I’m a public health nurse and I have a weekly public radio program, Healthstyles, in New York City. Fifteen years ago, when my kids were preschoolers, there was a local outbreak of head lice, and parents kept asking me to do a show about it. I thought it was a boring topic. They persisted and I did the show.
During that radio show I invited listeners to call in; in radio-speak, “the board lit up.” A mom called and said she’d applied an OTC shampoo for head lice, in three separate applications, to her six-year-old son’s head, but he still had nits and live lice—what should she do? A father reported that he’d applied another OTC shampoo for head lice to his nine-year-old daughter’s head, wrapped her head in plastic wrap, and let her sleep through the night that way; he asked, “Was that dangerous to do?” Producing this segment opened my eyes to how little we knew about the health effects of such treatments on children. It was a nursing “Aha!” moment: head lice weren’t just a big nuisance, they were a serious public health issue.
When over-the-counter applications fail, parents often turn to their child’s primary care practitioner, who writes a prescription for lindane, malathion, or permethrin. Of these three different pesticides, lindane has recently been getting all the press. So what do we know about lindane? It’s nasty. It’s a toxic organochlorine and it’s bioaccumulative. Studies report that exposure to lindane has been linked to seizures, developmental disabilities, and hormone disruption. It is known to be particularly hazardous to children. In 2003 the FDA required manufacturers to add a black-box warning label (the FDA’s strongest warning) to alert people to the risk of serious adverse events associated with the product’s misuse and overuse. In 2006, the EPA had sufficient evidence to announce that it was “cancelling the registrations of all pesticide products containing the pesticide lindane,” in effect banning lindane’s use in agriculture.
Internationally, more than 50 countries have also banned lindane. In May representatives from the Office of Environmental Policy at the U.S. Department of State attended the fourth Conference of the Parties to the Stockholm Convention on Persistent Organic Pollutants (POPs) in Geneva. Petitions from around the country were sent to Secretary of State Hillary Clinton, requesting that her representatives voice their support for a total ban on lindane. Because the United States signed but has not ratified the treaty, it is not a voting member but participates as an observer—a powerful one.
A source at Pesticide Action Network North America (PANNA) who was at the Geneva meeting reported that delegates for Kenya and India spoke out against a complete ban and wanted the right to keep using lindane in agriculture. Reportedly, India and China are the only two countries still producing lindane. The Convention delegates voted for a total ban (by the way, Kenya and India didn’t get what they wanted). A media frenzy followed, with some reports saying that lindane had been banned globally.
But when you read the word “banned,” do you think it means now or in five years? Because in the U.S., that ban won’t start until 2014. An exemption to the ban allows lindane to continue to be used pharmaceutically to treat lice and scabies in children and adults. The exemption also allows countries with stockpiles of lindane to continue selling it until 2014.
Much as there was dissension about the ban at the Geneva conference, there’s dissension in the nursing community about how to manage kids with head lice. So if we get stuck on arguing the rightness or the wrongness of the Stockholm ban, or on whether the exemption is justifiable or not, we miss the facts: more than 50 countries and the State of California have banned lindane. In the 1990s veterinarians knew enough to voluntarily stop using lindane on animals. We have the science, we have the evidence—as nurses let’s do what we need to do to protect the children.