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Prenatal and infant exposure to ambient pesticides and autism spectrum disorder in children: population based case-control study

BMJ 2019; 364 doi: (Published 20 March 2019) Cite this as: BMJ 2019;364:l962

Linked Editorial

Pesticides and autism

Raising awareness on the health effects of environmental exposures

The research by von Ehrestein et al is a welcome and timely addition to environmental health research.

The technological advances of the recent decades have seen an exponential growth in the number of environmental hazards, which is unmatched by research on their health effects. The health effects of industrialisation are most visible in developing countries, which are witnessing an increase in the incidence and prevalence of chronic diseases, cancers, reproductive and epigenetic effects. Doctors are increasingly called to address such health issues but are often ill-equipped to understand their causation and consequently effectively manage them.

The challenges in establishing environmental causation of disease should not be underestimated. These include practical issues in conducting experimental and non-experimental research; the multifactorial causation of many diseases, which often involves interaction of genetic and environmental factors; the limited knowledge on the biological pathways through which environmental influences exert their causal effects; the difficulties in testing causal inferences. The above are often compounded by the lay interpretation of the findings of environmental health research and the public’s perception of risk.

What can be done? Environmental medicine deserves a more prominent place in undergraduate and postgraduate medical curricula. Probable environmental factors should be highlighted when examining the causation of diseases. Environmental health research should be actively promoted, despite the practical, financial and societal barriers. Doctors should familiarise themselves with the hierarchy of hazard control system used in industry as an approach to controlling environmental health hazards. For example, addressing the root cause of disease through elimination or substitution of hazardous agents should rank higher than implementing cancer screening or biological monitoring.

Raising awareness on the health effects of environmental exposures will, at an individual level, empower doctors to more effectively counsel their patients and, at a societal level, enable them to more effectively influence public health policy.

Competing interests: No competing interests

29 March 2019
Anna Trakoli
Consultant in Occupational Medicine
Bradford Teaching Hospitals NHS Foundation Trust
Workplace Health and Wellbeing Centre, Bradford Royal Infirmary