Philip J. Landrigan

Developmental neurotoxicity of industrial chemicals

Neurodevelopmental disorders such as autism, attention deficit disorder, mental retardation, and cerebral palsy are common, costly, and can cause lifelong disability. Their causes are mostly unknown. A few industrial chemicals (eg, lead, methylmercury, polychlorinated biphenyls [PCBs], arsenic, and toluene) are recognised causes of neurodevelopmental disorders and subclinical brain dysfunction. Exposure to these chemicals during early fetal development can cause brain injury at doses much lower than those affecting adult brain function. Recognition of these risks has led to evidence-based programmes of prevention, such as elimination of lead additives in petrol. Although these prevention campaigns are highly successful, most were initiated only after substantial delays. Another 200 chemicals are known to cause clinical neurotoxic effects in adults. Despite an absence of systematic testing, many additional chemicals have been shown to be neurotoxic in laboratory models. The toxic effects of such chemicals in the developing human brain are not known and they are not regulated to protect children. The two main impediments to prevention of neurodevelopmental deficits of chemical origin are the great gaps in testing chemicals for developmental neurotoxicity and the high level of proof required for regulation. New, precautionary approaches that recognise the unique vulnerability of the developing brain are needed for testing and control of chemicals.

Neurobehavioural effects of developmental toxicity

Neurodevelopmental disabilities, including autism, attention-deficit hyperactivity disorder, dyslexia, and other cognitive impairments, affect millions of children worldwide, and some diagnoses seem to be increasing in frequency. Industrial chemicals that injure the developing brain are among the known causes for this rise in prevalence. In 2006, we did a systematic review and identified five industrial chemicals as developmental neurotoxicants: lead, methylmercury, polychlorinated biphenyls, arsenic, and toluene. Since 2006, epidemiological studies have documented six additional developmental neurotoxicants-manganese, fluoride, chlorpyrifos, dichlorodiphenyltrichloroethane, tetrachloroethylene, and the polybrominated diphenyl ethers. We postulate that even more neurotoxicants remain undiscovered. To control the pandemic of developmental neurotoxicity, we propose a global prevention strategy. Untested chemicals should not be presumed to be safe to brain development, and chemicals in existing use and all new chemicals must therefore be tested for developmental neurotoxicity. To coordinate these efforts and to accelerate translation of science into prevention, we propose the urgent formation of a new international clearinghouse.

Benzene and leukemia. An epidemiologic risk assessment

To assess quantitatively the association between benzene and leukemia, we evaluated the rate of mortality experienced by a cohort occupationally exposed to benzene. Using data from historical air sampling surveys, we estimated the daily benzene exposure for each member of the cohort. The expected number of leukemia deaths was calculated and compared to the actual number of leukemia deaths that occurred. The overall standardized mortality ratio (SMR) for leukemia was 337. Person-years at risk within the cohort were stratified by increasing levels of cumulative benzene exposure. The resulting SMRs increased from 109 to 322 to 1186 and to 6637 with respective increases in cumulative benzene exposure from less than 40 ppm-years to 40-199, 200-399, and greater than 400. The shape of the exposure-response relation was examined with a case-control analysis. Another analysis was performed to take into account an induction period for leukemia. All of the analyses demonstrated that a strongly positive exposure-response relationship exists between benzene and leukemia. Previous attempts to quantify this cohorts risk of developing leukemia were based on surrogates of exposure, such as duration of employment. Using actual air sampling data to estimate individual exposures represents a marked improvement over these previous attempts and emphasizes the importance of conducting industrial hygiene surveys and maintaining historical exposure records.

Public Health and Economic Consequences of Methyl Mercury Toxicity to the Developing Brain

Methyl mercury is a developmental neurotoxicant. Exposure results principally from consumption by pregnant women of seafood contaminated by mercury from anthropogenic (70%) and natural (30%) sources. Throughout the 1990s, the U.S. Environmental Protection Agency (EPA) made steady progress in reducing mercury emissions from anthropogenic sources, especially from power plants, which account for 41% of anthropogenic emissions. However, the U.S. EPA recently proposed to slow this progress, citing high costs of pollution abatement. To put into perspective the costs of controlling emissions from American power plants, we have estimated the economic costs of methyl mercury toxicity attributable to mercury from these plants. We used an environmentally attributable fraction model and limited our analysis to the neurodevelopmental impacts—specifically loss of intelligence. Using national blood mercury prevalence data from the Centers for Disease Control and Prevention, we found that between 316,588 and 637,233 children each year have cord blood mercury levels > 5.8 μg/L, a level associated with loss of IQ. The resulting loss of intelligence causes diminished economic productivity that persists over the entire lifetime of these children. This lost productivity is the major cost of methyl mercury toxicity, and it amounts to

Early environmental origins of neurodegenerative disease in later life.

8.7 billion annually (range,

What causes autism? Exploring the environmental contribution

2.2–43.8 billion; all costs are in 2000 US

NEUROPSYCHOLOGICAL DYSFUNCTION IN CHILDREN WITH CHRONIC LOW-LEVEL LEAD ABSORPTION

). Of this total,

The World Trade Center Disaster and the Health of Workers: Five-Year Assessment of a Unique Medical Screening Program

1.3 billion (range,

Methylmercury exposure in a subsistence fishing community in Lake Chapala, Mexico: an ecological approach

0.1–6.5 billion) each year is attributable to mercury emissions from American power plants. This significant toll threatens the economic health and security of the United States and should be considered in the debate on mercury pollution controls.

The Faroes statement: Human Health effects of developmental exposure to chemicals in our environment

Parkinson disease (PD) and Alzheimer disease (AD), the two most common neurodegenerative disorders in American adults, are of purely genetic origin in a minority of cases and appear in most instances to arise through interactions among genetic and environmental factors. In this article we hypothesize that environmental exposures in early life may be of particular etiologic importance and review evidence for the early environmental origins of neurodegeneration. For PD the first recognized environmental cause, MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine), was identified in epidemiologic studies of drug abusers. Chemicals experimentally linked to PD include the insecticide rotenone and the herbicides paraquat and maneb; interaction has been observed between paraquat and maneb. In epidemiologic studies, manganese has been linked to parkinsonism. In dementia, lead is associated with increased risk in chronically exposed workers. Exposures of children in early life to lead, polychlorinated biphenyls, and methylmercury have been followed by persistent decrements in intelligence that may presage dementia. To discover new environmental causes of AD and PD, and to characterize relevant gene–environment interactions, we recommend that a large, prospective genetic and epidemiologic study be undertaken that will follow thousands of children from conception (or before) to old age. Additional approaches to etiologic discovery include establishing incidence registries for AD and PD, conducting targeted investigations in high-risk populations, and improving testing of the potential neurologic toxicity of chemicals.