You go to the doctor because you're feeling sick, or perhaps for a regularly scheduled checkup. You're asked about your family's health history, whether you smoke, and maybe about your stress level. But you're not asked about what you eat, drink, and breathe. That's soon going to change.
Tens of thousands of industrial chemicals and metals are in commercial use today (including approximately 3,000 substances produced in excess of a million pounds annually), and many may be harmful to our health. "While only a small fraction have been adequately examined for toxicity, research has shown that even small exposures can be biologically significant, particularly if the exposure occurs during fetal development or in early childhood," says Ted Schettler, a Boston physician. "Such exposures may cause hormonal disruption, immune system disorders, cancer, infertility, miscarriage, birth defects, impaired memory and learning, or other developmental disabilities. But it's not only developing children who are at risk. Even adults who are exposed to contaminants in the home or workplace may be affected."
As doctors begin to understand the implications of such exposures-which may cause episodic, acute, or chronic illness-environmental inquiry will become a routine part of every health history and physical exam. In fact, Schettler and others involved with the Greater Boston Physicians for Social Responsibility have outlined the importance of environmental health histories in a report called Generations at Risk: How Environmental Toxins May Affect Reproductive Health in Massachusetts (www.igc.org/psr). Their research points toward a future in which physicians will want to know more about you and the environment you live in. Here are the kinds of questions they'll be asking you:
Geography-Your Body Holds Traces of the Places Where You've Lived
Where do you/have you lived and worked? Do you spend time near dry cleaners, gas stations, farms, greenhouses, waste incinerators, industrial facilities, or hazardous waste sites, including landfills or military bases? What else characterizes your physical environment? What do you know about the air and water quality there?
Home-Is It Really Sweet?
What household chemicals do you use? Which paints and varnishes, cleaning products, hobby materials, pesticides, building materials, home office products, and pet care products are in your cabinets? Which brand names do you use?
Work and Hobbies-Can Doing What You Love Make You Sick?
What chemicals, fumes, or dusts are you exposed to while you're working or playing? Do you work in electronics, health care, painting, dry cleaning, or auto repair (solvents)? Do you work on a farm or have a garden (pesticides)? Do you work in construction, painting, welding, or jewelry making (heavy metals)? How well is your workspace or home workshop ventilated? What are the results of any air monitoring in those places?
School-A Safe Place for Children?
What exposures might your child experience in school? What kinds of cleaning materials, pesticides, and art supplies are used? Do school policies require that parents be informed about pesticide use? Do your children develop any symptoms of illness while they're in school-wheezing and coughing, for example?
Diet-More Than Sugars and Fats
Do you eat conventional or organic produce? Do you eat meat (bioaccumulation of chemicals)? Does your diet include a lot of freshwater fish or predatory marine fish like swordfish, shark, or large tuna (which tend to contain mercury)?
Water-The Source Is Important
Where does your water come from? What do you know about the results of water testing there?
TELL ME MORE
The Canadian Association of Physicians for the Environment has created a children's health history, available on the group's Web site (
; 613/235-2273). More information is available from Physicians for Social Responsibility (
; 202/667-4260) and Healthy Schools Network (