DDT Paradox: Bouwman et al. Respond

SADC announced their intention to produce DDT locally (SADC 2011). Furthermore, the 35 heads of state and government who are members of the African Leaders Malaria Alliance (ALMA) recently endorsed use of DDT in indoor residual spraying (IRS) (ALMA 2010). Such organized actions by affected countries bespeak broad recognition of scientific issues and continuing need for DDT in malaria control programs. Those actions expose the mis representations of those who contend support for DDT is limited to a small number of extremists. Bouwman et al. (2011) argued that " evidence of adverse health effects due to DDT … is mounting " and therefore DDT should be accompanied by information on the potential side effects, just as with prescription medicine. We believe that the interpretation of the mounting evidence is itself a minority view and that their argument is false. The World Health Organization's (WHO) review of human health aspects of DDT use in IRS concluded that " for households where IRS is undertaken, there was a wide range of DDT and DDE serum levels between studies. Generally, these levels are below potential levels of concern for populations " (WHO 2011). None of the thousands of studies that have been conducted regarding possible human health effects of DDT satisfy even the most basic epidemiological criteria to prove a cause-and-effect relationship. In their commentary, Bouwman et al. (2011) confused a large number of studies that uniformly fail the criterion of consistency in demonstrating that DDT causes actual harm, with isolated studies revealing some statistical association or correlation as a suggestion of harm. It is on this basis that the authors argued for precaution in the use of DDT. In contrast, we argue that precaution should govern Bouwman et al.'s aggressive anti-DDT campaigning and not precaution in the use of DDT to prevent disease and save lives. The growing number of studies is not proof or evidence that DDT causes harm, but it is evidence of growing funding for research on this topic. Bouwman et al. (2011) argued that households should be informed about unproven and speculative risks from DDT. Their argument must be rejected as the worst form of scare mongering because it will result in growing risk of disease and death from malaria while providing no proven health benefit. Ignoring proven and catastrophic health decrements from malaria infections while warning of theoretical concerns about DDT exposures is a function of ideology. …