The NIH's "Mad as a Hatter?" Campaign - Protecting People and the Environment from Mercury

bridges vol. 15, Sept 2007 / Feature Article

by Edward H. Rau *

In the mid-1990s the National Institutes of Health (NIH) began a voluntary initiative to eliminate the use of mercury in medical applications at its research hospital, the Warren G. Magnuson Clinical Center. The intentions of the initiative were to prevent human exposures and spills, reduce facility decontamination costs, and contribute to state, regional, and national pollution prevention goals for persistent, bioaccumulative, and toxic chemicals.

The initiative was expanded in 2001 into a more organized, agency-wide campaign covering the approximately 5,000 laboratories and other non-clinical areas of NIH installations across the US. The campaign used the "Mad Hatter" character from Lewis Carroll's 1865 classic, Alice's Adventures in Wonderland, in designing publicity materials to stimulate employee interest, improve awareness of mercury hazards, and encourage participation in campaign activities.

The high level of public interest in the campaign and the high use of its Web site, brochures, and information materials by other government agencies, schools, and individuals came as quite a surprise. The evolution of an internal, laboratory-focused chemical health and safety initiative into a program with broad public health impact was probably unprecedented, and the methods used by the campaign could represent a best-practice model for similar national and international public health efforts.

"Why is a raven like a writing-desk?"

"Twinkle, twinkle, little bat..." - the Mad Hatter from Alice in Wonderland"

Confused speech - as demonstrated by the Mad Hatter in Alice in Wonderland - is just one serious symptom of exposure to mercury. Mercury is probably the most ubiquitous and potentially problematic contaminant in biomedical research facilities and waste streams generated by laboratories. It is used in a wide variety of items - thermometers, thermostats, switches, fluorescent lighting, vaccines, and other biologicals, and occurs in environmentally significant concentrations as a contaminant in many chemicals ranging from janitorial products to analytical reagents. Mercury presents serious potential indoor health hazards to employees, patients, and laboratory animals. Its persistent, toxic, and highly bioaccumultative properties have adverse affects both on wildlife and human health.

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The Mad Hatter - a medical case study
The felt hats that were popular in the 1800s were made of beaver fur and later of wool. Formulations of chemicals used to make the felt stiff and shiny included mercurous nitrate. Prolonged exposure to mercury vapors led to neurological damage and a constellation of symptoms including uncontrollable tremors - the "hatter's shakes" - visual disturbances, and confused speech, hallucinations, and psychoses.

An additional motivation for eliminating unnecessary use of mercury in institutional settings is the high cost of cleaning up spills. Very small volumes of spilled mercury have the potential to contaminate large areas to levels that exceed health and environmental standards; unfortunately, the disposal options for contaminated debris remain limited and costly.

The voluntary initiative to eliminate the use of mercury in medical applications at the NIH Clinical Center and the Ambulatory Care Research Facility (see NIH info box) first focused on reducing human exposure, preventing spills and facility contamination, and reducing clean-up costs.

The "Hatter's Pledge"

The Mad Hatter and his exploits were selected as the theme of the initiative. A key promotional item of the campaign was the "Hatter's Pledge" - a symbolic commitment by individuals to the campaign for a mercury-free NIH, made through its website .

The campaign was an overwhelming success: In the first year, approximately 2,500 pledges were received from employees.

Soon, other public and private organizations adopted the pledging feature for their programs. Since the kick-off event in April 2001, numerous presentations, displays, and poster sessions on the campaign have appeared at research festivals and professional conferences. The campaign Web site alone receives more than 1000 visits per month.

Although community outreach was not even considered initially as a major component of the campaign, the significant public interest quickly became evident - partly attributable to several major mercury spills that occurred at schools near NIH, raising awareness of mercury hazards.

Mad as a HATTER? – The campaign logo is an adaptation of the original black line drawing of the Mad Tea Party scene appearing in Alice in Wonderland.


Soon, the requests for promotional materials with the highly popular Mad Hatter logos far exceeded the available supply. Working with other organizations such as local governments and schools, a number of successful displays, educational booths, and thermometer exchanges were held in the vicinity of NIH installations.

Throughout all NIH facilities, nearly 10,000 mercury thermometers have been replaced so far. Numerous manometers, industrial switches, and other mercury devices have also been replaced.

Mad Hatters Wear Blue Hats

The mad hatter's plight has been used in several publications of the United Nations Environmental Programme (UNEP) as example of the health impacts of mercury exposure. And when member nations of the UNEP were invited to submit tools for increasing awareness and promotion of mercury free technologies to a clearinghouse established by UNEP Mercury Programme the submission for the U.S. made by the EPA included a presentation on the NIH Mad Hatter Campaign (available on the UNEP website).

Mercury in laboratory demolition and NIH's NPEP Goals

NIH - National Institutes of Health
The National Institutes of Health (NIH), an operating division of the US Department of Health and Human Services (DHHS), is the primary federal agency for conducting and supporting biomedical research. Its main campus, located in Bethesda, Maryland, is the largest biomedical facility in the world, consisting of over 5,000 laboratories and the Clinical Center, the nation's largest hospital devoted entirely to clinical research. The "bench-to-bedside" approach adopted in 1953, locates patient care units in close proximity to cutting-edge laboratories doing related research. The Mark O. Hatfield Clinical Research Center was opened in 2005. The facility connects to the original Warren Grant Magnuson Clinical Center to form the NIH Clinical Center. They serve the dual role of providing humane and healing patient care and the environment clinical researchers need to advance clinical science. The 870,000 square foot Hatfield building has 242 inpatient beds and 90 day-hospital stations.


Like many other biomedical research and educational facilities, the NIH campus has a large inventory of aging clinical and laboratory buildings. Most of the buildings designated for renovation or demolition have housed a large variety of chemicals, radioactive materials, and biohazardous agents used for research that create a potential for contamination. In addition, hazardous substances such as mercury, asbestos, lead, and polychlorinated biphenyls were widely used in the infrastructure and equipment of older facilities.

New mandates for increased recycling of construction and demolition debris also require improved methods to quickly identify, remove, and separate hazardous wastes from other debris. Those goals and requirements for increased recycling are outlined in recent sustainability initiatives and rating systems for federal facilities such as the Guiding Principles for Federal Leadership in High Performance and Sustainable Buildings set forth in the Federal Leadership in High Performance and Sustainable Buildings Memorandum of Understanding (2006). Many of those principles have also found their way into widely used facility sustainability certification systems such as the US Green Building Council's Leadership in Energy and Environmental Design (LEED) Green Building Rating SystemTM and the Green Building Initiative's Green GlobesTM rating systems.
At the NIH, which is also enrolled in the National Partnership for Environmental Priorities (NPEP), the first "real-life" full-scale pilot project for improved sustainability of laboratory facility decommissioning was "Building 3." This four-story lab building from 1938, located on the main NIH campus, was selected for studying the occurrence of hazardous substances.

Sampling and analysis results identified mercury as the most common hazardous substance in the building, present both as an intrinsic material (in construction components such as fluorescent lighting, switches, etc.) and as a contaminant.

The lessons learned from the Building 3 pilot study have been applied to much larger projects like the demolition of lab building 36. Improved mercury assessment methods, selective demolition and hazardous debris minimization techniques allowed virtually 100% of the building mass (about 5800 tons) to be recycled as nonhazardous material.

In 2007, Kenny Floyd, director of the Division of Environmental Protection, accepted an achievement award by the Environmental Protection Agency (EPA) on behalf of the NIH for its commitment to recycling, reducing mercury and remediating hazardous substances prior to demolition (see NIH record).

A major finding of the Building 3 project and of the subsequent demolition projects is that costs associated with mercury's remediation often exceed those for asbestos, lead, and all other contaminants combined.

So, just in case the goals of improved human health and environmental protection don't provide adequate incentives for reducing and prohibiting all unnecessary uses of mercury, avoiding these high costs might tip the balance. Hopefully, with all the innovative measures deployed by the NIH to reduce mercury use and contamination, the Mad Hatter can soon be sent back to Wonderland where he belongs.

For further information: A listing of alternatives for all major uses of mercury in biomedical facilities is available on the NIH Environmental Management System (NEMS) Web site at



*This contribution, by Edward Rau, was made with the assistance of Charles Blumberg , architect in the Division of Environmental Protection (DEP) at NIH, and the Director of DEP William K. Floyd.