Grand Rounds in Environmental Medicine: information on MCS needed.

In the "Preface" to Grand Rounds in Environmental Medicine: Cases from an Emerging Discipline, Howard Hu (2003) stated that

   Part of the value of Grand Rounds stems from
   the appreciation that in real life, patients rarely
   present with cut-and-dry cases of illnesses as they
   are described in medical school. Real people have
   unique combinations of preexisting health conditions,
   symptoms, and complaints.

No truer words have been spoken about a chemically injured patient--but more words could be added. Alas, mainstream doctors are not trained adequately to diagnose symptoms and adverse health events from pesticide poisoning, not even when the patient describes actual exposures to the doctor. Try to imagine what it is like for a patient suffering from perfume poisoning. I certainly hope that Grand Rounds in Environmental Medicine will do much to change that.

I was pleased to see the list of environmental exposures that affect human health--both those that are more common, such as lead, mercury, asbestos, organophosphate pesticides, and polychlorinated biphenyls, and others that are more unusual, such as manganese, bromine, and carbon disulfide (Hu 2003). As Hu (2003) also noted, other factors are beginning to be accepted as environmental health hazards, such as cockroach allergen and violence.

Hu (2003) continues:

   Some [Grand Rounds cases] pertain to illnesses
   arising from occupations that entail combinations
   of exposures that may have acted synergistically.
   Some arise out of new research on illnesses
   and exposures that had not previously been
   linked together, such as infant pulmonary hemorrhage/Stachybotrys
   mold and possible estuary-associated
   syndrome. Others explore illnesses
   that are still of uncertain etiology and biology,
   such as multiple chemical sensitivities.

I would be even more pleased if modern flavors and fragrances appeared in the list.

I am often displeased to see articles in mainstream newspapers in which doctors advise patients with asthma to rid their homes of the "usual suspects"--cats, cockroaches, and dust and dust mites, sometimes including mouse feces and mold for good measure--without mentioning the potential harm that fragrance chemicals can cause for people with asthma or other diseases exacerbated by fragrance products.

Fragrances are not benign. Each scent is composed of untold combinations of highly volatile petrochemical derivatives. How many of these chemicals are in the air, being breathed and absorbed by user and nonuser alike? People have good reasons to avoid using scented products; for example, an individual may have adverse reactions to these products, or a pregnant woman may be concerned about the welfare of her fetus. Illnesses that may be affected by petrochemically derived flavors and fragrances include asthma and other respiratory diseases, migraines and other headaches, neurologic events, and even cancer.

Unfortunately, people who do not use scented products become users nonetheless--from sharing space with people who use these products. These chemicals cross not only the blood--brain barrier but also the blood--placental barrier. They go directly through the skin to target organs and are stored in adipose tissue. Whether these toxic chemical mixtures are used as flavors or fragrances, they play a major role in the adverse health events experienced by millions of men, women, and children, as well as developing fetuses. Too often, mainstream doctors do not consider that modern pharmaceuticals may be petrochemically derived and could contain petrochemically derived flavors and fragrances. No wonder there are skyrocketing rates of asthma and cancers, as well as high rates of iatrogenic diseases and deaths.

The public needs to learn of this information through sources such as EHP. Although it is possible to dig deeply enough to find some information on government agency websites, the general public cannot readily and easily access the information from the Food and Drug Administration, the U.S. Environmental Protection Agency, the Consumer Products Safety Commission, the Agency for Toxic Substances and Disease Registry, or the Centers for Disease Control and Prevention. These agencies have not done all they could to protect public health and well-being regarding adverse health events associated with synthesized flavors and fragrances.

As EHP builds a "compendium of Grand Rounds in Environmental Medicine," I fervently hope that information will be included about adverse health effects caused, triggered, or exacerbated by modern flavors and fragrances, particularly those of the last 30 years. The tens to hundreds of chemicals used to build each scent can cause the varieties of diseases and illnesses associated with multiple chemical sensitivity (MCS).

It is past time for public agencies, mainstream medical doctors, and everyone touched in any way by this life-threatening and life-changing malady to learn more about the effects of petrochemically derived flavors and fragrances. We all are stakeholders when it comes to breathing.

I appreciate EHP for providing the forum for presenting and discussing important topics such as this one. Additional information on MCS is available on the web (Environmental Health Network 2004; Fragranced Products Information Network 2004; Health Care Without Harm 2004; Manura 1998).

The author declares she has no competing financial interests.

Barb Wilkie

Environmental Health Network

Larkspur, California

E-mail: [e-mail]

REFERENCES

Environmental Health Network. 2004. EHN Homepage. Available: http://www.ehnca.org [accessed 3 March 2004].

Fragranced Products Information Network. 2004. Fragranced Products Information Network Homepage. Available: http://www.fpinva.org [accessed 8 March 2004].

Health Care Without Harm. 2004. Pesticides, Fragrances & Cleaners: The issue. Available: http://www.noharm.org/ pesticidesCleaners/issue [accessed 3 March 2004].

Hu H. 2003. Preface. In: Grand Rounds in Environmental Medicine: Cases from an Emerging Discipline (Hu H, ed). Research Triangle Park, NC:Environmental Health Perspectives, National Institute of Environmental Health Sciences, 6-7. Available: http://ehp.niehs.nih.gov/docs/ admin/EMpreface.html [accessed 3 March 2004].

Manura JJ. 1998. The analysis of perfumes and their effect on indoor air pollution. Available: http://www.sisweb.com/ referenc/applnote/pp-73i.htm [accessed 3 March 2004].