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Summing the Factors Controlling Disease
(July, 2003) Research is showing us that some answers to controlling some disease is in the air. The links between the quality of the air-and its impact on the health of a wide spectrum of humans living and working in a variety of locations is being studied by the Office of Research and Development (ORD). The air we breathe is the environmental medium we all can visualize easily as an important determinant of our health, well-being and comfort wherever we may live.
There are loads of things in the air. From such naturally-occurring constituents as dusts, volcanic ash and pollen to components that are added as by-products of human activity, its no mystery that the quality of the air we breathe plays a real role in our health from early childhood to old age. We are in constant, inevitable contact with the atmosphere that supports us. We need to know how its components affect us. We need to know how to "connect the dots."
An imaginative and prolific "connecter-of-the-dots" that make up air pollutant threats to our health is Dr. Lucas M. Neas. He conducts his research out of the Epidemiology and Biomarkers Branch of the Office of Research and Development's National Health and Environmental Effects Research Laboratory (NHEERL). The Branch is part of the NHEERL's Human Studies Division (HSD) and is located on the campus of the University of North Carolina in Chapel Hill, North Carolina. We can think of his work in science as helping to paint a fuller picture of where, when, how, and why those pollutants are harmful to specific groups of people. He has been studying how exposure to a range of air pollutants is affecting people's lives and livelihoods worldwide.
Within NHEERL's Human Studies Division, the Epidemiology and Biomarkers Branch is the home of scientific research at the frontier of human exposure assessment. There, Dr. Neas specializes in applying the principles of epidemiology (that is, the sum of the factors controlling the presence or absence of a disease or pathogen in a population). Also, his work involves statistics (that is, the mathematics of the collection, organization, and interpretation of numerical data, especially the analysis of the characteristics of different population as inferred from sampling). He portrays his work in epidemiology as "the application of statistics to medical problems in a field setting."
One of the most important requirements of Dr. Neas' work in epidemiology is the need for a carefully characterized cohort (that is, a generational group; for example, "the cohort of schoolchildren aged 9 to 12 years of age"). Quite often, a major limiting factor for this type of research is the difficulty in collecting sufficient, relevant information from such a very large number of individuals. Epidemiology and statistics often are suspected by the layperson as being uncompromisingly solemn topics; but, using both, Dr. Neas is clarifying which groups get exposed to what things in the air, and what may be the consequences of this exposure.
Dr. Neas admits that he, ". . .likes challenges, especially those situations where someone challenges him to convince them of a fact or of a side in a debate." He revels in being able to come up with convincing, persuasive arguments likely to change someone's mind and position. What is endearing and intriguing when he takes on a challenge is his charm-and the way he uses that charm to convince people that he is right. One of his major motivators at an early age-that persists even today in his people-focused research work-is the ability to be purposely helpful. Being supportive in a collective group context helps to fulfill Dr. Neas' sense of useful participation. We might even represent his natural modus operandi as what is now described colloquially as 'plays-well-with-others'. His everyday devotion to the collectivist spirit translates easily to his chosen focus of research on populations. We will see later that this supportive role is a characteristic that plays large in the communication of the results of his work designed to unravel questions about the health of humankind.
Dr. Neas' first recollection of conducting an experiment was at the age of eight or nine when he concocted a blue "dye" with the help of his chemistry set. Needless to say, somehow the vessel holding his reagents burst, spreading its contents over everything. Neas likes to imagine that this early demonstration of his science craft could rightly be looked at as his Blue Period. Early in his career, Neas worked on the development and analysis of vital statistics within the West Virginia State Health Planning Agency. During that time, the Bhopal chemical disaster occurred, and the sister industrial plant of the Bhopal facility was located nearby at Institute, West Virginia. He became involved in health-related evaluations of the Institute plant, an involvement that allowed him to become more focused on epidemiologic research.
While Neas found his work in the mid-1980s as a vital events statistician with the West Virginia Department of Health challenging and important, he decided to broaden his career by undertaking graduate study at the Harvard School of Public Health. In 1991, he received his doctorate in Epidemiology, and he did postdoctoral training at the school's Channing Laboratory. Currently, in addition to his work with the ORD's Human Studies Division he holds adjunct positions at Harvard's School of Public Health (as Assistant Professor of Environmental Health) and at the University of North Carolina (as Associate Professor of Epidemiology).
In 1998, he joined the NHEERL's Epidemiology and Biomarkers Branch to conduct air pollution epidemiological research. He believes that the fact that his experience and research interests allow him to delve into many spheres of inquiry plays a significant role in keeping him at EPA. In line with his inclination toward group, collective participation, Dr. Neas is active in Boy Scout activities. His work with the Scouts capitalizes on his people-oriented organizational skills and focuses on improving the effectiveness of adult Scout Leaders. His work is going a long way in fostering and improving youth mentoring skills for adults devoted to the goals of Scouting.
Someone whose influence on Dr. Neas has been more than technical is Dr. Frank Speizer, the Co-Director of the Channing Laboratory within the Department of Medicine, Brigham and Women's Hospital at Harvard Medical School. Dr. Speizer-who is the Edward H. Kass Professor of Medicine at the School and Senior Physician at the Hospital-continually demonstrates what Dr. Neas characterizes as "a profound ethical perspective, a strong core sense of what was right in many situations." Drs. Neas and Speizer share enviable expertise in the design and conduct of long-range cohort studies (these involve large numbers of at risk individuals within populations) to understand the natural history of the development of chronic respiratory diseases. Another senior mentor, Dr. Benjamin Ferris, also influenced Neas' perspective on where epidemiology-as a science-has been and is going; in particular, the benefits of bringing more modern analytic techniques and tools to the discipline.
Dr. Neas feels that the best advice he ever received came from Frank Speizer. He relates how Speizer once told him, "Always know where your money is coming from." Neas sees this advice as being very 'client-focused'. He feels that following this sound counsel encourages intimate knowledge of one's customer and that such knowledge is paramount in meeting customer expectations.
As an air pollution epidemiologist practicing at the EPA, Dr. Neas feels he has developed a real sense of creativity in being able to conceptualize and then set human studies-based research initiatives into motion. These creative research activities are an indication to him that his ideas continue to reinvent the visions and the capabilities of his research specialty. He says that he derives a great deal of satisfaction from the wide latitude he has been given to accomplish his research. Also, he is encouraged by the palpable and continued support and reenforcement he receives from his senior managers. When asked what his favorite conference destination is he quickly answered, ". . .some remote, backwoods place from which the participants have little chance for escape." Being in such a place affords Neas a chance to collaborate fully with his colleagues undistracted. He finds it an ideal situation where scientific interaction is Number One on the slate of activities.
Having begun his research career as a respiratory epidemiologist, Dr. Neas gathered much of his data, at that time, through direct physiologic measurements of the respiratory system. Now, however, he notes that science has advanced to a point where cardiac, inflammatory, and neurologic endpoints complement respiratory measures. Coupled with this broadening of useful endpoints, he is encouraged that more and more information is now collected in a continuous series rather than on a count basis.
Dr. Neas sees continued development of-and strict adherence to-human subjects protections as paramount focus for his work, for the ORD and the Agency, and the wider scientific community. Part of that system of protections, according to Neas, involves a commitment to informing the public, the giving back of understandable responses to communities that have cooperated in research. He believes that this feedback ranges from clear, basic information about research to be conducted to subsequent medical findings. Dr. Neas thinks that epidemiologists have a longstanding tradition of giving special attention to public communication of information that may often be sensitive.
Being deeply invested in his research work and its underlying science, Dr. Neas ventures that he ". . .hopes never to get to a point in life where I do not enjoy this work." He sees his research as an inextricable part of his life-along with his family and his work with the Scouts. Most importantly, he is pretty sure that he can convince anyone that his work with the EPA in air pollution epidemiology is making a genuine contribution to society.
The Office of Research and Development is committed to showing the difference the important work its scientists and engineers are making in peoples lives. We welcome your reaction to-and any comments on-this "Spotlight" feature article; please send them to draggan.sidney@epa.gov.