Minimizing Mercury in Medicine.

The American Medical Association (AMA) has adopted a policy urging hospital administrators to eliminate mercury-containing devices such as blood pressure monitors from their facilities. "Elemental mercury and mercury compounds are known to be hazardous to human health and the environment," said Hilary O'Herlihy, a cardiologist from Glen Burnie, Maryland, and an assistant professor of medicine at The Johns Hopkins University in Baltimore.

O'Herlihy, who uses nonmercury blood pressure devices in his practice, said the AMA should back policies to minimize the use of such equipment. "There are widely accepted alternatives to mercury and mercury-containing devices for medical use," he said. O'Herlihy introduced the matter for debate at the June 2000 annual meeting of the AMA's policy-making House of Delegates in Chicago, Illinois.

During the debate, John Malcolm, Jr., a pathologist with Evangelical Community Hospital in Lewisburg, Pennsylvania, said that in nonpatient-care areas, particularly in laboratories, mercury-containing devices continue to be the gold standard. For example, Malcolm said, blood gas analysis devices are calibrated using barometers that contain mercury. Replacing those devices with quartz crystal machines would be costly for a hospital--and in order to calibrate the new machinery, a mercury-containing device is still required. "I think we should be a little cautious before we eliminate all mercury-containing instruments," Malcolm said. "If you use reasonable care, you can get around problems with the environment. Let's not go overboard with this idea."

Diana Dell, chair of the AMA committee that heard the debate, noted, "We heard persuasive testimony about the health risks of mercury and the need to minimize exposure, but heard conflicting testimony regarding the ability or need to eliminate all uses of mercury in health care facilities." Dell, an assistant clinical professor of psychiatry and behavioral sciences at Duke University in Durham, North Carolina, said her committee decided in the end that the adverse health risks of mercury are well documented, and that exposure should be minimized. "Our AMA should work with appropriate groups to identify available options and suitable alternatives to mercury use," she said.

O'Herlihy said that the incineration of medical wastes containing mercury--including broken medical equipment and mercury-containing salts used in a variety of practices--has been cited by the U.S. Environmental Protection Agency as a major source of mercury contamination. He said the AMA policy has only persuasive power with hospital administrators, who would be the ones to make the decision and take the steps to eliminate mercury-containing devices.

Bruce Scott, an otolaryngologist from Louisville, Kentucky, and a member of the AMA Board of Trustees, said the AMA's stance takes a prudent approach to risk reduction while not affecting devices that do not have an effective mercury-free alternative. "I don't believe [the policy] goes so far as a mandate in those areas where [mercury-containing devices] offer a health benefit," said Scott.