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Biomonitoring for Environmental Toxicants Thomas A. Burke Professor Johns Hopkins University Bloomberg School of Public Health July 27, 2005 Biomonitoring What is it? Measurement of chemicals or their metabolites in human specimens including blood, urine, hair, nails, cord blood, milk. "This is a giant step forward to understanding the relationship between exposure to chemicals and their potential health effects" Dr. Julie Gerberding, CDC's director Uses of Biomonitoring ¾ Measure amount of chemical absorbed into the body ¾ Provide a measure of individual or population exposure levels ¾ Evaluate health effects ¾ Identify those at highest risk ¾ Track trends ¾ Guide prevention strategies Environmental Health Tracking Agent is a hazard Agent is present in the environment Route of exposure exists Hazard Tracking Host is exposed to agent Agent reaches target tissue Exposure Tracking Agent produces adverse effect Adverse effect becomes clinically apparent Adapted from Thacker, et al., AJPH 86: 633-638 (1996) Health Outcome Tracking What does it mean? ¾ ¾ ¾ ¾ Our ability to measure pollutants has outpaced our ability to understand the health effects. Thresholds Cumulative effects Chronic impacts THE NATION; Rocket-Fuel Chemical Found in Breast Milk Perchlorate is found in almost all samples tested, a study finds, raising concerns about the substance‘s effect on the thyroid and brain effect on the thyroid and brain Marla Cone. Los Angeles Times. Los Angeles, Calif.: Feb 23, 2005. pg. A.12 Measures of Success Biomonitoring is a tremendous tool for policy evaluation Examples: ¾ Lead exposure reduction ¾ Environmental tobacco smoke ¾ PCBs, dioxins ¾ Persistent pesticides Advances Risk Assessment ¾ Improved measures of exposure reduce dependence upon assumptions ¾ Provide reassurance to workers, and community members ¾ Focus priorities ¾ Complement other Tracking Activities Health Effects of Mercury Expanding Applications of Biomonitoring ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ National surveillance Risk assessment Worker protection State surveillance Epidemiologic investigations Community studies Individual clinical measures Advocacy Litigation New approaches to environmental health and protection? Many challenges ahead ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Mercury Arsenic Cadmium Perchlorate PFOA PBDE flame retardants Pesticides Pthalates Nano materials Mixtures ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Chronic health effects Cancer Respiratory Immune system Reproductive Endocrine Neurological Cumulative impacts The NAS Study Committee on Biomonitoring for Environmental Toxicants ¾ ¾ ¾ ¾ Review current practices Recommend ways to improve the interpretation and uses of biomonitoring data Develop research agenda for improving the characterization of health risks Improve monitoring of changes relevant to public health and environmental policies Future Directions ¾ Linkage to environmental monitoring ¾ Epidemiological and toxicological research to evaluate health impacts and characterize risk ¾ Links to prevention, early warning of emerging hazards ¾ Policy evaluation and refinement
