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