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Interview with Exchange Speaker & Environmental Health Hero Ted Schettler, MD

Posted By Administration, Tuesday, October 4, 2011
Updated: Thursday, January 30, 2014
Dr. Ted Schettler will be speaking during the General Session at Exchange 2011 on the topic of Environmental Diabetogens on Friday, November 18, 2011, from 11:00 am - 12:00 pm. Learn more about Dr. Schettler in our interview with the Environmental Health Hero.

Interview conducted by Michelle Schiavo - Social Impact Coordinator for ACAM.

ACAM: How did you become interested and involved in environmental health issues?

Dr. Schettler: I practiced clinical medicine for many years with a parallel interest in the environment and environmental health. It always seemed rather intuitive to me that there is a strong link between environmental variables and human health. It was also striking to me that that connection was not typically realized in the world of clinical medicine. Of course there were a few exceptions; individuals that more readily saw that connection than others, and things like lead poisoning of children has a long history of attention in medicine, but it was a rather limited number of topics in environmental health that had made their way into clinical medicine. And I just felt that a lot of the diseases and disorders that we see in clinical medicine have an environmental link, to some extent at least, and it was increasingly interesting to me which helped to shape the more recent part of my career.

ACAM: How important do you think environmental exposures to toxins like endocrine disruptors are in the etiology of type 2 diabetes?

Dr. Schettler: This is a topic of intense research and a very good question that I don’t know and I don’t think that anyone really knows the answer to. We know that type 2 diabetes is what we may call a multi-factorial disease, where there are a number of things that contribute to it. Historically we’ve been aware that as populations of people tend to become obese and change their diets in certain ways they’re at increased risk for developing type 2 diabetes. Only in the past 10 or 15 years has the idea that environmental chemicals may be contributing to type 2 diabetes has had any real traction at all. Even today I think that the extent to which environmental chemicals explain the population variants of type 2 diabetes, I don’t think any of us really knows the answer to that yet.

I was recently at a conference where the main topics were both obesity and diabetes and their links to environmental chemicals. Most of the world’s experts were there, both epidemiologists and basic bench researchers, looking at the evidence and trying to come to some conclusions about how strong the links are, what we know and what don’t we know, and what should the research agenda look like. I think that even after that conference the jury is still out as to the extent to which environmental chemicals explain what we are seeing in the general public. But, it’s certainly now very plausible that the environmental chemicals are important contributors and it’s getting a lot of research attention.

ACAM: Would you say that the medical community is then understanding the importance of environmental exposures in the worldwide epidemic of diabetes?

Dr. Schettler: No, because the research interest is coming both from the field of toxicology and epidemiology and I think it’s fair to say that those findings (with certain exceptions obviously) have simply not made their way into mainstream clinical medicine. I would venture to say that many typical clinicians have not even heard of the issue, although it is possible that more have heard of it now because it is making its way into the newspapers a bit. But, the medical journals that clinicians tend to read don’t cover this topic and many other environmental health topics very regularly, so it would be very easy for clinicians to completely miss this unless they happen to be reading a little bit more widely than many clinicians do.

ACAM: You do environmental health work and research on behalf of several organizations. What are you currently working on to spread this important message?

Dr. Schettler: One of the projects that I have been working on for about the last 5 years or so is a report that I co-authored with several colleagues called, Environmental Threats to Healthy Aging. We had looked previously at environmental contaminants and environmental chemicals and how they influence both reproductive health and child development, specifically things like neurological developments in children which prompted our interest in what’s going on in the other end of the lifespan. What do we know or what don’t we know about the effects of environmental variables on older people. And as we got into that literature several things became clear. First was that we needed to have a very expansive view of what the environment is. So, it’s not just environmental chemicals but it’s things like social circumstances, diet, nutrition and so on. If you look at the built environment and whether or not people are living in a place where they can safely walk the streets and get regular exercise will influence whether or not they do get exercise. Secondly, even if we’re interested in the effects of environmental variables on health later in life it turns out that we have to look at the whole lifespan because a lot of what happens early in life, both during fetal development, childhood and early adulthood, influence health status later in life. So, it really ends up requiring a lifespan approach.

We published Environmental Threats to Healthy Aging, which covers a number of chronic diseases and conditions that are prevalent in our time, things like diabetes, cardiovascular disease and cognitive decline - dementia, Alzheimer’s disease and so on. Now we’re working to get this information out into the mainstream through multiple channels; grand rounds presentations to clinicians, getting shorter articles into medical journals, and getting other organizations that are particularly interested and concerned with the health of elders informed and interested in this topic. It’s really a multi-pronged approach to try to get this information out.

ACAM: How did it feel to earn the title of Environmental Health Hero for 2011 from Health Care Without Harm?

Dr. Schettler: It was a great honor and I’m especially grateful because I was chosen by my colleagues. I truly feel that I received the award on behalf of a whole community of people. This work in environmental health is truly community activity without question. We are picking up where people who came before us did, and this work is a collaboration, I think most of us couldn’t accomplish much doing it alone.

It was also an opportunity to reflect on the work that we’ve been doing at Health Care Without Harm to try and improve the environmental performance of the medical industry. Plus a chance to point out that the real gains to be made in terms of reducing the environmental footprint of the medical industry would be keeping people from getting so sick in the first place. We have so many high-tech interventions that we bring to people that are sick with preventable diseases. All the cardiovascular disease, diabetes, many different kinds of cancer, and so on are diseases and disorders that we know an awful lot about how to prevent and by preventing these diseases and conditions we will reduce the need for these high-tech interventions. As we know from the debate that’s going on right now in this country about the need to reform Medicare, it’s because these high-tech interventions are going to break the bank. In addition to the economic impacts are also environmental impacts. All of the surgeries, all of the medical equipment, all of the resources that are used to create that equipment and to use it, to transport it, dispose of it and so forth have a real environmental consequences. So I used this award as an opportunity to talk a little bit about the opportunities for disease prevention. You know, the greenest surgery is the one that’s never done. Just like, the greenest building is the one that’s never built. And we know a lot about how to reduce this demand on expensive healthcare interventions. So I do think that that is a frontier that we need to explore more seriously and more regularly.

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