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Defining The Problem


Editorial from the Progress Newsletter
Spring 1988, Vol. 4, No. 1
© 1988, 2003

At a recent meeting of a group of our scientific advisors, NPA staffers once again found themselves discussing the question of lice as a "social problem" vs. lice as a "medical problem." It might have been more productive to think about the question in another way: How can we hope to meet the challenge of pediculosis prevention if we are still struggling to define the problem?

We believe it is essential to view lice infestation as both a social and a medical issue - and to understand that we only add to the confusion surrounding pediculosis management when we attempt to separate the two perspectives.

As is the case with any communicable disease, head lice infestation is, by definition, a social problem. It involves blood-obligate human parasites that live and breed only with access to people in groups. The louse must continually locate new hosts to avoid inbreeding and avert its own extinction. It is also a social problem in that the individual's response to lice will always reflect the prevailing societal level of tolerance.

But head lice is also, clearly, a medical problem. The professional diversity of our own advisory board points to the wide variety of scientific/medical perspectives inherently involved in developing thorough pediculosis management strategies. These scientific perspectives are crucial to our work: Entomology for an understanding of lice biology and behavior; toxicology for an appreciation of the chemical effects of pediculicides on the body's tissues and organs; epidemiology to track the patterns and demographics of outbreaks; pediatrics because children are the population most vulnerable to lice and their chemical treatment; dermatology because both lice and their treatment agents affect the skin; parasitology to better understand the relationship of insect to host; etc. etc.

Once we can accept these medical/scientific components of management strategies, we need to incorporate into the process the social mechanisms by which effective procedures and protocols can be implemented. Let's look at the No Nit Policy as an example. The medical/scientific basis for such a policy is clear; in vitro studies show that commercially available products do not kill all the eggs and that survivors hatch to begin a cycle of reinfestation. It is also scientifically sound to suggest that removal of eggs in conjunction with the first application of pediculicide helps to minimize the need for an automatic second treatment or an unnecessary later treatment due to diagnostic confusion.

However, before implementation of No Nit Policies can take place, people need to re-evaluate the current community standard of dealing with this problem. The lack of any policy whatever sends a message to the community that complacency is acceptable and that lice infestation is a health problem not worthy of attention. A policy that lacks sound scientific basis provokes controversy and adds to the problem. But the social act of mandating a scientifically appropriate policy, such as No Nits, generates a climate of accountability in which parents learn to accept their role in keeping their children lice-free. With raised awareness, the community will be unwilling to tolerate the idea of knowingly allowing children to harbor lice, nits or even their dead remnants.

Meetings with our scientific advisors always result in an interesting clarification of ideas. Each advisor brings to the process the particular focus of his or her discipline and enables us to define appropriate goals. Our staff role, as we see it, is to synthesize their various medical-scientific perspectives into a socially workable health education agenda - one that will promote a spirit of community cooperation in which parents and health care professionals can agree on the importance of controlling lice outbreaks thoroughly and with the greatest margin of safety.



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