Environmental medicine is the clinical practice of environmental health
All humans are regularly exposed to a multitude of man-made chemicals from the air we breathe, the water we drink, the food we eat, and the products we buy and use. Canada, the USA and the European Union have been monitoring human chemical exposures for many years. We know that the average person is contaminated with industrial chemicals, pesticides, plastics, fire retardants, stain repellants etc. A multitude of different environmental chemicals are found in virtually every pregnant woman. Multiple studies of chronic exposure to air pollution during pregnancy state that the risks are increased for preeclampsia, hypertension, gestational diabetes, low birth weight, preterm birth, congenital malformation, intrauterine growth restriction, and neonatal mortality. Furthermore, many of these chemicals are detected in the cord blood of newborn babies. Fetuses may actually experience higher exposures of some chemicals, such as flame retardants, than their mothers, likely due to a less developed system for detoxification.
Most studies showing increased risks of developing chronic disease with outdoor air pollution consider the effects of long-term exposure. However, we spend more than 90% of our time indoors. While the building envelope of our homes and workplaces may reduce our exposures somewhat, we still remain exposed to outdoor air pollution while indoors. In addition, our indoor air is 2-5 times more contaminated with chemicals sourced from building materials and furnishings and products used by inhabitants such as fragrances, scented products (personal care, cleaning and laundry products, air fresheners, deodorizers and disinfectants), dry-cleaned clothes, etc.
So, how safe are these chemicals? Basic toxicity information is available for less than 50% of them and information on developmental (unborn and newborn babies and children) toxicity is available for less than 20%. Even worse, we have no safety data when there are multiple exposures, which is the norm in the world we live in.
What medical science does show is that the environment is responsible for 70 to 90% of the risk for developing chronic disease or making them worse. Environmentally linked diseases include allergies, autoimmune disorders, asthma, diabetes, cardiovascular disease, chronic migraine, progressive neurodegenerative disorders, such as Parkinson’s and Alzheimer’s diseases, childhood developmental disorders, like attention deficit disorders and autism, and some cancers. The risks increase with increased chemical exposures and/or if our bodies cannot detoxify them well.
The history
Clearly, taking an environmental exposure history and understanding why those questions are asked would allow physicians to better guide patients, not only in making healthier lifestyle choices, but also to advocate for improved public health policies aimed at reducing pollutant exposures, which would help reduce the burden of chronic disease.
Unfortunately, despite the call from numerous organizations to improve and expand training on environmental health for clinicians, environmental chemical exposure assessment is still largely overlooked in clinical practice. Surveys of practicing clinicians demonstrate low rates of knowledge in environmental health and the clinical practice of environmental health is still largely omitted in medical education. As a result, pollutant exposures are not considered, and appropriated advice is not usually provided.
It’s been 30 years since the US Institute of Medicine advised doctors to be prepared to diagnose, prevent and treat environmentally related conditions. However, most doctors still lack appropriate education and remain poorly informed about possible adverse environmental health effects.
Poorly understood conditions
There are new, emerging chronic conditions such as sick building syndrome, multiple chemical sensitivity (MCS), fibromyalgia (FM) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which also appear to be linked to the environment. As acknowledged recently by the Ontario Ministry of Health Task Force on Environmental Health, doctors remain poorly informed about the biology of these conditions or how to diagnose and manage them.
There are not yet enough physicians trained to practice environmental medicine. Those that do use a multidiscipline and integrative systems approach to recognize, treat and prevent illnesses induced or impacted by exposure to chemicals encountered in air, food, and water. They also have a special expertise in making the diagnosis and advising on the management of MCS, FM and ME/CFS.
John Molot 