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Kelsh, M., Buffler, P., Daaboul, J., Rutherford, G., Lau, E., Barnard, J., Exuzides, A., Madl, A., Palmer, L. and Lorey, F. (2003) Primary Congenital Hypothyroidism, Newborn Thyroid Function, and Environmental Perchlorate Exposure among Residents of a Southern California Community. Journal of Occupational and Environmental Medicine, 45, 1116-1127.
http://dx.doi.org/10.1097/01.jom.0000091683.25325.55

has been cited by the following article:

• TITLE: Implications of the Reanalysis and Weight of Evidence Determination of Human Health Studies for Exposure to Perchlorates under Cumulative and Aggregate Risk Assessment

  AUTHORS: Douglas Crawford-Brown, Sean Crawford-Brown

  KEYWORDS: Risk Management, Perchlorate, Cumulative Risk, Public Health

  JOURNAL NAME: Journal of Environmental Protection, Vol.7 No.12, November 14, 2016

  ABSTRACT: This paper applies cumulative and aggregate risk methods and weight of evidence determination to re-analysis of epidemiological and clinical studies of exposure to perchlorates. The implications of cumulative and aggregate risk are considered for 28 epidemiological studies on IUI, serum thyroid hormone levels and clinical indicators. Consideration is given to simultaneous exposures to perchlorates, nitrates, thiocyanates and organohalogens in the study populations. The elevation of effects by perchlorates alone is found only in the studies that use urinary perchlorate as the metric of exposure. These studies are beset by a problem with use of urinary perchlorate concentration in that there is large inter-subject variability in the relationship between intake and urinary concentration due to differences in metabolism and disposition of the compounds following ingestion. As a result, an individual placed into the “high urinary concentration” group may be there due to high values of exposure, to long biological clearance halflives, or due to high transfer fractions from the serum into the urine. The influence could be removed by correcting urinary levels by measured clearance half-times for individuals in a study, but that has not been done in the case of the studies examined here. It is of interest therefore that the studies that use direct measures of intake of perchlorates rather than urine concentration fail to display the hormone effects. The current study uses a “weight of evidence” approach for perchlorates, employing all 28 studies. The result is a slope of the exposure response curve (percentage change in hormone effect per unit exposure) of 0.3% per μg/kg-day, with 95% confidence interval of (?0.05%, 1%). This confidence interval for the slope encompasses 0, indicating no statistically significant slope when all data are combined in a weight of evidence determination. This is consistent with the conclusions of the USEPA and EFSA that the epidemiological studies do not provide compelling evidence for a causal association between exposures to perchlorates and either hormone effects or clinically adverse effects. The conclusions are 1) that current epidemiological results do not provide evidence of effects induced by perchlorates apart from the IUI effects, 2) that the same results provide evidence that the IUI effects induced at environmental levels of exposure are associated with down-stream adverse effects and 3) that effective risk management requires the cumulative and aggregate risk framework adopted here, suggesting a need for risk assessors to return to the original studies and provide separate estimates of exposure response relationships for all four compounds or at the least to control for exposures to nitrates, thiocyanates and organohalogens.