IS THERE anything new under the sun? Consider these excerpts:
An elderly neurologist in Marseilles told me about young Italian female patients, usually from southern Italy, who would be brought to his clinic .. in an ambulance, convulsing and thrashing in fits. "It would take four men to hold them down," he said. He cured them with sugar pills.(1)
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In every era, people have suffered varieties of symptoms not readily explained by "known" diseases of the day. To provide explanations and treatment approaches, individuals with symptom complexes were frequently provided a unifying disease label. At the turn of the 20th century, that label was autointoxication. Today, it is multiple chemical sensitivities (MCS). Autointoxication, a popular turn-of-the-century phenomenon[,] illustrates that absent common, reproducible, definable, and measurable findings and consistent, objective endpoints, newly named fad disorders have not survived long term. Autointoxication was a disorder very similar in manifestations to MCS. It was, we now know, a pseudo[-]disease, the treatment of which was based upon an unproved hypothesis. If MCS cannot withstand the probing of scientific investigation, it too will disappear as a diagnosis.(2)
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Clinical ecologists claim that various kinds of environmental insults may depress a person's immune system so that the exposed person develops a "multiple chemical sensitivity," that is, becomes hypersensitive to other chemicals and naturally occurring substances. According to this theory, not all persons will necessarily develop the same symptoms as a consequence of this hypersensitivity; each person exposed may present a distinctive profile.(3)
SEARCHING FOR MCS
Multiple chemical sensitivity (MCS) is a puzzling diagnosis. Its proponents believe that MCS results from chemical insult - almost any kind of chemical will do. What they cannot say is (1) what amount or concentration of a particular chemical, a mix of chemicals or indeed any chemical is necessary or sufficient to cause symptoms, (2) what time period the exposure must span before symptoms will appear, (3) what other conditions must be present to cause MCS, (4) what symptoms will result, (5) how long the symptoms will last, or (6) how severe the reaction will be. MCS detractors, on the other hand, believe that people who claim to have MCS are malingerers or suffer from psychological disorders and that doctors who diagnose the disease are more interested in the generous fees they collect for treating these patients than in accurate diagnosis.
MCS, as diagnosed by its supporters, encompasses almost any and every physical complaint, even contradictory ones, from runny noses to heart palpitations, from increased appetite to decreased appetite to ringing in the ears, from skin rashes to fungal infections, and on and on. The complaints in any given person are numerous and wide ranging. In virtually every case, the somatic complaints are entirely subjective. And despite Herculean efforts to find a mechanism for MCS, the etiology for the MCS disease process still eludes scientists in the field.
The group of practitioners who diagnose and treat MCS call themselves clinical ecologists or environmental physicians. They believe that MCS results when people become so overloaded with chemicals that they systemically are unable to cope with continuing interaction with chemicals. Clinical ecologists posit that at that point the individual's sensitivity "spreads" - that is, the individual ceases to be able to discriminate between the chemical that caused the initial reaction and other chemicals, or even among various concentrations of that same chemical. Thus, even minute amounts of some chemical can cause a severe reaction.(4) This theory, although creative, has not withstood scientific scrutiny.
Part of the problem with MCS rests with its greatest champions - the clinical ecologists. …