From its founding in 1987, the International Society for Environmental Epidemiology (ISEE) has been multidisciplinary and oriented toward improving the science that governments use to guide environmental health policy. This article describes how this orientation came about and the scientific and political context of the founding of ISEE.
In the fall of 2012, I suggested to the Executive Council of the ISEE that, because we would be holding the twenty-fifth meeting of the society in Basel, Switzerland, in 2013, we should solicit essays from the membership about what the society had meant to them as people and as professionals. Also, what impact, if any, did they think ISEE might have had on society-at-large? A few of the most motivated members have kindly posted their responses on the ISEE website at http://iseepi.org/About/reflections.htm.
My own response online includes perspectives of members who did not submit written responses but whom I interviewed by phone. In this short piece I reflect on the origin and original intentions for this society.
It was over lunch in Berkeley in 1987 that John Goldsmith spun out to a skeptical me his reasons for wanting to form an ISEE. His views reflected his long career as a governmental scientist in California, with the U.S. Federal government, as a World Health Organization (WHO) consultant, and as a professor in Israel. His vision reflected the fact that his main contribution had been in applying epidemiology, exposure assessment, and physiological and toxicological information to the formation of environmental health regulations and policies. He had also discovered the surprisingly effective power of governments and organizations to convene experts to provide pro bono advice for the common good. Hence, his goals for the proposed new society spoke more to a societal role than to the more usual goal of improving the quality and status of a profession or a single scientific discipline. John wrote this justification for the new society in a special issue of Science and the Total Environment1:
“Whereas environmental policy-making has been hampered by the scarcity or poor comprehension of good epidemiological studies of effects of environmental exposures on human populations, and
Whereas environmental epidemiology requires the cooperation of epidemiologists, statisticians, toxicologists, and those professionally qualified to estimate environmental exposure, and
Whereas no existing scientific professional organization is dedicated to stimulating the international communication among these groups and thereby to promote the effectiveness of environmental epidemiology, and
Whereas no existing organization provides a forum to which governmental agencies, industrial associations, or public interest organizations can turn for the organization of multi-disciplinary groups to make recommendations on substantive or methodological problem areas in environmental epidemiology, and
Whereas no existing organization is available to take the initiative in identifying areas or topics in which environmental epidemiology can make an impact on environmental policy,
Therefore we join in the establishment of the International Society for Environmental Epidemiology in order to meet these needs and to strengthen the scientific input to environmental protection.”
John’s faith in the value of remedying the “scarcity and poor comprehension” of “good science” by policy makers may reflect the simpler times of the 1950s and 1960s, when the universal exposure to priority air pollutants produced health effects that even an epidemiologist could demonstrate, and that affected everyone equally. By the late 1980s, environmental health concerns had turned to smaller carcinogenic and reproductive risks that were more difficult to demonstrate. These were also distributed in an environmentally unjust way—for example, possible risks to the small communities adjacent to hazardous waste sites, or to the few percent of people who lived very near to electrical transmission lines. This was unlike the priority air pollutants, which were equal opportunity afflictions. This unequal distribution of risk created a situation where the costs of remediation were spread to stakeholders who were not directly affected. Pollution, like global climate change, began to take on ideological dimensions. Evangelical and business-friendly stakeholders were finding ways to influence politically appointed environmental policy makers so as to prevent the collection, publication, or consideration of information that was “inconvenient” from an economic or ideological point of view. In 1987, the goals that John had articulated were particularly urgent.
Professor Evelyn Talbot at the University of Pittsburgh reminded me in a recent letter that the environmental epidemiology initiative started by Professor Bernie Goldstein at the United States Environmental Protection agency (US EPA) was crucial to the genesis of ISEE:
“When the US EPA in l985, started a Center of Excellence in environmental epidemiology at PITT, this became a target of opportunity for the creation of the first meeting of the Society for Environmental Epidemiology which actually occurred after one of the Center for Environmental Epidemiology meetings in the fall of l987. This was a small meeting with less than 50 people and was held after the PITT/EPA symposium. I remember that it was during the discussion of this early symposium that it was decided we should help found the ISEE. There was no meeting in l988 except for a Society for Epidemiologic Research ‘extra day’ meeting in Buffalo in which Drs. Pat Buffler, John Vena and I attended with Sir Richard Doll and others. This was followed by a meeting hosted by Drs. Leonard Hamilton and Sam Morris who hosted the 1989 meeting in Stony Brook, New York. Approximately 125 people attended this meeting. I mention this because these early meetings set the groundwork for the organization.”
The people mentioned above and the others who formed the steering committee for the establishment of ISEE benefited from the career-long networking of John Goldsmith. John’s epidemiologist son David emphasized to me the importance his father put on having a society that provided a professional home for governmental environmental health scientists. Our founding constituency also benefited from the network formed by Jerome Wesolowski, the head of the Air Laboratory at the California Department of Health Services, who had started an innovative indoor-air-pollution unit. A few years later, the exposure-assessment pioneers in ISEE decided to form the sister organization, the International Society of Exposure Science (ISES), that now proffers an annual award in Dr. Wesolowski’s name.
John proposed that the new ISEE have its first secretariat provided by my staff at the California Department of Health Services (now California Department of Public Health), and that I should offer myself as first president. At that point, I headed a unit with responsibility for birth defects, occupational health, childhood lead poisoning, environmental toxicology, and general environmental epidemiology, with a staff of about 200 people. As a physician with a doctorate in epidemiology and experience in quantitative decision analysis, and with seven years of experience in providing advice and risk assessments to California regulatory agencies, I was fully in sympathy with the goals John outlined. I suppose I also hoped that the society would help increase the sophistication of the way epidemiologic estimates of harm could be combined with economic facts and moral principles to form more rational and fair environmental health policy. Knowing that it is easier to ask forgiveness than seek permission, I quietly proceeded to use my administrative staff, in cooperation with Evelyn Talbott in Pittsburgh, to set up the society. We served together for two terms. We also hosted the second meeting of the society in Berkeley. From the beginning, there was a big emphasis in attracting and fostering young investigators, and this has continued into the present, as witnessed by the age distribution at ISEE meetings. I later encouraged Dr. Gayle Windham, one of my colleagues, to run for Secretary after Evelyn stepped down. She served with our second President, the late Pat Buffler. In her essay, Dr. Windham mentions how enriching her participation in ISEE has been.
When I was receiving my masters and doctoral degrees at Harvard in the late 1960s, and while teaching at Harvard and UCLA, noninfectious disease epidemiology taught that the “important” diseases were those that caused the most preventable morbidity and mortality. These were primarily driven by harmful lifestyles. Public concerns for anything else, including diseases owing to unfair exposures imposed on small populations, were thought not to be a cost-effective use of scarce investigative resources. Those with this point of view took comfort from Doll and Peto’s famous article to counteract what these authors rightly thought was the current exaggeration of the health impact of the chemical and physical aspects of “the environment.”2 Even the occupational epidemiologists looked down their noses at those of us studying the effects of environmental exposures delivered to worried middle-class environmentalist populations. The exposures we were studying were so low compared with occupational exposures. Furthermore, the unfairness of environmental exposures paled in their eyes when compared with the unfairness imposed on so many blue-collar workers. Although the environmentalist public demanded the kinds of studies we were doing, many public-health bureaucrats tended to look at satisfying these demands as a politically driven and inappropriate diversion of funds. The few governmental officials responsible for funding environmental epidemiology had little moral support from their other health-focused colleagues, and no efficient way to access experts in the field.
There were political and methodological problems that were more salient in environmental epidemiology and not so interesting to mainstream epidemiologists. The lifestyle-driven diseases whose study was then in vogue were pursued with questionnaire-based studies. The variability and complexity of the exposure scenarios that we environmental epidemiologists struggled with were much more complex than that of the lifestyle epidemiologists or even of the occupational epidemiologists. We needed to develop better exposure-assessment methods. Once exposures were defined for populations we studied, we needed to interpret those exposures in the light of animal and cellular toxicological evidence about the agent or agents in question. Those of us who studied identifiable communities composed of contending stakeholders had a new kind of relation with the people we studied that led me to write an early article entitled “Epidemiology for and with a Distrustful Community.”3 We had to develop good practices to work with all these stakeholders. If we failed, our publics let us know. The slots for oral presentations or posters at the Society for Epidemiological Research, the International Epidemiological Association, the American Public Health Association, or the occupation-focused societies were limited, and our chances of being chosen to present were low. Finding other environmental epidemiologists at these meetings was like finding a needle in a haystack. In retrospect, we had a primordial longing to find brothers, sisters, uncles, and aunts with whom to solve problems, celebrate our successes, and commiserate on our travails.
So what did our respondents think that ISEE had done to meet our original intentions in its first quarter century? For answers see http://iseepi.org/About/reflections.htm.
I thank Evelyn Talbott and other former officers of ISEE who refreshed my memories of the founding of ISEE.