Document k9Bg2w46G9K5KrdnwQvGxob6O

r Volume 5 Number 7 / December 1991 TOXIC REACTION/By Earon S. Davis and Mary Lamielle Legal Responses Vary To Chemical Illness Multiple chemical sensitivity is a newly defined, dual-level disorder that the law is just beginning to understand. MCS is an emerging health problem in which some people exposed to a number of toxic chemicals (for example, pesticides, solvents and/or formaldehyde) develop potentially debilitating symptoms to increasingly more chemical substances at lower and lower levels. This article presents an overview of scientific and legal issues related to chemical sensitivity disorders, popularly referred to as multiple chemical sensitivity (MCS). Nearly 15 percent of the population may have some chemical sensitivity, according to an internal National Academy of Sciences document. But, since the illness is not yet well-understood, there is no solid data on how many people may be affected. The majority are unaware of the cause of their health problems or simply think that their "dislike" of certain chemicals, such as those found in perfumes, fabric softeners or pesticides, for example, is merely a personal preference rather than a potential health problem. Many people suffer, but_CQ.niinue_toJgxpQse_l]ienisg ly esjo _ the pollutants. Increasing numbers of people, though, become so .ill. that they, cannot continue_t.Q,,fuoc.tipjQ-_ Those who xpernc svre MCS may be unable to engage in basic social and economic activities, such as shopping, going to restaurants or working in industrial or office settings. Many of the badly affected are totally disabled and must lead lifestyles that severely restrict daily activities because of incidental chemical exposures that make them sick. It appears that the exposures, which cause the development of MCS are substantial ones, although not necessarily unusual, given what some advocates feel is our society's cavalier attitude-iawariLebenncal exposures and ventilation. Nicholas A. Ashford and Claudia S. Miller's bench marK noolX^Chemicnl Exposures: Low Levels ana titgn Stakes, Identify four different populations in which MCS occurs. (Van Nostrand Reinhold, publisher, New York, 1991) They are industrial workers; workers in airtight buildings; people who live in contaminated communities; and those with personal exposures (often through consumer products and building materials). Once the sensitivities develop, people with MCS may become ill from future exposures to an increasing variety of different substances in the parts per billion range --exposures that would not even be noticed by the average person. Therein lies the debilitating nature of MCS. As sensitivities become more pronounced and spread to a broader range of substances, the individual's ability to function normally declines, sometimes to the point of total disability. aEven minute exposures to ubiquitous indoor pollutants such as perfumes, disinfectants, solvents, pesticides or combustio fumes result in symptoms of fatigue, headache, cognitive impairments, respiratory and skin disorders, and other flu-like or allergy-like symptoms. Other ailments involve digestive, cardiovascular and autoimmune disorders. The Emerging Legal Problem Hundreds, if not thousands, of personal injury cases involving MCS have been filed. In fact, it is likely that a majority of personal injury and product liability cases related to indoor air quality actually involve MCS. These cases allege harm from consumer products (e.g., pesticides, cleaning agents, glues and paints), building materials (e.g., particle board and carpeting), and generalized poor indoor air quality (e.g., remodeling activities in air-tight buildings or inadequate ventilation). Unfortunately, there is no centralized data base for tracking the number of cases involving MCS that have beer filed. Many of these cases are apparently settled or dismissed, or they arc initially turned down by attorneys. The complex and novel nature of the illness makes it difficult to find experienced attorneys to take a "chemical" case. In Continued mubor Pollution Law nepo/i ueutmium iuxi addition, the severity of the plaintifFs impairments often makes it difficult for him or her to assist in the development of case-related information. Many people with MCS cannot even travel to a lawyer's office, or remain there for any. period of lime, without experiencing severe symptoms. 1 Proving causation is complicated by the difficulty of finding credible, qualified experts to testify in court. It is A inevitable, though, that as science gains a belter understanding of the disorder, it will become easier to prove. <-. r | Case Examples )i Often; health symptoms more traditionally verifiable than MCS have been the focal point of these cases. For `' example, in the landmark sick building case, Call i\ Prudential, No. SWC 90913 (Indoor Pollution Law Report, September, October and November 1990 and April 1991), the employees involved in the lawsuit suffered from MCS. In addition; many of the formaldehyde cases in which respiratory and/or immune damage was alleged, involve MCS (Pinkerton v. Temple Industries, No. CV186-4651CC, Indoor Pollution Law Report, March 1990). { However, MCS is more directly involved in many suits. For example, a lawsuit was filed by several EPA employees who developed MCS (Bahura v. S.E.W. Investors, No. 90-CA10594, D.C. Superior Court). Victims of allegedly toxic carpeting and other consumer products and furnishings have also brought lawsuits. (Beebe v. Burlington Industries, No. A8103037, Cl. Common Pleas, Hamilton County, Ohio, Oct. 24, 1989, verdict Tor defendant). Plaintiffs* verdicts directly relating to MCS include a case of teachers exposed to roofing material in their classrooms (Peterson v. Polycap, No. H7276-0, Calif. Super Cl., Alameda Co., April 19SS) and a family1poisoned by pesticides in their home. (Monison v. Shell Oil Co., Indoor Pollution Law Report, May 1990). But at present, the largest liability exposure for MCS may not rest with personal injury cases. Currently, the largest number of cases for MCS involves workers compensation claims. Such claims probably number in the thousands and appear io be growing. As MCS victims learn of successful cases and government recognition of the illness, there., r will be a greater tendency o i people with MCS to overcome their reluctance to file claims for workers compensation, social security, reasonable accommodation, and to the legal/administrative benefits and rights protections. 1 l ::MI Induction and Triggering While there are inadequate data to identify the mechanisms leading to MCS, it is important to be clear about what is known. First, MCS is not an IgE-medialed ''allergy." (IgE is an immuno-globulin that is involved with most typical allergic reactions.) Second, MCS symptoms are most frequently identified with the central nervous system. Third, the financial, social and emotional ramifications of this illness can be s e v e r e . _____ . It is important to understand MCS as a two-staged phenomenon that involvesrindugion[and uriggerint!^ First, there appear to be high level and/or chronic low-level exposures; which affect the individual's susceptibility to future exposures. The ja m age appears to involve the central nervous system, the immune systenLand the endocrine (hormonal^svstem. However, it is not known whether the primary mechanism lor Thedevelopmenl, or-induction of susceplibility is through the central nervous system or through the immune system. Low-Level Exposure The, second stage of MCS is characterized by the "triggering" of symptoms by low-level exposures. These would normally be far beneath the levels necessary to cause known toxicologic injury other than minor, frequently unnoticed inflammation in the upper and lower airways. It is possible that other poorly understood "triggered" illnesses, such as asthma and vascular spasm, may eventually be round to entail similar mechanisms. ' Theories about the etiology and triggering mechanisms of MCS range from immune system damage and auto^ immunity io damage to the brain's primitive limbic area, damage to detoxification pathways, impaired endocrine functioi and behavioral conditioning. However, everyone agrees that the problem is not a typical IgE-mediated allergy. In the past several decades, the term "allergy" has been redefined to coincide with what is known about IgE. This narrowing of the definition of "allergy," which is classically defined as any untoward reaction to a substance in the environment, has helped to push MCS out of typical allergy practices and has led to many of the medical "politics" and "turf problems that plague MCS. Because of the emotional difficulties experienced by all individuals with severe, debilitating chronic illness, one would expect that people with MCS would have higher rates or depression and other emotional problems. Several studies have, in fact, shown this to be true. However, to conclude that MCS is psychogenic would be irresponsible and unscientific. A Medical Mystery t Experts at workshops held by Health and Welfare Canada in May 1990 and the U.S. National Academy of. Sciences in March 1991 concluded that the MCS problem is substantial and requires a serious research effort. In the meantime, Health and Welfare Cunada concluded, "the patient should not be caught in the medical, debate and denied social benefits." Clearly, until such research begins to provide the scientific answers, the primary battle grounds for MCS victims will be the courts and the legislative process. Continued ir