A Report on Multiple Chemical Sensitivity (MCS)

The Interagency Workgroup on
Multiple Chemical Sensitivity


August 24, 1998

Predecisional Draft

Table of Contents

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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