It’s the end of 2015, a time to celebrate the promise of the coming year but also a time to reflect on the 12 months that have just passed. It was an incredibly exciting year for me professionally. As a physician who advocated for my patients for so many years, I no longer feel that I am paddling upstream against the hardline, medically conservative current that has discredited environmental medicine for decades. The patient groups that I work with have realistic hope for improved care in the near future.
This year, I have had several opportunities to effectively represent the people with environmentally linked conditions. I have been actively involved with the Ontario Ministry of Health and Long Term Care in the development of the promised (2014) Task Force on Environmental Health. This task force will advise the government on a patient-centered approach to improving supports for people living with one or more environmentally-linked health conditions, such as multiple chemical sensitivity (MCS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia – the canaries.
In the neighbouring province of Quebec, I worked with the Ministry of Health regarding their literature review on MCS, and have been working with the Environmental Sensitivity Association of Quebec to build an ecological, affordable housing community for the canaries who suffer from environmental sensitivities and related conditions.
I also sit on the Canadian Committee on Indoor air Quality in Buildings. We continue to manage the online national forum for ‘best-of-knowledge’ information on the design and operations of buildings to improve indoor air quality and, ultimately, the health of occupants.
I was honoured to be asked to be part of a 7-person Task Group for Ventilation and Indoor Air Quality at the National Research Council (Canada). Our mandate is to develop and recommend changes to the National Building Code for 2020 to ensure that a minimum level of indoor air quality will be achieved in newly constructed buildings. At this point, we don’t even know how to define a minimum level. Presently, it is based on human comfort and not health, and certainly does not consider the adverse health effects on the canaries. But, at least the dialogue has begun, and I am an invited and respected participant.
2015 – The Science
The message of the canaries – that our typical daily chemical pollutant exposures are harming us – is being validated over and over again in the published scientific literature. Most common chronic diseases, such as autism, Alzheimer’s, Parkinson’s, and cardiorespiratory diseases increasing in prevalence because of continuous chemical exposures and are worse on bad air days. This year, the medical literature has continued to add to that evidence.
Here’s the problem though. Even though the doctors practising environmental medicine and public health are seeing more and more people getting sick from the environment, and science continues to add to the evidence proving it, the message still hasn’t reached the public at large.
Why is that?
2015 – The Media
Unfortunately, the news media has informed me that the fact that the environment is increasingly making people sick is no longer newsworthy because people already know about it. Really? Most pregnant women would be horrified to know that their unborn babies have 200 chemicals in them that can contribute to changes in gene function. Why is that not newsworthy? Does everyone know that outdoor pollution from the burning of fossil fuels can contribute to the development of autism? Is this information not newsworthy because everyone already knows these things but doesn’t care – or is the media missing something crucial and needs to be better informed? It is harmful to the public when someone with a degree just in journalism thinks that they are capable of deciding on the relevance of health issues related to the environment, when they haven’t studied the science in depth or obtained opinions from the medical experts. Clearly thus far, the media has been derelict in their responsibility to generate informed discussion with respect to pollution and health effects.
2015 – The Medical Profession
This year, the University of Toronto affiliated Environmental Health Clinic at Women’s College Hospital, together with the Department of Family and Community Medicine and the Dalla Lana School of Public Health, graduated the first two Fellows in Environmental Medicine. We are now training two more to graduate in 2016. In September, the Canadian College of Family Physicians re-accredited the four modules developed on the Environmental Impacts on Health. This includes one entitled, Diagnosis and Management of Chronic Pain, Fatigue and Chemical Intolerance, which teaches how to diagnose and manage patients with multiple chemical sensitivity, fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome. Unfortunately, the few workshops provided per year are limited to 25 doctors, and attendance is never full. There is still a glaring absence of, or interest in, education in environmental health, in both under- and postgraduate medicine, despite the mushrooming of scientific knowledge that needs to be incorporated into clinical practice.
On the other hand, obstetrician-gynecologists are becoming increasingly aware of their responsibility to encourage the reduction of environmental exposures during preconception and prenatal counselling. In 2015, a thought provoking article was published in the American Journal of Obstetrics and Gynecology. The authors suggested that continuing education credits in environmental health should be mandatory to ensure that currently practising obstetrician-gynecologists receive an introduction to environmental health topics. In other words, doctors should no longer have any choice about becoming more aware of the health impact of the environmental exposures that we experience every day.
Another way to enhance doctor awareness can be found in the October issue of the Canadian Medical Association Journal. The editors argued that hospital environments should be free of artificial scents and educating all hospital staff to adhere to this policy should be part of their accreditation process. Perhaps one of the barriers to accessible health care for the canaries will finally be removed.
2015 – Insurance Companies
Sadly, my experience supplying expert opinions for canaries denied disability insurance claims in 2015 remained the same as previous years. The case managers working for disability insurance companies continue to deny claims for benefits, arguing an absence of medical evidence. Even worse, they obtain ‘expert opinions’ recommending unscientific treatments for MCS, which involves repeated exposures to chemicals to get ‘desensitized’. When they insist that the patients follow these treatments, it should also be their legal duty to inform the claimants of the risk for damage. If patients refuse to comply, they will likely lose their benefits, and are subsequently forced to pay for legal help to obtain their benefits for disability,.
2015 – The Canaries
The year is ending on a happy note for the canaries because the medical evidence supporting the biological legitimacy of their disorders has become even more robust.
This year, several challenge studies on patients with multiple chemical sensitivity (MCS) were published. Some used brain scan images to objectively verify abnormal responses after chemical challenge and measured changes in brain activity. There was another study which showed an abnormal immune response in the respiratory system of people with MCS after chemical challenge, compared to healthy people. There was an interesting study in which a small number (8) of MCS patients wore monitors to measure chemical exposures and cardiac function. The measurements took place during normal, real life activities for 24 hours,with real life chemical challenges. Half the patients demonstrated a strong, clear relationship between chemical exposures, biological effects, and subjective symptoms.
We have known for a long time that women are much more likely to have MCS. There can be many reasons why, but it was gratifying to see a study published this year which actually demonstrated that women’s olfactory sensitivity increases faster and to a much greater degree compared to men’s.
The journal Reviews on Environmental Health dedicated its December issue to syndromes such as MCS, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia and electromagnetic hypersensitivity. The editorial stated that “these pathologic disorders should be recognized by the scientific and medical communities and international health institutions.”
And what about ME/CFS? The name CFS has been used in the USA since 1988; in the United Kingdom, it is called ME. Politically correct Canadians refer to it as ME/CFS. Many patients despise the term “chronic fatigue syndrome” because they feel that it trivializes their condition, and minimizes how severely debilitated they are. Others argue that the term “myalgic encephalomyelitis” does not accurately describe the major features of the disease, especially the post exertional exacerbation of symptoms with prolonged time required for recovery. So, this year, after being asked to perform a study by the American Department of Health and Human Services, the Institute of Medicine has chosen a new diagnostic term, calling it Systemic Exertion Intolerance Disease (SEID). There have numerous arguments presented against or in support of the IOM conclusions. But most important is their recognition that ME/CFS/SEID is a “disease”.
2016 – What’s to come?
Although I am frequently frustrated by the slowness of the current of change, in 2015 I have been excited to see that environmental health issues are percolating on political agendas everywhere. My hope for next year at this time is that my retrospective will report even more political and educational initiatives to train physicians and students to recognize and provide appropriate environmental medicine treatments for the canaries and all the other patients with environmentally linked conditions.
I would like to be able to report that there is an increased awareness of the effect of the environment on our health. I hope that the conversation is propelled forward as a result of good journalism and social media. I hope that more people will be motivated to change their personal environment and lifestyle to improve the quality of life for their family and for themselves.
I hope that we will see the promises made at the Paris Climate Summit are adhered to so that there can be a reduction in the fossil fuel burning that is also causing harm to us and our children.
And as always, I will be blogging, and tweeting to the canaries – and everyone else – about relevant developments in environmental medicine.
Wishing everyone a healthy and happy new year.