June 9, 2011 — Physicians in the United States would receive more training on environmental health issues such as water pollution and, using new billing codes, charge third-party payers for putting that training into practice under a government-sponsored initiative to better protect people from harmful chemicals.
The initiative, called the National Conversation on Public Health and Chemical Exposures, was launched 2 years ago by the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR). Today, the project's leadership council, representing industry, state and federal public health agencies, environmental activists, and academics, released recommendations on how to create a comprehensive system for using and managing chemicals safely.
Those recommendations include fostering better science about chemical exposure, expanding systems for monitoring chemical exposures and health outcomes, overcoming "environmental injustice" by paying more attention to vulnerable communities, and replacing problematic ingredients in consumer products with safer, "greener" ones.
An entire set of recommendations focus on enabling healthcare providers and the public health workforce to address the needs of individuals exposed to toxic chemicals. It begins with teaching more environmental medicine in medical, nursing, and other healthcare professional schools, with career-long learning to follow, according to the leadership council's "action agenda." The agenda urges professional organizations, such as the American Medical Association, to develop guidelines on what budding clinicians need to know about pesticides, sick-building syndrome, and the like.
Another ambitious recommendation states that the Institute of Medicine should convene an expert committee to draft environmental health practice guidelines for physicians, nurses, and others engaged in primary care. These guidelines would address history-taking, assessment, prevention, and treatment of chemical exposure and indicators on when to refer someone to a specialist.
Experts who drafted the National Conversation document recognize the need to give clinicians incentives to follow environmental health guidelines. Accordingly, the action agenda calls on the federal government to develop a reimbursement scheme for environmental health services that would include billing codes for such things as assessing chemical exposure in a childcare center and educating patients about household chemicals stored under the kitchen sink.
"I'm Certain Cost Will Be a Barrier"
The National Conversation's numerous recommendations now await adoption by both the public and the private sectors.
"There is no one owner of this document, but I would say that this document is...owned by the American public," Christopher Portier, PhD, director of the ATSDR's National Center for Environmental Health, said at press conference today. "I will take it on as my responsibility to make sure the document is widely communicated [and] shared with my federal partners. I will emphasize, when given the opportunity, where I think my federal, state, and local partners might use parts of the action agenda to improve what they're doing."
In an era of federal and state red ink, finding the money to carry out the National Conversation agenda will be hard, said Daniel Goldstein, MD, director of medical toxicology at Monsanto and a member of the National Conversation leadership council.
"I'm certain cost will be a barrier for implementing at least some of these recommendations," Dr. Goldstein said at the press conference. "Economic resources will undoubtedly get in the way." He also said industry may view the directives of the leadership council as slowing down the wheels of commerce.
However, the cost of protecting Americans from harmful chemical exposure must be weighed against "the staggering cost of environmental disease, not just in direct healthcare costs, but [also] lifelong earnings," noted Gail Shibley, an administrator in the Office of Environmental Public Health of the Oregon Health Authority.
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