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#165 - Multiple Chemical Sensitivity, 23-Jan-1990

Everyone knows someone who is sensitive to particular household
products. We all have a friend who must wear rubber gloves because
dishwashing detergent makes his or her hands break out or swell up. We
all know (or have heard about) babies who cannot tolerate cow's milk.
We all recognize that people vary widely in their response to a room
full of cigarette smoke--some people can ignore it easily while others
react with stuffy nose, teary eyes, coughing, sneezing, shortness of

It should be no surprise, therefore, to learn that medical doctors and
scientists are now confirming that different people react differently
to modern compounds such as dry cleaning solvents, perfumes,
detergents, glues, waxes, pesticides, and other common household and
industrial chemicals.

Some people react violently to chemicals, to the point of being made
extremely sick by very low doses of common substances. Typical symptoms
include fatigue, severe migraine-like headaches, nausea, that "run
down" feeling, rashes, itching, swelling, pain, stuffiness,
disorientation, and dizziness. This group of symptoms goes by various
names: ecological illness, total allergy syndrome, environmental
illness, and multiple chemical sensitivity (MCS).

We have discovered an excellent, short (151 pgs.) book called WORKERS
WITH MULTIPLE CHEMICAL SENSITIVITIES that can help doctors, patients,
and the general public understand this mysterious condition. Here is a
long quotation from the opening chapter, by the editor of the book,
Mark Cullen, MD:

"The idea for this volume evolved from a stark and disconcerting
clinical experience. Little more than a few months after the
occupational medicine clinic began at Yale, in 1979, the staff was
confronted with a problem none of us had ever seen before nor heard
about. A middle-aged man was referred [to us] because of delayed
recovery from an episode of pneumonia that had resulted from a chemical
spill on the job. As his [chest] x-ray cleared, he had become not
better, but worse. Particularly striking was the [fact] that exposure
to chemical odors would markedly exacerbate [worsen] baseline dyspnea
[shortness of breath] and chest pain. Upon return to work, he 'passed
out' on several occasions after a whiff of fume. Disability leave,
however, did not resolve the situation. Increasingly, even common
household products and environmental contaminants induced [caused]
debilitating respiratory and constitutional symptoms, reducing his
formerly vigorous life to a pitiful existence at home....

"One day a strident former machine operator came to the clinic wearing,
much to everyone's amazement, a respirator. Suddenly, the image of the
'gas mask' precipitated [caused] recognition of an identifiable
[pattern], characterized by severe, recurrent and toxicologically
inexplicable symptomatic reactions to quite low levels of common
airborne substances. We discovered shortly that we were not alone. Many
of our colleagues practicing occupational medicine around the country
began reporting similar cases; they too were stymied by them. Thus we
became aware of how widespread the problem is and how incredibly
expensive the costs are for medical care and disability in each case."

You will need to keep a medical dictionary close by as you read this
book because it's written by doctors for doctors. The book consists of
13 essays, each looking at some aspect of this difficult medical
problem. Each essay ends with a lengthy bibliography, for those who
want to dig further in a medical library. The book contains four
sections: 1) overviews of the problem; 2) attempts to define the
problem scientifically; 3) ways to diagnose the condition medically; 4)
therapy for workers suffering from multiple chemical sensitivity.

The book presents a broad range of views on the problem--including the
view that the problem is so non-specific that it cannot be
scientifically defined or treated. This view is presented forcefully by
a doctor from Stanford University, but the remainder of the book shows
that this view is out of date. Real progress has been made in defining
the condition and understanding some of its origins. The key problem is
that there are many symptoms and probably several causes that interact
with each other. Physicians are most at ease when one kind of germ
causes one kind of disease. Multiple chemical sensitivity lies at the
other end of the spectrum--many unknowns, many causes, many symptoms.
The majority of physicians simply will not try to treat people with
multiple chemical sensitivity--they say they don't know anything about
it and can't help. When this happens, insurance companies won't provide
compensation for medical expenses or lost time; sometimes families of
the patients (and society in general) fail to understand that the
symptoms are real. The victim feels betrayed, alienated, desperately
alone, and helpless. The victim is feeling real symptoms--they are not
psychological or imagined, yet has no one to turn to. Somewhere between
2% and 10% of the general population suffers from multiple chemical
sensitivity, and the number appears to be growing.

Now there is a small but expanding group of physicians who are willing
to treat patients with multiple chemical sensitivity. When physicians
agree to try to help a person suffering from the condition, the results
are mixed--some therapies work, others do not, and in both cases no one
is sure why. Unfortunately, those medical groups that do not try to
help victims of MCS react far more strongly against physicians who do
try than they would against nonphysicians trying alternative health
care approaches. There is a strong split in the medical community over
this condition. Both groups of doctors have gone through the same
medical schools and often they have gone through the same specialty
training programs. They have reached different conclusions on this
issue and the rift is deeply felt.

Many physicians studying MCS conclude that it has something to do with
a person's immune system-in some cases, a person inherits an immune
system that is not fully functional, or a healthy immune system is
harmed by chemical exposure and thereafter reacts strongly to
additional chemical exposures. It is interesting to note that the
National Toxicology Program of the U.S. Department of Health and Human
Services in 1984 observed that chemical damage to the immune system
could result in "hypersensitivity or allergy" to specific chemicals or
to chemicals in general. Damage to the immune system, of course, can
have far-reaching consequences for an individual, leaving him or her
vulnerable to attack by bacteria and viruses, at heightened risk of
cancer, and even predisposed to develop AIDS, according to the National
Toxicology Program.[1]

The best treatment for environmental illness is avoiding the offensive
agent(s). For people with strong reactions to many chemicals, this may
mean severe restrictions on their personal freedom. We know people who
are entirely confined to their homes because so many common chemicals
make them sick.

Anyone who reads this book will quickly become convinced that people
with MCS are genuinely made ill by noxious agents in their environment.
It is not yet clear whether such people are just different in that they
are more vulnerable, or whether they are reacting in a more acute way
to agents that may also, in the majority of the population, be
responsible for otherwise-unexplained chronic disease.

Society's recent reaction to tobacco smoke points the way to a general
solution: increasingly, by law, smokers must smoke in places and ways
that do not impact anyone beyond themselves. The same principal,
applied to the users of all chemicals, would protect the rights of
those with MCS, and would be consistent with the principle of "no
dumping" or zero discharge. (See RHWN #106 and #155.)

SENSITIVITIES (Philadelphia, PA: Hanley and Belfus [201 South 13th St.,
Philadelphia, PA 19107; phone (215) 546-4995], 1987). This is Volume 2,
No. 4 of the ongoing series called OCCUPATIONAL MEDICINE, STATE OF THE
ART REVIEWS. An annual subscription to the series costs $68; single
issues cost $32.00.

--Peter Montague


[1] U.S. Department of Health and Human Services, Public Health
Service, National Toxicology Program, FISCAL YEAR 1984 ANNUAL PLAN
(Research Triangle, Nc: National Toxicology Program [P.O. Box 12233,
Research Triangle Park, NC 27709; phone 919/541-3991], 1984), pg. 157."

Descriptor terms: ecological illness; mcs; food safety; consumer