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Clinical Ecology: Environmental Medicine or Unsubstantiated Theory?

Ephraim Kahn, MD, MPH; and Gideon Letz, MD, MPH
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Disclaimer: The views expressed by the authors are their personal opinion and are not necessarily those of the California Department of Health Services or the State Compensation Insurance Fund.

Requests for Reprints: Ephraim Kahn, MD, MPH, Hazard Evaluation Section, California Department of Health Services, 2151 Berkeley Way, Room 619, Berkeley, CA 94704.

Ann Intern Med. 1989;111(2):104-106. doi:10.7326/0003-4819-111-2-104
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A concept known by several terms, including "environmental illness," "multiple chemical sensitivities," "environmental hypersensitivity disorder," "20th century disease," and "total allergy syndrome," has recently attracted public attention and generated considerable controversy. The concept was developed by physicians known as clinical ecologists who now call themselves practitioners of "environmental medicine." These physicians believe that certain persons are adversely affected by synthetic chemicals in the environment at doses far lower than can be explained by accepted pathophysiologic mechanisms. They believe that such low-level exposures can damage the immune system and make these persons hypersensitive to all or most synthetic chemicals. The symptoms


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