Environmental Health Centre
"Centre Needed But
Lots of Problems"
Update Summer 2001
If the external review of the N.S.
Environmental Health Centre (EHC) in Fall River is any indication, environmental
illness (EI) sufferers should not hold their breath waiting for expanded
treatment options from the EHC.
The clinic review, commissioned by the
N.S. Department of Health, was released on November 29, 2000 . The reviewers
were mandated to evaluate whether "the Centre's current practices are conguent
with scientifically- recognized national and international guidelines and
accepted practices for research into diagnosis and treatment of 'environmental
intolerance of uncertain etiology.'" They also looked at other issues
including "whether there is sufficient scientific research evidence to
expand the EHC's mandate to offer treatment."
The reviewers gave particular attention
to this last question, one of the most important from the viewpoint of
environmental illness sufferers. They concluded "the EHC is having trouble
satisfying the current demands for patient evaluation and treatment.
The Clinic requires a major overhaul before any increase in their clinical
mandate can be considered."
In relation to the type of treatment
the EHC provides, the reviewers noted that the EHC "evaluated the usefulness
of one of the major foundations of diagnosis and treatment of IEI, antigen
provocation-neutralization; they found this to be sufficiently unreliable
that they have discontinued its use." However, the paper published
by EHC staff on provocation-neutralization did not, in fact, conclude that
it was unreliable. It stated that testing using reported symptoms alone
(which is not usually done) should not be a basis for treatment, but that
"skin response may be a more reliable indicator and will require cross-validation
with other tests..." This follow-up research has not been done by the EHC.
The reviewers concluded that discontinuing
antigen therapy and "routine" IV therapy " elevate(s) the EHC to a leadership
role in the IEI field." "How can this be leadership?" asks Karen
Robinson of the N.S. Allergy and Environmental Health Association's (NSAEHA)
treatment committee. "Real leadership is being provided by clinics in the
U.S. and Europe which are having considerable success returning patients
to more active lives through the skillful use of treatment combinations
including detoxification, avoidance, IVs and antigens."
Nova Scotia's original Environmental Health Clinic provided antigen provocation-neutralization
treatment and IVs, as well as information on making adaptations in diet
and the home environment. The Department of Health's review of that clinic
found a 97% patient satisfaction rate. Presently, some environmentally
ill Nova Scotians who can afford to pay for their own treatment are traveling
to Oromocto, New Brunswick where the Altlantic Environmental Health Centre
provides antigen provocation-neutralization diagnosis and treatment.
Dr Jeff Scott, Nova Scotia's Chief
Medical Officer of Health heads up the team acting on the review's recommendations.
He sums up the EHC's future this way. "The intent is for research
and treatment to have an equal balance. The treatment which is provided
should be that which is proven effective. Or, treatment can be provided
which is part of a research program." This raises the question of
what "proven effective" means for an illness which is defined as an "emerging
illness" and how long patients will have to wait until treatments are considered
"proven" by the Department of Health.
Should the fact that environmental
illness is considered an "emerging illness" have a bearing on what level
of "proof" is required? Are there ethical issues involved in a government
funded clinic not providing treatments which have shown high success rates
but are not "proven scientifically?"
The reviewers recommended that "the
EHC should confine its clinical services to documenting and characterizing
its clinical population, providing conventional symptomatic treatments
and refraining from the use of 'arbitrary treatments' unless these are
adequately justified and the subject of properly documented, scientifically
reviewed and approved protocols."
They allowed that "various services
and non-invasive treatments which are in use, such as psychological therapy,
return to work rehabilitation, sauna and others described above could be
considered within the scope of conventional, non-invasive, symptomatic
Eric Slone, NSAEHA president, notes,
"The government decided to appoint three reviewers none of whom has known
qualifications, experience or certification in the field of environmental
medicine. This led to predictable deficiencies in the review's conclusions
about treatment issues." Prior to the review, the NSAEHA called on the
government to include knowlegable environmental medicine physicians on
the review committee.
There are a number of different elements
used in treating environmental illness; diagnosis, prevention (including
avoidance advice and lifestyle changes), reduction of illness/sensitivity
(including detoxification, supplements, antigens, IVs, and other physical
interventions), and coping skills/psychological interventions (learning
how to live as well as possible with a chronic illness.)
"The reviewers and the EHC both seem
to emphasize the importance of coping skills and give a 'thumbs up' to
this type of
care," says Robinson. "Yet, as with
most illnesses, most patients look
to the medical system for help in reduction
of illness. .As with other illnesses, coping skills should be supplementary
and should not replace treatments which focus on curing the patient or
stopping the spread of illness."
The reviewers concluded that "there
seems to be an overall consensus that the EHC serves an important community
need...If the EHC did not exist or was to be abandoned, the plight of those
with IEI would be worsened." They recommend that the EHC should continue
with current funding levels until further developments warrant change.
However they noted serious problems
of accountability in academic practices, patient care, research and fiscal
matters. Patient care accountablity mechanisms did not meet accreditation
standards. The reviewers found that basic information required to
trace patient care and results were absent. Information is not kept
which is sufficient to give a clear picture of what patients get what treatments
with what results. Such data is "the basis for more definive research and
better care," the reviewers note.
In terms of research, the reviewers
concluded that there are few results. "Studies formulated coincident with
the opening of the Centre in 1997 are yet to be seriously launched.
In fact the flagship study of intravenous magnesium therapy is under consideration
to be cancelled." (IV therapy with magnesium alone is not a standard
environmental medicine treatment. In other clinics, IVs are given
using a combination of ingredients including magnesium.)
In terms of the EHC's leadership, the
reviewers recommended that "the leadership of the EHC must be addressed
with either professional development support for the incumbents or a change
"The government has accepted the report's
recommendations," says Dr. Scott. "The most important one is clear
accountability." A committee is working to develop a "business plan" for
the EHC, to integrate the clinic into mainstream health and academic institutions.
The plan includes linking the EHC to Dalhousie University's Departments
of Medicine and Pediatrics.
Once a plan is developed, stakeholders
(also known as patients and potential patients) will get a chance to have
some input. Will all the effort that patients put into obtaining
this review actually bring EI sufferers any closer to obtaining effective