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Statement Of Claudia S. Miller
Environmental Protection Agency
Aging Initiative Public Listening Session
San Antonio, Texas
April 8, 2003
Claudia S. Miller, M.D., M.S.,
Department of Family and Community Medicine
The University of Texas Health Science Center at San Antonio (UTHSCSA)
Department of Family and Community Medicine
The University of Texas Health Science Center at San Antonio (UTHSCSA)
Thank you for providing this opportunity to address research gaps related to aging and the environment. I am an associate professor in Occupational and Environmental Medicine here at the University of Texas Health Science Center at San Antonio. I will focus on two areas where I feel the Environmental Protection Agency could make important contributions.
First, the vast majority of senior citizens spend 90% or more of their day indoors, as do most Americans. Indoors, we encounter complex mixtures of pesticides and volatile organic chemicals, such as disinfectants, fragrances, and vapors from new carpeting and paint. As we age, our susceptibility to even low level chemical exposures increases. Community-based research is needed to determine which chemicals are commonly found in senior centers, nursing homes and hospitals. Practical approaches to eliminate or replace unnecessary and potentially harmful substances are need. This is one area in which the EPA could make a major contribution.
A second research gap that the EPA could help fill involves the need for an environmentally controlled medical research unit or EMU in the United States. An environmental medical unit is a specialized hospital wing where disinfectants, carpeting, chlorine bleach and other sources of indoor air contamination have been reduced or eliminated. The EMU is needed to diagnose and treat seniors and others with puzzling medical conditions, especially illnesses that have proven refractory to usual medical interventions. This approach allows patients to avoid potential environmental triggers while under medical observation. At the same time, food intolerances can be tested by eliminating suspect foods and later re-introducing them one at a time.
In 1991, I co-authored a book on this topic (Ashford NA, Miller CS: Chemical Exposures: Low Levels and High Stakes. Second edition. New York, John Wiley and Sons, Inc., 1998). This past January I co-chaired an international gathering of scientists in Tokyo, Japan, concerning the need for EMUs. The Japanese had read our book and taken its message to heart. Japan now has three EMUs in operation, with two more on the drawing boards. Pictures of the EMU at Kitasato Hospital in Tokyo, Japan, are attached. No such facility exists in this country despite strong recommendations by U.S. physicians and scientists for more than a decade. Analogous to a microscope, the EMU is an essential medical tool for evaluating which exposures are making a person ill.
What can the EPA do? The EPA could establish an EMU here in San Antonio where nationally recognized expertise exists. The Agency could then work in partnership with the National Institutes of Health/National Institute of Environmental Health Sciences (NIH/NIEHS) and with this campus to sponsor studies using this invaluable new medical tool.
Enclosed are copies of two papers, one entitled "Toxicant-induced loss of tolerance: an emerging theory of disease?" Miller CS, Environmental Health Perspectives 105(2):445-453, March, 1997; and the other "Empirical approaches for the investigation of toxicant-induced loss of tolerance," Miller CS, Ashford NA, Doty R, Lamielle M, Otto D, Rahill A, Wallace L, Environmental Health Perspectives 105(2):515-519, March, 1997. These papers describe the rationale for a research EMU.
Thank you for visiting San Antonio. I would be happy to answer your questions.