Examination of Witnesses (Questions 544-559)
DR JEAN
MONRO, DR
DAMIEN DOWNING,
MR DON
HARRISON AND
PROFESSOR SIMON
WESSELY
21 FEBRUARY 2007
Q544Chairman: I would like to thank you for
coming today. We have a lot of questions to get through. I am
sure that you may have comments relating to the previous session
and I wonder if you would please send those to us in writing after
today's session. It may be that we have time at the end to hear
them but I think it would be more important for the Committee
to be able to question today and then your comments could be submitted
afterwards, if you would. I think you were here earlier on when
I said there has been an information note with the declaration
of interests of members of the Committee. I am Baroness Finlay
and I am chair of this Select Committee inquiry. Could I ask you
to introduce yourselves and then we will go into the questions.
Professor Wessely: I am Professor Simon Wessely.
I am Professor of Psychological Medicine in the Department of
Psychiatry at the Institute of Psychiatry, King's College, London.
Mr Harrison: I am Don Harrison. I am Principal
of the British Institute for Allergy and Environmental Therapy.
Dr Downing: I am Dr Damien Downing. I am President
of the British Society for Ecological Medicine and Editor of the
journal Nutritional and Environmental Medicine, and I am
also a doctor.
Dr Monro: I am Dr Jean Monro. I am the Medical
Director of the Breakspear Hospital in Hertfordshire and also
consultant to the Krankenhaus, North Friedland in Germany.
Q545 Chairman: Could I start by asking
you all what is idiopathic environmental illness or multiple chemical
sensitivity?
Dr Downing: Simply, multiple chemical sensitivity
is just another form of allergy that is getting worse and more
common, as we see. There are reasons for that which I can go into,
but it is complex and one of the reasons which I think will in
due course be proven is environmental pollution and chemicals
having a disrupting effect on the immune system and making all
allergies worse. The obvious model for this is rhinitis which
is, paradoxically, worse in towns than in the countryside and
tracks better with levels of environmental pollution and small
particulates than with levels of pollen. I think that exactly
the same thing is happening with that as with food intolerances
and with chemical sensitivities. Ten years ago, the Royal College
of Physicians produced a report—it may be 12 years ago,
I am not sure—that said effectively that all this stuff
about food intolerances was a load of nonsense; and now your request
for submissions refers to the rise in food allergy as being a
fact. I think that another 10 years will probably see the same
sort of shift in our perception of chemical sensitivity. I certainly
do not think that it is in any way idiopathic. Idiopathic is one
of those words that doctors use when they are trying to pass the
buck really.
Mr Harrison: I agree with Dr Downing about the
wording. Certainly I do not believe that multi-chemical sensitivity
is idiopathic, which is of no known cause, but it does certainly
appear to arise from either a single substantial chemical exposure
or quite minor long-term exposure to chemicals. Examples of that,
just a few of them briefly: people living in high pollution areas;
factories; traffic; flight paths; laboratory work; farming in
particular, with the spraying of pesticides and also operations
in animal husbandry such as dipping of sheep; excessive inoculations
in time of war, as the Gulf War Syndrome has shown; and perhaps
surgical anaesthetics because in times of stress, as in a surgical
operation, the patient is introduced to a number of unusual chemical
gases, things they are not used to, and that may be the basis
for subsequent chemical allergies to appear. Certainly much of
the problem with chemical sensitivity arises in a problem with
liver function and liver support is almost always required.
Professor Wessely: It is an imprecise label.
People develop multiple subjective symptoms in response to perceived
exposures for which there are no obvious toxicological or immunological
explanations.
Dr Monro: I do not agree with that. I believe
that there are explanations emerging now. There is a considerable
amount of evidence that there are two principal pathways for allergies.
Most allergies present at the surfaces of bodies, the whole of
the outside surface and the surfaces of mucal membranes. There
the gatekeeper cells—I am going to mention something because
this is a scientific committee—the dendritic cells, are
the gatekeepers of allergies. These are linked with some of the
very fine nerve cells which are linked to the autonomic nervous
system called C-fibres. C-fibres transmit information extremely
fast and the information is passed into the autonomic nervous
system and into the central nervous system. There are two principal
mechanisms in allergy. One is the local mechanism where reactions
can occur peripherally and the second is central mechanisms where
the neural system of allergy is invoked. We know that the neural
system of allergy can be very easily switched on by exposure to
chemicals. There are receptor cites on these C-fibres which will
allow responses to be perceived quite quickly. Hence there is
in fact a physiological mechanism to explain a very swift onset
of symptoms which can be perceived neurologically as well by individuals
and often having an expression through the autonomic nervous system.
Professor Wessely: I am not an academic or clinical
immunologist and I do not have postgraduate qualifications in
it, I am not sure that any of us do, but those who do I do not
believe would recognise that. The people in academic immunology
and allergy in my institution and elsewhere repeatedly give the
definition I have just given that this is where symptoms arise
which do not have a recognised allergic, immunological or toxicological
basis. If they did, life would be easy and we would not be here.
Q546 Lord Taverne: Apart from excessive
vaccination and these multiple chemicals, do members of the panel
also think that part of cause of the allergy are electromagnetic
fields, phone masts, electric waves and these kinds of influences?
Dr Downing: Personally no. I do not think that
that happens in the sense of people becoming allergic to electricity,
but I think it is likely that electromagnetic waves add to the
overall pollution effect that we are all experiencing.
Professor Wessely: On both of those things,
first of all, Lord Taverne, I am not sure if you were actually
agreeing with the idea that multiple immunisations is a cause
of these illnesses or not.
Q547 Lord Taverne: No.
Professor Wessely: We did a lot of research
on that throughout the Gulf War Illness and we showed that receiving
multiple immunisations prior to the Gulf War was associated with
the development of symptoms. In other words, it triggered it,
but we were not able to show that there was an allergic or immunological
basis to this association. We are now in the middle of a randomised
trial to see precisely what was the explanation, so you have a
link but we are not convinced this was done to disturbances of
the immune system. Likewise, on the mobile phones we have published
a double blind trial in the BMJ a few weeks ago where we
allocated randomly people who were sensitive to mobile phones
but they were then given sham or real stimulation, and they were
not able to tell the difference, so again people report sensitivity
to the exposure but clearly whatever it is due to, it is not due
to the influence of electromagnetic radiation.
Mr Harrison: On that subject, although in our
work we mostly concentrate on food, and chemical and airborne
pollutant sensitivities and allergies, nevertheless we still look
at the involvement of dental amalgam in the mouth which also has
an electromagnetic effect and also during our case histories we
always look at electrical possibilities within the patient's environment,
either at work or in the home.
Q548 Chairman: Given your mention of
dental amalgam, have you done any work looking at mercury and
mercury leakage?
Mr Harrison: No, I have not but in the past
I have had prolonged discussions with the late J G Levenson, a
dentist who was an expert in the field.
Q549 Earl of Selborne: Could the panel
tell us of any projects currently underway to research the mechanisms
involved in environmental illness. Perhaps you could also tell
us whether you think there should be further research into these
issues and who should carry it out?
Dr Downing: I think to some extent we have had
the answer to this question already in the previous session. The
current climate in terms of funding and ethical clearance and
regulation in general makes it pretty much impossible in this
country, and if Professor Ernst with a team of 10 cannot manage
to mount prospective clinical trials then our society with a staff
of half a person is hardly likely to do so. There may be other
studies going on elsewhere; I could not speak on that.
Q550 Earl of Selborne: Could you or perhaps
one of the other members of the panel tell me who you think should
be funded to do this work?
Dr Monro: Yes perhaps I could answer that. Dr
Jaleil Miyan at the University of Manchester has shown that the
neural pathway of allergy exists in his biological tests that
he has done. With regard to translating that to humans we would
like to be able to do further research. We have done some preliminary
work and we would like to be able to substantiate that further.
With regard to the comment about electrical equipment causing
problems, there is in fact research which has shown that when
people are put in a Faraday cage and exposed to different frequencies
of very low levels they did respond with symptoms, and these were
quite distinct symptoms such as provocation of asthma. So although
that was a small piece of research it nevertheless does show that
there are effects which should be explored. With regard to chemical
sensitivity, yes, there is work but it is not being undertaken
in this country, it is being undertaken in the United States.
Professor William Meggs has demonstrated that there are quite
a lot of mechanisms which will explain some of the phenomena of
chemical sensitivity.
Professor Wessely: Academics always moan about
it is hard to get research money and more should be given but
there is an enormous amount done on environment and health and
I do not think it is that difficult to get money for research,
if you have well-designed studies with good hypotheses and good
outcome measures. We have certainly managed to get research money
in this area and so have many other colleagues, so I do not think
it is quite as difficult as that. I think it is hard to get money
for bad research and so it should be—but for well-designed
studies there are mechanisms, and they do produce research grants
which are carried out and published in reputable journals.
Q551 Earl of Selborne: Can you give us
examples of organisations which provide funding? Are you funded
by research councils?
Professor Wessely: All sorts. We get funding
from the MRC, the Wellcome Foundation, we get funding from the
Department of Health, the Ministry of Defence, from Leverhulme,
from Joseph Rowntreee. There is a variety of research organisations.
It is obviously always easier in America because they just have
more money than we do and so there is more going on there. That
is certainly true and there are many centres looking at these
issues directly across America, not just the one Dr Monro has
mentioned but many others as well.
Q552 Lord Taverne: But are these research
projects into environmental effect ones which look at the impact
on allergies?
Professor Wessely: Yes there are. We have just
reviewed 70 such papers on provocation studies, so clearly someone
has paid for those and they have been published. I would go so
far as to say we probably do not need any more now. I think that
is a debate that is largely concluded. On mobile phones and electrical
hypersensitivity there is a huge amount of studies, particularly
on the Continent where these issues are much more debated. I do
not believe we need any studies on dental amalgam any more, for
example, there are hundreds of studies on that, and again it is
a subject that is largely closed.
Dr Monro: That is not actually the opinion of
UNESCO. In the Paris Memorandum which was published in the November
2006 they said that they thought that environmental medicine should
be established as a specialty and, furthermore, that allergology
should be a sub- specialty of that, and they mentioned there particularly
the effects of amalgams and mercury and they also emphasised the
effects of pollutants, and they are calling for more research.
Furthermore, the Standing Committee of European Doctors was signed
up to by all 25 EU governments and the agreements that they have
produced in their memorandum are signed up to by all of the professional
bodies, representing doctors in each of the different 25 different
countries, so in fact they are all calling for more research.
Professor Wessely: I am a member of the European
Science Foundation's Committee and several others that consider
this area and I know what we signed up for and I know what we
called for. Of course we called for more research, absolutely,
but I said on certain questions, such as the influence of dental
amalgam on health, we have not called for more research in that
area.
Q553 Earl of Selborne: I wonder if we
could establish where you are calling for more research. Perhaps
each member of the panel could tell us the last time they submitted
a grant application and who it was submitted to?
Dr Monro: From our point of view, we submitted
a grant application to the Lang Foundation and they have kindly
said that they will sponsor that. That was submitted last year.
Mr Harrison: The big problem with allergy, and
I notice this did not emerge at the previous meeting, is that
allergy is a condition of great complexity. I have mentioned various
aspects of it and if you say our environment is everything we
eat, everything we touch, everything we breath, everything we
smell, both internal and external, then the complications begin
to arise immediately, so where is research to be directed? When
we work with patients, we look at foods, we look at dust, pollens,
moulds, we look at the effects of immunisation, the effects of
dental amalgam, the effects on the liver and the thyroid gland.
Working in this complex way, I believe is the only way that we
will reach satisfaction, so where one directs research is a very,
very difficult problem indeed because every patient is different.
There is not a patient with an allergy; there are multiple patients
with multiple allergies, and it is very, very difficult to direct
both treatment and research.
Q554 Chairman: Dr Downing, did you want
to make a comment briefly in response to that question?
Dr Downing: I do not personally do research
these days, I am too busy editing the journal and other things,
but where I would like to see research directed would be at the
effects of environmental pollutants in general.
Q555 Lord Colwyn: I just want to make
a comment about dental amalgam as a dentist of longstanding. I
have to say that amalgam probably would not get a product licence
if it was produced today but if there were a direction to remove
amalgams, and there are millions and millions of amalgams, the
NHS would go bust overnight.
Mr Harrison: It also would be unnecessary because
of course many people are not affected by their amalgams.
Chairman: I want to try and move on because
we have got a lot of questions today so if you could roll your
answers up concisely please.
Q556 Baroness Platt of Writtle: What
is an environmental allergist and how does a person become one?
Do these practitioners have to register with a regulatory body,
and what qualifications must they hold?
Mr Harrison: 30 years ago when I first started
looking at allergic conditions, there were no regulations, there
were no therapists, or there did not seem to be very many. I began
to pass on the results of my own work to alternative therapists
and to health practitioners too, and after about 10 years or so
it became quite obvious that regulation was important because
you collected a mixture of people in your seminars, some of whom
wanted to work with patients and some who did not, so then we
formed an institute for the people who had attended seminars and
were practising allergy work in the same way and we achieved a
measure of regulation that way. We made sure that the membership
were reasonably well-trained, that they had the interests of the
patient at heart, and that they were insured. Now we have reached
the stage where the same standards apply, and we also have continuing
professional development of course. We are ourselves regulated
by the British Complementary Medicine Association which I understand
has a responsibility to Government. We follow their precepts and
we make sure that our members follow them too. That is the type
of regulation that we have. We have a complaints procedure and
I am happy to say that over all the years of the institute I think
two complaints, or maybe three have been on the board, all of
which were dealt with satisfactorily as far as the patients were
concerned.
Dr Downing: The society which I represent, the
BSEM, is a society of doctors and you have to be a doctor to be
a full voting member. We conduct our own post-graduate training
and we are yet again in discussions towards establishing that
as a diploma or similar. In order to become a member of the Register
of Ecological Physicians therefore you have to be a doctor first
and then to go through our training course and to conduct an audit
within your practice and to present case histories and sign a
code of ethics. I am not sure that makes me an environmental allergist—that
is the problem I have with the question—but I hope that
answers it as far as we are concerned.
Q557 Chairman: So if I am hearing you
right, you have a validated qualification which is awarded by
your body, is that correct, so you have an assessment process?
Dr Downing: We have an assessment process which
is not yet validated but we are working towards that with the
Institute of Biology.
Q558 Chairman: And Professor Harrison,
you were talking about self-regulation.
Mr Harrison: Admission to our institute for
several years now has been via our own diploma course. That is
a course which is partly practical and partly theoretical. Currently
the course has been put up to the University of Wales with a view
to validation. It has been well received initially but as the
mills of universities drive exceedingly slow, unfortunately, it
is likely to be about another 18 months before it goes forward
to the committee.
Q559 Lord Colwyn: Could it be said that
the UK is taking a leading role in environmental medicine?
Dr Monro: We certainly have a society which
will represent doctors in this country, but I think that there
are quite a number of other countries in Europe which have got
organisations which are promulgating interest in environmental
medicine. In the States there has been an established training
course for many, many years. Certainly in Germany there are environmental
medicine hospitals, which are paid for by the federal government,
under the auspices of various Krankenhaus and patients
can attend there and their health insurance will pay for them.
In Germany and in France and the States they have quite a number
of organisations which will do this work also.
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