Take HEED-If Not Now, When?
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As never before in history, humans can dramatically change the world and do it
quickly. No more is there the need for millennia and the trials of natural
selection or the cumulative effects of human-related alteration of the environment;
we have genetic engineering on one hand, and industrial pollution and deforestation
on the other, occurring at an unprecedented speed and time scale. On the political
side, things can change even faster. An election, for example, is often quickly
felt within weeks, and the changes following the events in New York and Washington,
DC, on 11 September 2001 were effected in not more than a blink of the eye.
Although these may appear to be disparate themes, they are all related to the
environment, including the physical, the social, and the political. In addition,
they all impact in one way or another on the huge and growing global disparity
in the health of people in the rich nations versus the poor ones, which is
attributable in large part to environmental degradation, social disruption,
and political dysfunction. To make matters worse, these disparities are magnified
by a growing knowledge divide on the ways to improve health through new approaches
to a safe environment and strategies to develop and deliver drugs, vaccines,
and medical care; social organization; and political mobilization of resources.
In recent years, an important theme and a new paradigm has been emerging.
It begins with the dual recognition that riches without health impoverishes
the quality of life, and the fact that the impoverished cannot buy good health;
in fact, ill health directly contributes to poverty. In turn, poverty traps
and ill health lead to economic instability and may sow the seeds of political
instability. Like it or not, the world, its environment, and its people are
interconnected, even when separated by geography, socioeconomic gaps, or political
systems. SARS (severe acute respiratory syndrome) and bird influenza are but
two recent examples of the consequences of viral admixture arising in Asia
within uncontrolled and crowded populations of fowl, mammals, and humans. The
ripples of both emerging infections have been rapidly felt in distant and well-sanitized
corners of the earth--just ask the economists, public health professionals,
and the people of Toronto, Canada. Yet, humans can just as easily apply knowledge
toward solutions for common problems, if there is a will to do so. Science
advances allowed the identification of the SARS coronavirus within weeks of
its emergence, an unprecedented tour de force. This has set the stage for rapidly
scaled-up public health control efforts, vaccine development, and a search
for effective drugs. Global mobilization can also work to limit the spread
and impact of bird influenza. This global science is, importantly, no longer
colonial in nature; it is conducted by the well educated and privileged in
all countries, developed and developing, on behalf of the undereducated and
underprivileged. In reality, to be effective, contemporary science must include
scientists of all nations in order to identify problems quickly and to work
on solutions in timely fashion.
The National Institutes of Health (NIH) and its Fogarty International Center
(FIC) have played an increasingly important role in globalizing science to
developing countries. In the field of environmental health, the National Institute
of Environmental Health Sciences (NIEHS) together with the FIC has supported
critical and collaborative research as well as long-term investments in the
career development of the needed environmental health scientists in developing
countries. Together, the FIC and the NIEHS have promoted an ecologic research
approach toward emerging infections, have supported prospective multidisciplinary
studies on the relationship between improved health and economic performance,
have helped to train ethicists who can ensure that research conducted in developing
countries is both ethical and culturally consistent with global standards,
and are investing together in the improvement of medical journals in Africa
and medical journalism for the public. Some may be surprised that a high-level
national biomedical research agency such as the NIH would have such a global
perspective, but it is entirely consistent with the NIH mission to conduct
research to improve the health of people everywhere. In this context, science
is no longer alone in the ivory tower, separated from the real world, or conducted
for the sake of exploration alone. Although creativity, ingenuity, and invention
continue to be the guiding light of excellent science, this is not enough to
address the problems. It has long been said that science without dissemination
is not good science. Today, the thought must be extended to the concept that
science without application is also not good science. Biomedical and health-related
social science, however fundamental and "upstream," must maintain a goal orientation
toward ultimate application to improve human health; to this mantra, we must
also add the word "everywhere."
The Health, Environment, and Economic Development (HEED) program, codeveloped
by the FIC and the NIEHS and described in this issue of EHP, is an example
of bringing creative scientists together to address broad interdisciplinary
problems. HEED was created to focus science on the concept of sustainable development--specifically
to encourage research on the human health consequences of development investments
and their environmental consequences. It complements an existing FIC program,
International Studies in Health and Economic Development (also cofunded by
the NIEHS), which studies the impact of improving human health on productivity
and economic development. HEED represents the reverse intent--to better understand
the impact of development-related environmental alterations on health. Together,
the two programs will generate new information of considerable relevance to
the future of the human race and the earth, as well as all of the species that
coinhabit the planet with us.
There has never been a time when the availability of resources, trained people,
new approaches, and global awareness coincide as they do today. Given the continued
abuse of our physical, social, and health environments; the magnitude of global
environmental problems; and the potential to develop solutions, we must ask
if not now, when? To those who say we in this country cannot afford to pay
attention to the rest of the world, it can be countered that we actually cannot
afford not to.
Gerald T. Keusch
Boston University Medical Campus
Boston, Massachusetts,
E-mail: keusch@bu.edu
Gerald T. Keusch is a physician-scientist involved in basic
and applied research on global health problems in developing countries. Before
assuming his current positions earlier this year as Provost and Dean for Global
Health at Boston University Medical Center, he was Associate Director, International
Research, and Director of the Fogarty International Center, National Institutes
of Health.
Relevance of the National Institutes of Health Roadmap Initiatives to the
Field of Environmental Health
Advances in biomedical research have been remarkable during the decades of the
1980s and 1990s. Yet, translation of the basic research discoveries into prevention
and treatment strategies has been disappointing. In an attempt to make the
process more efficient, the National Institutes of Health (NIH) unveiled a
Roadmap initiative in October 2003. The overall objective of the Roadmap investments
is to provide scientists with the technologies, human resources, and institutional
infrastructures to enable the more efficient translation of basic science discoveries
into practice. The NIH Roadmap is entirely consonant with the mission of the
National Institute of Environmental Health Sciences (NIEHS) and presents numerous
opportunities for environmental health scientists to expand current research
studies and explore new directions.
In fact, the NIEHS has developed several new research programs over the past
6 years to achieve many of the same objectives targeted in the NIH Roadmap
initiatives. These include the Environmental Genome Project in 1997; the Mouse
Genetic Variation Mapping Initiative in 2000; the National Center for Toxicogenomics
in 2001; and the Consortium Centers Program for Parkinson's Disease and Breast
Cancer in 2002 and 2003, respectively. Multicenter clinical studies and community-based
prevention/intervention research programs were also developed in the early
1990s to promote translation into practice. The NIEHS initiated these efforts
because our investigators need access to the same tools, databases, and other
resources required for the advancement of biomedical research, irrespective
of the field of specialization.
Both the scientific opportunities and the scale and complexity of environmental
health research have changed dramatically over the past decade. Simplistic
models and reductionist approaches to the understanding of toxicity are giving
way to more holistic or systems biological approaches that allow us to investigate
multiple molecular events, pathways, and interactive networks simultaneously.
In part, this evolution in scale and complexity is the result of a voluminous
literature, derived from epidemiologic studies as well as human and animal
experiments, which show that human health and disease are the result of complex
interactions involving genetic, environmental, behavioral, and age-related
factors often combined with random or stochastic events. Also, investments
in the genomic sciences over the past 25 years have led to the development
of new knowledge, resources, and powerful technologies for use in probing biological
events at the molecular level. However, to untangle the complex interactions
between genes, environment, and behavior to prevent human illness, we will
need even more powerful tools--new databases and resources--and more robust
institutional infrastructures to translate the science into the practice of
public health and medicine.
One of the major challenges in understanding how genes, environment, and
behavior interact to influence phenotype is to develop technologies and methodologic
approaches to identify and characterize all of the functional molecules (e.g.,
RNA, protein, carbohydrate lipids, and metabolites) encoded by genomic DNA
of humankind and other animals (e.g., mouse and rat) used as surrogate models
in medical research. These technologies, reagents, and standards must be sensitive
and reproducible enough to detect a single molecule per cell. Also, large-scale
multi-institutional standardization studies are critical for developing robust
databases and other resources, and for sharing and comparison of data between
investigators and among laboratories. Although identification and characterization
of the above "parts list" is a daunting challenge, it is just the first requirement;
to prevent illness, we must understand how these parts work together in health
and disease. Such complex problems cannot be addressed within the framework
of a single field of knowledge, so this endeavor will require the creation
of radically new approaches and technologies. New multidisciplinary teams that
are capable of studying complex systems will have to be developed; this new
way of approaching biomedical research is at the core of the NIH Roadmap.
Environmental health research is an important discipline that has had a huge
impact on environmental health regulatory policies, public health and the practice
of medicine, and the national economy. To continue to play an important role
in the biomedical research enterprise, we must embrace new technologies and
model systems, as described in the NIH Roadmap, to elucidate interactions between
genes, proteins, and the environment. The time-honored way of determining which
drug or environmental xenobiotics are toxic to humans (i.e., to expose hundreds
of animals to the specific compound and observe them months or years later
for adverse health outcomes) costs millions of dollars, requires hundreds of
animals, provides little information with respect to mechanisms, and does not
take into account genetic and age-related differences in the human population.
I am pleased that the environmental health sciences are experiencing a renaissance,
being invigorated by efforts to apply "omic" technologies to gain a better
understanding of the biological basis of toxicity of drugs and other environmental
xenobiotics. I am proud of my involvement in the development of the NIH Roadmap
Initiatives because I believe they represent the "right" investments to "enable
or empower" medical researchers to make the next quantum leap in conquering
the epidemic of chronic diseases. Their development and pursuit represent a
welcomed and much needed departure from "business as usual." I expect that
the proposed initiatives will accelerate both the pace of discoveries in the
environmental health sciences and translation into practice.
Kenneth Olden
Director, NIEHS
National Institutes of Health
Department of Health and Human
Services
Research Triangle Park,
North Carolina
E-mail: olden@niehs.nih.gov
Note from the Editors:
Online Submission Begins This Month |
Beginning this month, authors will be able to submit
manuscripts to EHP over the Internet. Since the late 1990s, EHP has been
accepting manuscripts electronically as e-mail attachments. In fact, over
95% of submissions are currently received this way. Although an e-mail
submission system is much better than the paper submission process of old,
there are obvious limitations, such as file size and formatting issues.
We have chosen to use the Online Submission and Review System (OSRS) developed
and used by the American Society for Biochemistry and Molecular Biology,
publishers of the Journal of Biological Chemistry (JBC). If you have submitted
to JBC, you will have no problem with the EHP version. The new system will
not only simplify submissions but will also accelerate the peer-review
process by permitting our reviewers to access the submitted articles online.
We hope you will find OSRS to be a simple and flexible template-based manuscript
submission system. Authors will have the option of submitting the text
and graphics as a PDF document or as a word-processing document (preferably
Microsoft Word), and graphics can be submitted as EPS or TIFF files. If
you cannot submit a PDF file, we will produce a PDF document for you. However,
before beginning the peer-review process of your manuscript, you will be
asked to review the converted document for accuracy. This extra step would
necessarily slow down the entire process.
We anticipate that authors will be pleased with the ease of submission
and the more rapid peer-review process made possible by implementing our
Internet-based system for submission. Peer reviewers should find the online
review process to be easier and more efficient. These expectations have
been realized by journals that already have in place an Internet-based
submission and review system.
At first, the Internet-based submission system will be optional, but please
consider submitting your next manuscript to EHP using OSRS. The submission
site and instructions can be found online at http://www.EHPonline.org/submit.
Thomas J. Goehl
Editor-in-Chief, EHP
NIEHS
National Institutes of Health
Department of Health and Human Services
Research Triangle Park, North Carolina
E-mail: goehl@niehs.nih.gov
James G. Burkhart
Science Editor, EHP
NIEHS
National Institutes of Health
Department of Health and Human Services
Research Triangle Park, North Carolina
E-mail: burkhart@niehs.nih.gov |
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Last Updated: February 18, 2004