A boy collects drinking water from a rain puddle in Kabwe, Zambia, where the ground is full of lead after decades of mining. Inset: Study author Philip J. Landrigan, MD, MSc. Photo: Larry C. Price

For decades, families in Dong Mai, Vietnam, recycled used car batteries in their backyards and kitchens without any environmental controls. In Sovetskoe, Kyrgyzstan, homes, playgrounds, and schools were constructed with red sand that contained high levels of lead still present in the soil years after a Soviet-era metal processing factory was closed. In Madre de Dios, Peru, where livelihoods depend upon small-scale gold mining, dangerously high levels of mercury, a potent neurotoxin that is used to separate gold from other materials, have been found in the bodies of 78 percent of residents.

Indeed, rising levels of ambient air pollution, chemical pollution, and soil pollution are extracting a deadly toll on the lives of people around the world, in particular, the very young and very old, and those in low- and middle-income countries. The cost of pollution led to an estimated 9 million premature deaths in 2015—16 percent of all deaths worldwide. This number represents three times more deaths than from AIDS, tuberculosis, and malaria combined, and 15 times more than from all wars and other forms of violence.

These first-ever findings appear in the October 2017 issue of The Lancet in a study led by Philip J. Landrigan, MD, MSc, Dean for Global Health, Professor of Environmental Medicine, Public Health, and Pediatrics, Icahn School of Medicine at Mount Sinai; and Richard Fuller, Founder and President of the nongovernmental organization Pure Earth, and Secretariat of the Global Alliance on Health and Pollution. Dr. Landrigan and Mr. Fuller worked with Pamela Das, MD, Senior Executive Editor of The Lancet, in an exhaustive effort to document the data.

Study author Philip J. Landrigan, MD, MSc

“We want to turn this report into action,” said Dr. Landrigan, who spoke on Monday, October 23, at a special event on the Icahn School of Medicine at Mount Sinai campus that officially launched the study. The goal of the report, he said, was to raise global awareness of pollution and mobilize politicians to tackle it by providing them with comprehensive figures on its impact on human health and economics.

“Though the warnings are sobering, the optimistic message is that pollution can be addressed,” said Dr. Das.

The culmination of a two-year project that involved more than 14 international health agencies, the report is the first to document the global effects of environmental pollutants on human health and the worldwide economic costs of pollution-related disease and death. It also is the first study that brings together data on all forms of pollution, including air, water, soil, heavy metals, chemicals, and occupational pollutants. Pollution is defined as any material that people release into the environment that harms human health, and does not include naturally  occurring chemicals, cigarette smoke, drug abuse, or similar lifestyle factors.

At the event to launch The Lancet report, Dennis S. Charney, MD, reminded the audience of Mount Sinai’s decades-old role in promoting environmental health.

“We hope our findings will really elevate pollution within the political health agenda and inspire and encourage all levels of society to make pollution a priority,” said Dr. Das.

Speaking to the audience, Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System, said, “Mount Sinai will continue to investigate the role of the environment on health and disease and work with elected officials and others to impact changes that will improve the lives of our citizens and others around the world.”

Richard Fuller, co-author of the report

Pollution’s significant effect on the brains of developing fetuses and infants is particularly dire in the low-income and middle-income countries that have largely neglected the issue. Though they are diverse, middle-income countries—ranging from Kenya in the lower range to China in the upper range—comprise 5 billion of the world’s 7 billion people, and 73 percent of the world’s poor, according to the World Bank.

“A child with brain damage caused by pollution is never going to live the full potential of his life. It can’t be fixed but it can be prevented, and the next child can be protected,” Dr. Landrigan said.

Decades ago, Dr. Landrigan’s pioneering work led the U.S. government to remove lead from gasoline and paint, resulting in a more than 90 percent reduction in the incidence of childhood lead poisoning over the past 25 years.

Pamela Das, MD, the report’s editor

According to The Lancet report, the removal of lead from gasoline has returned an estimated $200 billion to the U.S. economy each year since 1980. To date, there has been an aggregate benefit of more than $6 trillion through the increased cognitive function and enhanced economic productivity of generations of children exposed since birth to only low amounts of lead. A decrease in IQ of one percentage point lowers lifetime earnings by as much as 2.4 percent, according to the study. Lower IQs also increase the cost to society by adding to the use of social welfare services and making incarceration more likely.

For every dollar invested in air pollution control since 1970, The Lancet reports that $30 has been returned to the U.S. economy, an aggregate benefit of $1.5 trillion on an investment of $65 billion.

A woman in Dong Mai, Vietnam, breaks down electrical transformers and other e-waste. Photo: Pure Earth www.pureearth.org

As a person’s exposure to pollution increases, his or her risk for noncommunicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lung cancer, also increase. But the slow progression of these diseases over time is one reason why pollution has not garnered the same level of attention as say, the Zika virus. In Southeast Asia, where ambient air pollution is the worst in the world, Dr. Landrigan says pollution is expected to increase 50 percent by 2050 if aggressive interventions are not put in place.

Among the attendees at Mount Sinai’s kickoff event were former Mexican President Carlos Salinas de Gortari and former Environmental Protection Agency Administrator Regina McCarthy. Achim Steiner, Administrator of the United Nations Development Programme, an international agency that supports sustainable development, addressed the audience via video.

“Failure to take the report seriously is detrimental to our children, families, and communities, and also to our economies and the planet at large,” Mr. Steiner said. “It is not a luxury for rich countries but an imperative for all.”

From left: Ash Tewari, MBBS, MCh, with three of the speakers, Ashok Hemal, MD, Wake Forest Baptist Health; Peter Carroll, MD, MPH, University of California, San Francisco; and Eric Klein, MD, Cleveland Clinic.

More than 500 doctors, nurses, and other medical professionals recently attended the 2nd International Prostate Cancer Symposium and Inaugural World Congress of Urologic Oncology at The Mount Sinai Hospital. The three-day event in September was hosted by the Milton and Carroll Petrie Department of Urology at the Icahn School of Medicine at Mount Sinai and held in collaboration with the Society of Urologic Robotic Surgeons and the Endourological Society.

Participants included more than 80 of the world’s leading experts in prostate, kidney, and bladder cancers. There were more than 100 presentations on improving patient outcomes, the genomic complexity of prostate and kidney cancers, novel biomarkers, and updates on the latest treatment techniques, including focal therapy and fusion biopsy. The symposium also recognized the 75th Anniversary of the Department of Urology at the Icahn School of Medicine at Mount Sinai.

“We were gratified by the number of leaders in our field who chose to attend,” says Ash Tewari, MBBS, MCh, the Kyung Hyun Kim, MD, Chair in Urology, Mount Sinai Health System, and the Director of the symposium. “We believe this symposium underscored the value of collaborating with colleagues from different countries and specialties in order to improve care for patients. We have already started planning for next year’s symposium.”

Among this year’s highlights were live robotic prostate and kidney surgeries performed in 3-D and in real time by Dr. Tewari and symposium co-director Ketan Badani, MD, Vice Chair of Urology, Director of Robotic Surgery, and Director of the Comprehensive Kidney Cancer Program, Mount Sinai Health System. Mount Sinai’s Department of Urology runs one of the busiest robotic surgical programs in the United States for prostate, kidney, and bladder cancers.

“These live surgery and video presentations are invaluable teaching opportunities,” says Dr. Badani. “Wearing the special glasses and with the cinematic projection, attendees can experience the same high-resolution, three-dimensional view that we have while performing robotic surgery.”

Says Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System: “The depth and breadth of programs—from live 3-D surgeries to point-counterpoint debates conducted by leaders in the field of urology—reflect impressive planning and organization on the part of Dr. Tewari and his team. Events such as these help advance the reputation of the Icahn School of Medicine at Mount Sinai.”

Leaders from The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai and the Lillian and Henry M. Stratton-Hans Popper Department of Pathology and Laboratory Medicine at the Mount Sinai Health System served as associate directors of the symposium. They included: Nina Bhardwaj, MD, PhD, Professor of Medicine (Hematology and Medical Oncology); Carlos Cordon-Cardo, MD, PhD, the Irene Heinz Given and John LaPorte Given Professor and Chair of the Department of Pathology at the Mount Sinai Health System; and William Oh, MD, Chief of the Division of Hematology and Medical Oncology, Professor of Medicine, and Urology, the Ezra M. Greenspan, MD Professor in Clinical Cancer Therapeutics, and Associate Director for Clinical Research, The Tisch Cancer Institute.

“This comprehensive event made me realize how much is already known and how much more needs to be done to advance patient care,” says Ramon E. Parsons, MD, PhD, Director of The Tisch Cancer Institute, and the Ward-Coleman Chair in Cancer Research and Professor of Oncological Sciences.

Isabelle M. Germano, MD, MBA, FACS, Professor of Neurosurgery, Neurology, and Oncological Sciences at Mount Sinai Health System, was recently chosen by the New York Society for Neurosurgery to give the 2017 Charles A. Elsberg Lecture. She is the first woman to receive this honor since the lecture’s establishment 67 years ago. The event was held October 19.

The annual lecture was launched in 1950 to honor Charles A. Elsberg, MD (1872-1950). Dr. Elsberg, who was born and educated in New York City and practiced at The Mount Sinai Hospital, was the first surgeon focused solely on neurosurgery. Dr. Elsberg is considered the father of spinal cord neurosurgery and was one of the first to successfully remove an intramedullary spinal cord tumor.

Mark Bilsky, MD, president of the society, introduced Dr. Germano’s lecture, titled “The Changing Landscape of Neurosurgery.” Her lecture encapsulated the changing landscape of neurosurgery through the lens of her multiple interests and her significant contributions to neurosurgery, including neuronavigation, brain tumor surgery, translational research, and education.

The Elsberg Lecture has honored many distinguished neurosurgeons, including Ernest Sachs, MD; Leonard I. Malis, MD; Robert Spetzler, MD; Charles B. Wilson, MD; Gazi Yasargil, MD; and Kalmon D. Post, MD.

Watch a video to learn more about Dr. Germano

Dr. Germano at the podium with James T. Goodrich, MD, PhD, professor of neurosurgery at Albert Einstein College of Medicine

Isabelle Germano, MD, MBA, FACS, center, shown with Mount Sinai Neurosurgery residents, left to right, Alejandro Carrasquilla, MD; Jeffrey Zimering, MD; Jonathan Rasouli, MD; Christopher Sarkiss, MD; Jeremy Steinberger, MD; Kurt Yaeger, MD; Frank Yuk, MD; Travis Ladner, MD; and Margaret Pain, MD.