One in every 110 American children today is diagnosed with autism, and the first diagnosis often comes in the first few years of life.
Within that same span of time just a few short years Dr. Philip Landrigan may have deciphered the code for the cause of autism written in genetics and exposures to chemicals in the environment. Dr. Landrigan, the director of Children's Environmental Health Center at Mount Sinai Medical Center in New York City, is leading a landmark effort to understand chronic childhood diseases not just autism, but asthma, obesity, attention deficit disorder and other illnesses that have for years beguiled doctors as they afflict more and more children. The National Children's Study has recently begun to sign up patients, and researchers will ultimately follow 100,000 American children from their mother's wombs until they reach the age of 20.
"The study is not just out there on a fishing expedition. It's guided by a set of specific hypotheses that are looking at specific diseases," Dr. Landrigan told The Daily Green. "We anticipate that we'll get information on different diseases at different points in time. Within a few years, after we have a sufficient number of babies in the study, we're going to be able to talk about connections between prenatal exposures and prematurity, pregnancy problems and low birth weight. A few years after that, we'll have data on learning disabilities, attention deficit disorder, autism and asthma."
It's a bold claim, but Dr. Landrigan is not your average pediatrician. He's one of The Daily Green's 2010 Heart of Green Award winners, and for good reason.
Dr. Landrigan has received several citations, from the Environmental Protection Agency, the American Public Health Association and others. He is the Ethel Wise Professor and Chair of the Department of Preventive Medicine at Mt. Sinai. He is a retired Navy Captain, having served for a decade in the Medical Corps, and he remains the Deputy Command Surgeon General of the New York Naval Militia.
>> See 8 of Dr. Landrigan's tips for pregnant women that you might not get from your doctor. >>
In the early 1970s, he studied the IQs of children in El Paso, Texas, where a lead smelter was operating. His results showed 60% of those children had lead poisoning, and that even low-level lead poisoning was causing irreparable harm to their brains. His research prompted Congress to crack down on lead pollution, banning or reducing its use in gasoline, paint and ultimately toys and other products. Those actions have reduced lead poisonings in America by 90%, raised American children's IQs by an average of six points, and injected $200 billion annually into the economy that had been lost to diminished economic productivity.
At the behest of Sen. Patrick Leahy, D-Vermont, Dr. Landrigan later turned his attention to pesticides. Before his studies, federal regulators considered the health effects only on adult men who weighed 150 pounds; after his studies, the Environmental Protection Agency began contending with the disproportionately large effects that chemicals can have on children, who absorb more chemicals per pound than adults do, and whose organs are still going through critical stages of development.
That work led the Clinton Administration to champion an effort to consider the unique health threats children face. The idea for the National Children's Study was born in a high-level committee made up of cabinet members and health experts like Dr. Landrigan. The idea, as he puts it, is to do for children what other large prospective epidemiological heath studies have done for adults. Everyone now knows that heart disease is a major cause of death in America, and that its causes include smoking, poor diet, high blood pressure, cholesterol, diabetes and lack of exercise. But you have to look back to 1948 to find the seed of that knowledge in a study of adult men in Framingham, Mass. The Framingham study is responsible for a 60% reduction in death from heart disease; it was a "blueprint for prevention," as Dr. Landrigan put it.
"We've had studies that look at men and women's health, and we knew that those studies had made very powerful findings that had influenced health in this country. The Framingham study...was wildly successful, beyond anyone's imagining," Dr. Landrigan said, adding: "We're very much in hopes that the National Children's Study will do the same for kids."
The study starts with women who volunteer in their first trimester to offer a detailed health history, to undergo a physical exam and a genetic analysis, and to provide samples of blood, urine and hair, which offer data about their exposures to chemicals in the environment. Similarly detailed testing continues for years before and after the birth of their children, so as any kids in the study develop illnesses, common triggers can be identified. (Women are being recruited from six locations currently, but that will ultimately grow to 105 counties across the U.S.)
"We'll be able to connect the dots," Dr. Landrigan said, "and relate prenatal exposures and genetic susceptibility to the appearance of disease later in life."
The study won't stop with early-onset childhood diseases; because it will follow children through their teens, it could shed light on other perplexing public health issues, like mental health or reproductive problems.
Parallel studies will focus on babies born at Mt. Sinai Hospital (6,000 babies are born there each year), attempting to identify exposures that may be unique to the population of New York, and to identify the particular causes of autism and learning disabilities.
Perhaps because it is so likely that the National Children's Study will identify problem chemicals that are now widely used in commerce and industry, the Bush Administration frustrated attempts to launch the study.
"It's absolutely true that doing this as a federal study has subjected us to politics," Dr. Landrigan said. "On the other hand, I would argue that there is probably no other entity in this society except for the Gates Foundation that has the resources to conduct a study like this. Resources include money but they also include long-term sustainability. We expect the government will be there for the next 20 to 25 years."
His focus on the National Children's Study hasn't stopped him from speaking out on issues that distinguished his early career. While substantial progress has been made on reducing lead poisoning, he said the current government health standard, set in 1991, that denotes any childhood blood sample with less than 10 micrograms per liter of lead as safe, is outdated based on current research. "If it's one or two, that's the norm. Under five, I'm content. If it's over five, find out where that lead is coming from," he said.
And while he's seen improvement in the regulation of chemical residues on foods by the Food Quality Protection Act, which was passed in part because of his studies of the health effects of pesticide exposure, he called the nation's Toxic Substances and Control Act "a joke."
"It's been so profoundly ineffective," he said. "There are 80,000-plus chemicals on the market today. Three thousand of them matter the high production volume chemicals that are all around us. The (Centers for Disease Control and Prevention) can measure levels of more than 100 high production chemicals in all of us. These are mostly synthetic chemicals that didn't exist in 1950 and 1960 so they're quite new to the planet and to the species. There is a great lack of toxicity testing on these chemicals, especially when it comes to toxicity to early childhood development. We have that information on fewer than 25 percent of these high volume chemicals. Seventy-five percent of chemicals that infants and children see every day have unknown effects."
Sen. Frank Lautenberg, D-N.J., has just introduced the Safe Chemicals Act to reform TSCA, as the law is known. "The health care act is fundamentally about providing a safety net and providing an insurance mechanism for people who are already sick," Dr. Landrigan said. "The Lautenberg act is supposed to control exposures and keep people from getting sick in the first place."
Keeping kids from getting sick in the first place. That's Dr. Landrigan's life work.
For taking the job of pediatrician to an entirely new level, The Daily Green honored Dr. Landrigan as The Protector at its 2010 Heart of Green Awards ceremony April 20 in New York City.
See more from the 2010 Heart of Green Awards
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