A conversation with MCS researcher, Pall, PhD

[Guest guest]

Dr. Pall, Faculty Info:

http://molecular.biosciences.wsu.edu/Faculty/pall.html

A conversation with MCS researcher, Pall, PhD by

Powers, Townsend Letter for Doctors and Patients > Sept, 2005

Dr. Pall is Professor of Biochemistry and Basic Medical Sciences at

Washington State University. He is currently writing a book called

Explaining " Unexplained Illnesses. "

How did you become interested in researching this group of illnesses-

-MCS, Chronic Fatigue, Fibromyalgia, Post Traumatic Stress Disorder?

I came down with a case of chronic fatigue syndrome (CFS) in the

summer of 1997. Unlike most CFS sufferers, I had a complete

recovery, over a period of about a year and a half. I decided to

dedicate the rest of my scientific career to understanding the

mechanisms causing this group of illnesses.

Who is at-risk for developing MCS? Is a genetic pre-disposition

necessary? Is early exposure to toxic chemicals in pesticides and

solvents critical?

There is evidence for an important genetic role in determining one's

tendency to get each of these related illnesses. For MCS, the

evidence so far implicates genes involved in chemical metabolism, as

well as a gene that helps determine the activity of the NMDA

receptors in the brain, receptors that I believe are central to the

mechanism of MCS. I would expect that a number of vitamins,

magnesium, selenium and a variety of antioxidants may well have a

role in preventing MCS. I think that in some individuals, early life

stressors may well make them more susceptible to MCS, but in others

this will not be a factor.

There are multiple short term stressors that are implicated in this

whole group of illnesses, including pesticides and volatile organic

solvents, particularly in MCS, infection, particularly in CFS, both

infection and physical trauma (particularly head and neck trauma) in

fibromyalgia and severe psychological stress in posttraumatic stress

disorder. All of these stressors can produce increases in nitric

oxide and I have proposed that they may trigger a common

biochemical/physiological response that is responsible for these

illnesses.

Why is there so much variation of symptoms from one individual to

another within this group of illnesses?

One can explain many of the symptoms as being produced by impact on

different regions of the brain, as well as different parts of the

rest of the body. For example, some people with MCS have lower lung,

asthma-like sensitivities, sometimes abbreviated RADS and some do

not--and those who have this have tissue impact in the lower lungs.

So a specific tissue when impacted by this biochemistry produces a

specific response.

Describe the focus of your work with these illnesses and the

grants/funding sought

Most of my work, over the past seven years or so has been trying to

master large areas of the scientific literature to develop the best

possible theory of the etiologic (causal) mechanism of these

illnesses. This does not require any outside funding and

fortunately, my university has been satisfied to have me do this and

has not " bugged " me to seek more grant funding.

This is the type of work that nobody does. The reason for that is

two-fold. Firstly, you cannot get research funding to do this type

of work. Secondly it is damn hard work and most people do not have

either the breadth of background or the interest in pursuing it.

This is despite the fact that some very prominent scientists have

commented that this is just the type of work that we most need in

the biomedical area. We are inundated by experimental results in

many areas of biomedical science (not on MCS, however) but have

little time to integrate these results into understandable

conceptual frameworks.

I did have a small grant on CFS, which allowed me to publish two

experimental papers providing support for my theory. I also tried to

get funding for two similar trials, one for CFS treatment and second

for fibromyalgia treatment. The two foundations that I went to for

funding both had the same response. They felt that if the trial

worked, we would not know why it worked because there were so many

components involved in the trial, and so the foundations were not

interested in it. I guess I'd like them to try to convince the

sufferers that an effective treatment would not be worth supporting

even if one cannot determine exactly how it works.

You've developed a treatment protocol that has a nutritional focus.

Describe it.

First, let me remind you that I am a PhD, not an MD, so nothing I

write should be interpreted as a recommendation or as medical

advice. I have been interested in therapy issues ever since I got

involved with this group of illnesses. I think that any etiologic

(causal) theory has got to show its value through its ability to

suggest effective therapeutic approaches.

Dr. Grace Ziem asked me to come up with a treatment protocol. She

had my protocol compounded by a compounding pharmacy and is trying

it on her MCS patients. She reports it seems to be substantially

more effective than her previous treatment approaches.

The approach that I have taken is based on the use of nutritional

supplements rather than conventional pharmaceuticals, and this

approach was taken for two reasons. One is that there are not a lot

of conventional pharmaceuticals that are attractive candidates for

therapy. Secondly, Dr. Ziem wanted us to use as natural an approach

as possible, one that might give the injured body (including brain,

of course) an opportunity to heal itself.

Most of the nutritional supplements we are using are already being

sold to people with these illnesses, so individually they are of

limited effectiveness. If any one of them was a magic bullet, we

would know about it. The goal is to come up with a series of over a

dozen such compounds expected to act synergistically with each other

to lower the biochemistry and physiology that maintains these

illnesses.

We have used a large number of antioxidants (over a dozen of these

alone), several minerals and some odd compounds, such as the amino

acid betaine.

Among the specific goals is to try to improve energy metabolism and

lower the activity of the NMDA receptors in the brain and other

parts of the body, as well as to lower the synthesis of and effects

of nitric oxide and peroxynitrite.

Describe the human clinical research you'd like to do, and explain

why placebo-controlled trials are important.

What is known as a double-blind, placebo controlled trial is

considered to be the " gold standard " of trials and such an approach

is needed to convince people of possible effectiveness. The idea is

that if an individual in the trial does not know whether he/she is

receiving the active material or a placebo, that comparing a

substantial number of individuals in each of the two groups will

allow one to determine whether the treatment is effective and to

quantify how effective it may be. We may end up with two types of

tablets, a gel cap and an inhalant and if this is the final

approach, we will need four different placebos, one for each.

How much funding is needed for this research?

Dr. Ziem estimates that it will take about $50,000 for the trial. I

will be donating my time to it. This is for a trial containing a

group of 30 for treatment and 30 for the placebo.

If the funding did come through, how would participants in the

trials be chosen?

Dr. Ziem has a large backlog of patients. If that is insufficient,

we can contact support groups near her (she is located in rural

land). She will have to examine potential participants to

determine if they fit the appropriate case definition.

Each participant will have a small blood sample taken before

starting the trial and two times after the initiation of the trial

so that I can measure some biochemical parameters that may be a

measure of treatment response. Response to the trial will also be

measured through the use of a previously validated questionnaire.

After the placebo-controlled part of the trial is completed, the

placebo group will be offered the opportunity to try the active

supplements, so everyone will have the opportunity to see how well

the therapy works in their case.