Since the 1980s, doctors have been fighting over the legitimacy of environmentally linked conditions – Environmental Sensitivities/Multiple Chemical Sensitivities (ES/MCS), Fibromyalgia (FM) and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). After years of paddling upstream, the tides are now turning strongly in our favour, that these are biological conditions. But, it’s not always good news on all fronts.
Task Force on Environmental Sensitivities
Monday was the first meeting of the Task Force on Environmental Sensitivities, organized by the Ontario Ministry of Health and Long Term Care. This Task Force was established in response to a business case proposal commissioned by the Ministry to develop a patient-centered Center of Excellence for Environmental Health. I am one of 15 members, along with patient representatives, researchers, and policy advisers, who attended this meeting. It is chaired by Dr. Howard Hu, who is also Dean of the Dalla Lana school of Public Health at the University of Toronto. I feel proud to have written the Academic and Clinical Perspectives, which contains 1100 citations from the medical literature, because it contributed significantly to this process.
The aim of this Task Force is to improve medical care and supports for people living with the environmentally-linked conditions listed above. One of the goals is to identify gaps in knowledge transfer because most physicians have no training and very limited knowledge on how to diagnose and treat these conditions.
A recent decision by the Ontario College of Family Physicians (OCFP)
Unfortunately, the OCFP has decided to eliminate their Environmental Health Committee,which has been responsible for the development of numerous educational workshops and scientific papers. And, not just regarding these three conditions, but also the impact of the environment on chronic disease in general. The reason given is that there is a lack of interest in the subject of environmental health among family physicians. Most likely that apathy is due to a lack of knowledge of the impact that our present-day environment has on the increasing prevalence of chronic disease in both children and adults.
The OCFP has now widened the gap in knowledge transfer and care for many patients. These will be repercussions:
- There are more than 570,000 people in Ontario with one or more of ES/MCS, FM and/or ME/CFS. They will continue to lack adequate medical care and social support.
- Because doctors lack the skills to diagnose and treat these disorders, these patients will continue to be high users of the healthcare system.
- They will continue to be frequently disabled from work because they do not get support for accommodation.
- They will continue to have marked reduction in their quality of life because of the difficulty in self-management.
The OCFP decision increased the gap of transferring medical knowledge to practice that the Task Force is trying to close.
Occupational Medicine may be softening their position on Environmental Sensitivity
I’ve been practicing environmental medicine for 30 years. When I first started to see patients with these disorders, I was considered an outsider to mainstream medicine, which labeled these patients with various psychiatric conditions. The argument from both sides has persisted. For example, many patients with ES/MCS have difficulties in the workplace because they no longer tolerate scented products worn by their colleagues or products used by cleaning staff. On the one hand, the Canadian Human Rights Commission has designated ES/MCS as a recognized disability with the right to accommodation. On the other hand, most Occupational Medicine physicians still do not support that opinion and do not advocate on behalf of these patients to allow them to continue to work. As a result, they lose their jobs and/or become involved in litigation.
Last Saturday, I was asked to make a presentation to inform the Occupational Medicine Section of the Ontario Medical Association about the Task Force. I was proud to be asked and happy for the opportunity to help educate my colleagues and contribute to the process of closing the knowledge gap.
In with the new (paradigm), out with the old!
It went very well until one elderly gentleman came to the microphone during the question period and began a speech of his own. He spoke as if he was an expert in this field and stated with authority that the medical literature is very strong in support of the fact that these conditions are psychiatric. I recognized him. He has been an outspoken foe of the concepts of environmental medicine as long as I have been practicing. He had been a leader in occupational medicine for many years and was responsible for many patients being denied accommodation and disability benefits. I had been the subject of personal attacks by him in the past. The moderator interrupted his uninvited speech to allow me to respond. I was able to do so from a position of strength; the medical literature in support of these conditions being psychiatric is very poor and outdated. Not only that, but there are now many different published studies providing robust evidence for the biological abnormalities found in patients with ES/MCS.
How different it was in years gone by when my opponent was considered the respected expert and held the microphone onstage to have the final say regarding the quality of the medical evidence. Now, finally it was my turn to be the respected expert – it was a vindicating moment!
The tide continues to turn.