Personal Biomonitoring: Single Chemical
If you are interested in being biomonitored for a particular chemical, or class of chemicals, you may want to ask your family physician to order tests. A physician is experienced in ordering and interpreting lab tests and will generally be willing to talk to you about your health concerns, your sense of your exposure history, and what kinds of health expects you might expect if you have been exposed to a single chemical at high doses.
Personal Biomonitoring: Multiple Chemicals
A physician will probably not be able to talk to you about how combinations of chemicals within the body might interact, how low levels at critical times of vulnerability may cause adverse effects, how particular populations may be more vulnerable, or discuss with you all the other factors associated with the complexity of chemical exposure and predicting individual health outcomes. Many studies have not been done, and the multitude of factors linking chemical exposures to health outcomes can make predictions about individual health next to impossible. A physician may be willing to order tests for a particular chemical but will probably not order testing done for a broad list of chemicals. (Generally, you will need to join a group who is part of a research effort in order to be tested for a broad list of chemicals.
Community or Group Biomonitoring
Because of cost factors, laboratories are more willing to test for a broad panel of chemicals when many individuals are being tested. A health professional of record is still required when ordering such tests. The study design will need to be approved by an Internal Review Board, (IRB) process. Please look at the IRB section of this website for more information.
Physician of Record
Placing an order at a lab for a human biomonitoring test is a little like requesting a prescription drug. A physician of record is required by most labs to place the request. A federal law, the Clinical Laboratory Improvement Amendments Act of 2000, specifies that all testing of human biospecimens must be performed according to state law, and that states mandate who can order tests to be done and who can receive the laboratory test results. For example, in California and New York, only physicians and nurse practitioners are so authorized, but in New Hampshire and Louisiana, non-health care professionals may order biomonitoring tests and receive test results.
The laboratory will provide the data, but community groups usually need to work with researchers and scientists with experience in analyzing laboratory data in order to understand the significance of the laboratory report. Most groups will partner with a scientist or a researcher from the beginning so that the study design and the lab tests are designed to answer the questions most important to community or NGO members.
Questions for Labs
- What kinds of chemical testing does the laboratory specialize in doing? You may also want to know who previous clients have been. (US military, CDC, NGOs, medical institutions, etc.)
- What kinds of matrices (biospecimens) does the lab customarily use in testing?
- What human biospecimens would be best for detecting levels and concentrations of your particular chemical of concern? (urine, blood, breast milk, hair, cord blood, meconium, etc.) How much of any particular specimen will a lab need in order to conduct tests for a particular chemical or class of chemicals?
- Who needs to order the tests done and who can receive the data?
- Are medical professionals required for sample collection or can community members be trained to collect samples? (Blood samples need to be taken at a medical clinic, but breastmilk, for example, can be collected by trained community volunteers.) Will the lab provide you with training materials for sample collection?
- What is the detection level for each chemical or class of chemicals you are interested in? Some labs cannot test for low levels.
- What is the cost for testing for each of the chemicals or classes of chemicals of concern to your group? (Biomonitoring can be expensive and a panel of tests including heavy metals, organochlorines, phthalates and other classes of chemicals can cost $1000 to $5000 per individual) What is the accepted payment process for the lab?
- What kinds of collection equipment is needed, how are the samples best shipped, how should the biospecimens be stored until they can be shipped to the laboratory?
- How much lead time does a laboratory need in order to schedule testing of your biospecimens and long a time will the laboratory need to produce data? (Testing may take months.)
- What assurances does the lab have for quality control? Labs used by medical professionals are tightly regulated for quality, but some labs that market directly to the public may have looser standards. Testing biospecimens for low levels of chemicals is not a simple process and there have been reported variations from lab to lab.
- How much experience has the lab had in testing your particular chemical of concern?
- Will the lab be testing for detectable levels of a chemical or for its metabolites? If the lab will be looking for the presence of metabolites, are there other chemicals, which might break down into the same metabolites?
- Discuss your hypothesis with your lab contact person, and ask them for their opinion about whether the chemical you are concerned about is likely to be detected in the samples you will be sending them. You will have already discussed this with your partner researcher/scientist and you probably will have done a literature search about previous, similar biomonitoring studies in developing your hypothesis, but another opinion is going to be very useful and may save you from heading in the wrong direction.
The private labs listed below have been satisfactorily used by NGOs
Pacific Toxicology Laboratories
9348 De Soto Avenue – Chatsworth, CA 91311
Phone: 800-328-6942 or 206-781-8526
Contact: Paul Donnelly at email@example.com
Midwest Research Institute
425 Volker Boulevard – Kansas City, MO 64110-2299
Phone: 816-753-7600, ext. 1160
Contact: John S. Stanley, Ph.D. at firstname.lastname@example.org
The Axys Group
P.O. Box 2219, 2045 Mills Rd. – Sidney, B.C., Canada V8L 3S8
Phone: (250) 655-5800
Fax: (250) 655-5810
State Labs perform biomonitoring analyses when there is a direct, pressing public health need. You may be able to enter into a partnership with a state lab to help design and implement a biomonitoring study. For example, California Communities Against Toxics worked closely with the California Hazardous Materials Lab, when the Lab was awarded a regional EPA grant to biomonitor for the presence of PBDEs, a class of flame-retardants, using the breastmilk of California women as a biospecimen. State public health laboratory staff are often interested in NGO and CBO proposed biomonitoring projects and can be good resources for discussing hypotheses, testing techniques, possible sources of exposure, etc.
State public health labs are part of state bureaucracies, so if you are interested in forming partnerships with these labs, you need to be in touch with your district’s state legislator about your chemical concerns and the reasons why a good biomonitoring study would advance public health issues. State labs need the approval of state agency lead staff for their projects, and laboratory heads will be able to tell you who within the state bureaucracy you should be talking to. Many states are ready to form NGO/scientist/government collaborations on biomonitoring projects, given the current public interest in biomonitoring and given the insistence from community groups that people should be tested along with the soil, air, water, and wildlife, that doubtless is already being monitored by these labs.
The newsletter of the American Public Health Laboratories contains updates on state-based biomonitoring projects. www.aphl.org
US Center for Disease Control lab-enhancement grantees
The US Centers for Disease Control have awarded lab-enhancement grants to New Hampshire, New York, and a consortium of six western states headed up by New Mexico to carry out a series of biomonitoring studies. You may be able to work with these labs as well. Below are listed the principal Investigators for each grant and a list of projects, as determined in their original grant application to the CDC. The grants were intended to help state public health labs engage with community organizations and environmental justice groups, so you should not hesitate to be in touch with these labs if you live in one of the grantee states.
1) New Hampshire – P.I. Veronica Mahlmberg – VMalmberg@dhhs.state.nh.us
Four goals of CDC funded projects in New Hampshire:
- Build infrastructure at public health labs
- Conduct pilot projects on arsenic, mercury, phthalates and PBDEs
- Build collaborative relationships through a biomonitoring council and workgroups for each of the analytes studied
- Develop strategic plan to support ongoing studies, community needs, data sharing, and reference range determinations
Pilot studies will measure:
- Body burden of people exposed to arsenic found in private wells
- Body burden of people exposed to mercury through fresh water fish
- Body burden of cosmetologists compared with general population re phthalates
- Body burden re PBDEs in breastmilk and blood.
Discussion: A number of NGOs have been involved in the planning process, including Clean Water Action, Biodiversity Research Institute, National Environmental Trust and others. P.I. Mahlmberg hopes to conduct more comprehensive studies in the future, possibly offer testing services, pending available resources, and plans to make data available in aggregate form through a website. Planned sample size ranges from 70 to 200.
2) New York – P.I. George Eadon – email@example.com
Dr. Eadon identified three themes:
- Urban air pollution problems;
- Exposure to persistent organic pollutants, especially in vulnerable populations;
- The need to measure exposure to individuals to support public health practices.
Feasible projects relating to public health problems within those themes were selected. Some of the 10-12 planned projects include:
- Measuring tobacco exposure and relating to health effects.
- A community NHANES study to measure same metal contaminants measured by CDC in NY City.
- Measuring mercury exposure in NYC children.
- Measuring PAHs in children’s urine reflecting exposure to diesel fumes
- Measuring PAHs in communities built on landfills of manufactured gas plants
- Measuring POPs – PBDEs, PCBs among anglers fishing in NY harbors (providing extra analysis to existing superfund study)
- Measuring Pops among fish eaters in upstate NY in the Great Lakes region.
Planning involved input from various groups, including 18 university, 10 NGOs, etc. More than 200 contacts recommended by these groups were surveyed in helping to identify chemicals and health effects of concern, with a response of roughly 50%, which were used to develop themes.
Implementation will mostly involve partnerships with academic institutions, though it is hoped some of the pilot studies will have high levels of community involvement. Long-term goals include expanding lab capacity, keeping abreast of public health concerns.
Discussion: Results of testing were health impacts are clear (e.g. heavy metals) will be reported back to communities/individuals – but when less clear, results may not be reported back, as this could cause unnecessary concern. This issue is still being discussed to determine the best way to proceed. The public at large will be kept informed, and there will be an advisory committee.
There’s little data for health tracking right now – some on metal concentrations – particularly mercury. The NYC project plans to do more coordination with health tracking efforts in the state.
3) New Mexico – P.I. David Mills & Lynn Flowers – David.firstname.lastname@example.org
The NM grant was funded as a consortium of 6 states (NM, CO, UT, WY, MT, AZ). The primary goal is to increase lab capacity, enhance collaboration among these labs and epidemiologists within and between states.
Fifty NGOs were contacted in the process of identifying potential projects. Eight projects were selected that meet the goals of conducting biomonitoring, complementing bioterrorism efforts, and complementing the existing health tracking program.
- Arsenic and metals in urine – analyze 5,000 samples include archived samples from a diabetes study
- Feasibility study on infant blood spots, measuring 5 metals, 400 samples
- Thiodiglycol in urine – bioterrorism study
- VOCs in blood (shallow ground water contaminated with VOCs)
- Cotinine in urine and saliva to measure effect of smoking statutes
- Mercury in blood to measure impacts of coal fired power plants
- Organophosphate pesticides & pyrethroids
Discussion: Long-term goals include identifying funding sources for ongoing support, and making biomonitoring capacity more accessible. The planned biomonitoring studies will provide all results to individuals, but such data may not necessarily be available to public at large. Plans include making general conclusions based on the biomonitoring studies available to the public. In the shorter term, data will be added to the project tracking website. Every state in the consortium will participate in all studies. Pesticides will be measured in both rural and urban areas, but this study is furthest out in the planning.
University Laboratories/Medical Research Facilities
You may be able to partner with medical researchers or university scientists on a biomonitoring project. ACAT, the Alaska Communities Against Toxics, has worked closely with Dr. David Carpenter at SUNY to do biomonitoring projects for the Yupik tribe on St. Lawrence Island. This study is described under Case Studies on this website.