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Aman Chopra: Folks, welcome back to another episode of the I AM GPH podcast. This episode has been a long time coming. Today we have Dr. Jack Caravanos who's a clinical professor of environmental health sciences here at NYU GPH. Anything to do with the environment that you might not even think of, such as mining, lead poisoning, gold extraction, Dr. Caravanos has probably published a paper on it, and if he hasn't, he definitely has the answer. We have seen previous students of his on our podcast and they've said nothing but amazing things about him. We're so excited to speak to him today. Dr. Jack Caravanos, welcome to the I AM GPH podcast.
Dr. Jack Caravanos: Oh, thanks so much for having me. It's an honor to be here.
Aman Chopra: I'm excited to speak to you because in the chatters around our school, you're the environment, you're the environment guy. Any question about the environment go to Dr. Caravanos. So I'm curious to know, actually, let's start with this. What is the environment? Like how would you describe environment if a person that's born and now they're going to school learning to speak and they ask you what is the environment, how would you answer that to them?
Dr. Jack Caravanos: Yeah, that's a good question because it's a big word and people use it in all sorts of different ways. And then I usually clarify it saying, well, I don't deal with whales and ocean pollution and deforestation. That's really environmental science, though I'm passionate about that. And then I clarify it by saying environmental health, which is things we've done in the environment that adversely affect our health. And then ultimately for people like my mother and family, I'll say pollution. I deal with pollution - water and air and land. So that's really my passion. And it's fundamentally, it's science and it's kind of applied science.
Aman Chopra: Hmm. Okay. It's fundamentally science and applied science. So what if the kid responds by saying, what is science? What is applied science? What does that have to do with the environment?
Dr. Jack Caravanos: Yes. That's a good question. It's, of course, we're looking at, in my basic introduction, right, we have the spheres of the planet. So we have the water sphere, and the hydrosphere, the geosphere, the atmosphere. And of course, we're in the middle of the biosphere. And that these areas of the planet all are interacting. And humans are clearly affecting the atmosphere, the atmosphere affects the biosphere, and they're all interlinked. And when you describe it like that, I think students and people see the connections because sometimes we lose the sense of all those connections.
Aman Chopra: Got it. Okay. So now for students to see something, I'm curious to hear when I, I've been hearing from all the guests that I've interviewed that climate change is the number one public health crisis that exists right now. And I'm curious to know from you, what is the most important environmental concerns to address today within public health?
Dr. Jack Caravanos: Yeah, in environmental health, we're still dealing with the effects of our society. It's kind of a legacy pollution. So we have many parts of cities and areas of the planet that are polluted so much, it's gonna take decades for them to restore. So we have that whole, that whole idea that we really have to go in and clean up what we've done. And I very often bounce it to the students. I said, well, look, we dirtied it up and now it's your chance to clean it up. You gotta make, do good by this.
Aman Chopra: It's something that got dirty and now we just have to clean it up. Is the idea behind it?
Dr. Jack Caravanos: Yes, but the most important thing about the dirty, the pollution is that, what are the health effects? And the problem with some of the challenges with environmental pollution is a lot of the diseases are not recognized right away. So with the exception of asbestos that we know causes mesothelioma, a lot of environmental disease is hidden and insidious and you don't really know it's happening. And a good example is like lead, lead pollution, lead poisoning in children. It affects cognitive development. And you have children that have lower IQ scores, attention deficit disorders. And many people, parents especially, can't link that this behavior may be related to an exposure I had many years ago. So we're always trying to identify that these environmental contaminants are really hurting your body, even though you can't see it as much like as an infection. COVID and malaria, you know, you get bitten, you get infected, you got a disease. Environmental pollution is a little bit more subtle that way.
Aman Chopra: What are some hot countries to look at when it comes to environmental health? Your work is so global, right? It applies to every single place that could be an answer. But what are some countries that are doing good and perhaps some areas, some countries that really need some attention right now?
Dr. Jack Caravanos: I'd say the first almost 20 years of my career, I focused primarily on the U.S., in occupational health and environmental health in the U.S.. Last 20 years or so, I've been doing almost exclusive work in low and middle income countries. And sometimes it's hard to convince even an NYU student why should I care about what's going on in Pakistan or in Bangladesh or in Zambia. And the reality is our supply, our food supply, all our goods are global. And a good example of that is what recently happened with cinnamon. I don't know if you're familiar with the lead poisoning case of cinnamon. And this was an Ecuador where they were processing cinnamon and for some reason lead got into the cinnamon. Well, the cinnamon was then exported to the U.S., integrated into applesauce, put into the pouches, and of course, consumers bought it. And sure enough, many people became ill. And you wouldn't have thought that something from another country can do that. But whether it's food poisoning or foodborne disease or workers coming in and being harmed, it's still happening. And we're seeing more and more of some of the foods and items and behaviors coming into the U.S. and then impacting us.
Aman Chopra: Wow. I had no idea about the cinnamon thing.
Dr. Jack Caravanos: Yeah. It freaked people out. And I kinda liked it because finally we could get people to say, look, we have to help Bangladesh with this problem. We have to help Sri Lanka, which produces a lot of cinnamon. We have to help African countries with cocoa, cacao beans come from Ghana, they go up to Europe to get processed into chocolate. So whatever happens in Ghana can find its way to high-quality chocolates in Europe, which then are sold on the U.S. market. So, and it freaks people out when contaminants like that are discovered, but it's going on all the time.
Aman Chopra: How are these problems even solved in these countries where it's impacting the entire world, then we're realizing there's an interconnected nature?
Dr. Jack Caravanos: Oh, it's a tough way to solve some of these. You know, there is no global police department, global group that can really enforce this kind of stuff. And for the cinnamon, people were critical of the FDA. Shouldn't the FDA have caught this stuff and stopped it. And same thing with chocolate and other products. The reality is we can't test every single can and product coming in, but we have to do more to help those people produce products that are safe for everybody, their home country, and the U.S.. And really, they don't have the resources and the money to do that. They have other problems they're dealing with, many low and middle income countries, so they absolutely need the help of high income countries to fix these problems.
Aman Chopra: I'm sure I can ask you right now about what are the health challenge, the environmental health challenges happening right now, but I think we're aware about it. I'm, I'm curious to hear from you, a decade from now, what are these trends that are coming when it comes to environmental health challenges that you're noticing, trends that are going to come that we might not even know about?
Dr. Jack Caravanos: Yes. That's a good question. And it's speculative. I think from my experience, you know, I've been doing this for many years, there's this cycle that seems like we never really fixed a problem. You know, it's a wound, we patch it up, we think it's healed, and then years later, it opens up again. So I'm always shocked that we have foodborne poisoning. I mean, didn't we cure foodborne poisoning? Should this be happening in New York and elsewhere? And the reality is some of these problems will just keep coming. An example, sort of related to climate change, is mold. So what happens is climate-induced flooding, hurricanes, you have homes that are flooded, all of a sudden they're drying out, they get to the range where mold can grow, whether it's Hurricane Sandy or Katrina, we have these widespread mold episodes. And they're episodic. So after 10 years, people sort of forget that it ever happened, but the next flood in a city will resuscitate that. And next thing, you know, we're, you know, teaching people about mold identification and contamination. So I think the same old stuff is gonna probably come back, but I'm, what am I concerned about? I am concerned our food system has gotten so processed, and more and more I'm reading that highly processed foods are not healthy. And I think epidemiology is slowly showing that. So I'm a little concerned about our move towards synthetic proteins and fake meats and highly processed vegan dishes. So I'm a little worried about that. I'm curious what's gonna happen years from now.
Aman Chopra: What about the industry of mining?
Dr. Jack Caravanos: Mining, there's so much going on. There's... First of all, we need these metals. Copper, we need gold, we need silver. And that has the usual problems. I think you may have heard from other episodes that a mercury is used to extract gold from various ores. And it's a cheap, fast way to do it. It's a very dangerous way to do it. But people, you know, have to choose sort of poverty versus health. And unfortunately, it's a difficult choice. But what I'm most concerned about now is the rare earth metals. So you probably heard that all these batteries, batteries are amazing, right? They're so small and they last so long, better than ever. And that's because there's various ingredients that have improved them. So rare earth metals for magnets and batteries have created a market where mining these is very profitable and very destructive. And it's not responsible mining. The high income countries may not care saying, well, we just wanna buy the ore, you know, what you do to your country is not our concern. So it's gonna be a challenge. They don't appear to be terribly toxic, some of these rare earth metals. But we don't have the epidemiology on that yet. So it's still an up and coming field.
Aman Chopra: I've not heard a guest say, we don't have the epidemiology on that. So what does that mean when you say the epidemiology on something?
Dr. Jack Caravanos: Yeah, that's very important in public health. You know, how do you know something's dangerous? Well, you know, you could feed it to animals, if at a certain level, the animals change, lose weight, die, you know, that's an easy marker. So there's the animal testing. But what we really need to regulate is proof that it affects humans. And epidemiology, of course, is the study of determinants and distribution of disease. So if we could show that a population that's eating a certain type of high processed food is getting more cardiovascular disease, then that would really put the nail in the coffin and say, okay, this is a done deal. For example, a good analogy, a good story there is, for many years, lead was considered pretty much a childhood health hazard, you know, brain development, cognitive damage, IQ change, all that stuff. Recently, finally, the American Heart Association, looking at all these studies, both animal as well as human as well as epidemiology, they finally realized that lead is a cardio toxin. It affects the heart and the blood vessels. So finally, lead is now shown to be an adult toxin. And that's gonna change the paradigm. And I was really happy that happened in July 20, I'm sorry, yeah, about a year ago. About a year ago, the American Heart Association came out with that statement.
Aman Chopra: July, 2023.
Dr. Jack Caravanos: Yeah, July, 2023. And we were so happy to hear it that they finally, 'cause cardiologists are a tough crowd to convince, but when they said it now, now cardiologists will maybe order a blood test for lead, whereas in the past, they would never put the two together. Wow. Yeah. And that's why we're seeing so much action on lead. And what you see in some of the things here, the lead in the famous Stanley cup and word came out that there's lead in this and people panic. They may not know a lot, but they know lead is not good for you. And it ends up the lead is sort of hidden in that cap, underneath that cap. It's a piece of solder that's se used to seal something. It's impossible for you to be exposed to that. But it made such a hit that it ran like wildfire on the internet. It was on BuzzFeed and everything. So we had to really explain, well, yes, lead is bad, but in this particular case, there's no exposure. So don't worry about it.
Aman Chopra: Interesting. Yeah. It's like one word and one perspective about something can just change the whole narrative around it, right?
Dr. Jack Caravanos: Oh, it's amazing. And the same thing may happen a couple years if there's a flood and mold. And maybe there's an explosion and there's an asbestos pipe that gets released and all of a sudden asbestos is back in the news. So it's very, you know, episodic, it's sort of the contaminant du jour, and contaminant today is lead. Yeah, we're still... 'Cause now with this finding, more and more people are doing better epidemiology on lead and health effects.
Aman Chopra: Are there any other macro trends that are coming up that might surprise us?
Dr. Jack Caravanos: I am still struggling and maybe not sound a good word, I'm still working out climate change and this relationship to environmental pollution. So how would a change in climate, warmer, colder in different parts of the world, how is that gonna mobilize poisons? Is material that was embedded gonna get washed up and redistributed through the population? So everybody says, Jack, can you connect climate change with environmental pollution? Some are obvious, you know, the warmer the climate, the more ozone, the more photochemical oxidants, the more air pollution, the more respiratory disease. That's pretty, you know, A, B, C, D. It's pretty straightforward. But the other aspects of environmental, land contamination is something we are still trying to better understand. Yeah.
Aman Chopra: Land contamination, what is that, the stuff we have created and it stays on land? Is that what it is?
Dr. Jack Caravanos: Yeah. It's everything from, whether it's oil spills on land or polluted places, for example, a lot of our waste are still buried. And years ago, we just buried them in landfills in Pennsylvania or Ohio, but now we're burying them using different technology. But years ago, it was pretty much put right back in the ground and covered with soil. So how's that gonna come back and maybe haunt us?
Aman Chopra: How are we burying it right now?
Dr. Jack Caravanos: Well, now to get rid of hazardous waste, some of the nasty stuff that sometimes you see in chemistry class, that has to get put in a special landfill, a ditch, which has many layers of protection, thick plastic, gravel to collect any leachate material that kind of soaks through the plastic. So it's pretty much buried, entombed underground with a good monitoring system. So if something goes wrong, we can catch it quickly. But it's amazing. Like for asbestos waste, there's a lot of buildings in urban centers that have asbestos. We're pretty much taking it off the steel and putting it in bags and putting it back in the ground. So it's still a lot of landfilling going on.
Aman Chopra: What is asbestos waste?
Dr. Jack Caravanos: So asbestos is a mineral that's used as a fireproofing. So all these tall steel structures in New York have used asbestos for fireproofing. So every time you renovate a building and even this building, our public health building, had to undergo some asbestos abatement before they started rebuilding it for our occupancy. And you don't hear too much about asbestos 'cause there hasn't been a dramatic event with a release or so.
Aman Chopra: How might the buried trash haunt us later on?
Dr. Jack Caravanos: Yeah, it depends on the type of material. How liquid is it and how mobile is it and how well was it buried? I'm a little worried that, you know, in a hundred years, a thousand years, will we remember where this stuff was? Is it just gonna get covered, and then a whole nother generation is gonna stumble across it? It does seem weird, right, to be sweeping it under the rug.
Aman Chopra: Literally.
Dr. Jack Caravanos: But economically, very often that's the cheapest way, the most, you know, cost-effective way to dispose of it.
Aman Chopra: I feel like in the short time I've chatted with you so far, I feel like I've read three research papers already and understood something. And I'm saying this because I'm curious on how someone like me or anyone can get more educated, how can we become more educated consumers, supporters of issues in the world out there?
Dr. Jack Caravanos: And the great thing is today social media is so abundant, and yeah, there's some inaccuracies out there, we all know that, but the great thing is once a story comes out like Stanley cups or like statues that have lead or cookware that may have arsenic in it or something, it gets out there really fast. It's important for us academics and specialists to go in there and clean up the facts, make sure people are hearing the right thing. So that's one of our obligations. But ultimately, it's our education system and I'm seeing more and more people teach about the environment and how humans have changed it at a younger and younger age. I mean, I think, I didn't hear about it until I was in college, but now, you know, someone in fourth grade is drawing pictures of saving the planet and helping, et cetera. But it ultimately comes down to behavior, right? If you and I really do recycle and we buy the right products, so long as we know what the right products are, so long as we're educated, I think that's what we'll do. Because, you know, we're a market-driven society. So capitalism will win out and say, if you're not buying this food, if you're not buying this container, we won't make it. So that's ultimately, I think, in our habits.
Aman Chopra: Tell me about that statue that's in front of us right there.
Dr. Jack Caravanos: Yeah, this was a, it's a cool story. This is a little statue of a person playing a classic Senegalese, a guitar instrument. And the story there, yeah. The story here is when you pick this up, and I want you just to pick that up. Very heavy. And I know right away that there's a lot of lead in that. And one reason they use lead, it's easily melted and molded. There's also some copper in there, but it is very heavy. I mean, it's gotta be like three pounds and you would never think it. And then if we were to shoot it with the X-ray fluorescence machine, that, yeah, that machine is... Yes, you want me to...
Aman Chopra: Yeah, please. Thank you.
Dr. Jack Caravanos: Let's turn it on and take a reading. And this is a wonderful way to educate, educate students of all ages. There's nothing like an instrument and you get an instant reading. Yes or no, high or low. So what's happening now is we turn it on and while this thing is booting up, so what happens here, when you press the button, it releases X-rays into the paint, into the statue, into the table, into the glass. And if there are metals or certain types of metals in there, it absorbs that energy, and then fluoresces bounces back another type of energy. So X-rays go in, excites lead atoms, and the lead atoms release a different type of X-ray. That's why we call it X-ray fluorescence. And it's a very common principle in analytical chemistry. The nice thing is this has been miniaturized. So now we could just sort of use it as a gun and just take a sample, and let's see. All right, let's do metals. And it's getting ready. Now, not only does it measure lead, but it measures arsenic, mercury, zinc, iron, copper. It's practically the whole periodic table. So other people that use this are recyclers. 'Cause they wanna know, is that iron, is that copper, is that zinc, is it bronze, et cetera, et cetera. All right, so let's take a reading. So what you're doing here is you're essentially holding it up to a surface and it's adjusting the temperature for the room.
Aman Chopra: That's so interesting.
Dr. Jack Caravanos: All right, I'll just hold it down for a couple of seconds. That was what, four seconds.
Aman Chopra: Yeah.
Dr. Jack Caravanos: Do you remember your chemistry?
Aman Chopra: 7,043 of iron, and then I have, let's take a look at... Let me show it to the camera as well.
Dr. Jack Caravanos: And lead is Pb, how much lead?
Aman Chopra: Pb, 20.8K.
Dr. Jack Caravanos: Yes, 20.8K. So that's...
Aman Chopra: The 20,800.
Dr. Jack Caravanos: Yes. Parts per million. So that's almost 2%, 2.8% of this statue is lead. And I just really hit one part of it. I didn't get a good reading.
Aman Chopra: Yeah.
Dr. Jack Caravanos: Now I didn't really need the instrument to tell me there's lead in here, but, you know, it's important to be able to confirm that. Yeah. So we use that all the time. So I want you to read what's on the bottom of this cup.
Aman Chopra: It says, it says ARTE ANTONIO PUE MEX LEAD FREE.
Dr. Jack Caravanos: Well, once you... You wanna shoot it? Put the sensor up against the device. Yeah, like that. A click and hold.
Aman Chopra: Oh my god.
Dr. Jack Caravanos: Oh, you could let go now.
Aman Chopra: That has more lead than the previous one.
- 557K, that's almost 500,000. That's like 50% of the glaze. So what were you testing? You really were testing that top part of the ceramic, that shiny glaze and the color. And it says it's lead-free. And I got that from Cancun on my last holiday. And it said lead-free. I said, well, let's see if it's really lead-free. So, you know, what do you do with that? I mean, do you trust anybody at what point, you know, should you believe them or not?
Aman Chopra: So would one ever know without this device?
Dr. Jack Caravanos: No. No, you could buy there these lead swabs, where there's a activating ingredient and it's color-metric, and if it turns red, it's got lead in it. But you would have to buy that and test each one. And there's no way someone's gonna let you test it, you know, there. So you have to have faith in the government, that the government is enforcing their regulations.
Aman Chopra: Wow.
Dr. Jack Caravanos: Yeah.
Aman Chopra: Are there any other metals similar to lead that we should be worried about in this way?
Dr. Jack Caravanos: Lead is so abundant in our industrial society. So it's used in so many, even in this room, a lot of your cables have lead shielding. There could be even lead shielding in the walls for radio frequency, right? Dentists use it for, you know, radiation protection. The antennas of many cell towers. So there's a lot of lead in there. Is there anything else? Well, cadmium and chromium are sort of abundant, but they're not as insidious. So I would say lead today is probably our heavy metal of most interest. Yeah.
Aman Chopra: You got a lot of stuff for us. I want us to go to the final one that you have the VR camera that you told me, this small dictaphone-looking thing.
Dr. Jack Caravanos: So I'm really excited. I'm a geeky guy. I love my toys. And what you're looking at there is a camera, but it's a 360 camera. And as you rotate it, you see there's a lens on one side and then another lens on the other side. So it's taking a picture in every single degree. So it's 180 degrees this way, 180 degrees that way, and sort of weaves it together. So every picture you take is practically like, you know, 200 megabytes. They're huge files. So what that does is produce an image like what you see on Google Street View, right? You go to Street View, you go down Broadway, you turn your computer, you could see how it's moving. That's what these cameras do. So consider I'm walking down a polluted place in Zambia with one of these cameras. So I'm actually filming 360 all around me. And then using various programs, you create a module so students can put on a VR headset, we use the Meta Quest 3, they put on these VR headsets and they're immersed in the polluted place in the factory, in the swamp, in housing development. So you really get a sense that, wow, I'm here. Because we're a global health program, we're a global health school, but we have to get our students, you know, overseas more. And this is one way we're doing it. So all our faculty in global health will have access to these cameras. So next time they go to Kenya, they could film a clinic, and then produce a tutorial where as you're walking through the clinic saying, what's this, what's this, what's this, and identifying different things. So it really is immersive, you know, we can get really fancy and get adaptive so that there could be a virtual Aman that goes in there, picks up the instrument and takes a reading of soil and says how much lead is there. So there's a lot of excitement with bringing virtual reality modules into education.
Aman Chopra: I wanna talk to you forever, but let me ask you two more questions. So the first one is very similar, but like, what are small actions we can take in our own individual spaces like apartments and our houses? Is there anything we can do to be more aware? You mentioned a little bit of that earlier, but what is something I can go home and do right now?
Dr. Jack Caravanos: Well, here, I'm still surprised how many people just day-to-day things like turning off the lights and recycling more often, picking up trash on the streets, you know, it's shocking how often I'll see NYU students just walk past a can, and it's a recyclable can and it could be collected and put into something. So very often, so much of what we can fix is easy just by turning off a light or using energy more efficiently. And I think it's not that people are malicious, they just sort of forget, you know, and they leave the air conditioner on all day or they do that. But so much of our environmental problems now are related to energy use and carbon dioxide generation and fuel consumption. So that is something, you know, I'm a little obsessed with and sometimes I get yelled at it because I'm turning off too many lights and stuff like that. But we make great progress, right? The computers are so, there's like no energy in that computer. It's not like the big monitors of years ago.
Aman Chopra: Yeah.
Dr. Jack Caravanos: And then I think things we buy in packaging, I really, it's very frustrating to see so much packaging when you buy something. And look, I order from Amazon as much as you do, and I'm not happy when I get this gigantic box and there's a little device in it. But yeah, I don't know what we could do about that. I think that's... We gotta push Amazon to do more about that.
Aman Chopra: The last thing because there's so many things I can ask you, but your research on gold extraction, how did that come to life? How does one even get there?
Dr. Jack Caravanos: Well, yeah, it all started when communities in Amazon were discovered to have high mercury levels in their urine. And it was part of another health surveillance project. I wasn't involved in the original, but the question is, why is there mercury in these residents, in these villages? And then you start digging down and you realize they do what's called artisanal gold mining. They'll go to a gold mine and using the leftover material. They'll try to extract that last little bit of gold using mercury. And mercury is, it's a nasty chemical. It gets rapidly picked up into the ecosystem and into your body. It also has neurological damage. And then we realize so many people are doing this artisanal gold mining. And so many people are exposed to mercury and it's abundant. I mean, Guyana, Venezuela, you know, every country on the planet, Mongolia, every country has mountains and there's gold in the mountains and people need money to eat. And they use this method to extract it.
Aman Chopra: This was when I first started hosting the podcast, we started asking this, we were asking this question to all our guests, and it's kind of fallen off the wagon, but I'd like to bring it back for you. If you had a magic wand to solve a public health crisis today, which one would you choose right now?
Dr. Jack Caravanos: Oh, that is a public health crisis versus an environmental health crisis, right? I think public health, I'm sorry to say, you know, viruses are still bad. You know, we saw what happened with the coronavirus and if there's one way we could sort of better deal with viruses, and they are tough because they are adaptable, they're smart, they change, and while I'm afraid of the toxins and PCBs and DDTs and lead, what scares me most in public health are viruses. So that's where. As far as environmental health, there's no doubt that lead poisoning is the biggest killer on the planet.
Aman Chopra: Interesting.
Dr. Jack Caravanos: As far as chemicals. Yeah.
Aman Chopra: I'm sure a lot of people don't know that as well.
Dr. Jack Caravanos: Yeah. But I think they will. I think the next five years the message is really gonna get out where you're gonna hear more and more from physicians and cardiologists that we should do a blood test and see what your lead level is and see why is it so high.
Aman Chopra: I love this.
Dr. Jack Caravanos: Yeah.
Aman Chopra: Well, Dr. Caravanos, we can talk to you forever. Thank you for getting us excited about topics like this, interested and educating us on this in such a short period of time.
Dr. Jack Caravanos: Oh, it's my pleasure and it's what I live for and I'm always here for NYU and my students, so thank you very much for having me.
Aman Chopra: I love it. All right folks, that's another episode. A really, really fun one. We learned a lot and we'll see you in the next one. Put a comment down below if you have any questions or would like to share your thoughts. We'll see you in the next episode. Take care.