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Multiple Chemical Sensitivities: A Workshop
for which only supportive treatments exist. It may even be true that some or all of the hypotheses and treatments proposed by clinical ecologists are valid but we found no evidence to support them. These hypotheses and treatments should be subjected to modern, scientific methods of evaluation. We think that this can be done provided genuine interest exists.
The task force is concerned that unproved diagnostic tests are being widely used by clinical ecologists in what may be incorrect or inappropriate applications. Decisions made on the basis of these tests can lead to misdiagnosis, resulting in patients being denied other supportive treatments and becoming psychologically dependent, believing themselves seriously and chronically impaired. This possibility underscores-the need for more adequate scientific studies to prove or disprove the value of clinical ecology tests and treatments. To consider the current practice of clinical ecology experimental is misleading, however. It can only be considered experimental when its practitioners adhere to scientifically sound research protocols and inform their patients about the investigative nature of then' practice.)1
The same year the Executive Committee of the American Academy of Allergy and Immunology issued a position statement on Clinical Ecology. The critique follows:
The environment is very important in the lives of every human being. Environmental factors, such as chemicals and pollutants, have been demonstrated to influence health. The idea that the environment is responsible for a multitude of human health problems is most appealing. However, to present such ideas as facts, conclusions, or even likely mechanisms without adequate support, is poor medical practice.
The theoretical basis for ecologic illness in the present context has not been established as factual, nor is there satisfactory evidence to support the actual existence of "immune system disregulation" or maladaptation. There is no dear evidence that many of the symptoms noted above are related to allergy, sensitivity, toxicity, or any other type of reaction from foods, water, chemicals, pollutants, viruses, and bacteria in the context presented. Properly controlled studies defining objective parameters of illness, properly controlled evaluation of the treatment modalities, and appropriate patient assessment have not been done. Anecdotal articles do not constitute sufficient evidence of a cause-and-effect relationship between symptoms and environmental exposure. The major techniques used by the clinical ecologists are controversial and unproven. The American Academy of Allergy and Immunology has previously published position statements concerning subcutaneous and sublingual provocation neutralization procedures and found them to be unproven. More recent review of new data submitted by a number of clinical ecologists to the Practice Standards Committee of the Academy has not changed that recommendation. There are no adequate studies of the cyclic diets, elimination diets, injection therapy with chemicals, or even the environmentally controlled units to substantiate their use. Many of the patients are reported to have a normal physical examination and normal laboratory tests.
There are no immunologic data to support the dogma of the clinical ecologists. To suggest that these patients lack suppressor T cell function has not been supported by published data. The suggestion that neutralization therapy can provide rapid relief witch minutes or hours cannot be supported by controlled clinical studies or immunologic data.2
The American College of Physicians published a position paper on Clinical Ecology in 1989. The summary from that publication is quoted:
Clinical ecologists propose the existence of a unique illness in which multiple environmental chemicals, foods, drugs, and endogenous C. albicans have a toxic effect on the immune system, thereby adversely affecting other bodily functions. The proposal uses some concepts that superficially resemble those that apply to clinical allergy and toxicology and others that are novel.