| Ilena Rose 2004-10-29, 7:16 pm |
| The Medical Denial of Environmental Illnesses
Harold E Buttram, MD
Introduction:
As a matter of personal opinion and observation, there is at present a
dichotomy of almost schizophrenic proportions between ongoing American
scientific research in the medical field, most of which takes place in
academic institutions and medical centers, and the genuine needs of
the American public.
The scope and direction of this research, most of which is funded by
the National Institute of Health (NIH), is of tremendous importance in
that it forms a source of guidelines and a scientific foundation for
the clinical practice of medicine. In other words, the clinical
practice of medicine as it exists today has been largely shaped by
decisions made in the NIH and other government health agencies in the
granting of research money.
This is a system which has existed since the 1930s, but there may be
serious misdirections which are proving to be very costly in terms of
the health and welfare of the American public, especially as applies
to its children.
There are two medical conditions from which it is predictable that
American society and economy will be strained to the breaking points
in coming years by overwhelming numbers of medical indigents unless
these conditions are addressed effectively and decisively in the very
near future.
The two conditions to which I refer are childhood autism and
environmental illness with chemical sensitivity, neither of which are
being recognized for their true nature by mainstream medicine because
of a misdirection of research funding in certain key areas, as will be
reviewed in the following:
Childhood Autism, Predominantly an Environmental Illness
In regards to childhood autism, a condition characterized by severe
mental regression, fifty or so years ago autism was so rare that many
pediatricians had never heard about it. At least this was the
experience of Dr. Bernard Rimland, founding director of Autism
Research Institute. In 1956 Dr. Rimland, whose Ph.D. is in research
psychology, had a son who was later found to be autistic.
In his annual DAN (Defeat Autism Now) conferences Dr. Rimland is fond
of telling the story about the early days with his son during which he
had great difficulty in finding a pediatrician who knew anything about
or who had ever seen a case of autism. How different it is now.
Childhood autism has become so prevalent that there are very few who
do not know of a family with an autistic child. Families with two
autistic children are not uncommon, and I personally have seen a
family in which all three of the family's children were autistic.
Latest statistics estimate that over one half million American
children are autistic, (1) and with numbers steadily growing, there is
no end in sight. It can be expected that treatments will improve the
outlook of these children, but as far as is known at present, many or
most of these will require custodial care for life, at an average cost
to society as much as three million dollars per child. (2)
In the opinion of this observer, the misdiagnoses in childhood autism
come not in the diagnosis of the condition itself, something that is
unmistakable once one has seen a few children with the condition, but
from a failure to recognize autism as predominantly an environmental
illness. (In this instance the term, "environmental illness," is used
to include illnesses brought about by exposures to commercial
chemicals and medical interventions as well infectious microorganisms
and other exposures from the natural environment).
This statement is based on a recent seminar on childhood autism held
in the Washington D.C. area as sponsored by the National Institute of
Health and other health agencies September 6th and 7th, 2001, at which
the largest portion of the meeting was devoted to areas of genetics
and neuropathology of autism. (3)
As related to childhood autism, it should be stressed that the field
of genetics involves a susceptibility to autism but, except in rare
instances, has nothing to do with its causes. The same could be said
about virtually all epidemic-type diseases, in which there will be
variability in genetic susceptibility.
By their very nature, epidemics always arise from environmental
sources of one type or another and not from genetic causes. Genetic
changes take place very slowly in an evolutionary scale over a period
of millennia and never with the rapid increases as seen today with
autism.
Major areas now under suspicion as being causally related to childhood
autism include childhood immunizations, (4) toxic environmental
chemicals, (5) commercial food processing, (6) and the overuse of
antibiotics. (7) The only possible way of salvaging the situation is
to find and modify the causes while at the same time doing the very
best we can to develop effective treatments for those already
afflicted with this condition.
Childhood Immunizations - Deficiencies in Basic Science and Safety
Guidelines
As reflected in a series of U.S. Congressional Hearings concerning
issues of vaccine safety which have taken place annually since 1999,
(4) there is now growing awareness of major deficiencies in safety
testing for current childhood immunizations.
A few examples will be given here:
(a) Safety studies on vaccinations are limited to short time periods
only: several days to several weeks. There are no (none) long-term
(months or years) safety studies on any vaccination or immunization.
(b) In 1994 a special committee of the National Academy of Sciences
(Institute of Medicine) published a comprehensive review of the safety
of the hepatitis B vaccine. When the committee, which carries the
responsibility for determining the safety of vaccines by Congressional
mandate, investigated five possible and plausible adverse effects,
they were unable to come to conclusion for four of them because they
found that relevant safety research had not been done.
Furthermore, they found that serious "gaps and limitations" exist in
both the knowledge and infrastructure needed to study vaccine adverse
events. Among the 76 types of vaccine adverse events reviewed by the
IOM, the basic scientific evidence was inadequate to assess definitive
vaccine causality for 50 (66%). The IOM also noted that "if research
.... (is) not improved, future reviews of vaccine safety will be
similarly handicapped. (8)
(c) In an article published in Adverse Drug Reaction & Toxicology
Review, (9) researchers Andrew Wakefield and Scott Montgomery, who
have been investigating a possible causal relationship between the MMR
vaccine (measles-mumps-rubella) and the autism enterocolitis syndrome,
carefully reviewed inadequacies of the early pre-licensing trials of
the MMR vaccine with a maximum follow up of 28 days and even shorter
periods in some of the studies.
They stressed that such short periods of observation following the
vaccine were totally inadequate to detect delayed reactions, including
pervasive developmental delay (autism), immune deficiencies, and
inflammatory bowel disease, which are known from earlier published
reports to occur following both the natural measles infection and the
measles vaccine.
The most interesting feature of the Wakefield/Montgomery article was
that it was reviewed by four leading British authorities, all of whom
had previously held positions in the regulation and licensing of
medicines in the United Kingdom. (10) Taken as a whole, the reviewers
were supportive of the article, three highly so. Peter Fletcher,
formerly a senior professional medical officer for the Department of
Health wrote, "being extremely generous, evidence on safety (of the
MMR vaccine) was very thin."
Noting that single vaccines for measles, mumps, and rubella already
existed, he argued, "caution should have ruled the day ... the
granting of a product license was definitely premature." Professor
Duncan Vere, former member of the Committee on the Safety of
Medicines, agreed that the periods for tests were too short. "In
almost every case," he wrote, "observation periods were too short to
include the onset of delayed neurological or other adverse events."
(d) In 1984 an intriguing study was reported in a little noted
letter-to-the-editor in the New England Journal of Medicine in which a
significant though temporary drop in T-helper lymphocytes was found in
11 healthy adults following routine tetanus booster immunizations.
(11) Special concern rests in the fact that, in 4 of the subjects, the
T-helper lymphocytes fell to levels seen in active AIDS patients.
If this was the result of a single vaccine in healthy adults, it is
sobering to think of the possible consequences of multiple vaccines
(19) within the first 6 or so months of life at latest count) given to
infants with their immature and vulnerable immune systems.
Unfortunately, other than clinical observation, we can only speculate
at these consequences, as the test has never been repeated.
Environmental Illness - Deficiencies in Basic Science and Safety
Measures
In my opinion, the second area of misdiagnosis is the common approach
of mainstream medicine in dealing with environmental illness and its
related condition of multiple chemical sensitivity (MCS). In contrast
to the American Medical Association, which denies the existence of MCS
as a valid diagnosis, there is a group of physicians in the field of
environmental medicine who believe that millions of Americans are
being made ill and sensitized in various degrees to toxic airborne
chemicals from a class of chemicals known as volatile organic
compounds (VOCs).
(12) Illnesses brought about by breathing these chemicals inside
buildings are referred to as "The Sick Building Syndrome." A number of
official government and health agency publications have been issued on
this subject. (13-18) However, the major thrust of most of these
publications is to stress how little we actually know about the
effects of these chemicals and emphasize the over-riding need for
further safety research in this area.
As pointed out in the text, Multiple Chemical Sensitivity, (National
Research Counsel, 1989), "about 70,000 chemicals are used in commerce,
of which several hundred are known to be neurotoxic. However, except
for pharmaceuticals, only 10% have had any testing at all for
neurotoxicity, and only a handful of these have been evaluated
thoroughly." (19)
Since the publication of Multiple Chemical Sensitivity, the situation
has changed in one respect: There is now a substantial body of
literature dealing with occupational exposures to solvent-type
chemicals or VOCs, prominent among which are publications by Lisa
Morrow and coworkers at the university of Pittsburgh, several of which
are sited here. (20-23)
For the issue of multiple chemical sensitivity, on the other hand, it
is far different. Once again we are faced with major deficiencies in
safety-oriented studies on the effects of potentially toxic
environmental chemicals on the human system and of safety measures
that would have followed, had these studies been done. Basic science
in this area, at very best, has been fragmentary.
For this reason and this reason alone, evidence for support of the
diagnosis of MCS has not yet reached standards of scientific proof.
However, the fact that adequate research has not yet been done to
prove its existence, it does not follow that MCS has been disproved or
that it does not exist. Yet, this is the practical conclusion one
generally finds in mainstream medicine.
Based on my own experiences in many workman's compensation cases
involving airborne chemical exposures, the near universal response of
mainstream medicine has been to deny its existence.
As a result, many patients with more advanced forms of chemical
sensitivity are becoming like the lepers of ancient times, disabled
outcasts of society, and their numbers are growing larger by the day.
(24)
However, we are not entirely barren in this area. Though small in
number and preliminary in nature, there are a number of publications
tending to confirm a widespread presence of MCS in our population,
publications which can form a nucleus for further study. A few of
these are enumerated below:
(a) Two publications involving studies with SPECT brain scans have
shown impairments in brain functions resulting from chemical
exposures. (20,25)
(b) In a recent study of a group of veterans with the Persian Gulf War
Illness, an activated coagulation system was found with platelet
activation and fibrin deposits on the endothelial surfaces of blood
vessels, which resulted in a constriction of blood flow. The authors
concluded that heavy exposures to toxic chemicals during the Gulf War
in all probability were the underlying cause of the pro-coagulant
state, although other possible causes were also mentioned in the
article. (26)
(c) Studies of patients with chronic fatigue and fibromyalgia at the
Electron Microscopy Unit at the Adelaide Institute of Medical and
Veterinary Science, Australia demonstrated deformities in the red
blood cells (RBCs) of these patients described as dimpled spherocytes
(rather than the normal oval shapes of RBCs) along with increased
rigidity of the RBC membranes, these changes resulting in reduced flow
of the RBCs as a result of their deformities.
The article went on to point out that a great majority of these
patients had been exposed to environmental chemicals, some working in
chemical factories, others in wheat fields or orchards subject to
periodic pesticide/herbicide sprayings, many patients noting
deterioration following these exposures. (27)
(d) In an article by P Beaune and coworkers, the term "suicide
inactivation" was used to describe the mechanism whereby foreign toxic
chemicals may damage and cripple the enzyme systems necessary for
detoxification and elimination of toxic chemicals. (28) This now
thought or suspected of being a major factor in the pathogenesis of
MCS.
(e) Among those working in the field of environmental medicine, (12)
The Environmental Health Center in Dallas, Texas has always been
considered a major center of research in this field. Authored by
William J. Rea, M.D., much of the work of this center has been
recorded in a four-volume set of books with the simple title, Chemical
Sensitivity. (29)
Many of those familiar with this center believe it will in time be
accredited with being one of the earliest centers to fully recognize
the increasing impact of foreign chemicals on human health and to do
meaningful, systematic study in this area.
With reports such as these now in the scientific literature, further
documentation and confirmation of environmental illness and MCS as
valid diagnoses cannot be long in following, along with a more
realistic appraisal of their prevalence.
Finally, no treatment of environmental illness would be complete
without mention of possible ongoing damage being done to the
reproductive systems of both men and women when exposed to toxic
airborne chemicals during their reproductive years, (30) or of fetal
damage when women work in such conditions during their pregnancies.
(5) Although as yet largely theoretical, sooner or later these are
issues which must be addressed.
Conclusions:
In the late 1800s and early 1900s there was a time now referred to as
the golden age of medical diagnosis. Those were the times of Sir
William Osler of Johns Hopkins University, remembered as the father of
internal medicine, and of other stellar names of the times. In those
days doctors took time to listen to their patients, and equally
important, took very seriously the information given by the patient.
It was a time of clinical observation, when doctors believed what
their eyes told them and deduced diagnoses based on these
observations. It is no small coincidence that the mythical master of
observation and deduction, Sherlock Holmes, the creation of Sir A
Conan Doyle, was based on a physician that Doyle had known in his
student days.
How does this compare with today? Based on personal experience, very
few doctors listen to parents of autistic children, or if they listen
to them, very few believe what they are told by the parents. (31)
This is even truer for patients with environmental illness who, in a
majority of cases in my experience, are commonly referred to
psychiatrists or psychologists by their physicians, their physicians
telling them that their symptoms are psychosomatic or imagined.
However, in defense of doctors directly involved in care of the
public, it is doubtful that there has ever been a time with greater
demands on their time combined with greater economic/political
pressures intervening in the care of their patients than at present.
Most of them are doing the best they can under the circumstances.
I take great pride in being a medical doctor. I would not change
places with anyone in the world. But I also fear for the future of my
profession. Whether in the realm of nature or human affairs, all
things must remain relevant to survive. In the natural world all life
forms must adjust to their environment or perish.
In the healing professions, these professions must both recognize and
address the genuine needs of the public or stand in danger of passing
into the limbo of forgotten things. Actually I believe the medical
profession will survive, but to do so will require a higher level of
vision with issues surrounding childhood autism and environmental
illness than has been the norm until now.
For practicing physicians to recognize the nature of their patients'
problems and treat them properly, the physicians must be provided with
valid science by those engaged in research, science realistically
directed at the genuine health needs of the public.
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