September 11, 2001   (REVISED)

Harold E Buttram, MD

Introduction:

As a matter of personal opinion and observation, there is at present a
dichotomy of almost schizophrenic proportions between ongoing American
scientific research in the medical field, most of which takes place in
academic institutions and medical centers, and the genuine needs of the
American public.

The scope and direction of this research, most of which is funded by the
National Institute of Health (NIH), is of tremendous importance in that
it forms a source of guidelines and a scientific foundation for the
clinical practice of medicine.  In other words, the clinical practice of
medicine as it exists today has been largely shaped by decisions made in
the NIH and other government health agencies in the granting of research
money.  This is a system which has existed since the 1930s, but there
may be serious misdirections which are proving to be very costly in
terms of the health and welfare of the American public, especially as
applies to its children.

There are two medical conditions from which it is predictable that
American society and economy will be strained to the breaking points in
coming years by overwhelming numbers of medical indigents unless these
conditions are addressed effectively and decisively in the very near
future.  The two conditions to which I refer are childhood autism and
environmental illness with chemical sensitivity, neither of which are
being recognized for their true nature by mainstream medicine because of
a misdirection of research funding in certain key areas, as will be
reviewed in the following:

Childhood Autism, Predominantly an Environmental Illness

In regards to childhood autism, a condition characterized by severe
mental regression, fifty or so years ago autism was so rare that many
pediatricians had never heard about it.  At least this was the
experience of Dr. Bernard Rimland, founding director of Autism Research
Institute.   In 1956 Dr. Rimland, whose Ph.D. is in research psychology,
had a son who was later found to be autistic.  In his annual DAN (Defeat
Autism Now) conferences  Dr. Rimland is fond of telling the story about
the early days with his son during which he had great difficulty in
finding a pediatrician who knew anything about or who had ever seen a
case of autism.  How different it is now.  Childhood autism has become
so prevalent that there are very few who do not know of a family with an
autistic child.  Families with two autistic children are not uncommon,
and I personally have seen a family in which all three of the family’s
children were autistic.  Latest statistics estimate that over one half
million American children are autistic, (1) and with numbers steadily
growing, there is no end in sight.  It can be expected that treatments
will improve the outlook of these children, but as far as is known at
present, many or most of these will require custodial care for life, at
an average cost to society as much as three million dollars per child.
(2)

In the opinion of this observer, the misdiagnoses in childhood autism
come not in the diagnosis of the condition itself, something that is
unmistakable once one has seen a few children with the condition, but
from a failure to recognize autism as predominantly an environmental
illness.  (In this instance the term, “environmental illness,” is used
to include illnesses brought about by exposures to commercial chemicals
and medical interventions as well infectious microorganisms and other
exposures from the natural environment).  This statement is based on a
recent seminar on childhood autism held in the Washington D.C. area as
sponsored by the National Institute of Health and other health agencies
September 6^th and 7^th, 2001, at which the largest portion of the meeting
was devoted to areas of genetics and neuropathology of autism. (3)

As related to childhood autism, it should be stressed that the field of
genetics involves a susceptibility to autism but, except in rare
instances, has nothing to do with its causes.  The same could be said
about virtually all epidemic-type diseases, in which there will be
variability in genetic susceptibility.  By their very nature, epidemics
always arise from environmental sources of one type or another and not
from genetic causes.  Genetic changes take place very slowly in an
evolutionary scale over a period of millennia and never with the rapid
increases as seen today with autism.

Major areas now under suspicion as being causally related to childhood
autism include   childhood immunizations, (4) toxic environmental
chemicals, (5) commercial food processing, (6) and the overuse of
antibiotics. (7)  The only possible way of salvaging the situation is to
find and modify the causes while at the same time doing the very best we
can to develop effective treatments for those already afflicted with
this condition.

Childhood Immunizations – Deficiencies in Basic Science and Safety
Guidelines

As reflected in a series of U.S. Congressional Hearings concerning
issues of vaccine safety which have taken place annually since 1999, (4)
there is now growing awareness of major deficiencies in safety testing
for current childhood immunizations.  A few examples will be given here:

(a) Safety studies on vaccinations are limited to short time periods
only:  several days to several weeks.  There are no (none) long-term
(months or years) safety studies on any vaccination or immunization.
(b) In 1994 a special committee of the National Academy of Sciences
(Institute of Medicine) published a comprehensive review of the safety
of the hepatitis B vaccine.  When the committee, which carries the
responsibility for determining the safety of vaccines by Congressional
mandate, investigated five possible and plausible adverse effects, they
were unable to come to conclusion for four of them because they found
that relevant safety research had not been done.  Furthermore, they
found that serious “gaps and limitations” exist in both the knowledge
and infrastructure needed to study vaccine adverse events.  Among the 76
types of vaccine adverse events reviewed by the IOM, the basic
scientific evidence was inadequate to assess definitive vaccine
causality for 50 (66%).  The IOM also noted that “if research…(is) not
improved, future reviews of vaccine safety will be similarly
handicapped. (8)
(c) In an article published in Adverse Drug Reaction & Toxicology
Review, (9) researchers Andrew Wakefield and Scott Montgomery, who have
been investigating a possible causal relationship between the MMR
vaccine (measles-mumps-rubella) and the autism enterocolitis syndrome,
carefully reviewed inadequacies of the early pre-licensing trials of the
MMR vaccine with a maximum follow up of 28 days and even shorter periods
in some of the studies.  They stressed that such short periods of
observation following the vaccine were totally inadequate to detect
delayed reactions, including pervasive developmental delay (autism),
immune deficiencies, and inflammatory bowel disease, which are known
from earlier published reports to occur following both the natural
measles infection and the measles vaccine.

The most interesting feature of the Wakefield/Montgomery article was
that it was reviewed by four leading British authorities, all of whom
had previously held positions in the regulation and licensing of
medicines in the United Kingdom. (10) Taken as a whole, the reviewers
were supportive of the article, three highly so.  Peter Fletcher,
formerly a senior professional medical officer for the Department of
Health wrote, “being extremely generous, evidence on safety (of the MMR
vaccine) was very thin.” Noting that single vaccines for measles, mumps,
and rubella already existed, he argued, “caution should have ruled the
day…the granting of a product license was definitely premature.”
Professor Duncan Vere, former member of the Committee on the Safety of
Medicines, agreed that the periods for tests were too short.  “In almost
every case,” he wrote, “observation periods were too short to include
the onset of delayed neurological or other adverse events.”

(d) In 1984 an intriguing study was reported in a little noted
letter-to-the-editor in the New England Journal of Medicine in which a
significant though temporary drop in T-helper lymphocytes was found in
11 healthy adults following routine tetanus booster immunizations. (11)
Special concern rests in the fact that, in 4 of the subjects, the
T-helper lymphocytes fell to levels seen in active AIDS patients.  If
this was the result of a single vaccine in healthy adults, it is
sobering to think of the possible consequences of multiple vaccines (19
within the first 6 or so months of life at latest count) given to
infants with their immature and vulnerable immune systems.
Unfortunately, other than clinical observation, we can only speculate at
these consequences, as the test has never been repeated.

Environmental Illness – Deficiencies in Basic Science and Safety
Measures

In my opinion, the second area of misdiagnosis is the common approach of
mainstream medicine in dealing with environmental illness and its
related condition of multiple chemical sensitivity (MCS).   In contrast
to the American Medical Association, which denies the existence of MCS
as a valid diagnosis, there is a group of physicians in the field of
environmental medicine who believe that millions of Americans are being
made ill and sensitized in various degrees to toxic airborne chemicals
from a class of chemicals known as volatile organic compounds (VOCs).
(12) Illnesses brought about by breathing these chemicals inside
buildings are referred to as “The Sick Building Syndrome.”  A number of
official government and health agency publications have been issued on
this subject. (13-18) However, the major thrust of most of these
publications is to stress how little we actually know about the effects
of these chemicals and emphasize the over-riding need for further safety
research in this area.  As pointed out in the text, Multiple Chemical
Sensitivity, (National Research Counsel, 1989), “about 70,000 chemicals
are used in commerce, of which several hundred are known to be
neurotoxic.  However, except for pharmaceuticals, only 10% have had any
testing at all for neurotoxicity, and only a handful of these have been
evaluated thoroughly.” (19)

Since the publication of Multiple Chemical Sensitivity, the situation
has changed in one respect:  There is now a substantial body of
literature dealing with occupational exposures to solvent-type chemicals
or VOCs, prominent among which are publications by Lisa Morrow and
coworkers at the University of Pittsburgh, several of which are sited
here. (20-23)

For the issue of multiple chemical sensitivity, on the other hand, it is
far different.  Once again we are faced with major deficiencies in
safety-oriented studies on the effects of potentially toxic
environmental chemicals on the human system and of safety measures that
would have followed, had these studies been done.  Basic science in this
area, at very best, has been fragmentary.  For this reason and this
reason alone, evidence for support of the diagnosis of MCS has not yet
reached standards of scientific proof.  However, the fact that adequate
research has not yet been done to prove its existence, it does not
follow that MCS has been disproved or that it does not exist.  Yet, this
is the practical conclusion one generally finds in mainstream medicine.

Based on my own experiences in many workman’s compensation cases
involving airborne chemical exposures, the near universal response of
mainstream medicine has been to deny its existence.

As a result, many patients with more advanced forms of chemical
sensitivity are becoming like the lepers of ancient times, disabled
outcasts of society, and their numbers are growing larger by the day.
(24)

However, we are not entirely barren in this area.  Though small in
number and preliminary in nature, there are a number of publications
tending to confirm a widespread presence of  MCS in our population,
publications which can form a nucleus for further study. A few of these
are enumerated below:

(a) Two publications involving studies with SPECT brain scans have shown
impairments in brain functions resulting from chemical exposures.
(20,25)

(b) In a recent study of a group of veterans with the Persian Gulf War
Illness, an activated coagulation system was found with platelet
activation and fibrin deposits on the endothelial surfaces of blood
vessels, which resulted in a constriction of blood flow.  The authors
concluded that heavy exposures to toxic chemicals during the Gulf War in
all probability were the underlying cause of the pro-coagulant state,
although other possible causes were also mentioned in the article. (26)

(c) Studies of patients with chronic fatigue and fibromyalgia at the
Electron Microscopy Unit at the Adelaide Institute of Medical and
Veterinary Science, Australia demonstrated deformities in the red blood
cells (RBCs) of these patients described as dimpled spherocytes (rather
than the normal oval shapes of RBCs) along with increased rigidity of
the RBC membranes, these changes resulting in reduced flow of the RBCs
as a result of their deformities. The article went on to point out that
a great majority of these patients had been exposed to environmental
chemicals, some working in chemical factories, others in wheat fields or
orchards subject to periodic pesticide/herbicide sprayings, many
patients noting deterioration following these exposures. (27)

(d) In an article by P Beaune and coworkers, the term “suicide
inactivation” was used to describe the mechanism whereby foreign toxic
chemicals may damage and cripple the enzyme systems necessary for
detoxification and elimination of toxic chemicals. (28) This now thought
or suspected of being a major factor in the pathogenesis of MCS.

(e) Among those working in the field of environmental medicine, (12) The
Environmental Health Center in Dallas, Texas has always been considered
a major center of research in this field.  Authored by William J. Rea,
M.D., much of the work of this center has been recorded in a four-volume
set of books with the simple title, Chemical Sensitivity. (29) Many of
those familiar with this center believe it will in time be accredited
with being one of the earliest  centers to fully recognize the
increasing impact of foreign chemicals on human health and to do
meaningful, systematic study in this area.

With reports such as these now in the scientific literature, further
documentation and confirmation of environmental illness and MCS as valid
diagnoses cannot be long in following, along with a more realistic
appraisal of their prevalence.

Finally, no treatment of environmental illness would be complete without
mention of possible ongoing damage being done to the reproductive
systems of both men and women when exposed to toxic airborne chemicals
during their reproductive years, (30) or of fetal damage when women work
in such conditions during their pregnancies. (5)  Although as yet
largely theoretical, sooner or later these are issues which must be
addressed.






Conclusions:

In the late 1800s and early 1900s there was a time now referred to as
the golden age of medical diagnosis. Those were the times of Sir William
Osler of Johns Hopkins University, remembered as the father of internal
medicine, and of other stellar names of the times.  In those days
doctors took time to listen to their patients, and equally important,
took very seriously the information given by the patient.  It was a time
of clinical observation, when doctors believed what their eyes told them
and deduced diagnoses based on these observations.  It is no small
coincidence that the mythical master of observation and deduction,
Sherlock Holmes, the creation of Sir A Conan Doyle, was based on a
physician that Doyle had known in his student days.

How does this compare with today?   Based on personal experience, very
few doctors listen to parents of autistic children, or if they listen to
them, very few believe what they are told by the parents. (31) This is
even truer for patients with environmental illness who, in a majority of
cases in my experience, are commonly referred to psychiatrists or
psychologists by their physicians, their physicians telling them that
their symptoms are psychosomatic or imagined.

However, in defense of doctors directly involved in care of the public,
it is doubtful that there has ever been a time with greater demands on
their time combined with greater economic/political pressures
intervening in the care of their patients than at present.  Most of them
are doing the best they can under the circumstances.

I take great pride in being a medical doctor.  I would not change places
with anyone in the world.  But I also fear for the future of my
profession.  Whether in the realm of nature or human affairs, all things
must remain relevant to survive.  In the natural world all life forms
must adjust to their environment or perish.   In the healing
professions, these professions must both recognize and address the
genuine needs of the public or stand in danger of passing into the limbo
of forgotten things.  Actually I believe the medical profession will
survive, but to do so will require a higher level of vision with issues
surrounding childhood autism and environmental illness than has been the
norm until now.

For practicing physicians to recognize the nature of their patients’
problems and treat them properly, the physicians must be provided with
valid science by those engaged in research, science realistically
directed at the genuine health needs of the public.

References:

(1) On April 25, 2001 James J Bradstreet, M.D., F.A.A.F.P gave testimony
before the U.S. House of Representatives, Committee on Government Reform
recalling his own experiences with an autistic son as well as providing
a broad review of issues surrounding childhood autism.  In a written
supplement to the oral presentation, which can be accessed on the
website: http://www.gnd.org/Testimony/Congressional.htm, Dr. Bradstreet
provided current statistics on autism, pages 3-7.
(2)  Ibid
(3) NIH/ACC 2001 Conference:  Potential Cellular and Molecular
mechanisms in autism and Related disorders Sponsored by NICHD and NIEHS,
Co-Sponsored by NIMH, NINDS, and NIDCD, September 6-7, 2001, Bethesda,
Maryland.  (Having personally had the privilege of attending the
meeting, there were very excellent presentations having to do with
neuro-anatomical findings as well as genetics of autism, areas
constituting basic science for the field.  A portion of the meeting was
also devoted to the possible roles of pesticides and other
neurotoxicants in causing autism, but even these were of an academic
nature.   Clinical studies of potential value in either the prevention
or treatment of autism were notable by their absence.)
(4) Annual hearings specifically dealing with questions about vaccine
safety have been taking place in the U.S, House of Representatives since
1999.  This is only one of many indications of growing public and
professional concern on this issue.
(5)  Edelson SB & DS Cantor, Autism: xenobiotic influences, Toxicology
and Industrial Health, 1998; 14(4):553-563.  (This study, which appears
to be the first of its kind, points out that the breathing of toxic,
chemical-laden air in sick buildings by women during their pregnancies
may be a contributing cause of brain damage to the fetus and a common
factor in the rising incidence of childhood autism).
(6) Among the many works dealing with the adverse health consequences of
“fast foods,” which form an increasing pattern in the diets of American
children, two books are recommended here:  Nourishing Traditions, by
Sally Fallon with Pat Connolly and Mary G Enig, Ph.D., ProMotion
Publishing, San Diego, 1995 and Special Diets for Special Kids, by Lisa
Lewis, Ph.D., Future Horizons, Arlington, Texas, 1998.
(7) No reference is needed here – the overuse of antibiotics in medicine
and the food industry is now universally recognized and is being taught
at leading medical centers.
(8) Stratton KR, CJ Howe and RB Johnston, Jr., Editors, Adverse Events
Associated with Childhood Vaccines; Evidence Bearing on Causality,
Institute of Medicine, National Academy Press, Washington D.C., 1994, pp
211-236.
(9) Wakefield AJ & S Montgomery, Measles, mumps, rubella vaccine:
through a glass darkly, Adv Drug React Toxicol Rev, January, 2001;
19(3):1-19.
(10) Hurley DR, DW Vere, A P Fletcher, Referee 1, 2, 3, & 4,  Adverse
Drug React Toxicol Rev, 2001; 19(4):1-2.
(11) Eibl M et al, Abnormal T-lymphocyte subpopulations in healthy
subjects after tetanus booster immunization, (letter), NEJM, 1984;
310(3):198-199.
(12) American Academy of Environmental Medicine, with headquarters at
American Financial Center, 7701 East Kellogg, Suite 625, Wichita, Kansas
67207-1705, phone (316) 684-5500, Fax (316) 684-5709.
(13) Pesticides in the Diets of Infants and Children, National Research
Counsel, National Academy Press, Washington D.C., 1993.  (Although this
book deals with foods rather than air, it provides further evidence of
concern in leading scientific circles about the potential impact of
toxic chemicals on human health).
(14) Neurotoxicity, Identifying and Controlling Poisons of the Nervous
System, Superintendent of Documents, Government Printing Office,
Washington D.C., GPO Stock # 052-003-01184-1, April, 1990.
(15) Environmental Hazards in Your School, A Resource Handbook, US
Environmental Protection Agency, Washington D.C., Publication #
201-2001, October, 1990.
(16) The Healthy School Handbook, Norma L Miller, Ed.D., Editor, a
National Education Association professional Library Publication,
National Education Association, Washington D.C., 1995.
(17) Multiple Chemical Sensitivities at Work, Produced by The Labor
Institute, NYC, 853 Broadway, Room 2014, New York, NY 10003, 1993
(funded by a grant from the New York State Department of labor,
Occupational Safety and Health Training and Education Program).
(18)  Multiple Chemical Sensitivities, National Research Counsel,
National Academy Press, Washington D.C., 1989.
(19) Ibid, page 2.
(20) Callender TJ, L Morrow, & K Subramanian, Evaluation of chronic
neurological sequelae after acute pesticide exposure using SPECT brain
scans, J Toxicol Environm   Health, 1994; 41:275-284.
(21) Morrow LA, CM Ryan, & M Hodgson, Cacosmia and neurobehavioral
dysfunction associated with occupational exposure to mixtures of organic
solvents, Am J Psychiatry, 1988; 145:1442-1445.
(22) Morrow LA, MJ Hodgson, & N Robin, Assessment of attention and
memory efficiency in persons with solvent neurotoxicity,
Neuropsychologia, 1992; 30(10):911-922.
(23) Morrow LA, CM Ryan, MJ Hodgson, & N Robin, Risk factors associated
with persistence of neuropsychological deficits in persons with organic
solvent exposure, J Nervous & Mental Dis, 1991; 179:540-545.
(24) Michelle Conlin, Is your office killing you?, Business Week, June
5, 2000, pages 114-125.  (In this article the authoress stated, “Experts
predict that the 5% to 10% of the population that is allergic to
chemicals will grow to 60% by 2020.”  She did not state where she
obtained these figures, but a general observation of the American scene
tends to support their validity.)
(25) Simon TR, DC Hickey, CE Fincher et al, Single photon emission
computed tomography of the brain in patients with chemical sensitivity,
Toxicol Industr Health, 1994, 10(4/5):573-577.
(26) Hannan KL, DE Berg, W Baumzweiger, HH Harrison et al, Activation of
the coagulation system in Gulf War Illness: a potential pathophysiologic
link with chronic fatigue syndrome – a laboratory approach to diagnosis,
Blood Coagulation and Fibrinolysis, 2000; 11:673-678.
(27) Buist RA, Chronic fatigue and chemical overload, Intern Clin
Nutrition Rev, Oct., 1988, 8(4):173-175.
(28) Beaune P et al, Autoantibodies against cytochrome P-450; role in
human disease, Adv Pharmacol, 1994; 30:199-245. (Note:  detoxification
in the body is centered around two enzyme systems.  The first is the
P-450 system which, by a process of oxidization, converts the
lipid-soluble state of volatile organic compounds into a more water
soluble form, in which form they are more readily excreted by the
kidneys.  There is a price to pay, in that the water-soluble forms of
VOCs may be more toxic than their parent compounds.  In health the
second phase of detoxification, that of conjugation, takes place
immediately to neutralize the toxicity in which process the toxic
product is combined with various natural substances in the body,
predominantly glutathione.  In many instances in chemical sensitivity
there appears to be a relative deficiency of the conjugation enzyme
activity which results in an accumulation of the more toxic products of
phase I oxidation.
(29) Chemical Sensitivity, Volumes I – IV, William J. Rea, M.D., Lewis
Publishers, Boca Raton, FL , Vol I, 1992, Vol II, 1994, Vol III, 1995,
Vol IV, 1997.
(30) The Case for Preconception Care of Men and Women, Margaret and
Arthur Wynn, AB Academic Publishers, PO Box 42, Bicester, Oxon, 0X6 7NW
England 1991.
(31) Among the parents with autistic children, a significant portion of
these parents believe that their children have been damaged by
vaccines.   A common story in such instances is that the child was
developing normally into his or her second year, was beginning to speak
a few words, was affectionate with parents and playful with siblings
until a vaccination took place, after which the child lost all speech
and regressed into a world of its own, no longer responding to parents
or playmates.

As further evidence of such a pattern, during October, 1999 an autism
conference was held in Cherry Hill, New Jersey sponsored by the Autism
Research Institute, referred to as a DAN conference.  Over 1,000 people
were in attendance, the great majority of whom were parents of autistic
children.  At one point in the meeting, when the chairman asked those in
the audience who believed that their child’s autism was caused by
vaccines to stand, a large majority of the audience rose to their feet.
Reportedly there was much the same response when the same question was
asked at the DAN conference in San Diego during October, 2000.

And yet, this writer has read many evaluations of autistic children from
major medical centers without finding a single instance where vaccines
were mentioned or considered as a possible cause.  In those instances in
which parents mentioned their suspicions about the vaccines, apparently
they were ignored.


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