Quack Attack

Got a headache? Back pain? Fatigue? It could earn you big bucks, with the help of clinical ecologists.

Meet Bertram W. Carnow, M.D., of the University of Illinois School of Public Health. His 22-page résumé 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.

We find Bertram Carnow in Missouri, in late 1985, testifying on behalf of 32 residents of the town of Sedalia. At a nearby plant, Alcolac Inc. manufactures specialty chemicals for soaps and cosmetics. Pollution from that plant is said to have damaged the immune systems of families who lived nearby. The trial will drag on for over four months. The jury will hear from 165 witnesses. The transcript will occupy 10,000 pages.

The plaintiffs will blame Alcolac's pollution for dozens of different afflictions, spanning nerve damage and heart disease, brain damage and vomiting, kidney infections and headaches. Young women report interrupted menstrual cycles. Others declare that dogs, cats, cattle, chickens, parakeets, and bee colonies died "unaccountably and without signs of predation." Carnow has ordered exhaustive laboratory tests. He presents by-the-numbers reports of immune-cell populations of various kinds. He has identified at least one abnormality (and as many as eight) in the immune system of every single plaintiff.

Carnow is backed up by Arthur C. Zahalsky, Ph.D., who teaches immunology to nursing undergraduates at Southern Illinois University. Zahalsky never actually studied immunology in graduate school; but he does claim to have audited immunology classes at Washington University in St. Louis. In any event, he is now a big believer in measuring immune-system performance. He uses every gun in the battery of laboratory tests that have recently been developed to tag, count, and measure immune-system cells and proteins. He runs test after test, records number after number. And then invariably finds something of deep significance in the results. The implications are always clear: Chemicals have surely undermined immunity.

In the Sedalia residents he tests, Zahalsky finds "pervasive abnormalities" everywhere he looks. Some of the cell and protein counts are too high—a surprising symptom for a disease described as an immune deficiency syndrome. Others are too low. In one plaintiff after the next, Zahalsky finds "a gross distortion in the ratio," an immune system "functionally wiped out" or "out of whack," "a 'severe' form of chemical AIDS," or, at the very least, "moderate immune dysfunction" certain to "develop [in]to the AIDS condition somewhere down the line." Zahalsky's prognosis, as later summarized by a court of appeals, is gloomy. "The chemicals have dampened the immune system so that the plaintiffs will become subject to a variety of diseases, neoplastic disease [cancer] included. The findings already suggest the possibility of leukemia." There isn't a normal immune system in the crowd. Not a one.

The jury is convinced. It awards $6.2 million in compensatory damages plus $43 million to punish Alcolac for its iniquity. The trial judge concurs. So does the court of appeals. Its opinion runs 371 pages of bloated prose. Cut through the periphrasis, and the appellate court's logic is simple. Chemicals can cause harm. There were chemicals at Alcolac's plant. Carnow and Zahalsky take care of the rest. Only one small reservation at the end: The AIDS metaphor, the court of appeals concludes, is just too inflammatory to be used in front of a jury. So a new trial will be ordered for the sole purpose of recalculating damages.

No, Alcolac is not a typical case. It is to tort law pretty much what the clinical ecologist is to science: an aberration, interesting because it is so peculiar. But if the clinical ecologist does not routinely deliver $49-million verdicts, he can quite often provide a fair shot at one. A busy witness can move from glory to disgrace and back to glory as fast as he can switch courtrooms.

Carnow, for example, failed to convince one court that a railroad employee's involvement in cleaning up a chemical spill caused his "multiple illnesses and diseases which have been progressive," and another court that the headaches, fatigue, heat intolerance, nausea, numbness, chest pains, and depression of another employee were caused by a liquid solvent. More often, however, Carnow delivers at least a split. For example, he was on call in the main Agent Orange case, which settled for $180 million on the eve of trial; the trial judge then ruled summarily against all remaining claims, on the ground that no serious science stood behind them.

Carnow appears again and again and again. His methods are, of course, much disputed: He uses such things as a kneejerk test to establish general nerve disorder and a single urine sample to reveal probable bladder cancer. A physician for the defense in one case testified that "no one educated after 1950 could possibly" have relied on the tests that Carnow used to diagnose liver disease. Nevertheless, Carnow bats a pretty good average. In another Agent Orange trial: summary judgment for the defendant. Chemical spill at Times Beach: a $14.5-million settlement for two defendants, followed by jury verdict for other defendants. Another dioxin case: jury award of $58 million, overturned on appeal, settlement of $22 million.

Carnow is not, of course, the only player on the field. Other clinical ecologists come to the aid of a woman who has "suffered chemical poisoning and damage to her immune system" from formaldehyde vapors emanating from a carpet. The trial judge bars the testimony, but a court of appeals finds that clinical ecology is good enough science for Texas. Clinical ecology proves critical in keeping alive another claim brought by employees of Bridgestone/ Firestone in California. Other courts in Louisiana, California again, and South Carolina all weigh in on the side of clinical ecology in worker's compensation claims. One case arrives at a $3.9-million verdict, another at $16.25 million. Other clinical ecology-backed settlements for $8 million and $19 million have been reported.

The clinical ecologists, though not always successful, routinely do manage to give the wheel a great big spin. And for repeat players, a spin is good enough. On the plaintiffs' side, there is little to lose and much to gain. The lawyers and their witnesses can be quite content if jurists remain zealously agnostic, let it all in, and wait to see just what comes out. If the judge is agnostic, clinical ecology goes to the jury. If the jury is agnostic, perhaps it will split the difference. The difference between nothing (as urged by the defendants) and everything (as urged by the clinical ecologists) may turn out to be a very large number indeed, especially when "everything" encompasses all aches and chills, constipation and cancers in a 50-mile radius in the last five years.

What do top-notch scientists from the mainstream think of all this? One among them is Stuart F. Schlossman, chief of the Division of Tumor Immunology and Immunotherapy at the Dana-Farber Cancer Institute and professor of medicine at Harvard Medical School. Like Zahalsky, like Carnow, Schlossman studies and diagnoses the immune system. The similarity ends there. When asked about Carnow, Schlossman responds with a short chuckle and then a long sigh.

In print, however, Schlossman works with the swift, sharp precision of a surgical knife. In 1989, he published a postmortem on the Alcolac case in the Toxics Law Reporter. Day-to-day living, Schlossman explains, tests the immune system constantly, and when the immune system is really in trouble, the symptoms are plain. Real AIDS patients all suffer frequent, unusual, life-threatening infections. They are not, however, unusually susceptible to run-of-the-mill infections like colds, the flu, or bronchitis. Thus, as Schlossman points out, "if a patient has the kind of routine infections common to most people—even if he complains that he seems to develop one cold or sore throat after another—the astute physician will be able to conclude that there is nothing wrong in the immune system without needing any laboratory tests to reach that conclusion."

With the exception of Mary Landon, a 71-year-old cancer patient on chemotherapy, none of the Alcolac patients had suffered from any kind of recurrent infection at all. "The inquiry should therefore have stopped right there," Schlossman concludes. "Without any resulting infections, the finding of damaged immune systems—whether that damage be called 'dysfunction,' 'suppression,' 'depression,' 'total suppression,' or some of the more colorful phrases, makes no scientific sense." Only the elderly cancer patient on chemotherapy clearly did have immune-system problems.

In the great tradition of far-siders, Carnow has dodged and bobbed his way around this simple, devastating point. In his Alcolac testimony, he has explained away the absence of infection with what Schlossman terms the "amazing contention" that B-cell deficiencies lead to recurrent infection but T-cell deficiencies don't: "Recurrent infection is the consequence of B-cell abnormality, since the B system is that arm of the immune mechanism which relates to infections. [Linda Sanders's] abnormality, as with most of the Alcolac plaintiffs, was to the T cells—and they tend to relate to very specific types of infections, like tuberculosis and things like that, and they relate more to destroying cancer cells."

Here, in reply, is Schlossman: "This testimony is nothing more than scientific bamboozlement. Not only were all tests of Linda Sanders's T cells normal—and not only did she not have a 'very specific type of infection like tuberculosis and things like that' (whatever that means)—but it is utter nonsense to suggest that an abnormality of T cells does not lead to recurrent infections. One only needs to think of AIDS patients to realize that. As a result of their loss of T-helper cells, AIDS patients suffer many repeated and severe infections."

And what about the piles of laboratory tests and pages of numbers? Laboratory tests of the immune system's condition commonly produce results that vary from day to day, and from individual to individual, by 400 percent or more. There is no great significance in being on the edge here; the range of "normal" is too broad, the boundaries are too blurred. Few of the Zahalsky-Carnow tests were repeated, Schlossman points out, and of the few that were, none showed consistent abnormalities. Even the single readings presented no coherent picture of impaired immunity. Three claimed abnormalities involved trivial elevations, insignificant in themselves but in any event "clearly inconsistent with 'suppression.'" Nine other readings fell slightly below the "normal" range but were still not remotely low enough to suggest immunosuppression.

There were, finally, the monoclonal antibody tests—the tests that were so high-tech and exotic, so seemingly compelling, so tremendously significant in the eyes of Carnow and Zahalsky. Nine such tests had been used. Not one, however, had been approved for diagnostic uses by the Food and Drug Administration; all, in fact, bore warnings that they were not suitable for any diagnostic purposes. Carnow and Zahalsky used them anyway. None of the results, according to Schlossman, "even suggest a suppression in any of the plaintiffs' immune systems.…[There was no overall pattern to the results as one would expect if the plaintiffs had all been affected by a common chemical exposure."

On one test, nine plaintiffs had results above the reference range, and four had results below the reference range. One plaintiff had a slightly elevated response to one test, and a slightly depressed response to the next, "even though those two tests are supposed to measure the same thing—total T cells." Two other tests were also supposed to measure the same thing—natural killer cells—but only one plaintiff had results out of the reference range on both.

A similar degree of confusion surrounded another antibody test, which reportedly detected 14 abnormalities. Carnow testified that one patient's results showed "immature, unprogrammed lymphocytes, probably pre-leukemic cells." Schlossman responds: "There is no monoclonal antibody yet developed which is capable of detecting 'pre-leukemic cells' in the peripheral blood." There were other errors, ranging from trivial to gross. Natural killers, Zahalsky's statements notwithstanding, are not part of the T-4 population. HNK-L, Zahalsky notwithstanding, "is by no means a helper-cell antibody." And so on down the line, as Schlossman dismantles one mumbled, misdirected, mistaken claim after another.

Schlossman writes with a certain quiet authority on the subject. Most of the monoclonal tests relied on by Carnow and Zahalsky had been developed by Schlossman's own research team at Harvard. Researchers in Schlossman's lab were also the first to describe the T4R8 or helper/suppressor ratio, on which Carnow placed great emphasis. "[The expert testimony in Alcolac was not only outside the mainstream of science," Schlossman concludes, "it was outside its widest perimeter."

So if it's all so obvious, why couldn't Alcolac's lawyers convince a jury? We will never know. But we do know what convinced the appellate judges. And their reasoning, set out at exhausting length, does show how intelligent people can some times slide helplessly into junk science's flaccid embrace.

Alcolac's biggest mistake seems to have been to rely for its side of the scientific story on a middle-of-the-road expert, inclined (like good scientists generally) to caution and understatement: Daniel J. Stechschulte, M.D., a board-certified immunologist and internist, and director of the Division of Allergy, Clinical Immunology, and Rheumatology at the University of Kansas Medical Center.

As any competent immunologist will readily concede, chemicals can harm the immune system. Drugs used in chemotherapy and for organ transplants certainly do. Very high exposures to chemicals in industrial accidents may on occasion have similar effects, though moderate and short-lived. Stechschulte is competent, and he was skillfully cross-examined. What about the specific chemicals used at Alcolac's plant? Yes, they might in some circumstances be toxic to human cells. And to immunesystem cells? Well, they could be toxic to any cells. And if plaintiffs aren't suffering from any unusual infections quite yet, mightn't those infections materialize later? Yes, disease might "be just later down the road." Meaningless concessions, because they are so sweeping and vague, but perhaps highly significant for someone who is eager to be persuaded.

The appellate judges, in any event, are persuaded. Immunologists for both sides agree that "toxic chemicals of the kind emitted by Alcolac can adversely affect the immune system." The numbers seal the verdict. What is outside the "normal" range is "abnormal." An "abnormality" is a disease—actual, incipient, prospective, or whatever, but an injury any way you slice it. No need, then, to dwell on the details, on dosages and exposure levels, on the vast differences between chemotherapeutic drugs and ambient pollution, on the vapid generality of such phrases as "can be toxic to cells." Pure oxygen or water, as any competent scientist would readily concede, "can be toxic to cells" too, but no matter. Just grab a few mildly general concessions from the defendant's side and run. The colorful confidence of a Carnow or a Zahalsky, their "completely zapped" and "chemical AIDS" diagnoses, their mind-numbing arrays of mumbo-jumbo charts, tests, and tables, overwhelm the diffidence of a serious scientist on the other side.

So the appellate judges go firmly on record—in 371 pages, no less—endorsing Zahalsky, Carnow, and the clinical-ecology movement from beginning to end. On appeal, Alcolac's brief has attacked clinical ecology as "pseudo-scientific flimflam." It's nothing of the sort, replies the appellate court. "The methodology used by Carnow to arrive at diagnosis for each plaintiff here—that of differential diagnosis of risk variables and confounding factors as to each individual plaintiff—was the orthodox methodology of environmental medicine.…We reject, accordingly, the Alcolac contention that the diagnostic procedure [was] a new methodology not generally accepted 'in the relevant scientific community.'"

The relevant scientific community, however, has other views. Though the clinical ecologists say otherwise, their claims have not been ignored by mainstream science. Far from it—they have been reviewed in depth. The results of such examinations have been remarkably consistent: Clinical ecology is medical fantasy, not fact.

Most tellingly, the theory finds no confirmation in studies of people who have been exposed to chemicals at levels millions of times higher than those encountered through environmental pollution. Serious epidemiologists have studied immune-system responses following high exposures to suspect chemicals after accidental spills in the United States, Italy, Japan, and Taiwan. Several of these accidents involved enormously high exposures. Serious follow-up studies tracked various aspects of the immune system for many years. As of 1987, with data going back 40 years, "there had been no published evidence of disease resulting from impaired humoral or cell-mediated immunity in the subjects studied."

A review paper thus concluded, "In light of the great excess of immunologic capacity in the human and the compensatory shifts in response to injury that are known to occur in the immune system, it is unlikely that significant irreversible damage to the immune system has occurred" as a result of any of these exposures. Good science has quite firmly established that, though scads of toxins might theoretically harm immune-system cells and proteins, only a very few, usually delivered intimately, knock out immune response while leaving no visible marks on other body systems.

In a systematic examination of 50 patients that clinical ecologists had diagnosed as sufferers, Abba I. Terr of the Stanford University Medical Center found that "[n]o pattern of symptoms emerged to define a disease or syndrome." Physical examinations proved completely normal in two out of three cases. Laboratory tests showed nothing out of the ordinary either. Thirty-one patients were found to have multiple symptoms "most likely of psychological origin.…The circulating levels of immunoglobulins and lymphocytes in this subgroup of patients did not differ significantly from those in the other two subgroups or in normal persons when the effects of prior infections were taken into account." None of the patients was "cured" by the clinical ecologists' ministrations; "in fact, the number of symptoms reported by most of these patients significantly increase after such treatment, probably reflecting increasing fear of other possible environmental hazards."

In 1984, a task force appointed by the California Medical Association conducted an independent review of the clinical-ecology literature. Clinical ecologists presented their claims and specifically identified three of the best papers in their field. Two of those papers, the task force found, failed to define the disease being diagnosed or treated and failed to use proper controls. One claimed to have used double-blind testing but, in fact, did not. One reported results that had been crudely fiddled. And so on, through the three model papers and the rest of the clinical-ecology literature. "There is no convincing evidence that supports the hypotheses on which clinical ecology is based," the task force concluded. "Clinical ecologists have not identified specific, recognizable diseases caused by exposure to low-level environmental stressors."

A 1986 assessment of clinical ecology by the American Academy of Allergy and Immunology reached similar conclusions. "The idea that the environment is responsible for a multitude of human health problems is most appealing," it acknowledged. But there is no "satisfactory evidence to support the actual existence of 'immune system dysregulation' or maladaptation.…Properly controlled studies defining objective parameters of illness, properly controlled evaluation of the treatment modalities, and appropriate patient assessment have not been done." The "diagnostic and therapeutic principles used to support the concept of clinical ecology" are "unproven." One by one, other mainstream medical journals examined clinical ecology and found no "there" there.

So what maintains the faith of the clinical ecologists and their patients? Some, especially among the patients, certainly have an eye on litigation. Terr's systematic examination of 50 consecutive patients referred for reevaluation of a clinical-ecology diagnosis found that 43 were pressing worker's compensation claims and two others were pursuing tort claims against chemical manufacturers. Only five, apparently, had no specific financial interest in being sick, and one of those was involved in child-custody litigation.

In other cases, patients undoubtedly are sick, distressingly so, but the illness is not centered in their immune systems. A 1983 paper by psychiatrist Carroll M. Brodsky describes her examination of eight clinical-ecology patients. "[M]ost have a history of overt psychiatric symptoms," Brodsky reports. "All too frequently they are seen by the same network of physicians who subscribe to clinical ecology, and their self-perception and diagnosis of 'allergic' to most substances have become an organizing principle in their lives, central to their identity and life-style."

Money surely contributes to clinical ecologists' zealotry, but it is probably not their principal incentive. What most clearly characterizes the clinical ecologists today is their activist faith. Carnow exhorts the modem physician to political action. "Whether the defense or the plaintiff wins," admits another like-minded colleague, "we're going to be much more careful in the future about the way we use toxic chemicals as a result of my involvement in toxic tort litigation, and that's my purpose in this game." Many concede, more or less directly, that faith must come before the facts. Carnow allows that "[a] heightened level of consciousness" about the links between environment and disease "is critical to considering the 'disease syndrome.'"

Anthony Z . Roisman, a plaintiff's lawyer, is just a shade more careful in his credo: "Do I believe that immune damage is caused by toxic chemicals for which plaintiffs can recover in court…? Believe in it? Hell, I've seen it done. I believe." That is what clinical ecology comes down to. There is no science here, but none is needed. As one mainstream student of the cult has concluded, the clinical-ecology syndrome "constitutes a belief and not a disease." Unlike his patient, or at least unlike his patient's immune system, the clinical ecologist himself is an outlier, an aberration, a living example of dysfunction and pathology. He is perfectly adapted, in other words, to modern-day testifying. He is adept at prevaricating, playing on credulity, scoring verbal points, forgetting inconvenient data, and dredging up convenient anecdotes. He has experience with persuading, for his clinical practice depends entirely on persuading patients first that they are sick, then that they have been cured. He has vast experience with conflict, for he is forever in conflict with his mainstream cousins.

He survives only by hiding and equivocating, for good science deals ruthlessly with error presented directly in the open. He is not about to be sandbagged on cross-examination, for he has survived that sort of attack countless times before. Through it all, he remains, in the words of Dr. Elliot F. Ellis, a "generally quite charming, often charismatic, reasonable sounding physician…with a definite evangelical bent." He will be, in short, an excellent witness in court.

He will need to be. Let us visit with Bertram Carnow one last time. Yes, in court again—where else?—but this time appearing not as a witness but as a defendant. The plaintiff is one Paul L. Pratt, Esq., no stranger to courtrooms either, for Pratt is a plaintiff's lawyer and Carnow's one-time employer. According to published reports about the suit, Carnow "misrepresented to Pratt the number of times he failed the board examination in Internal Medicine and, in addition, lied under oath about it."

Pratt claims that had he known the facts, he would never have hired Carnow. Since Carnow's credibility as an expert witness is now ruined, Pratt refuses to pay $643,935.20 in outstanding promissory notes to Carnow, demands reimbursement of payments already made amounting to $1,624,596.29, and seeks over $15,000 in punitive damages. Carnow, for his part, is suing elsewhere for full payment. 

Peter W. Huber is a senior fellow at the Manhattan Institute and a columnist for Forbes.