The full circle: from the Minamata disaster to the sick building syndrome. (Correspondence).

Pekkanen and Pearce (1) recently focused on the challenges and opportunities of environmental epidemiology. Their paper recalls to our minds the fascinating story of humans and environment: they continuously look for the best milieu for their lives. First, they think that industrialized areas are better than natural areas; then they reason that returning to the natural environment is probably better, always being sure that each choice is the safest. However, no choice allows environmental risks to be completely abolished, and the only way to cope with the problem of environmental risks is to face them [as Pekkanen and Pearce (1) did, by looking for the best studies to evaluate these risks], not to believe they have been blunted.

Can you imagine a paradise better than that of Minamata Bay, facing the Shiranui Sea in Japan? It has blue sea, white sand, green shrubs, burning sun, and bright stars. But in the mid-1950s, some unexplainable occurrences brought panic to Minamata: birds were strangely dropping from the sky, cats committed "suicide," and people began to notice a "strange disease" that caused numbness in limbs and lips, slurring of speech, vision constriction, uncontrollable shouting, involuntary movements, and unconsciousness.

The risk came from 27 tons of mercury compounds dumped into Minamata Bay from 1932 to 1968 by a company developing plastic, drugs, and perfumes, through the use of acetaldhyde, which is produced using mercury. Over 3,000 victims suffering from degeneration of the nervous system have been recognized as having Minamata disease (2,3).

Paradise was only a dream; good health in a pure, uncontaminated area cannot continue in the absence of safety controls.

Humans thought they had learned the lesson and began to construct safer buildings, as a modern paradise with many comforts and far from environmental risks. But, in the mid-1970s, some unexplainable occurrences brought concern: people living in recently built houses began to suffer somatic and psychological symptoms, including arthralgia, eye and throat irritation, cough, rash, pruritus, enhanced and/or abnormal odor perception, visual disturbances, mild to severe headache, nausea, vomiting, restlessness, and sleeplessness. Some volatile component of the building materials or some biological contaminant (perhaps endotoxin, mycotoxin, or trace elements) might be causing this unique systemic syndrome, the so-called sick building syndrome (4,5).

This constructed perfection was also a dream. Good health in an artificial, sophisticated structure is not guaranteed even in the presence of better safety controls, or perhaps by the presence of modern technological devices such as humidifiers and ventilation systems.

Nature is less perfect and more vulnerable than we used to surmise; for humans living on the earth crust, each new direction has its disadvantages. Can people win against the environment? Looking at environmental epidemiology with its opportunities and challenges (1) is a largely better approach than that of dreaming about unlikely simple and perfect solutions, such as that of coming back to pure, uncontaminated nature or waiting for a completely technology-modified environment.

Human life, either "natural" or industrialized, has some challenges, as both the Minamata disaster and the sick building syndrome demonstrate. A concern for sick building syndrome does not justify the claim that pure uncontaminated nature (including Minamata Bay or fresh unsterilized milk often containing tuberculosis bacteria) is the best goal for humans. A logical and scientific approach to the problem, such as that offered by Pekkanen and Pearce (1), must be shared because it offers the only possibility for humans to survive. Living without risks is impossible, but lowering the threshold of risks is necessary.

REFERENCES AND NOTES

(1.) Pekkanen J, Pearce N. Environmental epidemiology: challenges and opportunities. Environ Health Perspect 109:1-5 (2001).

(2.) TED Case Studies. Minamata Disaster. Available: http://gurukul.ucc.american.edu/TED/minamata.htm [cited 1 August 2001].

(3.) Minamata, and then.... Available: http://vest.gu.se/ ~bosse/Mercury/Culture/Events/minamata.html [cited 1 August 2001].

(4.) Bourbeau J, Brisson C, Allaire S. Prevalence of the sick building syndrome symptoms in office workers before and after being exposed to a building with an improved ventilation system. Occup Environ Med 53:204-210 (1996).

(5.) Redlich CA, Sparer J, Cullen MR. Sick building syndrome. Lancet 349:1013-1016 (1997).

Piero Stratta
Alessandra Messuerotti
Caterina Canavese
Department of Internal Medicine
S. Giovanni Molinette Hospital
Torino, Italy
E-mail: [e-mail]