Environmental illness is a variably defined collection of symptoms also known as multiple chemical sensitivity syndrome, total allergy syndrome, and 20th century disease. It is currently classified among functional somatic syndromes -- that is, physical illnesses without organic explanations and devoid of demonstrable structural lesions or reproducible laboratory abnormalities. The category also includes chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, premenstrual syndrome, interstitial cystitis, temporomandibular joint pain syndrome, repetitive strain injury syndrome, and atypical chest pain syndrome.
The degree to which these syndromes have been characterized as unique entities spans a considerable spectrum. At one end is premenstrual syndrome, a fully validated and scientifically accepted disorder, with symptoms that are directly associated with the luteal phase of the menstrual cycle and predictably responsive to selective inhibition of serotonin reuptake in the brain. At the other end of the spectrum one finds environmental illness, a condition said to be caused by exposure to levels of chemicals much lower than those known to cause sickness in the general population and the only functional somatic syndrome whose proposed definition and mechanism have not been recognized by any major medical organization.
Herman Staudenmayer has been at the forefront of the scientific investigation of environmental illness for two decades and has contributed important factual knowledge about the biologic and psychological dimensions of this syndrome. With exceptional candor, he acknowledges that the writing of this book was motivated by "incredulity, disgust, sadness, and frustration," as he witnessed the victimization of patients by "charlatans, manipulators, and social parasites who offer diagnostic tests which have never been scientifically validated and phantom treatment practices couched in pseudoscientific rhetoric."
These are strong words. And, oh, how different from the gentle composure we were supposedly taught by idolized role models who moved so fluidly from the classroom to the bedside and then to the laboratory. Yet Staudenmayer's book is not a derogatory pamphlet; it is a serious, stubborn, and successful defense of the scientific method as the only avenue for reaching the truth about this illness. After postulating that the testable hypothesis must prove the causal relation between chemical exposure and illness, Staudenmayer describes the experimental setting in which he conducted double-blind, placebo-controlled provocation challenges. Exposed to substances that caused symptoms during open-label challenges, the patients' appraisals of the ill effects were no different from those after exposure to a placebo gas delivered during the double-blind phase of the study. This fundamental finding has been upheld by a substantial number of epidemiologic assessments of symptoms occurring after alleged toxic exposure, ably described by Staudenmayer from the vantage point of the scholar informed by the principles of evidence-based etiologic research.
When all is said and done, Staudenmayer concludes that environmental illness is iatrogenic, induced in vulnerable patients by unscrupulous physicians and advocates. For him, the phenomenon represents nothing short of medical cultism, with the expected moral superiority, rigidity of thought, and contempt for scientific laws, in which much time is spent on rituals, confessions, and group testimonials. His is a courageous hypothesis and one whose testing merits our support.
Reviewed by Peter Manu, M.D.
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