Justice in the Workplace and Multiple Chemical Sensitivity
by Philip D. Ranheim, MD
Allergy & Environmental Medicine
The rejection felt by the person with sensitivities to low level chemical exposure is enormous. Caught between the need for a job and the realization that going to work is making one sick is, for many, a crisis which can be overwhelming. Add to that the great difficulty the worker’s disability system has in recognizing this condition, let alone treating it and making accommodations in the workplace, and we have in our society a major problem. There may be little justice at this time for the employee suffering chemical sensitivity, particularly if those chemicals are multiple.
In my experience, the individual who approaches most physicians with the claim of “MCS” is thought to suffer from what I call “6 C’s.” First, they may be considered crazy although that is usually quickly excluded: On the other hand, if no psychosis, could the person be a neurotic whose deep seated psychological problems have only found a new rationalization on which to roost? Second, the patient may be viewed as a worrywart who fears diseases like cancer. Third, one could be accused of being a crusader – out to save the environment from all kinds of destruction: The crusader’s zeal only serves to heighten whatever symptoms presumably exist. Fourth, the doctor may think he has another complainer on his hands who trembles at the slightest symptom. Fifth, perhaps this poor employee is really confused. He or she may have watched the latest TV special on the rising number of chemicals in the workplace and now personally thinks it is as bad as the hype suggested by the media. Sixth, the prudent physician will think the patient is in fact a con artist plying acting skills in order to acquire financial support on false claims.
There is however, a seventh “C” which is legitimate Chemical Sensitivity. Sadly, out of ignorance, most physicians will not recognize this true condition: This is because they have not had the opportunity in their training or work experience to have observed this real phenomenon. In fact, the better the doctor, the more likely the skepticism. As a part of training, all physicians are schooled in the habit of doubting everything, and it usually serves them well. Truth is, after all, often very difficult to discover: a critical mind is essential. Ironically, when one thinks he is an expert he may be blinded to the very truth which he seeks. In my opinion there is a clear information deficit which keeps the average doctor from seeing things clearly when it comes to the devastating effects of chemical sensitivity.
Now why is it that good doctors will miss diagnosing this condition we call MCS? The answer is quite simple: They have never had the tools necessary to scientifically study it. Most doctors, including experts, have not had the occasion to observe the effect of placing a truly chemically sensitive patient in an extremely clean environment for four days and observing their withdrawal. Things actually happen. First, the presenting symptoms usually intensify. Itching escalates, asthmatics get more wheezing, headaches become overwhelming, mental confusion worsens, and fatigue goes into exhaustion and so on. Secondly, symptoms clear. Itching, shortness of breath, pain, confusion and fatigue actually fade away simply by eliminating the chemical triggers that somehow impact the patient’s immune, autonomic, endocrine and other systems so as to generate disease states.
A second experience, which most doctors have not observed, is just what happens when, in a laboratory setting, a sensitized patient is challenged with a tiny extract of an offending chemical. (This is where we begin to distinguish between toxicity and sensitivity. While in toxic reactions a relatively large amount of a poison is presented to the subject, with sensitivity testing, tiny amounts are used, amounts at which the average well person would not note physical changes.) Typically, skin wheal changes are observed and not uncommonly, symptoms are experienced by the patient similar to those noted in the workplace. The tester may also see signs reflecting altered physiology. Interestingly, signs and symptoms may be observed at tiny doses such as 1:1,000 or even 1:1,000,000 of a common concentration of routine chemicals such as phenol, ethanol, formaldehyde or perfume. Clearly we are not dealing with toxicity but rather, a leveraged effect mediated by body systems not yet fully understood.
This is the dilemma: Those who evaluate patients in our workman’s compensation system have for the most part never been exposed to the needed training which would allow them to even consider the possibility of a diagnosis such as MCS.
What will it take to change the situation? Time, of course. But what could be done in a span of time so that in the future, let us say five years from now, things will be definitely better? First, a very clean test place could be established in local areas for the evaluation and study of alleged cases of chemical sensitivity. Such facilities are often called Environmental Control Units and they have been used in both the US and England for some time, but on a limited basis and without much recognition from the mainstream, largely because they have been out of the ordinary and have challenged conventional paradigms of disease and therapeutics. These units allow the clearing of symptoms in a medically supervised setting and later necessary challenges with inhalants, foods and chemicals when the patient is most easy to test, so as to establish the truth of alluded reactions. Secondly, doctors and other health care workers need to be trained in medical schools and in continuing medical education seminars regarding these phenomena. Thirdly, the public needs to know more and not be kept in the dark, fed misinformation and intimidated with the specter of being labeled “psychosomatic” should one of them claim a diagnosis of “MCS.” Fourth, the workplace needs to provide as part of its worker education, classes and posters alerting the employee to the early signs of chemical sensitivity before things escalate. Fifth, we physicians need to also note the early signs and do something for our patients before they get to the point of having an established disease which is easier to diagnose but often more difficult to treat. Sixth, our system would do well to begin to deal with diseases which may not be “fixed”: A lost eye is a fixed condition and easy to document: Asthma which only shows up with chemical exposure is not fixed but may be very limiting. (Unless the physician reviewing the case tests the patient in a challenged condition the diagnosis will be missed.) Seven, embrace the notion that treatments for these patients may need to include both conventional as well as non-conventional modalities which can include detoxification, specialized nutrition, neutralization of chemical reactions, general supportive measures as well as special accommodations for the job site. Eight, recognize that while many of these genuine MCS patients may have psychological manifestations of illness due to altered physiology or social isolation, that is quite different from psychogenic illness coming out of cognitive trauma. On the other hand, psychiatric conditions must never be ignored; appropriate referrals must be timely. Nine, employers too need protection from spurious claims by malicious employees, fraudulent claims which could put a company out of business leading to job loss for many co-workers. Ten, we need to stop sending chemically sensitive workers to psychiatrists for conditions which are physical: learning how to cope while being exposed to more harmful chemicals really breaks the first rule of medicine: First, do no harm. Eleven, develop new technologies which provide cleaner work environments: healthy workers are more productive and use up less sick leave. Twelve, help employers identify individuals more likely to become chemically sensitive up front so as to steer them into safer jobs from the start. Finally, let us encourage fragrance-free environments – they are healthier and their institution keeps us thinking about the reality of Multiple Chemical Sensitivity.
There can be greater justice in the workplace. We can take concrete steps to assure a better tomorrow for our workers as well as for those who own businesses and need to keep up production in a competitive manner. But let us not put our heads in the sand. The warnings are plain. To ignore this problem is only courting future disaster. It’s time to face up to the MCS problem and find real solutions for the sake of our citizens and for the benefit of our modern world.
Philip D. Ranheim, MD
Allergy & Environmental Medicine
9407 - 4th Street NE
Everett, Washington 98205 USA