It is necessary to clarify a part of the Juneau Empire's front-page article, "Alcohol's effect on fetus discussed" (Jan. 29). The wording that implies Fetal Alcohol Spectrum Disorders are more common in "poor families of Native origin" needs to be addressed more clearly.
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Race is not a risk factor for FASD. The essential risk comes from a combination of the amounts and duration of alcohol used during pregnancy. Researchers have identified some specific time ranges during pregnancy when fetal exposure can produce some of the syndrome's effects. Neither the exact dose of alcohol required nor exact duration of exposure has been fully identified. Most scientific investigators and clinicians advise the best method for prevention is no alcohol use during times of possible or known pregnancy.
Accurate public health measurements of prevalence rates (number of diagnosed cases per 1,000 live births) is new compared to rates of infections such as measles and chronic disorders such as cancer. FASD has been recognized for more than a century, but it was only scientifically demonstrated just over 30 years ago in France and the United States.
Various public health and medical publications are slowly revealing more accurate prevalence rates since the seminal article in Lancet by Seattle investigators in 1973. The Seattle study arose from the astute observation of pediatric resident, Dr. Christie Ulleland, who noticed the similar features of several children. These children came from a variety of racial and cultural backgrounds, yet to her they looked like siblings.
Diane Casto, director of the Alaska Office of Fetal Alcohol Syndrome, cites a study in the states of Alaska, Arizona, Colorado, and New York. As reported in the Centers for Disease Control and Prevention weekly report (Vol. 51) in May 2002, the authors stress the results are estimates because of several factors - especially limited diagnostic facilities. For children born between 1995 to 1997, prevalence rates ranged from 0.3 to 1.5 per 1,000 live births. Cases were higher among black and American Indian/Native Alaskan populations. The authors noted these results might be due to "increased awareness of maternal alcohol use and more complete documentation by Alaska Native health organizations."
Investigators generally agree prevalence rates are underestimated in all 50 states.
Like so many public health disorders (such as tuberculosis, cancer and AIDS), FASD is more common among people forced to live in poverty. As some who work with HIV/AIDS say, "Food is medicine." Poor nutrition is probably the major determinant of alcohol's damage to human fetuses and adults. Good to excellent nutrition is improbable for those living in poverty. Poverty, not race, is the common denominator influencing FASD rates.
Will Morris, the Empire reporter who covered the FASD conference, deserves special thanks for making the real human side of FASD available to the public. Laura and Larry Rorem, who have an adopted son with FASD, starkly described their family's human costs in Morris' article. Larry Rorem said, "I don't know what is more difficult - dealing with FASD or dealing with the systems."
All through the plenary sessions and workshops, the themes of hope and opportunity resounded. The conference theme, "An Overwhelming Opportunity," highlights what is most needed and still most difficult to accomplish - overcoming the massive public denial of alcohol's dangers. Alaska investigators have put the lifetime cost for one person with FASD at between $1.5 million and $3 million.
One conference speaker, Debra Evenson, a teacher who has supported many FASD students through the years, said one way to increase awareness is to build a supportive structure with family, neighbors, teachers and the community. Thirteen Alaska FASD diagnostic clinics help start the process of dispensing this supportive structure for thousands of Alaskans. We all benefit by this marvelous opportunity to extend our enthusiastic and untiring support for prevention and treating FASD.
Dr. George W. Brown is a Juneau resident and practicing pediatrician.
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