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|I wrote a lengthy essay on MCS, and I need criticisms of it before I submit it. To all those knowledegable in this area, please offer me some criticisms!
I owe thanks to Albert Donnay and Martin Pall for helping me grasp the medical/ scientific literature.
MCS stands for Multiple Chemical Sensitivity. It is often called MCSS for Multiple Chemical Sensitivity Syndrome, or E.I., for Environmental Illness. None of the titles address the cause(s) of the disease, but only describe the symptom of chemical sensitivity (obviously).
For over 50 years, MCS sufferers have commonly been dismissed and misdiagnosed as having a mental/emotional disorder. Some have even been viewed as "fakes". They've been fired from and forced to quit their jobs; forced to live in tents in the woods, their cars, or wander streets homeless despite financial situations; and often forced to have no social interaction. Some cannot pump the gas for their cars or even put on the heaters in the car without becoming ill. They cannot go grocery shopping, go malls, movie theaters, or even to their friends' homes without becoming ill. Some of them cannot even read the newspaper because of the ink.
Children and teens with the condition cannot go to school without becoming ill. Many of sufferers end up getting divorced, losing their friends and family (due to being perceived as "too weird"), and end up living alone without any help. Many end up committing suicide.
"My book, The Dispossessed: Living With Multiple Chemical Sensitivities, is a compilation of photos and personal stories of people who have relocated to the Southwest because of MCS. Some 80 percent of MCS sufferers in the region are basically homeless, living nomadic lives in stripped-down mobile homes, old RVs, used cars, made-to-order tents, lean-tos and shelters. Unable to interact with society, many lose their jobs, homes, careers, marriages, families and friends, or even commit suicide, as a result of the profound physical pain and isolation. Often, the only link to the outside world is the telephone." ~ Rhonda Zwillinger
Medical and scientific literature, particularly from the last decade, offers a large amount of data on the nature of the condition. Despite the data, MCS is still not entirely recognized as even existing. In addition, there are biased scientists and organizations that are actually trying to prevent further research from even taking place, let alone being used to form policies to reasonably accommodate the sufferers.
This essay will not only provide a comprehensive look at MCS, but will also critique Traditional Medicine and many of its doctors. Traditional Medicine desperately needs to be updated.
In 1999, clinicians and researchers reached a consensus definition for MCS. The MCS criteria, which are nearly the same as those proposed by Cullen, are as follows:
1. "The symptoms are reproducible with [repeated chemical] exposure."
2. "The condition is chronic."
3. "Low levels of exposure [lower than previously or commonly tolerated] result in manifestations of the syndrome."
4. "The symptoms improve or resolve when the incitants are removed."
5. "Responses occur to multiple chemically unrelated substances."
6. "Symptoms involve multiple organ systems."
See McKeown-Eyssen et al, Arch Env. Health 2001;56:406-12; and "Chemical Poisoning, Abraham Lincoln, and Flashdarks" by Bonnye Matthews (Author of an excellent book) at http://www.fedworkerscomp.net/matthews.htm
It should be noted that critics say MCS cannot be properly studied since there is no agreed-upon definition on which to work with. Even if there were no agreed-upon definition---which there is as seen above--- that would not be a valid reason for skepticism: At this time SARS has no agreed-upon definition.
MCS refers to persons who are adversely affected by various chemicals, such as those found in perfumes, colognes, cigarette smoke, and so forth; with symptoms occurring in multiple organs/systems that usually wax and wane with chemical exposure. Individuals who claim such should be thoroughly studied, in large numbers; and preferably in an Environmental Medical Unit. That has been recommended for many years. Yet medical authorities are not giving out grants to perform such research (see end section for more information).
IS IT BIOLOGICAL?
A review of medical/ scientific literature on the subject will show that MCS can occur on a biological basis, and that similar problems can also occur on a psychogenic basis (I describe the model for such later on).
Clinical Ecologists often view MCS?s etiology as immunologic. Although Immune system abnormalities include chronic T-cell activation and elevated ANA (McGovern, 1983; Ziem, 1997), there are no consistent immunologic abnormalities (Ashford and Miller, 1998). Thus, the immunologic abnormalities, whatever causes them, should be viewed as secondary (as a consequence), rather than etiological.
Martin Pall reported that MCS is associated with, and may even be caused by elevated levels of nitric oxide/ peroxynitrite. According to Pall?s theory, the elevated levels of such are said to lead to neural sensitization, which then produces MCS.
Pall lists 10 facts that support his theory.
1. Several organic solvents thought to be able to induce MCS, formaldehyde, benzene, carbon tetrachloride and certain organochlorine pesticides all induce increases in nitric oxide levels.
2. A sequence of action of organophosphate and carbamate insecticides is suggested, whereby they may induce MCS by inactivating acetylcholinesterase and thus produce increased stimulation of muscarinic receptors which are known to produce increases in nitric oxide.
3. Evidence for induction of inflammatory cytokines by organic solvents, which induce the inducible nitric oxide synthase (iNOS). Elevated cytokines are an integral part of a proposed feedback mechanism of the elevated nitric oxide/peroxynitrite theory.
4. Neopterin, a marker of the induction of the iNOS, is reported to be elevated in MCS.
5. Increased oxidative stress has been reported in MCS and also antioxidant therapy may produce improvements in symptoms, as expected if the levels of the oxidant peroxynitrite are elevated.
6.... [See ANIMAL DATA]
7. The symptoms exacerbated on chemical exposure are very similar to the chronic symptoms of CFS (1) and these may be explained by several known properties of nitric oxide, peroxynitrite and inflammatory cytokines, each of which have a role in the proposed mechanism.
8. These conditions (CFS, MCS, FM and PTSD) are often treated through intramuscular injections of vitamin B-12 and B-12 in the form of hydroxocobalamin is a potent nitric oxide scavenger, both in vitro and in vivo.
9. Peroxynitrite is known to induce increased permeabilization of the blood brain barrier and such increased permeabilization is reported in a rat model of MCS.
10. 5 types of evidence implicate excessive NMDA activity in MCS, an activity known to increase nitric oxide and peroxynitrite levels.
The above is taken from "Multiple Chemical Sensitivity - The End of Controversy" by Dr. Martin L. Pall, Professor of Biochemistry and Basic Medical Sciences, Washington State University, at http://molecular.biosciences.wsu.edu/Faculty/pall/pall_mcs.htm. His work has been in peer-reviewed journals. Martin Pall can be contacted by phone at 509-335-1246.
Not mentioned in his essay, is the fact that the Gulf War combatants who became ill and complain of chemical sensitivity were administered pyridostigmine, which is metabolized by PON1. However, the ill veterans were deficient of PON1 and thus their bodies could not metabolize the pyridostigmine. Pyridostigmine inhibits acetylcholinesterase, thus increases Acetylcholine, which then increases NO levels. (Personal communication between Martin and I)
Albert Donnay has a competing theory a CO poisoning as a cause of chemical sensitivity. Excessive levels of CO will increase levels of NO via iNOS. "Marty's theory is just one little slice of what CO poisoning does to people", said Donnay (personal communication).
Interestingly, stress of all kind (emotional, chemical, etc) increase CO levels via HO-1. This could explain why emotional stress often heightens sensitivity in sufferers.
According to Donnay (2000), some MCS sufferers have elevated levels of CO after the standard 23-second breath hold (over 3ppm). However, this elevation could be due to chemical and mental stress via HO-1.
EEGs and P300:
1A. Donald Dudley, M.D., studied twenty patients with MCS (under Cullen's definition).
Auditory and visual P300 were influenced "significantly" when the olfactory system was stimulated with chemicals that had six or fewer carbon fragments. The patients were exposed to perfume, felt tip pen, and other everyday chemicals in an everyday amount.
Left and right P300 auditory were greatly decreased upon chemical exposure. Though the visual P300 was not decreased to the same degree (but decreased none the less), there was a significant change in waveform quality that caused two patients to have occipital seizures.
In other words, the brain waves of MCS sufferers go haywire upon being exposed to chemicals they are sensitive to. This is not the work of psychogenic disorders. (See Defining Multiple Chemical Sensitivity by Bonnye Matthews, pg. 24, summary of "MCS: Trial by Science")
NOTE: According to Dudley, the olfactory system sends signals to every part of the brain and uses excitatory amino acids in neuro-transmission.
1B. In 1996, Bell reported abnormal EEGs in MCS sufferers, which was disrupting their sleep. See "Biomarkers of MCS" by Albert Donnay.
1C. Bell, Miller, and Schwartz studied the EEG reaction(s) to chemicals within three groups of women. Group #1 reported MCS and no sexual abuse (SA); group #2 reported sexual abuse without MCS; and group #3 were healthy women (control group).
The three groups were exposed to chemicals with and without odor once a week for 3 weeks. Upon exposure group #3 showed little to no abnormal EEG activity; groups 1-2 showed electroencephalogram (EEG) alpha sensitization, with group #1 showing a much greater alpha activity than #2-3.
These findings suggest intermittent chemical exposure produce (varying degrees of) sensitization in persons with MCS and SA persons without MCS, which supports the theory that MCS is, at least partly, a manifestation of TDS.
The study also shows that MCS sufferers had abnormal brain waves that differentiated from the control group and the group with psychogenic illness.
See "EEG sensitization during chemical exposure in women with and without chemical sensitivity of unknown etiology", Toxicol Ind Health 1999 Apr-Jun;15(3-4):305-12
A tool used by Nuclear Medicine Specialists is the SPECT brain scan. SPECT stands for Single Photon Emission Computerized Tomography.
Rather than show brain structure like CAT or MRI scans, SPECT scans show functioning of the brain. "Perfusion impairment" means there is a decrease in the flow of blood.
2A. Neurotoxicologist Dr. Gunnar Heuser performed before and after SPECT brain scans in many MCS patients. The patients were scanned after chemical avoidance, and were then scanned again after being exposed to perfume. His research findings are as follows: MCS patients generally have a decreased flow of blood to the brain, which becomes further decreased upon exposure to perfumes (see Defining Multiple Chemical Sensitivity pgs. 27-30 and a response to the Interagency MCS draft report by Ann McCampbell, M.D.)
2B. Nuclear Medicine specialist Dr. Theodore Simon, who trained at Harvard, and his colleagues performed over 1,500 SPECT scans on MCS patients. 90% of these patients showed brain abnormalities and deterioration in brain function that increased upon chemical exposure. The changes that took place upon chemical exposure were "very different from the changes associated with psychiatric disease."
(See Ross, G.H., W.J. Rea, A.R. Johnson, D.C. Hickey, and T.R. Simon. 1999. Neurotoxicity in single photon emission computed tomography brain scans of patients reporting chemical sensitivities. Toxicol Ind Health 15:415-420; and "Response to Errors Prevalent in the Understanding of Environmental Illness" by Dr. Gerald H. Ross [M.D., C.C.F.P., D.I.B.E.M., D.A.B.E.M., F.A.A.E.M., and F.R.S.M. Past President, of the American Academy of Environmental Medicine])
2C. Dr. Gerald H. Ross (M.D., C.C.F.P., D.I.B.E.M., D.A.B.E.M., F.A.A.E.M., F.R.S.M., Past President of the American Academy of Environmental Medicine), in a documentary, discusses before and after SPECT brain scans: MCS patients were scanned in a clean environment and then scanned after being exposed to a substance that by history they report being sensitive to, "in an amount that's an everyday experience (...it's not as if they're sniffing glue---it's an everyday experience of exposure)."
MCS patients have abnormal brain functioning. After the patients were exposed to a substance they were sensitive to a "profound" deterioration in brain function took place. The area in which this function deterioration is present correlates with the brain-related symptoms reported by the MCS sufferers. (See MCS documentary "Multiple Chemical Sensitivity How Chemical Exposures May Be Affecting Your Health", directed by Allison Johnson)
Dr. Ross, M.D. is board certified in both Family and Environmental Medicine, and is a Fellow of England's Royal Society of Medicine. In addition he has treated over one thousand chemically sensitive patients.
These MCS brain abnormalities are not found in normal controls. (See "Response to Errors Prevalent in the Understanding of Environmental Illness" by Dr. Gerald H. Ross [M.D., C.C.F.P., D.I.B.E.M., D.A.B.E.M., F.A.A.E.M., and F.R.S.M. Past President, of the American Academy of Environmental Medicine])
2D. Howard Hu, M.D., MPH, and his colleagues, studied 27 sufferers with MCS (the diagnosis of such was made by board-certified environmental physicians), 19 sufferers with CFS, and 27 healthy persons for the control group.
Hu used SPECT imaging on all of the subjects. Both the MCS and CFS sufferers showed decrease in brain circulation whereas the control group did not.
See "MCS and SPECT Scans" by Jule Klotter in the Townsend letter for Doctors and Patients.
PET---which abbreviates "Positron-Emission-Tomography"--- scans are very accurate at showing brain function and metabolism.
"My personal experience (I have evaluated several thousands of chemically injured patients) has convinced me that MCS is based on a physiological and not on a psychological mechanism. This is why I have been interested in finding objective evidence for MCS", wrote Dr. Gunnar Heuser, M.D., Ph.D., FAC.P.
Like his SPECT studies, Heuser has also performed before and after PET scans. According to his studies, PET scans reveal that the brain stem, hypothalamic, and limbic areas of the brain are harmed by chemical exposures. In regards to radioactive glucose uptake, these areas of brain become hypermetabolic upon chemical exposure, showing activity that resembles "focal seizure activity."
Heuser wrote, "Since the limbic system contributes emotional reactions and interpretations to sensory input, and since patients with amygdaloid (the amygdala is part of the limbic system) seizures can develop panic and related attacks during an amygdaloid seizure, our data appear to explain the emotional instability during a reaction to chemicals.
The previously mentioned structures also serve memory and cognitive as well as neuroendocrine and autonomic nervous system functions, all of which can be deranged in a patient with MCS."
See Heuser G, Wu JC, Deep subcortical (incl. limbic) hypermetabolism in patients with chemical intolerance. Human PET studies. Annals of the NY Academy of Sciences. 2001(or his web page, "The Role of the Brain and Mast Cells in MCS"); and PBS' article at http://www.pbs.org/wnet/brain/scanning/pet
SUMMARY and CLARIFICATION of BRAIN-RELATED STUDIES:
Auditory and visual evoked potentials are "a measure of the ray at which nerves transmit messages from the eyes and ears to the brain", and are not influenced by emotional factors. Dudley's 20 patients were having serious, non-allergic reactions to everyday chemicals on a biological basis. I must ask, what condition did they have? Remarkably, the results of Dudley's research have been known for many years; yet, alleged skepticism of MCS has remained. Dudley said he had a very hard time having his research results placed in journals. I must also ask, just who is pushing bad science: MCS proponents--- who provide data to back up their claims--- or alleged skeptics that refuse to reply to the data? I am confident that the readers will be able to think for themselves and come to their own conclusions.
In an article on MCS Roy Dehart, MD, inaccurately wrote that Nuclear Medicine specialists say SPECT scans cannot be used to detect MCS. However, the reference cited actually contradicts Roy's statement: "S.P.E.C.T. and P.E.T. can clearly be used to delineate functional abnormalities of the brain regardless of the cause" ~ Ethical clinical practice of functional brain imaging, Society of Nuclear Medicine Brain Imaging Council, J Nucl Med 1996, 37, 1256-9. Clearly then, SPECT and PET can detect MCS, but only by manner of before and after challenge imaging.
Doesn't it strike you as very bizarre that hundreds of MCS sufferers would consistently have decreased blood flow to the same areas of the brain, if each one were experiencing a psychogenic disorder? The brain functioning of the MCS sufferers improved after going on a detoxification plan.
The SPECT and PET abnormalities seen in MCS are not seen in control groups and are distinct from the abnormalities seen in those with psychogenic illnesses.
In addition, research by Gary Schwartz, Ph.D., has shown that brain abnormalities occur when the patients are unaware of the presence of chemicals. That's at least "blinded."
Although this does not show the cause of the disease, it does show that chemicals, through biological mechanisms, actually are the cause of symptoms.
MORE ON THE BRAIN:
The central nervous system communicates with every organ in the body. When chemicals are inhaled the olfactory nerve can carry them right into the brain.
As we saw, the limbic region of the brain is usually greatly affected in MCS.
The limbic region influences the immune system. Thus, damage to that region may lead to immune abnormalities, such as auto-immunity (when the body attacks itself). Auto-immunity and other immune abnormalities in MCS have been observed, but not consistently---pointing to consequence, rather than an etiological association.
The limbic region also controls emotions/ moods and cognition. Thus, irritation or damage to that region can result in a feeling of always being asleep or in a dream, depression, anxiety, mood swings, and can even cause personality disorders, irrational fears, panic disorder, and bizarre behavior. It many cases persons with MCS see a psychiatrist who simply notes psychological symptoms, without requiring physiological testing, and makes a diagnosis of anxiety disorder, or panic disorder, both of which are inaccurate. The presence of psychological symptoms does not = psychogenic illness if physiological mechanisms can explain such symptoms. Both anxiety and panic disorder require no major physiological changes during "attacks", whereas in MCS there are profound physiological changes occurring during "attacks"/ reactions. Thus [real] MCS cannot be accurately labeled as a psychogenic illness, and any attempt to do so is in direct contradiction to solid, consistent laboratory data.
(^See Ashford and Miller, 1998)
Unfortunately, the above information has not been kept in mind when it is noted that MCS sufferers have a much higher incidence of anxiety, depression, and panic than do controls. (See "Anxiety and depression linked to chemical sensitivity" by Health Newswire reporters. See also J Nerv Ment Dis 2003 Jan;191(1):50-5 and Psychol Med 2002 Nov;32(8):1387-94.)
Of course, the anxiety and depression in MCS sufferers are also the result of tremendous physical suffering and being told that it's a belief system making them sick (Staudenmayer).
Insurance companies are usually unwilling to pay for high-resolution, 3-camera SPECT scans (which are the useful ones), as well as PET and FRMI scans. This is disgraceful, but typical of insurance companies. As my Father always says, "insurance is a business, but it shouldn't be."
Magnetic resonance imaging (MRI) is the standard for brain scanning. However, MRIs measure a magnetic signal and are based on the brain?s water content, and only look at structure, not function.
I think Magnetic resonance spectroscopy (MRS) should be explored in MCS. MRS is a brain imaging technique that measures chemical composition. It is excellent in diseases like Alzheimer's disease and can detect brain tumors early on.
Dr. Robert Haley from the University of Texas, and others studied the brains of 22 Gulf War veterans with a control group of 18 healthy veterans using MRS. While the healthy veterans did not show any brain damage, the ill veterans had up to 25% of their brain cells depleted. Such magnitude of brain cell depletion is found in multiple sclerosis, amyotrophic lateral sclerosis (ALS), and other degenerative brain disorders. The journal of Radiology indicates that the study has endured and passed rigorous peer-review.
Molecular and Cellular biologist Arthur Kerschen, in his essay on GWS wrote that GWS is "an unfortunate bi-product" of "Tremendous media hype" and went on to write, "Make no mistake about it, the proponents of Gulf War Syndrome will stop at nothing less than a large monetary settlement with the United States government, at taxpayers expense." I contacted Kerschen and informed him of the above data on the Gulf War Vets, including the earlier genetic discussion. He offered no rebuttal and has refused to do so.
See "Brain scans of Gulf War veterans show brain damage" by Mindy Baxter (648-3404)
ENZYME DEFICIENCIES and MAST CELLS:
88% of the Mayo Clinic's MCS patients tested positive for disorders of porphyrin metabolism (Donnay and Ziem, 1995). Many of Grace Ziem's (M.D.) MCS patients tested positive for multiple blood enzyme deficiencies, particularly ALA-D, PBG-D, UPG-D (Ziem and McTamney, 1997).
In 1996 Heuser discovered that some MCS sufferers had a disorder of mast cells. In 1987 Schwartz reported that during reactions some MCS sufferers had variably abnormal serum tryptase.
In the overlapping disease FM(S)---fibromyalgia (syndrome)--- it is reported that some of the sufferers have an excess of mast cells, as well as indications of elevated levels of nitric oxide.
But Martin Pall has written papers on this, stating that nitric oxide is known to stimulate mast cells and may be able to lower the synthesis of the porphyrin biosynthetic enzymes, causing the changes of such reported in the chemically sensitive (as well as in FM).
See Ziem, G. and J. McTamney. 1997. Profile of patients with chemical injury and sensitivity. Environ Health Perspect 105:417-436; Heuser, G. and Kent, P. 1996. Mast cell disorder after chemical exposure. 124th nnual Meeting of the American Public Health Association, New York NY, 20 November 1996 [abstract and presentation]; "The Role of the Brain and Mast Cells in MCS" by Gunnar Heuser, M.D., Ph.D., FACP; "Defining Multiple Chemical Sensitivity," pgs 31-58; and Irene Ruth Wilkenfeld's response to the interagency MCS draft report at http://members.aol.com/enviroknow/ATSDR/irene.htm
DOUBLE BLIND RESEARCH FINDS CAPSAICIN-INDUCED SYMPTOMS IN MCS NOT FOUND IN CONTROL GROUP:
12 sufferers with MCS (under Cullen's definition) and a control group were unknowingly exposed to inhalant capsaicin. As a result, those with MCS experienced symptoms whereas the control group did not. The MCS group was completely unaware that they were being exposed to anything yet they still had a reaction.
"We conclude that airway sensory reactivity is increased in patients with MCS, a finding which suggests that neurogenic factors may be of importance in this condition", said the researchers who performed the study.
See "Increased capsaicin cough sensitivity in patients with multiple chemical sensitivity" in the Journal of Occupational and Environmental Medicine, 2002, Nov;44(11):1012-7
A TEENAGER'S SCIENTIFIC BREAKTHROUGH:
2, 3-diphosphoglycerate---2,3-DPG--- is a metabolite of red blood cells involved in releasing oxygen. An abnormal concentration of either spectrum---concentrations too high or too low--- imply that the body is inadequately oxygenated. If the concentration is too low it means that such causes the inadequate oxygenation. When the concentration is too high it means that the inadequate oxygenation (whatever its cause) causes the excess of 2,3-DPGs.
Diseases in which excess concentrations of 2,3-DPG are found in are obstructive lung disease, anemia, congenital heart disease, and cystic fibrosis.
Dilnaz Panjwani performed several double blind studies that revealed and confirmed a biomarker for MCS, FM, and CFS, which many consider sufficient enough to serve as a diagnostic test for the conditions. The double blind studies showed that MCS/ CFS/ FM sufferers have excess concentrations of 2, 3-diphosphoglycerate (2, 3-DPG), showing that the tissues of such sufferers are demanding more oxygen.
The symptoms include severe fatigue, muscle inflammation, weakness, brain fog, and "complete debilitation." The excess can also lead to, or worsen psychological symptoms due to oxygen deprivation of the brain.
The US Military invited Panjwani to use her simple blood test in military research. (NOTE: Other blood abnormalities will be discussed later on).
See "Teenager Makes Scientific Breakthrough" at http://www.environmentalhealth.ca/fall99breakthru.html; "Teenager's discovery termed a medical breakthrough" By Latafat Ali Siddiqui at http://www.dawn.com/1999/19991223/int7.htm; and "Student's study unveils clues to chronic fatigue" By Pippa Wysong
I contacted Martin Pall and asked him how nitric oxide (NO) could explain the above findings. He wrote, "Nitric oxide binds to heme groups just as does carbon monoxide. Having said that, I would think that there are other, more plausible mechanisms by which nitric oxide might produce increases in 2,3-DPG including the vasodilatation produced by nitric oxide, leading to increased pooling of blood in the lower parts of the body and decreased perfusion in other tissues."
Interestingly, CFS (a condition that overlaps with MCS and is also frequently viewed as psychogenic) sufferers have high concentrations of lactic acid, which is what muscles produce when they metabolize glucose without an adequate supply of oxygen. The result of the lactic acid build up is severe muscle inflammation after exercising (yet this doesn't stop many doctors from labeling sufferers as "lazy").
CHEMICALS, ASTHMA, and SENSITIZATION:
In Johnson's MCS documentary, William J. Meggs, M.D., discussed the data on asthma and its relationship to chemicals. (It's an impressive documentary. Speakers include Meggs, Ashford, Miller, Ross, and Heuser.)
There is a type of asthma, which most MCS sufferers have, that Meggs refers to as "chemical irritant asthma." This type of asthma works as follows: When certain chemicals (typically those found in carpet cleaners and perfumes) are inhaled they bind to the nerve endings in the airways and produce inflammation, which leads to an asthma attack.
I am unaware of whether or not Meggs was referring to RADS: Reactive Airways Dysfunction Syndrome, which was described by Brooks in 1985 and is caused by a massive exposure to chemicals, which leads to airway sensitization. From that point on, low level exposures to common chemicals---perfumes, detergents, and so forth--- result in airway constriction. This is a known, accepted and recorded phenomenon of sensitization, resulting in chemical intolerance of the airways. The question that needs to be posed is that if such sensitization can occur in the airways due to chemical exposure, then why could not such sensitization occur in the Central Nervous System [AKA, MCS]?
See "Chemical Exposures Low Levels and High Stakes" (Ashford and Miller), 2nd edition, pg. 9
NOTES: The ALA and AMA both state that perfumes are triggers of asthma. In fact, statistics show there is a higher incidence of asthma among persons who live near perfume manufacturing areas. I am writing a paper on the formulas of perfumes and how they relate to public health, which will be more detailed with many references.
In Johnson's documentary, Ashford and Bell discuss the animal research on MCS. It turns out, that if you expose animals to the very same chemicals reported to induce MCS in humans, then the animals often develop chemical sensitivity.
Even large, powerful animals such as horses can develop chemical sensitivity (reported by ACTA, 1999: see http://whis.nzl.org/snftaas/pt20.html).
Martin Pall wrote, "In a series of studies of a mouse model of MCS, involving partial kindling and kindling, both excessive NMDA activity and excessive nitric oxide synthesis were convincingly shown to be required to produce the characteristic biological response." (Pall's "...End of Controversy") In other words, animals cannot develop MCS without excessive levels of nitric oxide.
What are we to make of this data? Can we seriously say with a straight face that chemically sensitive animals are simply depressed, or are faking? Maybe they are having panic attacks?
OTHER BIOLOGICAL ABNORMALITIES:
Bell (1998) reported that some MCS sufferers have an abnormal echocardiogram. Bell (1998) also reported respiratory abnormalities such as inflammation in larynx & trachea and abnormal methacholine challenge.
Wilcox (1996) reported that some MCS sufferers have low plasma volume, high plasma lactate, and decreased red blood cell mass.
According to Ziem (1998), many sufferers have impaired phase 1 (Cp450) detoxification. Ziem (1997) also reported peripheral neuropathy in some sufferers.
Meggs (1993) reported that some MCS sufferers show evidence of olfactory neurogenic inflammation and degraded nasal epithelium.
Galland (1987) and Ziem (1997) reported deficiencies in vitamins (especially B) and minerals, including zinc, selenium, and magnesium.
Heuser (1992) reported that some sufferers show markers of heavy metal and pesticide poisoning.
In 1963 the first double blind challenge study on MCS was performed. The study showed that MCS sufferers were able to distinguish between fresh water and water that had been chemically contaminated (but tasted the same). (See Kailin E, Brooks C. 1963. Systemic toxic reactions to soft plastic food containers: a double-blind study. Med Ann Washington DC 32(1):1-8.)
See "On the Recognition of Multiple Chemical Sensitivity in Medical Literature and Government Policy", by Albert Donnay, International Journal of Toxicology, 18:383-392; 1999; and Donnay's "Biomarkers of MCS"
PEER-REVIEWED LITERATURE and MEDICAL OPINION:
Both the Department of Housing and Urban Development and Social Security Administration favor the organic view of MCS.
Dr. Gerald H. Ross [M.D., C.C.F.P., D.I.B.E.M., D.A.B.E.M., F.A.A.E.M., Past President of the American Academy of Environmental Medicine, May 2000; Fellow of England's Royal Society of Medicine] describes the growing body of evidence for MCS's physiological causation in his May 2000 essay "Response to Errors Prevalent in the Understanding of Environmental Illness".
Ross was invited to a meeting on MCS by the American Chemical Society. There he presented his research on MCS patients and brain damage. He noted that about 75% of all the speakers there presented data that supported a biological origin of MCS, while the other 25% presented, for the most part, opinions that MCS is psychogenic.
Nicholas Ashford and Claudia Miller published the first definite report on chemical sensitivity in 1991. In 1998 they published a second edition of their book. Ashford said that between of the 7 years between the two editions of the book, there had been a "mass" of published research on MCS, and the majority of it supported a biological etiology. "The last seven years of research has not furthered the case for psychosomatic origins at all-but it has definitely furthered the case for physiological origins", said Ashford (HSE meeting---www.safe2use.com/ca-ipm/0099-10-08a.htm).
As of 1999, there had been at least 609 published peer-reviewed articles/ editorials/ book chapters relating to MCS. Of these, 311 support a biological origin while 137 support a psychogenic view. This gap is continuing to grow (Ross, 2000; Donnay, 1999, 2002). To argue that those 311 MCS references, which show or discuss physical/ biological data and/ or critique the psychogenic view and, again, exclude articles in the Journal of Clinical Ecology, were all tainted/ biased is absolutely ludicrous. In other words, excluding anything from clinical ecology, credible scientists favor the organic view of MCS over the psychogenic view by ratio of 2:1.
"It amazes me that in spite of all these publications on MCS, that some people continue to loudly proclaim that [it] is a non-existent illness" wrote Ross, who later wrote that people who say there is a "lack of evidence" in regards to "the prevalence and organic origins of chemical sensitivity are completely at odds with the weight of evidence and opinion in the published medical and scientific literature."
Skeptical position statements on MCS by AAAAI, ACOEM, etc. are in direct opposition to the majority of actual [solid] research on MCS and fail to even take such into account. Thus, skepticism from such authorities is irresponsible and unwarranted.
In 1995, the California Medical Association had been aware of some of the MCS literature and reclassified its anti-MCS position statement of 1985 as "a historical document only". Likewise, the American College of Physicians now has no position statement on MCS (which, in my opinion, is also irresponsible).
If you look at the references from skeptical position statements you'll notice that over 400, peer-reviewed articles and studies that support MCS's biological etiology are not cited, which implies that the "skeptics" are either unaware of contrary data, or are ignoring it. I like to give the benefit of the doubt, but as you'll see later on, the issue of "skepticism" appears to be political.
I've written to the AMA president several times and have not once received a reply. I've also contacted the ACOEM. ACOEM refused to provide a rebuttal.
"A report commissioned by the British Health and Safety Executive has concluded that [MCS] does exist and could be caused by chemicals
affecting part of the brain. The study, carried out by the Institute of Occupational Medicine and endorsed by the Department of Health, also links MCS with other unexplained 20th-century illnesses, such as chronic fatigue syndrome and ME." ~ Independent, London, March 19, 1999
What basis is there for skepticism?
See "Response to Errors Prevalent in the Understanding of Environmental Illness" by Gerald H. Ross, M.D.; "On the Recognition of Multiple Chemical Sensitivity in Medical Literature and Government Policy", by Albert Donnay, International Journal of Toxicology, 18:383-392. 1999
PSYCHOGENIC/PSEUDO CHEMICAL SENSITIVITY?
There are data showing that some people who believe they have MCS actually have a psychogenic disorder. A more consensus term for such is somatization disorder, which is a bodily reaction to---in this case (see below), sub-conscious--- stress.
An example of how this can occur is as follows: A young person (say age 6 or so) is molested, raped, or undergoes some other traumatic event. However let's say that during that traumatic event, there was a perfume scent in the air.
Later on in life, when that person smells perfume or fragrance similar to the smell present during the trauma, then the person may have a sub-conscious reaction to the smell, which is then manifested physically.
For such people, some form of therapy that goes into the sub-conscious would most likely be beneficial. (See Ashford and Millers' book, "Chemical Exposures - Low Levels and High Stakes", 2nd edition, pgs. 221-222)
The above people are often studied with the results being generally applied to real MCS sufferers. Thus, studies that show a lack of objective test abnormalities are not all necessarily "chemical industry propaganda", but rather a misunderstanding. Though I will say that it seems obvious to me that chemical industry propaganda does play a role.
Some persons experience hypersensitivity to lights (seen in MCS), sounds (seen in MCS), and odors (often confused with MCS). The last one is of significant importance. Hypersensitivity to odors can cause troubling symptoms in response to strong odors (i.e., perfumes/ colognes). With such individuals, masking the odor and then exposing them to the substance usually causes no symptoms. Studying such individuals may cause confusion since they do not have MCS, but do not have a psychogenic reason for reacting to the [strongly odorous] substances either.
Chemicals are known to worsen eczema so if a person only has a skin reaction to chemicals, but is unaffected in other organs/systems, then it is not MCS. And some people have RADS, but not MCS.
Another interesting phenomenon of the brain is that pseudo sensitivity can occur after a genuine sensitivity: Some genuinely react to chemicals, but then the sensitivity goes away. However, in some cases the brain, in effect, "learns" to be sensitive to substances containing chemicals that the sufferer previously reacted to. However, upon challenge testing, no major biological changes will take place. For those who think this is just too weird, know that this phenomenon has been seen in cases other than chemical sensitivity. It has been known for some time now that some people can have a few genuine seizures and then have the origin of such cease; yet the brain often then "learns" to have seizures in certain circumstances. It is called pseudo seizure. If we take someone who used to have a genuine sensitivity to chemicals, but thinks that he/she still does due to pseudo sensitivity and conduct blinded studies then there will not be a reaction that can be objectively measured. The result is that MCS is labeled "psychogenic."
There are some who have genuine chemical sensitivity but are so "used" to reacting to odors that they, due to anticipation, react to the smell of substances that do not contain problem chemicals. Challenge testing them with such substances will result in no biological changes taking place. The sufferer may be inaccurately diagnosed as having a somatization disorder.
Then there are also those who are faking.
None of this changes the fact that actual, biological sensitivity to multiple chemicals does occur very frequently. But, that fact is masked (pardon the pun) by all of the skewed research. How can a doctor who is unaware of all of these scenarios properly study patients claiming to have MCS? Indeed, this is a very big mess.
I'd say that most of the time that persons report MCS, it is really MCS and not one of the above phenomena.
SUMMARY of SCIENTIFIC DATA:
Stephen Barret wrote, "With these, however, the range of symptoms is virtually endless and typically does not correlate with physical findings or science-based laboratory tests." (Quackwatch) Clearly, Barrett is either dishonest, or alarmingly ignorant of scientific literature.
Professor Ashford said, "People don't read the literature... 'The science isn't there' means 'I haven't read it.'.... You don't need ironclad evidence when a variety of disparate compass needles are all pointing in the same direction. In my 30 years in the area of environmental health, I see that in no case have we been wrong about environmental problems. The problem either got worse, or the evidence became stronger. Only the most robust environmental and occupational problems ever get noticed: That's why we've never been wrong." Ashford, who has a degree in chemistry, is an environmental scientist who serves as an advisor to the United Nations.
"The toxicologists are leaving after the first act; how can they know what's going to happen in the end? And the doctors and clinical ecologists are walking in half way through the second act; they see what's going on, but it makes no sense to them", said Ashford.
In Ashford and Miller's second edition of their book, they discuss a truly remarkable aspect of the condition. The bodies of MCS sufferers basically become addicted to the substances they're intolerant of. Thus, not only do exposures to such substances cause symptoms, symptoms also occur in response to withdrawal from substances that they're intolerant of (which can last over a week).
In summary, although the etiology of chemical sensitivity is not known for certain (though Pall and Donnay's theories of NO and CO poisoning have more evidence supporting them than any other theory on MCS. I think the two work together to certain degrees depending on the case.), there are clear and abundant enough data to confirm the existence of chemical sensitivity on a biological basis.
Excluding, repeat: excluding clinical ecologists (who specialize in MCS and strongly believe it is biologically based), the majority of researchers who actually study MCS believe it does exist on a biological basis or at least that it can. Claims to the contrary are no longer justifiable. MCS "skepticism" is no longer a respectable opinion as it ignores the vast majority of medical/ scientific data.
In one group (we'll call this group BB group) there is a genuine sensitivity to -or intolerance of-- chemicals on a biological basis, which may lead to psychiatric problems if the limbic area of the brain is affected (in most cases it is).
In another group of sufferers (we'll call this group PB group) the sufferers react to chemicals on a psychogenic basis, often due to an early childhood trauma.
There may also be cases where the sufferer is reacting to chemicals on both a biological and psychogenic basis (i.e., subconsciously reacting due to a trauma, but also due to biological mechanisms). "Etiologies for these conditions can be wholly physical, wholly psychological, or varying combinations of the two", write Ashford and Miller. (See their book, 2nd edition, pgs. 221-222)
[And let us not forget the odor sensitivity phenomenon]
An analogy can be drawn from recent studies on food intolerance. It is now known that people can have food intolerances on a psychogenic basis; and it is undisputed that people can also have food intolerances on a biological basis. To study a few people with food intolerances on a psychogenic basis and apply the results to the general population, concluding, "there's no evidence that the foods actually trigger symptoms" would be ridiculous and no rational medical authority would agree with such a conclusion---yet why is that type of logic allowed to be applied to MCS research?
MCS skeptics commonly ignore the data on group BB, and focus entirely on group PB. This is made clear in the articles written by the MCS skeptic Michael Fumento. He appears to be unaware of--- or is ignoring--- a great deal of data that contradict his generalized conclusions. Fumento is on record as referring to MCS sufferers and advocates as "fragrant-phobic fruit cakes."
Whenever someone asks me what MCS is I usually try to define it in an understandable way: A condition in which the sufferer is extremely sensitive to various chemicals, usually man-made, and reacts to such whether being aware of their presence or not (to distinguish from psychogenic sensitivity). Sufferers are often 1,000 times more sensitive to---or intolerant of--- chemicals than average people are. [NOTE: There is some evidence suggesting that some sufferers are up to 10,000 times more reactive to chemicals than average people are.] Symptoms are often chronic and occur in response to multiple, unrelated chemicals and often include anxiety and depression (aside from such as secondary).
Sufferers are also intolerant of various foods, drugs (especially caffeine), and alcohol. Such intolerances are "hallmarks" for MCS (Ashford and Miller, 1998). Interestingly, in 1881 alcohol, food, and chemical intolerances were reported in persons with "Neurasthenia" (Donnay). Also, during the 2nd World War German soldiers who handled certain chemical nerve agents developed intolerances to alcohol and drugs, including caffeine (Ashford and Miller, 1998).
WHY SO MUCH SKEPTISM?
Recently the AAAAI reported a high incidence of the cholecystokinin B receptor allele 7---CCK-B receptor--- in MCS sufferers. This genetic linkage is associated with predisposition to "panic disorder." Thus, the researchers concluded MCS is most likely a panic disorder. However, CCK-B receptor modulates NMDA activity, which increases NO levels. Thus, the study ironically shows a genetic predisposition to NO poisoning among MCS sufferers, supporting Martin Pall's theory of MCS's etiology/ mechanisms (Pall, 2002).
There are seven major studies that are used to show MCS is a psychogenic condition. Dudley provided a devastating critique of these studies. In these seven studies, there were a total of 334 patients studied. However, no more than thirty-three of these patients actually had MCS. In five of the studies, none of the patients had MCS. Of the remaining two, in one study, eighteen out of forty-one had MCS, and in the other study no more than fifteen out of fifty-three had MCS. Thus, it is fair to state that the studies have nothing to do with the real MCS, since it was not studied. (See Defining Multiple Chemical Sensitivity, pgs 111-130) Since no consistent laboratory abnormalities were found, these studies have been used to say that there are no consistent laboratory abnormalities found in MCS patients, despite the fact that these seven studies did not involve MCS patients. Due to these seven studies, policies were made denying accommodations to people with MCS, more anti-MCS essays were written, and many MCS sufferers have been left in the dark to suffer with their condition without the medical support they deserve. (Note: If you would like me to list the seven studies and go into detail on them, please do not hesitate to ask me: I can be contacted at email@example.com or firstname.lastname@example.org) There are many other problems with the studies as well.
See the earlier section on Psychogenic Chemical Sensitivity for more information on the causes of widespread medical confusion over MCS.
In their article "Multiple Chemical Sensitivity Syndrome" (http://www.aafp.org/afp/980901ap/magill.html), Michael Magill (MD) and Anthony Suruda (MD, MPH) wrote, "About one half of the patients with multiple chemical sensitivity syndrome meet the criteria for depressive and anxiety disorders." That would still leave 50% who do not meet the criteria for depressive and anxiety disorders---does that mean they are faking? That is the implication since the authors doubt MCS occurs on a biological basis. The reasons behind high occurrences of depression and anxiety (and it is probably more than 50%) have already been stated in this essay, I just want the readers to get an idea of how poorly researched a lot of the skeptical medical essays on MCS are.
A recent study in Japan by Ojima M, et al., noted that some MCS sufferers felt "unpleasant" when exposed to harmless odors more often than controls (Tohoku J Exp Med 2002 Nov;198(3):163-73 ). There are several problems with this study: (1) Not all of the MCS sufferers demonstrated this phenomenon. (2) The researchers fail to realize that chemical-induced olfactory inflammation or damage could cause a change in odor perception, and (3) that the high levels of biological, chemical, and mental stress in MCS sufferers elevates CO levels, which causes odor sensitivity (and thus symptoms in response to odors with harmless chemicals). The sufferers could also have been experiencing an anticipation or learned response.
Dr. Ronald E. Gots testifies in court against MCS. He is depended on more than any other person is to discredit MCS.
Gots and other "skeptics" often claim MCS is contradictory to accepted principles of toxicology. That claim is based on the notion of "the dose makes the poison." Ashford and Miller severely criticized that notion, and its frequent combination with pseudoscientific observations by alleged skeptics. A notion more in line with scientific evidence is "the dose plus the host make the poison" (Ashford and Miller, 1998). For example---and I don't know why Ashford and Miller did not discuss this---, photosensitivity describes persons who are several magnitudes more sensitive to/ intolerant of sunlight than average persons are. That doesn't mean there is anything "toxic" about the sunlight, but rather the sufferers of such have biochemical/ metabolic abnormalities. The same is true of MCS (although many of the chemicals MCS sufferers react to are indeed poisonous. Disturbingly, some of such are even found in perfumes/ colognes.). Interestingly, photosensitivity is often found in MCS sufferers (Donnay & Ziem).
Gots has said that MCS "defies classification as a disease" and that it "has no consistent characteristics, no uniform cause, no objective or measurable features." He even went as far as to say that MCS "exists because a patient believes it does and a doctor validates that belief." Gots continues with such an attitude to this day, despite the data on porphyrin metabolism, brain waves, nitric oxide, 2, 3-DPG enzymes, PET scans, SPECT scans, and other data that contradict his assertions. Is this what passes as "science" these days?
Gots likes to focus on the fact that the exact cause and mechanisms of MCS have not yet been proven (though this may change due to Pall and Donnay's research). That is not a rational approach: MS (Multiple Sclerosis) has no known "uniform cause", nor even a diagnostic laboratory test, yet those would not be excuses to deny its harsh biological reality.
Ashford and Miller talk about Gots' earlier work in 95 and 96. Gots wrote, "[e]verything that is known about MCS to date strongly suggests behavioral and psychogenic explanations for symptoms." Ashford and Miller said Gots' statement was "unjustifiable," and that, "Even if he were correct about the absence of physiological evidence (and he is not), the presence of psychological problems in patients is not proof of psychological causation. The work of Fiedler et al. (1992), and that of Simon et al. (1990, 1993) amply demonstrate that there are MCS patients with no premorbid or subsequent psychological problems" (pg. 280). They go on to describe Gots' work of 95 and 96 as "recycled opinion."
In his 1998 book, "Chemical Sensitivity: The Truth About Environmental Illness", co-written with Stephen Barret, Gots wrote, "people do exist who are very sensitive to various micro-organisms, noxious chemicals, and common foods." He then goes on to say, "there is no scientific evidence that an immunologic basis exists for such a symptom pattern."
"Multiple chemical sensitivity has none of the characteristics of an immunologic disease, and as long as immunologic criteria are required as proof of its [MCS's] existence, it will be seen as a non-disease", wrote Donald Dudley, M.D. MCS is not an immunologic disease, yet Gots and Barret require the criteria of such for proof of MCS--- but MCS does not meet the criteria of an immunologic disease, hence, they conclude that MCS is not biologically based. That is poor judgement on the their part, as it is a flawed scientific approach. Terr (an allergist) also takes this approach, as do most other "skeptics."
Dr. Gots has never treated a patient with MCS. He is trained in pharmacology, and neither he, nor Barret have any training or certification in toxicology (Donnay's "Junk Journalism"). I bring this up because Gots is often introduced as being "a Toxicologist."
In addition, Gots and Barrett have not actually done any peer-reviewed studies on MCS. They only offer their interpretations on anti-or-non-MCS studies, and completely ignore peer-reviewed publications that contradict them. That is not in line with scientific integrity.
Barrett's own daughter has FMS, which overlaps with MCS over 50% of the time (Donnay, I.J.T., 1999). She invited Donnay to speak at a MCS conference!
Gots founded the "Environmental Sensitivities Research Institute" (ESRI)---an Institute whose contributors and board members consist of pesticide manufacturers; representatives from The Cosmetic, Toiletry, and Fragrance Association; and other industry dominated representatives. Those representatives each pay up to 10,000 dollars per year. (See Ashford and Miller, 2nd edition, pg.279)
Gots' former associate, Frank Mitchell, had a very big role in the completion of the 1998 Interagency Draft Report on MCS. Interestingly, the report failed to mention the policies of at least 14 Federal Agencies, an EPA report that showed a very high incidence of MCS among persons poisoned by certain pesticides, the full extent of porphyrin metabolism's association with MCS, and much more.
Gots also likes to blame MCS on "risk perception." This, despite a recent study showing no abnormality in risk perception inventory among MCS sufferers (Scand J Psychol 2002 Apr;43(2):169-75).
Albert Donnay---Environmental Health Engineer and certified CO analyst---also noted the reoccurring pattern of politically motivated data manipulation. Donnay wrote, "For years I have been struggling to overcome the deliberate efforts of numerous federal agencies to cover up the results of research on multiple chemical sensitivity (MCS) that they have funded both intramurally and extramurally. Just last August, the federal government's Interagency Workgroup on MCS released a draft for public comment of its long awaited policy statement on MCS. Although four years in the making and supposedly a comprehensive review, only one of the 8 agencies involved disclosed any data from its own MCS research. Several agencies, including the Centers for Disease Control and the Defense Department, even denied doing any MCS-related research.
Yet two major studies of Gulf War veterans by CDC have produced significant (p.05) data on MCS showing a 2- to 3-fold increased risk among deployed personnel in both studies and an overall rate of MCS among the deployed in the range of 5 to 5.6 percent. One CDC study has published its MCS data and one has not, but CDC fails to disclose either in its own policy statement on MCS. This is not out of ignorance, of course - CDC and the Defense Department know very well the relevance of their MCS data to an MCS policy statement, and their failure to disclose them in this context is itself a significant policy statement." (Science and Environmental Health Network)
In Johnson's documentary, Ashford spoke very firmly about the political factors surrounding MCS, saying, "...I think it has to be said, that the [chemical] industries... have done their best to produce, basically, foundless propaganda against the physical nature of this condition... this remains a serious problem---lack of a finite and significant budget [for MCS research]; we have the research recommendations--people have generally agreed on the research protocols---but not enough money to follow through with the recommendations, and the reason is basically political."
My challenge to alleged "skeptics" to refute the data and arguments put forth by MCS proponents remains unanswered. When a party cannot refute data, but instead makes unwarranted insults, it is usually because they are incorrect.
With all of this being said, I close with the words of Bonnye Matthews:
"They [MCS sufferers] have lost health, careers, financial resources, friends, family, and some have committed suicide because the pressure upon them was too great. This while the media makes of them a laughingstock and doctors play word games and chase geese. The barbaric treatment afforded these people is ignorant, unethical, and amoral."
Multiple Chemical Sensitivity: A 1999 Consensus. Arch Environ Health 54:147-149. By Bartha, L., W. Baumzweiger, D.S. Buscher, T. Callender, K.A. Dahl, A.L. Davidoff, A. Donnay, S.B. Edelson, B.D. Elson, E. Elliott, D.P. Flayhan, G. Heuser, P.M. Keyl, K.H. Kilburn, P. Gibson, L.A. Jason, J. Krop, R.D. Mazlen, R.G. McGill, J. McTamney, W.J. Meggs, W. Morton, M. Nass, L.C. Oliver, D.D. Panjwani, L.A. Plumlee, D.J. Rapp, M.B. Shayevitz, J. Sherman, R.M. Singer, A. Solomon, A. Vodjani, J.M. Woods, and G. Ziem.
"Multiple Chemical Sensitivity: A Spurious Diagnosis" by Stephen Barrett, M.D.;
The Interagency Workgroup on Multiple Chemical Sensitivity, August 24, 1998 (the report can be read online at http://www.health.gov/environment/mcs/toc.htm)
Responses to the above report at http://members.aol.com/enviroknow/ATSDR/main.html;
"Defining Multiple Chemical Sensitivity" by Bonnye E. Matthews. The book has chapters by 5 highly qualified Doctors. Also her online essay "Chemical Poisoning, Abraham Lincoln, and Flashdarks" at http://fedworkerscomp.net/matthews.htm;
"Anxiety and depression linked to chemical sensitivity" By Health Newswire reporters;
"Multiple Chemical Sensitivities (MCS): What It Is, What It Is Not, And how It Is Manifested" by Dr. Sheila Bastien, Ph.D.;
"MCS - A Medical Perspective" by Dr. Mark Donohoe, MB BS;
"Multiple Chemical Sensitivity (MCS)" by Rabin Prusty, MSCE;
"Multiple Chemical Sensitivity [:] How Chemical Exposures May Be Effecting Your Health", MCS documentary directed by Alison Johnson;
"Understanding & Accommodating People with Multiple Chemical Sensitivity in Independent Living" by Pamela Reed Gibson, Ph.D. James Madison University;
"Multiple Chemical Sensitivity: Potential Role for Neural Sensitization" by Barbara A. Sorg;
"The Role of the Brain and Mast Cells in MCS" by Gunnar Heuser, M.D., Ph.D., FACP at www.tldp.com/issue/210/roleoftheb.htm;
"Response to Errors Prevalent in the Understanding of Environmental Illness" by Dr. Gerald H. Ross, M.D., C.C.F.P., D.I.B.E.M., D.A.B.E.M., F.A.A.E.M., F.R.S.M., Past President, American Academy of Environmental Medicine;
"The MCS Debate: A Medical Streetfight" by Eric Nelson, The Free Press (Quote: "a growing body of evidence and literature - rarely cited by the proponents of psychological explanations for MCS - indicates that neurotoxic chemicals can irreversibly disrupt the central nervous system.")
"Corporate Manipulation of Scientific Evidence Linking Chemical Exposures to Human Disease: A Case in Point -- Cigarette Science at Johns Hopkins" by The Alexander Law Firm and Alexander, Hawes & Audet, LLP.
"Porphyria - Another Connection with Multiple Chemical Sensitivities" by Linda A. Thompson, M. Div.
"Comprehensive Protocol for Evaluating Disorders of Porphyrin Metabolism in Chemically Sensitive Patients" by Albert Donnay, MHS, and Grace Ziem, MD, DrPH;
"ENZYMATIC INFLUENCES causation of BRAIN CELL DAMAGE" by Dr Brian E. Goble Ph.D., Professor Physiological Toxicologist;
"Testing for Toxic Metal- and Chemical-Induced Porphyrinuria" by Carl P. Verdon, Ph.D., Terry A. Pollock, M.S. and J. Alexander Bralley, Ph.D., C.C.N.
"Porphyria-How Modern Chemicals Trigger the Vampire Disease" by Hart Brent;
"Integrated Defense System Overlaps as a Disease Model: With Examples for Multiple Chemical Sensitivity" by S.C. Rowat
"Multiple Chemical Sensitivity" by Heidi M. Hawkins, MAc, LAc
"Multiple Chemical Sensitivities" by the U.S. Department of Labor Occupational Safety & Health Administration
"Pesticides & brain-function changes in a controlled environment" by William J. Rea, MD, FACSCDirector Environmental Health Center-Dallas, Dallas, TX, Joel R. Butler, PhDCNorth Texas State University, Denton, TX, John L. Laseter, PhDCCenter for Bio-Organic Studies of the University of New Orleans
"Multiple Chemical Sensitivity - The End of Controversy" by Dr. Martin L. (Marty) Pall, Professor of Biochemistry and Basic Medical Sciences, Washington State University, at http://molecular.biosciences.wsu.edu/Faculty/pall/pall_mcs.htm
"Multiple Chemical Sensitivity Syndrome" by Michael K. Magill, M.D., and Anthony Suruda, M.D., M.P.H.
"Multiple Chemical Sensitivity (Environmental Illness)" by Stephen B. Edelson, M.D., F.A.A.F.P., F.A.A.E.M.
"Dubious Allergy-Related Practices: Clinical Ecology and the Feingold Diet" by William T. Jarvis, Ph.D.
"Chemical Exposures-Low Levels and High Stakes", second edition, by Nicholas Ashford (United Nations advisor with a degree in chemistry) and Claudia Miller, M.D.
"Biomarkers of MCS" by Albert Donnay, on MCS R&R's web site (updated in 2000)
"EEG sensitization during chemical exposure in women with and without chemical sensitivity of unknown etiology", Toxicol Ind Health 1999 Apr-Jun;15(3-4):305-12
"Brain scans of Gulf War veterans show brain damage" by Mindy Baxter, University of Texas Southwestern Medical Center at Dallas, Office of News and Publications, 2000
"On the Recognition of Multiple Chemical Sensitivity in Medical Literature and Government Policy", by Albert Donnay, International Journal of Toxicology, 18:383-392. 1999