Clinical ecology--a critical appraisal.

In 1981 the California Medical Association (CMA) adopted the position that clinical ecology does not constitute a valid medical discipline and that scientific and clinical evidence to support the diagnosis of "environmental illness" and "cerebral allergy" or the concept of massive environmental allergy is lacking. As a result of requests from clinical ecologists for an opportunity to present to CMA evidence justifying their diagnostic and treatment methods, the chair of the CMA Scientific Board, Allen W. Mathies, Jr, MD, appointed a task force in 1984 to review clinical ecology. The task force conducted an extensive literature review and held a hearing. CLINICAL ECOLOGY IS BASED ON TWO MAIN HYPOTHESES: first, that the total load of low-dose environmental stressors is important in the induction of illness; and, second, that changes in the frequency of and intervals between exposures to specific substances can mask the clinical manifestations of or alter the degree of sensitivity to those substances. Treatment methods used by clinical ecologists include avoidance, symptom-neutralizing doses of diluted extract of the offending agents, rotation diets and an ecologically sound workplace and home.The task force recognizes that certain environmental chemicals and allergens produce well-defined syndromes in humans and that some patients suffer from illnesses that are not readily diagnosed and for which only supportive therapy exists. The conclusions of the task force are* There is no convincing evidence that supports the hypotheses on which clinical ecology is based.* Clinical ecologists have not identified specific, recognizable diseases caused by exposure to low level-environmental stressors.* Methods to diagnose and treat such undefined conditions have not been shown to be effective.* The practice of clinical ecology can be considered experimental only when its practitioners adhere to scientifically sound research protocols and inform their patients about the experimental nature of their practice.