A Pediatrician Looks at DNT 2006

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A Pediatrician Looks at DNT2006

• Cynthia F. Bearer, MD, PhD
• Associate Professor, Pediatrics
• Case Western Reserve University

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A Pediatrician Looks at DNT2 years later

• Cynthia F. Bearer, MD, PhD
• Cobey Professor of Neonatology
• University of Maryland Hospital for Children

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Thank you, Johns Hopkins!
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Take 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.

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Kids exist in the environment (Our moral duty)
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Spina Bifida (Neural Tube Defect - NTD)
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Developmental 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

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Is 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

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Is There Even More Cause to Worry?

• Barkers Hypothesis (Fetal Origins of Adult
  Disease)
• Alzeiheimers
• Parkinsons
• Multiple Sclerosis

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What 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

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DNT is the result of a gene - environment
interaction
GENE
ENVIRONMENT
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Asparagus
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How many people does it take to make a sensitive
subpopulation?
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Multiple, Interacting Influences
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A New Model of Children s Health and Its
Influences
Development
Birth
Early adult
Time
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Additional Research Needs

• Mathematical models to analyze the data (data
  mining vs hypothesis driven analysis)

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We will never have enough data

• Continuous functions
• Bigger brains
• Better learning and memory (maybe??)
• Discontinuous functions
• Language
• Music
• Mathematics
• Leadership

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Language

• 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

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MUSIC
Dancing with Cats
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MUSIC
William Wegman, Blue Period
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Leadership

• Everybody wants their kid to be President!!!

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Leadership
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Need to Act Now

• Chemicals which may be DNT may persist

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Neurotoxicants 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

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Total PCBs
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Total DDT
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Total pp-DDE
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Biomarkers
Biologically Effective Dose
Early Biological Effect
Altered Structure/ Function
Internal Dose
Out- comes
Exposure
Biomarker of Susceptibility
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Role 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

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In Vitro Testing

• Will in vitro testing identify biomarkers which
  may be used to identify affected children?

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www.nationalchildrensstudy.gov
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National 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

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Longitudinal 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

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What can we do now?

• Right to know inform parents that DNT testing
  has not been done on certain products

Anne Geddes
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What can we do now?

• Collect available data in both cell models/in
  vivo models/human data from academia/government
  and industry sources

Anne Geddes
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What can we do now?

• Handbook to guide parents (and physicians!)

Anne Geddes
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What can we do now?
Create a group charged with recommending initial
steps
William Wegman
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What Else??
Anne Geddes