Ep 70: Dr. Howard Hu - The Silent Health Crisis No One’s Talking About

I am so honored today to have my old research mentor and amazing leader in internal medicine preventative medicine epidemiology Dr. Howard who on the Savior's Health podcast. Thank you so much Dr. Who for being here. My pleasure. I'm going to start by embarrassing you with the bio and the story of how and then we'll share the story of how I met you and how we reconnected but first the accolades. So Dr. Who is trained in internal medicine preventative medicine and epidemiology. He was a tenured professor at Harvard from 1990 to 2006 department chair at the University of Michigan from 2006 to 2012 public health school dean at the University of Toronto from 2012 to 2018. Dr. Who's currently the professor of preventative medicine at the University of Southern California. He has led international teams investigating the determinants of impaired child development and adult chronic diseases and NIH funded studies in the USA. Mexico, India generating over 400 publications and winning awards from NIH the American Public Health Association the International Society for Environmental Epidemiology and others. Welcome. Thank you. They didn't mention the disc jockey at Brown University. Yeah I was a failed disc jockey but we'll take that off my resume. That was back when you were in college. That's right I was in college. And you had like a radio show there right? Yeah and I thought I had a good radio voice but it was putting people to sleep that was the problem. So you switched to have a storied career in public health and epidemiology. First of all I'm going to start maybe with the most controversial of topics and questions. Tell us what does the research stay about fluoride? Oh my gosh. For our health. What does the research say? Yeah so I'll just say as background that my research group is proud to have done really objective rigorous research on how pollutants may risk the chronic diseases that we worry about when we're adults but also may impair the development of children when they're in the womb and up through the childhood years. And what we did with fluoride was to raise the question which is initially posed by the US National Research Council as to whether fluoride which has been such a wonderful influence in preventing cavities since its introduction into water systems around the country for since the 1950s. Whether that fluoride might actually be impairing the development the neurodevelopment of children and our research which was funded by NIH showed in fact that the prenatal exposure to fluoride that children have is associated with lower IQ when their children at four years of age six and 12 years of age on and also some increase in anxiety and depression symptoms. And that coupled with other research findings from our colleagues in Canada some new research that's right here in the US and research that's elsewhere has made us quite alarmed about this unintentional but unfortunate adverse effect of fluoride. So for someone who doesn't know much about this topic to break it down for them the fluoride that we're getting through our water in through the products that we may be using may add up to a load for our bodies that may influence IQ in children. That's right but let's be very clear and specific. The research that I think is the most rigorous and which we can draw the most conclusions from is the research showing that the fluoride exposure during pregnancy and during the first year of life is the most important window of exposure that will impair childhood intelligence. I mean as a mom I think that is so important and shocking and I think that more people need to know about this. What is being done right now in the public health space to remedy dissituation? Well unfortunately it's still an area of incredible controversy as you can imagine. First of all I mean you know fluorides been added to water systems for decades and when some of this research is still was coming out there was a lot of disbelief in my own scientific community certainly in the public health dental community but a lot of that came to a head last summer when the National Toxicology Program which is a branch of NIH did a very rigorous systematic review of all of the evidence concluded that in fact the evidence shows that fluoride is impairing neurodevelopment and associated with lower IQ in children. One of the questions was well gee the evidence maybe it shows that the exposure has to be at a certain level that's higher than what women are used to in drinking fluoridated water. I don't think that's true frankly I think the research shows that even levels of fluoride in the drinking water of regular Americans in water that's fluoridated during pregnancy is associated with lower IQ and there's good basic science studies which show why because fluoride does seem to have some impacts on molecular systems that govern brain development, brain growth, the synapses that connect all the brain cells together that could explain why this is happening. But at this point the level of understanding and the general public as well as the I would say the general public health community is still at war with itself. I mean there's a lot of pushback and that's particularly why I wrote a commentary on this situation with the former director of the National Institute of Environmental Sciences trying to disentangle the issues and focus on what would be the most important policy recommendations now which I believe is recommending that women limit their fluoride exposure during pregnancy in the first year of an infant's life. For someone who doesn't know again you know they're drinking their tap water. That's the biggest source of fluoride for a typical pregnant mother. In the US and Canada I think the data shows that water that's been fluoridated is responsible for at least half of the fluoride that an individual is taking or pregnant mother is taking. There are other sources of fluoride. There are certain teas like black tea which has quite a black tea. Black tea? Like regular black. Regular black tea has a fair amount of fluoride in it. Wow. There are certain fish species if you happen to eat the bones of the fish species we'll have fluoride in it. Sardines are one of them actually so if you're going to eat sardines, eat the ones that have been deboned. Yeah I mean there's all these nuances to understanding the sources of fluoride and there's still more research to be done to understand that but given that water fluoridation is responsible for at least half I mean that seems to be a reasonable place to start. Yeah and that's still so from what I understand and I've been talking to a few people about this as well as reading your research. The cavity prevention that fluoride is providing it can be provided in other ways is that right? That's right and on top of that I think the evidence that I've seen shows that the fluoride intake that a pregnant mother has and that an infant has in the first year of life does not actually contribute towards the protection of the teeth from dental carries. Dental cavities that is carries is kind of the technical to dentists. It's actually the fluoride exposure that you get from having fluoride in your mouth. After the first year of life that's most instrumental towards providing the fluoride that will eventually end up in your enamel and protecting you from cavities. Actually the fluoride that you ingest has to be secreted into saliva for it to actually help your teeth. It's not an internally deposited element that then strengthens the teeth. So dental products are actually a very good way of protecting teeth whether it's brushing your teeth or using fluoride rinses or things like that after certain age. So are you saying so if I was pregnant and I'm not I'm not even close to but that I would be better off avoiding tap water? If it's fluoridated I think that makes sense. Is it most tap water fluoride? About 65 percent of Americans are supplied with tap water. So is it dependent on the state or something? It goes beyond that. It's actually even community by community on California. There's some communities or the waters fluoridated and some that aren't. These are choices actually that individual communities can make which is why you're starting to see in the media these fluoride waters where some communities will reject it some people some embrace it and there's just a lot of confusion out there. This might be a stupid question but can it get into the body through other ways meaning like showering with fluoridated water or swimming or? Not that I know of. I mean there's certainly things in water that you can absorb by showering. Those are in particular the volatile organic chemicals like benzene is a chemical that I think most people know now is toxic and benzene in water will volatilize when you're in the shower and then you'll inhale it and that's a very efficient way of getting benzene into the system but I'm not aware of fluoride being vaporized in that way and absorbed in that way. So if you're living in a community that is using fluoride in the water it may be in your best interest if you're a pregnant woman or you know feeding a small infant to avoid that water and to use other sources is that correct? That's correct and using you know other water for infant formula for instance. That's huge. I don't think most people know about this. This is something that I think every woman or every parent should know because whether or not you choose to make those decisions for yourself at least know the science so that you can make more educated decisions about what to do. I would agree with that. And do you think that fluoride in the water affects us beyond age of one year or when you know pregnant mother kind of passing it to the baby. Are there other health effects that those of us who aren't pregnant or aren't children should worried about? Well there are some concerns about very high levels of fluoride in bone health. There is also some concern about fluorides impact potentially on the nervous systems of adults but that research is in a very early stage I'd say. In what way would it affect or what did they hypothesize? Well you know what we all worry about especially I'm 68 years old so I worry about holding on to my marbles. Yeah cognition and memory. And of course you know the more pathological form is called dementia and there's various forms of dementia. The most feared of course is Alzheimer's but you know that's actually one of the things we're starting to do research on now is trying to understand the environmental footprint on an Alzheimer's and it's likely to be substantial. We just don't know what things are the biggest contributors yet. That is crazy. Okay well we started with the most controversial and I'll let at the end of it I'll let you guys pick your questions. We have an audience here and they had a couple of questions to ask you and I'll let them do that but let's start. Now let's backtrack and I wanted the reason I wanted to start with that is that I am just floored by the research that I've been reading and things I've learned from you and I just think everybody needs to know about it and so I wanted to kind of open with that but you do a lot of work and I think particularly your work around heavy metals the fluoride the post-COVID the multiple chemical sensitivity. I mean you have a wide variety of things that you're working on so can you tell us a little bit more about some of the other research that you do some other findings or things that are interesting that people may not know about? Sure well yeah I'm still a physician and I still see patients and what I've always been fascinating about in my career is trying to understand the most common illnesses that we suffer from and what are the things that might cause them or contribute to worsening because from a population and public health point of view those are the things that could be preventable and the human history is just rife with examples of progress that we've made in improving our health so much of it is because of prevention so much of it is because of cleaner air, cleaner water, cleaner food, more safe practices when we're designing cars and roadways to prevent injury. Designing of course the immunizations that we take to prevent polio, measles, mumps, rubella and all those other diseases. So you know one of the biggest things that I've been known for actually and this is research I was doing when I had the great pleasure of mentoring you as a student was understanding the environmental consequences of all the lead exposure that we've had in this country and in every country in the world. What are we talking about? We're talking about how lead has been used in paint and it's been used in plumbing it's been used in all sorts of different products it contaminates various things but the biggest vector lead exposure by far was the addition of lead and gasoline beginning in the 1920s and that resulted in research is very clear in this matter in the elevation of lead burdens and human beings to about somewhere around a hundred to a thousand times higher than it was in prehistoric man. And lead is one of those elements which is known as a xenobiotic, a xeno is a Greek meaning stranger it has no useful function in the body zero and then as it turns out based on a good 50 plus years of research now not just mine I mean I am just a representative of hundreds of scientists who do epidemiology who do basic toxicology studies and animals who do in vitro studies taking human organoids and looking at what's happening on a molecular level. The research clearly shows that even at the tiniest concentrations led interferes with the basic molecular processes that are involved in brain growth, brain development, brain synapse formation, brain synaptic pruning, all the things that are so important for us to have the most fulsome expression of our intelligence. And that's scary. Yeah that's scary. And that's why led even at really tiny concentrations has been associated with declines in IQ and why every federal agency now says there's not a safe level of lead. We have been able to find a level of lead below which we don't see in effect. It's true. And that's one of the things that colleagues and I have been working on trying to figure out. Here's another interesting angle fourth though that's true of all of environmental health. We used to think of disease as simply oh that's genetic. That's Huntington's career. It's genetic disease or you know something else. Oh that that's environmental you know that's smoking that cause lung cancer. Turns out that most disease is probably a complex interplay between genetics susceptibility factors and environment. It's not a clear division between one or the other. So a lot of what I do what my colleagues do is trying to understand the interaction between genes and environment. And ever since the human genome sequence now we have all these powerful tools to sequence your entire genome. We're just to drop a blood. Now it's down to about 80 bucks. And now we can sort of do these studies where we can find out oh you know you actually with this is some research that we did about 15% of people in this country. Most white people have a gene that's called the HFE gene. And if you happen to have a certain combination of the HFE gene you get hemicrimatosis. This is a disease called iron overload disease. But even if you only have one copy of one of the genes like I said 15 percent we've shown that your lead exposure will cause an accelerated decline in cognition when you're an adult. Bad news. And you know that's the kind of research that I think is for advancing our understanding of what are the complex interplays between genes and environment that's responsible for why some people seem to do worse than others. And that's the future of where we're going with trying to understand the environmental footprint on disease. For lead in particular what are the common sources of lead now for the modern American. You know obviously unlettered gasoline has been something that's changed the lead exposure levels. But we're Americans getting it from. Well we're pretty lucky because there are removal of lead from gasoline, from paint, from solder and most pipes has really improved things. But now what we've seen is these retained islands of high exposure. It's no longer you know every American has lead exposure to some extent. Now we know things like the Flint order crisis that happened in 2014. It's communities that have really aging infrastructure or have aging water distribution systems that the water authorities and like what happened in Flint didn't properly use them or they switched them to some other source of water and that disturbed the entire ecosystem and the pipes and liberated a lot of lead that was in the distribution system. And then this old sections of cities that still have a lot of lead paint. Any house built before 1975 can be expected to have lead paint unless it's been removed. So you know unfortunately it's become more of a kind of associate economic status class thing where a lot of people who can't afford good housing will be in areas where they're more prone to have exposure to lead contaminated water from aging distribution systems or houses with lead peeling paint. Those are the big exposures now. What about food sources? Yeah so we do have to worry about some contaminated food and there's been some headliners about you know contaminated spices which is true. We found that the certain spices particularly those that are imported that were contaminated like turmeric or worried about that. Iir Vedic medicines unfortunately have been found to have contamination with lead arsenic and a bunch of other heavy metals but it's scatter shot but it's significant enough so that the Consumer Product Safety Commission the FDA and other authorities that try to monitor these things are important. They need to be on their guard for people's self. So for example just going back to the food thing because you know I love products from India of South Asian background use a lot of spices. Is there is there a concern about the turmeric that we are getting with its contamination with lead? Yeah there is and unfortunately it's a real threat and there's various consumer groups that are trying to monitor the situation. One of them is an NGO that I do some work with it's called Pure Earth and they've been looking at the lead contaminant issue worldwide Asia but also in Eastern Europe and in Southeast Asia and and you know they try to advance the knowledge of this so they can promote public health friendly policies in the home country as well as what might be happening here when we import some of these products but it's it's tough to monitor all this stuff all the time. So in places like in India for example countries like that where are they getting lead from? How is it so much more prominent there? Yeah this is one of those issues which it's shocking how preventable it is because most of the lead contamination seems to come from the following sources. One of them are spice merchants who want to improve the color of their turmeric they want to make it more yellow. It's much more consumer friendly they'll put lead powder in it. Oh my gosh. It also increases the weight so they get more compensation for what they sell. I mean it's that preventable which is why you know there's active steps to being taken right now to try to get into that part of the economy which is often the informal economy you know it's not a big you know company that has stocks and people who are a board of directors you know these are small little shops where people are just doing what they've done for decades or centuries right. Another is cheap cookware you know because you know you want to make cookware you don't want to buy you know metal from you know prime source you'll take it recycled from wherever. Recycled radiator has about 30-40% lead in it you melt it down there it is. Metal that you can use for a pot or a kettle or whatever right. So it's those are some of the sources there's also apparently depending on the geological source of the coal in India some of this contaminant with leads you know a fossil fuel plant burning this stuff will then spew it over community. Those are few of some of the most important sources there have been discovered so far. So if you're getting us spices from India or you know whatever another country or you're getting Ayurvedic medicines how would you even know if it's contaminated with lead. I don't know. I'm letting you go online you can let me. Yeah I mean some some companies I've seen some like there's supplement companies now that will display their heavy metal testing on their website but I don't see that all across the board and so it's really important to know this because I think there's a lot of people who consume a lot of spices and they're probably getting quite a bit of lead. So is it something that they should get tested for like a blood test? If someone is listening and they're like I eat turmeric and all my food like I know whatever tell me this. What do they do? It's a good question. Well you know a blood test is pretty easy to get these days. You know a blood lead test and that will tell you how much lead you've been exposed to over the last few weeks to months. So it's it's pretty easy to get. You just have to ask your clinician to order a blood lead test. The laboratory protocols for measuring lead are very well standardized in this country so you'll get an accurate test and that will give you meaningful information about whether you're exposed or not. I'm smiling because I'm going to ask you a question I know they answer too but we have to say. Do heavy metal detoxes work? Oh gosh. So yeah I can ask this question quite a bit. So as a physician we do sometimes use so-called chelating agents which are medicine specifically designed to remove metals from the body for treating people with lead clinical poisoning. I say that specifically because clinical poisoning means that poisoning is so great that you have symptoms. You'll find all sorts of other laboratory abnormalities that are very specific for the the heavy metal poisoning. I think what's been a trend in this country has been the use of different keylaters to treat patients who may be at risk for cardiac disease or other diseases that have been linked to lead exposure or arsenic or some of these other metals heavy metals. The problem is is that unless there's been a randomized double-blind placebo control trial demonstrating that treatment will actually improve outcomes. As a evidence-based physician I don't believe that the evidence is sufficient to actually warrant that kind of treatment and there've been some really interesting developments over the last few years which underscore the importance of doing that kind of research. But one of the irony of this whole situation and I think I mentioned this to you when we had lunch together is that many of the practitioners who prescribing chelation will cite our research as saying oh yeah you know Dr. Hues showed that a lot of lead and then you have increased risk of heart attacks and declines and cognition that's true but that's not the same thing as saying getting the lead out in chelation will actually improve the outcome and chelation itself does has risks. So it's an area that has unknowns at this point. And I think what you said again when we were talking about it before what is someone's really concerned that they have had a lot of heavy metal exposure throughout their life what is the best things that they can be doing? Well like I said there's not much evidence that if you're not as long as you're not suffering from clinical heavy metal poisoning which is pretty big deal. I mean you'd have to be really sick. What do they what do they present? So well you know typical person with lead poisoning and I've treated quite a few cases you know the typical ones actually in my career have been yuppies who would buy a house in Boston that's old and they say you know I want to renovate it myself. Pull out a belt sander it starts sending all the pain off the surfaces they walk in with some of the worst lead poisoning I've ever seen and they'll have acute stomach pain, back pain they'll be having sometimes vomiting, anemia if it's been going on for weeks time sometimes neurological paralysis of their wrists or their feet yeah no it's it's bad. You know you you would know if you had well not you would know but it's pretty bad. Yeah it's pretty bad I mean it's not specific enough so that the average doctor will recognize it unfortunately but it's bad enough so that you know they'll feel pretty sick but short of that you know you can still have enough lead in you from spices and contaminated cookware and stuff to have raised your risk for all these different bad outcomes that we've been discussing and since the evidence isn't clear enough that curation will help I think you know the common sense recommendation is well improve your lifestyle practices in the other realms and you will have removed some of the other risk factors that will conjointly with lead put you at risk for these things right it's sort of like you know you've smoked and now you've stopped smoking okay well you can't get the cigarette smoke out of your lungs you know but what you can do is start to exercise eat right you know try not to devoid other things that cause cancer that could you know partner with what your cigarette smoking history to further elevate your risk for lung cancer avoid air pollution for instance or radon and you know so a healthy lifestyle makes sense for everybody including people who've had you know unfortunately if had exposures and unfortunately you debunked something that I was hoping to be true which is can you sweat it out can you sweat out heavy metal because I've heard you know son of therapy is real I mean obviously son of therapy has benefits for other things from the finished studies but doesn't seem to be super super helpful for heavy metal detox well it there's the evidence that son of therapy will actually allow you to sweat out the metals and therefore your embedded shape is thin to non-existent but son of therapy might help may help you feel good and improve your general sense of well-being and sort of the other like I was saying right improve the other health health wellness indices so that on balance you know you will have tried to mitigate some of the effects of the toxics well first of all I wanted to pause here and thank you because I think a lot of people hear so many mixed messages and I feel like talking to you is like going straight to the research because that's your research or your you know teens research or your colleagues research and what I think is so important is that people understand what they're like there's so much convolution and the messaging is um sometimes even divided around politics and belief systems and I think what I always recommend to my family my friends my patients is to go back to the research and make their own decision so if they're listening to you and your research and they still decide to take certain actions um that's fine but it's good to know what the research says and literally it's like going to the source and I think it's such a treat for so many of us we have so many questions around heavy metals so many questions around fluoride so many questions around long COVID that's another area where you're kind of the expert um and it's great to hear what you think about that not what you think but what you've done what you've demonstrated um so I just wanted to take a minute to just realize like tell audience how important it is to actually listen to what you're saying because this can really help them make decisions um on that note um tell us about your work with long COVID I think there's a lot of people out there who might be interested well you know there's over 25 million Americans who are suffering from some form of long COVID uh which I think all of us now know means uh having symptoms that uh last at least three to six months for longer since your last COVID infection um and this is one of the subsequent uh the long tail of the effects of the COVID pandemic uh that we're grappling with and um here at USC we started a long COVID clinic that was funded by the federal government um in which you know we see people of every age people of every social income um and it's shocking to see um relatively young adults in the peak of their productivity uh walking in saying you know I just couldn't remember damn thing today I mean I and I you know I sat in my office and I was trying to work out this deal and I just I just flood the details and I didn't I always just it was brain fog I just couldn't think it's such a common symptom yeah and uh you know there are other symptoms as well but um is that one of the most common for the long tail? That's one of the most common fatigue is another one of the most common then this folks who have various um more organ related things like shortness of breath or chest pressure or chest pain and um various particular or rather joint pains and and stiffness um but I think that uh you know at this point what's clear is that there are inflammatory processes that COVID has started uh that go beyond what we've seen ordinarily with other inflammatory type diseases uh that involve the brain in unique ways um and that are incredibly resistant to the usual things that a body does try to clean it up um and uh you know we're at this point where um we need to be using a combination of um molecular approaches to understanding the disease and your imaging approaches to understanding the disease um but quickly go towards um the kinds of molecular insights that allow us to target the kinds of therapies that are now uh pretty common with inflammation associated disease uh those are the monoclonal antibodies and that's what everybody's waiting for everybody's waiting for what are the targets yeah you know that could be uh treated with these kinds of new therapies because these nieces and therapies are are very um they're very specific they're very directed and they uh they tend to not have uh you know the kinds of side effects you have with some of the broad treatments for inflammatory disease like steroids yeah like what is the current treatments for long COVID no aren't any yeah i mean that is it's mostly supportive yeah you know it's like doing things to train your brain to be more um organized and how it approaches your daily tasks doing things that will improve your general sense of well-being in terms of created exercise all right um doing things to retain or improve your range of motion if your joints if that's what's bothering you all right but those are right those all fall into the category of supportive therapies uh not as actually you know uh directed treatments uh that will cure the disease or roll back the uh processes that are causing the disease so we're still waiting so if someone at home was listening to this and they're like oh my god i have i have all that it's where do they go for help are there clinics all over the country uh they're yeah well i could go online and find clinics that uh it's your clinic still oh yeah it's still up and running there's one also down down street at UCLA and there's one at Cedar Sinai those are the big three some medical centers here in Los Angeles um and uh you know our research program worked closely with a colleague at uh at Northwestern University in Chicago who's a neurologist who runs one of the largest sort of neurology oriented COVID long COVID practices in the country um and um you know but at this point we're all working on the research angle you know we're not i don't think we have any special therapies to offer anybody at this point um when we do you'll be the first to know well announced it um but the problem i guess my question also is how does it anyone even know that they have long COVID because a lot of the things you're saying the brain fog the kind of you know muscle aches and pains it can really be a mistaken for anything else like i'm just aging or you know um does it usually follow right after the infection is that how you link it to long COVID yeah long COVID typically are symptoms that you felt during the infection and that just won't go okay so usually it's happening during the infection and then they linger on and that's how you kind of know that it could be connected that's the usual there are instances of people have had relatively mild infections and then who develop more of the neurological symptoms and then they will fall into that basket too but i think that's a little rare got it well that's good to know because i think people are probably wondering like do i have it or did did you get COVID uh twice you were lucky well yeah uh i mean i i did fine and i've had all my COVID shots and COVID boosters and i feel very lucky because i felt fine after every one of them um but um you know it's it's it's interesting to have been a researcher in which you're living the same thing like everybody else so it's probably scary because you see kind of the long COVID effects and sure yeah i mean you i've got friends who've got long COVID and i mean we all have a personal investment in trying to figure it out yeah and uh you know improve things um i feel okay and then the last you've kind of uh also worked on multiple chemical chemical sensitivity syndrome and that was in I'm sure you don't remember but for those of you who don't know the backstory when i was at Cornell um i decided to be pretty met pretty much during my sophomore year and the summer my parents had moved to Boston and um i asked my research mentor at Cornell if they if she knew anyone um and they said you know i know this guy let me ask how he if he's taking any students and um she was the chair of the nutritional department at Cornell and she and that's how i got to work with you for that summer and then i worked with you for the summer after and the second summer i worked with you you were working on the multiple chemical chemical sensitivity or you had just started and that was like part of um i had done lead for the first summer but then the second one there was a little project that we did around multiple chemical sensitivity syndrome and it was about like how there's really no funding or um there's very little research around this topic and i didn't even know what it was so can you describe to everyone what it actually is because i think there's a lot of people who may have it but they don't know but yeah yeah so um so multiple chemical sensitivity syndrome first what comes in a number of different names but that's the most common one um the typical suffer will be someone who you'll see walk into a room with people and then immediately put on a charcoal mask because just inhaling your scented soap that you used in the morning or the deodorant you used or the doors a little bit open and just a whiff of motor vehicle exhaust comes in we'll start giving them headaches fatigue muscle aches and pains actually there's a lot of crossover in the symptoms of long covid yeah which is interesting because um you know the long covid research may actually have side benefits for other unexplained syndromes like multiple chemical sensitivities. Is that an inflammatory syndrome also? unclear unclear uh the trouble with MCS is that because uh the sufferers typically will have symptoms because of the workplace or because of a product that they use or because of the um termite uh infestation spraying that was done by the company it becomes this contentious uh situation where they're suing their landlord or they're suing the product company or they can't work and the in the company saying well why should we give you workers compensation because everybody says multiple chemical sensitivity syndrome is just something in your your brain it's psychological all right and that's the nuts of the the crux of the problems that there are no currently there's no physical exam findings or laboratory tests that are abnormal which is what makes your local physician scratch their head and say I don't know if this is a real disease but I can tell you after you know treating hundreds of these patients I used to direct the Harvard residency and occupational medicine residency so we had a academic occupational environmental medicine clinic where we saw hundreds of these patients and I was one of two physicians in Boston who was patient enough to see them right but they would they were gravitate to the bottom because they'd lose their jobs they would you know they wouldn't get disability benefits I mean they would say it's psychological but it's not really and I think the evidence shows that it's probably something that's involves a complex interplay between your neurologic system and maybe your immune system the real problem in my view of course I'm a little bit biased is that there's never been an NIH research grant on MCS to controversial I mean if you could think that long COVID is controversial but Florida is controversial this is much do controversial you're doing all the controversial things all the things yeah like it ends up being controversial yeah well it's it's it's really unfortunate in fact I was I was one of the advisors for interagency federal effort to come up with a research program for multiple chemical sensitivity this is in the late 1990s and someone pulled the plug on it and the report never came out yeah we have a copy of it somewhere in any case the reason why you came across this because I finally did get a grant wow it was not from NIH it was from the state of Washington Department of Labor and Industries this is in 1995 I did this research right up until like 2002 that had so many cases of MCS multiple chemical sensitivity syndrome backlogged in their workers compensation system that the state legislature gradually voted $1.2 million to study this so they put out a request for proposals and you know I applied I got one proposal those a proposal went to Hopkins that Johns Hopkins University that funded a antibody study that didn't show anything then there was a grant that went to a researcher colleague of mine at the University of Arizona who had some sort of fancy instrument to measure odor function but it didn't work and then we did a specs against study that's a single photon emission commuted to my computer tomography study it's this fancy imaging thing and I did that with the chair of radiology Lenny Holman at the Brickermann women's hospital one of the main Harvard teaching hospitals and at the end of it we measured 37 patients with very rigorously defined MCS 37 age and gender matched controls who were normal and found these several differences in these areas of the brain called the limbic system unfortunately Lenny Holman got his suffigil cancer and died before the study came out he handed the study off to his junior radiology colleague who spent a few weeks fearing out that MCS was incredibly controversial and then he said howard sorry I'm not I'm not doing this oh my god and so we published a report but we'd never got out into the peer-reviewed literature oh my god I know it's a tragedy but it was an object lesson on just how controversial the whole problem is and now I happen to be on the scientific advisory board of a new foundation that was started by a woman who I had seen as a patient turned out she was an oil ares and she committed 25 million towards studying MCS and now we're just we just released our first request for proposals to study MCS right so eventually you get there but sometimes you have to get there without the federal government which I mean working in clinical allergy and immunology for many years I have seen so many people come in thinking it's an allergy or thinking it's a reaction and wanting to and it's it's really hard as a clinician as a doctor to say I'm sorry but the symptoms that you're having there's really no tests for that I believe you but there's no treatment for that and it's like that's right you must see these cases right it's tough because it's like you know like for example a woman working at Costco at the checkout and she said every time I someone comes in with perfume or there's a scented item that someone's buying or and she said it's just triggers me every small time and we were thinking about different solutions I can she get you go wear a window walk outside during the you know because there's really not much you can do but it's it's obvious that it was very distressing and it was obvious to her and to me that it was every time she would smell or be in contact with a chemical that she was sensitive to yeah yeah now that's and you know the when I was in Canada I was the chair of a commission that was created by the province of Ontario the most populous province in Ontario and they asked us to provide a sort of state of the science in the report on three syndromes one of them was multiple chemical sensitive syndrome the other was chronic fatigue and the third one is fibromyalgia another you know a morefus condition and you know one of the things that they did was a real a nationwide survey representative survey and you know I think that that generated some of the most believable statistics about how prevalent this condition is and we're talking like two to five percent of the population it's huge it's a lot of people yeah I mean we I mean fibromyalgia two is really prevalent now it's oh my god it's crazy how there's a lot of things like that that we just don't have good tests for good treatments for so that's amazing that there's going to be more research on the multiple chemicals sensitivity because I think that's an area that's really interesting that people would want to know if there's anything more that they can do or you know think about so all right this is going to be the fun part of the interview you guys ready we have some we have a live studio audience for those of you can see us so um so I had the pleasure of being a student and working under you um and I the reason why I had reached out to you probably a year or two go it's because I thought of is something that was really formative in my career and really helped me and I had I noticed that you had moved over to SC and wanted to just connect and actually I had there's only one other mentor that I did that with you know when I was at in med school I had this research mentor Linda Harmonie that was at Albert Einstein and I felt like so much of what she taught me I took with me even though I didn't go into radiology at the end but um it's like that you know I'm sure there's many people like this that are influenced by impacted by you so we want to thank you for that because you've done a lot of great work but you've also mentored a lot of great people and um that are also doing great work um so that being said I wanted to uh give either of you the opportunity to ask who wants to go first you guys both have prepared questions for dr. Who I'm nervous hi dr. Who uh so starting out you trained as both a physician and an epidemiologist at what point did environmental exposure like things like lead and fluoride become more than just a variable and start to feel like you're calling oh gosh that's a different story so um when I was in college this was at Brown University uh saving up to buy a stereo way back in the 70s I cost a lot of money I mean you didn't get these tiny little things you can just stick in your ear and all of a sudden you hear high you know high fidelity music so I got the highest paying summer job I could which was a torch burner in a shipyard but it was not an ordinary shipyard it was a shipyard that was tearing apart these old navy liberty ships which are the ships that were transporting men and materials during world war two but in the 1970s we're rusting in shipyards in New Jersey and Boston and Long Beach elsewhere and so in this shipyard these giant machines would cut these ships and pieces and then these giant cranes would pull out all the deck plates and the gun turrets and the boilers and drop it into this giant warehouse where guys like me would swarm over it and we're pulling apart the different parts of metal to send it off here there to be refined and recycled but all the pipes and boilers and deck plates and other things are covered with this white stuff what do you think that was led no it was asbestos and asbestos you know was one of these horrible things that we used for decades as insulation it's a wonderful insulation compound but as it was explained to me by Susan Down who was a occupational physician a few years later when I was a medical school was that you inhale this stuff which I did I was not wearing any respiratory protection at all so for a summer I was just ripping the stuff off all these fibers flying around the fibers penetrate into your lung and they do several things one of them is that they causes inflammatory reaction and then scarring and then your lung shrink and you have this condition called asbestosis where at its at its end your lungs are about the size of a grapefruit and you can barely breathe and then you die but the other end is that it increases your risk for cancer drastically lung cancer and a kind of cancer called mesothelioma which even today is completely incurable there's no way to treat it so when I was listening to this you know I was I was you know a young medical student um said wow this is really worrisome and by the way don't worry I have to get a chest X every three years but I'm fine nothing's happened to me uh but then the person who was interviewing me as Susan Down said oh yeah you know I heard your interest in social issues so um I thought you might be interested in knowing that the company physician figured out that asbestos caused lung cancer in 1937 and then the company chose to suppress that information for the next 25 years which is what they did all this came out in the testimony that surrounded the federal litigation surrounding asbestos they uncovered all the paperwork on that and I said wow this is really interesting environmental is really interesting and that's how we got into it you know it's sort of a mix of you know the environmental movement that was started with pyrrachial Carson when she published the silent spring and we realized that DDT was screwing up the environment and wildlife all over the world but then also this all these social justice themes and that's um and the fact that you can do something about it and improve health was uh it was pretty attractive to me yeah that sounds really interesting I think the personal experience part of it is huge I have one more question um is there a question that you wish more people would ask you about your work? now I say no because you know I used to be accused by my former partner when we were in social situations and everybody's asking you well is this dangerous is that dangerous you're such a Debbie Downer you're in a party we're supposed to be having fun so the question the answer is no but I'm always happy to provide my perspective on public health and environmental questions thank you so much thank you very much okay so you've mentored many young researchers what is one piece of advice that you can give them that you wish someone would have given you earlier in your career oh well so um for those of you who are interested in like medicine and public health uh but maybe even research there was a point in my career in about 1987 or 8 I'd say no 1988 in 1989 where my fourth research grant was rejected I was like oh god this is crazy um and I went to see my mentor I was a guy named Frank Spiser he was a physician epidemiologist at at Harvard and he listened to me you know Kvatch and Growny complain and then he said how hard you know frankly this really only one reason to be still doing this um because you look your physician you could go out make a lot more money as a physician right there's only one reason to do research is if it's fun yeah you know if it's not fun don't do it yeah it's as simple as that and I thought to myself yeah well raise grants isn't fun oh but that paper I published that was a lot of fun oh gosh you know the questions are so much fun oh gosh if I could just get another grant and you know Frank said yeah you'll get your grants funded eventually you're smart and eventually I did and that was it you know so you know I think as physicians we're a great privilege of being able to do anything related to health whether it's treating people or doing research or you know writing policies that affect lots of people but you got to do what really speaks to you you know that's fun yeah right that's and if it's fun you'll just keep doing it because you love it and that's what I do that's my advice yeah enjoy what you're doing yeah okay it's another one about young people but what would you back to like public health policies but what advice would you give to young people who want to like understand the science between public health policies like the ones that we've been talking about hmm yeah well um I mean I think what makes it fun at least to do the research that I do is that it does have immediate ramifications I admire people who can do you know basic science stuff whether you know just trying to figure out the latest protein confirmation of some weird thing that sits on a you know parasitic membrane or something but for me being able to research that then provides a answer yeah that's for consumers or for policy makers I think is really rewarding and you know I think that that can help drive the questions that young people have right when they're trying to think of what they want to make their market science we need that yeah and it's amazing what young people can do even without a million bucks in NIH funding yeah try to prove that with your brother over there so yeah stick with it be creative and find yourself a good mentor and have some fun all right so we got the young the young voices in um I wanted to give you an opportunity first of all I know you're not on any social media platforms what we're gonna change that soon because we're gonna do our first TikTok um but if people want to learn more about you about your work where can they find you and then the second part of the question is what is kind of the message that you would like to give to anyone who's listening today so well I am on LinkedIn you can find me there okay and I still have a public you know email address on my USC faculty website but particularly in today's time this is a very fraught time for American science I think anybody who picks up the news and reads about what's happening at NIH or any of the other federal science agencies can see that you know there's a lot of concern about fiscal cutbacks about changes in leadership etc um and I guess it brings to me something that I I mentioned when we chatted earlier Amy which is what I do when I first walk in the door in my class on introduction to public health to medical students I I ask the students and well hi everybody I'm Howard who it's great to be here let me ask you a question anybody use the public health system today that's what I get silence it's like a lot I don't know I don't think so and uh you know that I asked and well you know did you eat breakfast today um did you open the window and take a breath of fresh air did you turn on the tap and use the water to make it you know your fruit juice or whatever did you get in your car put your seat belt on all of that is public health you know uh how many immunizations did you get as child did you get your covid shot and booster by the way I mean all of that it was based on decades of research that turned into policy and that has profoundly changed the health of Americans and so many people around the world which is why we don't die at the age of 30 why we don't have infant mortality that's over 50% why we have the ability for any child who's born to be able to use their nutritionally and medically protected brain to advance their lot in society that's prevention and public health at work on so my message is you know the public health system is essential um whether it's the state or the federal public health systems that help protect us they are essential I would be um careful in squeezing them our strangling them and also the research that we do uh to try to understand our modern ills whether it's long covid or the new set of chemicals that are being released in water and air that's essential too because we all want to equal chance at a productive life and uh you know prevention is the worth a pound of cure yeah I mean this has been so amazing not only for myself but I hope that people that are listening because um we've covered a bunch of topics that are very relevant in today's world um and also um like I said kind of going straight to um I would call you and probably a lot of people would call you kind of one of the world's leaders in these uh thought leaders in these topics um and so I want to thank you so much for being here and sharing your time and expertise with us and um you'll see you on month tick tock soon guys at coward um and so uh I'll end with you know giving kind of gratitude for all of the work that you've done in the public health sphere and uh for medical students for students for lay people for communities for um you know cities and countries uh countries because you've been influencing lots of different places um and thank you for your work my pleasure thanks everyone for listening um and listen to the next episode this episode of the saviour self podcast was with doctor Howard who HU and he is um uh online uh at LinkedIn um or you can search for his research on any platforms where you do so thank you for listening and have a great day