Environmental Health Centre review says:
"Centre Needed But Lots of Problems" 

Update Summer 2001

The clinic review, commissioned by the N.S. Department of Health, was released on November 29, 2000 . The reviewers were mandated to evaluate whether "the Centre's current practices are conguent with scientifically- recognized national and international guidelines and accepted practices for research into diagnosis and treatment of 'environmental intolerance of uncertain etiology.'"  They also looked at other issues including "whether there is sufficient scientific research evidence to expand the EHC's mandate to offer treatment." 
 
The reviewers gave particular attention to this last question, one of the most important from the viewpoint of environmental illness sufferers. They concluded "the EHC is having trouble satisfying the current demands for patient evaluation and treatment.  The Clinic requires a major overhaul before any increase in their clinical mandate can be considered."
 
In relation to the type of treatment the EHC provides, the reviewers noted that the EHC "evaluated the usefulness of one of the major foundations of diagnosis and treatment of IEI, antigen provocation-neutralization; they found this to be sufficiently unreliable that they have discontinued its use."  However, the paper published by EHC staff on provocation-neutralization did not, in fact, conclude that it was unreliable. It stated that testing using reported symptoms alone (which is not usually done) should not be a basis for treatment, but that "skin response may be a more reliable indicator and will require cross-validation with other tests..." This follow-up research has not been done by the EHC. 

 The reviewers concluded that discontinuing antigen therapy and "routine" IV therapy " elevate(s) the EHC to a leadership role in the IEI field."  "How can this be leadership?" asks Karen Robinson of the N.S. Allergy and Environmental Health Association's (NSAEHA) treatment committee. "Real leadership is being provided by clinics in the U.S. and Europe which are having considerable success returning patients to more active lives through the skillful use of treatment combinations including detoxification, avoidance, IVs and antigens."         Nova Scotia's original Environmental Health Clinic provided antigen provocation-neutralization treatment and IVs, as well as information on making adaptations in diet and the home environment. The Department of Health's review of that clinic found a 97% patient satisfaction rate.  Presently, some environmentally ill Nova Scotians who can afford to pay for their own treatment are traveling to Oromocto, New Brunswick where the Altlantic Environmental Health Centre provides antigen provocation-neutralization diagnosis and treatment. 
 
Dr Jeff Scott, Nova Scotia's Chief Medical Officer of Health heads up the team acting on the review's recommendations. He sums up the EHC's future this way.  "The intent is for research and treatment to have an equal balance.  The treatment which is provided should be that which is proven effective.  Or, treatment can be provided which is part of a research program."  This raises the question of what "proven effective" means for an illness which is defined as an "emerging illness" and how long patients will have to wait until treatments are considered "proven" by the Department of Health. 
 
Should the fact that environmental illness is considered an "emerging illness" have a bearing on what level of "proof" is required? Are there ethical issues involved in a government funded clinic not providing treatments which have shown high success rates but are not "proven scientifically?" 
 
The reviewers recommended that "the EHC should confine its clinical services to documenting and characterizing its clinical population, providing conventional symptomatic treatments and refraining from the use of 'arbitrary treatments' unless these are adequately justified and the subject of properly documented, scientifically reviewed and approved protocols."
 
They allowed that "various services and non-invasive treatments which are in use, such as psychological therapy, return to work rehabilitation, sauna and others described above could be considered within the scope of conventional, non-invasive, symptomatic therapies." 

Eric Slone, NSAEHA president, notes, "The government decided to appoint three reviewers none of whom has known qualifications, experience or certification in the field of environmental medicine. This led to predictable deficiencies in the review's conclusions about treatment issues." Prior to the review, the NSAEHA called on the government to include knowlegable environmental medicine physicians on the review committee. 
 
There are a number of different elements used in treating environmental illness; diagnosis, prevention (including avoidance advice and lifestyle changes), reduction of illness/sensitivity (including detoxification, supplements, antigens, IVs, and other physical interventions), and coping skills/psychological interventions (learning how to live as well as possible with a chronic illness.)
 
"The reviewers and the EHC both seem to emphasize the importance of coping skills and give a 'thumbs up' to this type of
care," says Robinson. "Yet, as with most illnesses, most patients look
to the medical system for help in reduction of illness. .As with other illnesses, coping skills should be supplementary and should not replace treatments which focus on curing the patient or stopping the spread of illness."
 
The reviewers concluded that "there seems to be an overall consensus that the EHC serves an important community need...If the EHC did not exist or was to be abandoned, the plight of those with IEI would be worsened." They recommend that the EHC should continue with current funding levels until further developments warrant change.
 
However they noted serious problems of accountability in academic practices, patient care, research and fiscal matters.  Patient care accountablity mechanisms did not meet accreditation standards.  The reviewers found that basic information required to trace patient care and results were absent.  Information is not kept which is sufficient to give a clear picture of what patients get what treatments with what results. Such data is "the basis for more definive research and better care," the reviewers note. 
 
In terms of research, the reviewers concluded that there are few results. "Studies formulated coincident with the opening of the Centre in 1997 are yet to be seriously launched.  In fact the flagship study of intravenous magnesium therapy is under consideration to be cancelled."  (IV therapy with magnesium alone is not a standard environmental medicine treatment.  In other clinics, IVs are given using a combination of ingredients including magnesium.) 
 
In terms of the EHC's leadership, the reviewers recommended that "the leadership of the EHC must be addressed with either professional development support for the incumbents or a change of personnel."
 
"The government has accepted the report's recommendations," says Dr. Scott.  "The most important one is clear accountability." A committee is working to develop a "business plan" for the EHC, to integrate the clinic into mainstream health and academic institutions.  The plan includes linking the EHC to Dalhousie University's Departments of Medicine and Pediatrics.
 
Once a plan is developed, stakeholders (also known as patients and potential patients) will get a chance to have some input.  Will all the effort that patients put into obtaining this review actually bring EI sufferers any closer to obtaining effective treatment?