At 10 o'clock on Sunday morning July 2, 1995, sitting comfortably in my study preparing to do some work on a biostatistics assignment, a sharp metallic, acidic taste suddenly emerged on my tongue and on the roof of my mouth. It was a sensation I had never felt before. Within less than six months I would be diagnosed with a toxicant induced chemical sensitivity disorder and my 52 year old life would be dramatically changed in ways I would never have guessed. I would find it virtually impossible to be in any of the carpeted rooms at the college where I am a professor (and almost all the college rooms were carpeted), my marriage would end, I would have to find a chemically safer place to live, I would be unable to get into my vehicle without becoming sick, I could not go out to restaurants, theaters, and many stores because they made me ill, I would not be able to go to church because of the chemicals in artificial fragrances that people wore, and I would sometimes find it almost impossible to be around even my own grown children because of a hypersensitivity to some of the chemicals in their homes and on their clothing.

Before this diagnosis I had been an almost perfectly healthy man in his prime years, who exercised and ran at least two miles every day (sometimes five miles or more), who had virtually no medical complaints, who loved his work teaching philosophy and who was considered quite good at it, who loved his family deeply, who enjoyed several hobbies, who was completing the writing of two books, and whose life was generally rather good.

In fact, at the age of 51, I had decided that I wanted to go back to graduate school and earn another postgraduate degree, this time a master's in public health (MPH). My degrees in philosophy had been earned 25 years earlier, and I was now eagerly anticipating the challenge of taking on an entirely new enterprise to complement my teaching and writing. In addition to teaching regular philosophy courses, I had been teaching courses in medical ethics and HIV/AIDS for approximately ten years and was enjoying it. It seemed like a good idea to earn a degree in public health, and it also seemed like it would be great fun. I applied to the University of Washington School of Public Health and was accepted.

Classes for the MPH started in mid-June 1995, just two weeks before the metallic taste began. I was enjoying the classes thoroughly, although they were challenging, and I liked my classmates a lot. I was relishing the experience of being a student again, and having fun working with peers to understand new concepts and to complete challenging homework assignments.

That Sunday morning, July 2, my wife was gone for a few days of traveling with friends, and I was cherishing the peace. I had just settled in, with a mug of hot coffee in one hand, my feet up on the desk, and a heavy textbook in my lap, to do some homework for the biostatistics and epidemiology courses we were all working through that summer.

The unusual metallic taste was sharp enough to be not only distinctive, but also immensely distracting. It was difficult to concentrate on the biostatistics assignment without wondering about what was going on in my body that would cause such an odd taste. "I wonder if it's the coffee," I thought. "Something foul about this particular cup." So I went out to the kitchen and made another mug, adding just the right amount of creamer and my usual two tablets of NutraSweet.'

After several hours of personal observation and experimentation, I discovered that the taste did not seem to be related to the coffee at all. Nor could I make it go away even when I went outside and sat on the front porch. It seemed to come and go on its own whim, regardless of where I was or what I was doing.

The next day in epidemiology class, I asked a few MD friends if they knew what might cause a metallic taste like that. Had I changed my diet lately, they asked. I had not. Was I on any medications? No. Well, it's probably nothing, they said. Wait for a few days, and it will probably go away on its own.

Unfortunately the taste did not go away. I could not make it go away. I was also, I now noticed, often feeling dizzy in the mornings after taking a shower. Sinuses and nasal passages were closing up during the shower, and just being in our bedroom for any length of time made my nasal passages close up so severely that I literally could not breathe through my nose at all.

During the next weeks, as the taste continued to come and go, I noticed a variety of other symptoms, particularly while in the classroom building where the MPH classes were being held; symptoms such as slight nausea, mental confusion, difficulty concentrating, an odd raspiness in my voice that sometimes led to coughing and choking, and occasionally sudden great fatigue. I eventually made an appointment with my regular family physician. She also seemed puzzled, though not terribly concerned. She ordered some routine blood work and, when the results came back a week later, all the tests seemed to be within normal limits. I eventually saw another physician in my HMO who specialized in occupational medicine and she too declared that nothing was discernibly wrong.

Over the next weeks I explored a variety of different hypotheses to explain what was happening to my body, one of which was that I had perhaps developed some kind of allergy. Allergy tests all proved negative, however. I eventually visited a physician who specializes in environmental medicine. After taking a thorough medical history, doing an examination of recent blood work, asking about what symptoms I generally experienced in relation to various exposures, and recommending more lab tests, he eventually diagnosed me with multiple chemical sensitivity (MCS), probably developed as a result of chemical injury.

As a diagnosis, MCS is considered somewhat controversial among conventional medical practitioners. However, since these physicians as a rule have received no medical training in low dose toxicant induced pathologies, either while in medical school or in postgraduate education, it is not surprising that they would find the diagnosis to be outside the limits of their expertise.

This, as societies will soon realize, is a significant weakness in medical training that sorely needs to be remedied. As the number of people suffering from toxicant induced pathologies continues to grow with each passing year, and as their impact on society begins to take an increasingly serious toll, it will become more and more important that our physicians be trained to recognize and treat such conditions.

This book examines some of the ethical issues associated with the increasing emergence of low dose toxicant induced illnesses.

I have written two other books on ethical issues in public health, but this one is different. In each of those I took great pains to argue both sides of the relevant issues, to explain the thinking on both sides, and to show the legitimate tensions between the two opposing positions.

This book is different from those in that it takes a clear position and argues for it. The position taken is this: today's public policy regarding the manufacture, marketing and use of toxics is inadequate. It fails to adequately protect the health of the world's citizens. Significant changes need to be made, and in Chapter Three I recommend several.

I am entirely aware that there is another side to this question: namely, that position represented by the chemical manufacturing corporations and by the recent crop of optimists who claim that today's environmental policies are entirely adequate to protect the environment and public health. I believe their position to be mistaken, and much of this book explains why.

The book is arranged (after the Introduction) in four chapters which have a logical progression. It argues that, given certain facts, about toxicant induced illnesses (Chapter One, Data), and given certain ethical principles (Chapter Two, Principles), some definite changes will need to be made (Chapter Three, Modest Proposals), despite some serious obstacles and challenges (Chapter Four, Brick Walls). The recommended changes are momentous, and the challenges heroic. But, as we will soon see, they must be faced if we hope to avoid some very serious threats to our physical health, to our mental capacities, and to the future well-being of our children, our grandchildren, and the generations to come.

Environmentally Induced Illnesses:
Ethics, Risk Assessment and Human Rights

Thomas Kerns
McFarland & Company, Inc., Publishers
ISBN: 0-7864-0827-8
304pp $39.95

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