The use of epidemiology and clinical toxicology to assess environmental health problems

Historically, epidemiology has played an important role in the changes that have taken place over time as epidemics of important infectious diseases have been replaced with modern epidemics of chronic, degenerative diseases such as elevated blood pressure, various types of cancers, diabetes, and stroke, among others. Two illustrations of the early uses of epidemiologic methods in investigations of disease outbreaks are described in the work of John Snow, who described outbreaks of cholera in the 1800s (1936, Snow on Cholera, Commonwealth Fund, New York), and J. Goldberger, who investigated the incidence of pellagra in the early 1900s (1964, Goldberger on Pellagra, M. Terris, ed., Louisiana State Univ. Press, Baton Rouge). The more contemporary use of epidemiology and clinical toxicology to assess the outcome of human exposure to environmental contaminants in the food supply are described for exposure to the polychlorinated biphenyls (PCBs) and to the polybrominated biphenyls (PBBs). Exposure to the PCBs has occurred in a variety of locations worldwide, with the greatest exposure taking place in individuals of many countries who consume fish and in Japan and Taiwan through contaminated cooking oil. Exposure to PBBs has essentially been limited to the State of Michigan where widespread contamination of cattle, dairy products, and poultry has taken place.