Report on the

working group at the

"Healthy Ecosystems / Healthy People" conference sponsored by the

International Society for Ecosystem Health

June 6 - 11, 2002

Washington, D.C.

By all accounts, the Working Group successfully completed its assignment. On the first day, we had excellent Case Study presentations with lively and interesting question and answer sessions. The second day consisted of a Roundtable Discussion, and everyone participated with insightful, constructive comments. There were twenty-four participants in total; twenty-three were present on day 1, and fourteen were able to make it on the second day. We reached consensus on a number of issues that were on the Agenda, specifically:

1. The Term, "Medical Geology,"

2. Promotion,

3. (Research) Priorities, and

4. Key Recommendations for the Field.

The Working Group agreed to continue using the term "Medical Geology," recognizing the need to emphasize the broad definition in the foreseeable future. While it is less than perfect to accurately describe the work we do, we agreed that the term is simple to remember, and is accessible to policy-makers and the public -- two groups identified as critical in our outreach and promotion activities. Numerous other terms were offered, such as Medical Ecology; Clinical Ecology; Environmental Medical Epidemiology; Geomedicine; Geohealth; Geoepidemiology; Geology and Health; Geology, Environment and Health; Medical Geography; Epidemio-Ecology; and Pathoecology. Perhaps the most accurately descriptive title for this field was lightheartedly suggested during the Summary Presentation to the overall conference on Monday, June 10: Hydrobiogeochemoepidemiopathoecology. One problem with using some of the above terms is that they have attached to them historical baggage that preclude their use in our context. For instance, from a purely linguistic point of view, Environmental Medicine might be an apt descriptor of what we do. However, that term is widely understood to refer to occupational issues, and to be focused at the molecular level.

The Group decided that it is more important to start getting the public to associate a simple term with what we mean for it to encompass than to try to please our own scientific sensibilities. The definition, "Medical Geology is the scientific discipline that examines the impacts of geologic materials and processes on human and ecosystem health," includes both natural and anthropogenic sources of potential health problems, and implies that wildlife and plant diseases are not excluded. It was pointed out in the Summary Presentation that in contrast to the emphasis on treatment and cure that the term "Medical" often implies, our work is really more accurately described as "Public Health" with its focus on prevention. Nonetheless, the consensus was that linguistic precision should be compromised in favor of a term that people have some general idea about what it may mean. We recognize that it is incumbent on us to be assertive in defining the term as we introduce it, helping insure that someday people will feel that they’ve always known what Medical Geology is. We now have the opportunity to assign our baggage of choice to Medical Geology! It was noted that within the USGS, the term Epidemio-Ecology will continue to be used internally due to sensitivities of the non-Geologic Disciplines; viz. Biological Resources, Water Resources, and National Mapping. Although it is rumored that the Director’s Office will require another name, as the word "ecology" has evidently acquired some negative baggage, at least with the current Administration.

The next item on the Agenda was to discuss ways to promote the growth and expand the credibility of the sub-discipline, Medical Geology. We first reviewed what was currently being done to this effect, and found that the International Union of Geological Sciences (IUGS) has recently created a Medical Geology Initiative directly under its Executive Committee. The ties this Union has to the International Council of Scientific Unions (ICSU), and the United Nations Educational, Scientific and Cultural Organization (UNESCO) may also be helpful for information dissemination. In Washington, D.C., the National Museum of Health and Medicine has an exhibit that will run indefinitely highlighting how Medical Geology is used by its parent organization, the Armed Forces Institute of Pathology (AFIP) to study health problems associated with arsenic. The exhibit, "Research Matters: Environmental and Toxicological Effects of Arsenic," explains how geoscience tools are complementing the skills of biomedical and environmental professionals to understand exposure to and effects of toxic metals such as arsenic. Also affiliated with the AFIP is the newly established Medical Geology Registry. This clearinghouse of information and resources should greatly facilitate training and education of future Medical Geologists. It should be beneficial to create a Repository for archived samples under the oversight of the Registry. The Medical Geology community has been represented in symposia at regional and national meetings of the Geological Society of America (GSA). Scientific American magazine used the term "Medical Geology" for the first time in the February 2002 issue. Olle Selinus is editor-in-chief of a textbook on Medical Geology currently in preparation.

We recognized the need to promote the field using popular science and general interest media outlets. To this end, it was agreed that we should produce a 30 - 40 page colorful, glossy, professional-looking pamphlet with assistance from the American Geophysical Institute. Production of an educational video would be helpful, and David Suzuki agreed to consider doing a special television program in his series devoted to Medical Geology issues. An unmanned roadshow that could be displayed at schools, at conferences, etc. would be useful to disseminate information. It was suggested that we produce an interactive DVD, appealing to technologically savvy impressionable minds.

The Working Group decided to create a Medical Geology Publications Advisory Board. This body will help steer authors to appropriate journals. Presently, Medical Geology papers are being published in a wide variety of journals. The Group felt that the Board could help the development of the field by channeling submissions to a smaller number of journals, while avoiding the presently undesirable launching of yet another new technical journal. Specifically, the Journal of Toxicological Pathology and the Journal of Environmental Geochemistry and Health have expressed interest in adding an Editorial Section and featuring a series of special editions, respectively, devoted to Medical Geology. The American Mineralogist is also entertaining the idea of showcasing work in this field.

Similar to the decision to not create a stand-alone journal, it was agreed that we should not start a new professional society at this time. However, we do feel that we should somehow make more formal the international community of Medical Geologists. It seemed most efficient to expand on what we’ve already done in terms of linking up with existing organizations. For instance, this very Working Group met under the auspices of the International Society for Ecosystem Health (ISEH). In point of fact, ISEH has indicated its willingness to take Medical Geology under its wing, to whatever extent we desire. Creation of Sections within the GSA and the Ecological Society of America were suggested.

It was decided that another effective way to promote the growth and development of the field will be to create a small fund designated to be used as Science Fair Award money. Doing so will generate visibility for the field among impressionable budding Medical Geologists. Other suggestions involving formal educational institutions were to have USGS and George Washington University continue developing the Certificate Program, ultimately leading to the development of an actual degree program in Medical Geology, offering a weeklong summer course at a local university, and to organize a postdoctoral-level short course under the auspices of the NATO Advanced Study Institutes. It was also noted that the short courses on Metals, Health and the Environment given by Finkelman, Centeno and Selinus should continue.

We agreed that doing good work will go a long way toward promoting the discipline. Specifically, we should make it easier to share tools and methodologies with our biomedical and public health community partners. They may not be aware of the possibilities that exist by analyzing samples with instruments and techniques common to geoscientists. Unless one knows that a method exists to address a particular problem, one may not be asking the right questions. These ideas and more are aimed at strengthening this transdisciplinary field by cross-fertilization, leading to hybrid vigor!

A number of topics were raised as priorities for the field of Medical Geology. Two main themes seemed to emerge as overriding priorities: study of trace elements, especially the bioavailability thereof, and a need to establish baseline, or background, levels of contaminants/xenobiotics/potentially harmful but naturally-occurring materials in water, soil, air, food, and animal tissue. And the need for research in the specific areas of radioactivity, earth materials, and infectious diseases was pointed out repeatedly.

In the short term, the Group felt that we should determine the geographic distribution of diseases, and make maps of them available to the public. We should study the relationship of trace metals to specific diseases (e.g., Zn and Cd to prostate cancer in New Zealand). We could simply take all of the information on Medical Geology case studies and put them in one place, such as Selinus’ website. As a general theme, we stressed the importance of making good use of geographic information systems (GIS) overlay tools. Doing these things should help ensure that we gain some handy success stories to point out in support of our outreach efforts.

It should be a priority of ours to solve a high profile issue, such as Balkan Endemic Nephropathy. We would do well to create a system for establishing and reporting standards for consumer products. For instance, are there Medical Geology issues related to construction materials? As relates to pathogens carried by dust, we could make strides in addressing their taxonomy and pathology. Effects of deficiencies and excesses of trace elements and nutrients in diets need to be better understood. There are likely to be exposure pathways yet to be discovered or fully appreciated. Global change as it affects ecosystem health and development of predictive models fall under the rubric of Priorities in this field. We must not stop at reporting observations of GIS-based correlations between apparent human health problems and environmental factors, but go on to using spatio-temporal statistical analysis and biophysical, pathological, or toxicological mechanistic techniques to demonstrate biological plausibility. Baseline/background determination came up as key to interpreting information relative to weapons of mass destruction. How else would we necessarily know when an anomaly occurs? We need to determine what sampling needs to be routinely done. Processes and mechanistic links need to be further explored. For example, how do metal solubilities, isotopes, modes of occurrence, etc. affect bioavailability? Our creativity is challenged to develop novel applications of existing tools. We need to establish a centralized repository, archive, or reference collection to enable the identification, collection, and validation of materials (e.g., tissues) that indicate origins of disease. Another priority of ours ought to be the continued analysis of research gaps.

One of our ultimate goals should be to take this baseline/background level monitoring to the global scale. Using consistent methodologies, we should characterize in detail the geology, soils and plants the world over. We need more synthesis studies. We should let our partners in the medical community understand our needs. For instance, death reporting criteria are highly variable. A system for accurately determining and recording cause of death must be standardized. Given our inability to predict what issues will become major problems in the future, we should push for long-term monitoring and tracking of as wide a variety of geologic materials as possible. By doing so, we will better be able to detect changes in the environment over time, and based on sensible application of modeling techniques, to predict and prevent those deemed deleterious. It is in our interest to consider legal frameworks and the permitting process when selecting which things to monitor and in what order. We need to build linkages to the agricultural sector, and in particular those working with foods. We need to increase public awareness of the benefits to society of Medical Geology in order to generate positive attitudes that will facilitate study participant recruitment. A recurring theme that came out of our Working Group was the need to get lots of presently disparate information into one place. After all, this is really the whole point of creating the distinct subdiscipline of Medical Geology.

One of our most important responsibilities at present is to foster acceptance of a generally recognized, distinct sub-discipline called (at least provisionally) Medical Geology. This will facilitate generation of substantial monetary support for research by raising awareness among funding agencies and decision-makers. Meetings such as this one are proving to be powerful means of getting the scientific community to take note of our progress. We must educate the general public as to the value of this field, with its promise of finding practical, effective solutions to serious public health problems the world over -- a good thing in and of itself, but also because people can encourage their elected leaders at the local, state, and Federal levels to champion this important cause. The Medical Geology Working Group that met in Washington, D.C. is urged to take an active role with the network of Medical Geologists under the IUGS Initiative mentioned above. A liaison could be established between the ISEH and the IUGS Medical Geology Initiative. Such a symbiosis would create a valuable opportunity for the ISEH to provide input, mutually beneficial to both organizations. Together, we are well poised to help build a strong, self-sustaining interdisciplinary scientific discipline.

Medical Geology Working Group Participants in Washington, D.C. June 7 - 8, 2002: