Environmental disease avoidable but tough to diagnose

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VOLUME 35, NO. 33, October 5, 1999

Environmental disease avoidable but tough to diagnose

By AndrÈ Fauteux

MONTREAL - In the early 1980s, Quebec hematologist Dr. Pierre Auger was the

target of skepticism and criticism from his colleagues. Today he is lauded

as a pioneer in occupational and environmental health and is consulting for

a new clinic in Montreal intended to help GPs deal with this difficult area

of medicine.

Dr. Auger was one of the world's first physicians to report a major fungal

contamination - one that incapacitated patients and staff at Saint-FranÁois

d'Assise Hospital in Quebec City.

" We were creating a new paradigm, " he recalled in a recent telephone

interview from his office in the provincial capital. " At the time, none of

this was written in any textbook. People suspected a virus. We had to bring

in American experts to testify that we were dealing with toxic mould. "

A few years ago, nine babies died in Cleveland from chronic overexposure to

Stachybotrys chartarum, a fungus that proliferates in houses with repeated

water damage. Since then, major flooding and TV reports of mould-infested

homes have led a growing number of Quebecers to consult about such problems,

which are still, however, underreported by family physicians.

Without medical reports, sentinel cases are missed and many people fall

through cracks in the system. " In public health, good evidence is hard to

come by because we're generally called upon after the fact, " said Dr. Louis

Patry, who heads Montreal's new Occupational and Environmental Health

Clinic.

" Our motto is 'At the crossroads of diagnosis and prevention,' " Dr. Patry

said. " We've created a network of experts in several specialties who will

assist primary care physicians in asking the right questions, making their

diagnosis, documenting causal links and supporting the reintegration of

workers. "

Canadian studies show that occupational and environmental diseases account

for 8% to 10% of consultations with primary care physicians, but family

doctors are insufficiently trained to answer most questions, Dr. Patry said,

particularly when it comes to grey areas such as the health effects of

electromagnetic fields. (In the case of EM fields, he recommends prudent

avoidance.)

" While occupational and environmental diseases are largely avoidable,

linking them to causes is less and less clear. For example, workers

intoxicated with styrene can appear very healthy because they are smiling

and singing, but in fact they are high. "

Launched last March, the new clinic aims to help family doctors who simply

don't have the time to track down top experts in every field of medicine,

some of whom are few and far between.

Twenty-two years after studying the health impact of pesticides on forests,

Dr. Patry is still one of only a half-dozen Quebec-based Fellows of the

Royal College of Physicians specialized in occupational medicine.

The clinic will work with Montreal's public health department, as well as

McGill University and the University of Montreal. " Everyone agrees we should

complement each other, not compete; our forces are limited in Montreal. "

The clinic can count on five consulting doctors, each fielding questions and

referrals from GPs one day a week. " We won't be treating people, " Dr. Patry

said. " Five local community health centres (CLSCs) will act as satellite

clinics. "

McGill has supplied the clinic's first home, within the walls of the

Montreal Chest Institute. " Files are opened on the phone and patients don't

come to us, we visit them in their workplace or homes. It's a kind of

community openness I have rarely seen elsewhere, " Dr. Patry said.

But for the clinic to thrive, it must demonstrate it's needed. " We need GPs

to refer cases to us, to document symptoms even when causes aren't apparent.

Sentinel events will indicate there's a problem somewhere. "

Dr. Patry said initially about 80% of cases referred to the clinic will be

in occupational medicine, but he suspects environmental problems will

command more and more resources.

Dr. Auger will be called upon to deal with another one of his specialties,

chemical sensitivities, which baffled him when he first came across the

problem in 1981.

Since then, he has researched the controversial syndrome and now uses

various questionnaires, including one developed by New-Jersey physician Dr.

Kippen, to distinguish normal patients from asthmatics and the

chemically sensitive.

Dr. Auger is prudent, because it's a new field strewn with unanswered

questions. But he's not alone: Environmental health clinics have recently

opened in Toronto and Halifax, notably to develop a clear definition and

diagnosis of the syndrome.

The Halifax clinic is the only one in Canada to treat chemical

hypersensitivity. It's headed by Dr. Roy Fox, one of many staff at Camp Hill

Hospital in Halifax who became ill from chemicals used in the ventilation

system. Dr. Fox certifies that 90% of his patients are bona fide.