CONVERSATIONS
Dr. Philip Landrigan
A Prescription to Better Serve Kids
Interviewed by Jennifer Bogo
Dr. Philip Landrigan has long
played an important role in advancing the field of pediatric
environmental health -- first as an officer in the U.S. Public Health
Service, then as an epidemiologist with the Centers for Disease Control
and Prevention, senior advisor on children’s health to the
Environmental Protection Agency and, most recently, director of the
Mount Sinai Center for Children’s Health and the Environment, which
was established in 1998 as the first of eight such national research
centers. He is widely recognized as one of the nation’s foremost
experts on children’s diseases and environmental exposures. Dr.
Landrigan’s forthcoming book, 101 Ways to Raise Healthy Children in a
World of Toxins, will be published in October by Rodale Press.
E: How have the patterns of
childhood illness changed over the last few decades?
LANDRIGAN: Fifty or 75 years
ago in this country, the dominant causes of illness in kids were
infectious diseases—pneumonia, influenza, measles, dysentery,
diphtheria, tetanus and polio. But today, the major causes of sickness
and death are, after injuries, all chronic diseases. Asthma has become
the leading cause of hospitalization, and cancer is the leading cause of
death.
What appears to be the most
insidious environmental threat to children’s health?
I’m worried about a whole
range of chemicals that have the potential to get into the developing
brain and cause damage. Chemicals can be toxic to the brain at a pretty
low level. We knew back in the 1950s and 1960s that a high level of lead
exposure could damage the brain, but in the 1970s and 1980s, studies
showed that there’s a spectrum of damage. Children exposed to lead at
lower levels who had no obvious symptoms still showed a loss of IQ,
slowing of reflexes and poor performance on psychiatric tests. We now
know that PCBs, mercury and probably pesticides act that way, too.
Are pediatricians and family
practitioners trained to recognize environmental threats?
Over the next few years, I
think we will see pediatricians become increasingly cognizant of these
issues. Pediatricians have long been good about checking up on
environmental causes of lead poisoning in children, and they are
certainly attuned to looking for the environmental causes of asthma. But
they have not systematically looked at children’s exposures to toxins
in the environment because most were not trained to think about
environmental factors as causes of disease.
What would you consider the
greatest accomplishment in the field of children’s environmental
health?
I think the removal of lead
from gasoline was an enormous accomplishment. In the 25 years since
then, we have seen a greater than 90 percent reduction in blood lead
levels in American children. It means that there is a lot less lead in
water, in air, in the food chain and in wildlife.
What, in the coming decade,
has the potential to be as serious a threat as lead?
There are three big ones. We
need to reduce the exposure of people of all ages to pesticides.
Pesticides are used in enormous amounts in homes, schools and day care
centers and on lawns and gardens. Once released, they are immediately
widespread in the environment and create enormous potential for harmful
health effects.
Number two is fine particulate
air pollution, which is well known to be a trigger of asthma. Since the
major source is cars, we are going to need to make some very fundamental
changes in transportation.
The third threat is chemicals
in our drinking water. Drinking water regulation is lagging way behind.
Are there social as well as
physical vulnerabilities that expose children disproportionately to
environmental threats?
Kids’ behavior puts them at
greater risk -- they are on the floor and constantly have their hands in
their mouths. Clearly, there are also discrepancies by income and by
race. Everything from lead paint and mold in poor-quality housing to the
placement of toxic waste dumps tends to impact negatively on poor kids.
There is evidence that
children are reaching adolescence a lot sooner. Should this be of
concern?
It’s very clear that sperm
counts are declining in lots of parts of this country and in Western
Europe. Rates of testicular cancer in young men have risen. A birth
defect in baby boys called hypospadia, which is a shortening of the
urethra that requires surgery to correct, has doubled in this country in
the past 20 years. Among girls, we’ve been seeing earlier puberty. The
big question is whether these various effects are caused by so-called
endocrine disruptors in the environment.
Are there vested interests
that would slow down the process of getting carcinogens and endocrine
disruptors out of the environment?
Some industry leaders are
enlightened and willing to take appropriate action. But some folks
don’t want to test chemicals for their toxic effects or to take them
off the market. Some say we shouldn’t establish a standard until we
know to what decimal point the chemical causes disease. That is too high
a standard. We don’t know today precisely how cigarettes cause lung
cancer, but we know that they do, and we know how to prevent it. The
same is true for a lot of chemicals on the market. We may not know
precisely how they cause brain dysfunction, but we know that they do.
Besides the presence of
chemical plants and other industries, has the American lifestyle changed
in such a way that would also affect the health and well-being of our
children?
A very positive thing has been
the decline in smoking among many sectors of the population.
Unfortunately, smoking rates are increasing among young girls and
minority kids, because they are targeted in advertising. In diet, the
consumption of red meat has gone down, while the consumption of fruits
and vegetables has gone up. But the rates for obesity and diabetes have
also increased.
Should biotechnology in
foods also be part of the discussion of children’s health?
We are developing genetically
modified foods, and we are putting them on the market and in our food
supply. We just do not know the potential consequences. It may turn out
to be the greatest thing since sliced bread. But we thought that about
DEET, and we thought that about PCBs. It was only many years later that
we realized those technologies have downsides. Here we are once again
embracing a technology, moving ahead full speed with no knowledge of the
downside. It is unwise.
What advice would you give
to concerned parents?
Encourage your children to eat
a diet rich in fruits and vegetables. Sure there are residues and
pesticides in fruits and vegetables, but kids who eat a lot of processed
foods are going to be at greater risk of heart disease, stroke and
diabetes in the years ahead. To reduce pesticide exposure, buy organic,
buy in season, and buy locally. Also, rotate the foods you feed your
children.
What advice would you give
to environmental and children’s health advocates?
Work for the battles you can
win.
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