Environmental illness.

Environmental Illness

This growing ailment of our improving standard of living is also known as Twentieth Century Illness and Multiple Chemical Sensitivity. It is being attributed to a number of chemicals in widespread use in our home and industry, including many that are components of coffee aroma. It could be responsible for decreased or discontinued consumption of the beverage by individuals subject to this complaint.

Increasing numbers of people ascribe to a wide array of their ill health symptoms, such as headaches, rashes, watery eyes, asthma, nasal congestion, fatigue, depression, etc. to very low levels of chemical fumes - amounts far lower than those defined as safe and free from toxicity hazards by the E.P.A. and other guardians of our national health.

In recent years, hundreds of people claiming to be victims of this affliction have filed (often successful) lawsuits seeking disability benefits under workman's compensation, social security or personal injury damages from work places or products. Large groups of professionals, including immunologists, toxicologists, epidemiologists, psychiatrists, psychologists, clinicians and others have begun to study the problem.

Although people with this illness are most commonly said to have an environmentally induced illness or chemical hypersensitivity disease, other descriptive names have been applied, depending on the form of illness that causes the suffering. These include such designations as cerebral allergy, immune disregulation, multi-chemical sensitivity syndrome, etc. The underlying causal concept is that common foods, beverages and chemicals create disruption of the immune system which leads to the development of physical and mental disorders.

Notwithstanding that there is no unanimously accepted definition for this poly-symptomatic disorder, it is usually diagnosed on the basis of reports of food intolerance or exposure to environmental pollutants; and the subsequent development of physical or mental symptoms in response to levels of such agents well tolerated by most people; and improvements in the sufferer associated with avoidance of these suspected agents. Further tests, elimination diets, oral food challenges that precipitated symptoms aid in diagnosis. In addition to avoiding the offending substances, special diets and symptom neutralization are the usual treatment.

The majority of the medical profession has been quite skeptical that this is a serious illness and ordinarily exhibits little sympathy for its victims. As a result, a subculture has developed around this concept largely led by a group of practioners who call themselves "clinical ecologists." These non-traditional unlicensed consultants claim to have expertise in diagnosis and treatment of environmental illness and its manifestations. They have their own organizations, journals, special hospitals/clinics and have acquired a substantial following.

Physicians are most likely to identify this affliction with a branch of psychiatry. They use the standard text book tests from the "Diagnosis and Statistical Manual for Mental Disorders" to demonstrate that these difficulties may be classified as personality disorders. Surveys have noted that individuals with diagnosis of environmental illness are mostly middle aged woman who tend to be well-educated, interested in details of their diagnosis, attend support groups and develop friendships with fellow sufferers.

A two-day workshop was held with experts concerned with this problem.

The working group on case evaluation agreed on criteria for the selection of subjects: They should have symptoms or signs related to food or chemical exposure at levels well tolerated by the population at large. (Exposures not to include well recognized allergies such as dust, mold or pollen). Symptoms must wax and wane with exposure, and may occur in one or more organ systems. It may not always be possible to identify the precise causative factor associated with the onset of the difficulty. Pre-existent or concurrent problems such as asthma, arthritis or depression should not preclude individuals from consideration.

A uniform database will be collected - to include the following information: history of sensitivity to foods, chemicals and drugs; dietary, smoking and medication background; and psychological screening information.

The group working on epidemiology suggested several different types of study be undertaken. These include a case comparison study involving occupational and environmental clinics that would enroll participants sensitive to low level chemicals. Psychological-psychiatric conditions, immune functions and neurological reactions would be assayed in these individuals along with suitable controls.

After review by the National Academy of Sciences, proceedings and recommendations will be published later this year. Annual meetings will be scheduled for progress reports and eventually more precise knowledge of cause and treatment may emerge.

Individuals suffering from environmental illness are believed by most psychiatrists to be genuinely ill with a disorder characterized by symptoms suggesting physical disorders wherein these symptoms are not voluntary. This contrasts with malingering which is the willful, deliberate and fraudulent feigning or exaggerating of illness symptoms to attain a specific benefit such as continuing sick pay, excuse from work, etc. It also contrasts with factitious disorder which is characterized by repeated intentional simulation of physical complaints for no apparent reason except obtaining attention and treatment. (This is also known as the Munchausen Syndrome.)

It is well recognized that individuals with environmental illness have extremely acute aroma acuity. They do not approach the smell of coffee as an overall bouquet like most people. Instead, like green coffee buyers, they are quite sensitive to the individual components that go to make up this fragrance. They have no difficulty detecting and reacting to single tones such as the mercaptan "skunk" component of freshly roasted ground coffee. Some can detect a nitrogenous, slightly fishy amine odor; the several different, more pleasant floral ester notes; the penetrating formaldehyde-like family of odors; or the alcoholic note in some types. When they are sensitive to any of these discrete types, even at the low level at which they are present, they may be repelled or even believe they are sickened by their effects, and will be turned off by the beverage. Hopefully, they might find that the objectionable note may be neutralized or overcome by one of the flavors now available in gourmet coffees, such as cinnamon, chocolate, vanilla, lemon, etc.