Documenting Exposure for Disease Prevention

CREDIT: Emilie Counil

French epidemiologist Emilie Counil often encounters suffering—much of which, she believes, is unnecessary. Since January 2011, Counil has led a multidisciplinary team at the Paris 13 University, working to link the occupational history of newly diagnosed cancer patients with exposure to workplace carcinogens. Among other projects, her GISCOP93 team examines individual cases to determine whether patients can legitimately claim that their disease is linked to occupational exposure so that they can seek financial compensation. This, they hope, will provide new incentives for employers to prevent future exposure.

“Occupational health is an especially difficult public health field to make things change because there are very strong forces operating and enormous economical stakes.”—Emilie Counil

One obstacle to cancer prevention, Counil says, is poor public awareness of the health effects of workplace conditions. Another, she says, is that at least in France, occupational health issues are rarely factored in to public health strategies. Counil aims to draw public attention to carcinogen exposure at work so that “occupational cancers … are put on the political agenda as part of public health policy.”

Trials and disappointments

Given the opportunity, Counil says, she probably would have studied medicine. But she needed funding because her family could not offer her financial support. She won a scholarship—but it was to attend an engineering school.

Soon after arriving at the Paris Institute of Technology for Life, Food and Environmental Sciences (AgroParisTech), Counil decided she couldn’t see herself as an industry engineer, the job the school’s master’s degree was preparing her for. So she specialized in the formulation of food products and, in her third and final year, leveraged that expertise into a 6-month internship with the French Institute of Research for Development researching malnutrition in Burkina Faso. This first contact with public health issues was “a revelation,” Counil says.

After obtaining her engineering diploma in 2000, Counil earned a 1-year professional Master of Science degree in public health from the Paris 7 University and the French School of Public Health (now called EHESP) in Paris. She spent the required internship at a French nongovernmental organization, assessing the environmental, health, and social risks associated with arsenic contamination in Mali, which is caused by gold mining. “At the time, there was no transparency. The information given by the company was very scarce,” she says. The experience convinced Counil of the usefulness of research to inform the decision-making process. Determined now to pursue a Ph.D., and again in need of financial support, she returned—ironically—to AgroParisTech to work under the supervision of Philippe Verger, her former professor there.

Starting in 2002, Counil developed epidemiological approaches to assess exposure to mycotoxin via consumption of contaminated goods such as coffee and cocoa, and the potential health effects of that exposure. She wanted to know whether the current regulatory limits were appropriate. She discovered a “double standard,” and also what she calls the “precautionary principle paradox” in international public health. Mycotoxin exposure, she learned, was probably sufficient to cause disease only in highly exposed groups, such as those working in agriculture in developing countries. Rich countries, meanwhile, set strict regulatory limits to protect their consumers, which threatens farmers' livelihoods. Dismayed by the inequities, she returned to fieldwork.

After graduating in 2005, Counil took a position as a field epidemiologist with the French Institute for Public Health Surveillance (InVS). She joined one of InVS’s Interregional Cells of Epidemiology (CIRE), which carry out disease surveillance and advise decision-makers on emerging public health issues. After a rare, nonoccupational case of mesothelioma was diagnosed, a group of people who had unknowingly lived for 40 years near an asbestos-grinding plant in Aulnay-sous-Bois, near Paris, asked the ministry of health to investigate their environmental exposure and possible health effects.

During her work at InVS, Counil demonstrated that she was capable of “a very high scientific rigor,” Hubert Isnard, the scientific coordinator of her CIRE, wrote in a recommendation letter he shared with Science Careers. The letter notes Counil's receptiveness to nonepidemiological approaches, her collaborations with modelers to understand how asbestos dust disperses, and her embrace of historical and social research to compensate for a dearth of company data. Counil also has “a very strong ability to relate with others, which allowed her to be recognized and accepted by all the stakeholders,” Isnard wrote.

Counil enjoyed the work and found the project exciting—then politics intruded. The publication of her report, which linked cases of cancer to environmental asbestos exposure and sought to motivate a national discussion, was delayed as authorities scrambled to make a public announcement. Afraid the report wouldn't be published, she quit her post in frustration.

A suitable track

Counil started a postdoc at Laval University Hospital Research Center in Quebec, Canada, in November 2006. There, she compared the exposure of Quebec and Greenland Inuit communities to industrial trans fats from food consumption. She found that people in Greenland had much lower levels of trans fats in their blood than the Quebec group, a difference she linked to more aggressive food regulations in Denmark, where Greenland's imported commercial food came from. Concerned about the health of exposed people in northern Quebec, she headed out into the field to advocate for better-quality foods to be sold in local stores. “This was really a very exciting project because I really could go from the generation of scientific information" to "public health action in the field,” she says.

After about 3 years, Counil and her partner, who had come with her to Quebec to do neurophysiology research, decided to return to France. At a conference, Counil served on a panel with French public health researcher and advocate Annie Thébaud-Mony, whom she knew from her days working on asbestos exposure. Thébaud-Mony invited Counil to join her GISCOP93 occupational cancer research team at the Paris 13 University. Counil was invited to join the group, Thébaud-Mony writes in an e-mail to Science Careers, because of her scientific and human understanding of public health issues, her strength as an epidemiologist, and their “shared vision of public health research as a production of multidisciplinary knowledge for action and of quantitative and qualitative approaches as complementary.”

Four months later, in January 2010, Counil won a research grant from the French National Cancer Institute and a 3-year tenure-track professorship in epidemiology at EHESP, her public health alma matter. Soon after, Thébaud-Mony retired and Counil took over the GISCOP93 project.

Since the survey kicked off in 2002, the GISCOP93 team has put together a database of more than 1000 cancer patients and their occupational carcinogen exposure. Counil added a quantitative approach to the project’s previous qualitative approach. Her aim is to identify industrial sectors and occupational activities where carcinogen exposure is common and to determine how occupational exposure relates to social inequalities. She also analyzes how social inequalities impact patients’ chances of getting financial compensation.

Toward greater transparency

One difficulty Counil has encountered is a lack of transparency—which has contributed to a paucity of accessible information—when it comes to occupational risks. “What occurred 50 years ago, in large part, we will never be able to reconstruct,” she says. “We can’t build efficient public health programs if we don’t build on history.” She often finds that her efforts to win the attention of industry and policymakers yield disappointing results. She equates her relationship to government and industry to a trick she recalls children playing, pouring itching powder into each other’s shirts. Another difficulty, she says, is finding adequate channels to communicate her results to stakeholders and motivate public discussion of the issues.

Most of all, she is frustrated at the slow pace of change. “Occupational health is an especially difficult public health field to make things change because there are very strong forces operating and enormous economical stakes,” she says. Yet she finds in this inequity a source of motivation.

Progress may be slow, but sometimes it comes. Counil’s asbestos report was published shortly after she left for Quebec, and the municipality is now overseeing the dismantlement of the asbestos-producing site. Local public health authorities funded a feasibility study—Counil has contributed—to assess what medical support could be provided to the exposed population. She will soon present the study—which, she says, offers arguments for and against medical support—to health authorities. “We don’t know if they will decide to do something or not,” she says. But “at least it will make the process transparent.”

Elisabeth Pain is contributing editor for Europe.

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