Crazy Until Proven Sane, WAS Re: Web Site

July 26, 2010

Here is a FREE complete article [so it can be posted here], by one of those

doctors who you are referring to. He has collaborated, and published, with many

of the doctors you have written about, in previous postings. Though the article

was written in 1994, his opinion has not changed, and it continues to influence

the medical profession to ignore our suffering. The gist of the short article is

that you and I, and ALL of us, should be considered CRAZY, until some test, that

THEY approve of, can prove us to be sane. When you finish reading the below

article, turn off your computer, and let your blood pressure return to normal,

before continuing your activities. --JOE

Multiple Chemical Sensitivities

Abba I. Terr, MD

Stanford University Medical Center, Room S-021, Stanford, CA 94305.

Multiple chemical sensitivities has been proposed as a name of a new disease in

which the affected patient has adverse reactions when exposed to numerous items

encountered under ordinary, daily conditions. The items, referred to as

chemicals, include organic solvents, pesticides, paints, new carpets, household

detergents, new clothing, building construction materials, and many others.

Reactions consist of subjective symptoms without accompanying physical signs or

biochemical abnormalities. Patients have many and varied symptoms, but the ones

they report most frequently include fatigue, malaise, headache, lack of

concentration, memory loss, and spaciness. Many of these patients report similar

intolerances to many foods and almost all drugs. In a few cases, the onset of

illness appears to coincide with a reported single high-dose exposure to a

specific chemical, usually in the workplace. This subgroup of patients has been

particularly perplexing to specialists in occupational medicine [1].

Multiple chemical sensitivities was first proposed as a new disease in the

1950s, at which time it was called environmental illness [2]. For many years,

proponents of the existence of environmental illness, or multiple chemical

sensitivities, have theorized that the disease results from an immunologic

dysfunction caused by inhalation of fumes from various chemicals. The chemically

induced toxic damage to the immune system is postulated to then lead to

sensitivities to other chemicals [3]. Recently, a neurologic dysfunction theory

has emerged as an alternative explanation of multiple chemical sensitivities

[4]. This theory proposes that inhaled chemical molecules travel along the

olfactory nerve to the forebrain, the hypothalamus, and other parts of the

limbic system. The many symptoms and alterations in mood and thought processes

that these patients experience are thought to be of neurotoxic origin, and

reactions to other chemicals are explained on the basis of kindling.

The phenomenon of multiple chemical sensitivities as a disease has generated

widespread skepticism among clinicians who encounter patients with this

diagnosis [5]. Seasoned internists, other primary care physicians, and

specialists recognize in these patients an all-too-familiar pattern of

over-utilization of medical diagnostic facilities because of many longstanding

unexplained symptoms. The only thing that distinguishes environmental illness or

multiple chemical sensitivities from this pattern is the attribution of symptoms

to environmental exposures.

A series of clinical investigations of patients with multiple chemical

sensitivities, including the one by Simon and colleagues [6] in this issue of

ls, now provides a reasonably coherent medical picture of the multiple

chemical sensitivities phenomenon. Immunologically, these patients are

functionally intact [7]. As a group they display no deficiency or excess in

their ability to mount appropriate immune responses, nor do they suffer an

excess prevalence of unusual or opportunistic infections, allergic reactions,

autoimmune disease, or cancer [8].

Because of the absence of consistent physical, biochemical, or immunologic

abnormalities, most studies have focused attention on a possible psychiatric

cause. Although selection bias and small numbers of patients suggest the need

for some caution in interpreting these studies, it is clear that diagnosable

psychiatric illness is common in patients with this disorder [9-12]. Early

studies suggested that the multiple chemical sensitivities entity was merely

undiagnosed somatoform illness [9, 13]. Later reports, however, documented that

anxiety, depression, panic disorder, schizophrenia, and affective disorders,

with or without somatization, could be diagnosed in most patients [10-12]. Does

this mean that common everyday environmental chemicals cause a group of

disparate mental illnesses? Probably not; psychological testing of patients with

multiple chemical sensitivities, as reported by Simon and colleagues and others,

reveals a substantial number with preexisting diagnosable psychiatric illness.

Other investigations that analyzed the previous medical records of these

patients point strongly to a much higher prevalence of preexisting psychiatric

illness compared with that uncovered by current psychological tests [14].

The temporal association of symptoms with chemical exposure rests solely on

patient reports. In most cases, awareness of an odor is the triggering factor.

An odorant-induced learned response has been proposed to account for an

expanding range of chemical sensitivities [15]. Thus, a pattern of increasing

intolerance to common, familiar, and formerly innocuous environmental exposures,

coupled with the iatrogenic suggestion of a serious underlying lack of

immunologic protection, readily explains the anxiety, depression, fear, and

frank panic experienced by patients with a diagnosis of multiple chemical

sensitivities.

The immunotoxic concept, however, can be acceptable to individuals with either a

susceptible personality type or a preexisting psychiatric illness who then

perceive their environment as physically harmful to them. The perception is

reinforced by frequent media reporting of pollution incidents and environmental

disasters and by inappropriate avoidance therapy prescribed by certain

environmental physicians. These physicians typically recommend a variety of

therapies of unproven worth [16, 17]. Central to their goal of preventing

multiple environmental sensitivities are chemical avoidance strategies, often

reaching extremes of social isolation and restrictive diets [18]. Detoxification

franchises are appearing that offer a program of niacin-induced flushing

followed by exercise and sauna combined with high-dose vitamin and fatty acid

ingestion promoted as a means of ridding the body of foreign chemicals [19].

Vitamins, minerals, diets, intravenous globulin, and other medications are

prescribed allegedly to enhance immunologic function. No clinical trials

assessing safety or efficacy exist to support these measures. In fact, some

evidence exists that patients worsen with such a treatment regimen [8].

Avoidance therapy, rotation diets, sauna detoxification, and various maneuvers

to boost the immune system serve merely to reinforce a counterproductive

behavior pattern.

Investigation of multiple chemical sensitivities by proven methods of clinical

science is a daunting endeavor. Clearly, more work needs to be done, but the

existing data provide clinicians with a reasonable framework for dealing with

these challenging patients who are disabled by factors that cause them no

physical illness or physiologic impairment. The task is made all the more

difficult by their mistrust of and hostility toward the medical profession in

general. It is not necessary to offer advice to treat patients with multiple

chemical sensitivities with sympathy and understanding, because compassion and

respect should not be withheld from any class of patients. Scheduling regular

visits, making extra time available for these visits, and establishing

short-term, modest, workable goals aimed at reducing disability rather than

focusing on specific symptoms is helpful. The temptation to order still another

test when the going is rough should be resisted. Antidepressant medication and

psychotherapy are rational approaches to current depression and anxiety,

although these patients usually reject psychiatric intervention, which they

often express in symptomatic intolerance to even low doses of antidepressant

medications. Beyond these general suggestions, firm recommendations for specific

treatment modalities must await results of definitive clinical trials. Based on

the current knowledge of multiple chemical sensitivities, behavior modification

therapy seems to be a good place to start.

.......................................

> So here are my questions: Why is it that doctors who belong to certain

> medical associations such as ACOEM, AAAAI and ACMT always seem to be the

> first to deem every illness they can't treat but someone else can as

> psychological instead of physical? And why are they always the first to

naysay

> treatment protocols that people and other physicians report are helping them?

>

> So...if these guys keep getting proven wrong over and over and over

> again...then WHY do they get to remain as main policy setters of American

> medicine? Seems to me, they cause a lot of the waste in health care costs

and

> poor patient outcome.

>

> Sharon

July 26, 2010

Yep...MCS = syndrome.

Hard to argue TE as the naysayers are the ones who created the tests to prove

it. Nice to know the shrinks did something right

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