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Interview: Dr. Shoji Nakayama MD, PhD
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Interview: Dr. Shoji Nakayama MD, PhD

Charting New Paths in Health: Dr. Nakayama's Journey from Clinical Practice to Public Health, Disaster Response, Risk Management and Exposome Research
Transcript

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Dr. Shoji Nakayama, active in Japanese medical and public health research, delves into his extensive career centered around environmental health and public safety. 

Dr Nakayama is currently serving as the deputy director of Japan's Environmental Children's Health Study (JECS), involving over 100,000 participants, Dr. Nakayama advocates for transformative approaches in public health – focusing on altering environments rather than solely individual behaviors. He is passionate about interdisciplinary approach to biomonitoring, exposome research and improving public health. 

We overview his career, his passion for public health, his exciting career in post disaster public health research, his groundbreaking research on forever chemicals substances and emerging contaminants. 

His vision extends to advocating for multidisciplinary methods in biomonitoring and exposome research, recognizing the complex interplay of factors affecting public health. 

Topics Covered with Time Stamps 

  • (0:40) Dr. Nakayama’s transformative journey from clinical medicine to public health advocacy

  • (7:47) His pioneering research on the implications of forever chemicals and emerging contaminants

  • (13:15) Research in fluorinated and experience at US EPA

  • (26:28) Insights in Regulation , EU vs US vs JP 

  • (27:44) Lessons learned from disaster response following the 2011 earthquake in Japan

  • (35:47) The importance of Disaster Response Research

  • (39:25) Insights from the monumental Japan Environmental Children's Health Study

  • (44:30) The expansive realm of exposome research and its practical applications

  • (46:54) Collaborative approaches in public health and the hurdles in research funding and policy formulation

  • (49:14) Discussion on Environmental Effects at a Population Level vs Individual Level

  • (55:16) Urbanization, green spaces, and their health implications

  • (57:35) Navigating public health challenges during the COVID-19 pandemic in Japan

  • (59:00) Debates and developments around HPV vaccination in Japan

  • (1:00) Dr. Nakayama’s source for his enduring commitment and passion for advancing public health.

Japan's Environmental Children's Health Study

Elsevier Profile: Shoji F. Nakayama, MD, PhD

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AI Transcript of Interview

Leafbox:

Today I had the pleasure of speaking with Dr. Shoji Nakayama. He's a medical doctor and public health researcher who's at the intersection of environmental health and public safety. Dr. Nakayama brings a wealth of expertise and exposure science, and he focuses on the vulnerabilities of children to environmental risks. Today we overview his career, his passion for public health, his development as a doctor, his exciting career in post-disaster health, his groundwork research on forever chemicals and emerging contaminants. Dr. Nakayama is the deputy director for Japan's pivotal environmental children's health study, which is including over a hundred thousand pair bonds and is passionate about interdisciplinary approaches to biomonitoring, exposome research and improving public health. Thanks for listening. Well, why don't we just dive in, Dr. Nakayama, I actually got email and recommendation from Jose Domingo who's a toxicologist, and he recommended that I talk to you because of your focus on children's health, heavy metals, exposome, and other related topics. But before we dive in, I wanted to know Dr. Nakayama, could you just give us a quick primer on your background, your current role, your background in chemistry, anything that's relevant?

Dr Nakayama:

Okay. So I am a medical doctor by training, and then after graduating from medical school, I did some medical training and then I went into a graduate school and then I took my PhD in Public Health. That was all in Japan. And then just after I took the PhD, I was invited by the United States Environmental Protection Agency. US EPA was about to start research on Polyfluorinated chemicals, I dunno (if) you have heard about, but it is called P-F-A-S. The problem is everywhere in the world. I took a position as a visiting scientist at the US EPA in 2005 and spent six years with the US EPA working on mainly Polyfluorinated compounds, as well PFAS exposure assessment. So that means how much people are exposing to those particular chemicals. But the later half of the years moved, well, I expanded our research interest into other chemicals including pharmaceuticals and environment and as well as personal care products we call PCP personal care products.

Then, so we assess the environmental exposure to those chemicals and then for their effect on human health. Then I was invited by the National Institute for Environmental Studies, the current institution of Japan, to join the Japanese National Scale hildren's study, which is called Japan Environment and Children's Study. This study involves a hundred thousand participants, I mean pairs of participants, mother and child. So that started in 2011. So I just joined the team when they just started. So I moved to Japan in April, 2011 and joined a team of the Japan environment and Children's Study, JECS, in short. Then since then I'm working on that study. And then as I told you that JS is a nationwide, nationwide birth cohort study. Birth cohort means recruit mothers with the pregnant mothers and then follow them up until they give birth to their children. And then we also follow the children.

They also follow adults for 40 or 60 years. So that's the long run national study. But as you know that just after I moved to Japan, that was just before I would say I need to say just before I moved to Japan, Japan had a great earthquake in the eastern, Eastern Japan. That was, I think on 11th of March, 2011. And then when I just came to, that was the first day of my work at the N-I-E-S-I was called by a team and then told that there are some mysterious pneumonia, what's happening in the area of the affected by tsunami. And then they dispatched me to the area and then to do the investigations. And then, so I was involved in this disaster response research just after I took this position. So since then, it's been already 12 years, but I've been doing this JAK study as well as disaster response study.

So recently five, six years, I was involved with the, I'm working with NIH of the us, NIH. They're doing disaster response research program. And then we're expanding that program to international setting. These couple of years we're trying to expand it to Asian countries. So the disaster response research means that we need the research just after, right after the disaster happening. For example, flooding, hurricanes, earthquakes, wildfires during the search and rescue period so that we can obtain pristine data from the residents involved in that disaster and then we can follow them up for a long time. So there is some emergency dispatch, for example, medical teams or chemical cleaning teams or firefighters. However, there have been no long-term monitoring program on those disaster impacted areas. Not only the residents, but also those response workers. So we are now involved in the program to increase the capacity of, for example, local universities or local government to do the research just after the disaster happening. So that's the overview of my, what do you call overview of my work, the past work, and the current work.

Leafbox:

Dr. Nakayama, I'd like to start maybe just by asking what drew you away from actual practicing medicine to the public health sphere? What were your interests in the toxicology or those spheres?

Dr Nakayama:

Yeah, so my training was at the hospital very near to the shipyard. I would see many patients coming from the shipyard. We treat the patient, they come back to work, but they soon come back to the hospital. So I thought that we need to do something about the prevention so that I went, jumped into the public health field so that we can do some preventive work. And then especially not just only doing epidemiology, but also I was interested in toxicology of, for example, the chemicals they use in the occupational settings. For example, paints or organic solvents or something. So I mainly studied those chemicals effects on the workers in occupational settings.

Leafbox:

What were the ship worker issues you were seeing? From the solvents they were using in repairs or what were your initial observations?

Dr Nakayama:

Right. So for example, they use paints and they need to use solvents to dilute the paint and then apply the paints. But they come into deep into, for example, the tankers. And then heat was very, they have very high heat and then they have very closed work environment so that they exposed to those chemicals. And then not only the shipyards, but also for example, the area was very popular for, what do you call that, the mining. So there are workers working on the mining. And then also there are workers on the, for example, the small ship making. They use fiber reinforced plastics and then also so that for that they use resins and then they need to use solvents and then they have to use face masks. But the workers tend not to put them on properly so that they're exposing to those chemicals and they're having liver function damage, liver damages, as well as vision impairments. So that drove me into the public health field.

Leafbox:

Did you have any effect with the shipyard owners or any relationship? I mean, did you try to initiate any kind of public health changes or educational programs? I'm just curious what the relationship with the actual ship builders or if you developed any rapport with them.

Dr Nakayama:

No, that time I did not have that much capability. So I just, well, as you know that medical school does not teach such kind of things. No chemicals, very little toxicology. So I need to learn from scratch in my PhD period. And I never did any chemical experiments since I entered the PhD program.

Leafbox:

So then after that kind of initial exposure, you move on to public health. And then how did you get recruited to the EPA in the US? Were you specifically working on forever chemicals or what was your focus that made you want to go to the EPA in the US?

Dr Nakayama:

Well, that's an interesting story. That was completely accidental. My PhD mentor, the professor died just after I took the PhD degree. And then as you know that I lost the way I go. And then that time I got the call, just a phone call from other professors in Kyoto. And then he just told me that if you are interested in, you can come to my lab and continue your work. And I took that offer and that lab was doing the very first, very initial research in that forever chemicals. At that time, they were only measuring PFOS and PFOA, but that lab was the first lab who did the systematic investigation of drinking waters all over Japan. And then they published the work in 2004. And then,

Leafbox:

Sorry to interrupt. Maybe you could just give a one second summary of what PFAS chemicals are for people who aren't familiar with that term forever, chemicals and whatnot.

Dr Nakayama:

Okay. So the PFAS as a chemical, fluorinated chemical that was used, for example, making polymers, non-stick polymers such as like Teflon. Teflon is a trade name, but there are many those polymers that are used for non-stick purposes. For example, inner coating of our hamburger wraps. Those chemicals repel both oils and water so that they can use that as repelling water or oil. So they can use those chemicals on the surface of, for example, carpet treatment, so that, or clothing so that they can keep their carpets or clothing clean. And also they repel water so that they can use that for skiing or other water activities so they can splay them those chemicals on the boots and shirts and stuff. As well as they have a surfactant, very, very high property of the performance of surfactants, so that they are used in firefighting forms. So they're heavily, they have been heavily used in firefighting in aviation industry as well as air force all over the world.

And then the use of those chemicals and such usage contaminated surface waters, ground waters or soils. And then there was little knowledge about toxicology of those chemicals back in 2005. Well, I think industry knew something about, but public didn't know. So the EPA and the other universities researchers studied the toxicity research, toxicology research on those performing chemicals and had been found in toxicity on human health. And then since then, there are many epidemiological studies and then are revealing some effects, all of those PFAS chemicals and on human health as well these days. P-F-O-S-P-F-O-A, and then the other chemical. And then also they're very persistent in the environment as well as in the humans. Their biological half lives are like three to five years in human being, so they stay in our body as well as in the environment for a very long time. That's why some of the chemical, some of the PFAS chemicals are listed in the Stockholm Convention, which is a regulatory agreement to restrict the persistent organic pollutants, which is POPs in short.

Leafbox:

What were some of the immediate health effects that you were finding with the Kyoto lab or with the EPA lab? Was it surprising or were they worse than you expected or less toxic? What were your general observations in the first and how that research has changed?

Dr Nakayama:

Yeah, so those chemicals are thought not to interact with any biological systems, but we found that, well, mainly EPA labs first found that they interact with, for example, lipid metabolism systems as well as some thyroid hormone systems so that they disrupt the lipid metabolism as well as thyroid hormone systems. And then recently in 10 years or so, the thyroid hormone system has been found to be very important for brain development. Then after that, the people are looking at the effect of those PFAS on the development, neural development of children, and then many researcher finding the effects of those chemicals on developmental effects. So that's the main concern on, however, how can I say, the human evidence is kind of P for PFAS and P four, I think human evidence is almost sufficient for regulation. But for the other chemical species of PFAS, we still don't have sufficient evidence.

Leafbox:

Dr. Nakayama, so you moved to the US and then what was your experience and what was your general impression of the EPA? What was your first impression coming from Japan?

Dr Nakayama:

Yes, it was very interesting. The first I learned my English from British teacher and I couldn't understand very much about the southern, so I went to North Carolina first, so I could not very much understand the Southern English. So I had hard time communicating with them, but it was the first year. But anyway, when I arrived, they were only dealing with toxicological samples. As you know that in the toxicological study, they use very high concentrations of chemicals to apply. So there were, for example, measuring blood or urine or any kinds of fluids or any tissues of, for example, mice or rats. So they are measuring very high concentrations. And then because of that, their analytical systems are very much contaminated by those chemicals as well. And then also those, as I told you, those chemicals are used everywhere. So those chemicals were used also in the analytical instruments and analytical equipment or tubes and anything.

So they were dealing with very high backgrounds of those chemicals, especially PFAS and PFOA, but any other kinds of PFAS. So my first task was to reduce the background so that they can analyze thousand times lower concentrations in the environmental samples. For example, surface water or drinking water. So my first task I was like, but I was from Japan and the first they may might not trust me, so might not have trusted me. So I asked them to give me a chance to occupy, for example, the lab for the first week so that I can wash all the instruments to reduce the background. So I did wash all the instruments for a week and then success to reduce the background so that we can now analyze the surface water samples, a thousand times lower concentrations. And then we started investigating the environmental contaminations.

Leafbox:

And what were some of your focuses there, like industrial sites, military bases, or what? Just general population water samples or what were you focusing on?

Dr Nakayama:

So we didn't know anything about that time. So first we took a boat, an EPA boat, and then we just sailed up the rivers near the EPA and that was one of the largest river system, river basin within the North Carolina. That's a Cape Fear river basin. And then you can see my publication on that. And then so we collected samples from the headwater all the way down to the mouth of the river. And then we analyzed the river water samples for the PFAS chemicals. And then we found very interesting things. For one, we found a discharge that contained very high PFAS concentrations very high PFAS. And later we found that was from DuPont in the manufacturer over there. And then we found another thing that a little creak just flowing through the Air Force reservation had very high concentration of PFAS, and that was the first, I think time we found the military could be a source of the PFAS in the environment.

Leafbox:

As you're doing this research, what is your general feeling about contamination and toxicology? Is it evolving or are you being surprised? Are you changing the way you live? I'm just curious how your personal feelings about this evolve

Dr Nakayama:

In that time. In the first three years or four years, it was like we were just, how can I say? Just shading, throwing some lights in the very dark field. There is only little thing that we can scratch. And then we've just found that there are so much things that we don't know yet. And then so we somehow collaborated with, well communicated, I would say with the industries. But because of the confidential business information, CBI, they can disclose very little to the researchers. I mean, EPA regulators might have known the information, but at researcher level, we couldn't know the information. So it was like having a torch in the very pitch dark place and then finding out some very little paths to, I don't know, nowhere. So we didn't know where to go. So we collaborated with the toxicology labs and they keep finding the interesting effects. But there are very few studies on humans In that time. Before 2010,

Leafbox:

Did the EPA contacted Dupont regarding, so they just said they weren't using those chemicals or they just didn't have to declare much information because they weren't regulated. Is that what you discovered?

Dr Nakayama:

Well, no, no, they have, because those chemicals are registered already, they submitted informations to the EPA regulators, but we were not in a position to know every information about those confidential business information. And then also those toxicological testings were mandated by a law, but those laws are, laws are regulations are kind of old so that they don't have, how can I say, new sciences and that regulations, for example, no mandate on doing, for example, thyroid hormone testing at that time or maybe developmental effect testing. So the industry I think did everything on those regulations properly. However, those regulations often does not do not cover everything. So we've been finding some toxicological effects that were not included in the mandatory testing in that time.

Leafbox:

Did you find the EPA to be captured by regulation or I'm just curious how you differentiated from the regulations of Japan. Is it stricter, looser, more vague? I'm just curious what that opinion is

Dr Nakayama:

That's on the situation. So that depends on the situation. So I can definitely say that the EU is more advanced than the US or Japan. So they take a precautional principles. So gray, it's black for the EU, but for US or Japan, gray is white. So I would say gray is not black. But for the EU, the gray is black. So the attitude towards the chemical regulation is very different from EU compared to the US and Japan. Japan is very close to the US attitude.

Leafbox:

Do you think that's a cultural issue or just a business climate or where does that come from?

Dr Nakayama:

It's a cultural plus business public's interest, public voices as well as business interest.

Leafbox:

Moving on, you moved back to Japan and then immediately the earthquake of 2011 hits. Could you tell me a little bit about your work on the emergency? What were you studying there? Were you focused on immediate chemical exposure during an earthquake or what were your initial observations there when you went back to Japan?

Dr Nakayama:

Yes. So you know, I think one disadvantage or a weak point of Japan is the lack of recourse of what we did in the past. So at that time, back in April, 2011, we had no instructions what to do, so didn't know what to look at. We didn't know how we can proceed the research on, for example, the pneumonia that are happening in that area. So we had to build our program from scratch.

Leafbox:

Immediately after the earthquake, people started developing pneumonia, like a rare type?

Dr Nakayama:

Right? And then they were developing some pneumonia and there was an interest in pneumonia. And then the doctors there was treating those pneumonia with antibiotics first. But after they cure the pneumonia with antibiotics, but they still have different kinds of pneumonia to that they had to use steroid. So it is very rare to have both infectious pneumonia as well as other type of pneumonia. So the doctors were wondering why they have those two together. For the infectious pneumonia, they shouldn't use steroids, steroids. So after they treat the infectious pneumonia, then they had to use steroid to treat the other type of pneumonia. But we don't know, we didn't know what was causing that. So now we know that.

So we first went to this site and then to see what was going on. And that time was like four weeks after the event was Where is this? This, yeah, the earthquake in tsunami. Four weeks after that you went to Fukushima or where did you go? It was in Miyagi. Yeah, the Sendai, there was also the her Sendai and Ishimiyake, and then those coastal area of Miyagi coastal area. We couldn't even come into that time in the Miyagi area. There was still the search and rescue time. There were many cards with tapes, and then that tapes means that the search done and then if the car is without the tape, that was the possibility that there was someone left in the car. That was the phase that time. And then, so we brought air samplers as well as we investigated some bacterials in air, and also we investigated some chemicals and then we collected some water samples and soil samples, and we analyzed them for chemicals and bacterials.

And then finally we found that the soils and the sediments, let's say, contain very high concentrations of endotoxin. Endotoxin is some materials touched on surface of bacteria like e coli, and then the bacteria die when bacteria die. So those endotoxins were released and those are very much immunotoxic. And then as you may heard that some hygiene hypothesis, when children live near the livestocks, they do not develop allergies. So the one hypothesis is that they expose, they were exposed to very little amount of those endotoxins and that stimulate immune system. And then so that they do not develop allergies to like food allergies or other pollen allergies. But if you take excess amount of those endotoxins, you have so much immune system stimulation and probably get the pneumonia. So that's what we found. However, we could not do systematic epidemiological studies over there because there were, I can say search and rescues were happening and then all these cleanups were happening. So we could not perfectly determine the causality however. But after that, we had many research related those endotoxins and pneumonia. And so currently we know that we need to look at the endotoxins over there.

Leafbox:

Were the endotoxins sourced from the livestock industry? Is that what your hypothesis ?

Dr Nakayama:

No, those were from sediment

. So tsunami brought up those sediments to the residential area and then dried and those bacterias and those sediments died. And then the people there had to clean up whatsoever. They had all the sediments on their floors and the houses and the streets. So they had to clean them up. So during the cleanup, they exposed to the dust, and then the dust I think had the endotoxins in it.

Leafbox:

And the theory is that because they hadn't developed kind of a natural relationship to those bacterial sediments, the overexposure triggered the pneumonia, correct?

Dr Nakayama:

Right, right. So because tsunami brought up all the sediments, like industrial areas or residential areas, so there are many bacteria that had the endotoxins on their membrane surfaces, and then they died in a massive amount. And then so dust, the dried dust of the sediment contain very high concentrations of endotoxins.

Leafbox:

That's very interesting because the work in the EPA was with human made chemicals. And then this work is more biological, I guess natural in quotes, sediments and exposure.

Dr Nakayama:

But later on, for example, the flooding events wiped out, for example, the automobile manufacturers, and then they released some lipophilic lipid type of chemicals as well as the tsunami also released oils, brought up the oils and spread oils all around the residential areas. So those oils also called some pneumonia. So the later on, so we found that the two, but there are no program that can do the systematic research at that time.

Leafbox:

Did you develop a program or did Japan develop kind of a post catastrophe research program?

Dr Nakayama:

So that is why I start working with NIH of the us, and they developed a program that is called Disaster Response Research, DR2 in short. So you can find those website in there. NIH, that's N-I-E-H-S is the leading institute within the NIH, however. So they developed many tools for the epidemiological studies in the disaster settings, and they put them into the National Library of Medicine so that everyone can use it. And those tools are pre IRB approved. So they have already ethical approval so that they can use those things very quickly. I need to tell you that I had to work with the local government to do the research just after the, so we just went to the site and then we thought that we need to do some research. However, we had to work with the local government to get the approval to do the research. And it took four weeks. We first get into the site just four weeks after the event, but we had to wait four to five or maybe six weeks to start the research. So that was also the lessons we learned at that time. We need to have the agreement first with the local government. We are the national institute, so to do the proper research and proper timescale. Was

Leafbox:

That a budgeting issue or just administrative control issue?

Dr Nakayama:

It's administrative thing. Interesting. And also those local government has their own labs, their own environmental institutes, but they're also wiped out. So they lost the ability to do the research. However, there were no framework to make the other municipality to help them. So we had to build all things after that event. So it's the same as the Fukushima research

Leafbox:

Moving on. So you helped develop the post-disaster program that the NIH developed. I wonder if they use that here in Hawaii after the Lahaina fires. I wonder if FEMA or the NIH did anything to control or protect against the toxicological risk profile.

Dr Nakayama:

I don't know, but probably they had some local university did some research, but I have not heard a particular event about that.

Leafbox:

Well, that's one of the local concerns here is that the combination, the fire was so massive that obviously all the toxic psychological issues or even to the emergency workers or people who didn't die, but the post-exposure death, Dr. Nakayama, I'm moving back to you then move. I'm curious what you've learned now from all this kind of disaster exposure and now you're kind of moving into the future with your children's study. Maybe we can talk about that and how you're trying to take those lessons and move it towards long-term longitudinal studies.

Dr Nakayama:

So I think we talked about two things. One is the manmade thing, and then the second is the natural disaster thing. And then first of all, the manmade thing. I think we need to involve different kinds of scientists and also dismally. For example, just recently, I think in the last few years I've talked with chemists, real chemists and also physical chemists as well as organic chemists. They do not anything about those toxicology things. And then those toxicology people do not anything about industrial chemical call research. So we need to have, multidisciplinary is kind of an old word, but in reality there's no such a thing From my experience in this children's study as well as EPA study, it's a cat and mouse story. It's never ending things. Industry, just develop new chemicals. And then we researchers research on the health effects, and then we find them, they changed their structure a little bit and then approved and then put them into the market.

And we do the research on that, the substitutes, and we find also the toxicity and then change the formula very little bit. And that's the cat and mouse things. But we need to change that circle. We need to input for this toxicology as well as epidemiology researchers has to focus on the mechanisms, why a particular health effect. And then we need to understand that, and then we need to inform that knowledge to the industry side of scientists so that they have to use those knowledge to create to safe chemicals from the first time. So coming back to the PFAS in very, very shortly, the industry did not know very much about the chemical, physical, chemical property or theory of the PFAS. So I talked with the many industry people and they did not understand about the physical chemical ferry that was recently proposed by the Japanese researchers.

And with that in affair, we can now very much understand the scientific, the basics of the chemicals so that we should be able to design safe chemicals. So the science in this field should move into that. So the health side of the, and toxicology and health side of the scientists should work with the industry side of the, or basic scientists to design a safe product, safe chemical product in the first place. That's the one thing, the manmade side for the natural disaster side, we still don't have enough program. The US is the best. I think the country who has those research program in the public is for public as well as response workers. However, we need to develop more programs on that. So

Leafbox:

Do you think it's mainly an education issue and having more liaison between the private sector or more regulations, or

Dr Nakayama:

Not only that, but also well, yes, that that's a training thing we just talked about with the NIOSH people. CDC, NIOSH people that we need such a program. They have to train the trainers programs, for example, they train the firefighters leaders how to protect their health, their men's health, well, I shouldn't say men, but we don't have that such a program in, for example, Asian countries. So we need that program. But at the same time, we need the research to reveal the effects of those, for example, firefighting. So that's why I'm doing the research in Thailand. They have a natural wildfires there. They have community firefighters. They do not have the occupational firefighters like personal protective. Yeah, yeah. So official firefighters protections. So we are now doing research on health effects of those firefighting on those community firefighters. And then we're finding new findings. So the research is important on that area.

Leafbox:

I mean, you want this kind of interdisciplinary integration. I think I saw that you have this research concept called the exome. Is that correct? You have this kind of exposome? Yes. Could you walk me through that concept and how that applies to your work?

Dr Nakayama:

So very recently, many researchers in this field realized that in reality we're exposing not only a single chemical, but also not only chemicals, but also other type of environmental hazards. For example, like radiations or emotional stress, heat and anything. There's all of the environmental stresses affects our health. Yes, that's understandable. And then also in the last 30 years, we have learned that genome research did not solve everything. So we thought that if we can read all the genomes, we can understand all the health status of humans or all the diseases. But it was not true. And we could not understand only the half of the etiology, the reasons for the diseases. So the researchers are now, that was first from cancer researchers, but researchers are now thinking about we need to incorporate the environmental factors, however different from genome. Genome. We need one instrument to read genome.

However, for the environment, we call that exposome just close to the genome. And environmental exposures, we need different modalities. For example, air pollution, we need air monitoring. For the chemical exposure, we need some, for example, biomonitoring like blood measurement, urine measurement. So we need many, many kinds of measurements. And then, so the method developments are happening all over the world. For example, in the US and in Europe, they have the big, big research programs on those exposome. However, it's just the start of the research and the concept. But I think the way the direction is correct, looking at environmental effects on our disease and our health is correct, but we need more research on that to disentangle the relationship between environment and our genome body itself. So

Leafbox:

Are you using some of that kind of multimodal approach to the children's study?

Dr Nakayama:

Right, but we are involved in a hundred thousand children. If you spend only $5 on children, that's a huge amount of money. I mean $500 per person, that gives up a 50 million a year. So we are doing as much as we can do to capture those exposure as much environmental exposures. But that's not perfect yet. So we are waiting for those research advances so that we can measure those environmental total exposures in blood system or urine systems.

Leafbox:

So in the Japan Environment, Children's Study, what are you finding? What are your initial kind of observations that are of interest? This is a massive study, so I'm

Dr Nakayama:

Right, right. So the initial focus of our study is on chemical exposures. So we've been finding, for example, effects of mercury, lead and cadmium on children's health, especially lead has very much effect in everything. And then also we are finding many other things on unexpected things. For example, screen times of children at the age of one affected the brain development on a age of three. For example, the autism spectrum disorders at the age of three. So we're finding many interesting things, but in the future we are focusing on reproductions and developments. And then how can I say that later on other diseases.

Leafbox:

Do you have children, Dr. Nakayama?

Dr Nakayama:

Yes. Two.

Leafbox:

Has this affected how you're raising your children?

Dr Nakayama:

Well, we found that environmental effects on children's health is individual. Children's are very small. This is kind of the climate change. 1.5 average degrees increase is almost nothing for us every day. So we have easily 1.5 degrees difference in the morning and in the noontime this time of period. So chemical effects on our health is very tiny individually. However, if you sum them up, for example, some chemical effects our IQ, but those effects are like one IQ decrease in one unit of chemical exposure increase. However, if you sum up that one IQ increase in all the children born, for example in the US or in Japan, that makes up a lot of, for example, economic effects. So for example, one IQ loss probably corresponds to percent of the GDP loss. So we don't know the effect of fluorine, but some chemical has effect on the iq. So one IQ loss for individual children, it's nothing. But if you sum up to the entire population, that gives up a big effects. So that's why I say that chemical effects or environmental effects is close to the climate change

Leafbox:

With the Japan's declining birth rate. And are you studying or trying to integrate any of the related reproductive strategies into the study?

Dr Nakayama:

Yeah, that's the next problem we need to look at. We recruited pregnant mothers so that we could not, cannot study the preconceptual effect. So we are going to follow our kids up until they have their kids. So I hope that we can see the effects, however, that should be like five, 10 years later.

Leafbox:

Do you have any initial hypothesis or observations you'd like to specifically focus on?

Dr Nakayama:

Yeah, mainly we're focused on developmental effects on children because children with the developmental disorders increasing very sharply in Japan, probably in the US too. So we're now focusing on those things.

Leafbox:

Do you have any hypothesis for why?

Dr Nakayama:

Some of them should be related to chemicals, chemical exposure?

Leafbox:

So when I talked to Dr. Domingo, his focus was on PFAS on clothing, and he's been a toxicologist for, I don't know, 40, 50 years. And basically he became paranoid about everything and basically just wore wool. But after a while he just kind of gave up. I'm just curious how your personal life has changed with all this research. Have you become more nervous, less nervous, kind of whatever? Just I'm curious how your daily life changes.

Dr Nakayama:

Alright, so myself, not much changed. So my focus is to change the society, change the industry, change the regulators so that we can create an environment, we can create the living environment where people can live healthier lives without noticing anything. So as a public health practitioner, I also gave up trying to change people's behavior. So people's behavior, not to drink, not to drink too much, not to smoke, to live a healthy life. It's not effective very much. So I'm moving on towards changing the environment itself. For example, built environment or municipality itself or chemical production itself so that people can live their healthier life without noticing anything.

Leafbox:

That's interesting. Do you think that's a lesson just because of where did that kind of shift in change come from?

Dr Nakayama:

So we need to inform public, so we need to inform their consuming behaviors as well. But I think most important thing is that, is there a change in the industry's attitude or government attitude towards those things? So that is also why that I'm saying that this is a very close to climate change. We need to change people's big industry, big country's attitude towards this

Leafbox:

Thing. Now I'm just curious what your relationship is with public policy people. Are they skeptical of your work? Do they get more nervous? How do they support you or not support you? I'm just curious what your relationship with them as with government.

Dr Nakayama:

So we are almost part of the government. We're under the ministry of the environment. So we have the close communication with them. However, they have laws, regulations, they kind of change very soon. So that is why, well, this JS research, children research is conducted by the government so that they're willing to take the research output into their policymaking.

Leafbox:

Are there any sectors that you feel that you want to study but can't because of either pressure or regulatory capture? I mean, going back to your shipbuilding background or where you studied medicine, I'm just curious if there's topics in Japan that are just off limits.

Dr Nakayama:

Well, I don't think so. We can do whatever we want to do. However, for the research, we need to get the research funding. So that's the bottlenecks.

Leafbox:

Oh, so you won't get the research, of course, the funding for the research, that might be problematic.

Dr Nakayama:

Right, right.

Leafbox:

My last question, Dr. Nakayama, what are some future threats that you're really worried about or interested in studying

Dr Nakayama:

Future threats? So one thing is the well climate change. But the other was the, I think urbanization. We were having lots of sharp increase in pollen allergy. And then this younger childrens are also surfing from that. So that could be coming from the urbanization. We need more green spaces, we need more natural things. So the next research I'm proposing is to investigate the natural environment on the effective natural environment on our health. But we don't have any modality to do the research. So I'm proposing to do the research to develop some modality to investigate that relationship between green spaces or the natural spaces and human health.

Leafbox:

Great. And then Dr. Nakayama, I'm curious if people are interested in your work, what's the best way for them to find your work or keep up to date with the work you're doing?

Dr Nakayama:

Well, I dunno, probably that's your professions,

Leafbox:

Well, I saw that the JECS has publications. I guess maybe that's the best way for people to follow the children's study or maybe

Dr Nakayama:

Your well publication English publication is not the best way, for example, Japanese public. So we are now doing, we're making for example, YouTube videos and I'm creating those things so that children and also their parents can capture those, our findings very easily.

Leafbox:

And then my last question was regarding Covid. How did Japan had a very different COVID public health experience than some of the western countries? I'm just curious how your approach to public health has changed or evolved during that period.

Dr Nakayama:

So COVID thing, yes. I think it's also the society matter, how you deal with those things. So Japan is very different. And then I don't completely agree with the process we took. However we need to, I think we need to, scientist has to work in the peace time to inform the public, the scientific knowledge so that in this kind of emergency time people can take their information very well.

Leafbox:

What were your critiques mainly? What was your criticism of the Japanese approach?

Dr Nakayama:

Well, not very much the criticism, but there was not, so Japan mainly takes case report very much so how people died or who died and how many people died or something like such a kind of thing, information. But however, so the Japan has little experience in the Japanese public, I would say, in this public health considerations. So mass benefits. So that's the thing.

Leafbox:

Interesting. So I was just curious because another researcher I was talking to, it just seems like the polarization in Japan wasn't there. And his theory was obviously because Japan's more homogeneous. So I just was wondering if you were seeing any of that kind of polarization issues in health in Japan?

Dr Nakayama:

The HPV virus issue here, HPV virus, HPV vaccination here, there was a very few, probably less than a hundred reports of the side effect of HPV vaccination about 10 years ago. And the Japanese government stopped doing the HPV vaccination. So at that time, because of those media output of those children affected by the side effects, only in that, due to that hundreds of thousands or maybe millions of kids had disadvantages of not having HPV vaccination in Japan. So we kind of take it back. So that's the Japanese society.

Leafbox:

So maybe it is more complicated than the other researcher was saying. My last question is, you seem to have quite a strong fast passion. Where does that passion come from? I mean, where do you get that? I appreciate that as a scientist. I'm just wondering where you get that passion for public health from

Dr Nakayama:

I think that I am a medical doctor. And then my childhood, I was admitting hospital very often. And then a doctor, pediatric doctor who treated me was very good, very nice female doctor. And then I wanted to be your doctor. But also, yeah, so that's the thing. My justice, I think environmental justice feelings probably coming from that point. Great.

Leafbox:

Well, I thank you for your research and your time, Dr. Nakayama. I appreciate your, anything else you'd like to

Dr Nakayama:

Share? No, thanks. Yeah, have a nice day too.

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