Research Engine

Changing the way we think about disease

In a series of videos, Bruce Lanphear seeks to re-imagine our approach to disease, putting the emphasis on public health prevention, eliminating the causes, rather than investing in treatments and cures

Image courtesy of Bruce Lanphear

Bruce Lanphear narrating his video, "Little Things Matter."

By Richard Asinof
Posted 10/9/17
A new series of provocative short videos by Bruce Lanphear seek to rebalance the system of health care delivery by putting the emphasis on investing in prevention, not treatment. Lanphear will be sharing the videos as part of a talk on Friday, Oct. 13, at the School of Public Health at Brown University.
How can the public health factors related to toxic contamination in Rhode Island become a factor in decision-making around economic development in the state? Would the Hassenfeld Child Health Innovation Institute be willing to conduct research about the potential link of autism, asthma and obesity with chemical toxins, the current three chronic diseases targeted by the Institute? Would the Warren Alpert Medical School be willing to bring Lanphear back as a guest lecturer for medical students?
As the study of potential contamination in Rhode Island’s drinking water from the toxic chemicals known as PFAs proceeds, another question for the health care community is: could research be conducted, using an epidemiological approach, looking at whether such contamination correlates with the prevalence of particular diseases in Rhode Island residents, in order to connect the findings of contamination to the potential incidence of diseases linked to PFA toxicity.

PROVIDENCE – In his video, “Little Things Matter: The Impact of Toxins on the Developing Brain,” Bruce Lanphear, professor of Health Sciences at Simon Fraser University in British Columbia, spells out the dilemma in clear, succinct terms.

“By allowing children to be exposed to toxins or chemicals of unknown toxicity, we are unwittingly using our children as part of a massive experiment,” Lanphear said.

In the video, Lanphear presented the evidence in easy-to-understand graphic images, demonstrating how the impact of toxins on the developing brain is often permanent.

“Children who are more heavily exposed to toxins do not have the same peak cognitive ability as those who have lower exposures,” Lanphear explained, showing how decreases in IQ can be attributed to the result of the effects from a stew of toxins on the developing brain, including lead, mercury, PCBs, organic and phosphate pesticides, among others.

But it doesn’t have to be this way, Lanphear continued. “Like the European Union, we could require industry to prove that the chemicals they use aren’t toxic before they enter the market.”

The video is part of a series Lanphear has produced, entitled: “Unleashing the Power of Prevention: Creating Video To Re-Imagine Our Approach to Disease.”

The other videos include: “The Deadly Impact of Airborne Particles”; and “Prevention Paradox: Why We are Failing to Prevent Disease.”

“We have lived out a narrative that we would find cures for cancer, heart disease and other chronic diseases,” according to Lanphear. Technology and drugs are apolitical and profitable, he continued. “But we won’t solve our health problems through technology alone; we need social reforms and regulations and to build healthy cities and curb pollutants and hazardous consumer products.”

Lanphear will give a talk and show the three videos on Friday, Oct. 13, from 12 p.m. to 1 p.m., at the School of Public Health at Brown University in Room 375.

Relevance to Rhode Island
Last week, the R.I. Department of Health revealed that testing of the Oakland Association water system in a section of Burrillville showed “slightly elevated levels” of certain man-made toxic chemicals, known as per- and polyfluoroalkyl substances, or PFAs, in the system’s drinking water.

The testing is part of a collaborative effort being conducted by the agency with the Brown University Superfund Research Program. [See link to ConvergenceRI story below, “A deep dive into the toxic stew.”]

In addition to testing some 35 municipal water systems that serve more than 10,000 customers in Rhode Island, the program is also testing another 38 smaller sites, including small water municipalities or sources that are dependent upon wells. It was testing on the Oakland Association water system, one of the 38 smaller sites, which revealed the toxic contamination.

As previously reported by ConvergenceRI: Among the potential adverse health impacts linked to the toxic chemical, according to the initial news release from the R.I. Department of Health, include: developmental effects to fetuses during pregnancy or to breastfed infants, cancer, and effects to the liver, immune system or thyroid.

According to a story published in The New York Times Magazine in January of 2016, scientists researching potential connections between PFOA and detrimental health impacts found there was a “probable link” between PFOA and kidney cancer, testicular cancer, thyroid disease, high cholesterol, pre-eclampsia and ulcerative colitis, according to the story.

In 2017, New Hampshire state epidemiologist Dr. Benjamin Chan alleged that there was a “probable link” between PFOA and serious illness, including “high cholesterol, thyroid disease, ulcerative colitis, testicular and kidney cancers, and pregnancy-induced hypertension,” according to a WMUR news story.

In a study published in
Obesity in November of 2015 by Joseph Braun, a research epidemiologist at Brown University’s School of Public Health, a study of 204 Cincinnati mothers and their children that looked at the potential effects of perfluorooctanoic acid, or PFOA, a toxic industrial chemical used in the manufacture of products such as nonstick coatings, was that relatively high exposure with pregnant mothers resulted in a statistically significant association with the amount and pace of body fat gain in children during the first eight years of life.

[Braun’s initial research on Cincinnati mothers and children was done as part of what was known as the HOME study, in which Lanphear served as a principal investigator.]

Braun’s study added to a growing body of evidence that man-made chemicals such as PFOA may trigger obesity, with the chemical passing from the pregnant mother to her child. Excess body fat in children may increase the risk of Type 2 diabetes later in life.


Here is the ConvergenceRI interview with Bruce Lanphear, in advance of his Oct. 13 talk at the School of Public Health at Brown University.

ConvergenceRI: What is needed to re-imagine our approach to disease?
LANPHEAR:
Let me put the question in an evolutionary perspective. Fifty years ago, chronic disease was beginning to take off, while infectious disease was on the decline.

At that time, it made a lot of sense to focus on treatment, on finding a cure. The war on cancer was first proposed in the early 1970s.

We knew what was causing cancer: tobacco, radiation, benzene. Still, there was a lot of pushback and controversy.

Basically, we were seeing this rise in chronic disease, without a consensus about why it was on the rise.

The emphasis was put on the never-ending elusive research for a cure, [following the model that had been pursued] with infectious diseases.

We still put most of our health dollars into the war on cancer.

Probably the poster child for finding a cure is childhood leukemia, where there has been a decline from 90 percent to 15 percent in the death rate.

By any stretch, it can be seen as a success. Even though we can call it a cure, there a still some drawbacks.

Treatment can be daunting; it can take two to three years of a family’s life, pumping kids full of poisons and toxics, with radiation and chemotherapy.

So, while mortality rates have plummeted it’s not a perfect cure.

ConvergenceRI: Can you further explain what you mean?
LANPHEAR:
In June, I spoke in Vancouver to a gathering of 200 pediatricians at a meeting of the Canadian Pediatric Society. After providing a little context, I asked the audience to make a choice: Option A was to continue to fund research to find a cure; Option B was to invest in ways to prevent childhood leukemia.

Then I asked for a show of hands. Take a guess: what percent said they wanted to continue funding research to find a cure; and what percent wanted to invest in ways to prevent childhood leukemia?

All of them – 100 percent – said they wanted to prevent childhood leukemia in the first place.

Yet, if you go on the Childhood Leukemia Foundation’s website, it’s all about treatment.

ConvergenceRI: Have the causes of childhood leukemia been identified?
LANPHEAR:
A group out of the University of California Berkeley, looking at the potential causes of childhood leukemia over a couple of decades, conducting a meta-analysis, synthesizing all the data. The study identified [the risk factors as exposure to] paints and solvents, tobacco smoke, pesticides, air pollution and proximity to highways.

These are risk factors. Exposures are not causal; there is not one single agent.

What can be said is that, for the population attributes present in cases of childhood leukemia in California, one in four cases of childhood leukemia can be attributed to these four agents.

Still, very little work has been done on prevention of childhood leukemia. At the National Cancer Institute, in terms of how much they invest in research on childhood cancer, what percent is invested in prevention? 1 percent.

We have gotten captivated, entranced by the technology; some of that is understandable – it’s profitable, and we have become fixated on this idea of finding a cure.

Wouldn’t prevention be better?

We currently spend 96 percent of our health care dollars on treatment and 4 percent on prevention.

ConvergenceRI: Why have you chosen to use video as the platform for your message? Whom do you see as your target audience?
LANPHEAR:
We were trying to find a way to make the information more accessible. We have created short, succinct videos, three to seven minutes in length, targeting younger people, or moms.

Mothers are often the agents of change in medicine. In the U.S., regulations are largely being written by the mega-corporations.

In Flint, Mich., it wasn’t until there was a community uprising and outcry that the authorities finally reacted. [They are pouring a lot of money at Flint; there are hundreds of communities just like Flint across the U.S.]

Until there is some kind of public outcry, our politicians are not taking action. Our leaders are caught in the treatment [treadmill].

As one psychiatric pediatrician told me: “We’re trying to keep up with the epidemic of ADHD, autism and learning problems. We don’t have any time to do anything else.”

Our [health care delivery system] is one where we expect our physicians to provide the answers.

ConvergenceRI: What can be done to put more emphasis on prevention instead of investing in treatment of chronic diseases?
LANPHEAR:
It is difficult task. Even people in public health research like me are expected to bring in 80-90 percent of our salaries. We’ve become a little industry of a sort.

As physicist Max Planck said, “Science advances one funeral at a time.”

I call chronic diseases the pandemic of consumption, in the consumer economy.

It’s profitable for industries to get people to consume, consume, consume. It has become increasingly profitable for hospitals and insurance companies and pharma to treat diseases, even though prevention is the most effective treatment.

It is the downside of operating in a free market; no one has figured out how to privatize the benefits of prevention. Treating diseases are more profitable..

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