"Chemical Exposures: Low Levels and High Stakes"
A Book Review by Agnes Malouf

"Chemical Exposures: Low Levels and High Stakes" (Second Edition), by
Nicholas Ashford & Claudia Miller, John Wiley and Sons, Inc., 1998, $64.95 US

If it's true that "the next big shift [in wellness] will be to focus on the environmental influences on health" (Megatrends), "Chemical Exposures: Low Levels and High Stakes" will be an invaluable forerunner in analyzing the increasing numbers of chemically-sensitive individuals since the 1950s.

Authors Ashford and Miller identify four groups of people presenting similar symptoms: industrial workers, occupants of tight buildings, families in contaminated communities, and various individuals with unique experiences with pesticides, domestic air and consumer products. This edition also includes  a new group of people exhibiting multiple chemical sensitivity symptoms, Gulf War veterans. The fact that all report multiple symptoms affecting multiple organs suggests that more is going on here than what has often been dismissed as psychogenic (arising from the mind.)

The first edition of "Chemical Exposures" was based on a report commissioned by the New Jersey State Department of Health which won the World Health Organization Macedo Award in 1990. The second edition (1998), more than doubles the original text. While careful to preserve the original understanding of multiple chemical sensitivities, this edition adds three new sections: Recent Developments, Key Research Findings since the First Edition, and Research and Medical Needs. There is also a 43-page bibliography and an in-depth questionnaire to help rate the severity of the disease as well as its impact on various organs and on lifestyle.

According to Ashford and Miller there is increasing evidence that low-level chemical sensitivity may signal an emerging new theory of disease, toxicant-induced loss of tolerance (TILT). They see this as analogous to the germ, immune and cancer theories, each of which underwent a painful process of acceptance by the medical community. The high stakes of this particular battle for acceptance include potential liability and revenue loss facing toxicant-producing corporations and massive workers' compensation and insurance payouts should it be established that there is
an organic (as opposed to psychogenic) cause to the illness. As the authors state: "...Unlike SAD, [with TILT] someone can be held liable for injury and illness".

The authors believe that there is a two-step process in the development of TILT: 

1) an initial exposure/event which sensitizes an individual to the point where 
2) even low-level exposures to formerly tolerated chemicals, drugs, and foods trigger symptoms. 
The authors state that while it is often difficult to determine the initial exposure, in cases where one has been identified, solvents, pesticides, wood preservatives and building renovations were frequently the cause. The list of subsequent triggers is
far longer and includes perfumes, diesel exhaust, foods, alcohol, caffeine and medications...as well as the initiators.

The authors stress the need for scientific research using an environmental medical unit and proper unmasking of subjects before testing. They state that many recent studies are flawed because researchers did not fully understand the nature of the illness and subjects were challenged with substances to which they had not had the time to become de-adapted. As well, researchers have often not taken proper steps to assure  a toxicant-free environment for testing.

"Chemical Exposures" devotes many pages to the various body mechanisms by
which individuals may become sensitized.  Despite the fact that the mechanism which causes chemical sensitivity has not been determined, the authors make it clear that there are things governments can and should be doing to alleviate existing problems and prevent people from becoming sensitized in the first place. "We do not have to know everything," they conclude, "before we do anything."

Agnes Malouf is a teacher and member of the NSAEHA Board.