DR. PHILIP LANDRIGAN: A Prescription to Better Serve Kids.

Dr. Philip Landrigan has long played an important role in advancing the field of pediatric environmental health--first as an officer in the U.S. Public Health Service, then as an epidemiologist with the Centers for Disease Control and Prevention, senior advisor on children's health to the Environmental Protection Agency and, most recently, director of the Mount Sinai Center for Children's Health and the Environment, which was established in 1998 as the first of eight such national research centers. He is widely recognized as one of the nation's foremost experts on children's diseases and environmental exposures. Dr. Landrigan's forthcoming book, 101 Ways to Raise Healthy Children in a World of Toxins, will be published in October by Rodale Press.

E: How have the patterns of childhood illness changed over the last few decades?

LANDRIGAN: Fifty or 75 years ago in this country, the dominant causes of illness in kids were infectious diseases--pneumonia, influenza, measles, dysentery, diphtheria, tetanus and polio. But today, the major causes of sickness and death are, after injuries, all chronic diseases. Asthma has become the leading cause of hospitalization, and cancer is the leading cause of death.

What appears to be the most insidious environmental threat to children's health?

I'm worried about a whole range of chemicals that have the potential to get into the developing brain and cause damage. Chemicals can be toxic to the brain at a pretty low level. We knew back in the 1950s and 1960s that a high level of lead exposure could damage the brain, but in the 1970s and 1980s, studies showed that there's a spectrum of damage. Children exposed to lead at lower levels who had no obvious symptoms still showed a loss of IQ, slowing of reflexes and poor performance on psychiatric tests. We now know that PCBs, mercury and probably pesticides act that way, too.

Are pediatricians and family practitioners trained to recognize environmental threats?

Over the next few years, I think we will see pediatricians become increasingly cognizant of these issues. Pediatricians have long been good about checking up on environmental causes of lead poisoning in children, and they are certainly attuned to looking for the environmental causes of asthma. But they have not systematically looked at children's exposures to toxins in the environment because most were not trained to think about environmental factors as causes of disease.

What would you consider the greatest accomplishment in the field of children's environmental health?

I think the removal of lead from gasoline was an enormous accomplishment. In the 25 years since then, we have seen a greater than 90 percent reduction in blood lead levels in American children. It means that there is a lot less lead in water, in air, in the food chain and in wildlife.

What, in the coming decade, has the potential to be as serious a threat as lead?

There are three big ones. We need to reduce the exposure of people of all ages to pesticides. Pesticides are used in enormous amounts in homes, schools and day care centers and on lawns and gardens. Once released, they are immediately widespread in the environment and create enormous potential for harmful health effects.

Number two is fine particulate air pollution, which is well known to be a trigger of asthma. Since the major source is cars, we are going to need to make some very fundamental changes in transportation.

The third threat is chemicals in our drinking water. Drinking water regulation is lagging way behind.

Are there social as well as physical vulnerabilities that expose children disproportionately to environmental threats?

Kids' behavior puts them at greater risk--they are on the floor and constantly have their hands in their mouths. Clearly, there are also discrepancies by income and by race. Everything from lead paint and mold in poor-quality housing to the placement of toxic waste dumps tends to impact negatively on poor kids.

There is evidence that children are reaching adolescence a lot sooner. Should this be of concern?

It's very clear that sperm counts are declining in lots of parts of this country and in Western Europe. Rates of testicular cancer in young men have risen. A birth defect in baby boys called hypospadia, which is a shortening of the urethra that requires surgery to correct, has doubled in this country in the past 20 years. Among girls, we've been seeing earlier puberty. The big question is whether these various effects are caused by so-called endocrine disruptors in the environment.

Are there vested interests that would slow down the process of getting carcinogens and endocrine disruptors out of the environment?

Some industry leaders are enlightened and willing to take appropriate action. But some folks don't want to test chemicals for their toxic effects or to take them off the market. Some say we shouldn't establish a standard until we know to what decimal point the chemical causes disease. That is too high a standard. We don't know today precisely how cigarettes cause lung cancer, but we know that they do, and we know how to prevent it. The same is true for a lot of chemicals on the market. We may not know precisely how they cause brain dysfunction, but we know that they do.

Besides the presence of chemical plants and other industries, has the American lifestyle changed in such a way that would also affect the health and well-being of our children?

A very positive thing has been the decline in smoking among many sectors of the population. Unfortunately, smoking rates are increasing among young girls and minority kids, because they are targeted in advertising. In diet, the consumption of red meat has gone down, while the consumption of fruits and vegetables has gone up. But the rates for obesity and diabetes have also increased.

Should biotechnology in foods also be part of the discussion of children's health?

We are developing genetically modified foods, and we are putting them on the market and in our food supply. We just do not know the potential consequences. It may turn out to be the greatest thing since sliced bread. But we thought that about DEET, and we thought that about PCBs. It was only many years later that we realized those technologies have downsides. Here we are once again embracing a technology, moving ahead full speed with no knowledge of the downside. It is unwise.

What advice would you give to concerned parents?

Encourage your children to eat a diet rich in fruits and vegetables. Sure there are residues and pesticides in fruits and vegetables, but kids who eat a lot of processed foods are going to be at greater risk of heart disease, stroke and diabetes in the years ahead. To reduce pesticide exposure, buy organic, buy in season, and buy locally. Also, rotate the foods you feed your children.

What advice would you give to environmental and children's health advocates?

Work for the battles you can win.

CONTACT: Center for Children's Health and the Environment, [phone], www.childenvironment.org.