Introduction to Environmental Medicine and Clinical Ecology: how chemical exposure, allergens, and pollution affect human health

This is a new page that will provide information about Environmental Medicine.  One of the main concepts in Environmental Medicine is that we humans are adverse affected by the chemicals in our environment.  Some people are more sensitive than others, and these people often develop what is called, "environmental sensitivity", "chemical sensitivity" or "multiple chemical sensitivities." 

According to the published medical research, diseases associated with chemical exposure include nerve and brain damage, Parkinson's disease, autoimmune diseases such as lupus and rheumatoid arthritis and systemic sclerosis, and of course cancer, as well as infertility.  See the articles below for additional information. 

 

An evaluation of hexachlorobenzene body-burden levels in the general population of the USA.

Robinson PE, Leczynski BA, Kutz FW, Remmers JC.

IARC Sci Publ. 1986;(77):183-92

Hexachlorobenzene (HCB) is a chemical of concern to the US Environmental Protection Agency. Although the use of HCB as a fungicide has virtually been eliminated, detectable levels of HCB are still found in nearly all people in the USA. This paper describes an examination of HCB-residue levels from the US National Human Adipose Tissue Survey, which is an annual programme to collect a nationwide sample of adipose-tissue specimens and analyse them for the presence of toxic compounds. The specimens are collected from surgical patients and autopsied cadavers according to a multistage statistical survey design that allows identification of geographic and demographic subpopulations with elevated HCB levels, and thus may help to indicate sources of human exposure to this chemical. Data on HCB body-burden levels are available for the years 1974-1983, excluding 1980 and 1982. The estimated average residue level of 6115 specimens is 0.053 ppm, the ninetieth percentile value is 0.09 ppm and the range is 'not detected' to 4.33 ppm. The analysis reveals that while the percentage of individuals with detectable levels is increasing, the annual average level is decreasing. A large percentage of specimens with elevated HCB levels comes from the Pacific census division and the oldest age group. In comparison, world-wide detectable levels are approaching 100% and average residue levels tend to increase with age. World-wide HCB levels are higher in females, which contrasts with findings from the National Human Adipose Tissue Survey.

 

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We are the canaries: self-care in multiple chemical sensitivity sufferers.

Lipson JG.
Department of Community Health Systems, School of Nursing, University of California, San Francisco, USA.

Qual Health Res 2001 Jan;11(1):103-16

This ethnographic study investigates the experiences of living with multiple chemical sensitivity (MCS), a condition increasing in prevalence but medically contested, on which very little qualitative research has been done. Participant observation included two treatment centers, a support organization, an Internet chat room, and conversations with MCS sufferers, activists, and educators. Semistructured interviews were conducted with 33 people with MCS, recruited to reflect a broad demographic range and severity of illness variation. This article describes several methodological issues associated with doing "peer research" and then describes self-care for symptom management. With no known cure, MCS sufferers manage their symptoms through three main avenues: prevention/avoidance, detoxification, and emotional self-care. Implications include education of health care providers and a warning from those who have MCS: "We are the canaries in the coal mine; what has happened to us will happen to many others unless we clean up our environment."

 

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Multiple chemical sensitivity syndrome: a clinical perspective. I. Case definition, theories of pathogenesis, and research needs.

Sparks PJ, Daniell W, Black DW, Kipen HM, Altman LC, Simon GE, Terr AI.

Providence Medical Center, Seattle, Washington 98122.

J Occup Med 1994 Jul;36(7):718-30

Multiple chemical sensitivity syndrome (MCS) does not appear to fit established principles of toxicology. Yet social, political, and economic forces are demanding that MCS be defined medically, even though to date scientific studies have not identified pathogenic mechanisms for the condition or any objective diagnostic criteria. Consequently, a working definition of MCS can rely only on an individual's subjective symptoms of distress and attribution to environmental exposures rather than currently measurable objective evidence of disease. Nevertheless, patients labeled with MCS are clearly distressed and many are functionally disabled. In this review, four theories of causation are explored: (1) MCS is a purely biologic/physical or psychophysiologic reaction to low-level chemical exposures. (2) MCS symptoms may be elicited by low-level environmental chemical exposures, but the sensitivity is initiated by psychologic stress. (3) MCS is a misdiagnosis and chemical exposure is not the cause. The symptoms may be due to misdiagnosed physical or psychologic illness. (4) MCS is an illness belief system manifest by culturally shaped illness behavior. Areas for further research regarding the etiologies of MCS are suggested. Recognizing that the cause of the syndrome may be multifactorial, strategies are proposed for clinical evaluation and management in Part II of this manuscript using a biopsychosocial model of illness.

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Multiple chemical sensitivity: a 1999 consensus.

Arch Environ Health 1999 May-Jun;54(3):147-9

Consensus criteria for the definition of multiple chemical sensitivity (MCS) were first identified in a 1989 multidisciplinary survey of 89 clinicians and researchers with extensive experience in, but widely differing views of, MCS. A decade later, their top 5 consensus criteria (i.e., defining MCS as [1] a chronic condition [2] with symptoms that recur reproducibly [3] in response to low levels of exposure [4] to multiple unrelated chemicals and [5] improve or resolve when incitants are removed) are still unrefuted in published literature. Along with a 6th criterion that we now propose adding (i.e., requiring that symptoms occur in multiple organ systems), these criteria are all commonly encompassed by research definitions of MCS. Nonetheless, their standardized use in clinical settings is still lacking, long overdue, and greatly needed--especially in light of government studies in the United States, United Kingdom, and Canada that revealed 2-4 times as many cases of chemical sensitivity among Gulf War veterans than undeployed controls. In addition, state health department surveys of civilians in New Mexico and California showed that 2-6%, respectively, already had been diagnosed with MCS and that 16% of the civilians reported an "unusual sensitivity" to common everyday chemicals. Given this high prevalence, as well as the 1994 consensus of the American Lung Association, American Medical Association, U.S. Environmental Protection Agency, and the U.S. Consumer Product Safety Commission that "complaints [of MCS] should not be dismissed as psychogenic, and a thorough workup is essential," we recommend that MCS be formally diagnosed--in addition to any other disorders that may be present--in all cases in which the 6 aforementioned consensus criteria are met and no single other organic disorder (e.g., mastocytosis) can account for all the signs and symptoms associated with chemical exposure. The millions of civilians and tens of thousands of Gulf War veterans who suffer from chemical sensitivity should not be kept waiting any longer for a standardized diagnosis while medical research continues to investigate the etiology of their signs and symptoms.

 

 

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Multiple chemical sensitivity syndrome: a clinical perspective. II. Evaluation, diagnostic testing, treatment, and social considerations.

Sparks PJ, Daniell W, Black DW, Kipen HM, Altman LC, Simon GE, Terr AI.
Providence Medical Center, Seattle, Washington 98122.

J Occup Med 1994 Jul;36(7):731-7

Multiple chemical sensitivity syndrome (MCS) does not appear to fit established principles of toxicology. Social, political, and economic forces are demanding that MCS be defined medically, even though scientific studies have failed as yet to identify pathogenic mechanisms for the condition or any objective diagnostic criteria. Consequently, a working definition of MCS can only rely on a person's subjective symptoms of distress and attribution to environmental exposures rather than currently measurable objective evidence of disease. Nevertheless, patients labeled with MCS are clearly distressed and many are functionally disabled. Without reconciling the different theories of etiology of MCS discussed in Part I of this report, and recognizing that the cause of the syndrome may be multifactorial, strategies are proposed for clinical evaluation and management of patients with MCS using a biopsychosocial model of illness. The social implications of this illness are also discussed.

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Environmental chemical pollution and risk of human exposure: the role of organochlorine pesticides [Article in French]

Charlier C, Plomteux G. 
Service de toxicologie clinique, Laboratoire de Toxicologie clinique, (Belgique).
Ann Biol Clin (Paris) 2002 Jan-Feb;60(1):37-46

There is an increasing concern about environmental exposure to multiple chemicals and adverse changes in reproductive development, function, or behaviour in wildlife. The major group of environmental chemicals, such as organochlorine pesticides, polychlorinated biphenyls (PCBs) and other xenoestrogens are currently known to have estrogenic effects in vertebrates or fishes. Recent studies suggest that past exposure to such estrogenic compounds may affects the risk of developing breast cancer, precocious puberty, or impaired fertility in man.

 

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The organochlorine pesticide residues and antioxidant enzyme activities in human breast tumors: is there any association?

Iscan M, Coban T, Cok I, Bulbul D, Eke BC, Burgaz S.
Department of Toxicology, Faculty of Pharmacy, Ankara University, Turkey.
Breast Cancer Res Treat 2002 Mar;72(2):173-82

The levels of some organochlorine pesticides (OCP)s (hexachlorobenzene, HCB, alpha-hexachlorocyclohexane, alpha-HCH, beta-HCH, gamma-HCH, heptachlorepoxide, HE, bis (4-chlorophenyl)-1,1-dichloroethene, p.p'DDE, bis (4-chlorophenyl)-1,1,1-trichloroethane, p.p' DDT and total DDT (E-DDT) and antioxidant enzyme activities namely Cu, Zn superoxide dismutase (SOD), catalase (CAT), selenium-dependent glutathione peroxidase (Se-GSH-Px), total glutathione peroxidase (T-GSH-Px), selenium independent glutathione peroxidase (GSH-Px II), glutathione reductase (GRd), level of reduced glutathione (GSH) and lipid peroxidation (LP), glutathione S-transferase (GST) activity toward several substrates including 1-chloro-2,4-dinitrobenzene (CDNB), 1,2-dichloro-4-nitrobenzene (DCNB), ethacrynic acid (EAA), 1,2-epoxy-3-(p-nitrophenoxy)-propane (ENPP) were measured in tumor and surrounding tumor free tissues of 24 female breast cancer patients and was evaluated whether there exist any association between the levels of OCPs and antioxidants. The mean levels of GSH, alpha-BHC, gamma-BHC and HE, and activities of SOD, Se-GSH-Px, T-GSH-Px, GSH-Px II,GRd, GST CDNB, and GST DCNB were significantly higher in tumors than in controls. In tumors, significant correlations were noted between: SOD and y-BHC; Se-GSH-Px and gamma-BHC; T-GSH-Px and gamma-BHC; GSH-Px II and alpha-BHC, gamma-BHC; GSH and alpha-BHC, gamma-BHC, HE; GRd and alpha-BHC; CDNB GST and alpha-BHC, gamma-BHC. These results show that free-radical mediated oxidative stress is, at least partly, associated with some of these OCP residues in human breast tumors. 

 

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Human reproductive system disturbances and pesticide exposure in Brazil.

 

Koifman S, Koifman RJ, Meyer A.
Departamento de Epidemiologia e Metodos Quantitativos em Saude, Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, RJ 21041-210, Brasil. 

Cad Saude Publica 2002 Mar-Apr;18(2):435-45 

The observation of reproductive disturbances in humans and in the wildlife has been reported in the last decade in different countries. Exposure to different chemicals possibly acting in the endocrine system or endocrine disruptors, including pesticides, has been a hypothesis raised to explain the observed changes. This paper aimed to present results of an epidemiological ecologic study carried out to explore population data on pesticides exposure in selected Brazilian states in the eighties and human reproductive outcomes in the nineties. Pearson correlation coefficients were ascertained between available data pesticides sales in eleven states in Brazil in 1985 and selected further reproductive outcomes or their surrogates. Moderate to high correlations were observed to infertility, testis, breast, prostate and ovarian cancer mortality. Despite the restrains of ecologic studies to establish cause-effect relationships, the observed results are in agreement with evidence supporting a possible association between pesticides exposure and the analyzed reproductive outcomes.

 

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Peripheral neuropathy in workers exposed to nitromethane.

Page EH, Pajeau AK, Arnold TC, Fincher AR, Goddard MJ.

Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH 45226-1998, USA. 

Am J Ind Med 2001 Jul;40(1):107-13

BACKGROUND: Two workers from a headlight subassembly plant developed severe peripheral neuropathy. These workers had extensive, but brief (1-2 months) dermal and inhalational exposure to nitromethane, a solvent. METHODS: Environmental sampling was performed for nitromethane and ethyl cyanoacrylate. Medical records, including electrodiagnostic studies, were reviewed. Literature on nitromethane, ethyl cyanoacrylate, and other exposures in the workplace was reviewed. RESULTS: Electromyography and nerve conduction studies performed on these patients were consistent with a severe, axonal neuropathy. No etiology was discovered despite an extensive medical evaluation. Environmental sampling revealed exposure to nitromethane at the threshold limit value. CONCLUSIONS: The history of acute onset of severe peripheral neuropathy temporally associated with exposure to nitromethane is suggestive of a toxic neuropathy. While it cannot be definitively concluded that these two workers developed peripheral neuropathy secondary to exposures at work, occupational exposure to nitromethane appears to be the most likely etiology.

As you can see from the chart below, a great number of toxic chemicals have been "found in human tissues."  This means that toxic chemicals have been found in American citizens--people like YOU.  These chemicals are known to cause diseases, from cancer to autoimmune problems like lupus.

This page is still under construction.

Check back later, Partner!

Rocket Fuel Residues Found in Lettuce

BUSH ADMINISTRATION ISSUES GAG ORDER ON EPA DISCUSSIONS OF POSSIBLE ROCKET-FUEL TAINTED LETTUCE


PETER WALDMAN, THE WALL STREET JOURNAL:

The Bush administration has imposed a gag order on the U.S. Environmental Protection Agency from publicly discussing perchlorate pollution, even as two new studies reveal high levels of the rocket-fuel component may be contaminating the nation's lettuce supply.

The lettuce studies, one published [April 28] by a nonprofit environmental group and one in final preparation by an EPA laboratory in Athens, Georgia., address a crucial question in the current process of developing a federal drinking-water standard for perchlorate: whether Americans are ingesting the chemical from food sources in addition to drinking water. The answer, according to both studies, strongly suggests they are, which means that any eventual drinking-water standard will have to be that much stricter to account for the other sources of perchlorate exposure.

Perchlorate pollution in drinking water has become a major concern in some 20 states across the country, after an EPA recommendation last year that found perchlorate in drinking water poses dangers to human health, particularly to infant development, in concentrations above one part per billion.

The Pentagon and several defense contractors, who face billions of dollars in potential cleanup liability for perchlorate pollution, vehemently oppose that EPA health-risk assessment, arguing perchlorate is safe in drinking water at levels 70 to 200 times higher than what the EPA says is safe. In January, U.S. Sen. James Inhofe, (Rep.- Oklahoma.) chairman of the Senate's Environment and Public Works Committee, weighed in on the industry's side with a long list of questions and criticisms of the EPA's report.

The White House recently proposed a bill in Congress, in the name of military "readiness," that would effectively exempt the Pentagon and defense industry from much of their potential liability for perchlorate cleanup.

In another step, the White House Office of Management and Budget intervened last month to delay further regulatory action on perchlorate, by referring the health debate to the National Academy of Sciences for review, according to people familiar with the matter. Pending that study, which could take an additional six to 18 months, the EPA ordered its scientists and regulators not to speak about perchlorate, said Suzanne Ackerman, an EPA spokeswoman.

The gag order prevented EPA scientists from commenting or elaborating Friday on the two lettuce studies, which show lettuce, available in U.S. supermarkets, appears to absorb and concentrate perchlorate from polluted irrigation water in significant amounts. Other scientists familiar with the studies said both are limited in scope and are only suggestive, not conclusive, on the question of whether Americans are consuming perchlorate in food.

According to these scientists, definitive data on the perchlorate content in U.S. produce --- specified as a top EPA and Pentagon research priority in the late 1990s --- were supposed to have been available at least two years ago. But in 2000, after much time and effort had gone into designing a perchlorate study plan with the U.S. Department of Agriculture's Pesticide Data Program, the Defense Department refused to fund the roughly $215,000 needed to collect vegetables for sampling, said Cornell Long, who heads perchlorate research on food sources for the Air Force.

"In a perfect world, we would have that farm gate data now" on vegetable content, Mr. Long said. "Everybody thought it was a good idea."

Mr. Long attributed the Pentagon's decision not to fund the study to bureaucratic issues involving budget cycles. Some environmentalists, however, say the Defense Department simply didn't want to know if perchlorate was in the U.S. food supply because of liability concerns.

"If they can spend $1 million on a cruise missile, it seems kind of ridiculous they won't spend $200,000 to see if our food is contaminated with rocket fuel," said Renee Sharp, a staff scientist with Environmental Working Group in Oakland, California, which initiated its own lettuce study instead.

Using private funding, the environmental group paid Texas Tech University, of Lubbock, Texas, to test 22 lettuce samples purchased in January and February in the San Francisco Bay Area. It chose the two winter months because nearly 90% of the nation's winter lettuce supply is grown in the desert in Southern California and Arizona with perchlorate-tainted irrigation water from the Colorado River.

The results: Four of the 22 samples tested were found to contain perchlorate in excess of 30 parts per billion, with the highest --- "mixed organic baby greens" --- registering 121 parts per billion. After a flurry of mathematical extrapolations, the group concluded that 1.6 million U.S. women of childbearing age --- the population of greatest concern --- are exposed daily to more perchlorate than the EPA's recommended safe dose from winter lettuce alone.

"We don't claim this study is conclusive," said Ms. Sharp, its primary author. "We're saying, 'Isn't it scary we only took 22 samples and found so much perchlorate in four of them?"'

The EPA's own study, which was completed and peer-reviewed several weeks ago but has yet to be publicly released pending final adjustments, showed that lettuce grown in a greenhouse with perchlorate-contaminated water absorbs and concentrates the chemical at varying rates depending on leaf location. The study, reviewed by The Wall Street Journal, found the outer leaves of the lettuce, which the study's authors wrote are usually not eaten, concentrated perchlorate by a factor of 17 to 28, meaning the outer leaves contained 17 to 28 times more perchlorate in them than did the water used to irrigate the plants. The concentration factor for the "emerging head" -- the part people usually eat --- was three to nine, the study found.

Hence, if those results are found to be applicable to winter lettuce grown with Colorado River water, which contained between three and ten parts per billion of perchlorate, the perchlorate concentration in the edible leaves could range as high as 90 ppb --- fairly close to the 72 parts per billion average perchlorate level that the Environmental Working Group found in its supermarket survey. The group says that level, for lettuce consumers, is four times the EPA's recommended daily dose for perchlorate.

"The studies have indicated we have reason for concern," says Allen Jennings, director of the USDA's office of pesticide management policy in Washington. "That's why it's critical to get as many foods as possible from the real world to find out."

References and additional information:
http://www.organicconsumers.org/toxic/lettuce042903.cfm
http://www.rhinoed.com/epa's_gag_order.htm
http://www.peer.org/press/508.html
http://yubanet.com/artman/publish/article_13637.shtml
"It is simply intolerable that the EPA, instead of providing an example for open scientific discussion, has continuously violated key environmental legislation, stifling legitimate dissent. The failure of EPA to properly encourage and protect whistleblowing has undermined the ability of the EPA and state environmental agencies to enforce environmental laws."
http://www.whistleblowers.org/statements.htm