A pregnant woman sprays for mosquitoes, then worries for the health of her unborn child. An elderly woman dies shortly after her house has been treated for ants. Several farm workers fall ill after spraying fungicide in a field.
These are not scenes from a television crime show. They are real-life scenarios that OSU medical toxicologist Dan Sudakin has helped investigate. Sudakin is one of only a handful of physicians in Oregon who are capable of investigating cases involving human exposures to toxic substances from both a scientific and a medical perspective. He has not only an M.D. but also an M.S. in public health and a specialty in medical toxicology.
“Medical toxicology spans the great divide between public health, toxicological research, and the medical world,” said Sudakin.
Sudakin’s work bridges many disciplines, from emergency medicine to epidemiology to occupational medicine, even into homeland security.
On the faculty of OSU’s Department of Molecular and Environmental Toxicology since 2000, Sudakin conducts epidemiological research, trains staff, and provides outreach for two OSU-based national programs, funded by the U.S. Environmental Protection Agency—the National Pesticide Information Center (NPIC) and the National Pesticide Medical Monitoring Program.
NPIC provides science-based information to the public to help them make decisions about pesticides. The center’s staff answers more than 2,000 phone calls and services many of the 80,000 web hits they get per month from around the country.
The National Pesticide Medical Monitoring Program provides information for those assessing human exposures to pesticides. Cases are referred to the monitoring program from government agencies, health care providers, NPIC, and the general public.
Combing through scientific journals, Sudakin collects exhaustive amounts of peer-reviewed, research-based information about the clinical toxicology of both natural and human-made toxins for the monitoring program library.
“We receive thousands of inquiries each year about exposures to toxic substances, from the EPA, from the public, from pesticide applicators, from state and federal agencies and from physicians,” explained Sudakin. “It can be anything from accidental poisoning to intentional poisoning.”
A typical day for Sudakin might include a phone call from a doctor in a hospital emergency ward calling the monitoring program for help interpreting a patient’s laboratory test.
“Doctors want to talk to another doctor when they are needing consultation for their patients, like what test to give them at what time,” he said. “I serve in that role.”
A query might come in from the Oregon Health and Science University (OHSU) School of Dentistry about the toxicity of dental fillings. Or a corporate occupational health specialist might request information about how to protect employees from toxic substances in their work places.
“I’m here to provide good supportable scientific information, to help make sound decisions,” Sudakin said.
As a teacher, Sudakin focuses on what he feels is the most common and lethal way people are exposed to toxins—through food. His course, Toxic Substances in Food, teaches students what happens to people when they are exposed to bacterial, fungal, and chemical toxins in foods.
And, Sudakin volunteers one weekend a month as an on-call physician for the OHSU Poison Center. He says he never knows what kind of problem he’ll be called on to help solve next. From cases involving lead poisoning to acute drug overdoses, he has been contacted for advice from Nevada to Alaska.
“I consult with the local doctors on each case, helping them provide critical care to their patients,” he said. “I often end up providing not only information but also reassurance. In my work I need to be able to speak in both layman’s terms and in technical terms. I may switch gears from talking with an EPA official in one call to talking with a factory worker in the next call.
“I love my job because I not only serve scientists, but also citizens and underserved populations like migrant workers too.”