As a young graduate, I began to practice family medicine in 1973, armed with the latest scientific knowledge and the smugness of youth. After 10 years of experience, I was less confident but more perplexed and bewildered because I was seeing an increasing number of patients with multiple, unexplained symptoms. I could find nothing wrong with them on physical examination and all the laboratory tests that I could think of to perform were normal. The various specialists that I referred these patients to for a second opinion invariably came to the conclusion that there was nothing wrong with these patients and their symptoms were in their heads. My problem was that I couldn’t agree. I had known some of these patients for years. To me, most of them were educated, emotionally stable, responsible members of society; trying to work hard, raising their kids and looking after older parents. Just like the rest of us.
Then I witnessed one of my long-time patients get significantly better by following a food elimination diet. However, according to my peers, the only possible explanation was placebo – that the patient was just neurotic because there was no such thing as food sensitivities. I wondered why none of the failed treatments that she tried earlier had the same effect. I started treating some of these patients with elimination diets and a number of them began to feel better.
One day, one of my patients complained to me that she was feeling unwell because someone in my office was smoking a cigar. She insisted that she could smell the odor despite the fact that I had tried to reassure her that no one was smoking. To prove her wrong, I checked the neighboring offices, and could find no one smoking anything. But she remained insistent. I needed to confront her; was the explanation a brain tumor or a delusional disorder? To be 100% certain that no one was smoking a cigar, I checked the office below mine first and was given a lesson in humility. I had found her cigar smoker. I wondered how could anybody be so sensitive?
I began to notice a pattern to the various conditions that I was assessing. Many of these patients had chronic pain and chronic fatigue. Some were diagnosed with fibromyalgia and/or chronic fatigue syndrome. A lot of them were also like my cigar lady; sensitive to chemical odors with a heightened sense of smell. Many had a difficult time working because of their sensitivity to the scents worn by others and cleaning products used in a typical office workplace. I started trying to advocate for accommodation or disability on their behalf. To my surprise, I was criticized and vilified by most of my peers, who insisted that there was no scientific evidence to explain their condition other than anxiety or depression, and that the attribution of provocation of symptoms to foods and chemical sensitivities was invalid. I watched how the patients were blamed for their illness, disrespected and denigrated by my peers, some of whom provided their expert opinions to third party insurance companies. I observed many patients’ lives get ruined as they were denied the accommodation and/or disability benefits that should have been rightfully theirs.
Frustrated, I began to look to the medical literature for the evidence required to validate my observations and confirm my opinion that these people were biologically ill. There were no medical search engines available on computers in the late 1980s and early 90s when I first started, so I spent my weekends browsing through the various journals available in the medical library. I could not find much published support then but that was 20 years ago. Times change.
Now, all I have to do is turn on my laptop and within seconds I am in MEDLINE, the search engine of the US National Library of Medicine, the most commonly used premiere biomedical database, and a major source of the primary literature in medicine. The amount of information available these days is astounding. For example, using “indoor air” as a search term instantly produces the abstracts for more than 10,000 papers. Within minutes, I can obtain the complete paper from the medical school library. This has enabled me to spend countless hours reading and gathering the information that now validates the patients’ experience, providing the evidence that the causes are biological, not psychological.
As a result, requests for this expertise now come from several federal and provincial Ministries of Health, the Canadian Environmental Law Association, the Canadian Transportation Agency and numerous lawyers looking for medical legal expertise to help their clients with personal injuries due to chemical exposures and disability claims due to chronic fatigue syndrome and fibromyalgia. I sit on the Canadian Committee on Indoor Air Quality and Buildings for the National Research Council. In 2003, I was awarded a Fellowship in Family Medicine by my peers for my “contribution to the enhancement of medicine” and I now write and provide accredited workshops on environmental medicine for theCollege of Family Physicians.
In October 2013, a business case proposal for the creation of a Centre of Excellence for Environmental Health was funded by the Ontario Ministry of Health and Long Term Care and submitted to them. I wrote the medical component titled,The Academic and Clinical Perspectives for the Ontario Centre of Excellence in Environmental Health. It contains more than 1100 citations from the medical literature. The proposal is actively supported by theUniversity of Toronto School of Public Health and the Ontario College of Family Physicians.
Indeed, times do change.
The environment is not just making people sick with chemical sensitivities, or chronic fatigue syndrome and fibromyalgia. It is increasing the incidence of multiple chronic illnesses: cardiovascular disease, respiratory illnesses, allergies and autoimmune diseases, chronic kidney disease, neurodegenerative disorders, diabetes, autism and even obesity.
John Molot MD
Author of 12,000 Canaries Can’t Be Wrong