[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[Extensions of Remarks]
[Pages E1992-E1994]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     MULTIPLE CHEMICAL SENSITIVITY

                                 ______
                                 

                          HON. BERNARD SANDERS

                               of vermont

                    in the house of representatives

                       Thursday, October 8, 1998

  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,

[[Page E1993]]

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.

              Recognition of Multiple Chemical Sensitivity

       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 occuring 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.


                    Alternate Names Proposed for MCS

       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,'' Toxic 
     Response Syndrome, 20th Century Disease.


  Disorders Associated With Single or Multi-Organ Chemical Sensitivity

       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 ligitimate 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.

              Recognition of MCS by 25 Federal Authorities

       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).
       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

[[Page E1994]]

     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)
       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]
       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].



     

                          ____________________