重金屬管制政策之研究—牙醫汞齊使用個案探討

Abstract

美國食品藥物管理局2008年六月初提出正式警告，認為牙醫使用之汞齊將導致懷孕、哺乳中的婦女、六歲以下的兒童、免疫力不全的民眾身體產生病變，蛀牙時最好避免使用汞齊補牙，FDA也將在 2009年七月討論是否禁用汞齊。在此之前，北歐國家挪威、瑞典已相繼在今年立法通過，禁止製造、輸入、販賣與使用汞齊合金。本文以牙醫使用汞齊補綴病患牙齒所可能造成的環境汙染為研究個案，希望能瞭解長期以來汞齊所存在的爭議？政府為何需要且如何制定管制政策？以及在制定合宜管制政策的過程中，需要考慮哪些影響因素？本文採用深度訪談、文獻分析與參與觀察等方式，藉由政策管制理論和市場機制為分析架構，以擬定管制政策的最適方案。並利用專家學者、利害團體、政府官員與牙醫師的意見，瞭解管制機構本身的運作能力、被管制者的態度意向和政策環境的其它干擾因素。研究發現，汞齊管制政策的制訂有賴管制理論與市場機制的互補，而政府已具備管制的經驗與能力，唯管制的共識與危機意識仍需要政府與業者的持續教育與養成。在汞齊長期處於爭議的情況下，步驟性的管制汞齊將可避免嚴重的社會衝擊，師法先進國家的管制政策並因地制宜可為政策制定的第一步，最重要的仍是政府必須具有政策創新與整合的魄力和決心。而針對台灣現存牙醫診所與環境汙染的問題，相關的改善方案與配套措施，以及政策制定前的前導計劃，也值得政府後續的重視與研究。

According to the warning from the U.S. Food and Drug Administration (FDA) in June 2008, the amalgam (mercury containing) filling used in dentistry may pose risk to pregnant, breast feeding women, children under 6 years old, and those persons who have suppressed immunity. FDA will be holding a discussion forum to determine whether to ban amalgams in July, 2009. By this time, amalgams have been prohibited to be produced, imported, exported, sold and used in Norway and Sweden.\r\n\r\nThe current study is aimed to assess the environmental hazard posed by dental amalgams. In addition, the study aims to understand why there is a long dispute with regard to amalgam safety issue. This research wishes to find grounds for the government to establish regulative policies, and identify what factors should be taken into account in establishing regulative policies. The study is based on in-depth interviews, literature review and participant observation by using the regulative theory and market-based theory as framework to develop a sound regulative policy proposal. \r\n\r\nThis research discovered the development of a regulative policy on amalgams is hinged on the combination or balance between the regulative theory and the market-based theory. Most important thing is that the government and the dentists need to provide continuous public education to build up the consensus for implementing amalgam regulative policies and become aware of the potential environmental crisis. In the due course, adopting step-wise regulative process may avoid unforeseen severe social impact. The government should also take reference of the existing policies of western countries, pay more attention to the current environmental pollution posed by dental practice, and provide improvement plans and supplementary measures to establish the relevant policies.