◆ Major Achievements and Contributions
Dr. Pau-Chung Chen is Distinguished Professor of the Institute of Environmental and Occupational Health Sciences at the National Taiwan University College of Public Health as well as Distinguished Investigator and Director of the National Institute of Environmental Health Sciences at the National Health Research Institutes. Dr. Chen has devoted to environmental and occupational health sciences for more than 30 years and has published more than 390 scientific articles. He received the Outstanding Research Award from the Ministry of Science and Technology in 2015 and 2020 and Outstanding Alumni Award in recognition of his achievement in science from Kaohsiung Medical University in 2018, and has been named in the world's top 2% scientists list since 2019. Dr. Chen served as chair of the Scientific Committee on Reproductive Hazards in the Workplace (RHICOH), International Commission on Occupational Health (ICOH) in 2012-2018 and was the first chair of the Birth Cohort Consortium of Asia (BiCCA) in 2012-2014. He has also served as an expert witness in the class action of the former workers of Taiwan RCA and gave oral testimony in court for 7 days nearing 50 hours in 2013-2014. He received the National Occupational Safety and Health Award - Personal Contribution Award from the Ministry of Labor in 2020. He also served as President of the Taiwan Public Health Association in 2017-2022 and Taiwan successfully became the first in Asia to pass the Public Health Specialists Act in 2020. NTU Scholars, ORCID, PubMed, Google Scholar, YouTube
- Reproductive Hazards in the Workplace and Environment
Silent Spring by Rachel Carson in 1962 was an eloquent and urgent warning about the dangers of the natural world contaminated by manmade pesticides. Our Stolen Future by Colborn et al in 1996 provided a vivid account of emerging scientific research about how a wide range of manmade chemicals disrupt delicate hormone systems, which play a critical role in processes ranging from human sexual development to behavior, intelligence, and the functioning of the immune system. Occupational or environmental exposures to heavy metals, organic solvents, persistent organic pollutants, pesticides, endocrine disrupting chemicals, and radiation could injure our reproduction and offspring and became important public health issues. Dr Pau-Chung Chen has been working in the research filed of reproductive and developmental epidemiology in recent decades and conducted several occupational or environmental cohort studies including lead-acid battery, semiconductor industry, and electronics worker cohorts, and a prospective pregnancy cohort in Taipei. Our team has achieved the continuing and unique contribution in this field and played a leading role in Asia as well as in the world. Dr Chen is honored to be a member of the executive board of the Scientific Committee on Reproductive Hazards in the Workplace, International Commission on Occupational Health (ICOH, The oldest scientific association in the field founded in 1906, with more than 2,000 members in 93 countries. ICOH is an NGO recognized by the United Nations and has a close working relationship with the International Labor Organization and World Health Organization.) since 2007 and was the chair of the committee in 2012-2018. We held the first International Symposium of Reproductive Hazards in the Workplace and Environment (RHICOH) in Taipei on April 20-21, 2010, the second symposium in Utrecht, The Netherlands on June 18-19, 2013, the third symposium in Barcelona, Spain on September 5-6, 2016, and the fourth symposium in Taipei, Taiwan on June 23-24, 2018 (our website).
- Children’s Environmental Health Based on Birth Cohort Studies
We started to conduct a longitudinal birth cohort follow-up study to investigate the environment, genetics, and children’s health issues in recent years. Children’s environmental health is increasingly recognized as a global public health issue of great importance. Given our current limited knowledge, the distribution of environmental contaminant exposure levels among reproductive-age, infants, and children is unknown; and the role of prenatal and postnatal exposures to environmental and genetic factors in the etiology of adverse child health is unsolved. The current problems in Taiwan we have identified to perform researches including: the prevalence of asthma is still increasing up to more than 10%; preterm delivery has been increasing up to 9% in 2003; neurodevelopmental disorders are highly prevalent and affected 8% of the examined children under the age of four years; and the prevalence of childhood obesity has doubled. Therefore, we started to conduct a project “Taiwan Birth Panel Study (TBPS)” to investigate prenatal and postnatal factors on infant and early childhood health. Through this prospective birth cohort, the main health outcomes focused on atopic diseases, child growth and development, and neurocognitive and language development. We investigated the main prenatal and postnatal factors including infection, herb use in pregnancy, breastfeeding, allergens and other pollutants such as environmental tobacco smoke, heavy metals, non-persistent pesticides, melamine, per- and polyfluoroalkyl substances (PFAS), phthalates, bisphenol-A, acrylamides, and psychosocial stress under the consideration of interaction of the environment and genes. The list of 55 publications you can find on our website.
Among them, our research team has been working on PFAS, referred to as forever chemicals and endocrine-disrupting chemicals (EDCs), and their health effects since 2009. We found that exposure to PFAS was related to reduced fetal (PLoS ONE 2012) and childhood growth (Sci Total Environ 2017), disturbed thyroid function (Environ Pollut 2017), delayed children’s neurodevelopment (Epidemiology 2013), increasing symptoms of attention deficit/ hyperactivity disorder (Chemosphere 2016), increasing IgE levels (Environ Res 2011), and reducing lung function development (Environ Res 2021). In addition, our team also found that PFAS are associated with increased risks of asthma (Environ Health Perspect 2013), reduced testosterone, increased estradiol level (Environ Int 2016), and increased uric acid concentrations (Environ Pollut 2016) in the Genetic and Biomarkers Study for Childhood Asthma (GBCA) study. Moreover, interfering with reproductive hormones (Int J Hyg Environ Health 2015), increased carotid intima-media thickness (Environ Int 2016), and increased risks of diabetes (Environ Int 2016) and female premenopausal breast cancer (Environ Int 2020) were found in our collaborative studies. We have published 35 articles in international journals and have now become a leading research team to study the human health effects of PFAS in the world. Taiwan Semiconductor Industry Association (TSIA) announced the complete withdrawal of PFOS in 2017 and Taiwan Semiconductor Manufacturing Company Limited (TSMC) also announced the replacement timetable of PFOA and related chemicals.
Other environmental contaminants are also common EDCs such as phthalates and phenolic compounds including bisphenol-A (BPA), nonylphenol (NP) and octylphenol (OP). We found that prenatal exposure to phenolic compounds interfered with neurobehavioral development in early childhood (Sci Total Environ 2017); prenatal exposure to phthalates increased IgE levels and risk of atopic dermatitis (Environ Int 2014); and postnatal exposure to phthalates interfered with childhood thyroid function and reduced their lung function development (Sci Total Environ 2018) in the TBPS study. Our research team also revealed that exposure to phthalates (Environ Int 2016) increased carotid intima-media thickness via increased DNA and lipid oxidative stress, reduced testosterone levels, and increased insulin resistance (Environ Pollut 2017) in the Young Taiwanese Cardiovascular Cohort (YTCC) study. In addition, exposure to phenolic compounds also increased carotid intima-media thickness (Environ Pollut 2019) in the adolescents and young adults.
We also participated in the project of Taiwan Birth Cohort Study (TBCS) and investigated breast feeding, vaccination, dietary supplement, Chinese herbal medicine, environmental tobacco smoke, parental stress and employment, and air pollution in relation to maternal and children’s health. The list of 32 publications you can find on our website. Recently, we first reported that household incense burning exposure (Environ Int 2018) and maternal shift work (Int J Epidemiol 2019) was associated with delay in motor neurodevelopmental milestones. This project bridges knowledge gaps and answer unsolved issues in the low-level, prenatal or postnatal, and multiple exposures, genetic effect modification, and the initiation and progression of “environmentally-related childhood diseases.” In addition, we play an active role in education, research, and services in the field of “pediatric environmental health” via integrating multi-disciplines. To provide clinical service, exposure assessment, and risk communication, we set up the Environmental Medicine Coordination Center at the National Taiwan University Hospital since 2014, continuously held the International Symposium of Environmental Medicine (ISEM, our website) in 2014, 2015, 2016, and 2019, participated in solving the issue of Taipei lead water pipes in 2015 and banning incense burning project of the 281-year-old Longshan Temple in 2017-2019, and recently also published a book “Understanding Toxics in Your Daily Life (毒懂您的生活)” and “Respiratory Protection Handbook in the Air Pollution Era (空汙世代的肺部養護全書)” for the general public.
- Birth Cohort Consortium of Asia (BiCCA)
The Millennium Developmental Goals (MDGs), which are derived from the United Nations Millennium Declaration, has rising the importance of child health and environmental sustainability in 2000. According to World Health Organization (WHO)’s survey, over 40% of the global burden of disease attributed to environmental factors falls on children below five years of age who account for only about 10% of the world’s population. The environmental health of children is one of the great global health concerns. What a developing child is exposed to in utero and in his/her early years has major consequences on later health. However, environmental risks or disease burdens vary from region to region. Birth cohort studies are ideal for investigating different environmental risks. The principal investigators of three birth cohorts in Asia including the Taiwan Birth Panel Study (TBPS), the Mothers and Children’s Environmental Health Study (MOCEH), and the Hokkaido Study on Environment and Children’s Health (Hokkaido Study) co-established the Birth Cohort Consortium of Asia (BiCCA). We held the first meeting for the BiCCA to investigate the environment, genetics, and children’s health issues in Asia and Dr Pau-Chung Chen was elected as one of the executive committee members and the first chair in 2012-2014. To date, 33 birth cohorts have been established in 17 Asian countries, consisting of approximately 90,000 study subjects in the BiCCA. Our introduction article provides the study framework, environmental exposure and health outcome assessments, as well as maternal and infant characteristics of the participating cohorts (Epidemiology 2017). The BiCCA provides a unique and reliable source of birth cohort information in Asian countries. Further scientific cooperation is ongoing to identify specific regional environmental threats and improve the health of children in Asia (Sci Total Environ 2017; Environ Res 2019). Please see our website for further information.
- Preventive Actions of Banning Herbal Medicine Containing Aristolochic Acid
The consumption of Chinese herbs containing aristolochic acid has been associated with an increased risk of urothelial carcinoma. The International Agency for Research on Cancer listed that plants containing aristolochic acid are carcinogenic to humans (Group 1) in 2002 and that aristolochic acid is carcinogenic to humans (Group 1) in 2012. We conducted a series of studies of Chinese herbs containing aristolochic acid and reported increased risks of chronic kidney disease, kidney failure and urinary tract cancers in Taiwan. In addition, increased risk of kidney failure and urinary tract cancers were also found among Chinese herbalists. Further, Chen et al. investigated 152 patients with upper urinary tract urothelial carcinoma and found the 93 had been exposed to aristolochic acid based on the presence of aristolactam-DNA adducts and AA-mutational signature in the renal cortex. Finally, aristolactam-DNA adducts were also detected in 76% of clear cell renal cell carcinoma (ccRCC) and AA-mutational signature was evident in 6 of 10 sequenced ccRCC exomes from Taiwanese patients (Cancer Epidemiol Biomarkers Prev 2016). Due to our early studies, we convinced our government to take preventive actions of banning Chinese herbs containing aristolochic acid in November 2003. There has been a gradual reduction in the incidence of bladder cancer and carcinomas of the renal pelvis and other urinary organs since 2011. Recently, we first found that a significant linear dose-response relationship between aristolochic acid consumption and hepatocellular carcinoma (HCC) among hepatitis B virus (HBV)-infected patients. This suggests that aristolochic acid, which may be associated with HBV infection, plays an important role in HCC pathogenesis, and HBV and HCV patients who took those herbs should be followed up (Int J Cancer 2018; Cancer Epidemiol Biomarkers Prev 2019). Aristolochic acid exposure might also increase risk of kidney, bladder, pelvis, ureter, liver, and colorectum in all patients, prostate cancer in men, and extrahepatic bile duct cancer in women (Phytomedicine 2022).
- Cancer Chemoprevention Based on Health Informatics Research
An ounce of prevention is better than a pound of cure. Cancer risk reduction using pharmacological means is an attractive modern preventive approach that supplements the classical prevention or treatment recommendations. Statins have potential protective effects against cancers, but no studies have focused on patients with chronic hepatitis B or C virus (HBV or HCV) infection. The purpose of this study was to investigate the association between the use of statins in HBV- or HCV-infected patients and the risk of hepatocellular carcinoma (HCC). We conducted a population-based cohort study from the Taiwan National Health Insurance Research Database. Statin use may reduce the risk for HCC in HBV- or HCV-infected patients in a dose-dependent manner. These findings have also been replicated in Denmark (N Engl J Med 2012), Sweden (Pharmacoepidemiol Drug Saf 2014; Ann Intern Med 2019), United States (Cancer Epidemiol 2014; Hepatology 2015; Clin Gastroenterol Hepatol 2019; J Clin Gastroenterol 2020), United Kingdom (JNCI 2015; Int J Cancer 2020), Hong-Kong (J Hepatol 2015), and Korea (J Hepatol 2017; Hepatology 2020) since then and cited by UpToDate. We published two original articles on Journal of Clinical Oncology, which have been listed as “Highly Cited Paper and Research Front Core Paper” by ISI Essential Science Indicators. We also reported that statin use was associated with a reduced risk of cirrhosis development in a dose-dependent manner among the patients with HCV infection (J Hepatol 2015) as well as a reducing risk of pancreatic cancer in type 2 diabetic patients (Int J Cancer 2016). Another cancer chemopreventive agent acarbose, an alpha-glucosidase inhibitor, has been shown to reduce the risk of incident colorectal cancer in patients with diabetes in a dose-dependent manner (Diabetes Care 2015). I was also invited to give a talk in the 2017 International Congress of Epidemiology to share our knowledge and experience of health informatics research and published an invited article which is listed as “Highly Cited Paper” by ISI Essential Science Indicators and honorably co-authored with Professor Liam Smeeth, Director of the London School of Hygiene of Tropical Medicine (Epidemiology and Health 2018).
- Expert Witnesses for the RCA Corporation Employees Caring Association
The long-simmering toxic tort against Taiwan’s Radio Corporation of America (RCA) is the civil lawsuit that uses the most scientific evidence and expert witnesses in Taiwan’s judicial history. In 1994, a hazardous waste site polluted by dumping solvents from a former electronics factory was discovered in Taoyuan, Taiwan. This subsequently emerged as a severe contamination case through chlorinated hydrocarbons with suspected occupational cancer. We found that female workers exposed to trichloroethylene (TCE) and a mixture of solvents may have an excess risk of breast cancer. Female workers with potential exposure to organic solvents during periconception might increase the risk of childhood cancers, especially leukemia. There were increased risks of infant mortality and deaths due to congenital malformation in the offspring of male workers. The first witness was summoned to testify in court in November 2009. The final argument was made on December 12, 2014, and the verdict was announced on April 17, 2015. The Court finds that RCA did expose the former workers at the RCA Plant to mixtures of contaminants, including TCE, tetrachloroethylene, trichloroethane, and methylene chloride. Routes of exposure include drinking groundwater contaminated with those organic solvents. Accepting testimonies of expert witnesses Professors Pau-Chung Chen (陳保中) and Jung-Der Wang (王榮德), the Court finds that exposures to a mixture of organic solvents such as TCE, TCA, and their derivatives may result in aggravated harms to the human body more hazardous than those caused by exposure to any single chemical within the mixture. RCA and its parent companies knew the health risks of the chemical substances. Still, they fail to fulfill their environmental maintenance and pollution control responsibility. They continue to expose the employees to organic solvents such as carcinogenic TCE and tetrachloroethylene, causing many workers to suffer from diseases. At least 133 people in this litigation have passed away and are still living and suffering from significant injuries (including but not limited to cancers). Another group of 1,163 injured laborers and their families have already filed the Taipei District Court on 9 May 2016, requesting a total amount of NT$ 7.3 billion. The Supreme Court of Taiwan upheld the liability of RCA and its mother companies, General Electric, Thomson Electronics, and Technicolor, on August 16, 2018. The Supreme Court orders them to pay some NT$ 564 million (around US$ eighteen million) in compensation to 262 plaintiffs. For the remaining 246 plaintiffs, the Supreme Court sends the file back to the Taiwan High Court for reconsideration. The Taipei District Court also awarded NT$ 2.3 billion (around US$ 77.5 million) in compensation to the second batch of 1,115 former employees of RCA, Taiwan, on December 27, 2019.
- Taiwan Passes Public Health Specialists Act
We proposed the first draft of the public health specialists act in 2000 when I served as Secretary General of the Taiwan Public Health Association. Past presidents and I have continuously advocated the act for 20 years. The final reading of the public health specialists act passed the Legislature on May 15, 2020, spotlighting the government’s continued commitment to improve the well-being of local residents. Comprising 40 articles, the act defines the qualifications, rights, obligations and scope of operation of a public health specialist. The responsibilities of public health specialists include conducting environmental health risk assessments, epidemiological investigations and disease prevention, health surveys and health promotion, food safety inspections and other tasks outlined by the Ministry of Health and Welfare in communities and public spaces. Since National Taiwan University set up the country’s first department of public health in 1972, Taiwan’s tertiary institutions have trained tens of thousands of public health professionals. For more than four decades, these individuals have shaped the country’s public health landscape by engaging in related policy making, providing health education to communities and taking part in epidemiological research. Given the country’s economic and social development, the legislation will greatly enhance the ability of Taiwan’s public health system to manage challenges such as the COVID-19 pandemic. President Ing-wen Tsai lauded the legislation as proof of the government’s belief in rewarding expertise. Taiwan’s success in containing coronavirus is thanks to the dedication of the country’s frontline medical staff and public health specialists. The Public Health Specialists Act certificate can be used to identify professional talents, establish the professional image of Public Health Specialists, enhance competitiveness in the workplace, and sustain the professional value of public health. In the future, we will continue to advocate for more refined public health career planning and the integration of professional teaching, examination, and application, and continue to consolidate the importance of public health professionals.