The impetus for the project began after the 2007 Gordon Cain Conference at CHF that focused on the intersection of environmental endocrine disruption and human biomonitoring. In conversations that followed, a small team from the EPA, an endocrinologist from University of Maryland, and I wondered how we might make all of this data more readily available for policy makers. We each had our own motivations. The endocrinologist, Mary Ann Ottinger, had decades of research that she was anxious to see extend beyond the laboratory. Cynthia Stahl, at EPA Region III, was interested in pushing the limits of a new decision-making tool she and a colleague had developed called MIRA. And I was curious about the ways in which uncertainty might be built into a decision-making model and might actually make the process more robust rather than being treated as something that would derail the process.

Over the course of the next 18 months, we brought on board a host of additional experts in environmental exposure and human and animal health. We divided them into teams along the lines of these specialties, and we asked them to create a matrix of possible health effects associated with the endocrine-disrupting capabilities of some well-known and widely used pesticides. The idea was to see how the groups would build these matrices from their perspectives. We would then integrate these data sets into a decision-making hierarchy already in use in Region III to see whether and how policies might be changed with access to this new information. We didn’t expect the process to be easy, but even we were surprised at what happened.

Unfortunately, we never even got to the stage of integrating the results into our decision-making hierarchy. When we brought the two groups (animal and human) back together, we found ourselves incapable of merging the data sets. It turns out (not surprisingly perhaps) that we conduct very different types of studies on animals versus the data we collect about humans, even when we are investigating the effects of the same chemicals on the same parts of our shared physiology. More important, the ways in which we speak about these effects varies in tremendous ways.

We found ourselves confronted with a deeply philosophical problem. For instance, it is not uncommon to characterize the effects certain exposures have on some species’ ability to exhibit proper mating or child-rearing behaviors. But such language never appears in discussions of effects on humans (could you imagine the politics involved in saying some people are bad parents because they were exposed to pesticides in utero?). But politics of behavior aside, there were two important places where the failures in the integration highlighted important problems to be noted for the future. First, difficulty in reproduction in animals is easily seen and classified and treated as a problem for the species. In humans, however, we treat reproductive difficulty as an individual (and private) matter. Second, building on this logic, we have a difficult time distinguishing and recognizing effects on an individual versus effects on a species. For animal specialists, effects on an individual can signal a problem but can largely be ignored if the species itself remains robust. Being able to maintain these two views allows us to think about multigenerational and nonlethal effects as potentially problematic even if an individual seems to be in good shape. In humans, however, the emphasis is almost entirely on the individual, which prevents us from thinking about larger systemic problems that may extend into the future and cause more population-based challenges. We were unable to reconcile these differences.

I’m not sure where we’ll go from here. I’ll be curious to hear the feedback offered by those in the audience. I don’t expect any easy solutions, but I do think that recognizing the difficulty the language poses helps us identify the ways in which the science of human health and the science of animal health are perhaps radically different and that these differences make it very difficult to integrate these studies into the environmental decision-making process.

The AAAS, at their meeting on personalized medicine at the end of last month, clearly aimed to address this question. On the agenda were talks about comparative effectiveness research (CER), biomarkers and clinical care, and health IT and personalized medicine.

More broadly, other meta-themes emerged. While advocates publicly like to frame personalized genomic medicine (PGM) in very futuristic and idealized ways—“tailored” treatment, “individualized medicines,” and “medicines that work for you”—speakers at the AAAS meeting, presented a reality of uncertainty about what personalized medicine (PM) is and the need for a lot of complex nuts-and-bolts efforts (that were often described in population rather than personalized terms).

PGM is a new term, and at this meeting it was primarily characterized as pharmacogenomics (PGx)—although some speakers, including the U.S. FDA commissioner, Margaret Hamburg, highlighted that PGM can mean different things to different people.

Speakers talked about the need to realign many of the institutions and their goals and practices to create more collaboration among agencies (the NIH and FDA in particular), to increase public-private partnerships, to create education initiatives to cross the conceptual and practice-based divides between so-called basic research and clinical research, and to make more efforts and approaches to study and include environmental exposures, not just genes, in PGM-related research.

An underlying theme of boundaries (these include professional, regulatory, disciplinary, conceptual, and scientific lab/social world boundaries) as barriers to PM/PGM was a strong one in most of these talks (although not stated in such terms), which at the end of the day were about moving PGM along. These boundaries are important to attend to. These are where concepts and practices are defined, negotiated, and contested and are also used in large part to define who can speak for and engage in PGM-related matters in the future.

So, while the term PGM is new and to some extent personalized medicine (in which today’s users of this term mean through genomics or attached to genomics in some way), stakeholders (including these speakers) redefine PGM at the same time that they redefine the institutions, practices, and/or sciences they think are at stake. In other words, they were re-presenting or describing how they want to remake themselves (their institutions) or other institutions under this rubric of PM/PGM and not start de novo.

Thus, for instance, CER was and is being re-presented to fit into a PGM scheme. These transitions are aspects that publics and public policy makers should be concerned with not the imaginary rhetoric of tailored medicine—although this rhetoric is important as social-science researchers who work on the sociology of expectations have pointed out.

While it may be enticing to use or create visions of “biomedical revolution,” or more specifically, “personalized medicine,” “tailored medicine,” or individualized medicine (these visions are of particular importance for advocates, who are attempting to create new allies for their cause), we also need more tempered discourses that are less promotional and more substantive. Underlying the AAAS talks were narratives more of continuum than of revolution, but perhaps more important, as some of the speakers hinted at (if not explicitly presented), PGM as they or others envision it may not be possible. In opening the black box of “tailored medicine,” as most of these speakers did, the enormity of PGM’s problem was revealed, as genomics was described as a newer term to characterize the study of all genes in a person/population as well as all interactions between genes and with a person/population’s environment.

Image via Genome Management Information System, Oak Ridge National Laboratory

Or is it? This is the question that circles through debates as an increasing number of people (scientists and non-scientists alike) discuss chemical effects. What exactly is in the air and in our water supplies? Are harmful chemical mixtures present in our products, or aren’t they? BPA has been largely publicized as an example, though these days few are arguing the absence of the chemical in consumer products. Instead, the argument focuses mainly on exposure levels. I read a New York Times op-ed about BPA levels discovered in canned food, such as particular brands of soup and juice. In addition, another recent article points to BPA traces found in products specifically labeled “BPA-free.” 

Do these discoveries make a difference? Not according to the American Chemistry Council, which sees no reason for concern by noting that “Americans absorb quantities of BPA at levels that government regulators have found to be safe.” The U.S. Food and Drug Administration relayed a similar message in 2008, though scientific backlash, as well as concerns presented by the National Toxicology Program, have led the FDA to reconsider BPA health effects and to present a new opinion on the chemical as soon as 30 November 2009. The real question remains: how has there been such obvious disagreement on the safety of this chemical? Aren’t there regulations in place to monitor chemicals in consumer products?

The answer, of course, is multi-layered. For one, the Toxic Substances Control Act (TSCA), the act passed in 1976 to regulate the 80,000 chemicals in commerce, is in need of sweeping reform. In addition, debate still exists as to whether studies done on BPA effects in rats can be translated to humans. According to Ted Schettler of the Science and Environment Health Network, however, the scientific-evidence conflict should not be the issue at hand. In a 2009 interview on NPR, Schettler says, “When there are credible threats of harm from some proposed activity, precautionary action should be taken even if some cause and effect relationships are not fully understood.”

Another article points out that BPA has already been the subject of hundreds of studies, a fact that led 33 scientists (all of whom had previously studied BPA) to send a letter to FDA commissioner Margaret Hamburg, accusing the Food and Drug Administration of stalling at the risk of public health. Other sources back up this sentiment, saying that waiting out the independent research versus industry debate about BPA is not smart: why wait for an overdue conclusion when Congress has the power to act now?

On a final note: check out Gwen Ottinger’s blog post from last March for additional insights into the broader public-health discussion.

Image via Flikr user tiffanywashko

For baseball players these necklaces may be part of a wealth of pregame superstitions, including lucky socks. But for the public the number of products touting themselves as “healing” or “alternative medicine” reaches all aspects of life. Metal products like the Phiten necklaces are nothing new; in fact, they’re part of a plethora of silver, copper, magnetic, and titanium products claiming to heal (the Wall Street Journal recently detailed the long history of health claims about different types of metals. In fact the American public has spent about four billion dollars each year on copper and magnetic bracelets alone, despite a growing number of studies reporting that magnets and copper do not relieve pain or give an athlete an “edge” and various lawsuits accusing makers of these bracelets of fraud. Believing the product works may give one the benefit of the placebo effect for a limited amount of time, but that belief provides no miracle cure.

So why do consumers continue to spend money on these “quick-fix” products, despite lawsuits, a lack of hard evidence, and randomized placebo-controlled trials, which show that the products are not any more effective than a bracelet without metal—as long as the consumer believes it could help him or her? Buying a bracelet to ease arthritis or relieve pain after throwing many 90-mile-per-hour fastballs is an easy fix, and as the Wall Street Journal noted, the claims of these metal products are most often “one part medicine to one million parts marketing.”

Does good marketing and pseudo-science speak account for the tremendous sales of these products? Or does a select crew of athlete or celebrity endorsers—in the case of the Phiten products or in the countless numbers of celebrities touting the benefits of “cookie diets,” cleansing remedies, and the various in-vogue health ideas lauded on the Oprah Winfrey show—take the place of talking to health professionals and doing some research on one’s own? For baseball players and the general public alike there are resources to assist decision making in terms of alternative medicine; the NIH has even established an Internet resource for CAM, or complementary and alternative medicine, which allows visitors to become informed consumers of health products. The National Center for Complementary and Alternative Medicine also is working to ensure that the standards of evidence for these forms of medicine will be raised, in the hope that people will be able to distinguish unhelpful or dangerous products from beneficial ones without having to rely on the endorsements of celebrities or athletes.

Image via Flickr user Danny Choo

This is not to say there isn’t science on television. Shows from CSI to Mythbusters make science fun and exciting, but each include a startlingly small amount of actual scientific information. Please don’t take this the wrong way; I love Mythbusters as much as the next geek. Unfortunately, these programs are representative of a decline in educational content on television, even on networks dedicated to science. At the same time, major network shows like CSI and Bones reflect what science would be like if Hollywood ran the world (let’s sequence DNA in ten minutes). We need scientists to come forward and be advocates of real science in the public eye, but who should it be? We can look at those with a nice low Erdos-Bacon number, and see that most of the people with good ones are working as consultants on films, not starring in them. If they are on television, it’s in a guest segment to talk about their latest popular-science publication. Scientists appear to be giving up on television in the United States.

It seems that PBS is the only station still pushing real science, with award-winning programming like NOVA and NATURE. And they’re great programs, but they lack the personality that we were exposed to by individuals like Sagan and Richard Feynman, both of whom have sadly passed away. We need charismatic scientists to share their excitement with the world. They must have the ability to explain complex science in clear language that is still entertaining. In January a new program will appear on PBS entitled The Human Spark, and it will talk about what makes us inherently human. This program, instead of being hosted by a scientist, is hosted by longtime science fan Alan Alda. Anyone who used to watch Scientific American Frontiers knows how much Alda likes science, but he’s not doing the work. He’s not encouraging children to get into the lab and learn about science; he’s looking at it as an outsider. 

So what are the reasons for the lack of scientists in the public eye? Is it the pressure to publish? The breakneck pace of current lab work? I don’t know the answer to this question, but as one who has been inspired by the likes of Sagan and Feynman, along with Bill Nye and Mr. Wizard, I hope it doesn’t stay this way. I hope someone has the heart to come forward and remind us of how fascinating real science can be.

Imaga via Flickr user wonderlane

The seven key technologies

1. Wind energy: move more generation offshore and resolve associated grid-integration issues.
2. Solar energy: divided into photovoltaics (PV) and concentrated solar power (CSP); PV stresses cost reduction through mass production; CSP calls for 10 first-of-a-kind pilot power plants.
3. Electricity networks: particularly in Europe, power must physically move between countries, and a unified business structure is required. The United States has similar needs.
4. Sustainable bio-energy: combined heat and power more than motor fuels.
5. Carbon Capture and Storage: acknowledges that coal will be used for the next 30 years; must deal with the CO2 in this period.
6. Sustainable nuclear fission: long favored by Europe, sets specific pathway to develop new “generation-IV reactors.”
7. Fuel cells and hydrogen: calls for portable, stationary, and transport applications; start now to build a hydrogen infrastructure across the EU.

Cost and funding

An important aspect of the plan is an estimation of cost and recommended allocation between the technologies. Solar would receive the largest share followed by carbon capture and storage, with a recognition that coal will be here for some time and the associated need to minimize CO2 to the atmosphere. Costs would be shared by private industry and public sector. A significant source of public funding would come from sales of carbon allowances from their cap-and-trade program. This, of course, is exactly opposite from U.S. plans, where it looks like they will be given away.

In my opinion, this plan is a significant challenge to the United States. Our Energy Department needs to step up and present its own comprehensive vision and use its legal powers, its purse, and the bully pulpit to push it forward. The United States is often philosophically wedded to the free market and absence of central control; however, these are not effective when time is of the essence. Time is of the essence for the problem of CO2. Think the Manhattan Project or the Apollo program—time mattered. The ability to make critical, timely decisions and a central coordinating function carried the day.

image from flickr user tristam sparks