Quack Attack

Meet Bertram W. Carnow, M.D., of the University of Illinois School of Public Health. His 22-page resume lists some 145 publications, some of them never in fact published, at least not under his name. Carnow obtained his medical degree in 1951 but hasn’t practiced medicine in 20 years. He registered for the board certification exam in internal medicine in 1957, 1958, 1960, 1961, 1962, 1963, and 1964, but withdrew twice and failed five times. He has since testified eight times, under oath, that he sat for board certification in internal medicine only once. “I had completely forgotten” the other tries, Carnow explained in a 1984 UPI story.

Today, Carnow heads up Carnow, Conibear & Associates the Conibear being Dr. Shirley Conibear, Carnow’s fourth wife. (Third, testifies Carnow.) The firm’s best-known service is expert testimony. The testimonial line is that the human body is under almost constant chemical assault, that chemicals cause nearly every human affliction, their mechanisms wonderfully subtle but their effects readily ascertained. It is a line most commonly labeled “clinical ecology.”

The modern roots of the theory can be traced to 1962, an interesting year for several reasons. By that time, older theories about cancer that it might be caused by bruises and other simple traumas, for example were on the wane. Doctors, public health specialists, and ecologists were scouting around for more plausible causes of disease. In Silent Spring, Rachel Carson had identified something important: Pesticides accumulate in animals (like birds) at the top of the food chain and can cause real harm. And 1962 also marks the year that Dr. Theron G. Randolph published his Human Ecology and Susceptibility to the Chemical Environment, a book destined to become the standard text of clinical ecology.

Like other great eccentrics, Randolph has some serious credentials. He is a Harvard-trained, board-certified allergist. By 1950, however, he had been dropped from the Northwestern University Medical School faculty, for what he later smilingly described as his “pernicious influence on medical students.”’ But ostracism of this kind inspires rather than discourages the new-age Galileos. Randolph claims to have identified a new illness; he has created “a new specialty of medicine concerned with a shadowy area unexplored, forgotten, and maligned by analytically oriented scientists.”

The human body, adapted for the Stone Age, is being assailed by toxins of the Space Age, Randolph reasons. “If viruses and bacteria can cause illness, why can’t phenol, formaldehyde, chlorine, and pesticides?” Cumulative exposures to the wrong chemicals, he concludes, induce a “susceptibility,” defined entirely by the symptoms that a patient actually exhibits. Chemical vapors from plywood and plastic telephones, furniture and food, may all be implicated. They will trigger allergic symptoms, inflammatory diseases like arthritis or colitis, neuromuscular disorders, headaches, wheezing, depression, and countless other symptoms. Seriously afflicted persons grow mentally exhausted; they experience what Randolph calls “brain-fag.’’ He does not know what causes this “total-allergy syndrome”; he attributes its symptoms to some as yet undiscovered mechanism. “To be truthful, the mechanism isn’t understood or accepted,” he told the Associated Press in 1985.

Understanding may be a long time coming, but acceptance comes surprisingly quickly, at least at some fringes of the medical profession-and in the courtroom. The modem clinical- ecology movement took shape in the two decades after Randolph published his first big book. The movement would grow to encompass a broad range of constantly shifting views, some of them much less diffident than Randolph’s. Today’s clinical ecologists are a varied group, a mix of general practitioners, psychiatrists, urologists, and pediatricians. Few have scientific training in laboratory or clinical research. The one conviction they all share is that lots of people are sicker than mainstream medicine admits, and that environmental chemicals are to blame. In the 1981 movie The Incredible Shrinking Woman, Lily Tomlin gradually shrinks to doll size under the onslaught of household cleaners and other chemicals. Clinical ecologists believe that in such matters truth is almost as strange as, and much more grave than, the comic fiction. Consider, for example, reports published in 1989 in the serious-sounding journal Environment International by Sherry A. Rogers, M.D., a self-diagnosed “universal reactor” to environmental chemicals. Rogers’s patients arrive complaining of (take your pick) hoarseness, headaches, failing grades in school, and any number of ailments from an endless list. Such symptoms, Rogers reports, have “baffled physicians from many specialties.” Rogers, however, notices that all the symptoms began some time (days, weeks, or months-it varies) after moving into a new house, buying new furniture, starting a new job, or doing something somewhere.

She injects each patient with small amounts of formaldehyde. One promptly reports “a warm feeling, ringing in the ears, and achy joints.” Another displays “visible flushing.” Yet another “began laughing and rocking in the chair and thought she was Jesus’ wife.” Amazingly, these are exactly the symptoms the patients complained of beforehand. Injections of pure saline solution reportedly produce no effect, though Rogers is sketchy about all details. Sooner or later, declares Rogers, the astonishing discoveries of clinical ecologists will “unavoidably ... usher in a new era of medicine.”

A medical breakthrough this grand requires more than unbaffled physicians like Rogers. It requires a theory. What exactly is going on? The clinical ecologists have much to explain, for their observations cover a lot of environmental and medical ground. The chemical culprits in the environment include almost everything: urban air pollution, fresh paint, pesticides, perfumes, household cleaners, felt-tip pens, and tap water. These irritants produce infinitely subtle and complex effects. Lots of effects: depression, irritability, poor concentration, poor memory, fatigue, diarrhea, constipation, cramps, asthma, headaches, joint pain, pounding heart, charley horses, cancer, and the common cold.

Equally significant, however, are the symptoms not observed. Clinical ecology patients display no distinctive lesions on their skin, or lungs, or digestive systems. Nor do they respond systematically to any standard tests for allergy. There must be some deep, subtle factor at the edges of medical understanding, one that can be implicated in virtually all facets of human health. What could it be? The clinical ecologists gradually settled on the human immune system.

It is a convenient, perhaps inevitable choice. Beginning in the late 1970s, and accelerating rapidly in the 1980s, medical science made huge, genuine advances in its understanding of the immune system. The immune system, it turns out, consists of an army of cells and proteins, differentiated into many distinct battalions-macrophages, helper T cells, killer T cells, B cells, memory cells, and five types of antibodies. All can be counted and catalogued. The development of monoclonal antibodies, among the most subtle and advanced of biotech wonders, makes possible laboratory tests that can tag individual proteins on cell surfaces and thus allow dozens upon dozens of different measurements. And all of this arcane detail is suddenly of enormous public interest because of a single, terrifying, immune-system disease called AIDS.

So the clinical ecologists latch onto a theory perfectly matched to a public whose health concerns have been defined by Rachel Carson and the bathhouses of San Francisco. They maintain that environmental pollutants of every description can subvert the immune system in just the same way as the AIDS virus. They claim expertise in immunotoxicity, which they also label “total allergy syndrome,” “20th-century disease,” or best of all-“chemically induced AIDS.” The beauty of clinical ecology is its breadth. You have cancer? It’s because your immune system’s ability to fight off cancer has been impaired. You have nothing but the common cold? Same reason. You have unspecific minor aches and pains, backaches and headaches, problems of digestion, concentration, and excretion? Same reason. You have no symptoms at all but are gravely worried that someday you may? Well, you have reason to be worried, for a crippled immune system is a cold or a cancer just waiting to happen. You want continuous medical monitoring? Monitoring is certainly needed.

The legal implications are enormous. For a time, legal scholars had dismissed liability for chemical pollution as a “phantom remedy.” It would generally be impossible, the pundits agreed, to prove any link between pollution and disease But no one had reckoned on the clinical ecologists, or on the eroding rules of evidence that would allow them into court.

The liability revolution of the late 1960s and early ’70s brought scientific controversies into the courtroom as never before in an effort to trace the causes of accidents. The drive to find the “cheapest cost avoider” for any given tort resulted in a relaxation of long-standing restrictions on the use of expert testimony. Prior to the last few decades, courts sought to strike a balance between the need to police incompetence outside the courtroom and the risk of rewarding incompetence within. Hence the Frye rule, based on a 1923 federal appellate court decision, required that expert testimony be founded on theories, methods, and procedures “generally accepted” as valid among other scientists in the same field. Federal courts adopted this standard, and state courts copied them.

But by 1975, when the Federal Rules of Evidence were first codified, the Frye rule was deemed obsolete. Expert testimony would be allowed, thenceforth, “if scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact.” This change signaled the adoption of a “let it all in” approach to expert testimony. In came the clinical ecologists.

The clinical ecologists can connect anything to anything. The legal stakes rise accordingly. The economic value of a chemical pollution case depends on the number of claimants signed up. “The ‘going rate’ for settlements,” reports Yale law professor E. Donald Elliott, “is $10,000 to $100,000 per plaintiff.” Clinical ecology sucks in potential plaintiffs like some enormous, indiscriminate vacuum cleaner.