"Environmental illness", a every genuine condition with a number of recognizable symptoms, is not as many doctors and vested interests maintain all in the mind.
Multiple chemical sensitivity (MCS) syndrome, also known as "environmental illness", has been described as the most puzzling disease of the Eighties (Ann Int Med, 1988; 322: 675-83). It's also one of the most political, because it touches upon the most powerful industries in the world, which have enormous vested interests in keeping the lid on this problem.
Although we have no idea how prevalent the syndrome is, increased sensitivity to a variety of chemicals is thought to be a growing problem (Occ Med, 1987; 2: 663-8; Ann Int Med, 1988; 322: 675-83). One investigator identified 49 out of 2760 patients, or more than 2 per cent, as suffering from MCS between 1986 and 1991 (Toxicol Ind Health, 1992; 8:15-9). What we do know is that many patients with chronic fatigue syndrome (CFS) or fibromyalgia syndrome (FS) also react to chemicals (Arch Int Med, 1994; 154: 2049-53); that many of the symptoms of those conditions are similar to those of MCS; and that three quarters of MCS patients are women (Toxicol Ind Health, 1992; 8:15-9). High sugar and carbohydrate consumption also seem to make people more susceptible.
Four major groups are most at risk: industrial workers, occupants of crowded buildings, communities with air or water contamination, and people with unique exposure to various chemicals (NA Ashford et al, Chemical Exposures: Low Levels and High Stakes, Van Nostrand Reinhold, 1991).
What unites all these diverse people is a collection of bizarre symptoms affecting many organ systems of the body (see box below), as soon as someone is exposed to chemicals, including seemingly innocuous ones like perfume. These range from headaches and depression, to breathing difficulties, flu like symptoms, ear, nose and throat disturbances, gastrointestinal problems, musculo skeletal problems like joint pains, and even heart and circulatory disturbances.
The disorder causes a progressive hypersensitivity to a variety of substances. People with MCS cannot tolerate drugs of any variety, prescription or recreational. They react to food, other chemicals, and are frequently intolerant of alcohol. In the view of Iris Bell, associate professor in psychiatry, psychology and family community medicine at the University of Arizona, and an expert on MCS, this disorder results from a "time dependent sensitization" (TDS), which is somehow triggered and then increases over time.
The principal culprit in MCS is undoubtedly pesticides, especially organophosphates (OPs). Other contaminants include air pollution, such as car exhaust fumes, or carbon monoxide; "indoor" chemicals such as solvents found in paints, varnishes, adhesives and cleaning solutions, or fumes from carpets, computers and photocopies, plastics, disinfectants and, of course, tobacco smoke; pesticides and the entire range of substances hormones, antibiotics, nitrates, heavy metals that make their way into our food and water supply; and even medical and consumer items like plastics, hairsprays, deodorants and felt tip pens.
OPs inhibit acetylcholinesterase (AchE), an enzyme that breaks down the neurotransmitter acetylcholine in junctions between nerve cells. This breakdown seems to precipitate an increase in supersensitivity to smell. One medical journal (JNNP, 1993; 56: 943-6) went as far as to suggest that chemical exposure may be behind a number of poorly understood neurological diseases.
Pesticides either inhaled or ingested are known to affect the hippocampus, the part of the brain responsible for placing short term memory into long term storage.
MCS could also be a general immune reaction to low dose chemicals caused by a malfunctioning enzyme neutralendopeptidase (NEP) in the airways (Toxicol Ind Health, 1992; 8: 221-28). In fact, many MCS patients have nasal problems and inflammation, excessive phlegm and catarrh (Arch Environ Health, 1993; 48:14-18).
Chemical intoxication also seems to cause porphyrin abnormalities. Porphyria is a metabolic disorder causing excessive excretion of porphyrins, the pigments found in hemoglobin, as well as neurologic disturbances and abdominal pain. These neurological symptoms are those usually listed by MCS patients, and over 90 per cent of MCS patients have porphyria.
According to the Chemical Injury Information Network, 3750 chemicals can cause this abnormality as can many antibiotics. Some researchers studying the more powerful generation of antibiotics which tamper with bacterial DNA worry that they could alter the recipient's ability to make porphyrins and also the structure of cells. As one doctor studying the syndrome put it: "If we damage the engine that keeps our cells going, then, of course, we can expect . . .what we see in our [MCS] patients" (Townsend Letter for Doctors and Patients, November 1996).
Another important factor in bringing on MCS could be the interaction between chemicals. Currently, some 70,000 chemicals are in commercial use, with another 1000 or so added every year (Rachel's Environment & Health Weekly, 13 June 1996). New research shows that some combinations of chemicals which disrupt hormone function in animals and humans are far more powerful than any of the chemicals by themselves (Science, 1996; 272: 1489-92).
Furthermore, combinations of two or three pesticides turn out to be up to 1600 times as powerful as any individual substance on its own. Chlorodane, which has no ability to disrupt hormone function by itself, has been shown to greatly magnify the hormone disrupting ability of other chemicals when used in combination. This would affect the 50 or so chemicals in detergents, plastics and pesticides which have been found to interfere with hormones and normal development, causing changes in sexual preference and behaviour, diminished sperm count or small penises, cancer and nervous system disorders and birth defects.
The main consequence of slow motion chemical poisoning is nerve damage (Arch Environ Health, 1994; 9: 37-44; Acta Neurol Scand, 1988; 78 (Suppl): 1-143; Environ Res, 1993; 60: 124-35). Nervous system disturbances have been found in many MCS patients, causing damage or loss of peripheral vision. Many show electromyographic abnormalities, and develop disturbances in bowel and bladder control (Occ Med State Art Rev, 1987; 2: 669-82). In brain scans, patients exposed to chemicals show changes in brain processes, and even in parts of the brain, particularly the frontal and temporal lobes, thalamus and cerebellum (J Toxicol Environ Health, 1994; 41: 275-84), while those exposed to dioxins, solvents or pesticides show a reduced cerebral blood flow (Toxicol Ind Health, 1994; 10: 561-71).
Environmental toxins also cause heart and circulatory problems, including arteriosclerosis, high blood pressure, ischemic heart disease, heart muscle disease and disturbances of heart muscle rhythm (Occ Med State Art Rev, 1992; 7: 465-78; J Occ Med, 1983; 25: 879-85).
Polyaromatic hydrocarbon levels have also been found to depress lymphocyte function (Toxicol Appl Pharmacol, 1992; 117: 155-64).
A number of prestigious scientists have identified multiple chemical exposure as behind many of our most puzzling illnesses like ME, or chronic fatigue syndrome. In 1993, Professor William Rea, author of Chemical Sensitivity (Lewis, Ann Arbor, Michigan), has suggested that reactions to a wide range of chemical substances may lie at the root of ME. Dr Charles Poser, a well known neurologist from Harvard Medical School, believes that a paradoxical or inappropriate response to medications one of the main symptoms of MCS is one of the most important criteria in making a diagnosis of ME. This suggests that MCS and ME are variations on the same illness (International Conference on CFS, Dublin, 1994). Or, it could be that a high body burden of pesticides is an effect of an illness like ME. A three year study in Australia showed a statistically significant connection between the level in the body of organochlorines and the severity of CFS. The high levels of pesticides in the body could be the result of a faulty detoxification system, which brings on CFS (Our Toxic Times, February 1996, as quoted in Townsend).
All in your head
Although orthodox medicine has given the syndrome some legitimacy by identifying it with a label, it categorizes MCS as psychosomatic that all purpose rubbish bin into which the medical profession throws all illnesses it doesn't understand. A 1996 report, prepared by a working group from the Royal Colleges of Physicians, Psychiatrists and General Practitioners, claims that as many as three quarters of the up to one million people believed to suffer from CFS have underlying psychological or psychiatric problems. Food and chemical sensitivities, which may play an important trigger in these diseases, are dismissed as "somatization disorders" a body dysfunction as though an environmental insult has nothing to do with it.
Psychiatrists have consistently maintained that problems like MCS and other allergic reactions can be explained in terms of psychological or somatization disorders (BMJ 1993; 307: 747-8; Clin & Exp Allergy, 1995; 25: 503-14). Medical "authorities" on the subject have even instructed doctors how to identify and diagnose a variety of disorders in such patients, including the bizarre Munchhausen Syndrome by Proxy (where the sufferer inflicts fake illnesses on others, say by adding sugar to a child's urine so it is diagnosed as diabetic). Nevertheless, many of the studies supposedly proving that MCS is just another term for neurotic are now known to be flawed. In one study, groups of workers of the aircraft manufacturers Boeing in Seattle, Washington State, were found to suffer from psychiatric disorders. Eventually their problems turned out to be caused by exposure to toxic substances used in manufacturing processes (Am Jnl of Psychiatry, 1990:147: 901-6).
This fact has now been acknowledged in a high court judgement in Washington State, whose judges decreed that Boeing not only was grossly negligent in the application of phenol resins, but also deliberately disregarded the known facts about health hazards.
In 1994, an analysis of the scientific evidence effectively demolished the notion that MCS is a psychological problem. After reviewing 10 papers published after 1980, which supposedly proved that MCS is all in the mind, the analysis identified 15 possible methodological problems; only one of the 10 studies failed on fewer than eight counts (Arch Environ Hlth, 1994, 49: 316-25).
Recent studies have now shown that MCS differs from common or garden psychiatric complaints in tangible ways. MCS researcher Iris Bell has shown that, unlike classic depression, where symptoms are on going, MCS patients experience depression, confusion and general apathy for only minutes or hours, and then only after exposure to chemicals. They also experience clumsiness and balancing problems, which don't occur in psychiatric illnesses like depression. Few have any prior history of mental illness (Our Toxic Times, February 1996, as quoted in Townsend).
A new diagnostic tool also provides a unique neurological signature of MCS. Brain scans using single photo emission computed tomography, which measure blood flow in the brain, have shown that exposure to neurotoxic substances, solvents and pesticides appear to significantly impair cerebral function. In one study, scan patterns from patients exposed to chemicals "differed markedly" from those suffering from depression (Our Toxic Times, February 1996, as quoted in Townsend).
Although the medical establishment has argued that no scientific studies have ever established the existence of MCS, researchers from Washington State performed a series of double blind studies on chemically sensitive patients 34 years ago. In the 1963 study, the reaction of patients to plastic food containers was tested after all chemical irritants had been withdrawn from food and environment for a week. When the plastic was reintroduced, three of the 14 displayed what we now consider classic symptoms of MCS. The studies were repeated until it was proved without a doubt that the patients were reacting to the plastic (Our Toxic Times, March 1996, as quoted in Townsend).
The undefinition of MCS
Patients with MCS don't simply have a doubting medical profession to contend with, but the pressure brought to bear by industry with an enormous vested interest in demonstrating that chemicals aren't capable of making people ill. In early 1996, a workshop on MCS was held in Berlin, Germany. Although co sponsored by the World Health Organization, the United Nations Environmental Programme (UNEP) and the International Labor Programme (ILP), lending the event the appearance of an objective international environmental taskforce, the actual sponsor was the International Programme on Chemical Safety (IPCS), an organization firmly on the side of industry. Most of the workshop attendants represented federal institutions and chemical and pharmaceutical industries, such as Bayer AG, BASF, Monsanto, Coca Cola International (CFIDS Chronicle, Spring, 1996: 5). No representatives of chemically injured people were permitted to attend. Several of the 17 "experts" convened by the IPCS testified for chemical companies against the existence of MCS. The workshop concluded that unexplained environmental intolerances do indeed exist, but recommended that the syndrome be labelled "idiopathic environmental intolerances" (meaning of undefined obscure origin), to be treated as psychological problems.
The workshop's proposals were subsequently rejected by a large group of international scientists, and WHO, UNEP and ILP distanced themselves from them as well (Zeitung fuer Umweltmedizin, 1997; 5: 20-22).
Nevertheless, the IEI label has stuck. In Germany, where a significant number of people suffer from MCS, IEI is now considered synonymous for wide range of so called "ill defined diseases", including sick building syndrome, clinical ecology syndrome, Gulf War syndrome, CFS, fibromyalgia and MCS. In a new environmental journal (Umweltmed Forsch Prax, 1996; 1: 229-38) the author claims that the first port of call for any MCS sufferer should be the psychiatrist's couch.
Doris Jones is an independent medical researcher.