Multiple Chemical Sensitivity - A NEW MECHANISM OF DISEASE?

[Guest guest]

" " We know more about the life of a tire than a breast

implant. " ) "

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Multiple Chemical Sensitivity

(from RACHEL'S ENVIRONMENT & HEALTH WEEKLY #585,

February 12, 1998.

For subscription information, see below)

A NEW MECHANISM OF DISEASE?

http://www.cqs.com/mcs.htm

Multiple chemical sensitivity (MCS) is an ailment, or

a family of ailments, that has very real consequences

for tens of millions of Americans.

In various large surveys 15% to 30% of Americans (37

to 75 million people) report that they are unusually

sensitive or allergic to certain common chemicals such

as detergents, perfumes, solvents, pesticides,

pharmaceuticals, foods, or even the smell of

dry-cleaned clothes. An estimated 5% (13 million

people) have been diagnosed by a physician as being

especially sensitive. Many of these people react so

strongly that they can become disabled from very low

exposures to common substances.[1,pgs.232-233]

Typical symptoms include prolonged fatigue, memory

difficulties, dizziness, lightheadedness, difficulty

concentrating, depression, feeling spacey or groggy,

loss of motivation, feeling tense or nervous,

shortness of breath, irritability, muscle aches, joint

pain, headaches, head fullness or pressure, chest

pains, difficulty focusing eyes, nausea, and more.

This group of symptoms is known as environmental

illness or, more commonly, multiple chemical

sensitivity (MCS), meaning " sensitivity to many

chemicals. "

MCS has been recognized by its symptoms for 50 years

because MCS sufferers in many geographical areas,

researchers studying them, and doctors treating them,

have reported a remarkably consistent picture of

disease. However, because MCS sufferers react to

chemicals at levels that are hundreds or thousands of

times lower than allowable occupational exposures,

traditional toxicology dictates that their symptoms

cannot be caused by chemical exposures. Nor is MCS a

true allergy because there are no IgE-mediated

reactions involved, so allergists don't know what to

make of it.

In sum, because MCS does not fit any of the three

currently-accepted mechanisms of disease --infectious,

immune system, or cancer --traditional medicine has

not known how to explain MCS, and so has often labeled

it " psychogenic " --originating in the patient's mind.

This has left MCS sufferers in limbo. Told they are

crazy, or imagining their disease, or making it up,

they find themselves passed from physician to

physician without any satisfactory answers and often

without relief from their very real distress. (Some

MCS sufferers DO have psychological symptoms, but that

doesn't necessarily mean their disease ORIGINATES in

their mind.) Forty percent of MCS sufferers report

having seen more than 10 medical practitioners.

MCS came to the attention of mainstream science and

medicine forcibly in 1987 when U.S. EPA (Environmental

Protection Agency) installed 27,000 square yards of

new carpeting and painted and remodeled office space

at its Waterside Mall headquarters in Washington, D.C.

Some 200 agency employees developed symptoms

associated with " sick building

syndrome " [1,pgs.174,76-77] --and several dozen EPA

employees later reported developing MCS. The National

Research Council has now accepted that " sick building

syndrome " is a real phenomenon, producing MCS-like

symptoms.

Most recently, MCS has been in the news because there

are two new, large populations of people who exhibit

some or all of the symptoms of MCS: Gulf War veterans,

and women with silicone breast implants.

Since 1990, progress has been made defining and

understanding MCS, though there is still a long way to

go. Nevertheless, real progress has been made. A new

book --a second, updated edition of CHEMICAL

EXPOSURES; LOW LEVELS AND HIGH STAKES, by A.

Ashford and S. [1] --offers a lucid,

thoughtful description of the current science and

medicine of MCS, suggests a hypothesis (which could be

tested) about the origins of the disease(es), and

offers real hope to sufferers that one day their

ailments will be understood and treated, possibly even

prevented.

The stakes are enormous, and the chemical industry

knows it. If a clearly-defined disease emerges from

research on MCS, with chemical causes that are

understood, then it can't be too many decades before

chemical corporations will have to face liability and

compensation claims from millions of victims harmed by

their products. Who knows where this might lead in the

relationship between corporations and an angry public?

Like the tobacco companies before them, the chemical

corporations are bent on casting doubt on the serious

medical research now being conducted to discover the

causes and physiologic mechanisms of MCS. The chemical

corporations have labeled such research " junk

science, " and they have funded a new research arm of

their own (modeled on the Tobacco Research Institute?)

called the Environmental Sensitivities Research

Institute (ESRI). DowElanco, Monsanto, Procter and

Gamble, the Cosmetic Toiletries and Fragrances

Association, and other companies and trade

associations involved in the manufacture of

pharmaceuticals, pesticides, and other chemicals, each

pay $10,000 per year to keep ESRI going. The head of

ESRI is Dr. Gots, who also runs something

called the National Medical Advisory Group, which

provides expert witnesses to defend the chemical

corporations in tort lawsuits. Dr. Gots has published

no original peer-reviewed research on MCS, yet he and

ESRI specialize in claiming that MCS is a mental

disorder. Dr. Gots says, " [E]verything that is known

about MCS to date strongly suggests behavioral and

psychogenic explanations for symptoms. " [1,pg.280] In

other words, if you exhibit some or all of the

symptoms of MCS, you are probably crazy and if your

doctor thinks otherwise, he or she is probably a

charlatan. Such a claim has special staying power

because it cannot be tested scientifically. As long as

anyone is around to assert its validity, such a claim

surrounds MCS research with an aura of controversy

--and controversial topics have trouble attracting

mainstream funding.

Here is a typical " advertorial " by ESRI from the

February, 1996 issue of THE MERCHANDISER (Spring

Grove, Pennsylvania):

" Multiple Chemical Sensitivities: Fear of Risk or Fact

of Life?

" Scientists are increasingly concerned that a doubtful

new diagnosis--supposedly caused by everything

'man-made' in the environment--is unnecessarily making

thousands of Americans miserable each year. One of

these so-called 'modern diseases' is called MCS, for

Multiple Chemical Sensitivities. Many established

scientists and physicians doubt MCS actually does

exist; it exists only because a patient believes it

does and because a doctor validates that belief. For

information on MCS, write the Environmental

Sensitivities Research Institute, 6001 Montrose Road,

Suite 400, North Bethesda, MD 20852. "

The authors of the new book on MCS are highly

qualified. Ashford is professor of technology

and policy at Massachusetts Institute of Technology

(MIT) with advanced degrees in chemistry and law.

is a medical doctor with a masters

degree in environmental health; she teaches at the

University of Texas Health Science Center in San

. Their 1989 report on MCS, funded by the New

Jersey Department of Health, won the prestigious

Macedo award of the American Association for World

Health. Their new book is a pleasure to read. It is

clear, thoughtful, intelligent, and carefully written.

It makes an important contribution to our

understanding of chemical sensitivity.

In reviewing several hundred studies --not all of them

of good quality --Ashford and describe the

common themes that emerge from the good ones: MCS

seems to be a disease (or family of diseases) that

occurs in two stages. MCS is " initiated " by a high

exposure (for example, a chemical fire, or spill) or

by repeated moderate exposure to pesticides or

solvents or some other strong chemical(s) such as

those found in chemical dumps or used in remodeling

homes or offices, including new carpeting. After the

" initiating " exposure, symptoms are then " triggered "

by extremely low exposure to many different chemicals,

such as those found in fragrances, or tobacco smoke,

pharmaceuticals, or foods. Not everyone exposed to

chemicals gets MCS, just as not everyone stung by a

bee goes into anaphylactic shock. A certain portion of

the population seems predisposed to react strongly to

chemicals after an initiating event.

The mechanisms of MCS are not understood, but recent

evidence suggests that the nervous system (or perhaps

the nervous and immune systems together) somehow

become sensitized by an initiating exposure.

Thereafter, low exposures to common chemicals bring on

major symptoms way out of proportion to the size of

the stimulus.

Ashford and suggest that MCS is not really the

best name for this ailment or family of ailments

because it fails to reflect the importance of the

initiating chemical exposure. They suggest that the

name Toxicant-Induced Loss of Tolerance (TILT) better

describes the true nature of the illness(es)

--initiated by a toxic exposure which leads to the

loss of tolerance for common chemicals. They suggest

that different initiating events may give rise to

somewhat different ailments, all of which cause

sensitivity to chemicals --just as different

infectious diseases can all cause a fever.

The scientific community has held several symposia on

MCS (or TILT) since 1990 and a scientific consensus

has been reached on the double-blinded,

placebo-controlled research that needs to be conducted

to define this disease (or disease family).

Despite this consensus, the research is not being

conducted because the needed facilities do not exist.

A special " environmental medical unit " needs to be

built, preferably in a hospital, to test MCS patients

by exposing them to chemicals under controlled

conditions and observing their responses. Despite

numerous recommendations that such a unit should be

built --including a recommendation from the National

Research Council --the funding is not there.

Without naming him, authors Ashford and blame

Gots and others like him for the logjam:

" ...those who continue to promote untested and

untestable psychogenic theories for MCS are part of

the problem. Their lobbying of policymakers and others

in this regard has contributed to widespread

governmental inertia on this issue, making it near

impossible to obtain funding for essential studies

specifically directed toward MCS. Many of those who

advocate psychological explanations in

government-sponsored meetings and in the scientific

literature are paid corporate spokespersons or

consultants with financial conflicts of interest. Yet

these conflicts generally are not revealed when these

individuals appear in scientific meetings, author

scientific articles, serve on official panels or

boards, or serve as reviewers of grant proposals.

Policymakers and publishers of scholarly journals need

to recognize and remedy this appalling

injustice. " [1,pg.256]

These are not academic questions. Seventy thousand

Gulf War veterans, alone, have sought help. They are

told they must prove their disease exists --but

without research they have no proof. The same is true

of tens of thousands of women whose breast implants

have left them with many of the symptoms of MCS.

( Kessler, when he was head of the Food and Drug

Administration (FDA) said, " We know more about the

life of a tire than a breast implant. " ) These and

millions of other people are genuinely suffering, yet

they are told --with no research basis --that there is

nothing medically wrong with them--it's all in their

minds. Only research can find the truth.

Quite possibly, MCS or TILT is a new, fourth disease

mechanism parallel to infections, immune disorders,

and cancer. Those suffering its symptoms cannot gain

relief from their torment until the needed research is

done. Those who are being paid by chemical

corporations to stand in the way of that research

deserve the labels inhuman and inhumane. Would

criminal be too strong a word? -- Montague

(National Writers Union, UAW Local 1981/AFL-CIO)

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[1] A. Ashford and S. ,

CHEMICAL EXPOSURES; LOW LEVELS AND HIGH STAKES. Second

Edition. (New York: Van Nostrand Reinhold, 1998). ISBN

0-442-02524-6.

Descriptor terms: mcs; multiple chemical sensitivity;

environmental illness; allergies; nicholas ashford;

claudia miller; low levels and high stakes; tobacco

strategy; junk science; monsanto; dowelanco; procter

and gamble; cosmetics, toiletries and fragrances

association; ronald gots; esri; national medical

advisory group; pharmaceuticals; pesticides; fires;

environmental sensitivities research institute;

solvents; nervous system; immune system;

toxicant-induced loss of tilerance; tilt;

environmental medical unit; research agendas; emu;

gulf war syndrome; silicone breast implants; breast

implants; disease mechanisms;