Experts: Mysterious syndromes involve more than environmental exposures

Posted: Friday, February 02, 2001

PISCATAWAY, N.J. (AP) -- People desperate for explanations of mysterious health problems from chronic fatigue syndrome to multiple chemical sensitivity shouldn't blame the nearest toxic dump or exposure to chemicals, experts say.

Numerous illnesses for which doctors can find no cause -- or even conclude it's all in the patient's head -- probably are caused by multiple physical, psychological and social factors interacting in complex ways not yet understood, scientists said at a recent conference at Rutgers University.

''Everybody (at the meeting) seems to agree that psychosocial factors are very important for how people feel, for how they experience an illness,'' said conference organizer Dr. Howard Kipen, a professor of occupational health at the University of Medicine and Dentistry of New Jersey's Robert Wood Johnson Medical School. ''But most physicians in the wider community don't agree.''

About 100 physicians, psychiatrists, chemical experts, epidemiologists and other researchers participated in discussions on the role environmental factors play in medically unexplained symptoms. That's an issue of great interest in New Jersey, a state full of Superfund sites (113), chemical plants, clogged highways, an unexplained autism cluster in Brick Township and abnormally high cancer rates among children in Toms River.

When pain, nausea or other troublesome symptoms send patients to a doctor, Kipen noted, anywhere from 30 percent to 70 percent of those cases cannot be explained by any known disease.

That's according to numerous studies of patients with what conference participants called ''Multiple Unexplained Symptom Syndromes.'' While they are poorly understood, most at least get names: chronic fatigue, irritable bowel syndrome, fibromyalgia, Gulf War Syndrome, Lyme disease, sick building syndrome, multiple chemical sensitivity, sensitivity to the gasoline additive MTBE, or connective tissue disorder, as in women with silicone breast implants.

The most common symptoms, at least in patients ill enough to seek medical help, include headaches, fatigue, trouble concentrating or remembering things, nausea, unusual chest pain, shortness of breath, trouble sleeping and musculoskeletal pain.

''We're seeing overlap of symptoms'' from one syndrome to another, said Dr. Richard Kreutzer of the California Department of Health Services.

Another puzzle, he said, is that ''We're all exposed to low levels of chemicals, but we really don't see (multiple chemical sensitivity) in most people.''

The symptoms often seem worst in patients paying the most attention to them, those living unstimulating, somewhat isolated lives, noted Anne Spurgeon of the University of Birmingham in England.

New syndromes crop up periodically, and some appear to have predecessors. For instance, some people working on computers or in slaughterhouses today develop repetitive strain injury, whose forerunners include telegraphist's cramp, Spurgeon said.

She is researching a ''new'' illness causing fatigue and memory problems among U.K. sheep farmers, who by law each year must dip sheep in a toxic chemical to kill parasites.

Despite the complexities of such syndromes, researchers hope to understand them better.

Dr. Benjamin Natelson and colleague Gudrun Lange of UMDNJ's New Jersey Medical School, for example, are testing two hypotheses on what causes chronic fatigue syndrome.

One involves previous findings that patients with CFS who have no psychiatric problems have abnormalities in the structure of their brains; the other concerns preliminary data that CFS patients have something wrong with their hearts or blood vessels.

Kipen said the conference helped participants decide where future research should go so that ''we should be able to design better treatments and prevention.''

The conference was sponsored by government agencies, the petroleum industry and the 15-year-old Environmental and Occupational Health Sciences Institute in Piscataway, which is jointly run by Robert Wood Johnson Medical School and Rutgers University.

The environmental institute brings together experts from different fields in programs focused on understanding how environmental factors affect human health, treating people harmed by environmental agents, trying to prevent risks to human health and the environment, and providing scientific information to policy makers.


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