Launch of the new discipline Environmental Medicine in Luxembourg

Luxembourg launched the National Service for Environmental Medicine on 17 November 2022. The goal of the outpatient clinic is to support a correct diagnosis of patients with health problems caused or aggravated by environmental or occupational exposures.

For more than 20 years, Luxembourg has been trying to set-up a discipline of Environmental Medicine. Aside from some ad hoc initiatives, the history was mainly one characterised by intense polemics between “believers” and “non-believers” on the expected impact of the environment on human health, and on how the implementation of environmental medicine in Luxembourg should look like. In 2021-2022, the Hospital Center Emile Mayrisch (CHEM) and the LNS Health Protection Department developed the strategy for the new discipline Environmental Medicine/Health, supported by a Scientific Council with experts from France, the UK, and the US. The Commission Permanente du Secteur Hospitalier gave the green light in July 2022, and the Health Directorate approved thereafter, giving new hope to patients with complex pathologies who have not been responding to prescribed medications.  Often, they have been suffering from their symptoms for years and have visited several physicians, without substantial improvement of the health problems that have been increasingly affecting their professional, social, and daily life.

A strategy built on 3 pillars

The new discipline Environmental Medicine/Health’s strategy is built on 3 major pillars:

Pillar 1: An outpatient clinic with consultations with specialist-physicians in the domain

Patients can make an appointment at CHEM where they will be examined by specialist-physicians in the domain of Environmental Medicine/Health. They will therefore need a medical prescription from their general practitioner or specialist-physician requesting further analysis by the National Service. The initial consultation consists in extensively mapping the patient’s history of medical symptoms as well as exploring potential environmental or occupational exposures.

Prof. Dr An Van Nieuwenhuyse, head of the Department of Health Protection explains: “We are like Sherlock Holmes: we do our best to deduce to what extent the patient’s symptoms may be due to or be aggravated by the environmental or working context, or vice versa, to what extent we may exclude a potential impact of the environment or work on the patient’s pathology.”

Depending on the patient’s symptomatic history and the clinical examination, the physician-specialists then prescribe further highly targeted analyses. Nurses who are present during CHEM consultations are in charge of taking samples, which are then sent for analysis either at LNS or CHEM. Finally, the LNS Department of Health Protection supports the outpatient clinic’s specialist-physicians by integrating all laboratory results and assessing the risks for human health.

Pillar 2: Applied research and science-policy support

For years, the discussion on how to implement Environmental Medicine in Luxembourg has drummed up a number of divergent perspectives with regard to the expected impact of the environment on human health. Indeed, as outlined by the Lancet Commission on Pollution and Health (Landrigan PJ. Et al. The Lancet 2018; 391: 462-512), the actual knowledge on environmental pollution burden is based only on substances and health effects that are well studied at this moment. As science will evolve further, it is for sure that new health effects, pathophysiological mechanisms and emerging substances will become evident. Environmental medicine/health is not different in that regard from other disciplines in internal medicine. Consequently, the strategy for the new Environmental Medicine/Health discipline limits the medical activities in the outpatient clinic to “evidence-based” practices. An equally important pillar, however, is being developed to further applied research and science-policy support in the coming years.

Pillar 3: Training new physicians and already practising physicians

The Medical School of Luxembourg has set-up a module consisting of 25 course units on environmental and occupational risk factors in the second year of studies, with the support of the LNS Department of Health Protection.  The courses are delivered by professors, mainly physicians, from Spain, France, Finland and Belgium, and topics include, amongst others, an introduction to toxicology and vulnerable time-windows in life and in the principles of evidence-based health impact assessment. For the already practising physicians, the new discipline of Environmental Medicine/Health will foresee more generic training and discipline-specific seminars being organised. This will be set-up at a later stage.

Major step forward in patient care

The launch of the National Service for Environmental Medicine at CHEM is a major step forward in the services offered to the patients and the physicians in Luxembourg. The fact that three major players in the field put their forces together, i.e. the hospital, the national health laboratory and the university, is rather unique as constellation in Europe. It lays the fundaments to optimise the health care, diagnostics and continuous formation and education in the new discipline of Environmental Medicine/Health in Luxembourg, and may open perspectives for further research in the future.