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Shampooing with Poison

From the NPA’s Progress newsletter, Winter/Spring 1995

On January 12, 1995, the National Pediculosis Association issued yet another alert to the public to avoid lindane-containing treatments for individuals with lice or scabies. (Such infestations are endemic among the American population, with estimates of as many as 1.2 million individuals treated annually for lice alone.) Lindane, described by its original U.S. manufacturer as a powerful contact and internal poison, is a known neurotoxin widely prescribed for direct application to young children, pregnant women, nursing mothers, and the elderly: Lindane is 99% pure gammahexachlorocyclohexane - manufactured with the raw materials of benzene and chlorine. In addition to its neurotoxic properties, lindane has been associated with aplastic anemia, leukemia, and other blood disorders.

A national reporting registry for lice and scabies related issues was established by the NPA in May 1994, and has received reports of over 330 adverse reactions to various pesticidal lice and scabies product treatments. Although the reactions have been reported by patients (or their families) rather than physicians, their numbers and particulars are sufficiently compelling to prompt additional serious concern about the exposure to lindane.

Consistent among the most common adverse effects associated with exposure to lindane and reported to the NPA's registry are illnesses including: seizures, behavioral changes, neuromuscular complaints, attention deficit disorders, chronic skin eruptions, and death. It was only when Ladies Home Journal published an article on the subject in June of 1994 that people first considered the possibility that their use of the chemical lindane made them ill. In spite of the endemic state of lice and scabies, and therefore the likelihood of subsequent exposure to potentially harmful chemical treatments, physicians rarely inquire about such exposures when taking routine medical histories.

NPA’s alert also goes out to residential .facilities where fear of a lice or scabies outbreak often prompts indiscriminate applications of lindane with little appreciation of the risks involved. This is especially worrisome when one considers the hazards for individuals who receive (or apply) multiple treatments. In 1994 a formal state investigation was launched on behalf of individuals who died following lindane treatments in a Kalamazoo, Michigan nursing home where it was mandated that everyone receive lindane treatments in order to prevent an outbreak of scabies.

According to Solomon et al, (Archives of Dermatology 1990), given the extremely narrow range of safety of this drug and the risk imposed by the "kindling" effect, which potentiates convulsion seizures, and that this potentiation may be carried on for a considerable period of time, there is no good reason to use lindane in children or adults when other perfectly effective, safer pediculicides are available.

While there are safer alternatives for treating lice and scabies available, they too are pesticides and must be used with extreme caution. (NPA and Centers for Disease Control urge everyone to avoid the use of "environmental" lice sprays marketed for childrens' bedding and often packaged in tandem with lice shampoos and lotions. These sprays are unwarranted, and may pose personal and environmental hazards. Reports to the NPA registry strongly indicate that such sprays maybe even more haemful than earlier appreciated).

The FDA has received 137 possible adverse reactions to lindane reported between 1976 (the date of its own lindane alert issued to the medical community) and 1992. The difference between FDA's numbers and the over 330 reports to NPA in a much shorter period raises questions concerning current reporting criteria and methods. The FDA's claim that insufficient evidence exists to ban human exposure to lindane has been maintained in the absence of controlled epidemiological studies on human exposure and without an exposure registry or any research directed toward the population most at risk; individuals who have lindane applied directly to their bodies. The FDA, despite years of controversy over lindane's potential toxic effects (especially to children), continues to call the substance "safe and effective when used as directed."

None of the cases reported to the FDA were attributed to "proper use" of lindane. One may be tempted to ascribe the NPA's much higher number of reports to cases of improper usage, but, in fact, many of these reports to the NPA involve cases in which lindane was used in accordance with physicians' directives. In any event, the reports to the NPA indicate that "improper use" is "normal use," for a large number of lindane users will utilize the product contrary to its instructions.

On November 22, 1994, the National Pediculosis Association sent its first volume of 330 adverse reaction reports to Dr. Sandy Kweder, Acting Director of the Division of Epidemiology and Surveillance of the FDA. “I encourage the NPA to seek serious scientific scrutiny to clarify the relationship between potentially toxic pediculicides and scabicides and the incidence of toxic reactions, whether immediate or delayed,” says John C. Snyder, M.D., Professor of Population and Public Health, Emeritus, Harvard School of Public Health.

According to Samuel Epstein, M.D., Director of the Chlcago-based Cancer Prevention Coalition, from 1973 to 1991 the incidence rates of brain and other nervous system cancers in children ages 0-14 have increased by 38.4%. His organization is joining a growing list of others calling upon the Food and Drug Administration (FDA) for an outright ban of lindane based on what his group believes is sufficient evidence of lindane's carcinogenicity.

It has been almost 15 years since Consumer's Union filed its original petition to ban lindane. Too many have suffered as a result of FDA's lack of resolve to protect the public from this dangerous chemical. Based on important new evidence collected via the NPA's national reporting registry, NPA is issuing this national alert to avoid all lindane-containing products.

Commonly used brand names for lindane include among others: Kwell, Lindane 1%, Bio-Well, GBH, G-Well, Kwildane, Scabene, and Kwellada.


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