Visionary Ideas: Translational Science
New Strategic Plan
- Idea 1: Development of programs that address policy resistant problems
- Idea 2: Environmental exposure & health - attributable risk model
- Idea 3: Environmental health and medicine
- Idea 4: Environmental intervention research
- Idea 5: Increase pediatricians’ understand of EH-related issue
- Idea 6: Invest to develop more animal-testing methods
- Idea 7: Spatio-temporal exposure assessment
- Idea 8: Translational research: letting patients be the guides
- Idea 9: Two-step process for effective screening
Idea 1: Development of programs that address policy resistant problems
These multidisciplinary programs must involve environmental scientists, physicians, health administrators, and public health professionals in collaboration where hypotheses are developed and tested on how environmental exposures interact with social and behavioral conditions to influence the development and progression of human disease. Here, the ultimate is to generate knowledge that can inform the development and prioritization of environmental policies, interventions designed to reduce the burden of human illness and disability, especially in populations that are impacted adversely by environmental exposure.
Idea 2: Environmental exposure & health - attributable risk model
There is significant potential value of an attributable health risk model applied to various environmental exposures. My historical reference for such a model is the Smoking Attributable Morbidity, Mortality and Economic Cost (SAMMEC) created several years back by Minnesota/CDC. http://apps.nccd.cdc.gov/sammec/ This model allowed States and localities to enter data on disease prevalence (lung cancer, heart disease, etc.) and get outputs of community disease burden, deaths, and economic costs (the mighty $). Such a model which comprehensive addresses environmental exposures does not exist. Many advances in research attributed specific environmental exposures to disease, death and economic consequences. EPA has done similar work on other areas, with air quality being most prominent and clearly showing very high benefits to society for air pollution reductions. (See http://www.epa.gov/air/sect812/ ) Similar data has been used to establish water quality Maximum Contaminant Levels. And researchers have touched on this is several recent papers (i.e. http://www.ncbi.nlm.nih.gov/pubmed/18300713 ) Efforts over the past few years with Environmental Health Tracking should also be of great value.
Perhaps NIEHS is the right place to figure out a way to create such a useful tool. It seems logical that NIEHS should consider funding an academic program to create such a model or do such work internally in collaboration with EPA, CDC/NCEH, NIOSH, etc.. Imagine a simple computer model in which local data could be entered on the prevalence of cancer, heart disease, COPD, asthma, certain communicable diseases, etc. combined with local data on air quality, employment data on the number of people working in various industries associated with specific environmental exposures, water quality (chloramines, disinfectant byproducts, arsenic, synthetic contaminants, …), radon levels, asbestos, pesticide use, etc. Once the data was put into the model, it would provide a local or state-wide burden of disease, deaths, and costs due to environmental exposures. Such data would be very powerful in communicating with the public, but even more so in justifying environmental health programs with local elected officials, boards of health, and legislators.
I agree! One model; good concept.
Idea 3: Environmental health and medicine
NIEHS should put efforts into better integrating traditional environmental health fields and disciplines, as well as research approaches, with medicine and medical subspecialties such as pediatrics. This would provide for translational research, multidisciplinary collaboration, and risk communication opportunities, as well as garner more support within NIH. Need to communicate and forge better relationships with physician and medical associations.
NIEHS needs to continue its commitment to interdisciplinary training.
I agree that one important way to help see environmental as well as occupational exposures addressed is to try harder to mainstream awareness of potential exposures, especially among primary care physicians, as well as to ensure that clinical laboratory testing is readily available. Readily available means within the scope of most health plans and medically interpretable. (Just giving levels is a non starter for most physicians and could create more problems with no solution.) Many people who would be leary of having this testing done at work, since they fear that it could have some impact on their employment status, would be more comfortable with having it done by their own doctor who would be trusted to maintain their privacy. Within EPA there is a similar interest in reaching "beyond the fence-line". This approach would be supportive of that EPA goal as well. At this time CDC / NCEH is working to develop a surveillance program, limited in scope so far, but grinding ahead, to look at actual chemical uptakes by human beings. This could be a huge driver for public health attention and deserves to be studied in that connection. I am not sure that there is general awareness or appreciation of this important effort. NIEHS would be well placed to take a look at this kind of translational interaction with medicine.
NIEHS needs to fund training programs for medical students. If doctors-in-training don't learn about the role of exposures in their patients' health and there are no role models for them, the current low level of understanding by the medical profession will not improve. Funding "champions" at each medical/nursing school would go a long way.
Idea 4: Environmental intervention research
It is time that environmental research began to focus more on interventions to reduce exposures and associated health outcomes. More studies are needed that show efficacy of environmental programs. In some cases, such as air filtration or improved over standard water treatment, randomized designs can also lead to stronger evidence for causal inference.
Idea 5: Increase pediatricians’ understand of EH-related issue
Parents learn about EH-related exposures to their children through the popular media, Internet, and friends. Then they turn to their doctor to ask for advice and help. But their doctor often hasn't been trained in EH-related exposures, may not believe that these exposures are important, may not include questions about environmental health in their patient assessment, and may lack the resources to help their patients do something about these exposures even if the doctor identifies them. Research the barriers to increasing doctors’ understanding of EH-related exposures to children, and to getting doctors to integrate environmental health exposures in their assessment and treatment of their patients.
What is EH? Environmental Health?
This is why medical schools need environmental medical units, so they can see how their patients respond in a clean environment on an elimination diet, if necessary. Seeing is believing. See comment under chemical susceptibility.
Idea 6: Invest to develop more animal-testing methods
Safety is an important issue in environmental health research. However, as the report "Toxicity Testing in the 21st Century" states, current models using animal models, are not the best to predict the health effects in human beings. Safety predictions based on animal models, often do
Idea 7: Spatio-temporal exposure assessment
NIEHS should fund more research that uses innovative and novel GIS technologies to perform spatiotemporal human exposure assessment to chemical, biological, and physical agents and multiple levels and scales.
Idea 8: Translational research: letting patients be the guides
Increase focus on translational research: start with studying patients’ symptoms, research possible mechanisms for those symptoms, study possible causes and potential treatments and do clinical trials of the treatments to see if they work. The patients should inform the process.
Idea 9: Two-step process for effective screening
Toxicology is a biological science to understand the adverse impacts of chemical and other agents such as radiation on biological function. To effectively screen large numbers of agents we need an iterative two stage process: 1) discovery of vulnerable biological processes in complex organisms and 2) high throughput biochemical and cellular screening of large numbers of compounds for that process. The biologic discovery process and screening processes would continually advance and update the screening process which would be re-run through the array of agents to knowledge base on the agents to which we are exposed.
looks good to me.