CHE Partner Forum: Call for Ideas and Comments

Dear CHE Partners,

We want your ideas! We’re in the process of evaluating various aspects of CHE’s services and initiatives and generating potential new ones. Given we are indeed a collaborative partnership, your innovative suggestions as to what CHE might do (within our mission, below) to address gaps or needs you see in the environmental health field would be genuinely welcome.

To facilitate this, we’re opening this Partner Idea Forum, a platform where you can offer your ideas. This one is interactive in that you can see, respond to and build on other partners’ suggestions.

As a major learning community for the field, CHE wants to do even more to serve our partners around the world. Please take a few to submit your thoughts. We’ve pulled some comments from recent surveys and posted them below to start the conversation, but feel free to start a new topic.

As with all comments to this blog, civil and respectful dialogue is expected. Please identify yourself as you submit comments. If you prefer to submit private comments that won’t be shared on this blog, please send them to us at

Note this Partner Idea Forum will stay open only until December 15th, so please get your ideas in soon!


The Collaborative on Health and the Environment’s (CHE’s) primary mission is to strengthen the science dialogue on environmental factors impacting human health and to facilitate collaborative, multifactorial, prevention-oriented efforts to address environmental health concerns. Founded in 2002 as a program of Commonweal, CHE is an international partnership of almost 5000 individuals and organizations in 87 countries and all 50 US states, including scientists, health professionals, health-affected groups, nongovernmental organizations and other concerned citizens, committed to improving human health across the lifespan.

CHE’s primary activities include:

  1. Sharing emerging scientific research on various  environmental factors that can contribute to disease and disability;
  2. Fostering interdisciplinary and inclusive collaboration among diverse constituencies interested in those links; and
  3. Facilitating effective actions to improve health across the lifespan.

CHE is nonpartisan and does not endorse specific policies. Anyone sharing CHE’s mission and supporting its Consensus Statement is invited to become a CHE Partner.

CHE has created graphical representations of the scope and structure of our work, shown at right and below (click on the graphics for larger versions).

CHE Administrative Graphic

I Am Now a Bionic Woman

written by Sarah Howard
Coordinator of the Diabetes-Obesity Spectrum Working Group

Sarah HowardJust in time for World Diabetes Day (#WDD, November 14th), I have started wearing an artificial pancreas to help manage my type 1 diabetes. Normally I wear an insulin pump along with a continuous glucose monitor (cgm), but the two gadgets do not actually talk to each other. That means I still have to manage my diabetes manually 24/7, like everyone else with diabetes. While manufactured artificial pancreases are being developed and are now performing well in clinical trials, they are not yet available to the public.

Thanks to CHE, I was able to attend the American Diabetes Association’s Scientific Sessions in Boston in June, where I met Dana Lewis and Scott Leibrand. These two extraordinary individuals, now married, worked to develop a do-it-yourself artificial pancreas for Dana by hacking into her insulin pump and cgm. They are doing this hacking both publicly (in talks with the FDA) and legally, working to make a safe, reliable, open-source artificial pancreas system: “The Open Artificial Pancreas System project (#OpenAPS) is an open and transparent effort to make safe and effective basic Artificial Pancreas System (APS) technology widely available to more quickly improve and save as many lives as possible and reduce the burden of Type 1 diabetes” (from Hacking Diabetes).

Since my husband Tim happens to know a little bit about programming, I texted him during the ADA meeting to see if he would be willing to try and make a pancreas. He said yes. He is awesome. Then I emailed my diabetes educator, and she just said, “Go for it!” With their blessings, and after talking to Dana and Scott about the legality of the effort, we decided to try to figure this out.

I scavenged some old pumps and other diabetes equipment out of the basement, and Tim started spending every free minute of his time combining the software tools developed by Scott and other programmers. Many months and infinite bouts of troubleshooting later, we are (mostly) up and running. By “we” I mean both my son and me. Our son, age 10, also has type 1 diabetes. Our first goal was to create an artificial pancreas for him to wear at night. Much of the time it is now working. Our next goal was to create an artificial pancreas for me to wear 24/7. Much of the time it is now working. He was the 13th person in the world to wear one of these; I am the 15th.

By “much of the time” I mean that Murphy’s Law is alive and well. I am now awaiting my 3rd battery system to arrive in the mail, as the other two have already failed. My son’s cgm sensor fell out of his arm last night, so obviously it can’t work without that. And those are only the technical glitches from the past 24 hours—there have been so many technical glitches over the past months that I can’t even begin to remember them all. But the beauty of this system is that if something goes wrong, it reverts to the regular insulin pump settings, so the worst-case scenario is just the regular life that everyone with diabetes deals with every day.

pancreas1For the past two nights, my blood sugar has been flat and in range. I have actually slept through the night, in normal range, for almost the first time in 17 years. I already have more energy than I can remember.

pancreas2My son is spending most nights with flat, in-range blood sugar as well, which means that we don’t have to get up at night to give him insulin or food.

However, I will say that this system is not a cure, nor even a magic bullet. We still have to give ourselves insulin manually when we eat, based on a simple calculation that includes grams of carbohydrates, grams of fat and protein, current blood glucose level, upcoming exercise, stress level, time of the month (hormones), amount we exercised yesterday, what we ate for breakfast, hypoglycemic events in past 48 hours, how long and how well we slept last night, vitamin D level, age of insulin infusion site, age of insulin, temperature, barometric air pressure, humidity, altitude…you get the idea of the complexity of managing type 1 diabetes. The system is also still limited by the characteristics of pharmaceutical insulin, which acts much more slowly than endogenous insulin, and takes longer to clear from the body. That means that so far, even wearing an artificial pancreas, I still get high and low blood sugars—especially if I do things like eat or exercise. Imagine.

But at night? So far, that is the real benefit for me. Diabetes is much easier to manage when you are not eating or exercising, as long as you are awake. To have something else take over so I can finally get some sleep, wow. Just wow.

Now, I might have more energy to work on what I really want to work on, which is figuring out what is causing the increasing incidence of type 1 diabetes, and how to prevent it. Did you see the new study that found that giving infants (at high genetic risk for type 1) probiotics in the first month of life successfully reduced their risk of developing type 1-associated autoimmunity? That is so exciting– this is one of the first type 1 diabetes prevention trials to actually have some success! See the abstract.

And speaking of the increasing incidence, did you see the new study from China that found type 1 incidence increasing at a rate of over 33% per year in children under five, between 2007 and 2013!? Wow. Why? We don’t know, but a number of other recent studies are finding links between air pollution and type 1 diabetes… hmmm….

For more on the potential causes of type 1 diabetes, including air pollution, see my website,

My artificial pancreas components: raspberry pi mini-computer, battery, insulin pump/cgm, and dongle.

My artificial pancreas components: raspberry pi mini-computer, battery, insulin pump/cgm, and dongle.

For more on the DIY artificial pancreas, see these sites:

And we can follow each other on twitter: @sarhoward and you can see my and others’ adventures at #OpenAPS and #WeAreNotWaiting.

Happy #DiabetesAwarenessMonth everyone!

Shangri-la Goes Up in Smoke (mostly PM2.5s)

written by Elise Miller, EdM

According to the Yale Environmental Performance Score in 2014, Nepal ranked 177 out of 178 countries in terms of poor air quality—stunningly, worse than China (ranked 176th). This would seem an abstract observation if it weren’t for the fact that my family and I will be in Kathmandu in about 10 days. My husband and I adopted our son (now 10 years old) from Nepal, and we are returning to his birth country for the first time since he was a baby. We’ll see his early caretakers and help with rebuilding a school and a milk shed in a village devastated by last spring’s earthquakes.

Not that long ago Nepal was seen to Westerners as a kind of Shangri-la, an earthly paradise. The term “Shangri-la” was coined in James Hilton’s 1933 novel Lost Horizon as a place where people were almost immortal, aging slowly and living years beyond the normal lifespan. Currently, almost the opposite seems true. Many look far older than their years given the pollution and poverty that permeate their lives. As we’ve been preparing to go, we have been repeatedly told to bring filter masks and spend as little time in Kathmandu as possible because of the terrible air quality. If it gets really bad, we’re of course the fortunate ones: Unlike the vast majority of residents, we can also simply leave.

airpollution2Sadly many cities around the globe share this plight. And concerns about the health impacts of air pollution (particularly, exposure to fine particulate matter—PM2.5) only continue to mount. (Note: Indoor air pollution is even more of a concern in certain regions of the world, but I’m only focusing on outdoor air pollutants for this piece.) Just in the last 10 days several different research studies on air pollution were published—results, respectively, showed associations with brain tumors in children, childhood leukemia, type 1 diabetes, and Alzheimer’s Disease biomarkers in children. That last one made me stop cold. What? Kids are now getting Alzheimer’s? Of course it’s more complex than that, but this research, conducted in Mexico City and published in the Journal of Alzheimer’s Disease and Parkinsonism, suggests that children’s long-term exposure to air pollution increases their risk of Alzheimer’s. Mexico City, like Kathmandu, is a huge metropolis in a valley surrounded by tall mountains. In this kind of geography, air stagnates under a high pressure thermal inversion that can trap the pollution for days, even weeks.

The more hopeful news is that cities such as Mexico City, Los Angeles, Beijing, and Delhi have all instigated efforts to address these outdoor air pollution issues, a few with marked success. But we are far from reducing PM2.5 levels, not to mention other air pollutants, such as ozone, to what might be considered acceptable levels (if there is such a thing). Even London’s pollution is on the rise again, according to an article in last Sunday’s New York Times. After thousands died in London in 1952 during the “great killer fog” (pollution mostly from coal and wood burning used for heating), the British passed a Clean Air Act. But with increasing car usage in London now, air pollution is apparently escalating too.

All of this is to underscore that we can’t wait until the last “Shangri-las” on the planet go up in smoke and Alzheimer’s becomes a disease of younger generations. We encourage you to continue to use the best available science that CHE highlights in multiple forums to grow public demand for prevention-oriented, health-protective actions and practices.

Breast Cancer Prevention Begins in the Womb

TedSchettlerwritten by Ted Schettler, MD, MPH
Science Director

As breast cancer awareness month ends with its primary emphasis on early detection I’ve been more interested in what we’ve learned about opportunities for prevention. Amidst all the pink ribbons and disagreements about optimal mammography scheduling an important theme seems to be finally taking hold. Although opportunities abound throughout life, breast cancer prevention begins in the womb.

This idea is not new. Twenty-five years ago Dimitri Trichopoulos proposed that breast cancer risk could originate in utero, influenced by maternal hormone levels.[1] Later studies linked hormone and growth factor levels with populations of breast stem cells in umbilical cord blood—a plausible mechanistic connection to cancer risk. A 2011 analysis reported a nearly two-fold increased risk of breast cancer in daughters of women who took estrogenic diethylstilbestrol (DES) during pregnancy before 1971.[2] This year, Barbara Cohn and colleagues reported that the highest maternal levels of the hormone-disrupting pesticide DDT during pregnancy were associated with a nearly four-fold increased risk of breast cancer in their daughters.[3]

The concept of windows of vulnerability to breast cancer risk during puberty and adolescence has been widely accepted for a number of years. We’ve long known, for example, that ionizing radiation exposure poses a larger breast cancer risk in adolescents and young women than in older women.

Studies also find that dietary patterns early in life have stronger associations with breast cancer risk than diets in adulthood. Childhood and adolescent diets with more whole soy products consistently seem to be more protective (associated with decreased risk) than dietary soy in adulthood.[4] Last year the Nurses’ Health Study II reported higher levels of red meat consumption in early adulthood were associated with increased risk of both pre- and post-menopausal breast cancer over 20 years of follow up. Substituting legumes or poultry or the combination of poultry, fish, legumes, and nuts for red meat was associated with a lower risk of breast cancer.

In 2007, Barbara Cohn and colleagues reported that higher serum levels of DDT were associated with a five-fold increased risk of breast cancer among women who were 14 years old or younger when exposed. Women who were not exposed before age 14 showed no association between DDT and breast cancer risk.[5]

But opportunities to prevent breast cancer begin even earlier. Graham Colditz from Washington University School of Medicine thinks that efforts at prevention should begin by age two. He says: “There is clear and growing evidence that diet composition in childhood and adolescence, physical activity, and alcohol intake before birth of the first child are all importantly related to the risk for premalignant breast lesions and invasive breast cancer. Diet and physical activity are the key factors. A child doesn’t end up obese at age 10 by starting to gain weight at age nine. Breast-feeding, avoiding drinking gallons of milk (which is associated with increased growth velocity), and keeping kids active—those are the key features in early childhood, and then moving to avoiding alcohol in late adolescence.”[6]

The DES story, Barbara Cohn’s work, and many animal studies tell us that it’s more than diet, exercise, and alcohol. Environmental chemical exposures in the fetus can alter gene expression, the trajectory of breast development and tissue architecture resulting in elevated breast cancer risk years later. Yet, we know far too little about those impacts because most commonly encountered chemicals to which the fetus is regularly exposed are simply untested.

Based on what we do know these data gaps are indefensible. But how do we proceed, given the enormous backlog of untested chemicals? Another of this year’s papers suggests a way forward. In “Screening for Chemical Contributions to Breast Cancer Risk: A Case Study for Chemical Safety Evaluation” Meg Schwarzman and her colleagues recommend a series of assays capable of detecting alterations to biological processes relevant to breast cancer, including cell molecular events, tissue changes, and factors that alter susceptibility.[7] This approach would help prioritize chemicals for more thorough evaluation and begin to identify needs for alternatives.EcologyOfBreastCancer

Breast cancer awareness month may be over but the urgency of breast cancer prevention has never been greater. Comprehensive efforts must begin before conception and continue throughout development and the entire lifespan. There is no single cause and there will not be a single solution. Diet, exercise, and avoiding alcohol are important. But let’s not ignore environmental chemicals that can shape breast cancer risk from the beginning.




[4] This refers to lightly processed whole soy products—not soy supplements or fractionated soy components in processed food.




Dr. Schettler is the author of The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing.

Camp Lejeune Male Breast Cancer Study

Dick Clappwritten by Dick Clapp, DSc MPH
CHE Partner and member of the ATSDR Camp Lejeune Community Assistance Panel

A recent scientific report has shed some light on chemical exposures and breast cancer, this time on male breast cancer in Marines who had spent time at Camp Lejeune, North Carolina. Last month, the online journal Environmental Health published a study titled “Evaluation of contaminated drinking water and male breast cancer at Marine Corps Base Camp Lejeune, North Carolina: a case-control study,” by Perri Ruckart, Frank Bove and co-authors at the Agency for Toxic Substances and Disease Registry.  The study was based on information about 71 male breast cancer cases in Marines and 373 controls that were in the Department of Veterans Affairs (VA) cancer registry and diagnosed between 1995 and May of 2013.  For those subjects who were at Camp Lejeune, it was possible to assign exposure levels to various drinking water contaminants based on previous models developed for mortality studies published earlier.

The results of this recent male breast cancer study indicated increased risk with exposure to tetrachloroethylene (PCE), dichloroethylene (DCE) and vinyl chloride in drinking water.  The excess risks were modest, with odds ratios ranging from 1.19 to 1.50, and the confidence intervals were wide and included 1.0.  This means that the results were not formally statistically significant, although the estimate of the effect of exposure was toward increased risk.  Similarly, there was a modest increased risk of earlier diagnosis of breast cancer in Marines who served at Camp Lejeune and were exposed to chemically contaminated drinking water.  The major limitation of the analyses in this publication is the small numbers of male breast cancer cases who were exposed at Camp Lejeune.  This is primarily due to the reliance on the VA cancer registry, which only collects data on about a quarter of the US veteran population.

While this latest publication is a preliminary indication of increased risk of male breast cancer from exposure to chlorinated chemicals in drinking water, and it supports the contention by former Marines and family members that there were excess cases, it is not the final word on this issue.  Previous studies of PCE in drinking water and female breast cancer in Cape Cod, Massachusetts, women have suggested an increased risk from this exposure.  Occupational studies of women exposed to chlorinated solvents at work and breast cancer risk are inconsistent and limited in statistical power.  As Dr. Patrick Breysse, director of the CDC National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry, said in a recent interview, it will be examined in more detail in a larger Camp Lejeune cancer incidence study currently in the planning stage.

October is Breast Cancer Awareness Month.

Will ECHO Ring True? Building on the Failed National Children’s Study

Will ECHO Ring True? Building on the Failed National Children’s Study

written by Elise Miller, EdM

In 2000, a bipartisan Congressional vote established the National Children’s Study (NCS). This birth-cohort study was intended to follow 100,000 US children from the prenatal period to age 21 in order to better understand the impacts of chemical exposures and other environmental factors on children’s health and development. Fourteen years and $1.3 billion dollars later, the National Institutes of Health (NIH) pulled the plug on NCS last December citing design flaws and feasibility challenges. At the end of last month, however, NIH launched a major new study, Environmental Influences on Child Health Outcomes (ECHO), asserting that it will build on NCS while correcting for what didn’t work.

Continue reading

Top 10: 3rd Quarter 2015

We present the ten most significant news or research stories in environmental health of the last quarter, in CHE’s view. The first three items are statements from major scientific or health organizations summarizing large bodies of research and drawing conclusions about the interaction of our environments and our health. These reports join a growing list of statements and documents (see compilations of consensus statements and of resolutions and scientific statements on CHE’s website).

Additional items in this list present notable new research, new policy developments, new focus or new thinking on their respective topics.

  1. FIGOInternational Federation of Gynecology and Obstetrics opinion on reproductive health impacts of exposure to toxic environmental chemical: The global health and economic burden related to toxic environmental chemicals is in excess of millions of deaths and billions of dollars every year, including impacts on health and quality of life. On the basis of accumulating robust evidence of exposures and adverse health impacts related to toxic environmental chemicals, the International Federation of Gynecology and Obstetrics (FIGO) joins other leading reproductive health professional societies in calling for timely action to prevent harm.
    Read CHE’s Blog post on the statement, written by a statement author, and join CHE’s call on the statement on October 30th.
  2. Executive Summary to EDC-2: The Endocrine Society’s second scientific statement on endocrine-disrupting chemicals: The full Scientific Statement represents a comprehensive review of the literature on seven topics for which there is strong mechanistic, experimental, animal, and epidemiological evidence for endocrine disruption, namely: obesity and diabetes, female reproduction, male reproduction, hormone-sensitive cancers in females, prostate cancer, thyroid, and neurodevelopment and neuroendocrine systems.
  3. PlanetaryHealthSafeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health: A growing body of evidence shows that the health of humanity is intrinsically linked to the health of the environment, but by its actions humanity now threatens to destabilize the Earth’s key life-support systems.
    See the infographic that accompanies this report.
  4. California bill leads nation with significant steps to limit antibiotic overuse in meat production: The US Centers for Disease Control and Prevention (CDC) has identified antibiotic resistance as one of the top health threats facing the nation. This action puts California at the forefront of efforts in the US to limit the misuse and overuse of antibiotics in meat production and protect the efficacy of precious antibiotics.
  5. Pesticide exposure linked to diabetes development: New studies, including a meta-analysis, appear to show that there is a link between exposure to pesticides and the later development of diabetes, researchers reported at the annual meeting of the European Association for the Study of Diabetes.
    See more about the meta-analysis: Analysis of 21 studies shows exposure to pesticides is associated with increased risk of developing diabetes.
    Although this meta-analysis and other studies were presented at a conference and have not been published, we felt this topic merited inclusion in the Top 10 because it reinforces the growing number of peer-reviewed studies that suggest a link between diabetes and pesticides.
  6. Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead: Our analysis suggests that the cumulative effects of individual (non-carcinogenic) chemicals acting on different pathways, and a variety of related systems, organs, tissues and cells could plausibly conspire to produce carcinogenic synergies.
    See news coverage on this report from the National Institute of Environmental Health Sciences (NIEHS): Exposure to low levels of chemical mixtures linked with cancer and Low-dose mixtures and cancer highlighted at NIEHS symposium, plus CHE’s teleconference call on the report: Theories of carcinogenesis: assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment.
  7. Association of child poverty, brain development, and academic achievement: Poverty is tied to structural differences in several areas of the brain associated with school readiness skills, with the largest influence observed among children from the poorest households.
    See a news report on the study, drawing from an interview with the study senior author: Effect of poverty on brains may explain poor kids’ lower test scores.
    As the author notes, this study “closes the loop and adds the missing piece” regarding the connection between poverty, brain development and academic achievement, finding that the effects are mediated by a smaller hippocampus and frontal and temporal lobes and that the decrease in volume of the latter two structures explained as much as 15% to 20% of the achievement deficits found. Of note is that children facing numerous other risk factors for poor brain development were screened out from this study. cumulativeImpactsThe impacts of poverty, nutrition, conflict, disease and other stressors in addition to exposures to toxic chemicals and radiation each may have individual and synergistic effects on brain development. This study brings focus to the role of poverty on brain development and achievement, but because children living in poverty often face other adverse conditions concomitant to poverty, the full effects of poverty are likely even greater than reported in this study.
  8. Two articles on health effects of hydraulic fracturing (fracking): Endocrine-disrupting chemicals and oil and natural gas operations: potential environmental contamination and recommendations to assess complex environmental mixtures and Environmental and health impacts of ‘fracking’: why epidemiological studies are necessary. These articles make the case for concern over serious impacts on health and call for more research, including regarding the endocrine-disrupting potential of chemicals used in the process.
  9. The scandal regarding Volkswagen’s programming cars to avoid emissions control. A flurry of news reports on this situation were published. We present two focusing on human health impacts: Scientists say car emissions rigging raises health concerns and How many deaths did Volkswagen’s deception cause in the US? Because 11 million cars worldwide may be affected, and because diesel-fueled cars account for just 3 percent of passenger vehicles in America but closer to 50 percent in Europe, the health impacts of VW’s intentional undermining of clean air standards could be enormous.
  10. The Center for Public Integrity’s series on occupational exposures and health. CPI’s reports published a long list of articles describing the health impacts of occupational exposures on workers and their families, the failure of current safeguards, the push to weaken even those, and recommendations for reform.