Meet Your Heroes: Brenda Eskenazi, MA, PhD

Dr. Brenda Eskenazi has researched Children’s Environmental Health (CEH) on every continent except Antarctica and Micronesia. Especially since I began this project, I tell my children – meet your heroes and talk with them. And there is no one whose work I have followed longer and whose research projects are more renowned than Brenda Eskenazi’s. In addition to all that, why should it surprise me that she is such a lovely, charismatic person? That she challenged me to do good and be better? For a nerd in this arena like me, it was a little strange conversing one-on-one with her – a mountaintop moment, to be sure.

There are some few people in each generation who, through talent, perseverance, and hard work, are truly exceptional, whose intellectual curiosity propels whole new fields of science and inquiry. Brenda Eskenazi is one such person. And of course, every person has their own story. Such is the wealth of this ethnographic approach – of sharing stories in order to piece together a vision of reality based on the web of community to which we all belong.

This interview has been lightly edited for length and clarity.

JMK:  Hello, Brenda – it is such a pleasure to meet you!

You have a long and storied history in this field. What first got you interested? I know you started in psychology. But is there some story from your childhood or your early training that got you to where you are now?

BE: There are so many stories! I was raised in a single-parent household, and my mother was very frugal, and she would buy whatever food she could get reasonably priced, including cow brains – and I would sit there dissecting the cow’s brain. I was fascinated with the human brain.

I have told this story multiple times. I was in college, a pre-med and an art major both, and I went off to Woodstock. I never made it there or heard a note, but I walked 15 miles in the pouring rain. I slept in the mud. I was intrigued by all these people who were having acid trips around me. The sun had just come out – I was standing in front of a car, and there was a guy standing on top of the car who was clearly having a bad trip. Right in front of me, he dove off the car into the concrete. I don’t remember what happened to him. I remember the moment he jumped off the car, and I thought, I wonder what happened in his brain that made him do that? What is the neurochemistry that is going on?!

JMK: I worked for a while in neurology as well. It’s still a mystery – much of it.

BE: It is a mystery – so fascinating. So I decided to become a neuropsychologist. The last year of college, I switched my major to psychology. My university, the University of New York, Queens College, was the graduate school for neuropsychology. In the early 70s, neuropsychology was not what it is now – it was more physiological psychology: the relationship between brain and behavior across different animal species, much more hard, biological science than it is now. I did surgeries on many animals – monkeys, cats, dogs, rats, mice, whatever they gave me to do. I took lots of neuroanatomy and lots of neurophysiology in graduate school.

At that time, I had a friend who was not able to spell and kept crossing out words. He was really smart, and college-educated. I asked my advisor about it, and he said, we’re just beginning to identify people with something we call dyslexia, and maybe it’s a version of aphasia or some language disability, but we don’t know very much about it.

In 1972, Macdonald Critchley published the first major book on dyslexia. I was really fascinated by how children’s brains get wired in this strange way. I wondered: is it genetics or environment (nurture vs. nature, not chemicals)? My advisor said, maybe you should do your dissertation on it, so I spent forever trying to find kids who truly had dyslexia. It, along with ADHD, was fairly unknown at the time. Somewhere along the way, I helped to start a clinic for kids who had developmental disorders at Mt. Sinai, mostly ADHD and dyslexia. These kids who had no place to go. They were treated as if they were cognitively impaired when they were really smart.

To make a very long story short, I started getting disillusioned with the clinical work. I had been getting training on clinical assessment, etc., and I started getting more interested in the etiology of all this. My advisor, Irving Selikoff, was a very famous clinician and occupational health doctor at Mt. Sinai at the time, and first identified asbestosis and mesothelioma. Phil Landrigan took over from him, and Bob Wright from Phil. My advisor was the neurologist on the team, and so whenever there was an occupational issue, he would evaluate if someone had neurological problems or if there was an environmental disaster.

I don’t know if you know about the poisoning in Michigan.

JMK: Yes – are you talking about Dow? Or the PCBs?

BE: The PBBs – Polybrominated biphenyls – there is actually a film called The Poisoning of Michigan. The accident occurred in the early 70s, but we were called in ’78, I believe. Bags of cattle feed got mixed up with bags of flame retardant, and the cattle were fed PBBs. People were eating the cattle and drinking the milk. The cattle started showing symptoms and dying. In the meantime, people all over the state, especially in the East Lansing area, were eating those cattle and drinking that milk – and so the entire state was probably affected by those PBBs. It took until 1978 when a proper study could be done of the health of the population. Sid Diamond, my advisor, was called in to do a neurological assessment, but Sid couldn’t go and so sent me to do neuropsychological assessments of my own kind on the population. The individual study never got published, but the volume eventually got published by the team, which included Andy Anderson at the Medical College of Wisconsin.

The important thing is what this experience did to me. I was still a senior graduate student in my sixth year of the dissertation, and I was amazed by how these environmental chemicals had affected the economics, the social coherence, the physical health, and the psychological well-being of the individuals in the community. It was what I was looking for – what was the etiology of these disorders in children, and how do you bring together the biological, social, psychological aspects – as well as the economic factors. It’s the interface of all those things that was the space I wanted to be in and that I felt my brain was well suited for – the gluing together of these pieces. It’s my specialty, you know – being able to see the social factors, and how the biological and psychological factors play a role. In a way, neuropsychology is exactly that.

So I came back from Michigan after three months of working there and said to my advisor, I would like to quit.

JMK: No!

BE: My advisor said, are you nuts? You’re six years into your dissertation. You’ve been collecting data. You worked so hard, and you’re going to quit? I said, yes. I want to do what that is, whatever that is. I don’t know what that is. How do you become trained in that, whatever those people are doing over there? That’s what I want to do, the interface of all that stuff.

He said, well, you need to become an epidemiologist. You need to learn environmental health. And I said, okay, I’m quitting. He said, don’t quit!

JMK: Good advice!

BE: I’m going to do that! But he convinced me to finish. At that time, I started working for my extremely dear wonderful friend and colleague, who was my first teacher in psychology when I was an undergraduate at age 18 and became one of my advisors on my dissertation committee, and then became my employer. She’s my dear friend, and I’m probably her other daughter. She is very sick right now – I just came back from traveling to New York to be with her.

JMK: I’m so sorry to hear about that!

BE: Rachel Klein is her name. She’s an extraordinary child psychologist. I was working with her at Columbia and at the Psychiatric Institute. I was her right-hand person, and at that time, she was helping to write the DSM on childhood disorders, including ADHD, and she was running some of those clinical trials on methylphenidate and dextroamphetamine, and later, Adderall. And so I was working alongside her as her assistant, a full employee even though I was still a graduate student. And I told her about my experience in Michigan. She said, you know, we have all these data on lead. Why don’t you analyze those data and look to see if there is any relationship with ADHD? And so I started working on this paper in the 1980s with her and her husband at the time, Don Klein; they are both extraordinarily well known in the field of psychiatry / psychology and wrote the DSM.

When I started work, I said, yes – this is it! At the time, I got really interested and started reading all the literature on lead. But still, I was puzzled by how you could get training to do this. There was nobody in the field except for Bernie Weiss, who was doing early work in lead and mercury in New York State in Rochester. He was a real behavioral toxicologist, along with Herb Needleman.

I wrote these two guys – the only people doing the thing that I wanted to do, Bernie in animals and Herb in lead in children as a child psychiatrist. I wrote them both, and they taught me something really important. They didn’t know me from a hole in the wall – and they took the time to talk to me. I was nobody. Bernie said to me, you need to get trained in epidemiology and environmental health, and you need to do a post-doc. There are NIEHS training programs to take people from different fields and bring them to know something about Environmental Health. So try to get one of those post-docs.

And at the very same time, Rachel was encouraging me to stay at Columbia; but a true mentor will help you follow your heart, not try to hold you back. You know, she would have loved for me to stay. But when you really care about your students, you want to create the environment for them to flourish and to follow their passions – whatever their passions are – even if it takes them away from you into a different field. And so she encouraged me and didn’t hold me back.

At that time – and this is another famous story that not too many people know – and it didn’t come to my realization until about a decade ago. In 1979, Herb was advertising for a psychologist to come work with him at Harvard on lead. I said, Oh my God! This is my job! I mean how many people out there could have a passion around environmental health and psychology? There was nobody in 1979. So I felt like such a big-wig because he flew me to Boston and interviewed me – so wow! I’ve never been full of myself, so that was not an issue, but I felt so proud. He told me he had a paper coming out that week in the New England Journal of Medicine (NEJM), the famous 1979 NEJM article on lead in children. I thought, that’s exactly what I want to do!

And what I realized about a decade or two ago when I was sitting in a room next to a good friend and colleague, David Bellinger – I said, David, you got the job! We were the only two who were interviewed. He looked at me and said, you haven’t done badly! [We both laugh.]

JMK: Well that’s a lesson – even if you don’t get the job, you can still do well.

BE: I wound up doing a post-doc at Yale, and unfortunately, as a physiological psychologist, they didn’t let me do what I really wanted to learn how to do – but what they wanted me to do.

I worked on smell research, looking at people with split brains and hemispherectomies – stuff that a neuropsychologist would be just overwhelmed to do. This was soon after Roger Sperry won the Nobel prize on that. I was working on unusual things, working with patients from the VA hospital in West Haven – but I wasn’t doing what I wanted to do. I kept telling people, I want to do environmental health and epidemiology, but I need to learn this stuff.

So I felt like I was cheating. Literally, I felt like I was two-timing a partner or something. During the day, I was working on smell research – and then riding across the street to the School of Public Health and meeting with Mike Bracken, who was a perinatal epidemiologist, or Stan Kasl, who was a psychosocial epidemiologist. I was just trying to suck out their brains, to learn everything they could teach me, taking every single class that the School of Public Health offered in epidemiology or environmental health, like I was a Masters or Doctoral student because I was just hungry for that information. I was trying to put it all together for myself, creating a field. So I created a class in behavioral toxicology and teratology, and I had to teach myself all the chemicals and how the chemicals were affecting the human brain – animal research, human research, case studies, poisoning studies, occupational health studies, children’s poisonings – whatever I could find, trying to teach students this.

Then I was asked to do things for OTA, the research office of the U.S. Congress. I had to write a report on toxicants that could affect human behavior. I was just a postdoc, and the Dean of the School of Public Health at Yale was the one encouraging me. He understood what I wanted to do, like Rachel, Bernie, Mike, and Stan, the people who were the true mentors, who see where you are going and try to help you get there. He said to me – why don’t you stay here, and I will create a tenure-track position for you?

JMK: Wow.

BE: So I joined the Faculty in a tenure-track, Assistant Professor position at Yale. There was nothing out there to apply to – so this position was like manna from heaven. I taught there for five years – two years as a post doc, one year as a Research Associate, and two years as Assistant Professor.

I wrote a grant at Yale, and I have to say it was prescient – on the effects of caffeine, alcohol, and smoking on fetal health. The effects of smoking on fetal health had been identified in a 1964 paper. I needed to understand the brain – so I needed to understand the developing brain – so I needed to understand what happens in the womb – so I needed to understand factors that could affect the fetus – all parts of the fetus, not just the brain. I kept pushing the window further and further back into reproduction, and then worked on sperm and female reproduction. I have done work on all those things – all because I feel like I needed to see how it all came together to create a whole healthy child, and later a healthy adult.

But that meant I had to learn all of those things. At that very moment was the accident at three-mile island. Stan Kasl asked me to work with him on the effects of the accident on the mental health of the community there. You see how it’s like a puzzle – how all the pieces fit together?

At that time, I found it difficult living from grant to grant and not knowing what came next – because most School of Public Health positions are funded by soft money. 

And all of the grants on olfaction were getting funded that I helped to write and didn’t want to do. But the perinatal epidemiology grants wouldn’t. I saw the handwriting on the wall; if I stayed at Yale, I was going to be doomed to work on olfaction for the rest of my life, and I didn’t want to do that.

In retrospect, it was really crazy – there was a maternal and child health job at UC Berkeley focused on environmental factors that could affect child health and development. I thought, what – are there two of us out here? That’s for me. So I interviewed for the job, and when I got here, they looked at me. I looked at them. And we realized that our concept of environment was completely different. They were back in the nurture thing – nutrition and social factors and the real maternal and child health stuff. And I’m coming in with environmental chemicals. They took me anyway – but really, we were all kind of surprised that by environment, you meant that, and I meant this.

JMK: It seems like a basic word.

BE: Exactly! So I got the job, and when I got here, I was in the right place because maternal and child was always my passion, but they also recognized that I belonged in epidemiology and environmental health. And so I got an appointment in all three. I think that’s the story of my life.

JMK: No wonder you are able to produce in so many different areas! It wasn’t just one thing after another. You really intentionally did that combination.

BE: It didn’t feel intentional – it felt like falling into it. When students say, where do I go? what do I do? I say, you have to keep your eyes open to what opportunities you have because you don’t know where it’s going to take you. I was open to those opportunities. You also have to recognize what you know and what you don’t know – and you have to find the people who can fill the gaps. And so, since I truly knew nothing about infectious diseases, I collaborated with Joe Lewnard, an infectious disease epidemiologist, on the COVID studies. You have to be honest about holes in your training – that you have them and where they are – too many people are egotistical, and they think they know it all. That’s a problem – it’s knowing what you don’t know that is the key.

JMK: Very wise – and that’s what Socrates says, too.

BE: Oh, really? Good – that’s another thing I don’t know anything about – philosophy! [We both laugh.]

JMK: The next question, about what work you're proudest of, could be a real stumper for you. CHAMACOS, maybe?

BE: It's not the project that I'm proudest of, but it's what I'm proudest of– my mentorship. I don’t know how you feel about being a professor – I’ve done a lot of work; I’ve published a lot of papers – I’ve moved, as I say, grains of sand in a beach. But what really makes a difference is being the limb of the tree that has the branches off of it that has the branches off that, and that has the branches off of that. That’s really what makes the difference.

JMK: I love being a professor too!

BE: I guess what I am proudest of is doing multidimensional studies in hard-to-reach, high-risk populations. CHAMACOS is one, but my study in Africa is another – some of the poorest black African peoples in South Africa. We are looking at health effects of pesticides for malarial control. The study in Seveso, Italy is with another higher-risk population exposed to a potent chemical carcinogen, probably the most potent carcinogen [dioxin], which made me have to learn about a lot of outcomes. But working again where there is so much politics involved – and then helping others with cohort studies all over the world – I like to say I think I have done a study in every continent except maybe Micronesia and Antarctica. I am proud of pushing this field forward.

JMK: It's so hard to have conversations with families and with parents; there's so much guilt, and there's so much fear. This is really tough news to hear, and especially if your child is sick. So many practitioners are afraid to make parents feel worse. And I just wonder how you handle that conversation with patients?

BE: I don't speak to patients anymore, so I can’t tell you that. But I do speak to subjects or participants.

I’m smiling because we found high levels of different exposures in the farmworkers in CHAMACOS – and we felt strongly as a research team that we needed to let people know what their exposure levels were. Most chemicals analyses are not CLIA (Clinical Laboratory Improvement Amendments). You may not know the clinical significance of what the results of that test means. So you don’t know what to say to somebody if they have a high level – or even what a high level is in some cases.

We really worked hard to get IRB to allow us to give results back to the population of farmworkers, who are mostly Spanish-speaking, low-education, low-income. Many are undocumented. Also, they don’t have good means of getting themselves out of the pollution that they may be exposed to. But we felt it was the right thing to do morally. And so we went through a long process to figure out the best way to do it. And this is an answer to your question. We created a pamphlet for each person’s result. We showed them where they stood relative to NHANES and relative to their own population, the ones we already tested in our group. And then, we told them simple things they could do to lower exposure.

We were in a huge school cafeteria, and there were tables set up everywhere. And at each table, there was someone like me and a translator. Each person got to talk to us about results. We counseled them individually, like a genetic counselor would do. And at the end of this very long night, I can’t speak for everyone, but I had second thoughts about whether we did the right thing.

 

JMK: Interesting.

 

BE: We were caught between the right to know and do no harm.

 

JMK: Yes.

 

BE: And I didn’t know if I did the right thing. In most cases, at least to us, the mothers – we counseled mostly mothers – seemed to be okay about knowing. This was their fate. This was their life. They were happy they could put food on their table, happy they had a shelter, happy they were not living in mud, impoverished in Mexico. But in other cases, I could see it hit home. And the best that we could do is say what they could do now, but that was after the fact. You know how that would feel, right?

JMK: Oh, I do. I know.

BE: You know personally. What do you do with knowing when you can’t change your circumstance?

JMK: Yes, I'm in different circumstances because I feel I can do something with my education and privilege to help others. But when you cannot protect your own children at all, it is a helpless feeling.

It’s so interesting what mixed feelings you have about it.

BE: It is interesting. It led me to take part of my sabbatical on medical ethics. Again, one of those other things.

JMK: You are a Renaissance woman for sure!

BE: I don’t feel like I am qualified to do anything. I'm not just being humble or anything because the more you know, the more you feel like you need to know. And every single piece is complicated; nothing is simple. And so the complications make you feel like you have to know more and more and more.

JMK: This is an epistemological problem, right? What are the limits of knowledge? At least you know what you don't know.

I will ask you the last question, and it's a follow-up to what we already talked about. It’s just to turn it around and ask, is there anything you would like to ask about my project or my experiences?

BE: I'd like to know everything about it, and what you're going to do with it. I sit in committee after committee. I'm on TENDR, and I’m on ISCHE. And I am on this forum and another, where my colleagues – I know their research well – can be dogmatic about it. I hope that you strike a balance where you're not dogmatic.

The way I look at it is a little bit different than the people who get on the bandwagon. I'll give you an example. I have been publishing study after study on the health effects of DDT. And a lot of them with negative consequences. I'm in South Africa, where they spray DDT legally under the Stockholm Convention. I was actually living at that moment with the head of health for the major hospital there. And there was a major outbreak of malaria, with children dying, 200 children and adults lying on the floor of the hospital because there aren't enough beds to deal with the horrible outbreak that is happening. And she looks at me and she says, what should I do? And I said, spray.

JMK: Absolutely. It's such a different calculation.

BE: Exactly. So. That's what I'm saying. Other colleagues are not seeing the full picture. And that's what I'm hoping that you do.

JMK: I will take that so to heart – more so coming from you. But you know, even Rachel Carson qualified her argument. She said, “It is not my contention that chemical insecticides must never be used.….” And so you're right up there with Rachel Carson for me.

BE: Good company! I hope she feels the same! [We both laugh.]

JMK: So I will treasure our conversation in my heart.

BE: Thank you, and it's been an absolute pleasure.

JMK:  Oh, it's been such a pleasure and an honor to talk with you. Thank you again so much for all you have done.

BE: Can’t wait to read the book!