Sick of it All

People with "Multiple Chemical sensitivity" are definitely suffering. The question is, why?

Michael Fumento from the June 1996 issue

(Page 3 of 4)

The most commonly used test for MCS is probably provocation-neutralization, in which subjects are given a tiny dose of various agents and questioned about how they feel. (This procedure is much more subjective than a conventional allergy test, in which a substance is injected just below the skin, and a positive result is indicated by redness and swelling.) Once an offending agent has been identified, the clinical ecologist injects it in various rising concentrations until a "neutralizing dose" is found. The problem with such testing is obvious. If MCS is brought on by suggestion, this procedure will not eliminate that possibility . A young woman convinced she's sensitive to Pierre Cardin cologne will get sick when you tell her you are now exposing her to Pierre Cardin.

In 1990 this test was put to the test. The study, which followed a protocol considered fair by both advocates and detractors of MCS, was financed by two clinical ecology organizations, the Academy of Otolaryngic Allergy and the American Academy of Environmental Medicine. Seven experienced clinical ecologists used their own food extracts in their own offices with thei r own patients. They gave 18 patients injections, some of which contained test substances and some of which contained saline as a placebo. The study was double-blind, meaning neither doctor nor patient knew who was getting what. The results, reported in th e August 16, 1990, New England Journal of Medicine, were not to the liking of the people who paid for them. The subjects reported the same number of symptoms whether they received test agents or saline solution. Furthermore, "neutralizing" doses of the food extracts and the placebo were equally likely to p rovide relief.

The chief researcher for this project was Don L. Jewett, an orthopedic surgeon at the University of California at San Francisco. He told a reporter he was surprised by the study's negative f indings. "I believed it was going to be positive," he said. "I looked at it every way I could think of. It's just completely consistent with randomness. And that's the only thing it's consistent with." Jewett said that at one time he had been very much a b eliever, having been treated by a clinical ecologist. Now he's one of clinical ecology's major critics. "I had believed in it [MCS] and when we did the experiment we expected it would turn out positive. We designed it carefully to convince any skeptics. So when it didn't work out it clearly showed the methods they [clinical ecologists] were using at that time did not work as claimed. Their basis was the doctor's impressions and I believe that's all they still use. It's not science."

By all traditional standards of illness--symptoms, causes, treatments, and tests--MCS comes up wanting. "Most physicians would agree that there are chemical sensitivities," says Staudenmayer, the Denver psychologist. "I believe there are. We have found the m in toxicology and in industrial medicine. So you have a legitimate basis of toxic evidence." But he emphasizes that it's one thing to be sensitive to a certain chemical, quite another to say that a sensitivity can somehow overwhelm the immune system, causing broad vulnerability to illness.

So what's causing all these strange maladies? In a study reported in The Journal of the American Medical Association in 1990, University of Iowa psychiatrist Donald Black and his colleagues tried to find out. Black discovered that patients w ho had been diagnosed by clinical ecologists as having MCS were far more likely than other people to have psychological problems such as depression, anxiety disorders, and panic attacks. "It's my belief," he said at the time, "that people diagnosed as havi ng environmental illness in most cases do have something wrong: a garden-variety emotional disorder." Don Jewett agrees: "My basic underlying theory is that these patients are very stressed. Almost all have very unsatisfactory lives."

Stephen Barrett, a retired Allentown, Pennsylvania, psychiatrist and author of The Health Robbers: A Close Look at Quackery in America, notes that the symptoms most commonly exhibited by MCS sufferers "have to do with the body's reaction to stress. That means you're going to get a lot more complaints of insomnia and headaches than of nose bleeds." Adds Staudenmayer, "These patients sort of live their belief. They believe their illness is caused by factors external to themselves, so they project problems or cause of problems onto the physical environment."

But couldn't it be that suffering for years from untreated MCS leads to the psychological disorders, rather than the other way around? No, says Black. "In many, if not most, of the cases," he explains, "their psychiatric history long predates any chemical exposure the clinical ecologist thinks is causing their problem." One woman he saw had hospital records of psychosomatic problems dating back to the 1930s, though her MCS diagnosis had been made just 10 years earlier. "We have that kind of history on a number of patients," he says. Furthermore, "a lot of these people have psychiatric problems that you wouldn't expect to see if it were just a reaction to chronic illness, such as panic attacks and somatizations" (turning psycholog ical stress into physical symptoms). The kinds of mental illness you'd be more likely to see if this were a response to chronic demoralization, he says, are depression, mild anxiety, and marital discord.

Doctors who treat MCS patients, like Ziem, seem rarely if ever to find that their patients have psychological problems. In the mid-1980s Canadian researchers preparing a report on MCS for the Ontario Ministry of Health looked through the files of the most prominent clinical ecologist, William Rea of the Environmental Health Center in Dallas. They found that only four out of 2,000 of Rea's patients had tested negative for environmental sensitivity, and those four were found to have cancer. The reviewers said Rea used "no appropriate controls and the patients were assumed to have environmental hypersensitivity mainly by being referred to the unit." It strains belief that out of all the hypochondriacs and people with psychosomatic illness out there, none manage to find their way to Rea's clinic.

Likewise, the New York City physician Warren M. Levin testified in court a few years ago that since 1974, when he began practicing clinical ecology, he had diagnosed every patient he saw as suffering from environmental illness. The suit was brought by the estate of a youn g man who had previously been diagnosed as a paranoid schizophrenic convinced that "foods were out to get him." Levin gave him the usual diagnosis and put him on a restrictive diet and supplements. He continued the treatment for several years, until the ma n's suicide. The jury found Levin negligent and awarded the estate $900,000 in damages.

Among the main instigators of the MCS syndrome, say MCS critics, are the clinical ecologists themselves. "They have a significant role in keeping these people sick," says Gots. "They tell them they're poisoned, and if you're told you're being poisoned you believe you're being poisoned. I've seen hundreds of patients like this." Black, the University of Iowa psychiatrist, says "people who receive this label of MCS are psychologically vulnerable. They tend to be suggestible individuals. Many have physical complaints of unknown origin and shop from doctor to doctor and are just delighted when a clinical ecologist gives them an explanation for years and years of ailments."

It has long been understood that suggestion can be very powerful in both curing and causing illness, but historically the emphasis has been on the positive side. The negative side is called a nocebo. It shows up regularly in tests in which one group is give n a real drug and another a fake drug as a control. For example, in one study of the antidepressant Prozac, 15 percent of the subjects claimed to have gotten headaches even though it turned out they were receiving a placebo. We've probably all suffered the nocebo effect, developing symptoms in response to somebody else's symptoms or upon receiving a diagnosis of illness.

The fact that a person's illness is psychosomatic doesn't mean the person isn't really suffering. A headache is a headache, whether it was caused by a blow to the head or because you smell cleaning solvent and are convinced cleaning solvent smells make you ill. Your head hurts just the same.

I know this from personal experience. During my first year in the Army I began breaking out in terrib le hives. Whole parts of my body, including hands, feet, and lips, would swell up. My face was covered with huge red welts. I felt like throwing a hood over my head and proclaiming to gawkers: "I...AM...A MAN!" This continued on and off for several horribl e weeks. No allergen could be found. Then one day a savvy soldier told me, "You're allergic to the color green." Well put and well diagnosed. Long before I began writing for libertarian magazines I had come to hate the authoritarianism of the Army. I was u nwilling to desert, unable to resign. My body burst out because I could not. Fortunately, the cure for my hives came in understanding the cause, and soon they were gone--though it took more than three years to eliminate the "causative agent."

Anxiety-induced illnesses are so common one wonders if there aren't other pseudo-illnesses stalking the land. Absolutely, says Gots. "Gulf War Syndrome is not particularly different from this," he says. "Neither are the breast implant complaints. I see a lot of those."

Those familiar with the role that litigation has played in the silicone implant controversy (see "A Confederacy of Boobs," October 1995) will wonder about that side of MCS. Some insurers and defendants attorneys are convinced that the threat from MCS suits is huge. So are trial lawyers. In 1987, the Association of Trial Lawyers of America voted to establish a clearinghouse on ecological illness and its legal aspects. In addition to personal injury lawsuits, MCS gives rise to worker's compensation and Socia l Security disability claims.