Review of Multiple Chemical Sensitivity: Identifying
Download 454.32 Kb.
|
- Navigate this page:
- 5.3The common ground
- Initial Presentation
- Diagnosis
- Prognosis and Treatment
- Education
5.2Problems encounteredFrom the beginning of the project, it was evident that a major barrier to progressing the issues surrounding MCS existed, best described as a strong divergence of clinical opinion and a lack of agreement about MCS in the literature. This was encountered in one-on-one interviews and confirmed at the collaborative workshop. In addition to polarised and strongly held views, two further barriers to progress were evident: 1. A lack of authoritative published research specifically related to MCS While there are many articles and books published about MCS in the world literature, much of which is featured on the websites of interest and advocacy groups including papers presented at meetings, little evidence for characteristic biological markers could be found in peer reviewed journals that supported the diagnosis of MCS. In Australia in 1992, an expert working group initially established by the Royal Australasian College of Physicians (RACP) and the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) set out to examine MCS but was soon diverted to focus on CFS. Whilst several clinical advocates have declared their belief that MCS is a component of, or related to CFS, others consider MCS a separate entity requiring different approaches to both diagnosis and management. 2. Limited available information on prevalence Generally, jurisdictions do not collect data specifically identifying MCS. Germany and Austria (via adoption of the German disease classifications) are the only countries in which MCS is a recognised ICD-10 disease term. Information on prevalence in Australia is based on telephone surveys in NSW and SA ranging from 2.9 per cent to less than one per cent (0.9%) of respondents, may be quite unreliable because of the way in which the questions were framed, particularly between studies, thus hindering the development of longitudinal datasets. Participants in the SA surveys were asked if a medical doctor had diagnosed MCS, while the NSW survey participants were asked if they had been diagnosed with chemical sensitivity. 5.3The common groundResponses to questionnaires demonstrated that individual clinical views were polarised, vigorously stated and defended, based mainly on individual belief and comparatively limited clinical experience with MCS within overall caseloads. As indicated earlier, interviews and literature searches revealed that on one side, some clinicians, together with some of the published literature, proposed that people with symptoms attributed to MCS do have an identifiable condition and that these people suffer from a chronic debilitating syndrome arising from continuing exposure to chemicals. Some of these clinicians considered the underlying mechanism had been defined, at least to their satisfaction, and provided publications to support their position. For others, the reality of the condition was accepted but the cause was still not understood nor satisfactorily explained by the evidence base. On the other side of the debate, some clinicians and at least one local clinical organisation stated strongly that MCS is neither a diagnosis nor a syndrome but a range of sometimes disparate disabilities with some common presenting symptoms. Some described the presentations as a somatoform disorder, with symptoms in the absence of an identifiable general medical condition. These clinicians consider that psychological conflicts become translated into physical problems. Other clinicians considered MCS to be a psychopathological condition created, enhanced, and perpetuated by the law and its application, termed a “nomogenic” disorder. They argue that some doctors and lawyers have provided patients presenting with a range of symptoms, some of which may be related and all of which become attributed to a sensitivity to chemical odours, with the identifying label, “MCS”. These clinicians consider that patients presenting with such problems are more often likely to have been exposed to chemicals in the course of their work and may be seeking something or someone to be responsible for their ill health and/or to achieve compensation from an employer or some other source to make recompense for the disability. Nevertheless, as the result of interviews with clinicians, responses to questionnaires and subsequently confirmed in workshop discussion, the following common ground was uncovered in the clinical review: Initial Presentation
Diagnosis
Prognosis and Treatment
Education
Directory: data -> assets -> word doc word doc -> Northern territory of australia word doc -> Number: caveat in the [Will/Will and Codicil/Estate of] word doc -> List of accessible executive records word doc -> National Industrial Chemicals Notification and Assessment Scheme word doc -> This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth word doc -> Commonwealth of Australia 2002 word doc -> Commonwealth of Australia 2000 word doc -> Priority Existing Chemical word doc -> Rail safety news issue 6 – October 2011 word doc -> Board Endorsed October 2009 amended 13-09-11 with extra units Download 454.32 Kb. Share with your friends:
|