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Environmental Medicine – Not Your Average Specialty

I recently received an announcement for a conference on “Inflammation and Autoimmunity.” The topic sounded interesting, but as I read further I saw some red flags:

A gathering of healthcare leaders with a shared vision.

This event focuses on the the [sic] true causes and effects of inflammatory and autoimmune diseases, including new treatments available for this rapidly emerging crisis.

Both of these comments sound ideology-driven. I would not expect to find language like this for, say, a conference organized by the American Academy of Pediatrics or the American Academy of Allergy, Asthma and Immunology. This conference was organized by the American Academy of Environmental Medicine. I did some checking, and it seems the AAEM is not your average academy, and environmental medicine is not your average specialty.

The AAEM is not recognized by the American Board of Medical Specialties.
It is listed as a questionable organization on Quackwatch. And the American Board of Environmental Medicine is listed as a dubious certifying board.

Note: The environmental AAEM should not be confused with the American Academy of Emergency Medicine, a reputable specialty organization that also carries the initials AAEM.

The AAEM website says:

“Autoimmune and inflammatory diseases have escalated dramatically in modern times. Most current treatments for these disorders primarily involve drugs that suppress the symptoms.”

“A quickly growing body of scientific evidence has revealed how many important inflammatory and autoimmune diseases are caused by man’s interaction with the environment, both internally and externally. At the AAEM, we understand this interaction. We can provide you with the answers you need and new insights that will open the door to newer and more effective, specific, cause-oriented, and preventive treatment for most of these conditions. [emphasis added]

Sound familiar? We’ve seen this kind of language from proponents of all kinds of alternative medicine. I’m surprised they didn’t use the word “allopathic” or attack evil Big Pharma.

When I looked up the members of the AAEM in my local area, one very disreputable name jumped out at me: Jonathan Wright. He has been in trouble with the FDA repeatedly for numerous violations and at one point he posted a notice saying that state-licensed physicians are “exempt from the restrictions and regulations of the federal Food and Drug Administration as a matter of federal law.” The notice also stated that “no employee, agent or inspector of the FDA shall be permitted on these premises.” His clinic used quack electrodiagnostic devices. The FDA raided his clinic and confiscated the machine.

Maybe we shouldn’t judge others by the company they keep. Let’s look at whether the conference offers good science.
There are two bonus electives:

One is a prolotherapy workshop. Prolotherapy is a controversial treatment not covered by insurance; a Cochrane review said there is conflicting evidence and found that prolotherapy injections were not superior to placebo injections, and that their effectiveness depended on co-interventions.

The other is on LDA Immunotherapy – Ultra Low Dose Enzyme Activated Immunotherapy (formerly known as EPD).

Learn how to treat complex inflammatory disorders, autoimmune diseases and allergies, including asthma, eczema, IBS, Crohn’s disease, rheumatoid arthritis, ankylosing spondylitis, interstitial cystitis and a multitude of others disorders with a definitive immunotherapy given only once every two months. LDA requires no testing and you can start it as soon as you get home!

While there is some preliminary evidence that seems to support enzyme activated immunotherapy, there is also evidence that doesn’t. There is certainly nowhere near enough evidence for them to make the statement they did.

Other questionable things on the agenda included sauna therapy for the management of toxicity and stool antibody testing for gluten sensitivity. None of the listings for sauna on PubMed have anything to do with toxicity. This study showed that stool testing was not suitable for screening.

Environmental medicine patients are told that the world has made them sick. They blame their symptoms on everything from cell phones to the very walls of their houses, from air pollution to food additives. The theory is that while one chemical might not be a problem, many different chemicals and substances overwhelm their ability to cope.

Environmental Medicine involves the adverse reactions experienced by an individual on exposure to an environmental excitant. Excitants to which individual susceptibility exists are found in air, food, water, and drugs, and are frequently found in the home, work, school, and play environments. Exposures to these agents may adversely affect one or more organ system and this effect is commonly not recognized by individuals and their physicians.

Their practice guidelines are explained here. Many of the diagnostic tests they recommend are questionable. Treatment includes avoidance, immunotherapy, nutritional supplements, detoxification, restricted diets, and drugs.

The poster boy for environmental medicine is Dr. William Rea, who was profiled on “Nightline” in 2008. They interviewed Rea and toured his clinic, seeing the detoxification saunas, the ceramic walls chosen because they are nonreactive, and the exercise machines that were cleaned of the lubricants that were putting fumes into the air. He claimed to have successfully treated 30,000 patients. They asked him about allegations that he had injected jet fuel into patients, and he explained that he only injected jet fuel antigens as a skin test for allergy. They asked him where his research was published and he evaded a direct answer, saying things like “The New England Journal of Medicine is a drug company journal.” (!?)

They interviewed one of his patients: a medical doctor who first thought she was depressed and saw a psychiatrist every day for a year. She had to stop because driving there exposed her to diesel fumes on the highway. Dr. Rea figured out what was “really” wrong with her: she was sensitive to practically everything in the environment. She can’t use her telephone because the magnets in it give her a headache. She injects herself daily with all kinds of unconventional allergy shots. She even injects herself with mercury. She moved to an island and created a pollutant free home. She spends 2 hours a day inhaling oxygen. Curiously, she has no sensitivities to her dogs, her horses, or the dust kicked up as she rides in a dirt arena.

They interviewed a real allergy specialist who explains that these people are reacting to stress and they have developed a conditioned response so that they have symptoms when they smell something they think they’re sensitive to. He says most of these patients have an underlying psychiatric problem. I suspect one of the reasons they improve is that they now have a mission and their attempts to avoid exposures and the effort required to detoxify and treat themselves takes up most of their time, keeps them entertained, and distracts them from dwelling on their psychological issues. But as was pointed out on Nightline, they are not cured.

As described on the Casewatch website, Rea is

facing disciplinary action that could lead to revocation of his medical license. The Medical Board of Texas has charged him with (a) using pseudoscientific test methods, (b) failing to make accurate diagnoses, (c) providing “nonsensical” treatments, (d) failing to properly inform patients that his approach is unproven; (e) practicing in areas for which he has not been trained; and (f) representing himself certified by a board that is not recognized by the American Board of Medical Specialties. Rea is best known for his promotion of the concept of multiple chemical sensitivity (MCS), a diagnosis not recognized by the scientific community.

The AAEM was so upset with ABC that it felt compelled to publish this defense.

To show how rigorous a scientist Rea is, here’s the most recent example of his published scientific studies:

Twenty-eight incapacitated individuals (average 43 years old, 7 males, 21 females, range 12-70) exposed to molds and mycotoxins were studied and treated with a protocol of cleaning up or changing their environment to be mold free. Injections of the optimum dose of antigens were given as part of the treatment protocol as was oral and intravenous (i.v.) antioxidants; heat depuration (sauna); physical therapy with massage and exercise under environmentally controlled conditions; oxygen therapy at 4-8 L/min for 2 hours with a special wood-grade cellophane reservoir and a glass oxygen container. Many patients were sensitive to plastics; therefore, exposures to these were kept to a minimum. Autogenous lymphocytic factor was given as an immune modulator. Of 28 patients, 27 did well and returned to work. One patient improved but did not return to work during the period of study.

With no controls and multiple interventions it is impossible to determine what worked or if anything actually did. Or even what was wrong with these patients in the first place. They are not trying to falsify a hypothesis or learn anything new; they are trying to justify a belief system. In my opinion, this kind of study amounts to junk science.

The underlying message of environmental medicine seems to be “The modern world is a dangerous place: technology and chemicals are bad; everything in the environment is out to get you, even your food.” The AAEM website has position statements against mercury in vaccines, GMO foods, and toxic molds. And against the FDA’s attempts to regulate bioidentical hormones. Their statement on multiple chemical sensitivity can be read here.  An excerpt:

Very sobering is the reality that certain man-made chemicals, like pesticides, were specifically designed to kill living things by poisoning their nervous systems. It should be no surprise that they wreak havoc on the brains of humans as well.

Common incitants include the following:

  • Those substances widely recognized as toxic, e.g., the aforementioned pesticides; natural gas; petroleum-based solvents like toluene and benzene; volatile organic compounds (VOCs) like formaldehyde; heavy metals like mercury and aluminum; molds and the potentially dangerous mycotoxins they release; tobacco smoke; the phthalates and other endocrine-disrupting compounds, like bisphenol A, found in plastics; flame retardants like PBDEs; and automobile exhaust fumes;
  • Those substances less often recognized as toxic, e.g., synthetic fragrances like perfumes, air fresheners, and other “pleasant-scented” products; newspaper print; personal care products; laundry detergents and fabric softeners; household cleaners; and fluoride-containing water and toothpaste; and
  • More generally, the many pollutants found in the air we breathe, the water we drink, and the food we eat.

Imagine being afraid of everything in your environment from your toothpaste to newspaper print. The lives of these people are totally disrupted. They are afraid to leave home. One woman “hung her mail on a clothesline for weeks before reading it, to allow the “toxins” in the ink to dissipate.” Quackwatch calls MCS a spurious diagnosis. MCS has not been meaningfully defined, diagnosis is based on unblinded, unvalidated tests whose findings vanish when blinding is used, and the treatment is everything but the kitchen sink.

The American Board of Medical Specialties was wise not to recognize environmental medicine as a legitimate specialty. It appears to have more in common with quackery than with science-based medicine.

Environmental medicine is not your average specialty.

Posted in: Science and Medicine

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