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Posted by Alli from ? ( on Friday, April 19, 2002 at 12:42PM :

Science, Apr 19 2002: 452-453
National Tracking Plan Picks Up Speed
by Jocelyn Kaiser

Parkinson's disease, autism, childhood leukemia, lupus, asthma: They are all chronic diseases caused by multiple factors--including, some suspect, environmental pollutants. Now an ambitious, $200-million-plus-per-year national plan to ferret out such disease links is gaining momentum among agencies and Congress. At a public meeting last week in Washington, D.C.,* the proposal met with enthusiastic support, although a few participants voiced caveats--such as the need to define environment broadly to include lifestyle factors as well as chemicals.

The Nationwide Health Tracking Network, as it's known, was first proposed as a federal project 2 years ago by a group of environmental health researchers funded by the Pew Charitable Trusts. They wanted to find ways to firm up suspected links between diseases like cancer and pollutants such as heavy metals and pesticides. "We need to move away from speculation about disease to interventions and action," says commission member Lynn Goldman of the Johns Hopkins School of Public Health in Baltimore, former chief of the pesticides office at the U.S. Environmental Protection Agency (EPA).

To do this, the Pew commission proposed that the federal government spend $275 million a year to build or expand mandatory state registries of diseases such as cancer, Parkinson's, and autism. The money would also be used to add more pollutants to databases such as EPA's inventory of chemical releases by industry. It would add more local data and more contaminants to existing exposure studies, such as a Centers for Disease Control and Prevention (CDC) national survey that measures levels of lead and other pollutants in participants' blood. And it would train a corps of experts to investigate whether potential environmental disease outbreaks are linked to the hazard data that has been amassed. The data would be available (with privacy protections) to the public and researchers. But just how the various databases would be connected "is still in evolution," says Shelley Hearne of the Trust for America's Health, a nonprofit in Washington, D.C., promoting the network.

National and state tracking of chronic diseases and environmental exposures
Nationwide environmental health rapid response service
National environmental health report
At least five biomonitoring labs; five environmental health centers; an environmental health scholarship program

CDC has put its weight behind the plan and received $17.5 million in 2002 as an earmark from Congress. Richard Jackson, head of CDC's National Center for Environmental Health, says the agency will fund pilot projects such as state tracking of immune diseases. The plan has also won the support of lawmakers such as Senator Hillary Rodham Clinton (D-NY), who in March co-introduced a bill to establish a national network that mirrors the Pew report (see table). Clinton says it "will help get to the bottom of" problems such as unusually high cancer rates in Fallon, Nevada, and on Long Island.

At the meeting last week, several participants, who included attorneys and toxicologists, cautioned that environment in the strictest sense could miss the bigger picture, because diet and lifestyle factors such as occupation and smoking are just as likely to contribute to these chronic diseases. "We may miss the actual" trigger if the network assumes that pollutants are to blame, said Carol Henry of the American Chemistry Council, an industry group. Others worried that epidemiology simply can't deliver the kinds of answers policy-makers want, because it may be impossible to pinpoint cause and effect for some diseases. "Some of the promises we're making make me a bit uneasy," said EPA toxicologist Harold Zenick.

At a logistical level, participants also pointed to the difficulty of coordinating activities in at least a half-dozen agencies. Some said that a federal-level committee is needed. "This is a very broad and complex initiative, a very ambitious idea. It's going to take a lot of patience and time, not just one or two symposia," said Sam Wilson, deputy director of the National Institute of Environmental Health Sciences.

Those familiar with the Clinton proposal say it already addresses most of these concerns: For example, it mentions collecting lifestyle data. "It's all been thought of," says Susan Polan of the Trust for America's Health. Supporters are hoping that Congress will allocate $100 million for 2003.

* Environmental Health Indicators, sponsored by the Roundtable on Environmental Health Sciences, Research, and Medicine, Institute of Medicine, 10-11 April.

-- Alli
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