This page contains two reports

This page contains two reports:

1. Notes from the workshop

2. Seminar report

Seminar report by Tony Berger, Olle Selinus, Catherine Skinner

WORKSHOP ON MEDICAL GEOLOGY

UPPSALA, SWEDEN, 3-8 SEPTEMBER 2000.

Notes

In September, 2000 a workshop on Medical Geology was held in Uppsala, Sweden. Over 35 people took part in the workshop. The particpants were divided into three groups where the following topics were discussed: the forthcoming book on Medical Geology, flyers and publications, and international working groups. The group as a whole also discussed the following questions:

- How can we make our information benefit "patients"?

Can you identify projects in each continent which can be linked to IGCP 454?
Publications
Can you identify some sort of activities where the consortium of different groups can cooperate?
How can we improve the newsletter?
How can we improve the webpage?

The proceding is a summary of the discussions that took place over the two days and a list of action points regarding the questions list above. A working outline of the book is also included.

How can we make our information benefit "patients"?

- The key is to approach the medical community and show this field will benefit the patients through addressing the following issues:

How to measure the level of exposure?
How to investigate a contaminant?
How to prevent exposure?
How to diagnose?
How to monitor?

Today patients want to be involved but doctors do not have information on the environment, geochemical mapping makes this data available.
Education and awareness: medical community needs to understand geochemical pathways
Practical solutions not just pathways
Use fieldwork opportunities to disseminate information
Flow of information: Geochem-Medical-Health Prevention in Communities

ACTION:

Search out contacts\links in various health care professions

Need several one page examples written for medics

Approach journalists with summaries

Approach UNESCO

Can you identify projects in each continent which can be linked to IGCP 454?

Goal is to link projects already in place around the world to the IGCP Project as well as providing a medium for geochemical mapping in areas that do not have the funding and technology to do so themselves.

standardization of methods (link to global geochemical mapping)

identify people who are willing to assist with analysis especially in developing countries , it is essential for developing countries to co-operate with developed labratories while building own facilities

overlays of geochemical data and medical\epidemiology information

3. Can you identify some sort of activities where the consortium of different groups can cooperate?

bring in a number of different professionals from medical to veterniarian sciences, for example Russian scientist hold a wealth of information; the US and Candian Academy of Pathology
Personal contacts
Incorporate other organizations e.g. GSA has a session on topic at upcoming meeting
Create local webpages
Press releases
Start links with institutions at the "top"
Marketing: base information of importance of activities, simple, consise.
Training courses
Need some overall organization and subfields
Determine who customer is, thus providing a focus.
bring together all the groups globally which are undertaking similar research the goal is to collaborate not compete.
Sponsor sessions, talks, meetings by consortium
find funding willing to provide for a multi-national project (possibilities include WHO, NATO)
joint fieldwork projects
statistical data
preventive measures for people to deal with geochemical parameters
remediation techniques: what to do once we know problem?
Interpretation of chemical analyses

ACTION:

Send Olle names and coordinates

Website links to medical geology

Listerver

FAQ sheets.

4. Publications

Informing people globally about what is going on in Medical Geology.
Marketing
Possibly create another publication (Note: it is easier to create a new section in an existing journal)
Agree on term "Medical Geology" other options include "Geomedicine"- need definition
Install term "Medical Geology" as keyword

ACTION:

Everyone must provide a list of newletters, magazines, journals, etc. suitable to advertise medical geology to Fiona by Nov. 3. In each a 1\2 page "ad" (info note) will be placed.

Improving the Newsletter

make it regular (bi-annually)
both paper and web copies
call for contributions and deadlines
key is to find stable funding, printing sources, alternative distribution (e.g. UNESCO, SEGH, etc)
mail to officialls who are not involved
encourage publications
possible have paid advertisements

Improving the Webpage

expand, try and form common webpage for several groups thus increasing exposure
include discussion groups
regular updates
redefine objectives
hotlink projects from Objective 2
get on more search engines
expand organization hotlinks
education links
list of conferences, symposiums,etc.

Compilation of bioliographic sources on Medical Geology

sources include: cogeoenvironment, the web (GEOREF, MEDLINE), local libraries.

ACTION:

Individuals can identify and collect locally
Add new finds to the website

Local Working Groups

Key question: How effective will a group be at various levels? In many cases a it is more effective if a group expands to a regional scale to incorporate larger areas, expanding groups creates flow of information.
Example of a regional working group DKMT a group which involves Romania, Serbia, and Hungary and includes a wide range of members from coal petrologist to toxicologists
Since pollution has no frontier countries must join together
Try and get medical groups, geological surveys,etc. to form local\regional groups
Each group will define own goals and obejctives

Sources of funding: COGEOENVIRONMENT, IGCP, SGU, IUGS

10. Brochures and Flyers

What do you want to achieve?

Advertise working group.

get people to join

get people to contribute.

Promote the medical geology field

- get people to join

raise awareness (G.P’s and doctors, regulators\consultants, general public)

How?

"Introduction to Medical Geolgy" flyer

content: cover field and group, contacts, website

mailable, catchy, informative, limited colour

9x20 cm

ACTION: Charlotte Bowman

Case Studis aimed at medics

"Finkleman Format", electronic, full colour, high quality, low volume

Aimed at medical profession

"disease" oriented (led)

ACTION: Howard Mielke (Pb) and Jose Centeno (As)

C) Case Study series

"Freestyle Finkleman Format" by disease, element, location,etc.
standardize format (template)
raw material will soon be available (eg, the extended abstracts)

-distribution can be both personal (handouts at meetings\talks, email documents, pin-ups) and centralized (sent out with newsletters, send out with documents of other organizations, emailed to group)

Summary of the Action Points:

1. Search out contacts\links in various health care professions ALL

2. One page examples written for medics Jose and Howard

3. Approach UNESCO, WHO

4. Approach journalists with information and summaries ALL

5. Send Olle names and coordinates of personal contacts ALL

6. Website links to medical geology ALL

7. Listserver? OLLE

8. Provide a list of newsletters, magazines, journals,etc suitable to

advertise "Medical Geology" to Fiona by Nov.3 ALL

9. Get on search engines ALL

10. Expand organizational hotlinks ALL

11. Official links to other groups (e.g., SEGH) OLLE

12. Local webpages ALL

13. Contact Journal of Pathology JOSE

14. Provide material for newsletter ALL

15. Summary flyer on Medical Geology Charlotte

16.BOOK OLLE, TBA

THE BOOK

Medical Geology Reference: Earth Science Information in Support of Public Health Protection (working title)

Details:

Deadline: Draft to be submitted by the end of 2002

Length: 1000 pages max. (600 p. if textbook)

the topic covers of number of disciplines (including biology, geology, and medicine) therefore the title must cause interest to each group i.e, make them want to pick it up.
Essential to determine who the audience is profesional vs student but also to determine what the message is.
Two possible target groups upper undergrad to masters level or the higher professional; if the goal is to improve public health it must be aimed at the higher professional.
Difficult to have both a reference and a textbook
Because it is a new topic the focus should be on the professional, by educating the higher level interest will develop and a text can be designed from there.
Should include diagonostic tools to assess health risks at a regional scale- geochemical issues and public health (the medical community do not have a clue about the environment).
the key is to get doctors involved, they will not look at the book if Dr’s are not involved.
Because doctors have limitted time must produce a book which is concise to grab attention
Must involve people\cases from both developed and developing countries to achieve a truly global product
Approach the topic from both points of view there must be equal coverage to be attractive to both fields
Maps provide a good link between elements and heath risks can show a geochem map and a disease map.
Want book to be the a catalyst to invoke new research, answer the basic questions while generating new ones; basic questions include why and how these problems are happening; identify areas of uncertainty for future research (ie, establish a framework).
Medics are not schooled in inorganic chemistry, therefore some explanation should be given in order to understand the geochemical aspect.
Important to encourage authors understand that not everyone has the same background.
Most essential part of the book is the introductory chapters, essential to the understanding of the rest of the book
A section opener- the subeditor paints an overall picture of each chapter in the section, making the information more accessible
At the end of each chapter there should be a summary and indicate areas\needs for future research
Case studies essential for truly show the link between the 2 disciplines.
Causality essential- must showwhy area with a deficientcy or toxicity results in a problem
Should also include risk assessment

Summary of answers:

Mission Statement

- To educate on the influence of the geological environment on human, animal, and plant health

To enhance the capacity to diagnose and predict human and animal health risk at a regional scale through an understanding of geological processes and influences
To give an introduction to the concepts of medical geology so that medics\vets can readily understand the importance of biogeoenvironmental factors on health and that geoscientists can understand the basic processing of elements in humans and animals
to define the subject area and outline and illustrate through case studeies the influence of geology on health with emphasis on humans but also with reference to animals and ecolystems where relevant

Audience

Geologists
Doctors and medical professionals, public health professionals
Vets
adiminstration boards\descion makers
students (upper undergraduate to graduate) in both geoscience and medicine
public

Book Content

Fundamental principles: geology, pathology, etc.
examples of effects
methods
main life elements in environment in relation to health
cycle and pathways of essential and toxic elements in relation to human and animal health
pathological changes and clinical manifestations of diseases
exposure
toxicology\pathology\epidemiology
case studies
food chain- follow elements from bedrock to humans\animals
historical overview
excess vs deficiency
future directions
maps: geochemical and epidemiology
definitions

THE WORKING OUTLINE

INTRODUCTION

addresses the audience on what the book is all about including a definition of medical geology, may also include a brief history of the field.
A temporary introduction must be produced in order to provide authors with goals and direction.

SECTION 1: FUNDAMENTAL PRINCIPLES

The section is the backbone of the book it provides the necessary information to understand the case studies etc., it also shows the linkage between fields.

GEOLOGY

ENVIRONMENTAL MEDICINE

BIOLOGY OF THE ELEMENTS

here it is possible to bring in the chemistry rather than an unique chapter

NUTRITION AND DIET

BIOLOGICAL RESPONSES

SECTION 2: (PATHWAYS) EXPOSURE PATHWAYS\ROUTES

AIR
WATER
SOIL
ANTHROPOGENIC (distinguish between anthropogenic sources and influences, focus on how anthropogenic activities, etc mobilize elements of concern)
Multiple exposure
Total integration of geoscience and medical paths with maps providing the interface
Water-------à Soil----------à Plants-----à Animals-------à Humans
Interlink the mediums rather than isolate, from micro to macro

SECTION 3: EPIDEMIOLOGY AND ENVIRONMENTAL PATHOLOGY

PATHOLOGY

organ pathology
use of collections, genetic markers, prevention

EPIDEMIOLOGY

natural sources of exposure
dose-response relationships (threshold vs accumulation)
diagnosis, treatment, and management
confounding factors

SECTION 4: VETERINARY SCIENCE

strong causality established
unique topic

SECTION 5: TECHNIQUES AND TOOLS

should involve only a brief overview of techniques. There are already books dedicated to specfic techniques eg. GIS and Health, can provide a good reference guide for further information.
Wide range of techniques in both fields goal to inform both fields on possible techniques
Possible to split section into two parts: Medical Techniques and Geoscience Techniques
Quality control\assurance issue: sample quality, reproducibility; possible to provide this for the individual techniques.
Need to know sources of error, etc for this section will provide information for interpretation of exsisting data.
Where is the line drawn, for example there are many geochemical techniques

SUMMARY

REFERENCE VALUES.

Academic Press website provides access to a working outline\book progress which allows people to find holes and redundancy.
Define individuals to write outlines and set deadlines
The key is to get a sample by drafting sections and chapters, this provides an example for other authors

MEDICAL GEOLOGY - AN EMERGING DISCIPLINE

A Report on a Seminar on Health and the Geochemical Environment, Uppsala, Sweden, September 4-6, 2000

If there was any doubt in the minds of the 40 or so earth and medical scientists who gathered in Uppsala last month that medical geology was emerging as a distinct discipline, it was soon dispelled. In a final declaration they agreed to join a medical geology network to share expertise and research in biology, biochemistry, geology and geochemistry related to health issues, with the overall aim of helping to create a better quality of life for people all around the world.

The seminar explored the continuum between the biogeochemical sciences by bringing together hydrologists, soil scientists, mineralogists, geochemists, geologists, geographers, physicians, dentists, pathologists, epidemiologists, veterinarians, plant physiologists and others. The discussions covered many aspects of the environment and climate that affect plant, animal and human populations locally, regionally and globally. Though study of the relationships between soil, water and rock chemistry and animal and human health goes back many years, and even to the very early days when the connection between salt and diet was first realized, current concerns and research progress are helping to re-establish the linkages between the earth and medical sciences. These build on an extensive knowledge base especially in geochemistry, including, for example, the work of the late Norwegian geologist J. Låg, who did much in his many books and papers to promote what he termed geomedicine.

Ravi Naidu (CSIRO, Adelaide) began the first-day session on "external pathways - geochemistry and geology" with a broad overview of natural ("geogenic") contaminants and toxicity problems associated with the groundwater-soil-plant-animal-human continuum. He concentrated on the source, release and transfer of As and Se from native minerals to plants and humans via water and soil in South Asia. Colin Neal (Centre for Ecology and Hydrology, Wallingford, UK) gave a broad overview of large-scale patterns of air, water and soil chemistry resulting from land use changes in Britain. He showed how industrial contaminants released over a century ago are still being dispersed by rivers today, and decried the general lack of monitoring of organic contaminants in surface and groundwater. A fascinating story of how Cu has been recycled between rocks, water and plants since the Precambrian was presented by Norrie Robbins (USGS, Reston) as "life in a copper province."

Pointing out that wildlife all over Africa have to survive on ancient (naturally degraded) soils commonly poor in nutrition, particularly where animals enclosed in parks and reserves cannot browse more widely, John Maskall (University of Plymouth, UK) described on-going studies to investigate this situation in Kenya. Levels of essential and toxic elements in animals living in rivers draining the Zambian copper belt were reported by Maxwell Mwase (University of Zambia), and Paula Cerruti (University of Capetown) described her initial studies on the effects of deficiencies in soil nutrients on joint disease and dwarfism in Maputoland.

In reviewing geophagy, the practice of eating clay or soil, Peter Abrahams (University of Wales), pointed out that in addition to obvious benefits (eg. reduction of stomach acidity) there were also harmful effects including mineral deficiency, toxicity, and excessive tooth wear. Archaeological work on an ancient mining and smelting site in Jordan provides evidence of the absorption of copper in the skeletons of Byzantine metal workers, and the effect is felt even today as bioaccumulation of metals in local plants, people and animals (John Grattan, University of Wales). Other topics included were the effect on pneumoconosis in Asia of the common and widespread dust storms (Edward Derbyshire, Royal Holloway University of London), and the mobilization of As and its tragic effect on health in the Bengal Delta (Prosun Bhattacharya, Royal Institute of Technology, Stockholm).

Extensive studies on the geochemistry of urban environments in the USA were reviewd by Howard Mielke (Xavier University of New Orleans), and in particular the effect on the health of children of Pb from paints, gasoline and, more recently, from tire wear. Eiliv Steinnes (Norwegian University of Science and Technology, Trondheim) discussed the biogeochemical cycling from sea to land of I and Se in southern Norway and showed how human influences might be distinguished from natural inputs such as those from atmospheric transport from coastal to inland areas. Gunnar Hillerdal (Uppsala University) discussed the effects of asbestos and other fibrous minerals on human health. Local problems in Greece were caused by the application of crushed tremolite used in household whitewash, and in Turkey inhabitants of cave dwellings dug in tuffs rich in fibrous and porous zeolites had high incidences of lung cancer.

Antony Berger (Victoria, BC) argued the importance of separating human from natural contributions to reduced health: the former can often be eased through effective policies and regulations, the latter not necessarily so. He suggested that medical geology may have an important role to play in re-conceptualizing the beneficial and harmful sides to the natural world.

The second day of the seminar on "internal pathways - biochemistry and biology" began with an overview of the biogeochemistry of bones and teeth by Catherine Skinner (Yale University). She reviewed the way in which specialized cells, enzymes and hormones record living conditions in the bones and teeth - rather like coral and tree growth rings. Considerable progress can be made using the kind of mineralogical approaches unfamiliar to medical doctors in investigating dentine and enamel, and minerals in bones such as apatite, hydroxyapatite and whitlockite. Likewise, Matt Pawlikowski (Academy of Mining, Cracow, Poland) summarized his extensive studies on mineralization of human blood vessels. He held out hope that a means could be found to dissolve these minerals, thereby clearing the circulatory system of some obstructions.

In his review of the connection between metals in the environment and the etiology of human diseases Jose Centeno (US Armed Forces Institute of Pathology, Washington DC) described the various internal pathways - absorption, ingestion, inhalation. Though most of the seminar focussed on the harmful health effects of metals and ions, he reminded participants that some metals are essential, for example as catalysts in cellular functions or forming integral part of important enzymes.

Jane Plant (British Geological Survey, Nottingham) described her own fight with breast cancer and the startling conclusions from careful study of the relationship between cancer and environmental conditions especially in China and Japan. She presented much evidence for links between risk of breast and prostate cancer and the presence of long-lived endocrine-disrupting chemicals (EDCs) such as pesticides and dioxins. Her major published conclusion is that there is an especially strong link between EDCs and dairy and other products from animals fed with growth hormones.

Ulf Lindh (Centre for Metal Biology) reviewed the principles of metal biology, stressing the importance of organic chemistry. The pathways from the environment through food into the body are well illustrated by direct links between coal use and human health in China (Robert Finkelman, USGS, Reston). Here, some 3000 people have been severely poisoned through the consumption of chili peppers dried over fires burning high-As coal. More than 10 million people suffer dental and skeletal fluorosis due to eating corn dried over burning briquettes made from high F coals and high F clay binders.

GIS techniques applied to the study of ground radon shows that the risk of leukaemia in children is higher where radon exposure is higher (Owe Löfman, Linköping University Hospital, Sweden)

Anders Lindvall (Centre for Metal Biology, Uppsala) related that the relatively high number of Swedes complaining about metal dental fillings seemed to reflect metal intolerance in those people. However, removal of dental amalgam did correlate in reduced Hg content of plasma and red blood cells. Calin Tatu (Country Hospital, Timisoara, Romania) described the search for causes of a kidney disease apparently restricted to Croatia, Serbia and Romania. Despite the spatial association with Pliocene lignite deposits being mined, there was still doubt as to the source of the toxins involved.

At the end of the seminar there was discussion about the name of this interdisciplinary field of research. Much work has already been done under the rubric of environmental geochemistry and environmental medicine, and the consensus was that the term "geomedicine" would not be accepted by the medical profession and that "medical geology" was a better term. The time was ripe now to push forward, with environmental concerns much in the public eye and in view of concern over large-scale issues such as the As poisoning in Bangladesh. It was pointed out that there was already some cooperation between geochemists, biologists and veterinary scientists, but that it was difficult to get the doctors to join. Clearly, it would be important to show medical practitioners how information from medical geology would benefit patients. Medical schools in Sweden are beginning to include environmental medicine as a standard component of the syllabus. An important tool in the search for connections between disease and rock/water/soil chemistry was regional geochemical mapping, and contributions to the IUGS Global Geochemical Mapping project were invited by its co-Chair, Jane Plant.

The seminar was co-sponsored and co-organized by Olle Selinus, Catherine Skinner and Antony Berger representing three overlapping activities. These are the IUGS Working Group on Medical Geology, directed by Olle Selinus of the Geological Survey of Sweden, IGCP Project 454 "Medical Geology" co-directed by Selinus and Peter Bobrowsky (Geological Survey of British Columbia), and the Unesco-ICSU-IUGS funded project "Paracelsus Revisited" lead by Catherine Skinner from Yale University and Antony Berger, Co-Director of the IUGS Geoindicator Initiative.

A series of short papers from the seminar are to be published in 2001 in the Special Paper series of the Geological Society of America. Researchers in the earth and other natural sciences, and in the health and social sciences, who are interested in contributing to the growing medical geology network are invited to contact Olle Selinus (olle.selinus@sgu.se) or Cathy Skinner (catherine.skinner@yale.edu). Further information on the Medical Geology Working Group can be found on its website at http://home.swipnet.se/medicalgeology.

- A.R. Berger, O. Selinus, and H.C.W. Skinner

October, 2000