Environmental Health Science: Setting the State of the Art

July 19, 2005
4:00 pm US Eastern Time

Listen to Recording

Call Transcript

1. Introduction: Eleni Sotos, MA, National Coordinator, Collaborative on Health and the Environment

My name is Eleni Sotos. I’m the national coordinator of the Collaborative on Health and The Environment. The moderator for this call will be Michael Lerner, president of Commonweal, and Co-Founder of CHE.

I am very pleased to introduce today’s guest speakers. We are honored to welcome Dr. David Schwartz -- the new director of the National Institute of Environmental Health Sciences. Dr. Schwartz oversees a $711 million budget at NIEHS that funds multidisciplinary biomedical research programs, prevention and intervention efforts that encompass training, education, technology transfer and community outreach.

Previously, Dr. Schwartz was the director of the pulmonary allergy and critical care division, and vice-chair of research in the Department of Medicine at Duke University. At Duke, Dr. Schwartz played a principle role in developing three interdisciplinary centers in the environmental health sciences, environmental genomics and environmental asthma.

Our next speaker is Dr. Lynn Goldman. Dr. Goldman, a pediatrician and epidemiologist, is a professor in the Department of Environmental Health Sciences, at the Johns Hopkins University Bloomberg School of Public Health, where her areas of focus are environmental health policy, public health practice and children and environmental health. From 1993 through 1998, Dr. Goldman served as assistant administrator for the U.S. Environmental Protection Agency Office of Prevention, pesticides and toxic substances.

Next, we will hopefully hear from Dr. Richard Jackson -- former State Public Health Officer for the California Department of Health Services. 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 Center for Disease Control and Prevention of the National Center for Environmental Health.

We will also hear from Dr. Shelley Hearne, the Executive Director of Trust for America's Health, and a visiting scholar at the Johns Hopkins University School of Public Health. In the past, Dr. Hearne served as the executive director of the Pew Environmental Health Commission, and director of the New Jersey Department of Environmental Protection’s Office of Pollution Prevention.

Finally, we’ll be hearing from Ms. Pamela Miller, Executive Director of Alaska’s Community Action on Toxics, which she founded in 1997. Previously, Ms. Miller served as a research biologist for Greenpeace, addressing toxics, problems from oil development in mining and military contamination. In the 1990s, she started the Community Toxics Investigative and Advocacy Project for Greenpeace, and also founded the Cook Inlet Keeper.

Welcome to all of our speakers. I would like to ask the operator to please put everyone on listen-only mode, other than the speakers. And I’d like to turn the call over to Michael Lerner. Thank you.

2. Moderator: Michael Lerner, PhD, President, Commonweal

Thank you, Eleni. Welcome to all of our speakers and to all of the CHE partners. We have a wonderful community of CHE Partners across the country, participating today. So as Eleni indicated, our first speaker -- Dr. David Schwartz -- we’re very delighted and honored to have you on the line.

3. First Speaker: David A. Schwartz, MD, Director, National Institute of Environmental Health Sciences (NIEHS) and National Toxicology Program (NTP)

Hi. This is David Schwartz. It’s a pleasure to be here. I’ll try to be rather brief, since I’m sure that will generate a lot of discussion and questions. As some of you know, I started directing this institute just a couple of months ago. I’m just beginning to understand how complex this institute is. Also, what the opportunities are in environmental health science. So what I’d like to talk with you about is just a few of the opportunities that I see in front of us, and then the plan that we’re putting in place to try to take the next steps in environmental health sciences, through the Institute.

As a physician-scientist, I’ve been mainly interested in applying knowledge of environmental health sciences to understanding human disease -- and also understanding how one maintains human health. Really, that’s what the focus of the institute is going to be: to use environmental sciences as a way of understanding how human biology is altered, and how that modification in human biology results in the development of disease in some individuals, and the preservation of health.

We’re going to be focusing on four different areas of development over the next five-year period of time. We’re going to be focusing on basic sciences. Primarily, we’d like to understand how biology fundamentally altered by environmental exposures.

Second, we’re going to be focused on our various aspects of human health and disease in a much more integrated way, so that we understand how the environmental sciences are affecting individuals’ risks of developing disease. And also, how we can use environmental sciences to understand how diseases change over time. In other words, the goal will be to bring environmental sciences to the patient’s bedside -- which is something that hasn’t really been done before.

The third area of development is going to be in global environmental health -- where we’ll be identifying populations that are exposed to extraordinarily high concentrations of toxins around the world. We’re not only trying to study that problem, but also trying to understand that problem -- so that we can prevent disease in individuals that are at risk of developing disease, as the result of extraordinary environmental exposures. We’re in the process of developing partnerships to begin to approach these problems, globally.

The fourth area of development -- as you might imagine -- is in the area of training. We need to develop a much more integrated approach to training, where individuals are trained beyond toxicology, and focused on areas of environmental health science, where they’re combining their training in areas of basic science and also clinical science -- both basic science and public health -- as a way of preparing them to work in integrated teams of scientists that are attacking bigger problems.

We’re also going to focus on some areas of transition. Areas where trainees often get lost, in moving from gradually training to more-independent forms of research, or even moving from college to graduate school. We think that if we develop a much more integrated program, paying attention to these points on which individuals might fall through the cracks, we’ll be able to retain a number of individuals in our field, and also attract really talented people to our field.

Underlying all of this is the fundamental culture change that needs to take place, which is to move from independent scientific activity to more integrated scientific activity. That’s something that we’re working on -- both in the intramural program as well as in the extramural program. We intend to create opportunities for scientists across the spectrum, to work in integrated teams of individuals. Quite frankly, we intend to develop training programs that reflect that integrated nature of training.

We’re not going to do this in isolation. We’ve embarked on a strategic planning process. We’ve already sent out a notice in the Federal Register, and have a website that’s active and soliciting input from a variety of individuals around the country and around the world. And we’re taking that input very seriously. We’re in the process of planning a strategic planning-meeting in the fall, where we’ll have about 150 individuals at NIEHS to discuss these four different topics of basic science, clinical sciences, training and global environmental health. Then we’ll be coming out of the document at the end of the year, identifying the priorities within each one of these areas, as well as the specific plans that we have for programmatic development in each one of these areas. We’ll have that document out for review, and we’ll hopefully finalize this document by January or February of 2006.

I think those are the main comments that I wanted to make. I do want to say that all of you are encouraged to go to our website at: http://www.hiehs.nih.gov/external/plan2006/planning.htm, to provide input and to give us your thoughts and ideas about how this institute could capitalize within those four areas of programmatic development. I really look forward to working with you, and continuing with the very important work that Ken Olden has initiated here at NIEHS, in terms of creating a real meaningful connection between the institute and the community.

Michael Lerner: Thank you, Dr. Schwartz. We hope you’ll stay on the line with us, of course, to respond to the questions and comments that are coming up. Our next presenter is Dr. Lynn Goldman. Dr. Goldman?

4. Second Speaker: Lynn Goldman, MD, Professor of Environmental Health Sciences, Johns Hopkins University

I want to start by thanking David Schwartz for joining us on this conference call, and extending him a welcome -- not only from me, but I’m sure from all of us on the phone. It’s very exciting, having you at NIEHS. I think that we’re excited for a number of reasons. You have a very strong reputation as a scientist. You’ve been a leader in environmental health. I think it’s important to all of us that you really share our concern about the environment and our sense that the environment has an important role in health and a real commitment to ferreting out what that role is. That’s really critical to us.

I think we also all appreciate the opportunity to give input as well, and accepting input from us not only on the phone -- but also that you’ve established the process we can use for providing input in writing. I’m sure that we’ll all take advantage of that. I think that that’s a wonderful thing that you’re doing, developing an agenda in a very open way for your term at the NIEHS, and that you’re giving us all the opportunity to participate in developing that agenda. I think that this is a harbinger of good things to come in the future, in terms of our being able to have interactions with you.

I just wanted to share some reflections that I have from my own experience. Part of that is certainly that your institute at the NIH is quite unique from the other institutes at NIH. A lot of them are looking at health issues that are important to our community. There’s a cancer institute. There’s an institute to look at heart and lung diseases. There’s an institute to look at immunologic diseases. There’s an institute to look at health and development. But only the NIEHS really makes the environment a priority, and is able to really put together all of the pieces, in terms of an appreciation the fundamental sciences, but also the interactions of individuals with the environment. I think we all welcome your bringing the light of a physician on this, in terms of the impacts on individual health and disease that we think are all very key.

The other thing that I think is very different in other institutes is that therefore, because of this focus, you have more stakeholders. You have all of our communities and many different types of communities represented on this call, today. I don’t think we have industry reps on this call, but it’s possible. I don’t think that all of those communities necessarily have the same access to the process, and access to the science. One way that NIEHS has been a real pioneer has been by opening the door to all communities; by holding town meetings and by emphasizing community involvement with various centers that you find. And making it possible for communities to have more contact with the science, which has been a good thing and I think it’s something you’ll continue.

The last thing I wanted to say is how I really see the relationship between these groups and the NIEHS -- it’s very much an interdependent one. I think I’ve already mentioned the reasons that many of us need you. We need you to fund the research. We need you to support the training, to support community involvement. But also to generate the knowledge that is so critical to us, in terms of understanding the linkages between health and the environment.

I also think that the NIEHS needs us, in terms of the support with Congress for the funding, for the research to be done. The fact is that we’re probably going into a time where maybe we can’t take the NIEHS for granted, as much as we had. I think frankly that during the last decade, when the budgets were entering and it was increasing, we kind of took it for granted that every year there’d be more money at the NIEHS. I don’t think that we can be so complacent any more. I think we’re all going to need to know what the needs are for the Institute. I hope that there’s enough of an interaction, and that people are aware of the needs, in terms of their concerns about continuing our expanding funding.

Before closing, I did promise to David and Michael that I’d also mention that tomorrow there’s a special supplement of the American Journal of Public Health that’s coming out. It’s on scientific evidence and public policy -- being that he and I both contributed to that. It’s not directly relevant to the call, but it’s probably of interest to many of you on the line.

Thank you, Michael Lerner, for putting this on and for allowing me to participate.

Michael Lerner: Thank you, Dr. Goldman -- very, very much. Dr. Shelley Hearne. You are our next presenter.

5. Third Speaker: Shelley Hearne, DrPH, Executive Director, Trust for America’s Health

Thank you, Michael. I’d like to actually build on Lynn’s comments. I think really, not only thanking Dr. Schwartz for the leadership role, but also making the connection that both NIEHS is in a unique position at the overall NIH, but also the role that community needs to continue to play. But also, it’s critical leveraging opportunities.

Let’s start with where NIEHS is. NIH in general has had an extraordinary doubling over the past five or six years of its budget. But NIEHS remains one of the smallest centers of the institute that are NIH. I think there are only two or three that are smaller. The dental research and alcohol abuse, I think, still are the smallest. But NIEHS is dwarfed by many of the other institutes in research.

While money has been coming in, I think this is going to be some tight fiscal times but it actually might be one of the key opportunities for NIEHS to shine, and to continue to grow and leverage in its role that it’s playing. In part, there are many challenges that NIEHS is facing. One of them is that there has been a growing recognition that NIH needs to play a grater role in the prevention side.

Predominantly, most of the funds over time have been spent on basic biomedical sciences, where while those are critical research investments, they may only lead to answers 20, 30 or 40 years down the road. NIEHS is in the great position that it could really be finding the answers today, to better preventing some disease -- chronic disease -- epidemics that are taking place. Whether it’s asthma, cancer, neurodevelopmental issues, developmental disabilities… The prevention side has traditionally been less than eight percent of the overall NIH funding.

One of the things that I think is a key opportunity here, and certainly again where the ties to community and Dr. Schwartz stepping in with leadership -- is a time to really maximize that visibility. While there will be a continued work on basic sciences, I think we couldn’t emphasize it more that working on continuing to enhance investments in issues such as the health tracking arenas and issues such as community concerns with clusters. Where, in fact, those issues have not been the focus of current research -- but in fact may be opportunities for the canary in the coalmines types of investigations.

Looking at how to both encourage the new training, but also ways to really emphasize and build up a prevention investigation response capacity. Maybe some of the new arenas that would also scatter the attention for new funding and priorities as NIH I think will be getting increasingly more and more pressures, to be looking at what are the solutions and opportunities to turn around some of these epidemics, today -- rather than just simple, theoretical, biomedical advances of the future.

That is one of the key opportunities that both under your leadership will be there -- but also to echo Dr. Goldman’s point of NIEHS has just been phenomenal with community support and integration. In fact, that’s where some of the passive stance of the NIH has taken place. It’s by the advocacy of outside groups. If more and more of that can be built in and encouraged at NIEHS, those will be the future for both increasing funds, making the research relevant today, and ensuring that the issues and investigations are dealing with the full integration problem.

I could go into some specifics, in terms of some of the critical programs like National Toxics Program (NTP). For a while, we’ve been advocating that a big spend is beyond cancer, and looking at the offers to integrate it with other diseases and other concerns of the communities. But I want to be sensitive to time. I just think this leadership change and that the openness of asking for comments -- the opportunity to really truly look at how community voices can be better integrated to further leverage the prevention research at NIH… It’s absolutely a wonderful time, and I hope we all see the product.

Michael Lerner: Thank you, Dr. Hearne. Ms. Pamela Miller, you’re our next speaker.

6. Fourth Speaker: Pamela K. Miller, Director, Alaska Community Action on Toxics (ACAT)

Good morning, everyone. Thank you for this opportunity. I would like to address some of the critical questions posed by NIEHS for the strategic planning process. I really appreciate the leadership that Dr. Schwartz is offering.

First, I would like to ask NIEHS to continue to support and expand the environmental justice and community-based participatory research programs. These programs have been critical in addressing the health disparities associated with the disproportionate burden of environmental degradation and pollution suffered by communities of color, and low-income communities.

Community-based research, we know breaks down the distinction between researchers and the research. This is a model that results in collaboration among community members and researchers, from the design of studies to the interpretation and dissemination of results.

We’ve seen how community-based research addresses environmental health and justice concerns of community residents, and it builds accountability, trust and capacity. Most importantly, community-based research is an effective way to create innovations and interventions that reduce and eliminate adverse health outcomes. It’s critical to address the concerns of fence-line communities that are affected by military and industrial contamination. There are many more communities in need than can be funded at current levels.

I would like to talk about the additional support needed to address critical questions of additive and synergistic affects of chemical contaminants, and the effects of living near industrial or military facilities on vulnerable populations -- including children, pregnant women, those with chronic diseases, and elderly people.

Communities need independent research concerning the links, exposure pathways and prevention of disease clusters in proximity to chemical facilities, military sites and hazardous waste sites. We would like to see additional support for research with communities affected by military contamination. The Department of Defense has attempted to exempt its operations from regulatory control, and has contaminated hundreds of sites around the country -- including water sources, air, lands and foods with massive fuel and solvent spills, chemical warfare agents, radioactive waste, PCBs, heavy metals and pesticides.

Lastly, I would like to address the particular vulnerabilities of people living in the North, and the high exposures of contaminants derived both from military and industrial activities in the region -- as well as those persistent chemicals transported via oceanic and atmospheric currents, from latitudes hundreds and thousands of miles to the south.

The arctic is experiencing drastic change, and is a hemispheric sink for the deposition and retention of persistent chemicals. I would like to see NIEHS provide support necessary to address the higher exposures and the particular vulnerabilities of people living in the northern and arctic regions. People here are reliant on fish, seal, walrus and whale, birds, berries and greens for cultural, spiritual and physical sustenance. These are very serious exposures that need to be addressed, and have not received the level of funding necessary to fully understand about ramifications and implications for particularly indigenous peoples reliant on traditional diets.

Thank you very much.

7. Questions/Comments/Discussion

Michael Lerner: Thank you, Ms. Miller. Dr. Schwartz, before we open the lines to other questions, would you like to comment on any of the issues raised by the speakers, so far?

David Schwartz: I just want to say that I think it’s really very, very important for the community to have full access to NIEHS, and for the community to have the kind of input that helps us identify the problems that are very relevant to health needs.

Also, that the community realizes that the appropriations process is an iterative process, and they can have a tremendous amount of input into the kind of support that comes to NIEHS. After all, the taxpayers are the ones who support the NIH. We’re beholden to the taxpayers.

Michael Lerner: Very good. Thank you, Dr. Schwartz. Now I understand the operator is going to instruct us on how to do the Q-and-A.

Operator: Certainly. This is the operator. At this time, we will open the floor for questions. If you would like to ask a question, you can press the * key followed by the 1 key on your touchtone phone. Questions are taken in the order of which they are received. If at any time you would like to remove yourself from the question in queue, you can press *2. Again, that is *1 to ask a question. And please note that this is a very large call. We will most likely not be able to get to everyone’s questions and comments.

Operator: Our first question comes from Terry Collins.

Terry Collins, PhD, Thomas Lord Professor of Chemistry and Director Institute for Green Oxidation Chemistry, Carnegie Mellon University:
Thank you very much. Hello, Dr. Schwartz. I’m very grateful to be able to speak with you, this morning. Thank you, Michael and everybody else, for this possibility.

Dr. Schwartz, I’m wondering if there may be an opportunity for you to support green chemistry in a new NIEHS. Green chemistry is an area of chemistry that would allow us to reduce or eliminate hazard in chemical products and processes. It’s very interdisciplinary. We need to be integrating the best understanding of toxicity and eco-toxicity into the training of chemists. Currently, that’s in deplorable shape. We need to be developing clean technologies to replace the losing ones. While our field is inherently critical of the status quo, it is very much focused on positive development. We possess good insight into how to develop possible replacements for technologies that for example, could reduce persistent bio-accumulative substances. Thank you.

David Schwartz: We have a program in extramural that supports small business development. It’s called the SBIR program. Through this, we support the development of technology, especially as it relates to technological developments that are specific to our field. I would encourage you to look at that potential support mechanism, as a way of attaining support and competing for support for green technology.

Operator: Our next question comes from Paul English.

Paul B. English, PhD, MPH, Chief, Epidemiologic Investigations Unit, Environmental Health Investigations Branch, California Department of Health Services:
Thank you Dr. Schwartz and the other speakers, for your great talks. I have a question for Dr. Schwartz. Under your topic of global environmental health, in the next couple of decades, we’re going to see a huge explosion in countries such as China and India, as individuals obtain private vehicles. We’ll see a large increase in traffic related to exhaust exposures, and also, of concern with diesel exposures.

Historically, there’s really been a dearth of research into health effects of traffic-related flues, here in the US -- with Europe taking the leadership in this area, and most of the studies coming out of Europe. However, recently we’ve been seeing these exposures associated with a whole host of health outcomes. From cancer, adverse reproductive outcomes, respiratory disease, cardiovascular disease -- just to name a few.

I’ve got two questions. The first one is do you view this as an area a possible program announcement or that an RFA may come from NIEHS? Secondly, do you think that NIEHS would also be interested in funding some of the upstream driving forces for exposures of these pollutants to populations? I’m thinking of the interaction of epidemiology with land-use planning, and conducting health impact assessments of development projects.

David Schwartz: To answer your first question, we do not have any RFAs, yet. We’re in the process of developing a strategic plan to pursue this. Even if we did have RFAs, I’m not really at the liberty of talking about those RFAs until they hit the street, because we can’t give anyone unfair advantage, in terms of the granting mechanism. But we don’t have any RFAs that are being developed in this area, yet.

Our plan is to use the strategic plan, as a way of focusing our effort and our thinking on the opportunities in this area. I do view outdoor air and indoor air, for that matter, in Southeast Asia, as a potential research opportunity.

Now, as this relates to more -- I guess downstream -- issues, as you stated… or peripheral issues… I just don’t know. We have a limited amount of funds. We have to focus on the scientific issues that are at hand. I view the built environment, so to speak as important -- but not necessarily critically relevant, in terms of a burning scientific issue. It’s a very relevant and very important sociologic issue that needs to be dealt with. But I just don’t know that it’s in a purview of our limited budget, to be trying to figure out how to reconstruct cities, and make them healthier places to live. I think it’s important for us to provide the science that fundamentally underlies what the toxins are, and what the diseases are and to provide some insight into how to avoid those. But I don’t know that we have the liberty or the ability right now to extend beyond that.

Operator: Our next question comes from Shanna Swan.

Shanna H. Swan, PhD, Professor, Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry:
I’m glad to have the opportunity to ask this question. As we look to the effects of increasing numbers of environmental chemicals at low levels that we’re all exposed to -- one of the things we’re learning is that prenatal exposure is so critical. That’s the area I work in. One of the problems that we come up against when we’re doing studies of fetal basis of adult disease is the problem of long-term follow-up. So if we’re going to make strong links between prenatal exposures and adult disease, we’re going to have to have documentation of exposure, which can only be attained during pregnancy, if it’s a biomarker, then, adults for later disease. With our current funding mechanisms, we have studies that are funded for four years -- possibly five -- which allows possibly for two years of follow-up and practice. So how do we do this? Has NIEHS even thought about ways to… perhaps there are some other mechanisms by which we could actually enter this area of long-term follow-up, to look at the effects of prenatal exposure on adult disease.

David Schwartz: You bring up a very important point. I agree entirely with you. We need to think a bit more creatively about how to fund these kinds of efforts that, in the end, may be much more meaningful than some of the five-year projects that we could ever fund. There are currently two efforts at the NIEHS, to do just what you’re talking about -- which is to create a cohort of individuals, and follow them extensively, over time. Probably the best-known cohort that’s been supported by the NIEHS is the Framingham Study. They’re, in fact, still being followed today, for cardiovascular endpoints and several other endpoints.

But what’s currently being discussed at the NIEHS are two different studies. One is the National Children’s Survey; I believe it’s called. That would identify somewhere around 100,000 children, and follow them prospectively, over time, from birth. I would imagine -- I don’t know the details -- but I would imagine that there would be exposure indices or exposure measures obtained during the pregnancy period, as well.

In addition, there’s another study being considered called “The Ages Study.” It’s a gene-by-environment study that would focus on Americans and approximately half a million Americans. That would be followed, prospectively, over a 20-year period of time.

In that study, we would also assess environmental exposure very critically, and follow the population to see what happened to them, over time. Both of these studies would be driven by intramural programs at NIEHS, but they would involve extramural investigators. So there’d be a real partnership between intramural and extramural scientists, in terms of attacking these problems. And there would be the opportunity to follow individuals or to commit to a much longer-than-five-year study.

I think there are many people that share your opinion, and at this point, it’s a matter of trying to appropriate the funds from Congress to allow us to pursue these avenues of research.

Operator: Our next question comes from Pete Myers.

Pete Myers, PhD, CEO, Environmental Health Sciences:
Thank you. Dr. Schwartz, I’d first like to join the other speakers and questioners in thanking you for taking on the challenge of leading NIEHS and doing so well with such a vigorous outreach program.

One of the gravest epidemics we face domestically and internationally is obesity, and the culture of metabolic disorders that accompany it. There’s some intriguing data coming out of a number of labs -- including Retha Newbold, there at NIEHS, indicating that nutrition and contamination during fetal life can disrupt adult weight regulation, profoundly.

Most research in this area to date has emphasized the contribution of reduced exercise and increased food consumption on weight. These are clearly important, yet the data on contamination or raising the possibility that other preventative interventions might be possible is also important. Do you expect to be investing in this line of research?

David Schwartz: Well, we have invested in this line of research. In fact, just last month, I approved $3 million of grant support for obesity research. So we’re in collaboration with the CDC. Funding, I believe, 12 different projects to identify the environmental determinants of obesity, with an intervention in mind for each one of the projects.

This is obviously a very important area of research. Just to relate this to the previous question, I believe that there’s probably an epigenetic component of obesity, in that there are probably exposures that occur in-utero that may predispose children to obesity, based on differential gene expression, as a result of in-utero exposures -- which raises the possibility that epigenetics may be a very important area of investigation to pursue, as it relates to the development of obesity and other childhood problems.

Also, in addition to the $3 million that we’re putting into the area of obesity, we’re very interested in the area of epigenetics. We will be investing in this area in the future, as well.

Operator: Our next question comes from Mark Mitchell.

Mark Mitchell, MD, MPH, President, Connecticut Coalition for Environmental Justice:
Yes. I appreciate the opportunity to speak with Dr. Schwartz. I’m particularly concerned about finding causes of environmentally related diseases, and how well we’re doing that. I understand that NIEHS is looking at toxicogenomics as perhaps a way of testing chemicals, to determine their toxicity. I believe that the science of identifying causality in environmental effects is very much in its infancy stage. I’m wondering about looking at epidemiological studies over environmentally related diseases, such as asthma and other environmentally related diseases. Is that the purview of NIEHS to do epidemiological studies?

David Schwartz: Absolutely. We have a very active program. We also work very closely with NHLBI in terms of an asthma-epidemiology program. We jointly support a program with NIAIV on asthma and epidemiology. So this is a very active area of investigation.

Operator: Our next question comes from Susan Marmagas.

Susan West Marmagas, MPH, Director, Environment and Health Program, Physicians for Social Responsibility: Yes. Hi, Dr. Schwartz. I would like to also thank you for joining us on this call, today -- and welcome to your new position.

I’m very interested in what you’re planning to recommend and do as the leader of NIEHS, around community-based intervention research. NIEHS has had a long history of funding very effective community-based research, and really has led the federal agencies in this effort. I’m interested in how this fits in with the 5 main focal points that you have laid out on this call. Thank you.

David Schwartz: Well, I think that when I think of community-based research or when I think of the important relationship that NIEHS can have and maintain with the community -- I think of it as a collaborative approach to work with the community, to identify the critical environmental concerns, and the critical diseases that might be related to environmental exposures.

Then, for NIEHS and the scientists funded by NIEHS, to develop the scientific approaches that would allow us to critically study these problems -- in a way, to move the field ahead and in a way to improve the health of the community. And those outside the community that are at risk of developing those diseases.

Operator: Thank you. Dr. Jackson has joined us, now. Dr. Jackson, you are free to comment on anything up to this point that you would like to.

Richard Jackson, MD, MPH, Former State Public Health Officer for the California Department of Health Services: I’ve only heard the last five minutes. I just want to express my best wishes to Dr. Schwartz. Good look on a wonderful and challenging job, David.

David Schwartz: Thank you. It’ll be great to work with you. As you know, we date back probably about 25 years.

Richard Jackson: When I heard your name, I thought, “Oh, I can remember the study of the birth defects and the farm-worker kids.”

David Schwartz: Yes. That was a long time ago. I really look forward to working with you. I plan to visit you when I’m out in California, and I have plans to invite you to NIEHS.

Richard Jackson: Thank you. You know, I understand that the biomonitoring report is coming out on Thursday -- have you folks discussed that?

Michael Lerner: We haven’t. Would you like to comment on that, Dr. Schwartz? That’s of intense interest to many of the folks on this call.

Richard Jackson: Maybe I should just tee it up for one second, if I could.

Michael Lerner: Yes.

Richard Jackson: I’ve heard through the back channels that CDC’s third national exposure report is based upon the samples that we’re taken in Hanes over the last few years will come out on Thursday. I’ve not heard or seen anything officially -- although I’ve been on vacation and leave for the last couple of weeks.

The issue of the biomonitoring is a very big one, David -- out in California. I had been pushing when I was in the State job for legislation that would extend that into the state. I could go on, but let me at least give people that information.

It will be very interesting to know whether they’ve gotten much higher levels of sensitivity for Atrazine. I believe that they have a bunch of new volatiles that they’re looking at. Perchlorate, I think is going to be in it. I’ve actually been careful not to get privileged information on this. But I would think that CHE Partners would like to be prepared to take a position very quickly, as this comes out.

Michael Lerner: Thank you very much. We’re certainly going to want to talk about it very soon after it’s released. Can we have the next question please?

Operator: Our next question comes from Cindy Russell.

Cindy Russell, MD, Plastic Surgeon, Santa Clara County Medical Association:
Thank you very much for putting on this conference call. I just had a question in regards to aspects of sort of a broader approach. It’s sort of a two-part question. You’re looking at individual chemicals and epidemiology in an individual approach, and certainly global issues, but what about the issue of precautionary principle, and bringing this into discussion, how you’re doing that?

The other question is, do you have a program to communicate directly with some hospitals and medical groups, to sort of push this agenda up with items such as the precautionary principle, in terms of green building, green pharmaceuticals and incineration issues that they may not be aware of? People have great respect for what you’re doing. I’m just curious if you have a program for that, and I just may not be aware of it. Thanks.

David Schwartz: Yes. What you’re bringing up is a very important issue. The question, I think, if I could rephrase it, is “How does science effect policy?” And how should science interface with policy? My view is that as a scientist, I specialize in trying to understand the basic mechanisms of various environmental exposures and health-related risks of various environmental exposures. That leaves me in a position of not being as expert in policy to understand how those scientific findings might be translated into policy.

However, also NIEHS is in an unusual situation, where some of the science that evolved from the funded scientific efforts will, in fact, affect policy. A good example of this is the Six-city study and the finding that ozone of particulate matter not only affected the development of respiratory disease, but also affected mortality. Then the question is how does that relate to putting restrictions on various pollutants in the environment.

I think that it’s important for us to figure out what the issues are and to frame the issues, as they relate to environment and policy, much in the way that the affects law and social links frame the issues as they relate to the genomic findings, to the Genome Institute.

So we’re exploring the possibility of developing a policy effects and law group here at NIEHS. That would interface with the community, in a way to frame the issues that are relevant to environmental exposure, susceptible populations. But in no way do I think that NIEHS should lead the way in terms of advocating for or trying to alter policy. I do think we need to help frame the scientific issues as they relate to policy.

Michael Lerner: Thank you, Dr. Schwartz. I think we have time for one last question -- a quick one.

Operator: Certainly. Our next question comes from Kim Storm.

Kim Storm, MSEd, Health and Wellness Program Director, YWCA Breast Cancer Awareness Program: I was interested in hearing a little bit more, Dr. Schwartz, regarding your statement about bringing science to the patient’s bedside. I work in the field of breast cancer, and certainly really appreciate that statement, in light of many patients I work with -- as we’re seeing prolific rates of cancer, are starting to question when it’s not in their lineage with their families, what actually is going on. I just was hoping you might be able to comment a little bit more about that.

David Schwartz: Obviously, there’s the issue of prevention. Once we identify environmental causes of breast cancer and other forms of cancer, there is this issue of identifying mechanisms for prevention. But I think also the mechanisms for environmental forms of disease, the basic biological mechanisms for environmental forms for disease, may be very different than the mechanisms related to non-environmental forms of disease. As such, they may dictate very different forms of treatment, or different forms of treatment might be identified through understanding the basic mechanisms that the environmental exposures cause malignant changes, or cause other pathologic changes that go on to the development of disease.

I was speaking specifically in terms of environmental health sciences, pointing the way to recognize disease at an earlier stage. Using environmental health sciences to potentially identify novel therapies, and using environmental health sciences as a way of preventing disease in populations.

Michael Lerner: Thank you, Dr. Schwartz. That is the last question. I just want to thank Dr. Schwartz, Dr. Goldman, Dr. Jackson, Dr. Hearne and Pam Miller for their presentations. And Eleni Sotos will have a final couple of words on the call. Thanks to all the CHE partners who’ve joined us for this important call with Dr. Schwartz.

Eleni Sotos: Thanks, Michael. I just want to mention that we are not having a call in August. That’s our one month for the summer that we are not having a call. We are planning a call in September, on biomonitoring. We will be sending out information about that call over the coming weeks.

That’s all I have. Thanks again to all of our speakers, and thanks to all of our participants. We look forward to talking with you all in September. Thank you.