Maturing Early

A puzzle in Puerto Rico

The symptom is alarming to the parents and bewildering to the affected children: breast development in girls six months to seven years old, and sometimes in young boys. Ordinarily, premature thelarche, as doctors call the condition, is a rare disorder, occurring in less than one out of 1,000 children. But in recent years doctors in Puerto Rico have reported more than 700 cases, mostly in children under two. Some slightly older patients display a fuller range of adult sexual traits, including menstruation at age seven. "When you see four cases a day of an uncommon condition, then you know something is very wrong," declares Pediatric Endocrinologist Carmen A. Saenz de Rodriguez of San Juan. Adds Dr. Adolfo Perez Comas of Mayagiueez: "We are seeing children with deep emotional problems. Their whole development, not only in the physical sense, has been accelerated."

The villain, according to Saenz and other Puerto Rican doctors, could be the local food--beef, chicken and that fundamental childhood staple, milk. These physicians suspect that meat and milk producers are unlawfully using estrogen and related compounds, including the federally banned carcinogen diethylstilbestrol (DES), to add heft to their animals. High consumption of such chemicals has been known to cause premature thelarche, and, say the doctors, when patients are withdrawn from the suspect foods, nearly all recover within six to eight months. The charges have triggered a spate of Government investigations, a volley of denials by the meat and milk industries and public panic that led to a temporary 30% drop in chicken sales and a 5.5% decline in the island's consumption of milk.

So far, attempts to assess the merit of the doctors' charges have been inconclusive. An FDA investigation in August found that two out of 17 poultry samples from Puerto Rico were "suspect for estrogenic activity." Despite this, says FDA District Director Lynn Campbell, the analysis "has uncovered no evidence of the unlawful use or abuse of estrogen or hormone-like compounds."

Saenz and her supporters insist that the Government is not looking hard enough. A private investigator hired by the physicians in Puerto Rico reported that he found it easy to buy restricted veterinary drugs containing estrogen, including DES. "They say it's not for sale here," says Saenz, "but there was plenty where he bought it." Indeed, Veterinarian Jose Diez of the commonwealth department of agriculture confirms that "all the large pharmaceutical companies and distributors peddle their wares to the breeders, not only estrogen but also antibiotics." What is worse, says Diez, "our breeders have no idea how to use them."

Puerto Rico's meat and milk industries are concerned. Kentucky Fried Chicken, Golden Skillet and others have placed full-page ads in local newspapers defending their products. To-Ricos, a poultry concern, helped arrange for a TV appearance by a U.S. Department of Agriculture meat inspector, who assured the public that it was safe to eat inspected local meat. At a legislative hearing, Salvador Pizarro, president of the Puerto Rican Farmers' Association, suggested that the estrogen controversy is a plot by food importers to destroy domestic production. Meanwhile, the milk industry has threatened to sue Saenz and Perez Comas.

Sixteen hundred miles away from the maelstrom, investigators at the Centers for Disease Control in Atlanta are trying to get to the bottom of the mystery. In the past decade, there have been outbreaks of premature thelarche in the Middle East and Italy. In the Middle East, the condition was traced to milk from a cow that had been getting DES injections; in Italy it was linked to contaminated beef. But the cause is not always dietary, and symptoms often disappear within a year, whether or not diet is altered. "The list of conditions that can cause this is fairly lengthy," says CDC Epidemiologist Jose Cordero. In Poland, it was discovered in 1967 that parents working in birth-control pill factories were inadvertently exposing their children to estrogen powder clinging to their clothes. Elsewhere, insecticides, including DDT, have been associated with the disorder. So far, however, the CDC has failed to uncover any link between the outbreak and Puerto Rican birth-control pill factories, which produce 90% of the U.S. supply. Investigation of meat and milk samples and other possible culprits continues. In the meantime, the CDC has issued no specific warnings. Says Cordero: "We cannot give any recommendations to parents until we know the exact cause of the outbreak, and that is why we are working hard on it." .

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