Continuing Medical Education (CME) Activity Jointly Sponsored by Physicians Scientists & Engineers for Healthy Energy and the Medical Society of the State of New York.

If you wish to receive credit for this activity please access the learning modules through the following web site: [ Ссылка ]

Educational Objectives:
The introduction of synthetic organic chemicals and heavy metals into the environment by the spatially intense industrial process of high volume hydraulic fracturing presents a challenge to the reproductive, developmental, hormonal systems of the body. Collectively, the terms endocrine and metabolic disruption describe a large emerging area of the biological sciences with a particular applicability to environmental and occupational medicine. Healthcare workers have little familiarity with this newly recognized important category of pathogenesis that is distinct from toxicology. This presentation provides a general overview to the field and allows learners to understand the significance of this risk related to unconventional natural gas extraction from tight shale formations.
After completion of this course the learner should be able to :
1. Describe the features of the endocrine and metabolic systems that make them susceptible to disruption.
2. Describe the 2012 Endocrine Society definition of EDCs "An EDC is an exogenous chemical, or mixture of chemicals, that interferes with any aspect of hormone action."
3. Describe how EDCs can act effectively at extremely low concentrations.
4. Describe how EDCs show non-monotonic dose-response curves.
5. Describe how EDCs may be most active at particular developmental windows, but manifest their effects years or decades later.
6. Describe how most assays for EDCs only test a small, but significant subset of endocrine receptors (EAT -- estrogen, androgen and thyroid).
7. Describe how there is an increasing awareness of disruption to metabolism including the development of diabetes mellitus.
8. Describe how many of the chemicals in slick-water used in HVHF are associated with effects on the endocrine system, but there has been no systematic attempt to screen them.
9. Describe the two heavy metals known to be EDCs (arsenic and cadmium) found in HVHF flowback and produced waters.
10. Describe why the precautionary principle is particularly suited to the risks presented by EDCs with HVHF and is close to the medical ethical principles of primum, non nocere and informed consent.

A specialist in endocrinology and diabetes, practicing in Ithaca, Dr. Adam Law, a Fellow of the U.K.'s Royal College of Physicians, is also Clinical Assistant Professor of Medicine at Weill Cornell Medical College. He trained in medicine at The Middlesex Hospital Medical School at the University of London, distinguishing himself by winning all eight major clinical prizes offered by the school, including a gold medal in surgery. After gaining membership in the Royal College of Physicians he turned his attention to medical science, and received a masters degree in biochemistry with distinction and a doctorate from the University of London. He has held post-doctoral fellowships at the University of California, San Francisco and Cornell University. He has published 13 research papers in clinical medicine and basic molecular biology. He has been in clinical practice in Ithaca, NY since 2004. In January 2007, he took a two-year appointment as Chair of the Department of Medicine at Ithaca's Cayuga Medical Center, and was President of the Medical Staff in 2009. In addition to several committee roles at the Medical Center, Dr. Law has served on the Recombinant DNA Advisory Committee at Cornell University from 1995 to 2000, and has been on the University's Health Careers Program Advisory Board since 1996. Since 2009 he has been the Cayuga Medical Center medical staff program coordinator for the active affiliation with Weill Cornell Medical College.

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