The Sixth Annual International Symposium on
Man & His Environment in Health and Disease
February 25-28, 1988
Sheraton Park Central Hotel - Dallas, Texas
Nicholas Ashford, Ph.D., J.D.
Associate Professor of Technology & Policy
77 Mass. Avenue
Cambridge, MA 02139 (617) 253-1664
Jeffrey S. Bland, Ph.D.
3215-56th Street N.W., Suite 1-B
Gig Harbor, WA 98335 (206) 851-3943
Miklos L. Boczko, M.D.
New York Medical College
12 Greenridge Avenue
White Plains, NY 10605 (914) 949-8817
Marvin Boris, M.D.
North Shore University Hospital
Cornell Medical Center
800 Woodbury Rd.
Woodbury, NY 11797 (516) 921-9000
Jonathan Brostoff, M.D.
Department of Immunology
Arthur Stanley House
London England W1P 9PG
Joel R. Butler, Ph.D., Professor
North Texas State University
Denton, TX 76201 (817) 565-2643
Francis Murray Carroll, M.D.
Southeastern Rheumatology & Allergy Center
104 East Seventh Ave.
Chadbourn, NC 28431 (919) 654-4614
Frederick Cox, M.D.
Associate Professor of Pediatrics
Dept. of Pediatrics, Infectious Disease Section
Medical College of Georgia
1120 15th St.
Augusta, GA 30912 (404) 721-4725
Nancy A. Didriksen, Ph.D.
Environmental Health Psychologists
Denton, Texas 76201 (817) 382-0072
Stanley Dudrick, M.D.
Clinical Professor of Surgery
University of Texas Medical School-Houston
6655 Travis Street, #880
Houston, TX 77030 (713) 791-9100
Ervin J. Fenyves, Ph.D.
Professor of Physics
University of Texas at Dallas
P. O. Box 688 BE22
Richardson, TX 75083-0688 (214) 690-2971
Ronald Finn, M.D.
Royal Liverpool Hospital
Liverpool L7 8XP
H. P. Friedrichsen, M.D.
Natura - Vit Clinic for Environmental Medicine
Am Riesenbuh1 14
Eduardo Gaitan, M.D.
Chief, Endocrinology Section
VA Medical Center
University of Mississippi
111G 1500 E.Woodrow Wilson Dr.
Jackson, MS 39216 (601) 362-4471 ext. 1120 & 1073
John Gerrard, DM
University of Saskatchewan
Saskatoon, Saskatchewan S7N 0X0 Canada (306) 966-8154
Arthur J. Goven
Dept. of Biological Sciences
North Texas State University
Denton, TX 76203 (817) 565-3623
Stuart Hill M.D.
Dept of Entomology
21, 111 Lakeshore Road
Quebec, Canada H9X IC0 (514) 398-7771
Satoshi Ishikawa, M.D.
Professor and Chairman
Department of Ophthalmology
Sagamihara, Kanagawa 228, Japan (011-81-427-78-8464)
Alfred R. Johnson, D.O.
Environmental Health Center - Dallas
8345 Walnut Hill Lane, Suite 205
Dallas, Texas 75231-4262 (214) 368-4132
George J. Juetersonke, D.O.
Department of Public Health and
Texas College of Osteopathic Medicine
Camp Bowie at Montgomery
Ft. Worth, TX 76107 (817) 735-2252
Amanullah Khan, M.D., Ph.D.
Wadley Institutes of Molecular Medicine
9000 Harry Hines
Dallas, Texas 75235 (214) 351-8570
James Larrick, M.D.
Dept. of Immunology
3400 W. Bayshore Road
Palo Alto, CA 94303 (415) 856-8600
John L. Laseter, Ph.D.
Enviro-Health Systems, Inc.
990 No. Bowser Road, #800
Richardson, Texas 75081 (214) 234-5577
Colin Little, M.D.
Melbourne Environmental Control Unit
26 Erin St.
Melbourne, Victoria, Australia
Andrew Marino, Ph.D.
Department of Orthopaedic Surgery
LSU School of Medicine in Shreveport
P. O. Box 33932
Shreveport, LA 71130-3932 (318) 674-6180
Mikio Miyata, M.D.
Department of Ophthalmology
School of Medicine
Sagamihara, Kanagawa 228, Japan (0427) 78-8464
Jean Monro, M.D.
London Neurological Center & the ECU
111 Toms Lane
Hertsfordshire, WD4 8NP
England (011-44-1-730 3417)
Cecil E. Pitard, M.D.
University of Tennessee School of Medicine
2001 Laurel Avenue
Knoxville, TN 37916 (615) 522-7714
Theron G. Randolph, M.D.
505 N. Lakeshore Drive, #6506
Chicago, IL 60611
Doris J. Rapp, M.D.
1421 Colvin Blvd.
Buffalo, NY 14223 (716) 875-5578
William J. Rea, M.D.
Environmental Health Center - Dallas
8345 Walnut Hill Lane, Suite 205
Dallas, Texas 75231-4262 (214) 368-4132
Sherry A. Rogers, M.D.
Northeast Center for Environmental Medicine
2800 West Genesee Street
Syracuse, NY 13219 (315) 488-2856
Colin G. Rousseaux, B.V.Sc., (Hons), Ph.D.
Dept. of Veterinary Pathology
Western College of Veterinary Medicine
University of Saskatchewan
S7N OWO Canada (306) 966-7294
James L. Rowland, M.S., D.O., Ph.D.
Ryodoraku Research Institute of North America, Inc.
8133 Wornall Road
Kansas City, MO 64114 (816) 361-4077
Douglas B. Seba, Ph.D.
2201 Valley Circle
Alexandria, VA 22302 (703) 548-0041
Cyril W. Smith, Ph.D.
Department of Electronic & Electrical Engineering
University of Salford
Salford M5 4WT
Professor E. A. Stemmann, M.D.
Westerholter Str. #42
4650 Gelsenkirchen 2, W. Germany
Major A. Ramsay Tainsh, MBE.
Industrial and Business Consultant
S-114 50 Stockholm SWEDEN (08-67-30-87)
Vernon Varner, M.D.
The Neuropsychiatric Clinic
328 E. Washington St.
Iowa City, IA 52240 (319) 337-6483
Francis J. Waickman, M.D.
Director of Continuing Medical Education
American Academy of Environmental Medicine
1625 West Portage Trail
Cuyahoga Falls, OH 44223 (216) 923-4879
M. Jeffrey White, M.D.
Assistant Clinical Professor of Ophthalmology
University of South Florida School of Medicine
5400 W. Gray Street
Tampa, FL 33609 (813) 872-1596
John M. Whittaker, DVM
3806 S. Broadway
Springfield, Missouri 65807 (417) 883-2477
John R. Wilkins, III, DrPH
Department of Preventative Medicine
Ohio State University
320 West Tenth Avenue
Columbus, OH 43210-1240 (614) 293-3897
Nicholas A. Ashford, Ph.D., J.D., Massachusetts Institute of Technology, Cambridge, Massachusetts
INFORMATIONAL AND REGULATORY CHALLENGES FOR LOW LEVEL EXPOSURES
As advances in both analytical measurement technology and in clinical observations of health effects due to low level exposures to toxic substances have occurred, new demands for responses from the public health and regulatory agencies have arisen. Attribution over both the sources of exposure and of causation are especially confounded. Yet, governmental entities are being asked to respond. New challenges and opportunities for both environmental and occupational health professionals will be discussed.
Jeffrey S. Bland, Ph.D., HealthComm, Inc., Gig Harbor, Washington
ENVIRONMENTAL REACTORS - THRESHOLD OR NO-RESIDUE STANDARD
There has been considerable interest recently as to whether environmental toxicants such as petrochemical hydrocarbons, polybrominated compounds, turpinoid residues and volatile petrochemically based products impart allergic manifestations at some threshold level or whether low-zone intolerance is seen clinically. This discussion has significant clinical implication with regard to control of the environment. A low-zone intolerance would suggest the need for a "no exposure" management approach, whereas a threshold would result in a "no effects" level of control. Based upon new data which evaluates the effect of chemical exposures on lipid peroxide producing systems and the nutritional status of the host, it appears as if low level of exposure can produce significant clinical manifestations that are correlated with serum analyte changes suggestive of a no threshold response.
This level of reactivity in a specific patient can be adjusted through altering the nutritional status of the host and modifying other potentiating factors. Reactivity to these environmental agents may be modulated in part by indigenous substances which potentiate an alarm reaction of the body which then serves as a trigger to lower levels of environmental exposures. This presentation will evaluate the debate between low zone tolerance and no threshold controversies, mechanisms that pertain to amplification of the sensitivity mechanisms and the relationship that nutritional status may have to these questions.
ENVIRONMENTAL REACTORS - THRESHOLD OR NO-RESIDUE STANDARD
The past several years have witnessed a major controversy between those professionals who have asserted there is a relationship between exposure to low-level environmental substances and chronic disease and those who feel that the connection is only psychogenic in origin. Barrett has commented, "Advocates of the belief (that multiple symptoms are triggered by hypersensitivity to common foods and chemicals) described themselves as "ecology oriented" and consider their patients to be suffering from "environmental illness," "cerebral allergy," "allergy to everything" or "twentieth century disease," which can mimic almost any other illness." (NUTRITION FORUM, 4/81; 1987.)
One of the major reasons for this controversy relates to the question of how low an exposure dose is required to trigger an inflammatory or alarm reaction. Some individuals have argued that there is a threshold of exposure below which there is no reaction, whereas others have argued that there may be individuals who have low-zone intolerance that back extrapolates to near zero residue. This presentation will review the nature of this controversy and specific research that would argue for low-dose intolerance.
The separation of the psychogenic manifestations from the true organic manifestation is a challenge to the clinical ecologist, and by utilizing the rigorous definition of what constitutes a low-dose intolerance, a diagnostic definition of the clinically reactive patient can be promulgated. Recently the California Medical Association task force on clinical ecology, the adhoc committee on environmental hypersensitivity disorders established by the Minister of Health of Ontario, Canada, and the American Academy of Allergy and Immunology have all published position statements that conclude that clinical ecology is speculative and unproven. Any of these conclusions are derived from the fact that they see the discipline as lacking a central theme and a scientific basis. This presentation will provide a rationale for low-dose intolerance to environmental substances and its relationship to environmental reactivity.
Miklos L. Boczko, M.D. New York Medical College, Valhalla, NY
ENVIRONMENTAL ASPECTS OF ALZHEIMER'S DISEASE
Alzheimer's disease is the most common and correspondingly the most frequently diagnosed dementia of later adulthood. However, many demented patients are labeled Alzheimer's without the benefit of excluding potentially treatable, environmentally related, conditions. Illustrative case histories will be presented. New data supporting the importance of environmental factors will be discussed.
Marvin Boris, M.D., North Shore University Hospital-Cornell Medical Center, Woodbury, NY
IMMEDIATE AND DELAYED RESPONSES IN CROHN'S DISEASE
Food sensitivity may play a prominent role in Crohn's disease. Eleven patients (CDP) and ten controls were evaluated by history, skin testing, total IgE, serum IgE and IgG4 to 5 foods (milk, wheat, corn, egg, soy) and 3 inhalants (dust, grass, molds), cell surface markers using monoclonal antibodies (CD4, CD8, NKH-1, 4NB4+) and lymphocyte proliferative response to food antigens. Skin responses and IgG4 except to egg did not differ in the CDP or controls, lymphocyte proliferation to food allergens were positive in CDP. Cell mediated responses in CDP showed, ,<CD8, <CD4, >CD4/CD8, and <NKH-1 compared to control 2.
Brostoff, J. and Scadding, G.K. Department of Immunology, Middlesex Hospital Medical School, London, W.I. U.K.
LOW DOSE SUBLINGUAL THERAPY IN PATIENTS WITH HOUSE DUST MITE ALLERGY
Double blind trial and the effect of the neutralizing dose on basophil histamine release in vitro.
In a double blind trial, low dose sublingual therapy was effective clinically in relieving the symptoms of house dust mite allergic rhinitis. Nasal sensitivity following treatment was reduced up to one thousand times. Oral therapy is safe and avoids the hazards of increasing dose subcutaneous allergen vaccines.
The basophil is an important cell to arrive in the nasal mucosa following challenge and can produce inflammatory mediators. "Desensitization" of this cell could perhaps explain the efficacy of neutralization.
House dust sensitive patients were assayed for basophil histamine release before and after a three day course of neutralizing drops, using house dust mite as the allergen. In a high proportion of patients, basophil histamine release was considerably reduced by this in vivo treatment.
Basophils from a further group of patients were incubated with their neutralizing dose of allergen, washed in balanced buffer solutions and then challenged with optimal doses of house dust mite allergen. Again, considerable inhibition of basophil histamine release was seen. Two patients who were made worse by the drops actually showed increased histamine release following challenge. Retitration produced clinical improvement and inhibition of histamine release. This phenomenon might explain the efficacy of neutralization therapy.
Joel R. Butler, Ph. D, Professor of Psychology, University of North Texas, Denton, Texas. Nancy A. Didriksen, Ph.D, Environmental Health Pschologist.
MULTIPLE MIND/BODY FACTORS IN WELLNESS AND ILLNESS
The unity of mind/body provides the conceptual framework for understanding the multiple mental and physical effects as a total response of an individual to the total stress load. The interaction between mind and body is constant and cannot be considered as denoting two separate or dual entities, but only as enabling the different manifestation of the same set of stress events. Threshold must not be considered as an absolute for any dosage level for any group or individual, but instead must be considered variable and dependent upon individual sensitivity for susceptibility to any given level of stress factors at a particular time and ecological condition.
The environment does not supply even distribution of anything sufficient for linear relationships to occur. Behavior is much more probabilistic than deterministic so that informed oddmaking on multiple factorial predictors of change for wellness or illness is the best bet for diagnosis and treatment.
Environmental changes likely follow stochastic shock wave models and thus are representative of a random drive process so that a premium is placed on individual adaptation.
F. M. Carroll, M.D., Chadbourn, NC
CONTROLLED ENVIRONMENTAL OBSERVATION OF ANA POSITIVE PATIENT
Inordinate results appear when a person with "University Diagnosed Systemic Lupus Erythematosus" subject themselves to procedures normally performed in a chemically controlled environmental unit.
These results will be discussed along with some of the more precise details that occur during a persons stay in a controlled environmental unit.
Frederick Cox, M.D. Medical College of Georgia, GA
PREVENTION OF NEONATAL INFECTIONS IN AN ANIMAL MODEL
Bacterial sepsis is a major cause of morbidity and mortality in neonates. Group B streptococci (GBS) and E.-coli are the 2 main pathogens and are acquired from vaginally colonized mothers during or at birth. GBS cause 12-15,000 cases of disease annually with a 50% mortality. There is no prevention of E.-coli disease but GBS prophylaxis with intrapartum or neonatal penicillin is effective. However, only 1% of colonized infants are sick and many patients would receive unnecessary antibiotics. An experimental maternal GBS vaccine is effective but not fully developed.
In a murine model, vaginal transfer of bacteria and yeast to neonates can be prevented by interfering with the adherence of organisms. Lipoteichoic acid (LTA) a bacterial cell wall component, is the ligand that attaches GBS to mucosal surfaces. Vaginal application of 0.5% LTA with alanine and glycerol phosphate in pregnant mice reduced the incidence of GBS colonization and bacteremia in neonates from 17/19 (89%) controls 4/69 (6%) in treated animals. In the same model, vaginally applied L-methyl mannoside ( a carbohydrate derivative) reduced the incidence of E-coli K1 bacteremia from 50/63 (79%) neonates to 0/50 (0%) in treated animals. Vaginal colonization with S. aureus resulted in neonatal bacteremia and colonization in 18/18 (100%) neonates while vaginal application of a 1% fucose solution reduced the incidence to 0/20 (0%). Maternal colonization with Candida albicans and treatment with mannosamine (an amino sugar) reduced bacteremia and colonization from 11/11 (100%) neonates to 1/11 (10%). No side effects or significant change in normal vaginal flora occurred with any of the treatments. This data suggests that neonatal colonization can be controlled by the inhibition of microbial adherence. These techniques may be useful in human neonates and overcome the need for vaccine or antibiotics.
Nancy A. Didriksen, Ph.D,, Environmental Health Psychologist, Ernest H. Harrell, Ph.D., Joel R. Butler, Ph.D., University of North Texas, Denton, Texas
ATTITUDE EFFECTS ON HEALTH AND DISEASE
Negative attitudes and emotions have appeared to influence the onset and course of illnesses ranging from cardiovascular, gastrointestinal, endocrine and nervous system disturbances, to illnesses mediated by the immune system. Conversely, positive states seem to enhance the wellness process.
In an effort to determine to what extent positive or negative attitudes and emotions may influence the course of environmental illness, a Health and Wellness Attitude Inventory consisting of 4l items was administered to 100 patients treated at Environmental Health Center - Dallas and 100 healthy control subjects. Participants were also asked to rate themselves on 13 emotional and cognitive dimensions. Environmental patients rated themselves significantly more depressed, anxious, fatigued, and mentally foggy, and lacking in self-confidence than controls.
Additionally, they reported themselves significantly more deficient in memory, concentration, comprehension and attention. Pain levels were also significantly higher among environmental patients. Significant differences were found between the groups on 16 attitudes.
Environmental patients differed most on attitudes reflecting victimization, having little control over illness factors and in perceiving themselves in intolerable situations. They also perceived themselves as more able to help others and as being more forgiving.
Ervin J. Fenyves, Ph.D., University of Texas at Dallas, Richardson, Texas
NEW RESULTS ON THE HEALTH HAZARD OF RADON EXPOSURES
Recent studies carried in the U. S. and Sweden on the:
showed that there is a good possibility for developing and implementing strategies to decrease the health hazard of radon exposures.
Ronald Finn, M.D., Royal Liverpool Hospital, Liverpool, England
Hydrocarbons can produce disease in several systems. Neurological manifestations include depression, loss of memory, reduced reaction times, unreality feelings and a tendency to violence. Aerosol solvents induce cardiac arrhythmia and can cause sudden death in aerosol sniffing. Prolonged exposure to organic solvents leads to T cell depression which increases the incidence of allergies and predisposes to neoplasia.
The evidence that hydrocarbon exposure predisposes to glomerulonephritis (GMN) is reviewed and a recent study of 19 females with GMN showed that they were all employed and there was no full-time housewife. This contrasted with a sex and social class matched control group with 30% full-time housewives. The evidence in favor of hydrocarbons playing a major role in GMN is now very strong and patients with GMN should be advised to change their occupation. Preliminary evidence indicates that avoiding further hydrocarbon exposure will prevent progression of the disease.
Hydrocarbon exposure is common and disease rare, suggesting a sensitivity rather than a general toxic reaction.
H. P. Friedrichsen, M.D. Natura-Vit Clinic for Environmental Medicine, Schluchse, West Germany; Prof. E.A. Stemmann, M.D. Children's Hospital, Gelsenkirchen, West Germany
This paper will show different aspects of diagnosis and treatment of the atopic dermatitis. It is looked upon as environmentally triggered rather than inherited. Psychological effects as well as nutritional and environmental conditions will be discussed.
Eduardo Gaitan, M.D., University of Mississippi Medical School and VA Medical Center, Jackson, MS
RESORCINOL: FINAL GOITROGENIC PRODUCT IN WATER FROM A GOITROGENIC WELL
In Candelaria town of Colombia, SA, goiter prevalence among children was 23% in Zone A and 11% in Zone B (p<0.05). Socioeconomic conditions, dietary composition, or iodine intake (250 mg/day) could not explain this difference. However, the water for the town was supplied by two wells through independent pipeline systems, one located in Zone A and the other in Zone B. Subsequently, the waters from these two wells were combined in a single tank and the whole town was supplied through a common pipeline system. Within a year, the goiter prevalence rose to 31% in Zone B, while that in Zoned A remained the same, 26% (p,NS). This indicated that water from Well A might contain goitrogen. In vivo and in vitro studies for goitrogenic and antithyroid activities were then conducted in which water or activated carbon (Nuchar C-190, 30 mesh) extracts from Well A were compared with water or extracts from Well B. Under identical experimental conditions rats drinking water or extracts from Well A developed significantly larger thyroid glands and more pronounced antithyroid effects than rats drinking water or extracts from Well B. Similar results were obtained by the acute in vivo suppression of thyroid 131I-uptake in mice and by two in vitro assays, demonstrating that water from Well A was antithyroid and goitrogenic, in a way similar to the action of thiourea-like goitrogens. Ultrafiltration of the goitrogenic water extracts (GWE) indicated that the material was heterogeneous: the active compounds forming dissociable complexes with larger organic molecules. Elemental analysis and infrared spectrometry of GWE gave similar composition and common absorption bands to those of aquatic humic substances (HS). The HS, fulvic and humic acids, inhibited thyroid peroxidase (TRO) in vitro with 15% of the potency of propylthiouracil (PIU). GC/MS analysis of GWE identified over 30 organic compounds, including resorcinol. In contrast only 4 compounds, not including resorcinol, were identified in the Well B non-GWE. Resorcinol was goitrogenic and antithyroid in two different rat strains, being 15-30 more potent an inhibitor in vitro of TRO, thyroidal 125I-uptake and thyroid hormones synthesis than the antithyroid drugs, methimazole and PIU. In conclusion, resorcinol appears to be a final goitrogenic by-product of the shale-derived HS contaminating water of the goitrogenic well of Canderlaria.
John W. Gerrard, D.M. University Hospital, Saskatoon, Sask. Canada
INTRINSIC ASTHMA TOTALLY CONTROLLED BY DIETARY MANAGEMENT AND KETOCONAZOLE
CT, a 50 year old, non-smoking owner of a print shop, presented with a two year history of nasal stuffiness necessitating a polypectomy, followed by asthma associated with a productive cough and much mucus.
Initial investigations: FEV1 1.01 1 FVC 1.9 1
After bronchodilator: FEV1 1.31 1 FVC 2.6 1
Sputum - no candida isolated
Prick skin tests - histamine pos, rest. neg.
ID tests - house dust #2 pos, #3 neg, candida #4 pos, #5 neg
RAST - potato and candida neg IgE 32 ku/1.
Food challenges - cow's milk, wheat, potato, peas, lentils caused wheezing. Asthma leared completely on diet and ketoconazole, but not on nystatin.
Arthur J. Goven, B. J. Venables and L. C. Fitzpatrick. North Texas State University, Denton, Texas E. L. Cooper. University of California, Los Angeles, CA
AN INVERTEBRATE MODEL FOR ANALYZING EFFECTS OF ENVIRONMENTAL XENOBIOTICS OF IMMUNITY
An understanding of acute toxicity and long-term sub-lethal effects of environmental xenobiotics is essential for the protection of the public health. Considerable work has been done on the acute toxicity and mutagenicity of chemicals, less has been done on their effects on immune function. Mammalian immunoassays are scientifically sound, however the use of mammals is costly and socially controversial. Our objective is to develop an invertebrate model biotic assay system using the earthworm (Lumbricus terrestris). We chose the earthworm because it is a non-controversial research organism, its potential is an in-situbio-indicator of terrestrial pollution and the similarity of its immune system with that of mammals. Our selection of the earthworm is supported by our studies on rosette formation phagcytosis and coelomocyte mitogen transformation. We have demonstrated that coelomocytes from earthworms exposed to Arochlor 1254 and extracts from refuse derived fuel flyash develop both a depressed phagocytic response and a reduced ability to form erythrocyte and secretory rosettes.
Dr. Stuart B. Hill, McGill University, Montreal
QUALITY OF FOOD: ORGANIC VS CONVENTIONAL FARMING
Nutritional quality of crops is determined by species, cultivar, climate, soil and site conditions, symbiotic relationships competition, predation and damage, timing and nature of interventions and operations including harvesting, and subsequent handling (packaging, transportation, storage, processing and preparation). The central goal of organic farming is, by taking into account these factors, to produce food of the highest possible nutritional quality. Conventional production, by emphasizing the goals of productivity, profit and cosmetic quality, compromises and goal of nutritional quality. This presentation will provide a theoretical framework for examining this topic and will review the evidence for differences in food quality.
QUALITY OF LIFE: ORGANIC VS. CHEMICAL FARMING
Organic farming is a philosophy and system of agriculture that reflects a state of awareness. It involves benign designs and management procedures that work with natural processes to conserve all resources, minimize waste and environmental impact, prevent problems and promote agroecosystem resilience, self-regulation, evolution and sustained production for the nourishment and fulfillment of all. It represents our best attempt to date to farm in ways that are consistent with our potential as human beings. Chemical farming, by confusing the goal of productivity with nourishment, has become a threat to the biosphere and to humanity.
Satoshi Ishikawa, M.D., Mikio Miyata, M.D., Takahiro Miyoshi, M.D. and Dai Hiramoto, M.D., Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan.
DIFFICULTY OF FOCUSING OF THE EYE DUE TO ENVIRONMENTAL CHEMICALS-IRIDO-CYCLOPLEGIA
Seven clinical cases who complained difficulty of focusing of the eye both near and far were examined. Clinically, they exhibited paresis or paralysis of the iris and/or ciliary muscle. The mean age was 16.6 years and the subjects included 1 male and 6 females. Hypersensitivity to certain food and pollen was seen in all cases. Pupil was maximally dilated and accommodation palsy was noted. Any miotics could not constrict the pupil and improvement of the accommodation was not seen by this treatment. By systemic examinations, the activity of erythrocytes cholinesterase (Ch-F) was reduced in all cases and that of serum cholinesterase was elevated in all cases. By HLA analysis all cases had either A26, B51 and/or Cw 7. Furthermore, all had some mild immune disorder, e.g.; elevated cofactor, B cell and immunoglobulin levels and reduced OKT 4/8. Detailed analysis of the environmental chemicals revealed all cases had been environmentally exposed to anticholinesterase pesticides. Four out of seven improved by systemic administration of atropine methylnitrate. When both types of Ch-E activity returned to normal values, involved iris and ciliary muscle's functions were normalized in four cases mentioned above. The results indicated that chronic exposure to anticholinesterase pesticides produced internal ophthalmoplegia.
James W. Larrick, Ph.D., Cetus Department of Immunology, Palo Alto, CA
NOVEL METHODS FOR THE STUDY OF MUTATION AND POLYMORPHISM IN THE HUMAN POPULATION
Our laboratories have developed a method to rapidly clone and sequence polymorphic genes or genes being studied for mutations. The method, called polymerase chain reaction (PCR), uses oligomers flanking a gene of interest to initiate a primer extension reaction. Each round of amplification doubles the amount of fragments of DNA between the primers. Polymorphic major histocompatibility complex (MHC) genes and immunoglobulin genes have been cloned and sequenced using PCR. A number of MHC class II DP-B genes have been cloned or sequenced and the relationship of these genes to autoimmune disease is under study. The frequency of various alleles in native populations is also under study. A rapid, nonradioactive technique using allel-specific oligomers (ASOs), has been developed to MHC type DNA that was PCR amplified from leukocytes obtained from Tibetans and Amerindians (Waorani) populations. These studies will permit us to more precisely determine the origin of these peoples. It should be possible to use PCR and ASOs to study the frequency of mutation in other genes of interest. The potential usefulness of PCR/ASO for the study of diseases environmentally initiated or of unknown etiology will be discussed.
John L. Laseter, Ph.D., - Enviro-Health Systems, Inc. Richardson, TX
THE MEASUREMENT AND HEALTH EFFECTS OF SELECTED INDUSTRIAL ORGANIC SOLVENTS
Measurement of toxic organic chemicals and their metabolic products in human body fluids for evidence of exposure is growing in clinical significance. It has been predicted that within the next few years, limit values (biological exposure indices - BEI's) will be common practice in the management of workplace chemical exposures. Important factors in biomonitoring include the choice of clinical specimen, the analytical method, a knowledge of background levels in a given patient population, as well as a knowledge of metabolism and pharmacokinetics. Information regarding a possible pattern of chemical exposure is also important. In terms of occupational exposure monitoring; when properly designed, provides a better indication of internal dose and a better estimate of risk than air monitoring.
Blood is the body fluid which usually shows the best correlation with atmospheric concentration, the amount absorbed (regardless of exposure route), the degree of retention, and severity of effect. Information will be presented on the anticipated blood concentrations following exposure to various common industrial organic solvents. Observed health effects along with selection criteria for appropriate clinical pathology methods will also be discussed.
Jean Monro, M.D., Medical Instructor, including Environmental Care Unit, Breakspear Hospital for Allergy and Environmental Medicine, Hertfordshire, England
Medical Instructor of the Allergy Department of the Lister Hospital, Chelsea Bridge Road, London, England
INVESTIGATE THE EFFECTS OF DIETARY INTERVENTION ON THE BEHAVIOR OF ALL DEAF SCHOOL CHILDREN
In a school for the severely deaf, it has been noted that there has been a deterioration in behavior of the children in the past three years, since urea formaldehyde foam insulation was put into the walls. To try to reduce the total environmental load to improve the children's behavior, a total change of diet was introduced. The children are unable to be transferred to other schools because this is the only school in the south of England for severely deaf children. We, therefore, changed the diet from a strict institutional diet to a whole food diet. At the same time, we asked the children to keep food diaries. Behavior patterns was scored by the teachers and the change in behavior was documented over nine months. The resident caretakers were also asked to note the children's behavior. We have shown that there has been an improvement in some parameters of behavior over a nine month period. The means by which the children were encouraged to adopt a whole food diet will be shown and the results discussed.
Cecil E. Pitard, M.D., University of Tennessee School of Medicine, Knoxville, TN
CONVENTIONAL BIOPHARMACOTHERAPY (BPT) OF CANCER
An update on a new conventional method of cancer treatment - biopharmacotherapy - with long-term followup case presentations.
BPT is widely applicable, uses familiar medications knowledge and techniques, is effective, in general non-toxic, has a good benefit/risk ratio, and is adjuvant with nutritional and environmental measures, surgery, radiation and chemotherapy.
The protocol employed in this study uses Cimetidine, Indomethacine, Butyrate, and Staphage Lysate and/or Mixed Respiratory Vaccines. Low dose (1.5 to 3 mil U) recombinant interferon alpha (Alfa-2a or -2b) is added when needed because it is synergistic with butyrate.
In cases where BPT is effective there is prompt reduction in pain, a feeling of well-being, and increase in energy and performance levels, within 4 weeks.
Development of resistance to this combination of BPT is much slower than with the chemotherapy agents. Remissions are accompanied by good quality of life.
BPT is in general compatible with the adjuvant to the other three conventional modalities of cancer treatment, and the others should be used with BPT where they offer an extension of good quality of life.
Theron G. Randolph, M.D., Chicago, Illinois
CHEST PAIN ON THE BASIS OF ALLERGIC MYALGIA
It has been estimated by physicians attending intensive care and cardiac units that at least one-half of arriving patients alleged to have an acute coronary occlusion fail to have this diagnosis substantiated. But when asked by patients: "What do I have?", most physicians simply reiterate: "You don't have a coronary." This reply leaves patients having recurrent chest pains in an acute quandary with each subsequent episode - a scenario which may be expected even more frequently as patients are urged to seek early medical attention for potential coronary episodes for optimal therapy by means of clot-dissolving techniques. Although the designation of chest wall pain may be made correctly, its possible allergic origin is rarely ever considered.
Acute or chronic chest, neck or shoulder pains may be induced or perpetuated in specifically susceptible persons by exposures to given food and chemicals (spray residues on foods, odors of insecticide sprays, utility gas or its combustion products, automotive exhausts, evaporating paint and varnishes, etc.). Avoidance of probable excitant relieves symptoms. Provocative reexposures induce acute test responses which demonstrate causation.1-3
Reactions characterized by intercostal myalgia are usually localized to a small tender interrib area and are accentuated by motion of the rib cage. Pectoral myalgia is usually characterized by localized tenderness and pain accentuated by motion of the arm of the affected side. Acute bursitis-type pain localized to the supraspinatus tendon insertion, acute torticollis or deltoid myalgia may also occur. Any of these chest, neck
or shoulder syndromes may be accompanied by sensations of heaviness, pressure or vice-like pains, associated with dyspnea and/or orthopnea most commonly localized to the anterior or midchest. These pains may radiate to the back, neck, shoulder(s) and sometimes to the wrists or lesser fingers. The duration of this distress, being longer than in anginal attacks and less readily relieved, makes it difficult to rule out myocardial infarction. Moreover, depressed T-waves of the electromycardiogram may persist in chronic phases and are sometimes induced in acute recurrence. Although this or these syndromes commonly occur in asthmatic patients, they may not be accompanied by coughing or wheezing. Several of these syndromes may coexist. Chest pressure-pain syndromes of allergic origin may be either immediate or delayed. Acute bursitis-myalgia attacks usually develop several hours after isolated exposures.
Both intermittent acute and chronic reactions are best treated by avoidance of specifically incriminated environmental exposures.
Doris J. Rapp, M.D. Buffalo, New York
EVALUATION OF ECOLOGIC CARE IN CHILDREN AGED TWO AND YOUNGER
The history of a typical infant and older child with histories dating back to infancy will be presented. The clues to detect these children earlier will be presented. The efficacy of early therapy will be briefly confirmed from the 1986 survey.
1986 Survey Results: 59% 51 questionnaires returned, 2:1 male to female ratio, age at time of survey - 60% 2-6 yrs.
Age symptoms began - 80% before 6 months.
Age treatment sought - 83% seen 6-18 months.
How long before better - 57% better in 1 week.
How long on treatment - 40% on treatment 2 years or less, 50% on treatment 2-4 years.
How much better - 67% believe children 80-100% better since Rx started.
What is used now - 87% use part or all of treatment, but 60% use allergy extract, rotating diet only, chemical avoidance, environmental control, 67% use rotary diet only, 73% use environmental control only, 52% use allergy extract only. Early treatment appears to be possible and efficacious. Increased public awareness of the symptoms, treatment and sequelae promotes earlier recognition and treatment of infant unsuspected allergies. Comprehensive treatment must be monitored and maintained for continued high level wellness. Periodic surveys help us evaluate the general and specific aspects of this treatment. Comprehensive initial and continued education, plus support, are required for patients who have to comply with a complex medical regimen in order to maintain an increased level of wellness.
William J. Rea, M.D. & Yaquin Pan, M.D., Alfred R. Johnson, D.O., , Environmental Health Center - Dallas, Texas
CLEARING OF VOLATILE HYDROCARBONS FROM THE HUMAN BODY
Chemically sensitive patients were evaluated for levels of toxic volatile organic hydrocarbons. These include Benzene, Toluene, Ethylbenzene, Xylenes, Styrene, Trimethylbenzenes, Chloroform, Dichloromethane, 1,1,1 - Trichloroethane, Trichloroethylene, Tetrachloroethylene, and Dichlorobenzenes. There were 13 patients hospitalized in the Environmental Control Unit, 41 outpatients and 6 patients who underwent the sauna-physical therapy program. Blood levels as well as sign and symptom scores were evaluated before, during and after treatment. Each group had some form of common treatment The ECU group had fasting, rotating diet, intravenous and oral nutrients including vitamins A,C,E, and B and safe water as well as excellent environmental control. The outpatient group had similar treatment but the environmental control was not as constant or clear as the ECU group. The sauna physical therapy group had similar treatment except their environmental control was not as good as ECU, but markedly (by time and quality in a controlled environment) increased over the outpatient group. In addition they received up to 2 hours of sauna at 140 to 160F with graded exercise and massage in between. The ECU group of patients were much sicker than the other 2 groups meeting the criteria for hospital admission. Results: All the ECU patients improved their signs and symptoms and decreased their toxic chemicals with an effective rate of 100%, 70% of the outpatients improved their signs and symptoms while 30% did not. 20.4% decreased all of their toxic volatiles and 72.2% decreased part of their toxic volatiles, while 7.4% did not. Their effective rate of cleaning was: Styrene 100%, Chloroform 90%, Dichlorobenzenes 90%, Trimethylbenzenes 88.9%, Dichlorobenzenes 77.3%, Benzene 72.7%, Trichloroethylene 68.4%, Xylenes 61.1%, Ethylbenzene 60.9%, Tetrachloroethylene 60.4%, Toluene 55.3%, and 1,1,1-Trichloroethan 48.7%. Three out of six sauna patients signs and symptoms improved with 5 decreasing the levels of toxic chemicals. In summary, the principles of ridding the body of toxic organic chemicals may be accomplished in a variety of ways using the time tried principles of avoidance and nutrient replacement. The addition of physical therapy and sauna appears efficacious in this small series.
Sherry A. Rogers, M.D., Northeast Center for Environmental Medicine, Syracuse, New York
ZINC DEFICIENCY AS A MODEL FOR THE SPREADING PHENOMENON
In over three hundred randomly selected allergy/E.I. patients, RBC zinc was abnormally low in over 50 percent. Since it's in over 90 metalloenzymes, a deficiency has far reaching effects in many systems; for example, defects in general body metabolism, the immune system, energy production, or gene repair could explain some of the fatigue, development of further sensitivities, and the seemingly overnight and irreversible change to a chemical victim.
Enzymes deficient in zinc are easily replaced by heavy metals, such as cadmium which further damages enzymes, causing aberrant function. And zinc is crucial to the metabolism of many other nutrients, so a rapid downward course ensues. For example, vitamin A (retinol) cannot be converted to its first breakdown step (retinaldehyde) until the zinc dependent alcohol dehydrogenate is sufficient.
Most importantly, xenobiotic metabolism is extremely dependent upon zinc, and increased vulnerability to chemicals because of defective detoxication further weakens the system and snowballs. Many pathways can explain the nebulous symptoms for the toxic brain to mood swings and paresthesias.
Correction of a zinc deficiency is also not without problem and must be carefully monitored so as not to create manganese, molybdenum, and copper deficiencies. The spreading phenomenon can now be explained biochemically by a prototype zinc deficiency as just one example; this should help to remove the mystery from E.I. that makes it so difficult to comprehend.
Colin G. Rousseaux, B.V.Sc. (Hons) Ph.D., M.R.C.V.S., Associate Professor, Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
COVERT OPERATIONS: THE PROBLEM OF INCRIMINATING MYCOTOXICOSES IN DISEASE
Mycotoxins are toxic secondary metabolites of numerous genera and species of the imperfect fungi. The reason for their existence is presently under debate. However, their importance in man and animals can easily be overlooked, as the diseases they cause are often obscure or subclinical. Mycotoxins have a broad spectrum of biological activity in mammals including: immunosuppression, target organ toxicity, teratogenesis and carcinogenesis. Clinical symptoms and pathological changes that follow exposure to mycotoxins often do not allow for a diagnosis on the basis of a singular observation; a few exception do exist, e.g., zearalenone, sporidesmin and ergot alkaloids. The non-specific nature of primary injury, often masked by secondary effects or delayed effects (e.g., neoplasia) hinder rapid diagnosis. Furthermore, interaction of two or more mycotoxins (possibly in conjunction with xenobiotics), species variability in response to the toxin, and the difficulty to identify a casual link because of temporal and analytical problems, may result in a lack of, or worse, mis-diagnosis. It is no wonder that mycotoxins have been labeled as agents in search of a disease; maybe these toxins should be considered masters of disguise in covert disease operations.
James L. Rowland, M.S., D.O., Ph.D, F.A.C.G.P. Ryodoraku Research Institute of North America, Inc., Kansas City, MO
BIO-ELECTRICAL MAGNETIC FIELDS AND ELECTROACUPUNCTURE
Presentation by film and slides demonstrating how the laws of the Universe and Cosmos and our own bio-electrical energies are related. Our body microcosm meet these same laws and are governed by microenergies. These energies will be demonstrated as well as a method that may be employed to balance them scientifically.
Douglas B. Seba, Ph.D., Private Consultant, Washington, D.C.
ENVIRONMENT AND HEALTH '88: A CHRONIC CANKER (PART I)
An ecologic paraphrase of the three laws of thermodynamics can be made. First law: "Life is a zero sum game." Second law: "You can't win." Third law: "You can't get out of the game." The same appears to be true of the global environmental problem and we, as a species, who pride ourselves on our supposedly adaptive intelligence are playing a very dumb game. A suicidal environmental game.
It has been 25 years since Rachel Carson's seminal book, "Silent Spring" on the chemical plague of pesticides has been published. She never could have foreseen a 400% increase in pesticide use since that time coupled with an attitude of regulatory indifference at all levels of government.
This indifference must stop. The ozone is down, the carbon dioxide is up, the whales are dying and the gypsy moths are spreading. There are many environmental events that are having both short and long term health effects. This paper will review some major events from 1987 that are apropos to this conference. This will help enable health practitioners to be aware of how subtle, but significant environmental contamination or alteration can have profound adverse health consequences in the patient.
ENVIRONMENT AND HEALTH 88: HEALING THE WOUND (PART II)
The first step in healing is the awareness that you are sick and certainly this conference has made that point with regard to environmental ills. We can change the way we play the environmental game.
At the global level we see new thinking in which, for example, Bolivia repays a monetary debt to the USA by setting aside a forest reserve. International agreements are being made (however tortuous) to cut chlorofluorocarbon production and decrease acid rain.
OSHA, EPA and other regulatory agencies, as well as the courts, are requiring that limits be lowered on exposure to many toxic chemicals and that individuals be given information on toxic exposures. As a result, pollutants have been lowered and ecosystems are recovering their health.
Even more exciting are the changes occurring at the individual level. Indoor air pollution has become a matter of concern to the common man. Nowhere is this more apparent than in the growing ban on cigarette smoking.
This paper, like this conference, will review progress that has been made in environmental rehabilitation and how the health practitioner can use this information to aid the patient in surviving the chemical milieu we have made for ourselves.
Cyril W. Smith, Ph.D. Department of Electronic and Electrical Engineering University of Salford, M5 4WT, England
THE MEASUREMENT OF ENVIRONMENTAL ELECTROMAGNETIC FIELDS AND THE VALUES EFFECTIVE IN TRIGGERING RESPONSES IN HYPERSENSITIVE PATIENTS
In respect of the biomedical and environmental effects of electromagnetic fields, coherence (precision) in space and time (frequency) are of equal importance to the field strengths. The duality between chemical structure and coherent frequency patterns is as fundamental as the chemical bond. The hypothesis that coherent frequencies can simulate homeopathic potencies and thereby produce the corresponding "proving" symptoms in sensitive persons, will be tested on data obtained in the testing of electrically hypersensitive patients.
Apparatus is being developed to determine the spatial distributions of environmental electric and magnetic fields over a range of precisely determined frequencies. Preliminary results showing typical environmental field distributions will be presented. The health and environmental implications of electromagnetic fields will be discussed.
Major A. Ramsay Tainsh, MBE., MA., FLS, FRSA Industrial and Business Consultant, Stockholm, Sweden
THE PEASANT APPROACH TO THE FUNGAL PROBLEM AND CURRENT MEDICAL RESEARCH
Peasants put the emphasis on keeping healthy and therefore work with Nature. They make full use of sunlight, breezes, potable water, fresh wholesome food, fuel to cook it, personal hygiene and sound sanitation. The traditional agricultural and horticulture makes use of compost, interplanting, crop rotation shade, ventilation, irrigation and drainage. Their crops are disease and pest resistant and when consumed pass on this resistance to man and beast. The Bihar peasant sayings concerning the drying and storage of grain have stood the test of time. The peasants teach their children how to cope with floods and disasters of all kinds and how to treat the "Mouldy Grain" and "Bloodymindedness Diseases."
During the evacuation of North Burma in 1942, the peasant methods proved to be most efficient and very simple. Between May and July, 1942, 20,000 refugees were given first meals using the peasant methods: of these 18 died. But on being admitted to hospital 2,000 died within 4 days when given unsuitable food and medicine. Between September and November, 1,800 refugees were given the traditional treatment with the loss of one. During November, a medical team took over to bring in the last 120 refugees and of these 50 died when given orthodox treatment.
Mycology and human mycotoxicology are understood by a number of veterinary surgeons. So far only a handful of men and women realize that Primary Mycotoxicosis is common in the tropics and Secondary Mycotoxicosis is the most common ailment in cool, damp regions.
Vernon P. Varner, M.D., J.D., Iowa City, IA
COMMON COMPOSITIONS OF INERTS - THE MOST TOXIC PORTION OF CHEMICAL PRODUCTS
Will discuss many different inerts and types of inerts. The breadth and number and differences in compounds and structures make it fundamentally impossible to write a meaningful abstract.
Francis J. Waickman, M.D. Cuyahoga Falls, OH
Age: 6 years old - when seen 12/18/86
Reason for Visit: "Jessica was asthmatic as a baby - was overdosed on slo-phyllin at age 2 yrs. And now has epilepsy. She has never been stable on medication and I'm not sure if some of her seizures are being caused by allergies or not."
History Allergy evaluation - teaching institution age 11 months "mild reaction only" - treatment none. First asthma attach - age 13 months. Second allergy evaluation treatment - slo-phyllin. First seizure - age 3 years. Three pediatric neurologist saw patient over next two years. Tegretol - "extreme irritability - totally off the wall". Phenobarbital - same as tegretol. Dilantin - "extreme sedation and memory loss". "Was stopped 2/86 and she lost everything she learned in previous 3 years." Dapakene - "extreme behavior peaks" - "levels keep shooting up", "the more drugs she takes, the more convulsions she has."
Question: 1) What other historical points would you like to know?
M. Jeffrey White, M.D. Assistant Clinical Professor Ophthalmology, University of South Florida School of Medicine, Tampa, FL
DETOXIFICATION OF XENO-BIOTIC AGENTS
The remarkable technological advances of the 20th Century have also brought many technological problems. The most serious problem concerning the people is the introduction of a myriad of wonderful but often toxic chemicals within our environment. There are approximately 60,000 different chemicals in production today. Mahy of these xenobiotic agents are entering the human body through drinking water, food, occupational environments, home environment, waste sites, chemical accidents, farming, and contaminated air. They create environmental diseases as liver disease, lung disease, blood dyscrasias, neuro-ophthalmological disease, reproduction and renal dysfunction, immunosuppression, and cancer. The general medical community has either treated these patients symptomatically or have basically ignored the obvious etiology.
The anser to this ecologic problem will be found in our ability to have accurate testing for any toxic chemical disorder and then to able to provide a proven therapy program to patients to reduce toxic chemicals in the bodies.
With the assistance of historical research and the academic prowess of many learned men, the Enviro Med Clinic of Tampa has developed such therapeutic regime.
I will describe the efficacy of this therapy on chronic and acute cases of xenobiotic poisoning and the ability to remove toxic chemical from the body.
The case reports will include such varied diseases as allergy, severe chemical sensitive, and optic neuritis. It will also demonstrate the removal of such varied chemicals as Chlorinated Pesticides, general volatiles, and Formaldehyde.
We do not have the final answer to this problem but we continue to learn.
John M. Whittaker, DVM Whittaker Associates, Springfield, MO
THE MYCOIOKIN PROBLEM - ANOTHER ECOLOGICAL BLUNDER?
Although the study of fungi is older than the study of bacteria and viruses, the lowly fungus for many decades has taken a "cheap seat" in the gigantic stadium of microbic-logical research and disease work.
Only recently has "mycology" really made the scene in veterinary and human medicine. This recent recognition was not prompted by the unglamourous mycotic infection, or mycosis, but by the more dramatic "mycotoxin" situation now facing the food industry.
Many molds have the ability to produce toxic metabolites and these chemical substances have the ability to produce toxic symptoms or death when the food stuffs containing these "mycotoxins" are consumed by man or animal. The "aflatoxin situation" is probably the one single happening that has focused much attention on the mold world.
Aflatoxins are highly toxic mycotoxins produced by the common mold, Aspergillus flavus, which is known to be highly carcinogenic in both man and animals.
This toxin was first identified in peanut meal after causing an extremely high death loss in turkeys but since then, most all other common feed ingredients have been found to be contaminated with aflatoxin. In fact, FDA now has a policy of red tagging any ingredient containing more than 20 parts per billion!
The A. flavus toxin, aflatoxin, is just one group of toxins in a smorgasbord of fungal toxins now facing the industry. One such smorgasbord of mold toxins struck Russian animal and human populations during the aftermath of World Ward II. In this case, several field fungi in over-wintered crops produced toxins causing a wide variety of symptoms and lesions.
Deaths in the many thousands were also recorded. The disease syndrome was called "alimentary toxic aleukia" and demonstrated symptoms and lesions ranging from necrosis of the alimentary tract to total exhaustion of the bone marrow and adrenal gland changes.
It is interesting to note that all age groups were affected but undernourished humans and animals were more severely attached. Secondary yeast and protozoan infections can often be complicating factors in the mycotoxins syndrome.
We know that modern day genetics has lowered resistance to the mycotoxin producers. The big question concerns the over use of arm chemicals. What role do they play in this mycotoxin tragedy?
John R. Wilkins III, Department of Prevention Medicine The Ohio State University, Columbus, OH
PARENTAL OCCUPATION AND CHILDHOOD CANCER
Epidemiologic studies that have investigated the hypothesized relationship between parental occupation and childhood cancer are reviewed. Nearly all available (published and unpublished) reports are case-control studies, where cases derived primarily from tumor registry records, hospital records, or death certificates, and controls derive primarily from birth records or general population sampling schemes. To date, attention has focused on leukemia, central nervous system tumors, and Wilms' tumor, and the association of these illnesses to paternal occupation. Although certain diagnostic groupings and several parental occupation/industry categories and/or specific occupation exposures have been statistically linked, the results are not wholly consistent from study to study. Methodologic difficulties such as exposure ascertainment and sample size problems are discussed, as are previously unpublished results of an ongoing case-control interview study in Ohio of selected environmental factors and childhood brain tumors.