Give Me a Test and I'll Give You a Diagnosis: Why We Should Have Diagnostic Tests to for Pesticide Overexposures

It is strongly suspected underreporting and under-diagnosis of pesticide poisonings are common among farmworkers. The decisions about whether to remove/restrict pesticides are made by EPA based on poisoning reports received through public surveillance systems or registrant reports made under the 6(a)2 requirement. This requires that a registrant report adverse effects of their chemicals to EPA. Potentially the weakest link in this system, which is intended to protect the population by monitoring pesticide health effects, is the lack of clinical tools to apply in the diagnosis of pesticide poisonings. Under FIFRA, EPA has the authority to require a wide variety of data from companies that register pesticides for sale in the US. EPA could, but does not, require registrants to supply a clinical test to confirm pesticide overexposure from their products. Pesticides, unlike all other environmental and occupational toxicants, are purposefully released into the environment with the intention of doing harm to living beings. Unfortunately, too often, the living being harmed is human. The need for a confirmatory test is underscored by the “objective findings” requirements of worker compensation systems. Until we can diagnose pesticide poisonings with relative certainty, we will continue to fail to offer our patients the benefits of the worker compensation insurance systems that they deserve and we will fail to participate in the important surveillance systems which influence the EPA decision making. The companies can do it, the EPA can demand it, and we need it. Give me a test and I will give you a report.