RE: 3 Chemical Brain Injury...- Barb and

[Guest guest]

Dear Barb and .

You two are wonderful. Thanking you both for your hard work helping to find

credible article for the neurologist that will help my friend.

I will print out and give to my friend and also save in my hard drive to

share with others in the future.

Can't thank you both enough for your concern and taking the time in your

busy life to help with this.

Huggies of appreciation to both of you,

Rosie

>>Just found the following article. Thought info. under

#3 was especially interesting.

Barb

Why is chemical brain injury ignored? Pondering causes

and risks - Editorial

Archives of Environmental Health, March, 2003 by

Kaye H. Kilburn

NEARLY A DECADE AGO, I was persuaded that the brain

was more sensitive to chemicals than were other

organs. (1) Evidence originated from studies conducted

by myself and others; we investigated the possible

association between human brain damage and exposure to

various chemicals contained in gases, organic

solvents, and pesticides. My earlier resistance to

this possibility originated from a lingering personal

doubt and a sincere hope that it was not true. Growing

support from the study of individuals--alone and in

groups (i.e., clinical epidemiology)--has challenged

the belief that epidemiology cannot prove causation.

(2,3) Repeated strong associations that establish

cause and effect in clinical medicine are considered

only suggestive, but this is not sufficient in

epidemiology.

During the past 50 yr, the hesitancy of researchers to

distinguish causes from risk factors has been an

unfortunate legacy of this paradigm of chronic-disease

epidemiology; it derives, in part, from the difficulty

in the extension of Koch's postulates beyond

infectious disease. (3) Forgotten is the observation

made 150 yr ago that halting exposure to fecal and

insect-borne agents stopped epidemics. This

observation was made prior to the postulates

introduced by Koch, (4) and the concept of

" infection " had not yet been introduced. A classic

example is Snow's mapping of London's cholera cases;

this approach allowed for the evolution of the

association with water from the Broad Street pump,

which was contaminated with human excrement. (4)

I presume that the numerous factors that currently

slow both individuals' and society's acceptance of

chemicals as major causes of diseases are the same as

those that created opposition so many years ago to the

demonstration that fecal contamination of water caused

cholera. I think it imperative to identify 13 such

factors.

1. Concealed damage. This factor is familiar to

shippers; often, an individual must open a package

before discovering damage not visible on the surface.

By analogy, subtle tests may be needed for the

identification of chemical brain injury. The wide gulf

between abnormal findings detected by subtle testing

and an individual appearing maimed encourages skeptics

to cry for strong proof that impairments truly exist.

When such findings were evident on sensitive tests,

they portended important defects or deficiencies that

needed follow-up studies to show progression. After 10

yr of follow-up, brain injury had worsened. (6)

2. Psychic resistance to vulnerability. The reluctance

of individuals to consider that the brain could be

vulnerable is an emotional defense to fear or

terror--like the outcry upon learning of the

unexpected death of a loved one. Inasmuch as we know

that the human brain is protected by a bony skull, and

that a barrier between blood and brain filters out

bacteria, we hope it also deflects harmful chemicals.

But, in another compartment of our logical brain, we

know that the barrier does not filter out anesthetic

gases (ether), alcohol contained in drinks, or

injected (street) drugs.

3. " It's all in your head. " Sometimes physicians

dismiss unfamiliar problems of patients with this

rejoinder, implying that the perceived problem stems

from a mind disorder or a psychiatric problem. Seldom

is the broader, literal interpretation made--that " in

your head " means a brain problem. While " mind " may be

a nebulous concept, brain dysfunction is susceptible

to orderly, objective investigation. It is strange

that few psychiatrists, when evaluating chemically

exposed patients, consider that the depression, mania,

and other disorders they treat with drugs (chemicals)

could be caused by other chemicals. Instead, the

tendency is to prescribe more chemicals (drugs), thus

further poisoning the brains of such patients.

4. Acceptance of mind-altering drugs. The average

citizen is well aware of the effects on the mind-brain

of illicit chemicals, such as heroin and cocaine,

marijuana, and lysergic acid diethylamide (LSD), as

well as legal chemicals like alcohol and caffeine, and

prescribed (and street) amphetamines. Many physicians

have prescribed Paxil and Prozac " reflexively " to

improve mood--especially for the treatment of

depression. Such obvious connections should not be

ignored. Thorazine, the first widely prescribed

psychic or mind-altering drug, has been prescribed for

50 yr, and iproniazid (a monoamine oxidase inhibiter

related to isoniazid, which is used to treat

tuberculosis) has been available for a similar time

period.

5. Not an imminent threat. Chemical brain damage is

not generally considered an imminent or personal

threat, like, for example, anthrax or

terrorist-piloted airliners. Exposure to Sarin in the

Tokyo subway, however, demonstrated that chemical

warfare is effective on large numbers of people. The

methyl isocyanate disaster at Bhopal, India, in 1984

had a worse outcome than that experienced in Tokyo.

Possible personal harm from chemical exposure has not

been inferred. Individuals with chemical brain injury

are frequently labeled as " emotionally disordered, "

but they should be viewed as a vanguard of individuals

who are knowledgeable about chemicals by virtue of

experience. There is no evidence that the

aforementioned individuals " were differently

susceptible. " Rather, they just happened to be present

when the exposure event occurred--for example, like

the victims on September 11, 2001.

6. Competition from other threats. This factor has

been suggested to be an explanation for indifference.

Critical review evidences little substance in these

" competing " threats. Recognition that a bacterial

infection (Helicobacter pylori) caused peptic ulcer

was only a minor newsmaker. Enormous concern has been

generated regarding acquired immune deficiency

syndrome (AIDS) and associated problems, which are

sexually transmitted diseases and threaten to

depopulate Africa. (7) AIDS is a serious brain

infection and intoxication. The emerging resistance of

bacteria to antibiotics was hyped in The Coming

Plagues (7) and Secret Agents: The Menace of Emerging

Infections. (8) Antibiotic resistance is a well-known

result of short-sighted practices, abetted by treating

colds and sore throats with antibiotics and adding

antibiotics to animal feed for the increase of

productivity (meaning: profits). Clearly, anthrax,

smallpox, and similar agents resemble the

aforementioned chemicals--Sarin and methyl

isocyanate--in being extremely difficult to guard

against.

7. Delay in acknowledging health risks. This factor

was a 20th century theme. Cigarette smoke was

associated with lung cancer in the 1950s. Inasmuch as

many physicians quit smoking, their rates of lung and

other cancers dropped quickly; myocardial infarction

and stroke decreased greatly by 1975. Twenty-five

years following 1975, nonsmokers' rights were

recognized, and indoor smoking was curtailed--despite

lobbying by powerful and rich tobacco interests under

the pretense of guarding the rights of smokers, but

whose underlying impetus was the protection of their

immense profits. The proscription of asbestos exposure

was, by far, more difficult than was the proscription

of spitting on the sidewalk or the quarantining of

tuberculosis patients. The banning of asbestos

required 75 yr--a time period that exceeded that

required for the banning of indoor cigarette smoke.

The asbestos lobby protected profits until companies

filed for bankruptcy in the early 1990s. American

corporations' general rule appears to be that the

health of workers takes a back seat to profits.

8. Economic interests. Economic interests may

discourage prevention--even of cancer. The avoidance

of exposure to toxins halted scrotal cancer in chimney

sweeps, bladder cancers in Rehm's aniline dye workers,

and radon lung cancers in miners in the late 19th

century. Enormous, expensive institutions do " research

on cancer, " and dedicated public organizations pursue

the biologically implausible myth of cancer cures. The

fact is that big reductions in lung cancer mortality

occurred when cigarette smokers quit smoking. Another

success was achieved when exposure to ionizing

radiation was curtailed following the bombing of

Hiroshima and Nagasaki, and after the Nevada/Utah

atomic testings. It is safe for us to assume that

other cancers can be prevented by the cessation of

exposure to cancer-causing chemicals (e.g.,

polyaromatic hydrocarbons from petroleum,

polychlorinated biphenyls).

9. The promise of human genome mapping. Genome mapping

is viewed as the key to human disease, and it

threatens to replace cancer as a rallying cry for

" believers. " Attention is consistently deflected from

the reality that only 5% of human diseases has a

genetic basis, with, perhaps, an additional 10%

showing genetic influence. Worst are the hollow claims

that we must know the site at which chemicals affect

the genome to stop their inhalation or withdraw them

from use--thus ignoring the lessons since cholera.

10. Splintering of medical and surgical practice. This

ongoing aforementioned process is creating experienced

technicians (still licensed as physicians and

surgeons) who cannot see and understand the interplay

of factors in their patients. These individuals have

been trained to perform triple-bypass surgery; to

transplant kidneys, livers, and hearts; to perform

angioplasties and stent blood vessels; to cannulate

intrahepatic bile ducts; and to conduct bronchoscopic,

gastroscopic, and colonoscopic examinations.

Therapeutic oncologists and hematologists wield

powerful chemicals to cure the 1st cancer and cause

the 2nd. Technical engineering characterizes doctors

who can barely perceive the edges of their

subspecialties--they might be sued if they venture

beyond set boundaries. Few academic departments train

internists or surgeons who consider problems in whole

patients or inquire beyond reflex responses when

unusual problems strike.

11. Neurology has been slow to consider causes.

Perhaps this slowness occurs because neurology focuses

on the structure of the brain, not its function.

Pathophysiological thinking began prior to 1950 in the

field of hematology, and shortly thereafter in the

pulmonary disease and cardiology specialties. In

contrast, neurology adopted the electroencephalogram

mainly to confirm seizures, and the computerized axial

tomography scanner and magnetic resonance imaging to

find localized lesions, but otherwise, with the

assistance of 19th century methods, it estimates

muscle strength, body balance, visual function,

memory, and problem-solving. Psychological testing,

such as that developed by Wechsler in 1940 and

Halstead (to Reitan) in 1950, is also ancient and

largely obsolete. (6)

12. Resistance to the idea that chemicals damage

brains and may cause chronic brain diseases. This

" bridge concept " has few disciples in neurology.

Examples of damage from specific organic solvents

include n-hexane and acrylacmide, both of which

destroy nerves (9); clioquinol (hydroxyquinoline),

which produces optic atrophy and permanent vision

loss; and ethambutol (for the treatment of

tuberculosis), which causes optic neuritis and the

loss of red and green discrimination. Regarding these

as special cases--not to be generalized to anticipate

similar problems from other chemicals--impairs

progress. Recall that Parkinson's disease,

described in 1817, was epidemic in manganese refiners

in 1837; and that new but strong associations have

been found between dying cells in the brain's

striatonigral system and herbicides and the street

drug MPTP

(1-methyl-4-phenyl-1,7,3,6-tetrahydropyridine).

13. Failure to recognize potential harm from low

chemical concentrations. Despite awareness that the

brain has enormous amplifier capacity, most

neurologists ignore--and some deplore--the concept of

sensitivity to low concentrations of chemicals. The

case in point is Multiple Chemical Sensitivity

Syndrome, which is labeled as " fringe " or " kooky, " as

if the battlements of medical thought must be defended

from such an idea. Some held to these biases while

they treated Gulf War veterans who died of premature

amyotrophic lateral sclerosis. In contrast,

occupational neurotoxicity has a rich history,

including the disturbance of brain function by mercury

in mirror silverers in 1700, and palsy and psychosis

caused by lead, as described in 1737 by Ben lin

in fellow printers who handled lead type. These 13

explanations for delayed acceptance of the reality of

chemical brain injury illustrate a cultural lag in

medical thinking and in society as a whole. Acceptance

of a new idea can take a generation--or 2 or 3. Recall

the classic hazards of cigarette smoking recognized in

the 1950s, of asbestos in the 1960s, and of nuclear

(ionizing) radiation (also in the 1960s). Half a

generation has ensued, so perhaps the existence of

chemically induced brain injury will be accepted by

2010. Ironically, acceptance will be slower if many

decision makers' brains have been damaged, and it will

be accelerated if damage has been limited to a few.

References

(1.) Kilburn KH. Is the human nervous system most

sensitive to environmental toxins? Arch Environ Health

1989; 44:343-44.

(2.) Hill AB. Principles of Medical Statistics. 9th

ed. London, U.K.: Lancet, 1971.

(3.) Hill AB. The environment and disease: association

or causation. Proc Roy Soc Med 1965; 58:295-300

(4.) Koch R. Postulates. Berlin Klin Woschenschr.

1882; 19:221-43.

(5.) Snow J. The mode of communication of cholera

(1855). Reprinted in: Snow on Cholera. New York: The

Commonwealth Fund, 1936.

(6.) Kilburn KH. Chemical Brain Injury. New York:

Wiley and Sons, 1998.

(7.) Garrett L. The Coming Plague. New York: Farrar

Strauss Geroux, 1994.

(8.) Drexler M. Secret Agents: The Menace of Emerging

Infections. New York: ph Henry Press, 2002.

(9.) Schaumburg HH, Spencer PS. Recognizing neurotoxic

disease. Neurology 1987; 37:276-78.

(10.) Ambrose SE. Nothing Like It in the World. New

York: Simon and Schuster, 2000.

(11.) Daubert v. Merrell Dow Pharmaceuticals, Inc. 509

U.S. 579, 1251 Ed 469 (1993).

KAYE H. KILBURN, M.D.

University of Southern California Keck School of

Medicine Environmental Sciences Laboratory, Bldg. A7

#7401 1000 S. Fremont Avenue, Unit 2 Alhambra, CA

91803

E-mail: kilburn@...

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