Santa Fe area physicians who oppose aspartame: Citizens Nutrition Council, Santa Fe: Murray 2005.03.29
From: Rich Murray (rmforall_at_att.net)
Date: 03/29/05
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Date: Tue, 29 Mar 2005 01:05:21 -0700
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http://groups.yahoo.com/group/aspartameNM/message/1162
Santa Fe area physicians who oppose aspartame: Citizens Nutrition Council,
Santa Fe: Murray 2005.03.29
[ Rich Murray: This post starts what will be an ever expanding reference
list for medical, nutrition, and health professionals in the Santa Fe area
who have to reject the safety of aspartame (NutraSweet, Equal, Canderel),
and are concerned in general about safe, healthy nutrition, including air,
water, drugs, chemicals, and environment. Its purpose is to facilitate the
evolution of many diverse practitioners into an open community network to
build tolerance, cooperation, communication, and authentic consensus, to
best serve the public good. As a medical layman, an ordinary citizen, I
volunteer to be a facilitator for this evolution.
Another facet will be the Citizens Nutrition Council, Santa Fe, which will
take the form of regular, convenient, flexible face-to-face meetings to
connect and share as best we may. For some time, there will be no special
organization or center of leadership, rather, only the dominant consensus of
the participants.
We are all citizens, all struggling with a growing avalanche of complex
challenges and opportunities:
obesity;
high national level of violence, crime, and citizens incarcinated;
drug abuse and addiction to old and new substances;
expansion of new physical and mental illnesses;
increasing premarital pregnancy, abortion, miscarriages, birth defects;
exponential medical costs intolerable to citizens and society;
the steep increase in the numbers, needs, and powers of our seniors;
deepening overt confusions about healthy lifestyle and nutrition;
shattered trust in the purveyors of drugs and medicines;
information overload from the collision of many ancient dietary traditions
with advertising bombardment, new corporate industrial food systems,
expanding mainstream sciences, proliferating new knowledge and practice
systems,
the many mainstream religious traditions, a wide spectrum of new, global
spiritual systems;
the situation remarkably accelerated in global world economic order;
now 800 million cooking together unpredictably on the frying pan of the Net.
Folks, here we all are together in the first 2005 there's ever been.
Let's seize this opportunity to do something about it.
Let's gather together here in Santa Fe to form our own town meetings:
Citizens Nutrition Council, Santa Fe.
Let us leave our televisions and monitors, and meet and greet each other.
Healthy and safe nutrition are the natural public commons, where all parties
and issues intersect, for each citizen and family is totally free to
exercise its forever sovereign choices, regardless of the seductions of
advertisers, the paramount profits of global corporations, the belated and
diluted regulations of governments, the inertias of our own cultural and
personal habits.
We are free to choose to become informed enough to make our own decisions
about what is good and safe and affordable, and what is harmful, toxic, and
expensive, for ourselves, and our world.
We support each other, neighbors of Santa Fe. We become for one another the
trustworthy purveyors of fact and builders of consensus.
It is efficacious to start with the signal issue of aspartame, whose main
open secret is that its 11 % methanol component is always fully quickly
released into the body, to be swiftly converted into formaldehye and formic
acid, both cumulative and potent poisons. Two liters (quarts) of diet soda,
about six cans daily, dumps 123 mg methanol, four times the lifetime limit
set by the EPA in 2003.
I welcome feedback and referrals. Please disseminate this post freely.
In mutual service, Rich Murray
Rich Murray, MA Room For All rmforall@comcast.net
1943 Otowi Road, Santa Fe, New Mexico 87505 USA 505-501-2298
http://groups.yahoo.com/group/aspartameNM/messages
179 members, 1,162 posts in a public searchable archive
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George R Schwartz MD 7518 Old Santa Fe Trail Santa Fe, NM 87505
992-1455 drgschwartz@yahoogroups.com
www.healingresearch.org 424-9467 610-8143 cell
"In Bad Taste: The MSG Syndrome", 1988, 123 p.
Eliza H Schmid MD (retired, now an artist) <elizak@cybermesa.com>
http://www.dsg-art.com/s/schmid/ESBio1.html
http://www.democracyfornewmexico.com/democracy_for_new_mexico/2005/02/sf_air_america_.html
C. Grant La Farge MD Santa Fe Pediatric Cardiology
638B Harkle Road, Santa Fe 87505 505-982-7661
Raymond M. Singer, PhD, PA consulting toxicologist
36 Alondra Road / Santa Fe, New Mexico /87505
180 E. 79th Street Suite 1-C New York, N.Y. 10021
(505) 466-1100 Fax: (505) 466-1101 RaySinger@aol.com
http://members.aol.com/neurosite/
http://members.aol.com/DonationDrive/SingerPesticideNeuro.html
Singer, R. (1999, expected).
Neuropsychological evaluation of bystander exposure to pesticides.
The Journal of Neuropsychiatry and Clinical Neurosciences, 9, 1.
Deborah Werenko, MD 753-9292, 800-238-7013
Los Alamos Medical Center
Sondra K. Spies, DOM, active practice 1979-2005
505-983-8250 rmforall@comcast.net
Leah Morton, MD ABFP 505-983-8387
Bruce Gollub, MD ABFP
Isis Medicine 401 Botulph Lane Santa Fe, NM 87505
Erica M. Elliott, MD 505-471-8531 EricaMElliott@aol.com
#A-2 2300 West Alemada Santa Fe, NM 87501
family and environmental medicine
Prescriptions for a Healthy House, by Paula Baker, AIA, Erica Elliott, M.D.,
and John Banta (InWord Press, 1998, $29.95). Available from the Healthy
Housing Coalition. [ revised and updated, 2001 www.econests.com ]
http://www.bakerlaporte.com/downloads/H147BA.pdf healthy houses
Ann McCampbell, MD 505-466-3622
Chair, MCS Task Force of New Mexico
P.O. Box 23079 Santa Fe, NM 87502
These last three female physicians, and lastly, Jacqueline Krohn, have all
struggled with their own Multiple Chemical Sensitivity (Environmental
Illness), perhaps caused by exposure to formaldehyde in medical school. The
majority of aspartame reactors are female.
Jacqueline Krohn, MD [aspartame mentioned in her 3 books]
Los Alamos Medical Center 505-662-9620
3917 West Road, Ste. 136 Los Alamos, NM 87544
http://www.lapho.com/physicians/krohn.asp [photo]
Dr. Krohn received an MD from Washington University in 1976 and an MPH in
Occupational Medicine from the Medical College of Wisconsin in 1994.
Dr. Krohn is the co-author of these books: The Whole Way to Allergy Relief
and Prevention, Natural Detoxification, and Finding the Right Treatment.
http://www.annals.org/cgi/content/full/120/3/249-e
LETTER
Controversy Over Multiple Chemical Sensitivities
Jacqueline Krohn, MD; Jill Ryan, BA; and Julie Jacobson, PhD, MS, RN
1 February 1994 | Volume 120 Issue 3 | Pages 249-251
To the Editors: Simon and colleagues [1] appear to present a case-control
study comparing chemically sensitive patients with controls without specific
and measurable prestudy hypotheses.
The results are useful only to develop recommendations for future studies,
and only if the study was done adequately. However, flaws in participant
selection and the information collected probably biased their results.
Simon and colleagues selected patients with a computer billing code of
multiple allergy, and then screened for illness lasting 3 months or more,
multisystem involvement (including the central nervous system), and
self-report of sensitivity to chemicals.
With no screening for length, type or severity of exposure, level of
sensitivity, or degree of illness, confounding variables remain unaddressed.
Controls were not screened for sensitivity to chemicals, masked regular
exposures, or previous occupations that could have provided chemical
exposures.
Bell and colleagues [2] report that in a random group of 643 college
students, 15% report symptomatic response to chemicals.
Musculoskeletal and back injury occur predominantly in "blue collar"
occupations such as manufacturing, where chemical exposures are common.
Cases and controls were then matched for age, sex, and educational level,
insufficient criteria that may have missed important factors.
We argue that dilution of cases and controls through systematic error in
participant selection, combined with a poor response rate and small sample
size, severely biased the results of this study.
Diagnosing mental illness when patients are known to have central nervous
system dysfunction and multiple system symptoms is difficult.
A presupposition of a healthy central nervous system exists in measures of
depression and anxiety.
Where known central nervous system dysfunctions exist, these measures are
less valid.
The validity of the somatization scale is lowest of all Diagnostic Interview
Schedule measures [3].
Using this diagnostic tool on a group of patients with variable multiple
system symptoms and unclear cause only emphasizes inherent problems with
validity.
Research has shown memory impairment in persons exposed to chemicals who
were chosen under careful criteria [4] and brain damage with related
emotional and functional disruption from exposure to chemicals [5].
For future study of environmental sensitivity, development of clear
classification systems and identification of confounding variables should be
priorities.
References
1. Simon GE, Daniell W, Stockbridge H, Claypoole K, Rosenstock L.
Immunologic, psychological, and neuropsychological factors in multiple
chemical sensitivity: a controlled study. Ann Intern Med. 1993; 19: 97-103.
2. Bell IR, Schwartz GE, Peterson JM, Amend D. Self-reported illness from
chemical odors in young adults without clinical syndromes or occupational
exposures. Arch Environmental Health. 1993; 48: 6-13.
3. Robin LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of
Mental Health Diagnostic Interview Schedule. Its history, characteristics,
and validity. Arch Gen Psychiatry. 1981; 38: 381-9.[Abstract]
4. Fledler N, Maccia C, Kipen H. Evaluation of chemically sensitive
patients. J Occup Med. 1992; 34: 529-38.[Medline]
5. Morrow LA, Callender T, Lottenberg S, Bucshsbaum MS, Hodgson MJ, Robin N.
PET and neurobehavioral evidence of tetrabromoethane encephalopathy. J
Neuropsychiatry Clin Neurosci. 1990; 2: 431-5.[Abstract]
Copyright © 1994 by the American College of Physicians.
http://www.naturalfamilyonline.com/1-nb/53-no-shampoo.htm
According to Jacqueline Krohn, M.D., in The Whole Way to Natural
Detoxification: The Complete Guide to Clearing Your Body of Toxins by
Jacqueline Krohn, MD, "Caustic chemicals, such as alkaline solutions, can
also penetrate the skin. Once a chemical has penetrated the stratum corneum
(the most superficial layer of skin), it moves through the epidermis and
into the dermis. Then the rich blood supply of the dermis readily transports
the chemical into the bloodstream."
Chemical content of shampoo
Following are just a small sample of the toxins found in most shampoos and
their detrimental side effects.
Alcohol, isopropyl (SD-40) is a very drying and irritating solvent and
dehydrator that strips your skin's moisture and natural immune barrier,
making you more vulnerable to bacteria, molds and viruses. It is made from
propylene, a petroleum derivative, and is found in many skin and hair
products, fragrances, antibacterial hand washes as well as shellac and
antifreeze. It can act as a "carrier," accelerating the penetration of other
harmful chemicals into your skin.
It may promote brown spots and premature aging of skin. A Consumer's
Dictionary of Cosmetic Ingredients says isopropyl alcohol may cause
headaches, flushing, dizziness, mental depression, nausea, vomiting,
narcosis, anesthesia and coma. A fatal ingested dose is one ounce or less.
FD&C color pigments are synthetic colors made from coal tar, containing
heavy metal salts that deposit toxins onto the skin, causing skin
sensitivity and irritation. Absorption of certain colors can cause depletion
of oxygen in the body and death. Animal studies have shown almost all of
them to be carcinogenic.
Mineral oil is a petroleum by-product that coats the skin like plastic,
clogging the pores. It interferes with skin's ability to eliminate toxins,
promoting acne and other disorders.
Propylene glycol (PG) and butylene glycol are petroleum plastics which act
as surfactants (wetting agents and solvents). They easily penetrate the skin
and can weaken protein and cellular structure. Commonly used to make
extracts from herbs, PG is strong enough to remove barnacles from boats!
Sodium lauryl sulfate (SLS) and sodium laureth sulfate (SLES) are detergents
and surfactants that may pose serious health threats. They are used in car
washes, garage floor cleaners and engine degreasers - and in 90 percent of
personal care products that foam. Animals exposed to SLS experienced eye
damage, depression, labored breathing, diarrhea, severe skin irritation and
even death.
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http://groups.yahoo.com/group/aspartameNM/message/1157
Sales volume: saccharin > sucralose > aspartame, Harold Brubaker
timesleader.com 2005.03.23: Murray rmforall
A very detailed, highly credible account of the dubious approval process for
aspartame in July, 1981 is part of the just released two-hour documentary
"Sweet Misery, A Poisoned World: An Industry Case Study of a Food Supply
In Crisis" by Cori Brackett: cori@soundandfuryproductions.com
http://www.soundandfuryproductions.com/ 520-624-9710
2301 East Broadway, Suite 111 Tucson, AZ 85719
http://groups.yahoo.com/group/aspartame/messages
Aspartame Victims Support Group Edward Bryant Holman, Chief Moderator
808 members, 18,204 posts in a public, searchable archive
http://www.presidiotex.com/aspartame/ bryanth@presidiotex.net
http://www.HolisticMed.com/aspartame mgold@holisticmed.com
Aspartame Toxicity Information Center Mark D. Gold also Co-Moderator
12 East Side Drive #2-18 Concord, NH 03301 603-225-2110
http://www.holisticmed.com/aspartame/abuse/methanol.html
"Scientific Abuse in Aspartame Research"
http://www.sweetpoison.com/ Janet Starr Hull, PhD, CN jshull@sweetpoison.com
http://groups.yahoo.com/group/aspartameNM/message/1092
Janet Starr Hull, who also had Graves disease in 1991, told Justin Dumais to
quit aspartame: Murray 2004.06.12 rmforall
http://www.aspartamesafety.com marystod@airmail.net
Mary Nash Stoddard, Founder
Aspartame Consumer Safety Network and Pilot Hotline [1987-2004]
P.O. Box 2001 Frisco, TX 75034 1-214-387-4001 [ 25 miles N of Dallas ]
http://groups.yahoo.com/group/aspartameNM/message/957
safety of aspartame Part 1/2 12.4.2: EC HCPD-G SCF:
Murray 2003.01.12 rmforall EU Scientific Committee on Food, a whitewash
http://groups.yahoo.com/group/aspartameNM/message/1045
http://www.holisticmed.com/aspartame/scf2002-response.htm
Mark Gold exhaustively critiques European Commission Scientific
Committee on Food re aspartame ( 2002.12.04 ): 59 pages, 230 references
http://groups.yahoo.com/group/aspartameNM/message/1131
genotoxicity of aspartame in human lymphocytes 2004.07.29 full plain text,
Rencuzogullari E et al, Cukurova University, Adana, Turkey 2004 Aug: Murray
2004.11.06 rmforall
http://groups.yahoo.com/group/aspartameNM/message/1088
Murray, full plain text & critique:
chronic aspartame in rats affects memory, brain cholinergic receptors, and
brain chemistry, Christian B, McConnaughey M et al, 2004 May:
2004.06.05 rmforall
http://groups.yahoo.com/group/aspartameNM/message/1067
eyelid contact dermatitis by formaldehyde from aspartame, AM Hill & DV
Belsito, Nov 2003: Murray 3.30.4 rmforall [ 150 KB ]
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http://groups.yahoo.com/group/aspartameNM/message/1143
methanol (formaldehyde, formic acid) disposition: Bouchard M et al, full
plain text, 2001: substantial sources are degradation of fruit pectins,
liquors, aspartame, smoke: Murray 2005.03.19 rmforall
http://groups.yahoo.com/group/aspartameNM/message/1155
continuing aspartame debate in British Medical Journal, John Biffra, Bob
Dowling, Nick Finer, Ian J Gordon: Murray 2005.02.09 rmforall
http://groups.yahoo.com/group/aspartameNM/message/1140
EPA Preliminary Remedial Goals, PRGs, 2003 Oct, air and tap water --
methanol, formaldehyde, formic acid -- not mentioned is methanol from
aspartame, dark wines and liquors: Murray 2004.11.20 rmforall
http://groups.yahoo.com/group/aspartameNM/message/1141
Nurses Health Study can quickly reveal the extent of aspartame (methanol,
formaldehyde, formic acid) toxicity: Murray 2004.11.21 rmforall
Rich Murray, MA Room For All rmforall@comcast.net
1943 Otowi Road, Santa Fe, New Mexico 87505 USA 505-501-2298
http://groups.yahoo.com/group/aspartameNM/messages
179 members, 1,162 posts in a public searchable archive
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http://www.aafp.org/afp/990415ap/letters.html
American Family Physician® Vol. 59(No. 8): April 15, 1999;
Letters to the Editor
Understanding Patients with Multiple Chemical Sensitivity
TO THE EDITOR: The article, "Multiple Chemical Sensitivity Syndrome," by
Drs. Magill and Suruda1 omits reference to the recent joint consensus
statement by the American Medical Association, the American Lung
Association, the U.S. Environmental Protection Agency, and the U.S. Consumer
Product Safety Commission. 2 This statement concludes that multiple chemical
sensitivity (MCS) should not be dismissed as psychogenic and recommends
giving patients a thorough medical work-up.
The conclusion of this statement is supported by researchers at Johns
Hopkins University who analyzed the current medical literature that supports
a psychologic origin for MCS. Because all of the studies analyzed were found
to have such serious methodologic problems, it was concluded that available
evidence does not support a psychologic etiology for MCS. 3
I am a physician practicing occupational medicine who cares for hundreds of
patients with MCS. In my experience, reducing environmental exposure to
exacerbating irritants and pollutants consistently results in the long-term
reduction of symptoms. The effect of reducing exposures has also been
documented in the medical literature. 4 Furthermore, MCS is often
accompanied by complications such as adrenal insufficiency; reduced
secretory IgA with parasitic or other opportunistic infections; disturbances
in energy metabolism; impaired detoxification usually involving phase II of
the detoxification pathway; and numerous other biochemical, nutritional and
endocrine impairments.
Quantification of symptoms in 100 new patients with MCS who were seen in my
medical practice between January 1996 and January 1998 revealed that 88
percent met the diagnostic criteria of the Centers for Disease Control and
Prevention for chronic fatigue syndrome and 49 percent met the diagnostic
criteria of the American College of Rheumatology for fibromyalgia. The
overlap between these syndromes has been documented elsewhere in the medical
literature. 5
Half of the medical literature on MCS has been written in the past five
years; hundreds of articles are now available that discuss physiologic
abnormalities in patients with MCS. A bibliography is available by writing
MCS Referral and Resources, 508 Westgate Rd., Baltimore, MD 21229 or through
their Web site (http://www.mcsrr.org/).
MCS often develops after repeated symptomatic exposure to petrochemicals,
combustion products or irritants. Common causes of MCS that are discussed in
the medical literature include "sick building" exposure, exposure to
pesticides (e.g., organophosphates, carbamates, pyrethroids,
organochlorines), solvents, chemicals used in renovations and remodeling of
buildings, adhesives, aldehydes, chlorinine dioxide and other halogenated
irritants, and heavy frequent occupational exposure to carbonless paper.
A researcher from Johns Hopkins University developed a valuable screening
instrument that evaluates the degree of response to various well-defined
exposures. A copy is available through the 501 C3 nonprofit MCS Referral and
Resources.
Based on my experience, family physicians who care for patients with MCS
tend to provide more comprehensive care with better continuity and
prevention, compared with "organ system specialists" who care for these
patients. I encourage family physicians to continue expanding their role as
sentinels to further scientific understanding of this major public health
problem. Chronic illness accompanied by chemical sensitivity has been found
in 3.8 to 6.3 percent of the population,6 with milder forms affecting 15
percent or more.
GRACE ZIEM, M.D., DR.PH.
Occupational and Environmental Medicine
16926 Eyler's Valley Rd. Emmitsburg, MD 21727
REFERENCES
Magill MK, Suruda A. Multiple chemical sensitivity syndrome.
Am Fam Physician 1998; 58: 721-8.
Indoor air pollution: an introduction for health professionals. New York
City: American Lung Association, Environmental Protection Agency, Consumer
Product Safety Commission, American Medical Association, 1994.
Davidoff AL, Fogarty L. Psychogenic origins of multiple chemical
sensitivities syndrome: a critical review of the research literature.
Arch Environ Health 1994; 49: 316-25.
Lax MB, Henneberger PK. Patients with multiple chemical sensitivities in an
occupational health clinic: presentation and follow-up.
Arch Environ Health 1995; 50: 425-31.
Buchwald D, Garrity D. Comparison of patients with chronic fatigue syndrome,
fibromyalgia, and multiple chemical sensitivities.
Arch Intern Med 1994; 154: 2049-53.
Meggs WJ, Dunn KA, Bloch RM, Goodman PE, Davidoff AL. Prevalence and nature
of allergy and chemical sensitivity in a general population.
Arch Environ Health 1996; 51: 275-82.
TO THE EDITOR: We read with interest the article, "Multiple Chemical
Sensitivity Syndrome," by Drs. Magill and Suruda1 and the accompanying
editorial by Dr. DeHart. 2 We agree with Drs. Magill, Suruda and DeHart that
evidence is insufficient to establish a relationship between allergy, toxic
exposure and neurobiologic sensitization, and symptoms expressed by these
patients.
As physicians who specialize in occupational medicine and medical
toxicology, we frequently evaluate patients who are labeled as having
multiple chemical sensitivity (MCS). In our clinical experience and ongoing
review of the research concerning this issue, we believe that the term
"idiopathic environmental intolerance," which is recommended by the
International Programme on Chemical Safety of the World Health Organization,
3 is a more suitable name for this syndrome. MCS denotes an unsupported
judgment on the relationship between chemicals and allergy. Since the
etiology and underlying mechanisms 4,5 of this syndrome have not been
proven, idiopathic is a more suitable term. Furthermore, this syndrome has
no validated clinical criteria for diagnosis; thus, "environmental
intolerance" would better describe the condition.
As Dr. DeHart emphasizes in his editorial, physicians must not contribute to
the patient's belief in chemical and social avoidance. In extreme
situations, when social isolation becomes one of the psychologic defenses,
patients are at risk for increased depression and suicidal ideation. In
order to find a solution to this phenomenon, we physicians must adhere to
the scientific method that is the foundation of biologic medicine.
FREDERICK FUNG, M.D., M.S.
University of California, San Diego
Sharp Rees-Stealy Medical Group
2001 Fourth Ave.
San Diego, CA 92101
ROY KENNON, M.D., J.D.
Naval Medical Center
San Diego, CA
REFERENCES
Magill MK, Suruda A. Multiple chemical sensitivity syndrome.
Am Fam Physician 1998; 58: 721-8.
DeHart RL. Multiple chemical sensitivity [Editorial].
Am Fam Physician 1998; 58: 652-4.
UNEP-ILO-WHO. Conclusions and recommendations of a workshop on multiple
chemical sensitivities (MCS).
Regul Toxicol Pharmacol 1996; 24: 188-9.
Fung FY. Multiple chemical sensitivity and environmental toxicology.
Allergy Proc 1991; 12: 81-4.
Staudenmayer H. Multiple chemical sensitivities or idiopathic environmental
intolerances: psychophysiologic foundation of knowledge for a psychogenic
explanation [Editorial].
J Allergy Clin Immunol 1997; 99: 434-7.
TO THE EDITOR: I strongly disagree with Drs. Magill and Suruda, the authors
of "Multiple Chemical Sensitivity Syndrome," 1 that avoiding exposures to
chemicals does not help patients with multiple chemical sensitivity (MCS).
I do not believe that patients should be encouraged to work and socialize
despite the symptoms and that it is possible to establish a respectful and
empathetic physician patient relationship when the physician does not
acknowledge the patient's illness. I also do not agree that "standard
treatment" should be provided for identified medical disorders in patients
with MCS, since many of these patients cannot tolerate standard drugs or
customary dosages. They often require nonpharmaceutical treatment or
medications that are specially formulated to be free of preservatives, dyes,
fillers and binders.
Far from being contraindicated, the avoidance of exposures to chemicals is
the cornerstone of the treatment of MCS. Two polls of patients with MCS have
shown that the overwhelming majority of respondents, 95 percent 2 and 93
percent, 3 reported that avoiding exposures to chemicals was either a major
or enormous help in reducing symptoms. None of the 243 respondents in one
study 4 and only one of 305 respondents in the other study 3 reported that
this practice was harmful. Even an article that was referenced by Drs.
Magill and Suruda states that "odors and exposure to volatile organic
compounds in the workplace and home, which are perceived as irritating or
noxious by the symptomatic person, should be reduced and controlled as much
as possible." 4
In my practice, I have repeatedly witnessed the benefits of reducing
exposures to chemicals. One of my patients is a 45-year-old corporate
consultant who developed incapacitating confusion, headaches, insomnia,
emotional lability and chemical sensitivities following a month-long
exposure to mothballs containing naphthalene. She was instructed to move
from her house and, after staying with a friend in a less contaminated
environment for six months, she recovered to the point that she was able to
go back to work.
By contrast, another of my patients was a school teacher who tried to keep
working even though she was getting sick from the remodeling chemicals and
pesticides that were being used at her school. Since her doctors told her
that nothing was wrong with her and because she loved children and her job,
she pushed herself to the point that she is now permanently disabled and
unable to work.
Symptoms of MCS are not just irritating autonomic disturbances, such as
those associated with stage fright, but often are caused by serious
reactions such as malignant arrhythmias, asthma, seizures and anaphylaxis.
Patients with MCS can no more ignore their symptoms than someone who is
having an anaphylactic reaction to peanuts. Recently, one of my chemically
sensitive patients was exposed to a neighborhood herbicide, which caused her
to have protracted vomiting and eventually be hospitalized for upper
gastrointestinal bleeding.
Encouraging patients with MCS to slowly increase their exposures to
chemicals in hopes that their reactions will go away is no more rational or
ethical than having patients with diabetes slowly withdraw from insulin and
attempt "to work and socialize despite the symptoms."
ERICA M. ELLIOTT, M.D.
2300 W. Alameda #A-2 Santa Fe, NM 87501
REFERENCES
Magill MK, Suruda A. Multiple chemical sensitivity syndrome.
Am Fam Physician 1998; 58: 721-8.
Johnson A. Table of survey results from 243 respondents.
MCS Information Exchange, September 18, 1996.
LeRoy J, Davis TH, Jason LA. Treatment efficacy: a survey of 305 MCS
patients. The CFIDS Chronicle, Winter 1996.
Sparks PJ, Daniell W, Black DW, Kipen HM, Altman LC, Simon GE, et al.
Multiple chemical sensitivity syndrome: a clinical perspective. II.
Evaluation, diagnostic testing, treatment, and social considerations.
J Occup Med 1994; 36: 731-7.
TO THE EDITOR: Multiple chemical sensitivity (MCS) is a serious, growing
health problem that affects children and adults of all ages, races and
economic backgrounds. We have seen an increasing number of such patients in
our practice. Patients with MCS are made sick by exposures to many commonly
encountered chemicals at levels that ordinarily do not affect other people.
This condition may be distinguished from other illnesses by the fact that
symptoms of MCS come and go in relation to various exposures to chemicals.
MCS is recognized as a potentially disabling condition by the Social
Security Administration 1 and the U.S. Department of Housing and Urban
Development, 2 and it is covered under the Americans with Disabilities Act 3
on a case-by-case basis, as are all other conditions.
The authors of the article, "Multiple Chemical Sensitivity Syndrome" 4
stated that "the incidence and prevalence (of MCS) are unknown," but at
least two states have obtained data on the prevalence of chemical
sensitivities and the diagnosis of MCS. A 1995 California Department of
Health Services Behavioral Risk Factor Surveillance Survey (BRFSS), a random
population-based study, found that 15.9 percent of 4,000 respondents
reported being unusually sensitive to chemicals, and 3.5 percent reported
being diagnosed with MCS/environmental illness and being sensitive to
chemicals, according to Richard Kreutzer, M.D., Acting Chief, Environmental
Health Investigations Branch, California Department of Health Services (oral
communication to Ann McCampbell, M.D., Chair, MCS Task Force of NM, January
8, 1997).
In a 1997 New Mexico BRFSS study, 17 percent of 1,814 respondents (21
percent of the women participants and 11 percent of the men participants)
reported being unusually sensitive to everyday chemicals (such as those
found in household cleaning products, paints, perfumes, detergents and
insect sprays), and 1.9 percent reported that they had been diagnosed with
MCS, according to Ron Voorhees, M.D., M.P.H., Deputy State Epidemiologist,
New Mexico Department of Health (oral communication to Ann McCampbell, M.D.,
Chair, MCS Task Force of NM, January 28, 1998). The study also found that
2.1 percent of participants had lost a job or a career because of their
chemical sensitivities. Respondents in New Mexico who reported chemical
sensitivities were evenly distributed throughout the state. They were also
evenly distributed among racial and ethnic groups, except among Native
American respondents, of whom 31 percent reported being chemically
sensitive.
BRUCE GOLLUB, M.D., A.B.F.P.
LEAH MORTON, M.D., A.B.F.P.
401 Botulph Ln. Santa Fe, NM 87505
REFERENCES
Medical evaluation of specific issues--environmental illness. In: Social
Security Administration. POMS, Program Operations Manual System. Baltimore:
Dept. of Health and Human Services, Social Security Administration, 1988.
SSA publication no. 68-0424500, Part 04, Chapter 245, Section 24515.065.
Multiple chemical sensitivity disorder and environmental illness as
handicaps. Washington, D.C.: Dept. of Housing and Urban Development, 1992.
Americans with Disabilities Act handbook. Washington, D.C.: Equal Employment
Opportunity Commission, Department of Justice, EEOC-BK;19, October 1991:
III-21.
Magill MK, Suruda A. Multiple chemical sensitivity syndrome.
Am Fam Physician 1998; 58: 721-8.
TO THE EDITOR: Dr. DeHart's editorial, "Multiple Chemical Sensitivity," 1
amply demonstrates and perpetuates the disdain that is commonly directed by
the medical community toward patients with multiple chemical sensitivity
(MCS). Physicians must realize that patients with MCS are not the enemy.
Most physicians seem to be so worried that they will be "fooled" into
thinking these patients are ill that they don't realize they have already
been fooled in a much bigger way by a sophisticated disinformation campaign
being waged by the chemical industry. This campaign is similar to the
campaign used by the tobacco industry to deny the health hazards of its
products. In my experience, information that strives to discredit people
with MCS and cast doubt on the existence of the illness comes from industry
non-profit front groups, industry associations or physicians who work for
the chemical industry, either as expert witnesses or in some other way.
In its 1990 Environmental Illness Briefing Paper, 2 the Chemical
Manufacturers Association (CMA) vowed to work to prevent the recognition of
environmental illness (now called MCS) in order to preserve the profits of
its member corporations. It also vowed to work with physicians, if
necessary, to accomplish this. "Should environmental illness arise as an
issue, a coalition with the state medical association is absolutely
necessary." 2 The CMA's clearly stated goal is to block the recognition of
MCS, not to learn the truth about it or to help those who have it.
I suspect most physicians do not realize that the pharmaceutical industry is
part of the chemical industry, and that many of these companies make
pesticides as well as pharmaceuticals. For example, CIBA-Geigy Corporation
(now Novartis) makes the widely used herbicide atrazine; Novartis is also a
large manufacturer of the organophosphate insecticide diazinon; Eli Lilly
used to be part of DowElanco (now Dow AgroSciences), the largest
manufacturer of another organophosphate insecticide, chlorpyrifos; and
Bayer makes a popular pyrethroid insecticide, cyfluthrin. Hence, drug
companies have a financial stake in blocking or distorting information about
MCS, too.
In my opinion, pharmaceutical companies have been key in preventing
physicians from obtaining accurate information on MCS through their
influence on journal publications, conference proceedings, refusal to
conduct research on MCS and lobbying to block research by government
entities. In 1996, a CIBA-Geigy lobbyist traveled from another state to
submit testimony to a New Mexico legislative committee opposing, among other
things, funding for a prevalence study of MCS, the creation of an MCS
information and assistance program, and an investigation into the problem of
homelessness among people with MCS. Thus, the criticism that the
pharmaceutical and chemical industries are impeding the necessary research,
education and services needed by chemically sensitive people is not without
merit.
The author complains that MCS "may become a disease by legal fiat" and that
there is "a strong activist agenda." 1 Considering the abysmal response by
the medical community to this burgeoning public health problem, it is not
surprising that individuals who typically have lost their health, career,
family, friends, income, home and independence due to MCS are dedicated to
bringing attention to this illness in any way they can-- both for themselves
and to prevent others from getting sick. Rather than dismissing patient
complaints as psychogenic, as is the author's implied suggestion, I urge the
medical community to take a leadership role in demanding comprehensive
research on MCS, providing accessible offices and hospitals for patients
with MCS, and making a commitment to helping patients with this devastating
illness.
ANN MCCAMPBELL, M.D.
Chair, MCS Task Force of New Mexico
P.O. Box 23079 Santa Fe, NM 87502
REFERENCES
DeHart R. Multiple chemical sensitivity [Editorial].
Am Fam Physician 1998; 58: 652-4.
The Chemical Manufacturers Association. The Chemical Manufacturers
Association Environmental Illness Briefing Paper.
The Reactor Fall 1990; V(4): 1,2,9-13.
IN REPLY: The comments made by the letter writers illustrate a point we
made in our article 1: multiple chemical sensitivity (MCS) is a subject that
elicits controversy and emotion. At no point in our article did we suggest,
as was implied by Dr. Ziem, that the symptoms of MCS should be "dismissed as
psychogenic." Indeed, referring to the same article 2 that Dr. Ziem cited
in her letter, we said, "studies suggesting causality, rather than merely an
association between MCS and psychiatric problems, are fraught with
methodologic problems." However, we also believe it would be unnecessarily
cruel to withhold effective treatment for psychiatric illness, such as
depression, when such illness is recognized in patients who are also living
with MCS.
The article by Dr. Meggs and colleagues, 3 cited by Dr. Ziem, assessed
self-reported prevalence of "becoming sick after smelling chemical odors,"
and the authors themselves cautioned that "this study was not designed to
determine the prevalence of . . . the MCS syndrome."
We have no doubt that some patients experience decreased symptoms with
reduced exposure to irritants, as suggested in the quotation from an article
by Dr. Sparks and colleagues 4 that Dr. Elliott includes in her letter.
However, there is a big difference between anecdotal experience and proof
that reduced exposure to low-level pollutants eliminates the panoply of
metabolic abnormalities described by Dr. Ziem. Indeed, it was the same
article by Dr. Sparks that also stated, "recommendation for long-term
avoidance of chemical exposures is contraindicated. It is also impossible to
accomplish." 4
Dr. Elliott relies largely on anecdote and analogy to suggest benefit from
avoidance of chemicals. The article to which she refers to support this
assertion was a self-report study from a sample of patients with MCS, not a
therapeutic trial. 5,6 We do not believe that this is sufficient evidence
on which to make such a disruptive therapeutic recommendation as extreme
avoidance of low levels of chemical exposure for all patients suffering from
MCS.
Drs. Gollub and Morton seem to imply that legal or regulatory recognition of
a syndrome may substitute for scientific evidence of its etiology, and that
unpublished data prove a substantial prevalence. We disagree.
Drs. Fung and Kennon object to our use of the name MCS. We chose this name
because it is in common use and has a clear definition that, as we stated in
the article, denotes no judgment about causality. While we have no
fundamental quarrel with the use of the term "idiopathic environmental
intolerance," in our view this change of label without change in meaning is
a distinction without a difference.
MICHAEL K. MAGILL, M.D.
ANTHONY SURUDA, M.D., M.P.H.
Department of Family and Preventive Medicine
University of Utah 50 North Medical Dr. Salt Lake City, UT 84132
REFERENCES
Magill MK, Suruda A. Multiple chemical sensitivity syndrome.
Am Fam Physician 1998; 58: 721-8.
Davidoff AL, Fogarty L. Psychogenic origins of multiple chemical
sensitivities syndrome: a critical review of the research literature.
Arch Environ Health 1994; 49: 316-25.
Meggs WJ, Dunn KA, Bloch RM, Goodman PE, Davidoff AL. Prevalence and nature
of allergy and chemical sensitivity in a general population.
Arch Environ Health 1996; 51: 275-82.
Sparks PJ, Daniell W, Black DW, Kipen HM, Altman LC, Simon GE, et al.
Multiple chemical sensitivity syndrome: a clinical perspective. II.
Evaluation, diagnostic testing, treatment, and social considerations.
J Occup Med 1994; 36: 731-7.
Johnson A. Table of survey results from 243 respondents.
MCS Information Exchange, September 18, 1996.
LeRoy J, Davis TH, Jason LA. Treatment efficacy: a survey of 305 MCS
patients. The CFIDS Chronicle, Winter 1996.
IN REPLY: The juxtaposition of the two letters by Dr. McCampbell and Drs.
Fung and Kennon illustrates the controversy associated with the phenomenon
of multiple chemical sensitivity (MCS).
In her letter, Dr. McCampbell implies that most physicians are victims of a
"sophisticated disinformation campaign" that is being waged by the chemical
and pharmaceutical industries. Dr. McCampbell currently chairs the MCS Task
Force of New Mexico.
Last fall, a draft report issued by the Federal Interagency Workgroup on MCS
was released for public comment. 1 The Workgroup found that no single,
accepted case definition of MCS has been established and that proposed
definitions all differ in key criteria. The Workgroup noted that MCS is
currently a symptom-based diagnosis without laboratory tests to support it
or agreed on clinical manifestations. Although a patient can have disabling
symptoms, objective clinical or laboratory evidence of disease is often
lacking. It is doubtful that the distinguished members of the Workgroup
could, as a body, be compromised by an industrial disinformation campaign.
Dr. McCampbell suggests that there has been little research conducted and
few articles on this topic. The phenomenon of MCS and related topics has
received wide dissemination. In 1993, the Human Ecological Action League
published a selective bibliography that cited approximately 600 articles
related to MCS. 2 On February 6, 1999, I searched the National Library of
Medicine Database using the phrase "multiple chemical sensitivity" and found
96 citations in peer-reviewed journals since 1995.
Both the medical peer-review literature and the lay press have given MCS
wide coverage. As early as 1989, the American College of Physicians reviewed
the status of the literature on MCS and found it lacking; however,
recommendations were made for implementing research methodologies. 3
In 1991, I was the principal drafter of a position paper on MCS by the
American College of Occupational Medicine (now the American College of
Occupational and Environmental Medicine), which stated in part: "It is the
position of the American College of Occupational Medicine that the Multiple
Chemical Hypersensitivity Syndrome is presently an unproven hypothesis and
current treatment methods represent an experimental methodology. The
College supports scientific research into the phenomena to help explain and
better describe its pathophysiological features and define appropriate
clinical interventions. This research should adhere to established
principles of scientific inquiry and the results submitted for publication
in recognized peer reviewed journals." 4
The National Academy of Science has supported the need for MCS research
since 1992. 5 Modest research funding for MCS has been provided by both
state and federal governments. The Veterans Administration has established
three environmental referral centers and added several million dollars
annually to their budget to support these centers.
Dr. McCampbell suggests that I dismiss these patients' complaints as
psychogenic. Over the past decade, I have seen approximately 70 patients who
had been diagnosed with MCS. Nine of these patients were diagnosed with
organic disease, including multiple sclerosis, lupus erythematosus,
isocyanates-induced asthma and farmer's lung. Several additional patients
were diagnosed with psychosocial conditions that included panic disorder and
conditioned response to odor. We were unable to provide a definitive
diagnosis for many of the patients. In my experience, most physicians
consider patients with MCS to be truly ill; the issues to be dealt with are
diagnosis and causation.
In their letter, Drs. Fung and Kennon suggest substituting the name
"idiopathic environmental intolerance" for the name "multiple chemical
sensitivity." I agree with the suggestion and have begun to use the phrase
in my own practice. However, this substitution does not meet with universal
acceptance, especially among some advocates of MCS.
ROY L. DEHART, M.D., M.P.H.
Vanderbilt University Medical Center
Center of Occupational and Environmental Medicine
1211 21st Ave. S., Suite 403 Nashville, TN 97212-2721
REFERENCES
Federal Interagency Workgroup on Multiple Chemical Sensitivity. Report on
Multiple Chemical Sensitivity (MCS). Atlanta: ATSDR Information Center,
1998.
Kosta LA. Chemicals and health: a selected bibliography. Atlanta:
Human Ecology Action League, 1993.
American College of Physicians. Clinical ecology.
Ann Intern Med 1989; 111: 168-78.
American College of Occupational and Environmental Medicine. Multiple
Chemical Hypersensitivity Syndrome. Position Statement adopted by the Board
of Directors, May 2, 1991.
National Research Council. Multiple chemical sensitivities: addendum to
Biologic markers in immunotoxicology. Washington, D.C.: National Academy
Press, 1992.
Send letters to Jay Siwek, M.D., Editor, American Family Physician, 8880
Ward Pkwy., Kansas City, MO 64114; fax: 816-333-0303; e-mail:
afplet@aafp.org. Please include your complete address, telephone number and
fax number. Letters should be double-spaced, fewer than 500 words and
limited to one table or figure and six references. Please submit a word
count. Letters submitted for publication in AFP must not be submitted to any
other publication. Possible conflicts of interest must be disclosed at time
of submission. Submission of a letter constitutes transfer of copyright to
the American Academy of Family Physicians. The editors may edit letters to
meet style and space requirements.
Copyright © 1999 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one
printout of the material and may use that printout only for his or her
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downloaded, copied, printed, stored, transmitted or reproduced in any
medium, whether now known or later invented, except as authorized in writing
by the AAFP. April 15, 1999
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