Meet Dr. Michael Holland, CTEH’s Senior Medical Toxicologist
Dr. Michael G. Holland has more than 20 years of experience in medical toxicology, occupational and environmental medicine, and emergency medicine. He is a practicing physician who conducts evaluations of patients for conditions or diseases associated with work- place and toxic exposures; human health risk assessments; community and worker health evaluations, and regulatory compliance consultations. He joined CTEH full-time in January, so we sat down to get to know him a little better…
Tell me what brought you to CTEH and what is your vision for your role here?
I started full-time with CTEH in January. Prior to that – for about a year-and-a-half – I worked with CTEH part time. About 10 years ago, I joined the American Industrial Hygiene Association’s (AIHA) Emergency Response Guidelines (ERPG) committee that produces the critical guidelines to help first responders and incident command leaders make decisions about evacuations. Not long after I joined that group, I met Glenn Millner, PhD, an owner and principal toxicologist of CTEH, who was also on the committee. We quickly became friends, and we even took a skiing trip together. He was always talking about CTEH when we were together and it didn’t take long for the recruitment to begin. Unfortunately, the timing wasn’t right because my wife and I had kids in school. We’re empty-nesters now, though, so things finally worked out.
My primary job is medical support for emergency response efforts. During chemical incidents, I offer my perspectives to local physicians about exposure and provide general advice, directions to helpful online resources and so forth. When CTEH has a team on the ground and our other toxicologists are providing input on evacuation, I go to local emergency departments and consult on treatments for those exposed. When community meetings are held during these types of events, many people have health questions, and I can address these. I’m very comfortable talking about potential health effects related to chemical events.
What attracted you to this particular field – workplace and environmental health? Was it something that you knew during medical school or did it come later?
I was always interested in emergency medicine, and in that field you need to know all aspects of medicine – acute care, chronic care, adults, children, you name it. I really didn’t want to be pigeonholed, because I was interested in everything. When I was working on paying back my public health scholarship, I was assigned to a rural hospital in West Virginia and, shortly thereafter, I got a teaching appointment at the West Virginia University (WVU) School of Medicine’s Charleston Division. The school is located in the state capital, which is also where the West Virginia Poison Control Center is based. They had no toxicologist at the time, so I took on the role of medical director of the poison control center. It was during my time there that I really became interested in toxicology, so I went back to study toxicology, took a part-time fellowship in New York, and passed my board exams in Medical Toxicology.
How would you explain to someone outside the profession – an “average person” with no knowledge of the field – what “medical toxicology” is all about? How would you define it and what should everyone understand?
The simplest way to say it is that medical toxicologists are physicians caring for a poisoned patient. Poisoning can result from a wide range of causes – venom from snakes or insects, accidental or intentional overdoses on medicines, accidental ingestions (mainly occurs in children), workplace exposures to gas or vapors, chronic exposures to vapors, environmental exposures, and so on.
What are the critical or “hot” issues in your field right now?
One of the top issues right now is opioid overdose. A few years ago, accidental drug overdoses surpassed motor vehicle crashes as the leading cause of accidental death in the U.S. We really have an epidemic of overly prescribed opioid pain relievers – particularly methadone, which is very potent, long-lasting, and dangerous. This is very much a hot-button issue throughout medicine and it’s a complicated one. Some states are limiting prescriptions of these drugs or adding new restrictions. Unfortunately, we’ve seen recently that cutting people off of these drugs after they become addicted to these prescription opioids suddenly can lead to heroine abuse. So it is a complicated problem and is affecting all communities in the US.
Based on data or incidence/mortality numbers, what are the most dangerous chemicals to humans?
The number one cause of accidental poisoning deaths worldwide is carbon monoxide. It’s formed whenever incomplete combustion of any fossil fuel occurs, be it coal, fuel oil, natural gas, propane, etc. It is in the exhaust of all internal combustion engines, which are obviously quite common: automobiles, trucks, gas-powered tools, etc. In addition, the risk goes up each fall or winter when people turn on their furnaces after not using them all summer, because, if something has nested in your chimney, furnace gases can back up and come into the home. In short, if you have any kind of fuel-burning appliances, you need carbon monoxide detectors. They save lives.
What are common poisoning symptoms (based on the home/workplace answers) that people should be aware of?
Carbon monoxide (CO) has no odor or taste and it’s invisible, just like air. That’s why you need an alarm or detector. You may get some symptoms – maybe a headache or some nausea. As the concentration gets higher, you may get dizzy, lightheaded, and sleepy. This can be very dangerous as many people die in their sleep from CO poisoning.