VI. Organizational
Statements Relating to MCS
Several organizations have issued formal statements about
MCS. Selected portions of several of these statements are presented here. The statement of
the American Academy of Environmental Medicine (AAEM) differs from those of other medical
organizations. All these statements request the caring and compassionate evaluation of the
MCS patient.
United States:
AAEM has published its philosophy in An Overview of the Philosophy of the
Academy of Environmental Medicine (AAEM, 1992). This statement suggests that the
nature of system dysfunctions can best be elucidated by the application of a comprehensive
model of environmental medicine. Definitions of key terms used in their model were
presented in Section III. The Overview also presents in detail AAEM's approaches to
the diagnosis and treatment of MCS.
A number of other medical organizations have also issued formal statements about MCS or
closely related issues. These include the American Academy of Allergy, Asthma and
Immunology (1986, 1997), the American College of Physicians (1989), the American College
of Occupational and Environmental Medicine (1991), and the American Medical Association
(1992). Their statements are, in general, skeptical of MCS as a distinct disease entity
and critical of the quality of MCS research. The following examples represent the
viewpoints contained within these statements.
The American Academy of Allergy, Asthma and Immunology, which updated their position
statement in 1997, included the following in their statement: "[B]ecause of the
subjective nature of the illness, an objective case definition is not possible. Allergic,
immunotoxic, neurotoxic, cytotoxic, psychological, sociologic, and iatrogenic theories
have been postulated for both etiology and production of symptoms. There is no scientific
evidence to establish any of these mechanisms as definitive. . . A causal connection
between environmental chemicals, foods, and/or drugs and the patient's symptoms is
speculative and not based on the results of published scientific studies."
The American College of Physicians (1989) concluded that
provocation-neutralization therapy is unproven. They recommended that clinical ecologists
who want to definitively study provocation-neutralization testing and neutralizing therapy
establish a precise definition of the condition to be diagnosed and treated, and document
the fact that study subjects meet this definition.
The American College of Occupational and Environmental Medicine (1991) stated their
views on multiple chemical hypersensitivity syndrome (MCHS), commenting "[I]t is the
position of the American College of Occupational and Environmental Medicine (ACOEM) that
the MCHS is presently an unproven hypothesis and current treatment methods represent an
experimental methodology. The College supports scientific research into the phenomenon to
help explain and better describe its pathophysiological features and define appropriate
clinical interventions."
The American Medical Association (AMA) (1992) includes in their position
statement on clinical ecology: "[U]ntil such accurate, reproducible, and
well-controlled studies are available, the American Medical Association Council on
Scientific Affairs believes that multiple chemical sensitivity should not be considered a
recognized clinical syndrome." A subsequent report, Indoor Air Pollution,
which was coauthored by the American Lung Association, AMA, the Consumer Product Safety
Commission, and EPA stated that "[T]he current consensus is that in cases of claimed
or suspected MCS, complaints should not be dismissed as psychogenic, and a thorough workup
is essential. Primary caregivers should determine that the individual does not have an
underlying psychological problem and should consider the value of consultation with
allergists and other specialists" (American Lung Association, 1995).
In addition, the published statements from all these groups have called for further
study and publication in peer-reviewed journals of other specific research areas,
including adaptation/deadaptation, spreading, and diet rotation techniques.
International:
In February 1996, a workshop organized by the International
Program on Chemical Safety (IPCS) in collaboration with several of Germany's federal
health and environmental agencies met in Berlin to discuss multiple chemical
sensitivities. Invited participants represented a range of disciplines involved in
researching, investigating, and treating MCS and other environmental illnesses. The
majority of the invited participants suggested that the term "idiopathic
environmental intolerances" (IEIs) should be used to describe MCS, because they
concluded that there were neither accepted theories of underlying mechanisms nor validated
clinical criteria for diagnosis, and a relationship between exposures and symptoms was
unproven (IPCS, 1996).
The recommendations of the workshop included the use of the descriptor IEI only after a
thorough examination of patients, careful consideration of alternative explanations, and
focused interdisciplinary approaches for the diagnosis and treatment of these patients.
Research recommendations included challenge studies to distinguish psychogenic from
toxicogenic or other responses and epidemiologic research directed at the prevalence of
relevant symptoms and demographic, time, and disease correlates. There was a call (1) for
communication and cooperation between all responsible healthcare systems, institutions,
and insurers to coordinate approaches to patient care; and (2) for the promotion, through
the World Health Organization (WHO) of a continuous exchange of knowledge and
international cooperation on research into IEI.
After the meeting, controversy arose about the workshop's conclusions and
recommendations that were sent to the workshop attendees (Abrams et al., 1996; Dayan,
1996; Goldman et al., 1996; Mercier et al., 1996), and no final report has been issued.
However, a summary of the workshop's recommendations can be found elsewhere (Lessof,
1997).
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