Talk:Mercury poisoning

From Wikipedia, the free encyclopedia

	Mercury poisoning is part of WikiProject Pharmacology, a project to improve all Pharmacology-related articles. If you would like to help improve this and other pharmacology articles, please join the project. All interested editors are welcome.
Start	This article has been rated as Start-Class on the quality scale.

	This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
Start	This page has been rated as Start-Class on the quality assessment scale
High	This article has been rated as High-importance on the importance assessment scale

Contents 1 Fetuses and Mercury 2 Coherency in this article 3 Elemental Mercury 4 Homeopathic option? 5 Effects in Humans - Vaccinations Containing Thimerosal 6 Thimerosal edit 7 Touch it? 8 Mad as a hatter 9 Dental fillings 10 Current Picture 11 Merge proposal 12 Mercury and Fish 13 Article structure 14 Acrodynia merger proposal 15 Autism and mercury exposure 16 Suggestion: read Clarkson and Magos 17 Largest point sources are gold mines 18 Could gold jewelry such as necklaces and bracelets cause mercury 19 Pink disease / acrodynia 20 Ongoing effects of Pink Disease in adults 21 In popular culture section? 22 Number of authors in medical citations 23 Elemental mercury dermal absorption - Edit? 24 Clifton mischaracterized by recent edit 25 Sources for TCVs in the 1930s 26 Mercury is actually good for you.

[edit] Fetuses and Mercury

This article says the following: Mercury and its compounds are particularly toxic to fetuses and infants. Women who have been exposed to mercury in pregnancy have sometimes given birth to children with serious birth defects (see Minamata disease).

Now, where is the citation for that. How much damage does it cause to fetuses. In addition, how come advisory websites tell pregnant women to cut back on fish intake but they do not advise to eliminate all fish intake? message me. Sp0 (talk) 19:17, 14 May 2008 (UTC)

[edit] Coherency in this article

This article needs to be reworked to make it a bit more coherent, as some things are mentioned multiple times in different places. Agateller 00:47, 2 December 2006 (UTC)

[edit] Elemental Mercury

The first paragraph goes directly into Elemental Mercury toxicity which is NOT the most common source of mercury poisoning. That section should be moved down to a more relevant sub-section. arfon 08:03, 25 March 2006 (UTC)

[edit] Homeopathic option?

That paragraph seems a tad speculative. Rōnin 05:16, 1 May 2006 (UTC)

I inserted the paragraph on homeopathy noticing that there was previously no information on treatment of mercury poisoning on the page. Of course chelation therapy must go there, and I'm very happy to see that it is there now. I just don't quite see why the homeopathy information was removed entirely? There was a caveat in the paragraph on the disputed validity of homeopathy as a mode of healing, along with the link to homeopathy so the reader could then go to the page on homeopathy and read up on it, just as there is now a link to chelation therapy. I think there's little chance that a wikipedia reader who is facing the need to flush mercury from his/her body will decide what to do without researching all therapies thoroughly. So, what is the harm in letting a reader know the information available from a mode of healing that IS used by many, though not by the American Medical Association? As long as there's a caveat explaining that chelation is the officailly approved form of therapy, but that there are other ways that do not have harmful side effects that people use to heal this very serious problem, why would it be necessary to remove the information completely? Iris Anthe 22:00, 14 May 2006

Homeopathic treatments often have no scientific evidence backing it up and often cause more harm by delaying "proven" treatments.

[edit] Effects in Humans - Vaccinations Containing Thimerosal

As per the Wikipedia.org entry for Thimerosal, most vaccines in the United States no longer contain this preservative. The article should either note this fact with a reference or modify the statement.

http://en.wikipedia.org/wiki/Thimerosal

[edit] Thimerosal edit

User D-truth made the following edit, replacing the claim that most US vaccines now contain no Thimerosal:

Even knowing these risks vaccine manufacturers continue to add the mercury preservative thimerosal to the vaccines used to protect preschool children against infectious diseases. For example the MMR vaccine is almost always contains thimerosal. Parents are left with the choice either to administer the vaccine and take the batch number and hope that no reaction occurs, or not to administer the vaccine and deal with those consequences. In some states the MMR(Measles, Mumps and Rubella) vaccine can be split into three separate vaccines, thereby eliminating the thimerosal.

Since the original claim was referenced, and the new edit was not sourced, I reverted the page and moved the edit here. Bobo12345 05:56, 30 September 2006 (UTC)

[edit] Touch it?

Can you touch normal mercury and not suffer any damage? I've always wanted to touch it to see how it feels but I've stayed many meters away from any exposed mercury due to fears of toxicity.--Energman 18:24, 5 October 2006 (UTC)

Go ahead, touch it. Holding a blob of mercury in your hands for part of a minute isn't going to hurt you. Do it over a paper towel or plate so that if you spill it, it doesn't go bouncing around on the floor. Elemental mercury is safe to use and experiment with as long as you keep it contained when not in use, don't heat it, and so on. A brief exposure to a low level of mercury vapor won't harm you either. This article is biased and speculative but there's no convincing some people that mercury isn't the Devil, so I hardly see the point in cleaning it up. Joseph N Hall 16:25, 18 April 2007 (UTC)

[edit] Mad as a hatter

Moved this contribution from an anonymous editor to the Talk page. Is it relevant? Can you find cite source?

"There is, however, some controversy. A Web page on urban legends maintains that "mad as an atter" actually meant 'venomous as a viper'. It quotes a 1901 book called Edwards's Words, Facts, and Phrases which states that the word "mad" meant 'violent or venomous' in Anglo-Saxon, and that "atter" is a variant of "adder," a type of viper, so that mad as a hatter meant 'venomous as a viper'. Actually, "atter" meant 'poison', not 'viper', in Old English, and the original sense of mad was 'unreasoning, foolish, insane'."

Bobo12345 06:29, 17 November 2006 (UTC)

The origin of "mad as a hatter" may belong on Wiktionary, not Wikipedia. Let's see...

--Una Smith (talk) 23:32, 23 November 2007 (UTC)

[edit] Dental fillings

Cut from "poisoning" section:

• Another source of exposure to mercury may be dental fillings. In their policy paper written in 2005, "Mercury in Health Care", The World Health Organization confirmed that "mercury contained in dental amalgam is the greatest source of mercury vapour in non-industrialized settings, exposing the concerned population to mercury levels significantly exceeding those set for food and for air".^[1] WHO states, however, that total mercury exposure from amalgams (<5 micrograms/day) is roughly 3% of the "tolerable" dose (140 micrograms/day) for a 70 kg (155 pound) person.^[2] The possible adverse health effects of dental amalgams containing mercury is an ongoing scientific controversy, with strongly held views on all sides. There has been no definitive proof of either position.

We should stick to the science. If there's no proof of the position, then it's not an "occurence of poisoning".

I'm thinking of a spin-off article on the campaign to ban mercury or "efforts to ban mercury". Maybe it should be called mercury controversy.

Anyway, we need an article on the pros and cons of using mercury in dental fillings and thermometers. No one wants 32 years of massive dumping in a Japanese harbor, but that was an extreme case. --Uncle Ed 02:05, 9 December 2006 (UTC)

Exactly right and more in fact. Mercury poisoning is of two distinct types and symptomatology: acute ( as in the Minamata Bay event) and subacute or chronic (micromercurialism). I wish to start a new article Mercurialism. The term Mircomercurialism was coined by German Professor Albert Stock in the 1920's and received widespread attention in Germany and Russia at the time.Drdooley (talk) 22:50, 9 May 2008 (UTC)

Mercury poisoning already talks about micromercurialism, no? Why start a new article? Eubulides (talk) 23:13, 9 May 2008 (UTC)

I am here to tell you it is true i have suffered damages both mental and endocrine wise because of the number of fillings i had done in the 70's

By Chippo1 11:15, 26 April 2007 (UTC):

• The Dental amalgam subsection of the Mecury poisoning page has an NPOV warning and says to see the Talk page.
• The Talk page does not seem to directly mention what the neutrality issue is and what we should be doing to resolve it.
• There's a whole page dedicated to this neutrality issue.
• It is a Good Thing (tm) to reduce the number of NPOV warnings in wikipedia

So, I'm going to add a link to the NPOV article and remove the NPOV warning.

[edit] Current Picture

I think the current picture of Mercury should be changed as we should endeavor to use pictures without filters. The current one makes the uninformed believe that Mercury is greenish in color rather than silver. —The preceding unsigned comment was added by 24.128.225.175 (talk) 05:09, 19 January 2007 (UTC).

Seconded. Unfortunately, that greenish picture was the only public domain image I could find at the time. Anyone is more than welcome to replace it with a better version, as long as it's GFDL compatible. Bobo12345 06:39, 19 January 2007 (UTC)

[edit] Merge proposal

[edit] Mercury and Fish

This problem that fish build up mercury in their bodies, does it happen in all the world? Because if it's something that just happen in the United States, for example, should also be added. I doubt all fish from every ocean has mercury on their bodies otherwise it would be banned to sell them as food in all the world.--Shadowy Crafter 01:01, 5 June 2007 (UTC)

Trace amounts of mercury is everywhere. Most seafood has tiny amounts of mercury. I do not have a reference, but that is how I understand the topic. Maybe someone else will know more details. - Dozenist talk 19:02, 5 June 2007 (UTC)

It should also be noted that people, women in particular are suffering from mercury poisoning as a result of eating canned tuna. I know lots of women who in efforts to lose weight eat canned tuna for lunch every day and this can be very damaging to their bodies. One lady did in fact get very sick from doing this and ended up in hospital with mercury poisoning. And to answer above, nearly all fish have mercury in them, its just the bigger deep sea fish that eat lots of little fish have larger amoutns of mercury. So depending on the country you live and the type of fish that are common, will depend on how much you should eat. For example, shark have extremely high amounts of mercury, so if that is a fish you enjoy eating then recommendations in Australia are that it should be eaten once of month with no other fish being consumed. 203.62.236.200 06:43, 26 June 2007 (UTC)

[edit] Article structure

This article seems to be in need of a bit of an overhaul, as the sections don't seem to be in a very coherent order. The Manual of Style for medicine-related articles has recommendations for the structure of articles on diseases which can serve as a guideline for this article. I will work on this when I get the chance, but if someone wants to do it sooner that'd be fine too. :)

In the immediate future, I propose that the Alternative names section be worked into the rest of the article. If the names really are synonymous with mercury poisoning (mercurialism and hydrargyria, see [1]), they should be put in the opening sentence, and if not (all the rest aren't, as they refer to acrodynia, a specific type of mercury poisoning and not mercury poisoning in general), they should be put elsewhere. ~ Danelo 18:43, 1 August 2007 (UTC)

I agree that the article needs overhauling. As for the alternative names, I could be wrong about this, but the names seem to me to be very nearly synonymous. For example, acrodynia is mercury poisoning in infants and children, but it is not so called only because it was found in the early 1900s (first identified as "pink disease") before mercury poisoning was discovered as the true cause in the 1940s (see Dally reference cited in the article). There may be other precedents for alternative disease names based on patient age to have separate articles, but it would seem clearer and more logical to have a single article that covers all the variants of mercury poisoning (mentioning the synonyms for each variant where it is first described). At the moment, all the alternative names for acrodynia have Wikipedia redirects to acrodynia. I'd propose the acrodynia article be merged into this article. Incidentally, my references say acrodynia/pink disease is/was caused exclusively by mercury, whereas the Wikipedia article on acrodynia says that it is caused by heavy metals, which doesn't seem to be supported by any references.

The reason I put the alternative names all in a separate section is because there are so many of them, and I wanted to avoid making the overview too long and intimidating by including the obscure alternative names there. If you think some of them are not synonyms or that it would be better anyway having them in the overview, feel free to edit.

I added a list of symptoms because the existing article seemed to say very little about symptoms. What do you think about "Symptoms" being in a separate section? I noticed that having a separate "Symptoms" section seems to be in line with other Wikipedia medical articles.

I'm not sure how well the "Toxicity in human beings" section title sits with the contents; the title and the headings of the first three sub-sections imply the aim is to address the effects of different types of mercury toxins, but the focus is on routes of absorption and modes of action (would either/both of these be a better section title?), rather than on any specific symptoms. The "Toxic effects" section, where several symptoms are mentioned, now overlaps with the "Symptoms" section; perhaps they could be merged? Neparis 20:04, 1 August 2007 (UTC)

Okay, well for now, I have added "mercurialism" and "hydrargyria" to the intro sentence as every source I have consulted considers them synonymous with "mercury poisoning". I have added "acrodynia" there as well, but noted that it is specific to cases involving children. Also, I added Acrodynia epidemic as a subsection of "Occurrences of mercury poisoning" with a link to the main Acrodynia article and worked the History section into there, so there is only one section that deals with historical cases of mercury poisoning. All the other "Alternative names" seem to be synonymous only with Acrodynia and not currently in common usage, so I included them in the Acrodynia epidemic section. I think it improves cohesiveness in the article a bit, though eventually the Occurences section will probably need to become a History section (as per the MOS).

I agree about the Toxicity in human beings heading. The subheadings should be worked into the rest of the article, with some possibly receiving their own level 2 heading. Toxic effects and Symptoms should definitely merged. I'm still working on it, but I'm currently at my real job and can only edit for short periods of time. :) ~ Danelo 19:13, 2 August 2007 (UTC)

Did a bunch of restructuring today. I put "Toxic effects" into its own section (it corresponds with "Mechanism" in the medicine MOS), so Symptoms and Toxic effects weren't merged (b/c they're different: symptoms are caused by the toxic effects). Most sections are still in need of a bunch of work, especially Prevention. I'll work on it more next week (but once again, if anyone wants to work on it as well, that's all the better!). ~ Danelo 20:13, 3 August 2007 (UTC)

The structure is much better now than it was. I agree the content in many sections still needs work. Unfortunately I doubt I'll have time to do much if anything about it in the near future. Neparis 22:52, 7 August 2007 (UTC)

[edit] Acrodynia merger proposal

[edit] Autism and mercury exposure

The section dealing with the connection between mercury exposure and autism seems to be (as the paragraph indicates) somewhat controversial. There is significant circumstantial evidence correlating mercury exposure and autism, which I think should at least be mentioned. From Muller et al ([2]):

some studies have shown a correlation between mercury exposure and the risk of autism (pg. 442)

and

Taken together, all the above mentioned data (...) appear to show that repetitive mercury exposure during pregnancy (through thimerosal and dental amalgam), and after birth, through thimerosal containing vaccinations in generally susceptible individuals is one potential pathogenic factor in autism (pg. 443)

I propose this paragraph, or something like it (with sourcing, of course): Mercury poisoning in the young has been hypothesized as a cause of autistic behaviors. While there is significant circumstantial evidence correlating mercury exposure, usually from vaccinations containing thimerosal, and autism,(Muller et al) this hypothesis is controversial, as much evidence suggests that about 90% of autism is explained by genetics. The hypothesis has not been confirmed by reliable studies. ~ Danelo 14:42, 16 August 2007 (UTC)

That is not an accurate summary of the cited source, and it gives the misleading impression that there is serious scientific debate on the subject. First, as the cited source notes in its abstract, epidemiological studies have found no association between thimerosal and autism. Second, the cited source is weak: it is a review article appearing in a letters journal whose goal is rapid publication with minimal review, which raises a red flag; why should a review article be rushed to publication? Third, the cited source is extremely biased: it dismisses large-scale surveys published in high-quality journals showing no association between mercury exposure and autism, and cites with approval dubious and unreplicated small studies published in low-quality journals. Finally, the proposed wording gives way too much emphasis to the controversial claim that mercury causes autism, and way too little emphasis on the widespread consensus that the claim lacks reliable scientific evidence. There is some scientific evidence for environmental factors for autism (in particular, teratogens such as rubella infection during early pregnancy; see Causes of autism #Teratogens). By comparison the mercury hypothesis is very poorly supported; see Causes of autism #Mercury. Eubulides 16:12, 16 August 2007 (UTC)

After further searching, I've found multiple sources that suggest at least some connection between mercury exposure and autism:

• Bernard et al. ([3]) state that their findings "support a hypothesis that mercury in vaccines may be a factor in the pathogenesis of autism" (S42)

• Bernard et al. is not a study and does not have findings per se. The quote that you mention states that two reports by clinicians have findings that support the hypothesis in question. But the two reports in question are Congressional testimony; they are political and not scientific reports. Later studies have failed to substantiate these reports. Eubulides 23:11, 16 August 2007 (UTC)

• Mutter et al (discussed above) find that the incidence of autism increased 12-fold in the United States in the 1990s, which corresponded with the introduction of three new thimerosal-containing vaccines.

• Mutter et al. are incorrect. It is not known whether the incidence rate of autism increased in the U.S. during the period in question. This is another indication that their review is not reliable. See the last paragraph of Autism #Epidemiology, which cites four high-quality reviews that contradict this claim by Mutter et al.

• Geier and Geier ([4]) determine that "there was a close correlation between mercury doses from thimerosal-containing childhood vaccines and the prevalence of autism from the late 1980s through the mid-1990s." (PI33)

• Mark Geier and his son are controversial sources and cannot be called reliable. Eubulides 23:11, 16 August 2007 (UTC)

• In another paper ([5]), Geier and Geier found "statistical increases in the incidence rate of autism" when comparing the those who received thimerosal-containing and thimerosal-free vaccines

• Again, let's stick to reliable sources. Eubulides 23:11, 16 August 2007 (UTC)

• Palmer et al ([6]) found, "On average, for each 1000 lb of environmentally released mercury there was (...) a 61 % increase in the rate of autism" (203)

• This study is better than the others you cite, but it is also relatively weak. It is summarized by Newschaffer et al. (PMID 17367287) in a paragraph that begins "Data on the developmental effects of elemental mercury are very limited." and which summarizes the results of Palmer et al. with the following sentence: "An ecologic study of industrial emissions reported a slight association of higher mercury levels with numbers of autistic children in special education, but it did not examine other, or earlier, exposures." which is a fair summary. One can hardly conclude from this unreplicated study that mercury causes autism. For an example of a much stronger ecological study, please see the following study (it should be noted that this study is also unreplicated and preliminary): Roberts EM, English PB, Grether JK, Windham GC, Somberg L, Wolff C (2007). "Maternal residence near agricultural pesticide applications and autism spectrum disorders among children in the California Central Valley" (PDF). Environ Health Perspect. doi:10.1289/ehp.10168. Lay summary – Los Angeles Times (2007-07-30). 

• Blaxill et al ([7]) support Bernard et al's mercury-autism hypothesis ([8])

• And, like Bernard et al., this paper is published in Medical Hypothesis. It is speculation, not review. Speculation is of course a useful thing, but by itself it does not support the claim in the proposed text. Eubulides 23:11, 16 August 2007 (UTC)

• Adams et al ([9]) recently found that "Children with autism had significantly (2.1-fold) higher levels of mercury" in their baby teeth, which are a "good measure of cumulative exposure to toxic metals during fetal development and early infancy".

• This is another small, unreplicated, preliminary study. It is not good evidence by itself. It is too recent to have been either replicated or refuted by other researchers. Eubulides 23:11, 16 August 2007 (UTC)

Granted, Adams et al dealt mainly with prenatal exposure, and Palmer et al did not distinguish between pre and postnatal exposure. It could be mentioned in the article that pre and/or postnatal mercury exposure is hypothesized to cause autistic behaviours. Either way, I think there should be some mention of the evidence supporting the mercury-autism hypothesis. ~ Danelo 21:00, 16 August 2007 (UTC)

The proposed text gives way too much credence to weak evidence. There is a good reason that the consensus is that there is no convincing scientific evidence that mercury causes autism. The text should not attempt to say or imply otherwise. Eubulides 23:11, 16 August 2007 (UTC)

I agree, the text shouldn't state or imply that mercury causes autism; the proposed text above did imply that (my fault on that one), so it should be changed. What about something like, "While some studies have shown a correlation between pre or postnatal mercury exposure and autism, much evidence suggests that 90% of autism is genetic..." ~ Danelo 15:30, 20 August 2007 (UTC)

Sorry, that's not correct either. No study, to my knowledge, has never claimed to show a correlation between autism and mercury exposure of any kind. And even if the word correlation is changed to some more-accurate word, the proposed text still places too much weight on claims for causation. The current scientific and medical consensus is that existing evidence does not show that mercury exposure contributes to autism, nor does it rule it out; if there is any contribution, it is most likely relatively minor. The article's text should emphasize this consensus. It is OK to mention non-mainstream opinion but any such mention should be placed within context. If anything, the article's current wording in this area is a bit too strong; as I understand it, most of those who are hypothesizing that mercury exposure contributes to autism are not theorizing that it's mercury poisoning, but is some other effect. There are important differences between the symptoms of mercury poisoning and those of autism. Eubulides 16:42, 20 August 2007 (UTC)

The Adams et al study found that children with autism spectrum disorder had higher levels of mercury in their baby teeth than "typically developing children", with baby teeth being a "good measure of cumulative exposure to toxic metals". Palmer et al found that as the amount of environmentally released mercury increased, so did rates of autism. Therefore, didn't both of these studies find that the two variables (rates of autism and levels of mercury exposure) departed from independence and are thus correlated? ~ Danelo 17:01, 20 August 2007 (UTC)

No. Departure from independence does not imply correlation, in the usual statistical sense of the Pearson product-moment correlation coefficient. Please read Correlation #Correlation and linearity. The usual way to fix this problem is to use the word association rather than correlation, but that alone does not suffice to address the objections mentioned above. Eubulides 17:25, 20 August 2007 (UTC)

So this statement in the correlation article is incorrect: "In general statistical usage, correlation or co-relation refers to the departure of two variables from independence"? ~ Danelo 17:43, 20 August 2007 (UTC)

That statement is correct as far as it goes, but it is misleading if taken out of context. By "general statistical usage" it refers to advanced concepts of correlation that are not normally used in medical or scientific articles. Normally, correlation means the standard Pearson measure which ranges from −1 to +1. Careful scientific writing uses correlation to talk only about the Pearson measure, unless there's some need to talk about the more-general measures, which there usually isn't. For more on this subject, please see: Roy Leipnik (1961). "When does zero correlation imply independence?". The American Mathematical Monthly 68 (6): 563–5. 

Doesn't this finding, from the Palmer et al study, indicate a positive correlation between the two: "for each 1000 lb of environmentally released mercury there was (...) a 61 % increase in the rate of autism" (203)? Anyway, what would be an appropriate way to mention the two studies (Adams and Palmer) in the article? ~ Danelo 20:29, 20 August 2007 (UTC)

That is a correlation, yes, but it is a correlation between mercury emissions in a region and diagnosed cases of autism in that region. It is not a correlation between an individual's mercury exposure and autism. One can reasonably argue that this study indicates an association (a weak association, as Newschaffer et al. say), but it isn't reasonable to describe the result as a correlation between exposure and autism in the usual statistical sense. Moving on to your second question, a good way to cover weak evidence (if it is to be covered at all) is to say that it's weak, to give the stronger evidence on the other side, and explain why the stronger evidence is stronger. Typically this will result in more space being spent on the strong evidence than the weak. Please consult a solid recent review article on mercury toxicology to get a sense for how much space to devote to this particular issue. Eubulides 21:05, 20 August 2007 (UTC)

Although this thread is long over, I think it is worth mentioning here that correlation does not imply causation. --Una Smith (talk) 00:56, 25 November 2007 (UTC)

[edit] Suggestion: read Clarkson and Magos

The article as it stands has some real problems: it doesn't answer even simple questions raised on the talk page (e.g., is quicksilver poisonous?). To strengthen it I suggest that an editor read Clarkson & Magos (PMID 16973445) carefully, and make sure that each topic covered by C & M is also covered in this article, roughly in the same proportion. C & M is by far the best recent review of the subject, but it doesn't seem to have influenced this Wikipedia article much, which is too bad. Clarkson & Magos answer the question about quicksilver on page 613, by the way. Eubulides 18:57, 20 August 2007 (UTC)

[edit] Largest point sources are gold mines

“Though cumulatively coal fired power plants are the predominant source of atmospheric mercury emissions, the three largest point sources for mercury emissions in the United States are the three largest gold mines there.” Winged Mercury and the Golden Calf; Two elements, one economic theory, and a cascading torrent of collateral damage; by Rebecca Solnit; Published in the September/October 2006 issue of Orion magazine[10] -69.87.202.73 15:30, 4 November 2007 (UTC)

[edit] Could gold jewelry such as necklaces and bracelets cause mercury

poisoning because of trace amounts of it on the gold surface? Thanks, rich Peterson130.86.14.88 (talk) 06:14, 20 November 2007 (UTC)Rich (talk) 06:15, 20 November 2007 (UTC)

[edit] Pink disease / acrodynia

Pink disease, also known as acrodynia, is a symptom of mercury poisoning, not a synonym. Pink disease refers to the palms and foot soles turning bright pink. An eye-opening article about this is available free in PubMed Central: PubMed. --Una Smith (talk) 18:43, 23 November 2007 (UTC)

Pink disease is the name of a condition, not a symptom, although it does take its name from one of the diagnostic symptoms — bright pink hands and feet. See the first two sentences of the Black paper you cited for details. - Neparis (talk) 21:00, 23 November 2007 (UTC)

Pink disease / acrodynia is a condition which in turn is a symptom (or if you like a sign) of mercury poisoning. But my point is that at present in the lead paragraph of this article acrodynia is given incorrectly as a synonym for mercury poisoning. --Una Smith (talk) 23:27, 23 November 2007 (UTC)

Can we use indentation in replies please? Neparis (talk) 23:58, 24 November 2007

Sure. --Una Smith (talk) 00:51, 25 November 2007 (UTC)

"Pink disease / acrodynia is a condition which in turn is a symptom (or if you like a sign) of mercury poisoning." What makes you believe that? When acrodynia was first widely diagnosed in the early 20th century, mercury was not known to be toxic and was therefore not considered as a possible cause of acrodynia. However, as a result of later research, acrodynia is now known to be mercury poisoning in children. Neparis (talk) 23:58, 24 November 2007 (UTC)

Because not all children with mercury poisoning develop acrodynia.^[3] --Una Smith (talk) 00:51, 25 November 2007 (UTC)

Where does Black say that? Neparis (talk) 17:02, 25 November 2007 (UTC)

Pages 480-481, including "this still leaves the question why some children developed pink disease while others who had received a similar amount of calomel remained unaffected." --Una Smith (talk) 00:36, 26 November 2007 (UTC)

BTW, that invites another question, not addressed (yet) in this article: are all cases of acrodynia due to mercury poisoning? --Una Smith (talk) 00:51, 25 November 2007 (UTC)

The answer to the question is unknown and very likely never will be known because unfortunately the history of the condition begins in the early to mid 20th-century before the era of the double-blind randomized controlled trial, which is now considered scientific best practice. - Neparis (talk) 17:02, 25 November 2007 (UTC)

A modern controlled trial is not necessary to disprove the hypothesis all cases of acrodynia are due to mercury poisoning: it is necessary only to find one case of acrodynia in which there is no evidence of mercury poisoning (history clear, urine clear, etc.). --Una Smith (talk) 00:25, 26 November 2007 (UTC)

Perhaps PubMed would be informative, one way or the other. Its abstract notes a family in which a spill of elemental (liquid) mercury was vacuumed up; 4 children treated for mercury poisoning; 3 children with symptoms consistent with acrodynia; 2 children with thrombocytopenia. --Una Smith (talk) 00:43, 26 November 2007 (UTC)

[edit] Ongoing effects of Pink Disease in adults

3 paragraphs copied from Wikipedia talk:WikiProject Medicine. --Una Smith (talk) 18:45, 24 November 2007 (UTC)

– — … ° ≈ ≠ ≤ ≥ ± − × ÷ ← → · § Can anyone identify research that shows ongoing effects of Pink Disease (Acrodynia) where origina; exposure was severe. I am aware of the research of Dr Linda Jones on the effect of mercury poisoning in dental workers after 30 (?) years time lapse but there seems to be nothing showing the same effects on children.Williamjireh (talk) 07:16, 23 November 2007 (UTC)

Are you asking about late effects (in adulthood) of severe mercury poisoning in children? Have you searched PubMed? --Una Smith (talk) 17:59, 23 November 2007 (UTC)

Yes. I have a relative who had severe Pink Disease as a child. I believe, from research I have been able to do, that some of the emotional/mental things she experiences now are reflective of the impact of mercury poisoning, such as are described as neurotoxicity, but want to know if there has been any difinitive research which suggest this is possible. I have looked at PubMed but can't find anything.Williamjireh (talk) 03:33, 24 November 2007 (UTC)

I think you have two questions for Wikipedia: Does Pink Disease occur only from mercury poisoning? and Can childhood mercury poisoning have late effects in adults? Is that about right? Or do you mean Can childhood mercury poisoning have life-long effects? --Una Smith (talk) 18:45, 24 November 2007 (UTC)

I think such questions should be made on the reference desk, unless William feels they are not being addressed by the article and need to be included. JFW | T@lk 21:37, 24 November 2007 (UTC)

I read Williamjireh's questions on Wikipedia talk:WikiProject Medicine and I decided they belong here, not on the reference desk. --Una Smith (talk) 01:04, 25 November 2007 (UTC)

... Thank you for moving the information to this site. I am a novice. There is information about what immediate effect mercury poisoning has on people; in the case of children, pink disease. The research/information appears to be about the immediate effect of the event. There appears to be no research on the long term effects, i.e. in adulthood of children who suffered from Pink Disease. The research of Dr Linda Jones (Massey University, New Zealand) highlights the long term effects of mercury poisoning on women who were dental nurses, i.e. exposed to mercury in amalgum fillings. She is convinved that there is a residual effect, sometimes serious, from such exposure after 30 (?) years. I believe (observation) that there potentially is a residual effect on adults who suffered such poisoning as children, effects which are similar to what Dr Jones suggests (emotional and mental inhibitors) but I am not aware of any research which has dealt with this. My interest is in what symptons may be ascribed to such a cause and what treatment may be available/suggested. The Wiki articles on Neurotoxicity and Acrodynia have been of assistance. I have to recall that I did get two articles from PubMed, one by Black and the other by Crinnon, but neither deal with this issue.Williamjireh (talk) 05:31, 25 November 2007 (UTC)

PubMed abstract mentions one significant late effect of childhood pink disease is male infertility. That's all I find on PubMed, but not necessarily all there is. The full article may provide leads to evidence of other late effects, if any. --Una Smith (talk) 00:50, 26 November 2007 (UTC)

[edit] In popular culture section?

I've noticed that a number of articles, regardless of their subject, have sections listing fictional media that feature the subject. Should one ever be created for this article, know that mercury poisoning is featured in the fifth season of Nip/Tuck and discussed in episode 513. Not the most encyclopedic piece of information there is, but there you have it. --85.5.47.205 (talk) 06:33, 16 February 2008 (UTC)

Not in this article, no. Please see WP:MEDMOS #Trivia. Eubulides (talk) 06:48, 16 February 2008 (UTC)

Trivia sections are discouraged, but cultural references can be illuminating. For example, it would be appropriate to include a mention of the Mad Hatter in this article, even if that character's behavior isn't necessarily representative. --Arcadian (talk) 20:58, 16 February 2008 (UTC)

The article already talked about mad as a hatter; I made this change to cover the issue of the Mad Hatter, who does not exhibit symptoms of mercury poisoning. Eubulides (talk) 06:40, 17 February 2008 (UTC)

[edit] Number of authors in medical citations

Re this change which added the full author list for PMID 9765315: Wikipedia:Manual of Style (medicine-related articles) #Citing medical sources mentions the AMA style and the URM style. The AMA style (which I use) is to list all authors if there are six fewer authors; if there are more, then list just the first 3 authors with et al. The Vancouver style is to list just the first six authors, with an et al. if there are more. In Wikipedia it's often not practical to list all authors; an extreme example is PMID 17280267 but I often deal with papers with so many authors that Wikipedia can't reasonably list them all, and the AMA style is better than making up our own style. Eubulides (talk) 21:02, 3 April 2008 (UTC)

I really don't think this is an issue when we are only talking about any small number of authors less than ten. The difference it makes is only of the order of bytes per reference on average, which is a trivial amount (see also WP:PAPER). And the extra visual space used is hardly significant in relation to most non-stub articles.

The reason I think it is useful, and better, to list all authors, up to, say, nine of them, is because the last author is often the research group leader, and highly notable as a researcher. Indeed, in the current example, PMID 9765315, the last of the seven authors is Aposhian, a highly notable researcher who is the research group leader at BMCB. It is useful and informative in a multimedia encyclopedia to be able to see at a glance in the article who were the research group leaders involved in the work behind a particular publication.

Following links to third-party websites simply to read a full list of authors is just annoying and an unnecessary waste of time, and can be unreliable, and in the case of non-free or foreign language publications, it is quite possible that the full citation details are not available online. Many people print out Wikipedia articles to read offline, and for them clicking on PMID links to read a full author list is not an option. I often do that myself when traveling, and I would be glad to be able to read instantly from my printed copy of the article, the names of eminent researchers, such as Aposhian, where they are listed as the last author.

Truncating references at the third author hides potentially significant and useful information on who were the research group leaders involved in the work. Hiding any co-author names greatly reduces the immediate utility of the references in the article, and really it saves relatively very little space, just bytes in total, which might be an issue for a WP:PAPER encyclopedia.

It is normal in many disciplines outside medicine to list all authors, and the majority of Wikipedia articles use full author lists, even including many of our medicine articles. I can't see any benefit in insisting upon different citation styles in articles in different subjects in Wikipedia. Using a consistent citation style across all articles seems better, and full author listing seems to be generally preferred. Much though I respect AMA and URM, I doubt there will ever be consensus in WP:MOS to demand all articles, including non-medical ones, switch to follow what is a somewhat idiosyncratic proscription such as AMA's or URM's. - Neparis (talk) 23:03, 3 April 2008 (UTC)

I agree with most of what you say, and I don't use the medical style in the non-medical articles I edit. Nor am I insisting that we stop at 6 or at 3 for this particular citation. However, in general, it's better to stick to a standard style, and listing all the authors simply isn't practical for Wikipedia articles with dozens of references many with dozens of authors. Did you follow the reference to PMID 17280267? Here's the citation it would generate, if we insisted on always listing all authors. Eubulides (talk) 23:27, 3 April 2008 (UTC):

Sorry if I wasn't very clear. I am not saying that all authors should be listed — I fully agree with you that it would be totally impractical for papers with hundreds of authors, such as the nuclear physics paper you cited, and even for numbers of authors in the low tens. The reason I think it is useful and informative to list up to, say, nine authors, rather than three authors per AMA, is that I once saw an interesting graph of number of science papers published as a function of number of authors, which showed a rapid drop-off up to somewhere around ten authors, with relatively extremely few papers with more than ten authors (I remember the graph, but unfortunately not where it was published — quite possibly Nature, early to mid 1990s).^{[citation needed]} A cut-off at around nine authors captures the vast majority papers, whereas a cut-off at three (and even six too) hits a sizeable minority of papers. - Neparis (talk) 00:59, 4 April 2008 (UTC)

[edit] Elemental mercury dermal absorption - Edit?

I have never edited before - and it looked like I had to know various coding schemes to add links etc. Rather than do nothing - I posted here for consideration. The current article states, "Elemental mercury (pure mercury) is readily absorbed through the skin." This is an uncommon view that is stated as fact.

The following sentence assumedly by the same editor supports the fact that elemental mercury in its liquid form is not well absorbed dermally. "However, because mercury has a very high surface tension at room temperature, [14] it does not wet the skin (as water would) and the contact area is therefore limited (reducing absorption rates)." The editor further adds, "Nonetheless, handling mercury with unprotected hands has resulted in cases of severe mercury poisoning.[2]".

I have no issue with attributing toxicity, in this case acrodynia, to mercury exposure. However, I do not believe there is justification to to ignore the somewhat limited scientific studies of Hg absorption to make the assumption that this case is indicative of dermal absorption of elemental mercury causing illness. There are various case reports that relate dermal exposure to mercury in cosmetic products and even diapers to acrodynia. In these,Hg is typically in the form of inorganic salts or in some cases organic mercury compounds (phenyl mercuric acetate). The association of mercury vapor exposure with acrodynia is also reported. Handling elemental Hg would also result in inhalation of Hg vapor.

To my knowledge there is no scientific scientific study evaluating direct dermal absorption of liquid elemental Hg and the editor in reference 14 aptly cites the reason - it's physical properties preclude that.

Mercury vapor is dermally absorbed but in most cases this is a "trivial" contribiton to dose compared with inhalation. Approximately 80% of inhaled Hg vapor is absorbed compared with ~ 2% dermal absorption of vapor. Half of that dermally absorbed is “shed” through desquamation of the keratinized epidermis. ( Hursch et al., 1989). Typically the GI tract is viewed as a more "absorptive surface" than the epidermis. Ingested elemental Hg is poorly absorbed here as well (~ 0.01%).

In summary the following supports editing the referenced statements:1. inhalation exposure, a documented cause of acrodynia, was likely present and cannot be ruled out. 2. the physical properties of elemental Hg as referenced by the editor preclude dermal absorption. 3. "Good" dermal absorption is illogical since GI absorption is "poor".

I wouldn't mind doing the edit - however, I am confused by the coding in the body of the text and have no idea whether this is HTML or something else. If I can learn these in an hour or so from the "how to edit" page - I can do it. I'd appreciate some feedback on that.

If someone else chooses to do it - here are some primary sources regarding Hg absorption. 1.Cherian M.G., Hursh J.G., Clarkson T.W. 1978. Radioactive mercury distribution in biological fluids and excretion in human subjects after inhalation of mercury vapor. Archives of Environmental Health 33: 190-214. 2.NIELSEN-KUDSK, F. (1965): Absorption of Mercury Vapour from the Respiratory Tract in Man, Acta Pharmacol Toxicol 23:250-262. 3. Hursh J.B., Clarkson T.W. Miles E.F., Goldsmith L.A. 1989. Percutaneous absorption of mercury vapor by man. Archives of Environmental Health; 44:120-127. 4.Lin J.L., Lim P.S. 1993. Massive oral ingestion of elemental mercury. Clinical Toxicology 31: 487-492. Peace, ggaretano Ggaretano (talk) 02:58, 5 April 2008 (UTC)--Ggaretano (talk) 02:58, 5 April 2008 (UTC)

Thanks very much for noticing that problem. The discussion of dermal exposure was unsourced, which is not right for Wikipedia. I worked around the problem with this change, which used Clarkson & Magos 2006 (PMID 16973445) as the source. If you can see any further room for improvement please let us know; it certainly is nice having an expert in the house! Eubulides (talk) 04:41, 5 April 2008 (UTC)

Thank you for identifying the problem and for your excellent suggestions, Ggaretano. If you feel like reviewing the rest of the article, please do. Eubulides, thanks for fixing the error. I have added a citation to the Hursh paper suggested by G, to clarify that the skin exposure route is feasible for mercury vapor, albeit uptake is only approximately 1% of uptake by inhalation. - Neparis (talk) 05:34, 5 April 2008 (UTC)

I will try to read the general guidance that you provided before asking too many questions or giving too many possibly irrelevant opinions. There is plenty of room for tune-up here depending on the intended depth of the article. In prior "talk" someone suggested a format similar to Clarkson's review (Three Faces of Mercury?)- I agree. I also believe a section should be added on "opportunities for exposure" and am not sure how you handle crossover between this and the "mercury" article. Anyway, I'll be glad to help as I'm able. Ggaretano (talk) 18:09, 6 April 2008 (UTC)

There's really no such thing as an irrelevant opinion on Wikipedia, nominally the encyclopedia that anyone can edit. Thanks very much for your latest edits. I too was a bit concerned that the earlier version gave the impression that Hg(0) was harmless, which was not supported by any of the sources cited.

If by "tuning up" the article, you are suggesting there is room for greater depth of coverage, I would agree with you. I would certainly like to see detailed coverage of mechanisms of toxicity in a new "Mechanisms" section; the present coverage is very thin, and scattered between the "Signs and symptoms" and "Toxic effects" sections.

In terms of the format of the article, I agree it could be improved, but I would have reservations about large-scale changes to the layout. In medical articles, we usually aim to follow approximately the Wikipedia Medical Manual of Style (MEDMOS) format, section layout, and style. The article is currently roughly in line with the MEDMOS recommended section titles and order of sections (not sure the order of "Prevention" and "Treatment" is reversed). It is only a guideline though, so we are free to ignore it and add a section "opportunities for exposure" if that seems like a better way of structuring the article. I might point out that the "Causes" section already addresses some opportunities for exposure; what do think about working on that section or a new subsection "Opportunities for exposure"?

Incidentally, there has been significant peer-reviewed criticism of the Clarkson and Magos review by Mutter et al (2007) PMID 17661216. I think these criticisms should be cited too, since we do cite Clarkson and Magos in the article. - Neparis (talk) 19:49, 6 April 2008 (UTC)

Points well taken. By irrelevant POV I meant being too opinionated before reading the general guidelines you so kindly forwarded. I'll review the entire article again before responding on "opportunities for exposure". If it it might be a reasonable approach - I'd be willing to work on it - assuming there is no urgency (in a week or two). The Clarkson article I was referring to is: The three modern faces of mercury. Environ Health Perspect. 2002 Feb;110 Suppl 1:11-23. PMID: 11834460 Interestingly enough, as I recall, he reviewed the probable mechanisms for Hg^o toxicity including that from amalgam which it looks like Matos et al. criticised the later article for downplaying.. Any way no politics, no synthesis (will be a challenge). thanks, Ggaretano (talk) 20:08, 6 April 2008 (UTC)

[edit] Clifton mischaracterized by recent edit

This change altered "no scientific evidence links it as a cause of clinically significant toxic effects, except for the rare local hypersensitivity reaction" to "scientific evidence links it as a cause of clinically significant toxic effects". However, the cited source (Clifton 2007, PMID 17448359) says "Several epidemiological studies have investigated any possible link between this type of mercury exposure and human disease, including amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s disease, and Alzheimer’s disease. The available scientific evidence reveals no link between amalgams and clinical toxicity." Furthermore, the same edit planted a "Fact" template on the sentence "The National Institutes of Health has stated that amalgam fillings pose no personal health risk, and that replacement by non-amalgam fillings is not indicated." But the cited source supports this claim; it says "The National Institutes of Health (NIH) has also stated that there is no personal health risk imposed by the presence of amalgams, and that replacement with a non-amalgam polymer to reduce mercury exposure is not indicated."

Since the cited source supports the original claim about toxic effects (and does not support the revised one), and supports the deleted claim about the NIH, I've restored the original text. Eubulides (talk) 00:03, 21 April 2008 (UTC)

My apologies. The abstract says this:

More recent mercury toxicity issues include the extreme toxicity of the dimethylmercury compound noted in 1998, the possible toxicity related to dental amalgams, and the disproved relationship between vaccines and autism related to the presence of the mercury-containing preservative, thimerosal.

I figured with their strong statement against thimerosal, they would have a similarly strong statement against amalgams. You can probably find a more accessible source for the NIH claim. However, your quote presents a biased view of the scientific literature. If you glance at the main page, you'll find that there are quite a few studies which find 1) significant correlation mercury concentration in the body with mercury fillings and 2) correlation of improvement of various diseases when removing the fillings. Here is the study which should suffice in balancing this page. Unequivocally demonstrating harm is more difficult than showing uptake, but with a metal as toxic as mercury, showing that, for example, mercury fillings are correlated with mercury in the brain and kidneys gets you pretty close to harm. Mind adding the lit. review? OptimistBen | talk - contribs 02:49, 21 April 2008 (UTC)

I am aware of Mutter et al.'s work, but a quick look at recent reliable commentary on the subject, including Rasines 2008 (PMID 18364694), Richards 2008 (PMID 18364680), and Jones 2008 (PMID 18327185), just to limit ourselves to articles published in the last couple of months or so, indicates that the scientific consensus is what is summarized in Mercury poisoning #Dental amalgam, which is that there's no valid scientific evidence that dental amalgam poses a health hazard. If the minority view to the contrary is to be presented, the mainstream view would have to be beefed up considerably as per WP:NPOV; I'm not sure that it's worth doing that here, though obviously the minority view should be covered in Dental amalgam controversy. If you'd like to draft something along those lines, please propose it on the talk page first, so that we can take a look at it. It's better to use recent reviews; referring to 20-year-old primary studies like Nylander et al. 1987 (PMID 3481133) is not the way to go. Please see WP:MEDRS for details about reviews versus primary studies. Thanks. Eubulides (talk) 06:00, 21 April 2008 (UTC)

Why are you pointing out MEDRS when I just pointed you to a literature review (Mutter et al) and stated that it was the appropriate thing to reference? Further, MEDRS says this: Reliable primary sources should be used with great care because of the potential for misuse. For that reason, edits that rely on primary sources should only make descriptive claims that can be checked by anyone without specialist knowledge. I agree that Nylander doesn't belong on this page, but the interpretation in the abstract is fairly clear-cut: people with mercury fillings have more mercury in their brains and kidneys. And I don't think the methodology or methods have improved much in 20 years; if anything, it seems as if they would be more precise. I know for certain the OLS regressions haven't changed much in 20 years.

As for Mutter: this page states that "no scientific evidence links it as a cause..." -- that is clearly false. The replies to Mutter are not reviews of the literature, either. They sound like individual disagreements, and they all likely refer to the same studies while excluding Mutter's studies. Do you have the full-text of all those available? Unfortunately, I don't. You should do us the service of summarizing what they say. Are they grounded in science? Do they point out flaws in the studies Mutter reviewed? I'm not surprised to hear some disagreement from dentist organizations -- just about every dentistry organization endorses dental amalgam. However, these dentists are not researchers or physicians: they are dentists. As outside editors rather than experts, we are not capable of judging whether Mutter's work reflects a significant minority in the literature, either. The FDA's most recent 2006 independent scientific panel voted 13-7 to reject the FDA's characterization of dental amalgam as safe; the experts listed many concerns here on record. The WHO has expressed concern, noting in its policy paper that "there may be no level at which mercury is safe. You're going to have to back up your assertion that you have the strong majority view better. Obviously dentists have a lot to say on the issue, but they are not professionals in the area of health research or toxicology; most of them have never studied mercury's effects on the body, only its efficacy in teeth. OptimistBen | talk - contribs 06:54, 21 April 2008 (UTC)

The Mutter et al. review has been obsoleted by more recent primary studies, which is why it's better to use more recent reviews such as Clifton 2007 (PMID 2007), the review that Mercury poisoning currently cites. The 2008 articles I mentioned are not reviews, just commentary (I don't know of any review more recent than Clifton) but they underline the fact that Clifton is presenting the mainstream opinion. Other reviews since Mutter et al. back this up; this includes Martin & Woods 2006 (PMID 17044804) and Clarkson & Magos 2006 (PMID 16973445). I know of no reliable recent reviews agreeing with Mutter et al. Mutter also promotes mercury chelation therapy for autism (see Mutter et al. 2005, PMID 16264412), and this also disagrees with the mainstream (see, for just one example, Doja & Roberts 2006, PMID 17168158). Clarkson & Magos (and Doja & Roberts) are not dentists, so this is not a matter of dentists against the rest of the world. The FDA panel didn't say amalgams were unsafe; they asked only for more literature reevaluation. Eubulides (talk) 07:39, 21 April 2008 (UTC)

[edit] Sources for TCVs in the 1930s

This change replaced with a citation to Eldred et al. 2006 (PMID 16489901) with a citation to Clarkson, Magos & Myers 2003 (PMID 14585942). There are two problems with the latter citation. First, its URL ([11] (PDF)) doesn't work. Second, it is obsoleted by Clarkson & Magos 2006 (PMID 16973445), which is more recent and far more extensive.

The log entry for the change said "See WP:V; sources do not need to be freely available. Get an interlibrary loan." I have access to and have read all the sources in question; that is not the issue.

A later change restored the Eldred citation, but there still is the problem that the old Clarkson et al. citation has a bogus URL and the paper is obsolescent. Clearly Clarkson et al. are more authoritative on the subject, and it's not worth citing two sources for this uncontroversial point. I attempted to improve matters by substituting the newer Clarkson et al. citation. Eubulides (talk) 02:48, 4 May 2008 (UTC)

I agree Clarkson et al 2006 is a better source than Clarkson et al 2003. I wouldn't object, however, to restoring the citation to Eldred et al 2006. I think Eldred's review of thiomersal and other vaccine components is more comprehensive than Clarkson's. - Neparis (talk) 17:17, 5 May 2008 (UTC)

[edit] Mercury is actually good for you.

Could someone please add something about this? http://www.youtube.com/watch?v=JNsbNmRRUZs —Preceding unsigned comment added by Joehoe665 (talk • contribs) 00:28, 10 June 2008 (UTC)

A random Youtube copy of some broadcast is not a reliable source. The broadcast talks about Pediatrics, which I suppose could be cited, if someone could track that stuff down. Eubulides (talk) 01:36, 10 June 2008 (UTC)

This is actually referenced in the thiomersal controversy page (footnote). The authors state that this was most likely due to confounding factors -- the kids who are not getting vaccinated have other problems as well (socioeconomic status was not tracked). This study was also focused on Europe, where they don't apply as much mercury. ImpIn | (t - c) 01:47, 10 June 2008 (UTC)