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.
Unlike NCS, which planned to enroll a very large new birth cohort, ECHO will primarily use existing cohorts and tissue repositories to try to get at similar questions. There is certainly a logic to doing it this way. First, ECHO as currently defined would minimize the pragmatic challenges of recruiting tens of thousands of pregnant women with the intention of following their offspring for two decades—something that proved far harder and more complex at the early stages of NCS than hoped. Plus, by utilizing research that has already been undertaken, costs inherent in designing and implementing new studies could be reduced. In addition, ECHO intends to employ technological advances that didn’t exist 15 years ago, including much more sophisticated exposure measurement tools. This could mean more in-depth, complex, and edifying analyses over time. Furthermore, budding areas of research, like the microbiome, that weren’t a research priority in 2000, are to be included in ECHO.
That said, some experts in children’s environmental health have expressed concern that ECHO may be hindered for the very reasons that NCS was created in the first place. For example, the reason for recruiting 100,000 kids in NCS was so that associations found between environmental exposures and certain diseases and disabilities could be interpreted with greater confidence. By contrast, ECHO plans to utilize smaller birth cohorts already enrolled in previous or ongoing studies—studies that may or may not employ the same design and methodologies, thereby potentially making research results harder to assess. Furthermore, exposure samples taken a number of years ago may not adequately provide the information needed to fulfill specific aspects of ECHO’s research agenda.
The last concern I will mention here is that ECHO is not funded for the long term, which was a major undoing of NCS. Nor does it have a long-term research strategy beyond five to seven years, in large part because there isn’t secure funding. This “chicken before the egg” scenario could result in lots more money being invested without the hoped-for results—namely, robust, coordinated, sophisticated research that can provide the grounds for more effective interventions to improve children’s environmental health (see: Growing a New Study: Environmental Influences on Child Health Outcomes).
Given all these caveats, it makes sense to wonder whether ECHO will simply echo the pitfalls of previous efforts, or instead, ring true to its stated purpose. Yet it is the best thing going now. Indeed, it has the greatest potential of any major children’s environmental health research initiative currently funded. By uncovering patterns of exposure and biological mechanisms, ECHO can help better inform our individual and collective decision-making regarding children’s health.
In this light, it seems prudent to do whatever we can to ensure that ECHO receives the necessary funding and dedicated attention it deserves for years to come. Failing again would only leave our children’s health and future even more at risk.
P.S. To learn more about CHE’s recent activities honoring World Environmental Health Day (September 26th) leading into Children’s Health Month (happening now!), please see the blog posts written by several luminaries in the field or listen the MP3 recording of the recent interview I did with Dr. Phil Landrigan.