Occupational Physicians Want MCS Report Released

The American College of Occupational and Environmental Medicine (ACOEM; Arlington Heights, IL) wants the Agency for Toxic Substances and Disease Registry to publish "A Report on Multiple Chemical Sensitivity (MCS)." ACOEM feels the report "is a matter of critical public and scientific importance."

MCS, also referred to as "environmental illness," is a controversial illness. Sufferers claim a variety of physical symptoms that are triggered by exposure to a number of chemical, biological, and physical agents. Some sufferers have been rendered almost incapacitated by their illness, unable to do "normal" tasks such as work, shop, or socialize. Critics claim that MCS is more psychological than physical in nature, or that sufferers are "faking" illness to receive some type of compensation.

The ACOEM Board of Directors issued a position statement on MCS in April, that endorsed the "predecisional draft" prepared by the Interagency Workgroup on MCS and urged open scientific debate on the topic. The position statement asserts that, "Irrespective of the scientific uncertainties regarding the diagnosis, etiology, and management of MCS, the impact of these symptoms on the wellbeing, productivity, and lifestyle of those affected can be dramatic. It is neither helpful nor appropriate to address the problem solely by hypotheses that emphasize malingering or a desire for compensation."

The ACOEM recommended the following research agenda:

• A cooperative agenda that examines the non-specific syndromes of chronic fatigue, fibromyalgia, and MCS should be adopted, although the ACOEM warns, "no assumptions should be made that these conditions represent the same phenomenon." Research into societal factors that influence the prevalence and natural course of MCS should be high on the agenda.
• Consensus must be reached on a clear case definition that establishes diagnostic criteria and specifies which individuals may be included in a study.
• Descriptive epidemiologic investigation should be initiated to determine who is affected, their demographic characteristics, associated risk factors, and the patterns of their symptoms.
• Pathological mechanisms leading to the development of MCS should be investigated. Further study of the influence of the central nervous system on an organism's response to low-level chemical exposure is important.
• Research must focus on the efficacy and side effects of treatment. Long-term outcomes of those exposed to different treatment methods and those left untreated must be examined.

ACOEM President Robert McCunney, MD, MPH, sent a letter to Jeffrey P. Koplan, administrator of the Agency for Toxic Substances and Disease Registry, urging him to publish the report. "The opportunity presented by this report for open scientific debate must not be squandered in the morass of controversy that has mired progress in understanding MCS. Rational public policy, health care, and private actions depend on scientific foundation. Publication of the Interagency Workgroup's report provides the basis for constructing this groundwork," wrote McCunney.