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Mercury Contamination in Fish

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Interview with Dr. Jane Hightower:
My Patients and Mercury

Dr. Hightower, how did you come to study mercury?

I'm a diagnostician and an internal medicine doctor, and I'd seen cases over the years where I couldn't find the cause for certain symptoms. I first started to connect it to mercury when I had a patient with hair loss, fainting spells and stomach upset. She had seen a dermatologist, who, by serendipity, had heard a radio story about hair loss problems related to eating fish from a mercury-laden lake. And in walks my patient, who happened to be a big fish-eater, and who was having these symptoms. At about the same time, I had a second patient with similar symptoms, who said she was certain her house was poisoning her. I asked if she ate a lot of fish and took a whole history. In the end, both patients proved to have elevated mercury levels.

So I did a lot of research -- and there wasn't a lot out there to go on, I have to say. The Food and Drug Administration, for example, was still relying on a 1971 study of mercury poisoning from tainted grain in Iraq. But my patients were relying on me to put it together, so I kept researching. And that eventually led me to put together a study to determine whether the various symptoms in my patients were linked to mercury in their bodies, and whether that mercury could be linked to what they were eating.

What did you expect to find?

I really wasn't sure. There just wasn't a lot of data out there at the time that would direct me, and I didn't know a lot about the differing mercury levels in fish.

How did your patients with elevated mercury levels react to the news?

It varied by patient. For some of them it was pretty shocking at first. And there were a few naysayers. But they all accepted the news one way or another. And those who were symptomatic got their mercury levels down by taking my advice to stay away from fish for six months.

Were they aware of mercury as a threat at all? Was this even on their radar screen?

They had no idea. They ate fish because it is an otherwise healthy food, and they assumed the FDA was protecting them from poisons in their food. I think a lot had a sense of betrayal, because they trusted the government agencies, and yet they hadn't ever heard anything about the problem.

Did any of them experience mercury-related symptoms?

Yes. The link to mercury is hard to prove, of course. But many of my women patients who ate fish during their pregnancies have reported that their kids have learning disorders. I can't prove it was mercury that caused it, but I can say that I saw it happen in my practice.

Some of the women have guilt about that, and as I say, many feel betrayed. They were careful during pregnancy -- they didn't take drugs or drink caffeine or alcohol -- following the advice they got. But then something they hadn't been warned about comes up. They feel like they had a right to know.

What's your sense of the level of knowledge about this in the medical community?

Well, my colleagues in San Francisco say they can't read the fish menu in a restaurant without thinking of me!

But most doctors have not heard enough about this problem, and many are completely unaware of it. We absolutely need to get more information out to the medical community. In fact, I just recently wrote a resolution for the American Medical Association's annual meeting that calls for more research, updated safety standards, food labeling and more education on mercury. And, of course, we need NRDC and others to work with people in the field, and to take it to the masses.

But, as an example, every time I do a talk on this subject to medical audiences, I get a call about seven to 10 days later from a doctor asking me to interpret his or her own blood numbers -- and these are clinicians, professors, heads of laboratories and so on. So, there's plainly more education to do.

Has your own diet changed as a result of the study, and your other work on this issue?

Well, I was never a huge fish eater, and when I do eat seafood, I've always tended toward the crab and shrimp end of the spectrum anyway. I grew up in a modest family in Sacramento, and didn't know what a swordfish was until I met my husband! Really, it's his diet that's changed as a result of my work on this.

What kind of progress do you think we're making on mercury problems?

Well, a number of things have come together nicely in the last year or so. I think I provided a missing piece of the puzzle: That this exposure is coming from fish that we purchase at the grocery stores and restaurants. It is not just the subsistence or noncommercial fish that have mercury. Some people are eating so much of the commercial, high-mercury fish that they are over the mark for tolerable allowances set by the Environmental Protection Agency, the FDA, the Agency for Toxic Substances and Disease Registry and the World Health Organization. Although there is some data on the mercury content of fish, testing is still scarce. Having government agencies, non-governmental organizations, consumer action groups, health care professionals and the fishing industry continue to be involved is vital to set the balance. We need numbers and hard facts available. Without them, we cannot make educated, consensual choices.

Photo: Richard Rider

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Dr. Jane Hightower

Photo of Dr. Jane Hightower

Dr. Jane Hightower's year-long study of mercury levels in patients in her San Francisco medical practice brought national attention to what has been a badly under-publicized health threat. First published in the November 1, 2002, issue of Environmental Health Perspectives, a journal from the National Institute of Environmental Health Services, the study found elevated mercury levels in many of her patients, levels that Dr. Hightower associates with patients' consumption of fish from commercial sources.

Dr. Hightower graduated from the University of Illinois at Chicago Medical School in 1988 and did her residency at St. Mary's Hospital and Medical Center in San Francisco. Today she is a doctor of internal medicine at the California Pacific Medical Center in San Francisco, and lives in the Bay Area.

NRDC spoke with Dr. Hightower on June 13, 2003.

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