October 9, 1998   *     October 13, 1998   *   October 15, 1998    *    October 20, 1998

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From the Congressional Record of the United States
CONGRESSMAN BERNARD SANDERS
Extension of Remarks to the House of Representatives

concerning

CHEMICAL INJURY AND SENSITIVITY
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HON. BERNARD SANDERS
Extension of Remarks to the House of Representatives
(Extension of Remarks - October 09, 1998)

MULTIPLE CHEMICAL SENSITIVITY
[Page: E1992]

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HON. BERNARD SANDERS
in the House of Representatives

THURSDAY, OCTOBER 8, 1998
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Mr. SANDERS. Mr. Speaker, I rise today to discuss the issue of Multiple Chemical Sensitivity as it relates to both our civilian population and our Gulf war veterans.

Multiple Chemical Sensitivity or MCS is a chronic condition marked by heightened sensitivity to multiple different chemicals and other irritants at or below previously tolerated levels of exposure. Sensitivity to odors is often accompanied by food and drug intolerance, sensitivity to sunlight and other sensory abnormalities, such as hypersensitivity to touch, heat and-or cold, and loud noises. MCS is often accompanied by impaired balance, memory and concentration.

As a member of the Human Resources Subcommittee, which has oversight jurisdiction for the Veterans' Affairs, I have been involved in the issue of Gulf war illness and Multiple Chemical Sensitivity. I have been concerned for many years about the role that chemicals may be playing on human health, not only in Gulf war veterans and their families, but in civilian society as well. I have talked to many people who are suffering symptoms not dissimilar from the symptoms that our Persian Gulf veterans are experiencing because of chemicals in their homes or workplaces.

As has been well-documented, the military theater in the Persian Gulf was a chemical cesspool. Our troops were exposed to chemical warfare agents, leaded petroleum, widespread use of pesticides, depleted uranium and burning oil wells. In addition, they were given a myriad of pharmaceuticals as vaccines. Further, and perhaps most importantly, as a result of a waiver from the FDA, hundreds of thousands of troops were given pyridostigmine bromide. Pyridostigmine bromide, which was being used as an anti-nerve agent, had never been used in this capacity before. In the midst of all this, our troops were living in a hot, unpleasant climate and were under very great stress.

The Department of Defense and the Department of Veterans Affairs have downplayed the presence of Multiple Chemical Sensitivity in Gulf war veterans. In the very beginning, the Defense Department and Veterans' Affairs actually denied that there was any problem whatsoever with our veterans' health. Then, after finally acknowledging that there was a problem, they concluded that the problem was in the heads of our soldiers--of psychological origin. The DOD and the VA responded very poorly to our veterans' concerns. Tragically, our veterans were discounted. They were called malingerers.

Ever so slowly, the truth about chemical exposure in the Persian Gulf has begun to surface. On July 24, 1997, the Defense Department and the Central Intelligence Agency gave us their best estimate--that as many as 98,910 American troops could have been exposed to chemical warfare agents due to destruction of `the Pit' in Khamisiyah, an Iraqi munitions facility.

Not waiting for the DOD and VA, many other Federal, State, and local government agencies have recognized the existence of Multiple Chemical Sensitivity. I want to submit for the Record the latest `Recognition of Multiple Chemical Sensitivity' newsletter which lists the U.S. Federal, State, and local government authorities, U.S. Federal and State courts, U.S. workers' compensation boards, and independent organizations that have adopted policies, made statements, and-or published documents recognizing Multiple Chemical Sensitivity disorders.

[Page: E1993]

Multiple Chemical Sensitivity or MCS is a chronic condition marked by heightened sensitivity to multiple different chemicals and other irritants at or below previously tolerated levels of exposure. Sensitivity to odors is often accompanied by food and drug intolerances, photosensitivity to sunlight and other sensory abnormalities, such as hypersensitivity to touch, heat and/or cold, and loud noises and impaired balance, memory and concentration. MCS is more common in women and can start at any age, but usually begins in one's 20's to 40's. Onset may be sudden (from a brief high-level toxic exposures) or gradual (from chronic low-level exposures), as in `sick buildings.' The syndrome is defined by multiple symptoms occurring in multiple organ systems (most commonly the neurological, gastrointestinal, respiratory, and musculoskeletal) in response to multiple different exposures. Symptoms may include chronic fatigue, aching joints and muscles, irritable bowel, difficulty sleeping and concentrating, memory loss, migraines, and irritated eyes, nose, ears, throat and/or skin.

Symptoms usually begin after a chronic or acute exposure to one or more toxic chemical (s), after when they `spread' to other exposures involving unrelated chemicals and other irritants from a great variety of sources (air pollutants, food additives, fuels, building materials, scented products, etc.). Consistent with basic principles of toxicology, MCS usually can be improved, although not completely cured, through the reduction and environmental control of such exposures. Many different terms have been proposed in medical literature since 1869 to describe MCS syndrome and possibly related disorders whose symptoms also wax and wane in response to chemical exposures.

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Acquired Intolerance to Solvents, Allergic Toxemia, Cerebral Allergy, Chemical Hypersensitivity Syndrome, Chemical -Induced Immune Dysfunction, Ecological Illness, Environmental Illness or `EI,' Environmental Irritant Syndrome, Environmentally Induced Illness, Environmental Hypersensitivity Disorder, Idiopathic Environmental Intolerances or `IEI,' Immune System Dysregulation, Multiple Chemical Hypersensitivity Syndrome, Multiple Chemical Reactivity, Total Allergy Syndrome, Toxic Carpet Syndrome, Toxin Induced Loss of Tolerance of `TILT' [see Dr. Claudia Miller 's Congressional Testimony
on Chemical Intolerance], Toxic Response Syndrome, 20th Century Disease.

Akureyri Disease (coded as EN), Asthma, Cacosmia, Chronic Fatigue Syndrome, Disorders of Porphyrin Metabolism, [Benign Myalgic] Encephalomyelitis, Epidemic Neuromyastenia (EN), Fibromyalgia Syndrome, Gulf War Syndrome, Icelandic Disease (coded as EN), Mastocytosis, Migraine, Neurasthenia, Royal Free [Hospital] Disease, Sick Building Syndrome, Silicone Adjutant Disease, Systemic Lupus Erythematosus, Toxic Encephalopathy.

Listed alphabetically below are the U.S. Federal, State, and local government authorities, U.S. Federal and State courts, U.S. workers' compensation boards, and independent organizations that have adopted policies, made statement, and/or published documents recognizing MCS disorders under one name or another as a legitimate medical condition and/or disability. An introductory section summarizes recognition or MCS in peer-reviewed medical literature, and the last section lists upcoming MCS conferences as well as past conferences sponsored by Federal Government agencies.

The exact meaning of `recognition' varies with the context as each listing makes clear. Recognition by a court of law, for example, usually refers to a verdict or appeal in favor of an MCS plaintiff, while recognition by government agencies varies tremendously--from acknowledgement of the condition in publications and policies to research funding and legal protection of disability rights.

U.S. Agency for Toxic Substances & Disease Registry in a unanimously adopted recommendation of the ATSDR's Board of Scientific Counselors, which
calls on the ATSDR to `take a leadership role in the investigation of MCS' [1992, 24 pages, R-1]. To coordinate interagency research into MCS, the ATSDR co-chairs the Federal Work Group on Chemical Sensitivity, which it convened for the first time in 1994 (see below). The ATSDR has helped organize and pay for three national medical conferences on MCS: sponsored by the National Academy of Sciences in 1991, the Association of Occupational and Environmental Clinics in 1991, and the ATSDR in 1994. The combined proceedings of these three conferences are reprinted in Multiple Chemical Sensitivity, A Scientific Overview, ed. Frank Mitchell, Princeton NJ: Princeton Scientific Publishing, 1995 (609-683-4750 to order). ATSDR also contributed funding to a study conducted by the California Department of Health Services to develop a protocol for detecting MCS outbreaks in toxic-exposed communities via questionnaires and diagnostic tests (see entry below on California Department of Health Services). Officially, however, ATSDR has not `established a formal position regarding this syndrome' [1995, 1 page, R-2].

U.S. Army, Medical Evaluation Board on US Army Form 3947 (from the U.S. Army Surgeon General), Army Medical Evaluation Board certified a diagnosis of `Multiple Chemical Sensitivities Syndrome' for a Persian Gulf veteran on 14 April 1993 [1 page, R-3]. MCS is defined on this form as `manifested by headache, shortness of breath, congestion, rhinorrhea, transient rash, and incoordination associated with exposure to a variety of chemicals.' The Board's report further recognizes that this patient's particular MCS condition began approximately in April 1991 (while the patient was serving in the Gulf and entitled to base pay), that the condition did not exist prior to service, and that it has been permanently aggravated by service. At least five other active duty Persian Gulf veterans have been diagnosed by the Army with MCS, as reported by the Persian Gulf Veterans coordinating Board in `Summary of the Issues Impacting Upon the Health of Persian Gulf Veterans,' [3 March 1994, 4 page excerpt, R-4]. The Army Medical Department also has requested funding for a research facility to study MCS (reported in an Army information paper on `Post Persian Gulf War Health Issues,' 16 November 1993).

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U.S. Congress in a VA/HUD Appropriations Bill for FY1993 signed by President Bush in 1992 appropriating `$250,000 from Superfund funds for chemical sensitivity workshops.' These funds were used by the U.S. Agency for Toxic Substances and Disease Registry (see above) to co-sponsor scientific meetings on MCS with various other organizations [1992, 3 page excerpt, R-5] and support an MCS study (see California State Department of Health Services below). For FY 1998, Vermont Congressman Bernard Sanders proposed and Congress appropriated $800,000 to start a new 5-year civilian agency research program into MCS among Gulf War veterans. Congress also requested that the administration report back by January 1998 on how it planned to spend the funds (text of appropriations is quoted in report; see below: U.S. Department of Health Services, Agency for Health Care Policy and Research).

U.S. Consumer Product Safety Commission, U.S. Environmental Protection Agency, American Lung Association, and American Medical Association (jointly) in a jointly published booklet entitled Indoor Air Pollution An Introduction for Health Professional [US GPO 1994-523-217/81322] under the heading `What is `multiple chemical sensitivity' or `total allergy'?, these organizations state that `The current consensus is that in cases of claimed or suspected MCS, complaints should not be dismissed as psychogenic, and a thorough workup is essential.' The booklet is prefaced by the claim that `Information provided in this booklet is based upon current scientific and technical understanding of the issues presented . . .` [1994, 3 page excerpt, R-6]

U.S. Department of Agriculture, Forest Service
in its Final Environmental Impact Statement on `Gypsy Moth Management in the United States: a cooperative approach', people with MCS are mentioned as a `potential high risk group' who should be given advance notification of insecticide treatment projects via `organizations, groups and agencies that consist of or work with people who are chemically sensitive or immunocompromised.' MCS also is discussed in an appendix on Human Health Risk Assessment (Appendix F, Volume III of V) under both `Harzard Identification' and `Groups at Special Risk' [1995, 11 page excerpt and 1 page cover letter from John Hazel, the USDA's EIS Team Leader, to Dr. Grace Ziem of MCS Referral & Resources, R-130].

U.S. Department of Education in the enforcement by its Office of Civil Rights of Section 504 of the Rehabilitation Act of 1973 which requires accommodation of persons with `MCS Syndrome' via modification of their educational environment, as evidenced by several `agency letters of finding' (including San Diego (Calif) Unified School District, 1 National Disability Law Reporter, para. 61, p. 311, 24 May 1990; Montville (Conn.) Board of Education, 1 National Disability Law Reporter, para. 123, p. 515, 6 July 1990; and four letters (along with an individualized environment management program) in the case of the Arminger children of Baltimore County, MD [in 1991, 1992, 1993 and 1994; 20 pages total, R-7]. These accommodations also are required under the terms of Public Law 94-142, now known as the Individuals with Disabilities Education Act (CFR34 Part 300). The Department of Education as a whole, however, has no formal policy or position statement on the accommodation of students with MCS.

U.S. Department of Energy, Oak Ridge National Laboratory in being the lead sponsor of the 11th Annual Life Sciences Symposium on `Indoor Air and Human Health Revisited.' This 1994 conference was co-sponsored by the US Environmental Protection Agency and Martin Marietta Energy Systems' Hazardous Waste Remedial Action Program. The proceedings are published in Indoor Air and Human Health (Gammage RB and Berven BA, editors, Boca Raton FL: CRC Lewis Publishers, 1996) and contain several peer-reviewed papers of critical relevance to MCS by DoE, EPA and other federally funded researchers. (4 page excerpt with table of contents, R-175)

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U.S. Department of Health and Human Services (HHS), Agency for Health Care Policy and Research in a `Report to Congress on Research on Multiple Chemical Exposures and Veterans with Gulf War Illnesses' by agency administrator Dr. John Eisenberg (who is also the acting Assistant Secretary for Health). Dr. Eisenberg proposes spending $300,000 in 1998 for a `consensus building' and research planning conference, $400,000 for research into the health effects of chemical mixtures, and $100,000 for an Interagency Coordinator in the Office of Public Health and Science [January 1998, 7 pages including MCS R&R press release, R-168]. Congress requested the report in 1998, as part of an $800,000 appropriation for a new civilian research into MCS (see U.S. Congress, above).

U.S. Dept. of HHS, National Institute on Deafness and Other Communication Disorders in the funding of MCS-related olfactory research by its Chemical Senses Branch since NIDCD's creation in 1988; including $29,583,000 in fiscal year 1998. The Chemical Senses Branch supports both basic and applied research, with most of its funds going to just five `chemosensory research centers': the Connecticut Chemosensory Clinical Research Center (860-679-2459), Monell Chemical Senses Center (215-898-6666), Rocky Mountain Taste and Smell Center (303-315-5650), State University of New York Clinical Olfactory Research Center (315-464-5588), and University of Pennsylvania Smell and Taste Center (215-662-6580). Free information is available from NIDCD Information Clearinghouse, 800-241-1044.

U.S. Dept. of HHS, National Institute of Environmental Health Sciences in `Issues and Challenges in Environmental Health,' a publication about the work of NIEHS, research priorities are proposed for `hypersensitivity diseases resulting from allergic reactions to environmental substances' [NIH 87-861, 1987, 45 pages, R--8]. It is not clear from the context if this statement was meant to include or exclude MCS, since the condition was still thought by some at the time to be an allergic-type reaction. In 1992, the director Dr. Bernadine Healy responded in detail to an inquiry from Congressman Pete Stark about the scope of NIEHS research into MCS: `It is hoped that research conducted at NIEHS will lead to methods to identify individuals who may be predisposed to chemical hypersensitivities. . . . NIH research is directed toward the understanding of the effect of chemical sensitivities on multiple parts of the body, including the immune system.' [1992, 3 pages, R-9]. In 1996, director Dr. Kenneth Olden wrote US Senator Bob Graham that `NIEHS has provided research support to study MCS. . . . NIEHS has also supported a number of workshops and meetings on the subject.' [15 April 1996, 2 pages, R-101]. Dr. Olden also states that `Pesticides and solvents are the two major classes of chemicals most frequently reported by patients reporting low level sensitivities as having initiated their problems.'

U.S. Department of Health and Human Services, National Library of Medicine . . . in the 1995 Medical Subject Headings (MESH) codes used to catalog all medical references, which started using Multiple Chemical Sensitivity (and its variations) as a subject heading for all publications indexed after October 1994 [3 pages excerpt, R-10].

U.S. Department of Health and Human Services, Office for Civil Rights (OCR) . . . in the final report by the Regional Director (of Region VI) regarding OCR's investigation of an ADA-related discrimination complaint filed by a patient with MCS against the University of Texas M.D. Anderson Cancer Center for failing to accommodate her disability and thereby forcing her to go elsewhere for surgery. Prior to completion of the investigation and the issuance of any formal `findings,' the OCR accepted a proposal from the Univ. of Texas to resolve this complaint by creating a joint subcommittee of the cancer center's Safety and Risk Management committees. This subcommittee's three tasks (as approved by the OCR) are to `identify a rapid response mechanism which could be triggered by any patient registering a complaint or presenting a special need which is environment related; develop a `protocol' outlining steps to be taken to resolve environmental complaints by patients . . . ; and inform the medical staff through its newsletter of the mechanism and the protocol so that they will better understand how to address such questions or concerns.' The OCR has placed the M.D. Anderson Cancer Center `in monitoring' pending completion and documentation of these changes, but it may initiate further investigation if M.D. Anderson fails to complete this process within the 13 months allowed. [27 March 1996, 11 pages, R-99]

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U.S. Department of Health and Human Services, Social Security Administration . . . in enforcement of the Social Security Disability Act (see Recognition of MCS by Federal Courts, below), and in the SSA's Program Operations Manual System (POMS), which includes a section on the `Medical Evaluation of Specific Issues--Environmental Illness' stating that `evaluation should be made on an individual case by case basis to determine if the impairment prevents substantial gainful activity' [SSA publication 68-0424500, Part 04, Chapter 245, Section 24515.065, transmittal #12, 1998, 1 page excerpt, R-11]. In 1997, the U.S. District Court in Massachusetts required Acting SSA Commissioner John Callahan to spell out the agency's position on MCS in a formal memo to the court (31 October 1997, 2 pages, R-164; see Creamer v. Callahan below, under Recognition of MCS by US Federal Court Decisions). With this memo, SSA now officially recognizes MCS `as a medically determinable impairment' on an agency wide basis. MCS is also recognized in several `fully favorable' decisions of the SSA's Office of Hearing and Appeals: in case #538-48-7517, in which the administrative law judge, David J. Delaittre, ruled that `the claimant has an anxiety disorder and multiple chemical sensitivity,' with the latter based in part on the fact that `objective [qEEG] evidence showed abnormal brain function when exposed to chemicals' [1995, 7 pages, R-12]; in case #264-65-5308, in which the administrative law judge, Martha Lanphear, ruled that the claimant suffered severe reactive airways disease secondary to chemical sensitivity and that this impairment prevented her from performing more than a limited range of light work [1996, 8 pages, R-120]; in case #239-54-6581, in which the administrative law judge, D. Kevin Dugan, ruled that the claimant suffered severe impairments as a result of pesticide poisoning, including `marked sensitivity to airborne chemicals,' which prevent her from `performing any substantial gainful activity on a sustained basis [1996, 4 pages, R-135]; in case #024-40-2499, in which the administrative law judge, Lynette Diehl Lang, recognized that the claimant suffered from severe MCS and could not tolerate chemical fumes at work (as a result of overexposure to formaldehyde in a state office building), as a result of which he was awarded both disability benefits and supplemental security income [1995, 8 pages, R-140]; in case #184-34-4849, in which administrative law judge Robert Sears ruled that the claimant suffered from `extreme environmental sensitivities,' and particularly `severe intolerance to any amount of exposure to pulmonary irritants' [11 June 1996, 7 pages, R-156]; and in case #256-98-4768, in which the administrative law judge, Frank Armstrong, classified the claimant's `dysautonomia triggered by multiple chemical sensitivities' as severe and said it `prevents the claimant from engaging in substantial gainful activity on a sustained basis' [18 March 1997, 8 pages, R-157].

[Page: E1995]        

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From the Congressional Record of the United States
CONGRESSMAN BERNARD SANDERS  Extension of Remarks to the House of Representatives
~Top~  *   October 9, 1998   *   October 13, 1998   *   October 15, 1998    *  October 20, 1998 
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HON. BERNARD SANDERS
Extension of Remarks to the House of Representatives
(Extension of Remarks - October 13, 1998)

MULTIPLE CHEMICAL SENSITIVITY
[Page: E2151]

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HON. BERNARD SANDERS
in the House of Representatives

TUESDAY, OCTOBER 13, 1998
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Mr. SANDERS. Mr. Speaker, I rise today to discuss the issue of Multiple Chemical Sensitivity as it relates to both our civilian population and our Gulf War veterans. I continue the submission for the Record the latest `Recognition of Multiple Chemical Sensitivity' newsletter which lists the U.S. federal, state and local government authorities, U.S. federal and state courts, U.S. workers' compensation boards, and independent organizations that have adopted policies, made statements, and/or published documents recognizing Multiple Chemical Sensitivity disorders for the benefit of my colleagues.

In a letter from HUD Assistant Secretary Timothy Coyle to Senator Frank Lautenberg, confirming HUD recognition of `MCS as a disability entitling those with chemical sensitivities to reasonable accommodation under Section 504 of the Rehabilitation Act of 1973' and also `under Title VIII of the Fair Housing Amendments Act of 1988' [26 October 1990, 2 pages, R-13]. This was followed by a formal guidance memorandum from HUD Deputy General Counsel G.L. Weidenfeller to all regional counsel, detailing HUD's position that MCS and environmental illness `can be handicaps' within the meaning of section 802(h) of the Fair Housing Act and its implementing regulations [1992, 20 pages, R-14]. Also recognized in a HUD Section 811 grant of $837,000 to develop an EI/MCS-accessible housing complex known as `Ecology House' in San Rafael, CA, consisting of eleven one-bedroom apartments in a two-story complex. This grant was pledged in 1991 and paid in 1993. [2 pages, R-15] (See also Recognition of MCS by Federal Courts, Fair Housing Act, below.)

In response to a disability rights complaint filed against the Baltimore County Parks and Recreation Department (BCPRD) by Marian Arminger on behalf of her three children, which the National Park Service (NPS) accepted for review pursuant to both Section 504 of the Rehabilitation Act and Title II of the Americans with Disabilities Act. The Acting Equal Opportunity Program Manager of the NPS ruled that `the BCPRD must accept the determination of disability by the Baltimore County Public Schools [BCPS, see US Department of Education, above] regarding the children and their disability of MCSS [MCS Syndrome]. This will eliminate possible retaliation with a different conclusion by the same public entity.' [Case #P4217(2652), 1996, 4 pages, R-102]. The NPS further ruled that `With the determination that these children are individuals with a disability (MCSS), it is necessary to make reasonable modifications to program facilities. It appears that discontinuing, temporarily or permanently, the use of outside or inside pesticide application and toxic cleaning chemicals is the basic reasonable modification necessary in this case. . . . Therefore we believe that steps should be taken by the BCPRD to provide the necessary communication with other affected agencies such as the BCPS and develop, in consultation with the parents and others deemed appropriate, a plan for the reasonable modification of the program environment for these children.'

In its enforcement of the Americans with Disabilities Act of 1990, under the terms of which MCS may be considered as a disability on a case-by-case basis, depending--as with most other medical conditions--on whether the impairment substantially limits one or more major life activities. The Office of the Attorney General specifically cites `environmental illness (also known as multiple chemical sensitivity)' in its Final Rules on `Non-Discrimination on the Basis of Disability in State and Local Government Services' (28CFR35) and `Non-Discrimination on the Basis of Disability by Public Accommodations and in Commercial Facilities' (28CFR36), as published in the Federal Register, Vol. 56, No. 144, pages 35699 and 35549 respectively [26 July 1991, 2 pages, R-16]. `Environmental illness,' also is discussed in the ADA Handbook, EEOC-BK-19, 1991, p. III-21 [14 page excerpt, R-17], jointly published by the Department and the U.S. Equal Employment Opportunity Commission. The ADA Handbook describes environmental illness as `sensitivity to environmental elements' and, although it `declines to state categorically that these types of allergies or sensitivities are disabilities,' it specifically asserts that they may be: `Sometimes respiratory or neurological functioning is so severely affected
that an individual will satisfy the requirements to be disabled under the regulations. Such an individual would be entitled to all the protections afforded by the Act.'

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In recognizing MCS as a medical diagnosis (although not as a `disability') in the case of at least one Persian Gulf War veteran [Gary Zuspann, October 1992, 3 pages, R-18]. It is impossible to know exactly how many other Persian Gulf veterans may have been diagnosed with MCS as the diagnostic data recorded in the VA's Persian Gulf Registry are based on the International Classification of Diseases (ICD-9CM), which does not yet include a specific code for MCS. In June 1997, VA released its `Environmental Hazards Research Centers' Annual Reports for 1996.' These included preliminary data from the New Jersey EHRC showing that, of the 1161 veterans randomly selected from the VA's Persian Gulf Registry (living in NJ, NY, CT, MA, MD, DE, IL, VA, OH or NC) who completed the center's questionnaire, 12.5% `endorsed symptoms compatible with a conservative definition of MCS' [1997, 5 page excerpt, R-144]. When the NJ EHRC published its first report on this study, however, in an abstract entitled `Preliminary prevalence data on Chronic Fatigue Syndrome and Multiple Chemical Sensitivity,' it said 26% of 104 veterans randomly selected from the VA Register `were especially sensitive to certain chemicals, and 4% reported that this sensitivity produced at least 3 of 4 lifestyle changes . . . suggesting that something about serving in the Gulf substantially increased the risk of developing CFS and MCS' [1996, Journal of CFS, 2(2/3): 136-137; R-177]

[Page: E2152]

In a peer-reviewed memorandum entitled `Review of Chlorpyrifos Poisoning Data' from EPA's Jerome Blondell, PhD, MPH, and Virginia Dobozy, VMD, MPH, to Linda Propst, Section Head, Reregistration Branch. The memo discusses data from several sources on acute and chronic health effects, including MCS, associated with exposure to Dursban and other chlorpyrifos-containing pesticides, and recommends many changes (subsequently agreed to by DowElanco, the manufacturer) in the use and marketing of these products, including the phase out of all indoor sprays and foggers, consumer concentrates, and all pet care products except flea collars. Most significantly, the memo documents that of 101 cases of unambiguous chlorpyrifos poisoning reportedly directly to EPA in 1995, 38 had chronic neurobehavioral effects (including 4 who also had peripheral neuropathy), while 50 `reported symptoms consistent with multiple chemical sensitivity' [1977, 70 pages, R-145].

In its August 1989 Report to Congress on Indoor Air Quality, entitled Assessment and Control of Indoor Air Pollution (EPA/400/1-89/001C), the Environmental Protection Agency's Indoor Air Division describes MCS as `a subject of considerable intra professional disagreement and concern (Cullen, 1987). While no widely accepted test of physiologic function has been shown to correlate with the symptoms, the sheer mass of anecdotal data is cause of concern.' [14 page excerpt from Vol. 2, R-19]. In 1991, the Indoor Air Division asked the National Research Council to sponsor a scientific workshop on `Multiple Chemical Hypersensitivity Syndrome' the proceedings of which are published in Multiple Chemical Sensitivities: Addendum to Biologic Markers in Immunotoxicology [National Academy Press, 1992].

Describes `chemical sensitivity' as an `ill-defined condition marked by progressively more debilitating severe reactions to various consumer products such as perfumes, soaps, tobacco smoke, plastics, etc.' in The Total Exposure Assessment Methodology (TEAM) Study, Summary and Analysis: Volume 1, by L. Wallace, Project Officer, Environmental Monitoring Systems Division, EPA Office of Research and Development [1987, 2 page excerpt, R-20]. The Office of Research and Development (ORD) began conducting human subjects chamber research at its Health Effects Research Branch in Chapel Hill (NC) in 1992 to identify possible diagnostic markers of MCS. (See also joint entry under U.S. Consumer Product Safety Commission, above.) In the justification for its fiscal year 1998 budget, ORD devotes one paragraph to MCS in the section on Air Toxins, saying that it plans to release `information comparing individuals who identify themselves as belonging to a particular subgroup (multiple chemical sensitivity) against established norms for a variety of health-related endpoints,' and will make `recommendations for follow up to evaluate the potential relationship between the signs/symptoms reported by these individuals and objective/quantitative health endpoints' [1997, 3 page excerpt, R-160].
~~~~~

In the ADA Handbook EEOC-BK-19 [1991], 14 page excerpt, R-17], jointly published by the EEOC and the Department of Justice (see above) and in a Determination Letter signed by Issie L. Jenkins, the director of the Baltimore District Office, recognizing MCS as a disability under the Americans with Disabilities Act requiring workplace accommodation, consisting in this case of a private office with an air filter, Mary Helinski v. Bell Atlantic, No. 120 93 0152, 17 May 1994 [2 pages, R-22].

In its Final Report: Principles of Neurotoxicology Risk Assessment, published in the Federal Register by the US EPA's Office of Health Research [17 August 1994, 45 pages for entire report, R-161, or 3 page excerpt, R-162], which says in Section 2.5.1 on `Susceptible Populations' that: `Although controversial [Waddell 1993], recent evidence suggests that there may be a subpopulation of people who have become sensitive to chemicals and experience adverse reactions to low-level exposures to environmental chemicals [Bell et al 1992].' The report is `the result of the combined efforts of 13 Federal agencies comprising the ad hoc Interagency Committee on Neurotoxicology,' including ATSDR, the Center for Food Safety and Applied Nutrition, Center for Biologies Evaluation and Research, Center for Drug Evaluation and Research, Consumer Product Safety Commission, Dept of Agriculture, Dept. of Defense, Environmental Protection Agency, National Center for Toxicological Research, National Institutes of Health, National Institute of Occupational Safety and Health, and the National Toxicology Program.

Formed in 1994 to review and coordinate the role of federal agencies involved in research on multiple chemical sensitivity [1 page agenda from 9/14/94 meeting, R-91]. The Work Group is so-chaired by Dr. Barry Johnson, Assistant Surgeon General and Assistant Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR) and Dr. Richard Jackson, Director of the National Center for Environmental Health at the Centers for Disease Control and Prevention. Other agencies represented include the Departments of Energy, Defense, and Veterans' Affairs, the Environmental Protection Agency and two other institutes within the Department of Health and Human Services: the National Institute for Occupational Safety and Health, and the National Institute of Environmental Health Sciences. Draft report is expected to be released by ATSDR in September 1998 for a 60-day public comment period.

In ADA Watch--Year One, its `Report to the President and Congress on Progress in Implementing the Americans with Disabilities Act,' which recommends that Congress and the Administration `should consider legialtion to address the needs of people with `emerging disabilities,' such as those . . . `with environmental illness who are severely adversely affected by secondary smoke or other pollutants in public places' [5 April 1993, 8 pages, R-23].

In its report to the President, entitled Operation People First: Toward a National Disability Policy, which recommends that the federal government `develop, refine and better communicate methods of `reasonable accommodation,' in particular, the accommodation needs of people with . . . chronic fatigue syndrome and multiple chemical sensitivity' [1994, 5 pages, R-24] encouraging the Deputy Ministers of Housing, Health Community and Social Services `to begin a consultative process and help to establish some guidelines' spelling out exactly what services and benefits are available to provincial residents with MCS, including possible admission to treatment facilities in the United States [27 October 1989, 2 page letter and 2 pages of press coverage from the Globe & Mail, R-158].

In a report written for the general public entitled Topics: Multiple Chemical Sensitivity with sections on What is MCS, Symptoms of MCS, People Diagnosed with MCS, What Can Cause MCS, Treatments, MCS and the Medical Community, MCS is Now Recogni