No Environment in Medical Practice
Most of us need little convincing that the air in urban environments is polluted. Climates are changing. The belief that the food chain is contaminated with toxic chemicals is universal and readily validated. But, what branch of the medical sciences will responsible for the diagnosis and treatment of patients who suffer environmental disease? Who is studying and documenting the new patterns of illness that emerge from our continuously deteriorating circumstances? Where do sick people with ill-defined illness get help? Who is changing the curricula of medical schools and teaching medical students what is really going on out there?
The underlying idea of medical practice is to receive the sick and injured, patch their wounds and alleviate suffering when there is no effective treatment. Whatever the determinants of injury and disease are, the doctor and the hospital are ready to attempt rescue you. It is up to you, dear reader, to investigate the causes of disease and to change your food and environment so that you are less likely to become injured and ill.
Physicians who work in occupational medicine develop expertise in the toxicology of work environments. Government agencies such as NIOSH in the USA develop standards for limiting toxic chemical exposures and provide excellent sources of information about work hazards. The US EPA sets standards intended to reduce air and water pollution but its policies and powers are constrained by political interference.
Not much progress has been made in bringing knowledge of the environment into community medical offices and hospitals; in this regard medical practice reveals itself to be out-of-date and often irrelevant to the real needs of many patients. Instead the environment has come to hospital in the form of destructive winds, floods and sudden unexpected changes in environments that people often assumed to be more stable and enduring.
No medical specialty has assumed the responsibility of applying knowledge of environmental principles, ecology, or toxicology to all citizens. It is very difficult for anyone suffering any sort of environmental problem or chemical toxicity to get even a cursory hearing from public health authorities or individual physicians. Lung disease is usually treated as an individual problem with no reference to the environment that people with lung disease share.
The only physicians directly involved in toxicology issues work in occupational medicine and supervise working conditions in industries that expose workers to dust, molds, toxic chemicals and other hazards. Here the emphasis is on preventing acute exposures to know toxins in concentrations that are know to be harmful. In industrial settings and the community at large, little is known about the long term effects of chemical exposure at low doses and there is a tendency for "authorities' to deny illness caused by chronic exposure.
Allergists intend to deal with some of the medical problems caused by the environment, but often limit their knowledge and practice to a few selected environmental problems, such as hay fever and asthma. Even though asthma receives considerable research attention, the contribution of indoor and outdoor air pollutants is not well understood and ignored in medical practice. By narrowing the definition of allergy to type 1 hypersensitivity responses, allergists leave countless millions of patients without help. Some physicians perceive the shortcoming of the medical system and begin to move toward a new methodology. Many years ago, Knicker, a prominent Allergist and Immunologist, stated, in a challenge to his colleagues: "The estimated group of 40 million citizens with classical allergies is possibly the most underserved of all diseases in the U.S; medical marketing surveys suggest that many atopic individuals are not yet diagnosed or are poorly treated. In addition, there are countless millions of other individuals who have unrecognized adverse reactions to various antigens, foods, chemicals, and environmental or occupational triggers." (Knicker WT. Deciding the Future for the Practice of Allergy and Immunology 1985 Annals of Allergy.55;106-113 )
Selner and Staudenmayer stated: "...Allergists typically have focused exclusively on the respiratory system, the skin, and the gastrointestinal tract, to the exclusion of other body systems. They are generally not familiar with the vast toxologic literature which suggests that attention must be paid to symptoms other than those characteristically anticipated with IgE-mediated response. Allergists must broaden their interests to include all body systems other than those traditionally associated with immunological phenomenon if they are to appropriately respond to patients needs and society's expectations."
They referred to the need for a whole systems approach - a comprehensive approach to the interactions of food, air, and water with human bodies. While Knicker and others urged allergists and immunologists to emerge from the practice of narrowly defining their specialty, into the real modern world, with all its unsolved medical problems, the American and Canadian Allergy associations moved to further limit the scope of their practice and focused on skin tests for allergy and asthma as an allergic disease related to pollen and dust allergy. The needs of sick people were neglected while professional debates and methodological arguments continue to this day.
More Biology is Needed In Medicine
A biologist sees living creatures connected to and interacting with their environment. It is normal for a biologist to think in terms of populations, food supply, seasons, weather, and social-behaviors, and to do field studies which reveal patterns of adaptation to specific environments. Anyone who has worked with animals or fish in closed environments knows how critical environmental conditions and diet are in determining both the behavior and the physical status of the residents. When a fish in an aquarium displays disturbed behavior, you do not call a fish psychiatrist; you check the oxygen concentration, temperature, and pH of the water. You have to clean the tank and change the fish diet.
A proper biological method of medicine recognizes and solves problems in food, air, and water supplies. A steady flow of molecules from the environment enters the body of each individual through the air breathed and the food and liquids ingested. This body-input determines health and disease in whole populations over the long-term and the moment to moment functional capacity of the individual. The quality and composition of air, food, and water changes continuously. The illusion of food continuity in the supermarket conceals changes in the growth, contamination, storage, spoiling, transportation, and merchandising of food products.
History of Clinical Ecology
In the seventies, one group of environmentally-aware physicians, under the banner of "Clinical Ecology," made contributions to the clinical care of patients with "chemical sensitivities" or "Environmental Hypersensitivity Disorders." The ideas of this group have been summarized by Dr. Iris Bell in "Clinical Ecology". Bell stated: "Clinical ecology has developed over the past 50 years as a interdisciplinary offshoot of environmental medicine. Clinical Ecologists propose that chronic exposure to common foods, environmental chemicals, and natural inhalants...can trigger a wide range of mental, emotional, and physical disorders in susceptible individuals. Although clinical ecology began within the field of allergy, the theories of the two disciplines and their methods...have diverged...Classical allergic mechanisms (i.e. antibody IgE) are not necessarily involved, but other dysfunctions of the immune system have been implicated."
Traditional Allergists and Clinical Ecologists assumed an adversarial status. The American College of Allergists issued "Proposed Position Statements" to its members. The summary of its adversarial positions toward Clinical Ecology was as follows: "An objective evaluation of the diagnostic and therapeutic principles used to support the concept of clinical ecology indicates that it is an unproven and experimental methodology. It is time-consuming, and places severe restrictions on the individual's life-style...advocates of this dogma should provide adequate clinical and immunological studies supporting their concepts..."
The Ministry of Health of the Ontario (Canada) government appointed a committee to review "Environmental Hypersensitivity Disorders" (EHD). Their report is a valuable resource for anyone who is studying either the subject matter itself or the medical/political controversy it inspires: "In regard to the apparent dispute over who deals best with environmental illness, the committee stated: "...We have become increasingly dismayed at the polarized and adversarial positions taken in the United States on the issue of environmental hypersensitivity...We believe that confidence in the health care system is eroded when productive dialogue between different medical specialties disappears or is replaced by acrimonious debate before a confused public. Protagonists take positions that are clearly untenable: e.g. `all medical treatments are based upon sound scientific research; all the identified patients are emotionally ill.'...This committee feels strongly that taking an absolute stance in this field is not only risky scientifically, given that there is a great deal we do not know about our environment and its effects on us, but it is also unproductive and divisive, antithetical to the task of promoting collaborative efforts that will help in understanding and treating the problems of a growing number of patients."
We prefer clean air and water