Review of Multiple Chemical Sensitivity: Identifying
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- Department of Defence (DOD)
- Department of Veterans Affairs
- National Institute of Environmental Health Sciences (NIEHS), National Institute of Health
- Environmental Protection Agency (EPA)
- Occupational Safety and Health Administration (OSHA)
6.2US GovernmentIn America, interest in MCS within federal government health departments and agencies has a relatively long history dating from 1979 with the issue being discussed and examined through several workshops and conferences (Read, 2002). Agency for Toxic Substances and Disease Registry (ATSDR)The ATSDR keeps a watching brief on the issues surrounding sensitivity to low levels of chemicals. In the past, given the need for additional scientific research, the ATSDR has supported MCS conferences to further well-designed scientific research into MCS aetiology. One meeting by the National Academy of Sciences on MCS was held in March 1991. Another meeting on MCS in September 1991 was cosponsored with the Association of Occupational and Environmental Clinics. Another meeting on low level chemical exposures and neurobiologic sensitivity sponsored by the ATSDR was held in 1994. The proceedings from these meetings are available in a combined publication (Mitchell 1995). Department of Defence (DOD)Due to the work environments that employees of the Department of Defence (DOD) face, the DOD has sponsored several projects to investigate chronic multi-symptom illnesses, focussing on the relationship between Gulf War illnesses and other diseases such as CFS, MCS and FM. In 2003, the DOD Appropriations Bill provided US$ 5.2 million to further fund this research on chronic multi-symptom illnesses (Department of Defence Appropriations Act, 2003). Department of Veterans AffairsThe Department of Veterans Affairs has funded three Environmental Hazards Centres for the purpose of conducting research on environmental health and toxicology related to military service. Some of the centres performed research into MCS. Detailed studies of those diagnosed with MCS (according to Cullen’s criteria) include psychiatric status, neuropsychological function, symptom reports, occupational and economic outcomes, pulmonary function, neurologic status and evaluation of possible triggers. The results from some of these studies have been published (e.g. Black et al., 1999, Gray et al., 2002). Black et al. (1999) noted that of 3695 Persian Gulf-War military personnel, 4.6% met Cullen’s criteria for MCS, with most reporting they were on Veteran’s affairs disability status or receiving Veterans affairs disability compensation. In 2008, the Research Advisory Committee on Gulf War Veterans’ Illnesses published a detailed report on the health of Gulf War veterans which examined MCS (Research Advisory Committee on Gulf War Veterans' Illnesses, 2008). The report noted both similarities and differences between Gulf War illness and other multisymptom disorders found in the general population. The report recommended studies that determine the extent to which objective measures distinguishing CFS, FM and MCS patients from healthy controls are also associated with Gulf War illness. National Institute of Environmental Health Sciences (NIEHS), National Institute of HealthThe NIEHS has provided research support for studies related to MCS and to areas of research associated with MCS outcomes, and has supported a number of workshops and meetings concerning MCS to assist NIEHS in developing new and innovative research ideas to better understand MCS. Environmental Protection Agency (EPA)In 1991, the EPA requested that the National Research Council organise a workshop on MCS. The papers presented at this workshop cosponsored by the National Academy of Sciences and the Environmental Protection Agency were published as an addendum to Biologic Markers of Immunotoxicology (Board of Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council, 1992). The EPA also initiated a federal government Interagency Workgroup on MCS that was co-chaired by the ATSDR and the National Centre for Environmental Health of the Centres for Disease Control and Prevention. A draft report intended to be a guide to public health policy-making and research planning was released for public consultation in August 1998 (Interagency Workgroup on Multiple Chemical Sensitivity, 1998). The draft report provided a public health evaluation of the extent and nature of MCS and recommended future actions for federal agencies to consider. The workgroup concluded that there is a need for research in the areas of case definition, basic epidemiology and challenge studies are necessary to address the concerns surrounding MCS. The report received some criticism from MCS advocates for procedural problems and not including all available literature (Donnay 1999). A National Environmental Justice Advisory Council was established in 1993 to provide independent advice to the EPA on issues relating to environmental justice. In 2000, this council recommended that MCS be a notifiable disease, that existing environmental laws be reviewed to assure protection from chemicals that initiate and trigger MCS and that MCS be included as a factor when setting standards and establishing regulations. In response to these recommendations, the EPA stated that the state of knowledge regarding the definition, causes and treatment of MCS was insufficiently defined to warrant the type of regulatory action called for by the council (Read, 2002). More recently, a guide for health professionals on indoor air quality co-sponsored by the EPA as well as the American Lung Association, American Medical Association and the Consumer Products Safety Commission notes that definition of MCS is elusive and its pathogenesis as a distinct entity is not confirmed. The guide also notes that the current consensus is that complaints in cases of claimed or suspected MCS should not be dismissed as psychogenic, and that a thorough workup is essential (American Lung Association, Environmental Protection Agency, Consumer Product Safety Commission and American Medical Association, 2009). Occupational Safety and Health Administration (OSHA)The Occupational Safety and Health Administration (OSHA) of the Department of Labor notes that MCS is a highly controversial issue. In theory, MCS is an adverse physical reaction to low levels of many common chemicals. Chemical sensitivity is generally accepted as a reaction to chemicals but debate continues as to whether MCS is classifiable as an illness. There is insufficient scientific evidence to confirm a relationship between possible causative theories and symptoms (Occupational Safety and Health Administration, 2008). 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