When The System Works

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I received a phone call from my friend Dr. Richard Besser this afternoon as I was finishing a long day at the hospital. He told me that he was preparing a story for the next morning that the FDA had decided to reduce the acceptable limit of arsenic in juice and bottled water to 10 parts per billion. This is important for reason beyond its implications for protecting public health – it is indicative that our system works.

First, I want to applaud the FDA for reviewing and revising the limits. While it’s their job to set standards in our food that keep us safe from toxins, sometimes things fall short. In the fall of 2011, many remember I had a very public disagreement with the FDA when our show tested various bottles of store bought apple juice and found arsenic levels that were higher than those allowed by the EPA for drinking water. While the EPA sets acceptable arsenic levels for what comes out of your kitchen faucet at ten parts per billion, the FDA is supposed to regulate levels for water and juice that you buy off a store shelf. Our show brought two critical issues to light – first that there was no standard for arsenic in juice and bottled water, and second the levels we found had exceeded those set by the FDA for tap water. Arsenic causes various chronic diseases like cancer, diabetes, and atherosclerosis – ailments on the rise in our country – although we cannot trace this change directly to arsenic. This was a scary discussion to have with my audience, but a necessary one since that is why we do the show in the first place – to educate and be an advocate for our viewers.

What happened next was a scene that happens almost every week in grand rounds when I meet with other physicians. Doctors disagreed. First, the scientists at the FDA expressed concern about our testing methods, and then Dr. Besser and I had a heated conversation on television. This made news because people were unaccustomed to the nature of scientific debate among physicians. The truth is that through a difference of opinion and interpretation, a more elusive truth is often uncovered. Most of our conventional wisdom was born out of arguments among doctors who disagreed with one another and had enough respect for each other to have the conversation.

The FDA is responsible for the oversight of a huge beverage industry. Their concerns were legitimate and realistic. They didn’t want to scare parents and they wanted to be scientifically accurate. I had a series of discussions with the FDA after our broadcast, and I met with the juice industry trade groups to share my findings and hear their concerns. Almost three months after our initial broadcast Consumer Reports released data of its own which corroborated our findings and the tone of the conversation changed. In our last discussions, the FDA agreed that arsenic levels warranted review and said they would be examining whether limits should share parity with tap water. These new limits are a result of that review.

The important detail here is not that reduced arsenic levels are a new standard, but that we now have a safer grocery store because the system worked. After raising the discussion to a national level and appealing directly to parents, the agency we commission with oversight to insure our food doesn’t contain harmful poisons did what it does best and instigated a scientific process to set new and better standards. Years from now, this will be accepted conventional wisdom and not much thought will be given to where it came from. But it’s important to recognize that we discover knowledge through discussion, debate and disagreement. It takes the whole village working together to make the village safer, and a new and better dawn awaits above the voices of dissent. As a surgeon, I depend on the cooperation of my team in the operating room even when our opinions differ. As a society, we depend on the same cooperation and today it brought us to a better safer place.