contaminated with arsenic from past pesticide and industrial use, that arsenic will be sucked up the trees and end up in the apples they produce.

That's one way, the other way has a bit more of the yuck factor involved.

If you look at the NHAMES data Consumer Reports references, and focus on this statement they make in their report, you will maybe understand why it is "ubiquitous."

Because most ingested arsenic is excreted in urine, the best measure of recent exposure is a urine test. (1)

Perhaps I can make my point using a song from the play "The Book Of Mormon."  That song, "Joseph Smith American Moses" has lyrics that discuss the spread of dysentery.  Now if you are familiar with South Park, the guys who wrote this play are the same ones who write that, so if you have sensitive ears or eyes you may not want to go looking for them.

So with apologies to Stone and Parker, here are my lyrics to illustrate the ubiquitousness of Inorganic Arsenic.

Arsenic goes out in the urine

Urine goes down the sewer

The sewer ends up in the river

The river irrigates the apple tree

The apple tree makes the apple juice

The apple juice goes in the cup

The cup goes to the mouth

The mouth goes to the stomach

Arsenic goes out in the urine

So now that I have that little ditty out of the way, let me put it all together using Vinny Gambini: - from "My Cousine Vinny - as a way to further illustrate what may be happening.

I'll set the scene: Vinny is in court cross examining Russell H. Greenfield, MD who made this statement:

"...the US government put a stop to the use of inorganic arsenical pesticides years ago. The same action, however, has not been taken by other countries, such as China, which just so happens to be the major source of apple juice products found in American stores. Chinese farmers, including apple farmers, still may use pesticides containing arsenic." (1)

The courtroom audience is hush, the air thick...

Vinny Gambini: And where does apple juice come from?
Dr. Greenfield:  China
Vinny Gambini:  Good...but more specifically....
Dr. Greenfield:  From the apples that grow on apple treesVinny Gambini: And those trees...do they require anything other than sunlight and soil to grow?
Dr. Greenfield: They need water.
Vinny Gambini: Water, that's right, don't be afraid just shout 'em right out when you know 'em.  And where does that water come from?
Dr. Greenfield: The rain
Vinny Gambini:  Rain...that's right, is that all?
Dr. Greenfield: Groundwater
Vinny Gambini: Ahh...pumped up from below the surface.  Anywhere else?
Dr. Greenfield: Rivers...
Vinny Gambini: Yes, rivers, streams. pounds, lakes...tanks - as you call them in Texas.  You mean surface water?
Dr. Greenfield: Yeah...surface water
Vinny Gambini: And is the water pumped up from the ground always free of arsenic?
Dr. Greenfield: No
Vinny Gambini: And that urinary arsenic we've been talkin' about.  Anyway that can get into the surface water?
Dr. Greenfield: Yeah, if that's where the treated water is discharged.
Vinny Gambini: So, what do you think? Isn't it possible that the arsenic is naturally coming from the soil or is present in the surface or groundwater used to irrigate the apple trees and not just from pesticides?
Dr. Greenfield: I suppose.
Vinny Gambini: I'm finished with this guy. 

I (almost) rest my case.

Next (and finally the last) Post: Apples, Arsenic, and Risk - Part 20: It is, and always will be, about the dose.


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

Russell H. Greenfield, MD writes:

Dr. Oz and his staff have performed their own investigation into this matter, and they, too, found high levels of arsenic in some apple juice products. The findings raise significant health concerns for us and for our children, and have generated incredulousness that this could happen in our country.

After everything I have read on this topic, a theme began to take shape. A theme that may help answer the question I asked in my last post: Where is the connection being missed by these well educated professionals?

Let's see if you can pick it out:

"...in our country."

"...the US government put a stop to the use of inorganic arsenical pesticides years ago. The same action, however, has not been taken by other countries, such as China, which just so happens to be the major source of apple juice products found in American stores. Chinese farmers, including apple farmers, still may use pesticides containing arsenic." (1)

"More and more food comes into our country from foreign soil each year, but the FDA is able to inspect only a small and woefully inadequate percentage of the products reaching our shores before they reach our store shelves and then our plates. Why? Because funding for the FDA is consistently on the chopping block in Washington, DC. It is this fact that merits our anger." (2)

"Also, request that they apply pressure to improve Chinese agricultural practices, both for our safety and their own population." (3)

"Look for the country of origin on your apple juice label. You’re likely much safer drinking a product that comes only from the United States." (3)

"Go organic when possible. Organic apple juice comes from apples that are, by definition, not treated with harsh pesticides." (3)

"For the past decade, most concentrate has come from China. Concerns have been raised about the possible continuing use of arsenical pesticides there, and several Chinese provinces that are primary apple-growing regions are known to have high arsenic concentrations in groundwater." (4)

"Currently there's an alert for increased surveillance of apple concentrate from China and six other countries "where we have a suspicion there may be high levels of arsenic in their products," says FDA spokeswoman Stephanie Yao. But in fiscal 2010, the agency conducted physical inspections of only 2 percent of imported food shipments." (4)

"The fact is that the U.S. is getting more and more of its fruits and vegetables from other countries, and many of them do not preclude or limit arsenic in their pesticides or even their water supplies as the U.S. does. Oz reported that apple concentrate comes from up to seven countries; 60 percent of it is imported from China alone." (5)

Notice somethin'?

What would a nerdy public health blogger do with that theme?  Hmmm, I wonder what was found in the samples collected and analyzed by Consumer Reports?  Let me be clear here, I am writing this BEFORE I have crunched the numbers.  My initial observation is that we will not see any difference in the amount of arsenic from country to country.  I hope so, because I have a really good song to use to make my point!

Okay, back.  Here is what I found (mean value):

Source: Consumer Reports

Interesting....

Looks like the apple juice from China has less inorganic arsenic than that from the USA.  I wonder what that means?  Well, here is what I think, lets look at these two statements:

"The fact is that the U.S. is getting more and more of its fruits and vegetables from other countries, and many of them do not preclude or limit arsenic in their pesticides or even their water supplies as the U.S. does. Oz reported that apple concentrate comes from up to seven countries; 60 percent of it is imported from China alone." (5)

"For the past decade, most concentrate has come from China. Concerns have been raised about the possible continuing use of arsenical pesticides there, and several Chinese provinces that are primary apple-growing regions are known to have high arsenic concentrations in groundwater." (4)

If arsenic pesticides are no longer used in the USA, and apple-growing regions of China have high arsenic concentrations  then we would expect the apple juice from China to have more arsenic than the USA, not less.  In fact, look at the concentrations Consumer Reports found.  I have ranked them from highest to lowest.

Source: Consumer Reports

You know the terrible thing about looking at the data that is reported?  It sometimes makes you have to admit that your assumptions have been wrong.  We assume that foreign apple juice is bad because they don't have our standards.  But when you look at theirs compared to ours, that's not what the data shows.

But the data does show something.  It shows that arsenic is in all apple juice and it looks like the country it comes from plays little into the concentration.  Which makes me wonder what that organic apple juice ol' Chuck Norris wants us to drink contains?

So if it's not arsenic pesticides putting the arsenic in our apple juice (if it is, and we don't use it, that does not bode well for us) where is it coming from?

Enter the word "ubiquitous."


Next Post: Apples, Arsenic, and Risk - Part 18: Like Dysentery, Only Sweeter.


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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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