Body Burden: The Pollution in Us -- A Conversation on Biomonitoring
4:00 pm US Eastern Time
1. Introduction: Eleni Sotos, MA, National Coordinator, Collaborative on Health and the Environment
Welcome to the September CHE Partnership Call, Body Burden: The Pollution in Us—A Conversation on Biomonitoring. Our first speaker is Howard Frumkin, MD, Dr.P.H., Director of the National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry at the U.S. Centers for Disease Control and Prevention. Dr. Frumkin is Chair of the Department of Environmental and Occupational Health, at the Rollins School of Public Health at Emory University, as well as Professor of Medicine at Emory Medical School. He’s an internist and environmental and occupational medicine specialist and epidemiologist. Dr. Frumkin founded and directed the Environmental and Occupational Medicine Consultation Clinic at Emory from 1991 to 2000.
Our next speaker is Dr. Richard Jackson, MD, MPH, former State Public Health Officer for the California Department of Health Services, where he was responsible for direct leadership and oversight of public health-related activities. Previously, Dr. Jackson served as Director, and then Senior Advisor to the Centers for Disease Control and Prevention’s National Center for Environmental Health. Welcome, Dr. Jackson.
Next, we will hear from Dr. Asa Bradman, Associate Director of the Center for Children's Environmental Health Research, at the University of California, Berkeley. Prior to joining the center, Dr. Bradman served as a research scientist with the Environmental Health Investigation Branch, and the childhood lead-poisoning program of the California Department of Health Services.
We will also hear from Mr. Ken Cook, who is the Executive Director of Environmental Working Group, a Washington DC-based organization composed of scientists, engineers, policy experts, lawyers and others, who review government data, legal documents, scientific studies and their own lab tests, to bring to light and find solutions to health problems.
I welcome all of our speakers. I’d like to turn the call over to Michael Lerner.
2. Welcome: Michael Lerner, PhD, President, Commonweal
Thank you, Eleni. We are thrilled with the response to the call from the CHE Partners. We have 150 Partners are on the line. We have a wonderful group of speakers, here. We are very honored that Dr. Howard Frumkin is with us. He will have to leave the call in the middle of the call, because of his responsibilities related to Hurricane Katrina.
Our subject today is biomonitoring – the pollution in us. I think many of us know that biomonitoring, also called body burden studies, has brought out tremendous interest, both in the scientific community and among Americans, as we really learn for the first time about the hundreds of chemical contaminants that all of us carry in our bodies, and as the revolution in environmental health sciences tells us more and more about the possible implications.
The question is, “How do we work responsibly with this new information? How do we communicate about it? How do we talk about it? What happens when people know what is in them, as individuals? What happens as the country learns more and more about what is in all of us from population studies?"
I want to emphasize that Dr. Frumkin has wide latitude in his comments, and may address issues of how he will be working as Director of both the National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry. He may go beyond comments, specifically, on biomonitoring. We’re simply very delighted to have him on the call. Beyond that, the other speakers will focus specifically on the biomonitoring issue.
With that, I’d like to welcome Dr. Frumkin, and ask him to give us a sense over the next five minutes, of where he plans to take his agency, and what comments he has, if any, on the specific issue of biomonitoring. Dr. Frumkin.
3. First Speaker: Howard Frumkin, MD, DrPH, Director, National Center for Environmental Health, Agency for Toxic Substances and Disease Registry, U.S. Centers for Disease Control and Prevention
Thank you, Michael and thank you, Eleni. I want to begin by acknowledging the great work that CHE and Commonweal have done to advance environmental health. As Eleni said in introducing me, I’m brand new in my job here as Director of NCEH/ATSDR. I’ve been here for just over a week.
This is my very first public utterance in my new habitat. So I’m especially pleased to be doing it with all the CHE Partners who are on the call, today. As if CHE didn’t have a good enough record, CHE just hired Susan West Marmagas as one of its environmental health advocates. That’s a marker of CHE’s success and vision.
I also want to acknowledge the great work that’s been done in California, in support of biomonitoring – including the recent passage by the California legislature of Senate Bill 600. Let’s hope it gets signed. That will be a nice example of state leadership in advancing biomonitoring.
I’m especially glad to speak to you as director of NCEH, because I didn’t realize until Michael just said this, but I am given a longer leash than the other speakers on the call. I certainly don’t deserve it, but I’m glad to have it.
I’ll just make a few quick points in my five minutes. The first point is that biomonitoring is good. This is so obvious that it may not even bear saying. Good data on issues about which we care deeply are a good thing. As Phil Lee said in Commonweal's “Taking It All In,” report – any scientist can tell you that in order to do good research, you need good data. We shouldn’t be afraid of good data.
Biomonitoring is an especially good kind of data. If we’re concerned about environmental exposures, we are concerned about how much of something may be in the air or the water or the food. But ultimately, the level of most interest, in terms of impact on humans, is the level in human bodies. This is an especially important kind of data, and it’s a good thing to collect it.
Second point is that the science of biomonitoring is advancing very fast, on at least two fronts. One is that the analytical sensitivity of our instruments is higher than it’s ever been. The second is that we know how to detect more kinds of chemicals than we ever have in the past.
An indicator of this is that the number of chemicals that are examined in the exposure reports that CDC puts out every couple of years has risen dramatically, from 27 in the first report in 2001, to 116 to 148 in the most recent report released in July of this year. In the coming report, we’re expecting about 300 chemicals to be listed. So the amount of information that we have is vast. That is a reflection of the rapid advances in the field of biomonitoring.
The third point is a cautionary point. Data are not information. We create a lot of data through biomonitoring. In fact, we create so much data that the amount of data we have may outstrip our ability to explain them adequately. As a clinician, if I send you for an MRI and you come back to me for your results and I say, “Well, I have the MRI results, but I don’t really know what they mean…” That’s not liable to be very satisfying to you.
I think those of us in the environmental health community who are involved in generating these kinds of data for the public, need to anticipate that very same problem. We’ve really in some senses of it, gotten ahead of our ability to explain and interpret what we find, for the public. That will be an ongoing challenge for us, as we learn what chemical levels mean.
The next point is that the policy implications of biomonitoring are very complex and challenging and interesting. It’s been the case through the last few decades that a lot of our policy responses to hazardous exposures are based on documentation of the hazard. In some senses, our hands are tied until we can be sure that something’s dangerous. We don’t regulate it or limit it.
On the other hand, it might be that evidence of exposure should be enough to trigger policy responses. Those who pushed for the precautionary principle tell us that we don’t need to wait for evidence of harm before responding to an exposure. I think that biomonitoring takes us directly into a national conversation about what the policies are that govern how we handle chemical exposures.
The last point that I want to make, and this is taking Michael up on his kind invitation to think and talk a little more broadly. The subtitle of today’s call is, “The Pollution In Us.” That is a very appropriate title for a call about biomonitoring. But, “The Pollution In Us,” isn’t the whole story. I think that as we move forward in envisioning and creating safe, healthy environments for the American people, we need to remember that the pollution in us is only one of the problems.
The way we build our communities, the extent to which nature survives and we have contact with nature, the psycho-social environments that we offer our communities and our families, the food environment...there are many, many factors that comprise the environment. We need to be thinking about all of those, if we want to pursue a global vision of safe, healthy environments for the American people.
That’s not at all to minimize the importance of chemical exposures, or the importance of biomonitoring to learn more about them. But we need to put that in context, and remember that environmental health needs to advance on many different levels, simultaneously, including but not limited to the one we’re talking about, today.
Thank you very much for the opportunity to be here. I’m looking forward to hearing the other speakers.
Michael Lerner: Thank you very much, Dr. Frumkin. Now, Dr. Richard Jackson.
4. Second Speaker: Richard Jackson, MD, MPH, former State Public Health Officer for the California Department of Health Services
Well, it’s a pleasure to follow my successor. Howie, that was a wonderful summary. I spent about nine years at CDC and was shocked when I first arrived, to see the wonderful work that the folks in the Environmental Health Laboratory were doing.
We were generating huge and important work around Agent Orange and other toxins. It became very quickly clear, however, that the $7 million deficit they were running every year was unacceptable. It was going to have to be turned around.
I looked far and wide for the kind of support to make this happen. It came, in part, from Michael Lerner, Commonweal, Nancy Pelosi, the Rockefeller Family Fund, Barbara Levine and APHA. Many partners worked very, very hard to bring the funding, and to get that laboratory at the level it needed to be. Not the least of which was the NCEH Advisory Committee, which was then chaired by Tom Burke, who did a terrific job, and helped us think through, as things went forward.
In the beginning, the analytes that were being tested were generated by either who was paying for the test, or, to an extent, laboratory feasibility depending on the specimens they had and the panels they were running. It was important to then go forward, and proactively select what items in the body we’d look for.
That advisory committee was an important process. It was very challenging. Probably one of the biggest challenges I had was in early 2001. There was a brand new administration, and here was this large volume of data that was going to come out in the first biomonitoring report. We were challenged, “Aren’t you going to do this to scare people?”
Over and over again, we said, “No. This information is absolutely essential in decision-making.” The practicing clinician needs it. The epidemiologist needs it. We were dealing with retrospective events, whether it was a methyl parathion mist application in tens of thousands of homes in half a dozen states or other kinds of pesticide applications. Having the ability to test and say, “Yes, People were exposed,” or “no they weren’t exposed,” was hugely important.
The important thing about that report as it came out, was the data were really unimpeachable. They were extensively peer-reviewed and of extraordinarily high quality. Howie’s point about good data being important… I will say the corollary here is bad data is worse than no data at all. The peer-review process and the quality-control process are extremely important, going forward.
It was pretty challenging. There were half a dozen people on my childhood lead-poisoning committee that were replaced as well as the overall center’s advisory committee. New nominees were directly asked about whom they voted for, and their political affiliations, much to the concern of the scientists who were appointed.
This quickly sort of bubbled through the political process. But we worked very hard to just make sure it was about the science. Two years later, when the next report came out, we did our best to insure that the data was available to researchers – including Asa Bradman. Many of you who are on this call could and did go to the national databank that’s available within NCEH and do your own analysis.
There are many opportunities for partnership with researchers as they are doing specific studies. One example I was interested in was a pediatrician who asked, “Do children who are eating organic diets have lower pesticide body burdens than children who did not?” So there are many studies that have come out of this. I think the third national report, again, showed the value of this.
I was in multiple meetings when I was in Sacramento. On the one side, advocates were coming in. I was concerned because they were linking the biomonitoring data a bit too closely to a regulatory hammer to action process. There needed to be a scientific process between the data generation and regulator action to go forward. I think that’s been remedied in the latest version of the California bill.
I also heard from the opposite side, and I will say bluntly… I know I’ve got industry representatives on this call, but they were overstating the risks of telling people. Maybe this is my final takeaway, here. The public is much better off with real information than they are with no information. The public is much more capable of absorbing and interpreting this information than it is alleged they can handle. I find at times, some of these statements that, “Average people won’t understand this,” to be demeaning and paternalistic and inappropriate.
States absolutely need some of their own data. California has been on its own around tobacco issues, air toxics issues, lead-poisoning issues and many others. The State needs some State-specific data. One of my deep dreams while I was at CDC was to begin to put together State-level HANES-type activities. Hopefully, as we look into the future, that can happen.
I’ve probably talked long enough. Thank you very much for your attention.
Michael Lerner: Thank you, Dr. Jackson. Now, we hear from Dr. Asa Bradman. Dr. Bradman.
5. Third Speaker: Asa Bradman, PhD, Associate Director, Center for Children's Environmental Health, Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS), School of Public Health, University of California at Berkeley
Thank you for inviting me to participate today.
I’m going to provide an on-the-ground description of a project, where we’re using biomonitoring as a tool, to look at outcomes and exposure and risk assessments in a low-income Hispanic population in the Salinas Valley of California.
We’re part of – many of you have probably heard of this – the CHAMACOS Study – which is the Center for Health Assessment of Mothers and Children of Salinas – which also stands for “Small Child,” in Mexican Spanish. We’re a longitudinal birth-cohort study, looking at the relationship of environmental exposures in health outcomes in children.
We are not just focused on pesticides and chemical pollutants. We’re looking at halogens and endotoxins and other kinds of exposures. But certainly, one primary focus of what we’re doing is to look at pesticides, in particular—organophosphates, potential endocrine disruptors, organochlorines and also lead.
I’m going to focus primarily on our experience communicating our results to our participants in the communities we work with. I’m just going to give you a chronology, to kind of provide a case example.
Initially, we were not providing results to individuals. That, in part, had to do with the fact that we didn’t have results. It takes a couple of years to get results back. We didn’t have a process to communicate both with individuals and the community. We define “community” broadly – to include our participants, farm workers and other low-income residents of the county, county health and environmental agencies and also industry representatives.
The keys that we all discussed were, “How do we interpret the results?” The response of our community was interesting. The medical people we were working with were generally opposed to returning results. They were concerned it would scare people, and also that they would then create an extra burden on the healthcare providers – because they wouldn’t know how to interpret the results.
Generally, farm worker members of our advisory council and advocacy groups wanted the results back. Interestingly, the industry side that we worked with also felt that there was justification for returning individual results. Because it was seen as an individual rights issues. So there was an interesting mix of responses.
Through a number of long and involved discussions and dealing with our own institutional review board here at Berkeley, which initially was also opposed to returning individual results – we developed a process that involved offering individuals the opportunity to ask for their results. We provided some mechanism to interpret what they meant and with meeting with them individually.
One of the key events that allowed us to do this, and brought consensus in the group, was the publication of the initial NHANES exposure report from CDC in 2001. Because then at least we had some national reference data that we could compare results to – in addition to various local studies. I can’t overemphasize the importance of having that resource, and the ability to compare our results to that. We were also fortunate that most of our measurements were conducted in the same laboratory. So we were sure of the quality of our data, and the comparability of it, to the primary NHANES data.
As I mentioned, we offer each participant the opportunity to ask for results. We meet individually with them. Then we compare the results to reference data. This has been a positive experience for us. It is very time-consuming. One thing that we didn’t always budget for carefully was the staff resources needed to conduct such in-depth contact with participants. But it has worked out, and we’ve made time for it. No one who’s asked for results, and we’ve given results to, has been unduly frightened or scared or freaked out. That’s been a success, on that front, as well.
We’re lucky in some sense that we’re looking at serial measurements of exposure in our population. Usually, we don’t provide a single data point. We have it over time. Often, if there might be a high level at some point, at another point, there’s a low level, and participants can see their variability and that a single high measurement doesn’t mean they’re overexposed on a chronic basis.
We also return results to the community. I think that’s an important component of the discussions, in the process. We work with individuals at the community level. We have a community advisory board, and we make sure we consistently inform them. They include the whole spectrum of groups in Salinas – as I mentioned, farm workers, advocacy groups, industry, and health and environmental agencies.
We conduct forums with participants in the study. We also conduct forums with local community groups, churches, housing cooperatives and that sort of thing. Then we also plan to bring our findings to the State and other levels. Certainly, we publish in scientific journals.
We see this whole array of activities as part of communicating our results. The community response overall has been appreciative. There’s a certain frustration that things aren’t changing faster. And they would like to see action follow-up on the results.
So, in summary, I want to emphasize the earlier points about the importance of NHANES and CDC's national biomonitoring reports. Then, when we take our testing results back to the community, we do have to respect the intelligence of the people we’re working with – whatever their level of formal education.
Michael Lerner: Thank you very much, Dr. Bradman. Now, Mr. Ken Cook. Ken?
6. Fourth Speaker: Ken Cook, President and Founder, Environmental Working Group
Thank you, Michael. I very much appreciate this opportunity. It’s an honor to join the distinguished experts on this call. This is, indeed, a national conversation now, about the pollution in people, and it’s long overdue. I think it’s very important to many individuals and organizations that are exploring potential connections. I want to emphasize, “potential” connections – between chemicals and pollutants and arrays of health problems.
The fact that we are seeing some very significant increases in certain health problems that – once we account for better diagnosis, better testing, better monitoring, better classification of diseases – are still real; at a pace that can’t be explained by genetic change. It is natural and appropriate to look at ways in which our environment – and interacting with our environment – including pollutants in our environment – might be aggravating or perhaps in some instances might be causing diseases.
I want to talk about three things very quickly, in the interest of furthering this national conversation. I want to talk about why it’s important to do these kinds of studies. Two – a little bit about the most-recent study we conducted with Commonweal on cord blood. Then finally, to just pinpoint a place to focus this national conversation, now – which is legislation that was introduced earlier this summer in the Senate of the United States.
Why do we do these studies? At the Environmental Working Group, one reason we do them is because we think this dialogue is very important. We think it’s very powerful to explain to people not the abstract characteristics of toxic chemicals alone, but also to talk about them in a very personal way, in the context of human exposure.
When people understand that they have been exposed to an array of toxic chemicals that they often times aren’t aware of, we rarely find people assuming that their exposure automatically might explain some aspect of their health status. But it is a very productive conversation for people to know that it’s okay to talk about that. There’s a very sound scientific reason for exploring the potential links.
So whether it is looking back over the history of public health in this dimension – whether you’re looking at the history of uncovering Minamata disease with the exposure to mercury, or what we’ve learned about childhood lead poisoning, exposure to tobacco smoke, or more recently, what we’ve learned about exposure to chemicals that were used to make Scotch-Guard and are used to make Teflon now. These chemicals now are found in all of us.
There are lively scientific debates, and in some cases, settled scientific consensus that environmental exposures did cause health problems. This is a very relevant area for those of us who are looking at those potential links.
Secondly, our most-recent study with Commonweal – we looked at over 400 chemicals in a sample of 10 cord blood specimens that we received through the research program at the Red Cross. These were samples that we only know the rough date of birth. Otherwise, we have no idea who these babies are and where they were born.
This is the first time that 261 of the 400 or so chemicals we looked at had even been studied in infants. It was the first time 209 of these various chemicals had been reported in people. We found 200, on average, across the 10 samples, 287 across all 10, collectively. In many instances, these are chemicals that are under intense regulatory scrutiny, right now. The fact that babies are exposed to them and have these contamination levels before they even emerge from the womb is a very important consideration, we feel – knowing that there’s enhanced scientific controversy, but also intense scientific concern about early childhood exposures.
That takes me to Point three – which is the bill that was introduced this summer. Just to give you a sense of how important this debate, I think, is going to become. This is the first legislation in 30 years that would look to reform the Toxic Substances Control Act.
I’ll be very brief on the one aspect that relates to biomonitoring, which is the criteria for identifying the chemical substances in this proposed legislation, introduced by Senators Lautenberg, Jeffords, Clinton, Kerry and others. The first criterion that they looked at for identifying and prioritizing chemical substances for study – and many of them are not studied at all, under current law – is if it is found in human blood, fluids or tissue. That is where they said we should look, first.
Secondly, there’s a focus – once this chemical is found in humans – a very serious change… we think an improvement in safety standards… modeled after the landmark Food Quality Protection Act, the pesticide policy reform in 1996. To look and see, through various means, whether the exposures that we find of these chemicals – when we do find them in people – are safe. Can we say that there’s a reasonable certainty that no harm will be caused by these chemicals individually and in aggregate, through the exposure to a fetus, infant, child, worker or any other sensitive group?
This, I think, is an important new focus for this national conversation – as Dr. Frumkin said. Which is exactly what we’re trying to encourage, now.
Michael Lerner: Thank you very much, Ken. I’d like to ask three CHE Partners to begin the comments, if they’re on the call. Clif Curtis of World Wildlife Fund, Pam Miller of Alaska Community Action on Toxics, and Sharyle Patton of Commonweal, we would just welcome very brief comments from each or any of the three of you, in any order that you choose.
Clifton Curtis, Director, Global Toxics Program, World Wildlife Fund: I apologize, I was in a meeting at the office, and only got back for a few minutes of the presentation – which I really wanted to hear. I will just be really brief in saying that for WWF, we’ve found biomonitoring to be a tremendous tool to help us advance a strong new chemical reform policy. It’s worked, in terms of individuals that we’ve tested, politicians and key decision-makers. Right now, we’re in the final stages of preparing three-generational family testing results that we tested back in June. It’s been three weeks in Brussels, and is generating a good amount of press. It really helps us to say how important it is to have better information about the fates and effects of chemicals. It’s just so powerfully linked to a core point in the EU chemicals bill, and we’re trying to make sure that they do that in an effective way. Beyond that, I look forward to hearing what others have to say in the remainder of this call.
Michael Lerner: Pam Miller, can you comment from Alaska on your work with Native American communities?
Pamela K. Miller, Director, Alaska Community Action on Toxics (ACAT): My pleasure. Thank you. We’ve been engaged in a study for about four years with the Yup'ik people of St. Lawrence Island in the Northern Bering Sea. They are very concerned about impacts from military contamination – also long-range transport of persistent pollutants into the northern arctic environment. We’ve been working with scientists with the State University of New York, Dr. David Carpenter and others, to try to determine how these sources of contamination might be affecting people, and did body-burden testing.
Just briefly, some of the results were that we were able to do congener specific analysis of PCBs and testing for other pesticides. We found that there was a discernable impact from the military activities because we were able to distinguish the long-range transport sources, compared with the local military contamination sources. Some levels – generally, seven to nine times higher in the bodies of the Yup'ik people of St. Lawrence Island – than you would find in the general population of the lower 48.
I think doing the congener specific analysis was very important, because we were able to show these data both to State and federal agencies, as well as the military – to say that, in fact, there was a discernable contribution from the military contamination left by the military there. In presenting the results back to the community, we met individually with people, as well as holding community meetings. That was very important. I think rather than the people being upset necessarily by the results, the people felt that they had confirmation of what they had already known to be happening to them. In fact, one elder literally cried with relief – and felt that that information was so important to their struggle. It was, in fact, very beneficial just to know that information. So it was an important right to know.
Sharyle Patton, Director, Biomonitoring Resource Center at Commonweal, Director of Special Projects, Collaborative on Health and the Environment: Just briefly, I wanted to talk about California SB600 bill. It will be the first bill that will mandate Statewide, community-based biomonitoring. That means demographic or geographical communities within California will be able to have input into the design and implementation of biomonitoring studies, should this bill pass. This means that before more comprehensive safety studies are done – which can take decades to determine whether or not chemicals are safe – and before legislative regulation on chemical policy reform happens – individuals within communities will be—according to the mandates of the bill – told their individual results and receive counseling.
We know that that is complex and very complicated, and people will be learning to deal with that complexity and uncertainty. But nevertheless, it will provide them with the information to make personal choices. They may choose to shop differently. It may encourage them to become politically active. It may encourage them to push for more research and to support the biomonitoring work in California, to establish a California HANES, which would be enormously useful.
I think we’re seeing all the rewards of different kinds of community biomonitoring around the country, and in Europe. We’re providing models of what might happen in California. Now the bill is on its way to the Governor’s desk. The bill has been removed from the Chamber of Commerce's "job killer" list and the Chamber has changed their position from "oppose" to "neutral." CDC has promised $1.5 to 2 million support for the bill, to help us get jumpstarted. So we just very much hope that the Governor will do the right thing and support the bill.
Michael Lerner: Thank you. I just want to underscore the tremendous leadership of the Breast Cancer Fund, in moving the bill through the legislature. This showed really wonderful leadership from one of the founding CHE Partners.
Sandra Miller Ross, PhD, Health and Habitat: I’m wondering if there are any chemicals that show up enough to become a candidate for litigation.
Ken Cook: There’s a great deal of biomonitoring work that relates to litigation. In most cases, just the presence of a chemical is not adequate, unless harm can be shown, to pursue litigation for damage to human health. If it’s damage to resources, the standard is lower, legally. The best example of where litigation has come into play is where you have a toxin that has been extremely well studied, and in some cases but not all, banned or at least really restricted. There have nonetheless been exposures to individuals that have gone to court.
Two good examples of that are lead, where people have taken landowners or paint companies to court for failing to protect them. And of course there’s asbestos, where there’s no dispute really about the potential of this material to cause mesothelioma or asbestosis and in some cases, there’s strong evidence of cases for lung cancer.
Primarily, these are pieces of a litigation story. I think a lot of companies worry about that, but except in the case of resource damages very rarely is there adequate information to make a case, unless it’s a chemical that’s well studied, and we know there’s harm.
Question: What about bisphenol A?
Ken Cook: I’m not a lawyer. But I don’t think that right now, there are many cases in the works. At least that I know of – where people feel that the evidence is strong enough that just the presence of bisphenol A in someone’s body would be adequate, anyway, to pursue litigation.
Richard Jackson: I just want to jump in. I feel it’s very important when government is deciding how to spend the nation’s and state’s resources on what chemicals to study, that those decisions be made by scientists – health professionals – and, for that matter, the community. But it’s also important that the issues of litigation be kept off the table, because if you start involving all of that, it becomes an impossible set of choices.
Sandra Steingraber, PhD, Distinguished Visiting Scholar, Ithaca College, Division of Interdisciplinary Studies, Program on Breast Cancer and Environmental Risk Factors: I am just now making my way through the 53-page PDF file from Greenpeace in Europe, which reports on body burden monitoring. I think it’s called, “A Present for Life.” They looked at, I think, 27 umbilical cord blood samples, as well as 42 maternal blood samples. So, Ken – I would look forward to an analysis comparing the kind of range and mean concentrations of what’s in European babies, to what you all found.
Then, my question to Ken, Sharyle and others, would be… Is it your experience that when the public hears about pollution in people, that their reaction is really a function of the media in which we’re reporting it? For example, what’s the difference when the public hears about contaminants in breast milk versus umbilical cord blood? Versus the number of pesticides in the urine of Seattle school children? Versus blood samples drawn from adults? Is that a consideration that we need to be thinking about in our advocacy work?
Ken Cook: We are planning to do that. There are a lot of chemicals that are not in common. I can say that for certain. But we’re researching it now and I would recommend it to everyone. It’s very good work.
On the second question, we don’t have enough experience, I think, yet to know how the various biospecimens tested impact people. We certainly felt that during this cord blood study, together with Commonweal, which was by far the most ambitious that had been undertaken to date. Not just from a scientific standpoint – but doing the initial survey work as well. Secondly, we did feel that it would help people focus on the fact that we’re all in this together. Even in the womb. We are all connected to our environment. Even from the very beginning of life. You are exposed to these chemicals. We have not studied them very well.
We thought that this was an important question – a good point to make to people. Many people in the medical profession felt, not too long ago, that babies were protected in the womb by the placenta and that a lot of the chemicals were being blocked. They were being shielded from harm that might be associated with them. We wanted to find and break open that discussion
Sharyle Patton: It’s very hard to control the headlines. The media tends to go for the flashiest headlines and say, “Breast Milk is Contaminated.” Even though the NGOs who work in these areas are very careful to say breast milk remains the best food for babies. It’s hard to always get that message across. It’s curious how the media always wants to go for the highest level. They just try to scare people about it, when mostly the message is to say, “Isn’t it interesting that we’re finding in peoples’ bodies not necessarily extremely high levels of this or that, but we’re finding a wide range of chemicals. That’s really interesting.”
We know that low-level amounts of chemicals can be harmful. We know there are special vulnerabilities. Don’t we want to think about what all these factors mean? And how long do we want to consider taking chances, considering we do know that some of these chemicals essentially dehumanize us. These are very serious games that we’re playing with ourselves, by allowing these chemical exposures.
So whether the urgency of that message warrants putting out information about breast milk, which will – in fact – be read, possibly, by the 16-year old Latina woman who is reticent to breastfeed in any case, that has no community support. It’s a debatable question. I think NGOs are starting to look at other biospecimens to monitor, in terms of advocacy work, because engaging in that conversation has often led to a lot of contention, rather than bringing together movements between environmental groups and activists.
Clif Curtis: I think similar to what Ken and Sharyle have said – we’ve done no focus groups to try to get at what type of biomonitoring grabs people the most. But the family testing we did in the UK – through WWF-UK –went off the charts, compared to earlier testing. The testing of the Minister of the Environment, celebrities and well-known officials grabbed people there too. That was why we took that same idea and chose three-generational families from 12 EU countries, that are the basis for the results we’ll release in a couple of weeks.
There, too, in the run up to the release date, in a few weeks, the press on that has been far more than it was in the earlier rounds. I don’t think it’s just the building, from one to the next, I think it’s the inter-generational aspect of it; the same with the cord blood, which we co-funded with Greenpeace. We’ve been really watching the press widely, and it’s covered in all 25 EU states, much more than any of the earlier biomonitoring that’s been done in the context of REACH.
Jackie Hunt Christensen, Minnesota State Coordinator, Parkinson’s Action Network: Have any of you had experience or problems with HIPAA or privacy issues in your biomonitoring? And is there value in trying to link establishing disease registries with biomonitoring? And vice versa.
Asa Bradman: Our study is with enrolled participants through community health clinics – and we worked closely with the local county hospital. So far, HIPAA really has not been an obstacle for us. It’s created another level of bureaucracy – we have to have additional forms. We work very closely with the hospital staff and medical records people to make sure that confidentiality is preserved. But by following the rules, we’ve been able to access medical records. We’ve been able to recruit people through the medical facilities. Although it has involved some extra steps, we’ve been able to get through those hoops.
Richard Jackson: Two thoughts come quickly to mind. One is, I know that NCEHS was looking at how they could go back and look at the year 1990 cohort of NHANES or samples – and see what’s happened to them – their overall health. That study is much bigger than just the biomonitoring part. Then, it would be very interesting to see if levels had dropped or changed in that population. Secondly, there had been a whole series of what could be new cohorts that have been identified. For example, the first responders at Ground Zero with large-scale monitoring of the firefighters that were there. I believe that they are being followed, over time.
Clif Curtis: There is a different aspect of this, which has to do with biomonitoring refugees. In Norway, an anti-biomonitoring scientist filed a complaint with the health agency, saying that the WWF was violating medical ethics by doing the testing without meeting certain research protocol requirements. They had to run that up the side pole in the government. We took the person out of Norway, and they were tested in Denmark. The guy went to Sweden and did the same. That family that we tested there, we brought to Brussels, to test. In the end, both countries said this is not medical research. It doesn’t rise to the level of requiring that type of oversight and review-and-approval. But it caused us some real problems for a while, there, of how to handle it.
Laura Fletcher, MD: What role do you foresee the individual medical practitioners playing in the future? How do we create a bridge between this collection of public health data and physicians evaluating and treating individual patients?
Richard Jackson: It’s been very difficult in the past for the clinician to really give people advice. Over and over again, I remember folks who would have their homes treated with pesticides, or who were on a high fish diet or other kinds of things. It’s the availability of knowing what the benchmarks are. What’s the 50th percentile and am I in the 95th or 98th percentile? That’s an important piece of information – to the patient and for the doctor.
At times, we might not be able to say much more than, “You’re really high, you might want to change your diet or your work practices or something else." But we really don’t have the data yet to interpret this. It’s biomonitoring that will actually give us or enable us to do the studies in larger populations. Not just a single individual. Where we can say, “Well, it looks like there’s a cause-and-effect here, between the levels we’re measuring and the symptoms that are being reported in this population.”
The one thing I’ve been surprised by is, as I’m always surprised – what we predict we’re going to find. When you actually go out there and collect real data, you find that the models you go into it with don’t always hold up and you’re surprised in both directions.
I’m just going to put in another quick point, because I think it’s a subsequent discussion for this group. That is, we need to think deeply about the use of nanotechnology. Many of the agents that are being used are not biodegradable. If we get any lesson out of the biomonitoring, it is that molecules that endure – that stay around for a long time – often end up being problems.
Michael Lerner: I think we absolutely should explore that.
Asa Bradman: Just to respond a little bit to the last question. The issue you raised is one of the main concerns of the primary care providers that we work with in Salinas. There was definitely a fear about getting questions to doctors, and them not being able to answer the questions. I think that is an important issue. There are efforts to develop pediatric, environmental treatment protocols. Dick Jackson has actually been involved in that for years, starting in California. That kind of training is important for physicians to be able to understand what information is out there, and how to translate it.
I think a good example is lead. Where there were exposure studies – biomonitoring studies – done years ago. A cause-and-effect relationship was established. Then public health-based benchmarks were established for exposure-and-response. Right now, for other kinds of exposures that might be similar in the magnitude of effect, there are no benchmarks. But we need to work toward understanding those exposures, and what they mean, and establishing those benchmarks, so there’s a clear protocol for people to respond to.
Michael Lerner: I just want to make one comment, myself, as one of the people that Environmental Working Group monitored in the first citizen Body Burden study that they did. Just for example, I had very high mercury and arsenic levels – and 2.5 years ago, I had a heart attack. Well, mercury is a cardiovascular risk factor. I have no idea whether the mercury contributed to that heart attack, but it was an interesting exploration for me. As Dick Jackson suggested, I shifted my diet away from fish with a lot of mercury in it, in the wake of learning that. Similarly, I have benign essential tremor. Well, both arsenic and mercury are related to tremor. Now, do they contribute to my benign essential tremor, which is familial and has a strong genetic aspect? I don’t know. But again, it was that process of dialogue that we’d been talking about.
So, my experience is that, in addition to the care with which clinicians are looking at these issues, people tested themselves enter into a process of inquiry and exploration, which – as Ken Cook and others have suggested – is quite constructive. Most of the people that I know that have been tested have been able to hold the information, not knowing what the relationships are. But as Ken said, the potential relationships deepen the dialogue that we have among ourselves, and also with regard to our own health.
We are right at the top of the hour. I thank our speakers and all those who spoke, for a wonderful conversation about biomonitoring.
Finally, I’m happy to announce and welcome Susan West Marmagas as the Director of Health Programs for the Collaborative on Health and the Environment. Susan comes from a distinguished career at Physicians for Social Responsibility and elsewhere, and, as Howard Frumkin said, is one of the most-widely respected environmental public health leaders in our community. Susan, would you like to say a word or two?
Susan West Marmagas, MPH, Director, Environment and Health Program, Physicians for Social Responsibility: Thank you very much. It’s quite an honor to join CHE and all of you. Many of you I’ve worked with in my role here at PSR and elsewhere, as Michael said. I’m very excited to join CHE. I think that the last three years of growth that CHE has had really positions it with all of us to do so much more important work in the environmental health community. I’m quite honored to be taking on this new role. I’ll continue to work with all of you, I think, in that role. I’m really excited about it. Thank you very much, both Michael and Eleni.
Michael Lerner: October 12th is the next CHE Partner Call on Hurricane Katrina. We will be sending details about that shortly.