Environmentally induced illnesses : ethics, risk assessment, and human rights

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Readers drawn to Rachel Carson's Silent Spring, Laurie Garrett's The Coming Plague, or Theo Colburn's Our Stolen Future will appreciate this work by Thomas Kerns as well. The growing epidemics of chemically induced illnesses from long-term, low-dose exposure to toxicants in both developed and developing nations are being studied by serious researchers. Questions are being raised as to how societies will deal with these new problems. Kerns's book is the first to directly address the ethical dimension of managing environmental health and ubiquitous toxicants (such as solvents, pesticides, and artificial fragrances). The work includes recent medical literature on chronic health effects from exposure to toxicants and the social costs of these disorders; relevant historic and human rights documents; recommendations for public policy and legislation; and primary obstacles faced by public health advocates. College instructors and students, victims of chemical sensitivity disorders, public health workers, scientists, and policymakers who are interested in the challenge of these emerging epidemics will find Kerns's text highly informative.

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Kerns noticed a metallic taste in his mouth when he was 51. He consulted various doctors but got no diagnosis until a doctor experienced in environmental medicine identified it as multiple chemical sensitivity (MCS). Kerns, then working on a master's in public health, began the research and reasoning that eventuated in this thoroughly documented, closely argued book on the problems of long-term exposure to low doses of chemicals. Kerns is trying to increase awareness of MCS, which leads to much more than just cancer and which lack of government regulation and labeling, the ubiquity of the substances causing MCS (found in artificial fragrances, furniture, carpeting, pesticides, and many other products), and the political and financial power of chemical companies make a widespread debilitating condition. Kerns describes the body systems that can be damaged by MCS and relates many aspects of the problem to human rights. Readers who stick with the book or use it as a reference will learn much about a frequently hidden or casually dismissed malady that affects millions. --William Beatty

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Whether one calls it EI (environmental illness), MCS (multiple chemical sensitivity), or something else, some people are exquisitely sensitive to chemicals even at such low levels that they are tolerated by a majority of people. These conditions are controversial. Do they result from true biochemical, physiologic, or immunologic causes, or are they psychogenic (and does it matter)? Medical ethicist Kerns covers a wide variety of conditions that have been attributed to low-level chemical exposure, dividing the discussion into four sections: "Data," "Principles," "Modest Proposals," and "Brick Walls." Among other topics, "Data" surveys cancer, endocrine disruption, MCS, and pesticides. However they arise, these conditions are devastating to the victims and costly to society. "Principles" introduces ethical issues, the "precautionary principle" and "the tragedy of the commons." "Modest Proposals" examines ethical and legal issues and explains avoidance both for individuals and society. "Brick Wall" identifies how chemical corporations deny the existence of these conditions and sensitivities and interfere with the necessary steps to prevent chemically induced sensitivity. The author is guardedly optimistic that society will take the steps necessary for prevention. Recommended for all levels of readers. M. Gochfeld Robert Wood Johnson Medical School

Acknowledgments	p. v
Preface	p. 1
Introduction	p. 5
1. Data	p. 25
1. Health Effects Overview	p. 25
2. Cancers	p. 29
3. Respiratory Disorders	p. 32
4. The Immune System	p. 33
5. Increased Incidence of Infectious Diseases	p. 38
6. The Blood-Brain Barrier	p. 40
7. Sleep Abnormalities	p. 42
8. Intellectual Function	p. 43
9. Endocrine System Dysregulation	p. 45
10. Detoxification Pathways	p. 50
11. Behavioral Disorders	p. 51
12. MCS	p. 52
13. Pesticides	p. 54
14. Life Disruption	p. 56
15. Actual Costs	p. 60
16. How Many People Are Affected?	p. 61
17. Mechanisms	p. 67
18. Controversy	p. 76
2. Principles	p. 91
1. Prevention	p. 91
2. Risk-Benefit Assessment	p. 95
3. Human Rights: An Ethical Counterbalance	p. 111
4. The Golden Rule, Silver Rule, and Sufferings of the Other	p. 135
5. The Precautionary Principle	p. 136
6. Nonconsensual Exposure	p. 140
7. Tragedy of the Commons	p. 141
8. Absence of Evidence Is Not Evidence of Absence	p. 143
9. Moderation in All Things	p. 144
10. Summary	p. 147
3. Modest Proposals	p. 154
1. Research	p. 155
2. Initial Clinical Presumptions	p. 165
3. Informed Consent	p. 170
4. Burden of Proof	p. 183
5. Disaggregated Safety Standards	p. 191
6. Safe Schools	p. 192
7. Safe Workplaces	p. 196
8. Transparent Processes	p. 197
9. Full Disclosure	p. 197
10. Access to Public Spaces	p. 202
11. Additional Proposals	p. 204
4. Brick Walls	p. 214
1. Globality	p. 216
2. Multinational Chemical Corporations	p. 217
3. Public Relations	p. 225
4. Medical Paradigms	p. 230
5. Others	p. 236
Conclusion	p. 241
Appendices	p. 247
Appendix I North Seattle Community College Indoor Air Quality (IAQ) Policy	p. 247
Appendix II The Nuremberg Code (1947)	p. 251
Appendix III International Ethical Guidelines for Biomedical Research Involving Human Subjects	p. 253
Appendix IV Draft Declaration of Principles on Human Rights and the Environment (1994)	p. 258
Appendix V Charter on Industrial Hazards and Human Rights (1996)	p. 263
Appendix VI Twenty Most Common Chemicals Found in Thirty-One Fragrance Products	p. 278
Bibliography	p. 283
Index	p. 293

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