Title: A Pediatrician Looks at DNT 2006
1A Pediatrician Looks at DNT2006
- Cynthia F. Bearer, MD, PhD
- Associate Professor, Pediatrics
- Case Western Reserve University
2A Pediatrician Looks at DNT2 years later
- Cynthia F. Bearer, MD, PhD
- Cobey Professor of Neonatology
- University of Maryland Hospital for Children
3Thank you, Johns Hopkins!
4Take Home Messages
- DNT affects at least 5 million Americans NOW
- There will NEVER be enough data or the right data
to know exactly what is harming our kids - We need to do something NOW protect kids now and
to protect future kids.
5Kids exist in the environment (Our moral duty)
6Spina Bifida (Neural Tube Defect - NTD)
7Developmental NeurotoxicityMagnitude of the
problem
- 50 of the 250,000 malformed children born each
year have nervous system or behavioral deficits - 4- 8 of children born each year anatomic or
functional deficits - 7 million Americans have mental retardation
- 0.4 million have autism spectrum disorders
- 10 of Americans have learning disabilities or
attention deficits - 17 of children lt18 y have gt 1 developmental
disabilities - In 1996, 12 of schoolchildren received Special
Ed
8Is There Even More Cause to Worry?
- Health conditions governed by adequate
functioning of the nervous system - Ex. Preterm birth
(the fetal
hypothalamo-
pituitary-
adrenal axis) - 10 live births
- NICU as a DNT
9Is There Even More Cause to Worry?
- Barkers Hypothesis (Fetal Origins of Adult
Disease) - Alzeiheimers
- Parkinsons
- Multiple Sclerosis
10What To Tell Parents?
- Parents with an affected child
- No, it wasnt that lawn product (for which there
is no DNT testing!) - Parents who are pregnant, or have a family
- Avoid everything!
- Dont use products where DNT testing has not been
done - Try to do your best?
- Right to Know Laws these we can do right now
11DNT is the result of a gene - environment
interaction
GENE
ENVIRONMENT
12Asparagus
13How many people does it take to make a sensitive
subpopulation?
14Multiple, Interacting Influences
15A New Model of Children s Health and Its
Influences
Development
Birth
Early adult
Time
16Additional Research Needs
- Mathematical models to analyze the data (data
mining vs hypothesis driven analysis)
17We will never have enough data
- Continuous functions
- Bigger brains
- Better learning and memory (maybe??)
- Discontinuous functions
- Language
- Music
- Mathematics
- Leadership
18Language
- Different parts of the brain from
vocalizations/gestures - Incredible speech acquisition of young
infants/children - Poetry
- To make a prairie, it takes a clover and one
bee,-- - One clover, and a bee,
- And revery.
- The revery alone will do
- If bees are few.
- Emily Dickinson
19MUSIC
Dancing with Cats
20MUSIC
William Wegman, Blue Period
21Leadership
- Everybody wants their kid to be President!!!
22Leadership
23Need to Act Now
- Chemicals which may be DNT may persist
24Neurotoxicants in Meconium
- Cincinnatis Childrens (B. Lanphear, PI)
- 450 mother-infant pairs
- Prospective
- Collect maternal samples/infant samples including
meconium - Collect maternal questionnaire and environmental
samples - 2 year follow up
25Total PCBs
26Total DDT
27Total pp-DDE
28Biomarkers
Biologically Effective Dose
Early Biological Effect
Altered Structure/ Function
Internal Dose
Out- comes
Exposure
Biomarker of Susceptibility
29Role of Biomarkers in DNT
- Indicate which chemicals humans are exposed to
- Can intervene at the point of exposure
- If collected over time, can establish trends in
exposure levels - Like flame retardants, perhaps rising levels in
humans merits restriction before health effects
are known
30In Vitro Testing
- Will in vitro testing identify biomarkers which
may be used to identify affected children?
31www.nationalchildrensstudy.gov
32National Childrens Study
- 100,000 children enrolled periconceptually
- Followed to 21 years of age
- Multiple biosamples obtained
- Exposure/outcomes data linked
- Opportunity to validate biomarkers from in vitro
testing to human data - Adjunct studies must be proposed
33Longitudinal Tracking Over Time
- NCS
- Other Countries Norway, Finland, Denmark,
England have health registries and linked data - Other Countries are going ahead with longitudinal
childrens studies
34What can we do now?
- Right to know inform parents that DNT testing
has not been done on certain products
Anne Geddes
35What can we do now?
- Collect available data in both cell models/in
vivo models/human data from academia/government
and industry sources
Anne Geddes
36What can we do now?
- Handbook to guide parents (and physicians!)
Anne Geddes
37What can we do now?
Create a group charged with recommending initial
steps
William Wegman
38What Else??
Anne Geddes