From: Robina Suwol
Date: 17 May 2008
Remote Name: 126.96.36.199
How Much Do Chemicals Affect Our Health?
Philip Landrigan tracks how dangers like the WTC can cause problems like ADD.
by Linda Marsa;
photography by Jesse Chehak
Philip Landrigan doesn’t look like a tough guy. With his nest of white hair and vibrant blue eyes, he seems more like an amiable country doctor than a Harvard-trained physician who has fought the world’s most powerful corporations and bullied bureaucrats to protect the public from poisonous pollutants for nearly 30 years.
In the early 1970s, as a newly minted pediatrician, he was dispatched to El Paso, Texas, by the Centers for Disease Control (CDC) to investigate lead poisoning in children living near a lead smelter. His medical sleuthing revealed that even minuscule levels of lead caused profound damage to health and cognition, a discovery that helped propel the phaseout of lead in gasoline in 1976.
It would set the pattern for his career. In the forefront of battles to eliminate environmental toxins ever since, the Boston native has helped show the relationship between asbestos, pesticides, and benzene and human disease. From 1988 to 1993, Landrigan was chairman of the National Academy of Sciences committee whose chilling report showed that children in the United States were steeped in pesticides from a host of environmental sources, resulting in the Food Quality Protection Act. More recently, his cavernous, sparsely furnished office at the Mount Sinai School of Medicine in New York has served as nerve center for tracking the environmental impact of the 9/11 terrorist attacks.
Currently a professor of pediatrics and director of the Mount Sinai Center for Children’s Health and the Environment, Landrigan is hardly ready to hang up his hat. Instead, the 65-year-old scientist is gearing up for his most ambitious project yet: the National Children’s Study, a landmark field investigation that will follow 100,000 American children from as soon as possible after conception to age 21. He hopes the research will identify factors in the environment—cultural, genetic, social, physical, and chemical—that make us more susceptible to disease. He also hopes it will shed light on why rates of birth defects, childhood cancers, asthma, obesity, violence, ADHD, autism, dyslexia, and other learning disabilities are skyrocketing.
Once headed for a career as a surgeon, Landrigan talked with DISCOVER about why he traded in his scalpel for a stethoscope, why he is unafraid of wading into battle against entrenched corporate interests, how he navigates hostile political waters, and what propelled him to become a champion of children’s environmental health.
You planned to become a surgeon. Why the switch to children’s health?
I had an uncle who was an ophthalmologist who did a lot of surgery. I had scrubbed in on operations with him when I was in college, and I had always thought I was pretty good with my hands. But as I went through medical school, pediatrics appealed to me more, both intellectually and emotionally. I like kids, and I thought it was a fascinating exercise to think about how you diagnose and treat disease in small people who can’t talk to you. It taxes your skills to the utmost.
You joined the Epidemic Intelligence Service, essentially the CIA of the CDC, and they sent you to El Paso to sleuth a case. In the process you changed history. What happened?
In winter 1971 the El Paso health department had a director named Bernard Rosenblum who was a transplanted New Yorker. He was concerned about a smelter’s putting out sulfur dioxide that was causing respiratory irritation in children, and so, along with the city attorney, he started a court case against the smelting company, Asarco. In the course of the case, they requested papers through legal discovery, and that’s when they learned that Asarco had released 1,000 tons of lead, 500 tons of zinc, and smaller amounts of cadmium and arsenic into the city’s air over the preceding three years, an amount that was vastly greater than anybody in the health department had imagined. There weren’t any cases of obvious lead poisoning [that is, blatant damage to the brain or other vital organs], but there was an exposure situation and so they asked us to come down and investigate. We reviewed their data and began a small pilot survey of some children who attended a nursery school within a mile of the smelter. It was an economically upscale neighborhood, but it was very much in the polluted zone. You know, usually pollution falls most heavily upon the poor, but it turns out that the University of Texas at El Paso was right beside the smelter and so there was a neighborhood where a lot of university professors lived, and that’s where the nursery school was located. We went in and took blood samples from 30 or 40 little children in the nursery school, and all but two or three had blood levels that were strongly elevated. In those days, an elevated blood lead level was anything greater than 40 micrograms. Today the limit is 10 micrograms, but back then we didn’t know as much.
With all the untested chemicals in the environment, we’re conducting a vast uncontrolled experiment and children are the guinea pigs.
How could you be sure the smelter was to blame?
On the basis of those findings, we went back that summer to do a more systematic survey. We divided El Paso into three concentric circles with the smelter at the center. We went door to door. As you moved away from the smelter, the levels declined so that the pattern corresponded precisely to the levels of lead in the air. We found heavy contamination of dust in people’s homes and heavy contamination of the yard soil. We reckoned that kids were exposed by several routes at the same time. They were directly inhaling the lead that was in the air, and they were certainly transferring lead from dust and soil into their bodies through their mouths.
And yet the children weren’t stuporous or blatantly sick with the kinds of symptoms often associated with lead poisoning. How did you prove the lead was harming them?
I was becoming friends with Herb Needleman, the University of Pittsburgh pediatrician celebrated for his work on lead poisoning. Needleman had not yet published his landmark paper on loss of IQ in children who had lead exposure in the absence of symptoms, but he was already thinking along those lines, and we conversed. I said to myself, well, we have a great opportunity to test that proposition at El Paso. So we went back in the summer of ’73, a year after we did the field studies, and did IQ testing and testing of peripheral nerve function in a group of the kids there. We found that the kids who had the higher lead levels had significant slowing in their motor skills and significant reduction in their IQs—an average of eight points.
This was a new area of knowledge at the time. How did it come together?
It was like writing a new book. We were changing the paradigm. We knew that lead paint could cause lead poisoning, and it was understood that the routes of exposure were the eating of paint chips and the ingestion of lead dust that would get on children’s fingertips. Then, of course, there were poison control centers dealing with acute ingestions. But it was only through my work in El Paso and Needleman’s work in Boston that people came to understand the notion of subclinical toxicity—that pollutants could have harmful effects in children at levels that were too low to produce grossly visible symptoms. Very real damage was still being done.
Did things change after that?
It took us a while to realize it, but we were dealing with an entrenched vested interest in the smelter. When you’re doing measles outbreaks or fighting smallpox, there is no vested interest and nobody is in favor of smallpox, at least nobody in their right mind. Here, however, we were dealing with one of the largest employers in El Paso, and they actually commissioned a counterstudy. They got a local pediatrician and a guy who was a psychologist for the school board to do another little study of the city’s children. Those researchers claimed to find no difference in IQs. It escalated into a major food fight at several national meetings. The whole thing hung unresolved until Herb Needleman confirmed our work in the New England Journal of Medicine in 1979. The essence of his paper was his demonstration that kids who had no signs of lead poisoning still had loss of IQ and alterations of behavior and shortening of attention span as a consequence of their lead exposure.
Between the new discovery and the fight with the powers that be, it sounds as if the pattern of your career was set right then.
Yes, I would say so. From that experience I realized there were probably a lot of environmental hazards out there about which we knew very little that could cause toxicity across a broad range of exposure. All of a sudden we had the beginnings of a map, and we could start to explore the effects of a whole range of chemicals on children. That realization coincided with the development of precise laboratory instruments that enabled us to measure chemicals in blood, in urine, and in environmental samples down to low levels. This gave us the tools to explore the effects of chemicals on children.
So with those tools in hand, you looked at pesticides?
In 1988 Senator Patrick Leahy of Vermont became concerned that children were more susceptible to pesticides than adults. When we finally figured out what children were being exposed to in their daily diet, it was clear that kids were being substantially overexposed and that government standards were not protecting children. It seems ludicrous in hindsight, but at the time standards were set, they aimed to protect a 21-year-old guy who weighed about 150 pounds. Finally someone proved that children and adults require different sets of standards.
After five years of detailed analysis, you went to work on a large report for the National Academy in 1992. What happened next?
We got the report mostly ready, and we turned in what we thought was a virtually final draft to the Academy that fall. There was a woman there who had been a senior staffer in the Office of Management and Budget in the Reagan administration and the first Bush administration. She was the senior support person for our committee at the National Academy. She was very helpful, and then we gave her the report around October of ’92, and she said she’d go through it, clean up the English, check the punctuation, do the footnotes, and all that kind of good stuff that a good staff person is supposed to do. She did all that and she sent the text back between Thanksgiving and Christmas of ’92, and thank God we read it because she had gutted the report. She had softened the conclusions. She had changed the word cancer to tumor throughout and just deeply weakened the report.
Was she under orders?
I never found out. I wrote a scathing report back to the National Academy that somehow got into the hands of Senator Ted Kennedy and led to the Academy’s being somewhat embarrassed. They granted my request, which was to reconvene the committee that had been dismissed. We had one more meeting in January of ’93, and we did the final rewrite of the report with the woman sitting right there. It got unanimous approval.
Was that a turning point in the regulation of pesticides?
It was a huge victory to get that report out. But then nothing happened because a few months later the [Newt] Gingrich Congress came to town, so the report gathered dust. By 1996 it was toward the end of the Gingrich Congress, and they suddenly realized the public perceived them as antichild and antienvironment, so they passed the Food Quality Protection Act by a unanimous vote of both houses. The stars lined up. It’s an old story—you have to work hard and get everything ready, then wait for the right political moment.
So at that point you said, all right, we’re done with pesticides—now we can move forward to the thousands of other chemicals in the environment?
Yes and no. The most important thing in the Act was the requirement that it establish special standards for children. When the EPA wants to set a pesticide standard, they have companies test the pesticide in rodents and measure what’s called the no observed effect level—the NOEL—which becomes the threshold. To extrapolate from rats to humans, they divide that NOEL by 100. But 100 wasn’t good enough to protect kids, so they had to divide it by 1,000. But in the mid-’90s, after the passage of the Food Quality Protection Act, the pesticide industry found a way around that: Instead of testing pesticides in rodents, they began testing them in humans—usually very poor people. For 15 years they have been paying these so-called volunteers a couple of thousand dollars to swallow the pesticide and see what happens. Then they just divide the figure where damage is first observed, the NOEL, by 100. And the EPA has been accepting these data over the protests of a lot of people, turning a blind eye to the third tenfold safety factor for children and not enforcing the law. The EPA’s decision to allow people to swallow pesticides to see what’s going to happen to them is frankly immoral.
The story seems to repeat itself again and again: No one wants to admit that damage has been done. Your department has also been monitoring the health effects from the collapse of the World Trade Center in the aftermath of the 9/11 terrorist attacks. When the towers collapsed, 2 million tons of dust containing concrete, asbestos, glass, lead, and carcinogens rained down on Lower Manhattan. Yet less than a week later, the EPA said it was safe to work there and breathe the air. What is your perspective on this?
[EPA director] Christine Todd Whitman’s statement that the air in Manhattan was safe to breathe was stupid and ill considered because she was making a very strong assertion with almost no data. It’s like a doctor telling a patient that the patient is healthy before he’s done any tests. At that point only minimal air sampling had been done because all the air monitors had been destroyed. And most of the early sampling was focused on asbestos because people got it fixed in their minds that asbestos was the big hazard. It took a few more weeks before we realized the complex mix of chemicals and dust—especially the pulverized concrete, which was extremely alkaline—was the hazard. We realized only later that concentrations of dust in the air were so high that they overwhelmed all the normal defenses of the human respiratory tract, and people inhaled ounces of dust into their trachea or their bronchi.
Now some experts are saying there is a third wave of Ground Zero illnesses—cancers and, in particular, myelomas.
What we don’t know is whether these cases are related to Ground Zero and if this is the beginning of a trend or just background noise. Frankly, only time will tell. Mesothelioma as a result of asbestos, for example, typically takes two or three decades to make its appearance. Children have many more years in future life than we adults, and if they are exposed to asbestos, for example, they’ve got five, six, seven, or eight decades to manifest any disease.
The government was initially reluctant to recognize that people were harmed by exposure to this caustic dust. What do you think finally turned the tide?
It just became painfully obvious that people were damaged, and the press was filled with stories about the World Trade Center cough. A critical event was the David Prezant paper on it in the New England Journal of Medicine in September 2002.
The EPA’s decision to allow people to swallow pesticides to see what’s going to happen to them is frankly immoral.
When power players know about health hazards yet don’t alert us or admit harm, are you shocked, appalled, or surprised?
No, none of those. Too many people have been motivated by greed. It becomes the job of people like me to expose that wrongdoing and hopefully prevent its recurrence. But their persistence and how they can set out to destroy people is painful. What they did to my friend Herb Needleman was unconscionable. After the lead industry was unsuccessful in rebutting his arguments scientifically, after they lost the battle to keep lead in gasoline, after the ambient air lead standard went from 5 micrograms per cubic meter down to 1.5 in the ’70s, they decided to attack him personally, and what they did was recruit two scientists who raised concerns without initially mentioning they had been hired by the lead industry. Herb invited them to come to Pittsburgh to look at his records. They found some minor numerical discrepancies in his data, which you’re going to find in most people’s data if you look far enough, and they claimed that he had committed scientific fraud and they brought charges against the University of Pittsburgh, all without first mentioning their affiliation. The University of Pittsburgh suspended Needleman for a couple of years. He was investigated by the National Institutes of Health, and at the end of the day—that day being four or five years later—he was fully vindicated. Since that time he’s won the Charles Dana Award for public health. He’s won the Heinz Award in the Environment. He’s renowned as an environmental hero (pdf), but people in the industry did their best to destroy that man.
Do you ever worry that someone will come after you?
Earlier I was relatively protected because I was working for the government. And I’ve always had options. I’m a licensed pediatrician. I could hang out my shingle. I’ve always felt that it was more important to do the right thing than to worry about what someone was going to do to me.
You are now involved in your largest effort yet, the National Children’s Study. What is that about?
The study is going to follow 100,000 children from early in their mothers’ pregnancies to age 21. The children will be selected from 102 counties across the United States. The plan is to recruit babies as close as possible to conception. We’re hoping to get a pretty complete picture of what’s in the mom’s body during the pregnancy, get breast milk samples, cord blood samples at the time of delivery, and then repeated samplings as the child grows up. We’re learning more and more about the environmental causes of diseases like ADHD, asthma, autism, cancer, and birth defects. The hope is that the National Children’s Study will enable us to pin down some associations that we’re beginning to suspect and probably uncover some new stuff. Genetics sets the stage but the environment is the trigger, and with all the untested chemicals in the environment, we’re conducting a vast uncontrolled experiment and children are the guinea pigs.
What do we know so far about autism and the environment?
There have been three or four very high-quality studies that have tried to link thimerosal exposure in vaccines to autism, and none of them found anything. I know people have said it could be a vulnerable subgroup of children that’s buried in the larger group. Maybe. Who’s to say it’s not there. All I can say is that right now there’s no evidence that thimerosal causes autism. On the other hand, there are lots of reasons to think that something in the environment must be causing autism. The disease runs in families to some extent, so you know there’s a genetic component. But then you’ll have kids with no family background, so clearly environmental things trigger the disease. We just haven’t been smart enough yet to recognize them.
Do you think the National Children’s Study could change that?
I’ll be looking at the links between autism and known neurotoxins, like lead, mercury, and pesticides. If the autism rate is indeed one in 150, then a population of 100,000 will give us about 650 to 700 kids with autism, which will be about the largest collection of autistic children ever put together.
What about ADHD?
We’ll be in an even stronger position with ADHD because it’s more common than autism, and we’ll have several thousand ADHD kids.
The study has a high price tag—$2.7 billion over 25 years. Critics have called this unacceptably high, especially when federal funding is stagnant. How do you respond?
Look at the enormous cost of diseases of environmental origin in children—which we’ve calculated at about $55 billion each year for the 4 million babies born in this country. And that’s looking only at four diseases where we’ve established environmental connections and we have cost data—asthma, lead poisoning, cancer, and learning disabilities. Compared with the cost of these diseases, the cost of the study is minute.
Can we do anything now to mitigate deficits from exposures experienced long ago?
There’s nothing we can do to reverse the damage that’s already been done. I recommend against taking chelating agents. Yes, they get the lead out of your body, but they are known to damage the kidneys and are of no proven benefit. Better to ward off brain decline by staying mentally active and using your brain. Read. Physical exercise keeps the brain healthy. Social networks are very important. People who have lots of friends age much more gracefully than people who are isolated. A general prescription would be to eat well, exercise regularly, have a lot of friends, and laugh.