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Ms. Altschuler profiled on Amazing Women Everywhere

“Deborah Z. Altschuler is president of the National Pediculosis Association (NPA), a mother, grandmother, and advocate for all children. She has worked tirelessly for years educating parents , professionals and the general public on the safe way to treat headlice, without exposing children to toxic pesticides. The LiceMeister comb is the safest non toxic way to treat head lice. In fact in 2011 the Stockholm Convention identified the LiceMeister comb as a POPs-free product and featured it at a global meeting of more than 150 countries, as the safe, non-chemical treatment choice over the use of lindane and other pharmaceutical applications using insecticides.”
— Source: Amazing Women Everywhere

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Schools ease up on head lice policies, bugging some parents

Reprint from New York Daily News (via Associated Press), November 2013.

Schools across the country are no longer sending home ‘lice notes’ to parents or requiring kids with lice to stay home from school. Nurses say the notes cause unnecessary panic, while some parents complain about their kids being exposed.

Some parents are scratching their heads over less restrictive head lice policies that allow children with live bugs in their hair to return to the classroom for the rest of the day. Above, over the counter products for treating lice. Some parents are scratching their heads over less restrictive head lice policies that allow children with live bugs in their hair to return to the classroom.

And some school nurses are no longer sending home the dreaded “lice note” to other parents with kids in the classroom, alerting them to the possibility of lice in their own child’s precious locks. The policy shift is designed to help keep children from missing class, shield children with lice from embarrassment and protect their privacy.

“Lice is icky, but it’s not dangerous,” says Deborah Pontius, the school nurse for the Pershing County School District in Lovelock, Nev. “It’s not infectious, and it’s fairly easy to treat.”

Usually by the time an itchy child is sent to the nurse, Pontius says, the child has probably had lice for about three weeks to two months. She says classmates already would have been exposed. There’s little additional risk of transmission, she says, if the student returns to class for a few hours until the end of the day, when a parent would pick up the child and treat for lice at home.

Pontius also doesn’t send lice notes. “It gets out who had lice,” she says, and there’s no need to panic parents. Parents with elementary school-aged kids should check their children’s hair for lice once a week anyway, she says. If they are doing that, then there’s really no need for the notes.

The idea of letting kids with untreated lice remain in class doesn’t set well with some parents.

“I’m appalled. I am just so disgusted,” says Theresa Rice, whose 8-year-old daughter, Jenna, has come home from her elementary school in Hamilton County, Tenn., with lice three times since school started in August.

“It’s just a terrible headache to have to deal with lice,” says Rice. To pick out the tiny eggs, or nits, and lice from Jenna’s long blond hair is a four-hour process. Add to that all the laundry and cleaning — it’s exhausting, she says. Rice had to bag up her daughter’s treasured stuffed animals, which remained sealed for weeks even after Jenna was lice-free.

Jenna’s school implemented a new policy in the past year that allows children with untreated lice to go home at the end of the day, be treated and then return to school. The policy, the district said, complies with the guidelines of both the Tennessee Department of Education and the Centers for Disease Control and Prevention.

Other schools, in California, Florida, Nebraska, New Mexico, South Carolina and elsewhere, have similar policies.

The National Pediculosis Association in Massachusetts is opposed to relaxing bans on lice and blames the updated policies for spreading the bugs.

“The new lice policy throws parental values for wellness and children’s health under the bus,” says Deborah Altschuler, head of the Newton-based group. “It fosters complacency about head lice by minimizing its importance as a communicable parasitic disease.”

The association says lice treatment shampoos are pesticides that are not safe for children and not 100 percent effective. The group instead urges parents to screen regularly and use a special comb to manually remove lice and nits from a child’s hair.

Lice are tiny grayish-white bugs that infest a scalp, sucking bits of blood every few hours. Lice don’t jump or fly. They crawl. They are not a sign of poor hygiene.

The Centers for Disease Control and Prevention estimate that there are 6 million to 12 million head lice infestations each year in the United States among children 3 to 11 years old. While itchy and unpleasant, health experts say lice don’t spread disease and are not a health hazard. The American Academy of Pediatrics updated its guidelines in 2010 to adopt a “do not exclude” infested students recommendation for schools dealing with head lice.

The National Association of School Nurses revised its position the following year. In its guidance, the association said children found with live head lice should remain in class but be discouraged from close direct head contact with others. The school nurse should contact the parent to discuss treatment.

The association doesn’t have figures on how many schools have adopted less restrictive policies. It varies by state and often by school district.

The ways in which schools manage head lice have been changing over the last couple of decades.

It used to be that schools wouldn’t allow children to return to the classroom until all the lice and the nits were removed. The academy has long encouraged schools to discontinue “no-nit” policies. The itty-bitty nits — which can often be confused with dandruff — cement themselves to the hair shaft, making removal difficult.

The CDC says the nits are “very unlikely to be transferred successfully to other people” — and many schools have dropped their no-nit policies. But supporters of no-nit rules, such as the National Pediculosis Association, say the eggs will hatch new lice and need to be removed from a child’s hair to be considered lice free.

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Markey to FDA: Stop Use of Toxic Chemical in Children’s Shampoo

Use of insecticide ‘lindane’ in treatment for lice could harm children, pollutes environment

WASHINGTON, D.C. – Congressman Edward J. Markey (D-Mass.), senior member of the Energy and Commerce Committee, today called on the Food and Drug Administration (FDA) to halt the use of the insecticide lindane in pharmaceutical treatments for head lice in children. Despite research supporting its toxicity and ineffectiveness, the FDA continues to allow lindane to be used in prescription shampoos and lotions to treat cases of lice and scabies, overwhelmingly on children. Lindane has been found to cause skin irritation, seizures, and, in rare instances, even death. Infants and children are especially sensitive to the health risks posed by pesticides such as lindane because of their developing bodies. In 2005, the U.S. Department of Health and Human Services determined that lindane could cause cancer in humans, and the EPA cancelled all pesticide registrations for agricultural uses of lindane in 2006 because of its toxicity to humans and persistence in the environment. A 2002 study that compared efficacy of five available products on head lice found that lindane was the least effective of all the products.

“In the case of lindane, the cure is worse than disease,” said Rep. Markey. “There is not a nit of scientific evidence to support the FDA’s decision to continue to allow the use of this toxic chemical for treatment used predominantly on children.”

Rep. Markey’s letter to the FDA can be seen below.

Rep. Markey’s letter also notes that the presence of lindane in treatment products has led to its detection in and contamination of waterways. Officials in Los Angeles found that a single treatment for head lice or scabies contains enough lindane to bring six million gallons of water above the California water quality standard. The pharmaceutical use of lindane was banned in California in 2002. And in 2009, more than 160 nations agreed to ban the agricultural use of lindane.

Rep. Markey’s letter to the FDA asks for responses to questions that include:

Why is this compound still allowed for use on children even after the FDA noted that lindane is especially harmful to this segment of the population? Has the FDA taken into consideration the long-term chronic impacts that lindane exposure may have on children?

Has the FDA evaluated the increased resistance that head lice and scabies have developed to lindane treatment?

If FDA determined that approval of lindane as a treatment for head lice and scabies was no longer warranted because of safety and efficacy concerns, what immediate actions could FDA take to halt the use of lindane and to ensure the public is protected from this dangerous chemical?

###

Rep. Markey’s letter to the FDA

May 31, 2012

The Honorable Margaret Hamburg
Commissioner

U.S. Food and Drug Administration
10903 New Hampshire Avenue
Silver Spring, MD 20993

Dear Commissioner Hamburg:

I write to urge the Food and Drug Administration (FDA) to take immediate steps to halt the use of lindane, a toxic and environmentally persistent insecticide, as a pharmaceutical treatment for head lice in children. Lindane is classified as an organochlorine insecticide that has been used both in prescription shampoos to treat head lice and scabies, under the jurisdiction of the FDA, as well as in agriculture as a common pesticide to treat crops, forestry products and livestock under the jurisdiction of the Environmental Protection Agency (EPA). Out of recognition of its toxicity to humans and its environmental persistence, in 2006 the EPA cancelled all pesticide registrations for agricultural uses of lindane. In addition, in 2009 more than 160 nations agreed to ban the agricultural use of lindane under the Stockholm Convention on Persistent Organic Pollutants. Despite these actions and the known danger that lindane poses to human health, the FDA continues to allow the use of this insecticide as a treatment for head lice in children. Lindane’s continued use in prescription shampoos and lotion have also been associated with increased resistance and reduced efficiency in the treatment of head lice as well as with contamination of waterways.

A variety of adverse reactions to lindane pharmaceuticals have been reported, ranging from skin irritation to seizures, and, in rare instances, even death. Based largely on animal studies, the International Agency for Research on Cancer (IARC) classified lindane as a possible human carcinogen, and in 2005 the U.S. Department of Health and Human Services (HHS) determined that lindane may be reasonably expected to cause cancer in humans. In addition to carcinogenic effects, lindane exposure can harm the nervous system. When the EPA evaluated the health and environmental costs associated with lindane use in agricultural settings it noted that “lindane primarily affects the nervous system causing neurotoxic effects… when people are exposed to lindane through food, water or the atmosphere, they will accumulate lindane residues in their fatty tissues, and these lindane residues will remain there for an undetermined amount of time.”

Since infestations of lice and scabies are most often found in large institutions such as schools, it is reasonable to assume that a large portion of the U.S. population of patients treated with lindane is comprised of children. In fact according to the Centers for Disease Control and Prevention (CDC), in the United States, infestation with head lice is most common among children 3 to 11 years of age, with an estimated 6 to 10 million infestations that occur each year. As the EPA has noted, infants and children are especially sensitive to the health risks posed by pesticides because of their developing organs and immature excretory system. Furthermore, recent evidence suggests that because of the widespread use of this chemical treatment, lice and scabies have become increasingly resistant to lindane, reducing its efficacy as a treatment. In fact, studies of lindane have found that it only kills 50-70 percent of lice eggs.6 As FDA has previously acknowledged, parents may be inclined to overuse lindane in their zeal to treat their children as quickly as possible, which increases the amount of lindane children are exposed to, consequently increasing the likelihood of adverse impacts. Additionally, head lice and scabies can be effectively treated without the use of lindane. A 2002 study that compared efficacy of five available products on resistant head lice found that lindane was the least effective of all the products. With other alternatives that are more effective, non-toxic, and less expensive, the continued approval of lindane as a treatment for head lice and scabies is unnecessarily dangerous.

In addition to lindane’s toxicity and ineffectiveness, it also has been found to contaminate Waterways. This occurs when lindane­containing shampoos and lotions are rinsed down the drain after use. According to the EPA the “pharmaceutical use of lindane for treatment of lice and scabies results in exposure to the treated individual, as well as exposure to the general population as a result of ‘down the drain’ release into drinking water.” This contamination of water supplies and the expense associated with wastewater treatment was part of the reason why California took action in 2002 to ban the pharmaceutical use of lindane. Wastewater treatment engineers in Los Angeles calculated that a single treatment for head lice or scabies contains enough lindane to bring six million gallons of water above this California water quality standard. Although lindane does have a drinking water standard set by the Safe Drinking Water Act, it is not required to be removed completely. Since lindane is highly stable for long periods of time, it has the potential to accumulate in the bodies of in organisms, including humans, at levels that could pose health concerns.

Given the scientific evidence on the toxicity of lindane, its ineffectiveness as a lice and scabies treatment and the ability of this chemical to enter into U.S. drinking water supplies despite its removal as a viable pesticide by the EPA, there is simply no basis for FDA’s decision to continue to allow the use of this substance for head lice and scabies treatment. In order to better understand FDA’s plans and progress on this issue, I ask for your prompt response to the following questions.

  1. The pesticide registration that allowed lindane to be used on seeds, lumber and cattle was withdrawn by the EPA, with last uses of this chemical cancelled in 2007. Why is this compound still allowed for use on children even after the FDA noted that lindane is especially harmful to this segment of the population?
  2. What has FDA learned from adverse event reports and other information collectively gathered by the federal government, including information gathered by the Agency for Toxic Substances and Disease Registry (ATSDR), with regards to lindane’s impacts on children? Please provide copies of any adverse event reports that inform your response.
  3. Has the FDA taken into consideration the long­ term chronic impacts that lindane exposure may have on children? If so, what has FDA concluded? If not, why not?
  4. In 1995, the FDA labeled lindane as a “second ­line therapy” meaning that it should be used in patients who did not respond to other FDA approved therapies, such as the pesticides malathion, pyrethrin and permethrin. Much like lindane, all of these pesticide treatments have also been associated with toxic impacts on the nervous system. As a result, children may often be exposed to multiple similarly ­acting chemical lice treatments in a short­ period of time. Has FDA evaluated the cumulative short and long term health impacts associated with exposure to multiple pesticide treatments in children? If so, what did FDA find? If not, why not? Has FDA considered these cumulative impacts in context of whether lindane should remain as an approved therapy for lice and scabies?
  5. Has the FDA evaluated the increased resistance that head lice and scabies have developed to lindane treatment? If so, does FDA continue to believe that lindane is an effective treatment for head lice and scabies in children? Please explain. If not, why not?
  6. The National Environmental Policy Act (NEPA) requires all federal agencies, including FDA, to include any “new and significant” information regarding the environmental consequences of their proposed activity. Does the FDA believe that EPA’s withdrawal of lindane’s registration as a pesticide is “new and significant” information that would trigger a new NEPA analysis? lf not, why not? If yes, please provide information regarding the new NEPA analysis and what the FDA concluded.
  7. Does the information regarding lindane’s transmission down household drains and into waterways and drinking water supplies factor into the decisions the FDA makes regarding lindane’s continued approval for use in lotions and shampoos? lf so, how? lf this was not considered, why not?
  8. If FDA determined that approval of lindane as a treatment for head lice and scabies was no longer warranted because of safety and efficacy concerns, what immediate actions could FDA take to halt the use of lindane and to ensure the public is protected from this dangerous chemical?

Thank you for your assistance and cooperation in this matter. I request that you provide a full and complete response within 15 working days or no later than June 21, 2012. Should you have any questions about this request, please have your staff contact Dr. Avenel Joseph of my staff at (202) 225-2836.

Sincerely,

Edward J. Markey

Notes

  1. Thomson Micromedex. Lindane topical. In: Volume 1: Drug Information for the Healthcare Professional. 2. Greenwood Village, CO: Thomson Micromedex; 2006. pp. 1940-1943.
  2. Agency for Toxic Substances and Disease Registry, U.S. Department of Health and Human Services. Toxicologic profile for alpha-, beta, gamma» and delta-hexachlorocyclohenxane. August 2005 and lntemational Agency for Research on Cancer (IARC). Summaries & Evaluations: Hexachlorocyclohexanes (Group 2B). Updated March 2, 1998.
  3. U.S. EPA, Lìndane Voluntary Cancellation and RED Addendum Fact Sheet, available at http ://www.epa. gov/opp0000 l/reregistration/REDS/factsheets/lindane_fs_addendum.htm
  4. See: http://www.cdc.gov/parasites/lice/head/gen_ínfo/faqs.html
  5. See: http://www.epa.gov/pesticides/food/pest.htm
  6. Barbara L. Frankowskì, MD, MPH, etal., Head Lice, 3 Pediatrics 1 I0, 638-643 (2002).
  7. http://www.fda.gov/Drugs/DrugSafety/PostmarketD1‘ugSafetyInformationf`orPatíentsandProviders/ucml 10 845.htm
  8. Terri L. Meinking, et al., Comparative in vitro Pedículicidal of Treatments in a Resistant Head Lice Population in the United States, 2 Arch. Dermatol. 138, 220-224 (2002)
  9. U.S. EPA, Lindane Voluntary Cancellation and RED Addendum Fact Sheet, available at http://www.epa.gov/opp00001/reregistration/REDs/factsbeets/lindane_fs_addendum.htm (last visited May 5, 2010).
  10. CSDLAC. Lindane Usage Reduction Pilot Project, 1998 Pollution Prevention Leadership Grant Program, Final Report. Los Angeles: County Sanitation Districts of Los Angeles County; 2001.

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The LiceMeister® comb featured as a lindane alternative at a global meeting of the Stockholm Convention!

In 2009, more than 150 governments agreed to list lindane in the Stockholm Convention on Persistent Organic Pollutants (POPs) for global elimination. However, they provided a temporary exemption for its use as a human pharmaceutical to address head lice and scabies. In response to this and other listings, the Stockholm Convention Secretariat launched a pilot project to help countries identify POPs-free alternatives to listed substances. Among various requirements, candidates had to submit products for testing by the Environmental Agency of Austria (EEA) to ensure they did not contain any of the 21 substances listed in the treaty. The project identified the LiceMeister® comb as a POPs-free product and will feature it at the global meeting of more than 150 countries April 25 – 29, 2011.

The LiceMeister comb is considered a safe, non-chemical treatment choice over the use of lindane and other pharmaceutical applications using insecticides. The LiceMeister comb has the US Food and Drug Administration clearance as a medical device for the purpose of screening, detecting and removing lice and their eggs (nits).

In a recent editorial, NPA’s president, Deborah Altschuler reaffirmed: “Combing is a scientifically reliable method to remove all lice and nits – which is another way to say it can end an infestation – literally. Combing is the safest and most cost effective approach that accomplishes what chemicals cannot. It enables families to be self-reliant, proactive, and preventive. It allows regular screening and early detection which makes the combing approach practical and realistic. While chemical treatments, pediculicides, and broad spectrum antibiotics develop resistance and potentially adverse health effects, nothing compares to the kindness of a comb.”

Altschuler adds that the most gratifying part of participating in the POP-free initiative is the way it has put children’s health at the forefront.

More Coverage of this important development

POPs-Free Initiative

Stockholm Convention Launches POPs-Free Initiative – International Institute for Sustainable Development

LiceMeister® Comb

“April 2011: The Secretariat of the Stockholm Convention has launched an initiative on products and processes free of persistent organic pollutants (POPs).

According to the Secretariat, the initiative seeks to encourage consumer product manufacturers and retailers who have phased out POPs to provide information on POPs-free products, and on possible alternatives and substitutes, and processes for introducing such alternatives and substitutes.

In the pilot phase of the project, two entities agreed to have their products tested for POPs through a laboratory hosted by the Environment Agency of Austria.

These products included: the LiceMeister® comb, a potential alternative to pharmaceutical applications containing lindane, listed under annex A of the Convention with a specific exemption…”

Read the rest of this article.

IPEN Quick Views of Stockholm Convention COP5 – International POPs Elimination Network

“COP5 should request the Secretariat to cooperate with WHO to do the following:

  • Identify and compile information on safer alternatives, especially technically feasible, affordable non-chemical alternatives such as the LiceMeister® Comb identified in the POPs Free Project
  • Develop a guidance document on transition to safer, alternative treatments
  • Promote use of safer alternatives to lindane as a treatment for head lice and scabies
  • Promote awareness-raising on safer alternatives among all Parties
  • Review the continued need for the specific exemption for evaluation by COP6″

Read the rest of this article (note: PDF document).

POPs-Free Initiative Pilot Project – Stockholm Convention

In a pilot project, two entities have agreed on a voluntary basis, to test products through a laboratory hosted by the Environment Agency of Austria.

The key criteria for being a POPs-free product was that such a product did not contain or consist of chemicals listed in Annex A, B or C of the Stockholm Convention. POPs-free was defined specifically for the pilot project and was not to be used as a definition outside of the project…

The LiceMeister® comb – The National Pediculosis Association®, a non-profit organization from the United States, submitted the LiceMeister® comb. The comb is an U.S. Food and Drug Administration cleared medical device to screen, detect and remove head lice and their eggs (nits). This combing tool is used instead of applying pesticides to the hair and scalp. Of particular relevance to the Convention, the LiceMeister® comb could be considered as an alternative to pharmaceutical applications containing lindane, listed under annex A of the Convention with a specific exemption.

More on the POPs-free Initiative and the Stockholm Convention (note: PDF document).

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Barbara Glickstein and 25th Anniversary Podcasts

Barbara Glickstein’s, (Public health nurse and Cofounder and Director of the Center for Health Media and Policy at Hunter College, City University of New York) interview with NPA’s President Deborah Z Altschuler. The Barbara Glickstein podcast segments are part of an educational outreach project produced by Dan Gingold and Zach Kuperstein with LaShawn McGhee as editor.

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Activists in Public Health

By Deborah Z. Altschuler

“With the exception of an occasional accolade for all the hard work that goes into being an activist, I generally find myself resenting the term.”

To paraphrase an old proverb, Citizen Activists will never disappoint you if you observe two rules: 1. Find out what they are; 2. Expect them to be just that. Many of us come naturally to advocacy in our role as parents. The activist in public health, however, can face a peculiar set of problems.

Regarding Pediculosis, the consensus among contemporary physicians is that head lice are essentially a nuisance, leaving treatment protocols to the pharmaceutical manufacturers who market pediculicides for direct application to human skin. Although it can be a positive force, the pharmaceutical industry is not a proper guardian of children’s health.

This is where the activist evolves into educator, support system and collector of personal accounts – sometimes appalling – of families and individuals who have suffered from unnecessary, unsuccessful or excessive chemical treatments. The activist must do what disinterested experts will not do: investigate the origin, nature, methods and limits of knowledge in Pediculosis and its management. The activist must also seek allies – often the school nurses, occasionally the press, and sometimes (in cases where a child has suffered grievous harm), the lawyers – when there is no mechanism in place to exchange insights, experience and research.

With the exception of an occasional accolade for all the hard work that goes into being an activist, I generally find myself resenting the term. Perhaps it is because of what other think an activist should be. Activists are do-gooders working “on the outside” – people whose commitment to their cause keeps them from pursuing a “real job”. Here are some common perceptions:

  • Activists have information – Academics possess knowledge
  • Activists have points of view – Scientists have hypotheses
  • Activists have anecdotal evidence – Researchers have reports to the literature
  • Activists provide outreach – Specialists give consultations

No matter what the cause, such perceptions can alienate the activist as a key player in providing society with what it requires in the way of a unified effort to deliver the truth – on Pediculosis-related issues or on other important matters affecting the public’s health.

Meanwhile, families must be enabled to make informed decisions and seek safer alternatives before using potentially harmful but readily available chemicals for lice and scabies. The age-old disease of Pediculosis isn’t going away. It is the activist’s particular challenge to educate the public in spite of the relative indifference to this issue on the part of the professional communities the public turns to for advice. Ultimately, the task will be accomplished when we successfully teach the “experts” what the “experts” need to be taught. That it’s not about lice – it’s about kids.

Deborah Z. Altschuler
President
National Pediculosis Association
www.headlice.org

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