Meeting for Justice


I_1III
sus monkeys, according to Mary Lou
Ballweg, cofounder and president of the
Endometriosis Association. The original
study, which was begun in 1977 and
involved 24 rhesus monkeys randomly
assigned to a diet containing 5 parts per
trillion (ppt) dioxin (low dose), 25 ppt
(high dose), or no dioxin over a 4-year
period, examined only reproductive and
neonatal impact.

It was years after the dioxin diet had
been discontinued and autopsies implicat-
ed severe endometriosis in the deaths of
several of the monkeys, a finding that
reached Ballweg by word-of-mouth, that
the Endometriosis Association stepped in,
just in time to prevent the dispersal of the
monkey colony to the highest bidders. The
association brought in two of its expert
advisors, one of whom coauthored the
Fundamental and Applied Toxicology study,
to perform a daylong laparoscopy examina-
tion on the survivors. The scopes were
blinded, and the results were astounding,"
Ballweg says.

Meanwhile, the colony is dwindling as
more animals die, and the survivors will
reach menopause within three years. The
Endometriosis Association is mobilizing to
fund as many studies as possible in the
remaining time, with a particular interest
in exploring dioxin-related immunological
alterations. "Endometriosis may be more
an immunologic disorder with reproduc-
tive consequences, rather than the other
way around," Ballweg suspects.

"The sad fact," says Rier, who is con-
ducting immunologic studies, "is that the
best time to have done these studies would
have been from the time of exposure over
the years the disease was developing, so
that changes in immune function and dis-
ease progression could have been observed
side by side. At this point, we can't tell
cause from effect-if the immune changes
arise from the dioxin exposure or from the
disease."

Linda Birnbaum, director of the envi-
ronmental toxicology division of the EPA's
health effects research lab, concurs: "We
do know that dioxin alters the immune
system of rhesus monkeys, but 10 years
postexposure it's hard to sort out the
composite effects. It's highly likely
though." Birnbaum adds, "These chemi-
cals are associated with an increased
risk of endometriosis. This is a very
relevant study."

Rier's preliminary studies reveal dis-
ease-related differences in markers of
immune dysfunction such as immune cell
cytokine production, increases in tumor
necrosis factor, and decreases in inter-
leukin-6. Rier is also examining natural
killer cell activity and antiphospholipid
antibodiles in ongoing studiles.

In the randomized rhesus study, as well
as in the general rhesus population at the
primate center, the spontaneous endo-
metriosis rate was about 30%, considerably
higher than the apparent rate among
women. Even so, the findings in these ani-
mals were "minimal," Rier observes, com-
pared to the severe and symptomatic mani-
festations in 79% of the dioxin-exposed
monkeys. Moreover, Rier and others note,
the incidence of mild, asymptomatic
endometriosis among women is not
known.

The results of this study have prompt-
ed a joint effort by NIEHS, CDC, and
Duke University investigators to compare
the blood levels of dioxin and related com-
pounds in 30 women with and without
endometriosis. A larger, more definitive
study will be undertaken if higher levels of
dioxin are found among endometriosis
patients than controls, says George Lucier,
chief of the NIEHS Laboratory of
Biochemical Risk Analysis. The results of
the preliminary study-the first to explore
in humans the hitherto unsuspected link
between dioxin and endometriosis-are
expected by the end of the year. Even if
rhesus monkeys are actually more suscepti-
ble to endometriosis than are women, "the
dose-response relationship and the severity
of disease give the rhesus dioxin findings
more power," Lucier comments, noting
that dioxin's actions both as a potent envi-
ronmental hormone and an immunotoxin
provide two plausible mechanisms for a
role in endometriosis induction.

Meeting for Justice
An upcoming symposium in the nation's
capital will bring together community
leaders, government health agency repre-
sentatives, and members of academia with
the goal of developing research strategies to
eliminate environmental health injustice in
the United States. Environmental justice
indudes issues such as race, socioeconomic
class, occupation, differential exposure,
and proximity of housing to environmen-
tal hazards, all of which may directly affect
a person's health.

NIEHS, EPA, the Agency for Toxic
Substances and Diseases Registry, the
National Institute of Occupational Safety
and Health, the Department of Energy,
and the NIH Office of Minority Research
are co-sponsoring a symposium entitled
"Health Research and Needs to Ensure
Environmental Justice," to be held 10-12
February 1994. Participants will meet for
three days in an interactive environment
to:
* identify at-risk populations and

research gaps;
* acquire information to develop a com-

prehensive, long-term intra- and inter-
agency research agenda (with projected
funding) that incorporates community
needs and priorities of at-risk popula-
tions.

* design a prevention and intervention
model as part of a larger research, edu-
cation, training, and community out-
reach (multilingual, multicultural, mul-
tiracial, and multiethnic) effort;

* facilitate public input and participation,
especially from underrepresented com-
munities, to address problems, design
research plans, collect data, and imple-
ment plans;

* develop mechanisms to diversify the
pool of health science professionals to
include experts from affected and
underrepresented communities trained
in environmental health fields as scien-
tific advisors and peer review panelists
on research studies and health research
grants; and

* make recommendations on interagency
cooperation related to research needs of
at-risk populations and target resources
that build on strengths of existing
agency mandates and directives.
"This symposium was planned with the

participation of community leaders and
concerned citizens working as full part-
ners," notes Dan VanderMeer, director of
the NIEHS Office of Planning and
Evaluation. "We see this as an exciting
opportunity to expand and accelerate fed-
eral efforts to improve environmental
health in urban and rural areas through the
involvement of underrepresented persons
in development of strategies that recognize
community needs."

GnomPrjc

572 Environmental Health Perspectives