This is the first of Moms’ Call the Doctor series, where we peek behind the medical privacy curtain and get to know the people we entrust our health with, including their motivation, research, career goals, and daily work.
Most medical students get between one and four hours of environmental health training. This includes Dr. Leonardo Trasande, Director of NYU Grossman School of Medicine’s Division of Environmental Pediatrics and NYU Langone Health’s Center for the Investigation of Environmental Hazards. “I got taught about lead. I got taught about air pollution. That was about it,” he recalls.
Instead, Dr. Trasande’s real training came out of his interest in health care policy. In 2002, after a pediatrics residency, he worked for then-Senator Hillary Rodham Clinton. “I was told to work on children’s environmental health issues. And I figured, ‘OK, I got the child health part down. The environmental health part I’ll figure out as I go.’ Boy, was I in for a surprise,” he says.
Surprise—and opportunity
Young Dr. Trasande quickly realized just how large the scale of impacts of toxic environmental exposures is on kids’ lives, and the opportunity to do something about it hooked him. “So much in medicine is about writing prescriptions or doing treatments or procedures on patients who already have chronic disease. Well, there’s so much we can do to prevent it in the first place. That blew my mind and reset what I wanted to do with my career.” So he trained in environmental pediatrics and set out to work at the interface of environmental health, pediatrics, and health care policy.
Tell EPA: Hands Off Chemical Safety Reviews
Daily work
In the 20 years since this pivot, Dr. Trasande now spends the majority of his days running a 50-person research team, writing grant applications, and developing new ideas. “The main study is a platform from the perspective of a birth cohort that now has enrolled over 5,000 moms and has about 4,000 kids in various phases of life,” he explains. His team follows them as part of a program called the Environmental Influences on Child Health Outcomes, or ECHO. “It’s a big national study intended to identify the preventable and environmental causes of the diseases that are increasing in children all too much.” They consider chemical exposures but also think about social and physical impacts as well as other aspects of the environment. Funding for this initiative began in 2016 and, “knock wood,” should be stable through 2030.
The platform facilitates other studies too. Dr. Trasande is especially known for studying the health effects of endocrine-disrupting chemicals, which are commonly found in plastics and other consumer products. “We’re looking at microplastics in placentas and at what we call mini puberty, an important sex hormone window of development at about two to four months of age. As much we talk about pregnancy as a window of susceptibility, life is a window of susceptibility. It’s just a matter of what effects you can see at what time points.”
Microplastics, a turning point
While supporting the next generation of doctors working in all specialties in his role as vice chair for research in pediatrics at NYU, Dr. Trasande is able to step outside of his “environmental health tunnel.” Though, historically, his department colleagues haven’t stepped inside or relied on him much for his expertise. “People said to me, ‘Your stuff is invisible. I can’t see the problem. Chemicals, we all have chemicals. These low dose exposures don’t matter,’” he says.
But then a microplastics study published in 2024 in the New England Journal of Medicine found a fourfold increase in heart disease, heart attack, stroke, and death. “That was an aha moment, a punch in the gut in terms of recognition. They literally saw the micro- and nanoplastics in the carotid arteries. And then other studies were showing plastics in all sorts of body parts, including what would horrify certain adult men to know: that they have it in their testicles.” Though unrelated to pediatrics, interest was clearly piqued.
Caregiver concerns: plastics, extreme heat, PFAS
While Dr. Trasande no longer sees pediatric patients, working in a department of pediatrics helps him stay connected to the pulse of parent concerns. When it comes to climate chaos and extreme heat, he hears dread about what the future will hold both in terms of asthma and mental health. He’s also hearing concern about nonstick PFAS chemicals and broad-scale water contamination.
“Exposures are really on people’s minds in a way that haven’t been before. And as much as we think of PFAS as a whole different exposure, it’s a molecule in many plastics. To me, it’s front and center of this broader micro- and nanoplastic chemicals phenomenon that we’re facing,” he says.
Parents can, uniquely, turn dread and fear into action just by asking environmental health-related questions at doctor visits. “I don’t know that it’s always going to be smooth, but it’s the kind of conversation we need to have in 2025,” says Dr. Trasande. “We know that the modern environment is more complicated and problematic than it was even 20 years ago. We’ve had one to 3,000 new chemicals added into the environment annually. And we recognize that what we use is creating not just chemical contamination, but particle contamination in people’s bodies that we are barely scratching the surface of.”
Parents can also turn to national Pediatric Environmental Health Specialty Units, which are funded by the Centers for Disease Control and Prevention. “They’re underutilized. If we use them more, it would prompt a dialogue about building better infrastructure,” says Dr. Trasande.
Career goals
Dr. Trasande’s overarching career goals include moving environmental health around plastics and chemical exposures in general into the clinical care and education paradigm. “I can do more research studies till I end my career. I’ve driven policy sometimes, but the progress is slow. What’s really going to move the needle is if every doctor is testing a kid for phthalates and bisphenols and PFAS someday. That’s going to be more impactful, both on what patients and their families do, but also to hold people accountable—in government, industry, and other sectors—that they are committing some toxic trespass.”
Proper testing of materials and humans, performed by informed doctors, will allow us all to know the full extent of the problem, especially at a time when national surveys like the CDC’s National Health and Nutrition Examination Survey are under threat.
The considerable challenges are both frustrating and overwhelming, but they’re also what keep Dr. Trasande going. He energetically repeats today what he realized many years ago about pediatric environmental health: “There’s a lot we can do.”