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1994”N‚Ɋ‹«’¡‚âThe American Lung Association (ALA)‚âThe Consumer Product Safety Commission (CPSC)‚âThe American Medical Association (AMA)‚ªŽº“àŠÂ‹«‚ɂ‚��‚ďo‚µ‚½ƒuƒbƒNƒŒƒbƒg‚ªu—Տ��ŠÂ‹«ˆãŠwv‚ɂ‚��‚ÄŽQÆ‚µ‚½•ï¿½ï¿½Œï¿½ï¿½Ducataman et al.(1999)‚ðÐ‰î‚·‚éB‚�}‚̕��Œï¿½ï¿½‚ÍŽÀÛ‚ɂ́A•Ä‘E‹ÆˆãŠw‰ï(ACOM)‚̓ŕ�NŠw•ª‰È‰ï‚Æ‚µ‚Ẵ|ƒWƒVƒ‡ƒ“ƒXƒe[ƒgƒƒ“ƒg‚Å‚ ‚éB‚Ü‚½AACOM‚ÍŒ»Ý‚͕葐E‹ÆŠÂ‹«ˆãŠw‰ï(ACOEM)‚ƉüÌ‚³‚êA1999”N‚É‚Í‘½Ží‰»Šw•ï¿½NŽ¿‰ß•qÇ‚ɂ‚��‚Ẵ|ƒWƒVƒ‡ƒ“ƒXƒe[ƒgƒƒ“ƒg<‚ðo‚µ‚��‚éB

‚ŁAu—Տ��ŠÂ‹«ˆãŠwv‹y‚сu‘½Ží‰»Šw•ï¿½NŽ¿‰ß•qÇv‚Æ‚³‚ê‚銳ŽÒ‚ւ̑Ώˆ‚ɂ‚��‚ď‘‚©‚ꂽ•”•ª‚͈ȉº‚̂Ƃ�N‚è‚ŁA‚©‚È‚è‹­‚­u—Տ��ŠÂ‹«ˆãŠwv‚ð”á”»‚µ‚��‚éB

[American College of Occupational Medicine, Toxicology Committee: Ducataman et al. "What is Environmental Medicine?" Journal of Occupational Medicine 1990; 32: 1130-32. ]

Wider recognition of the many features of the environment that may adversely affect human health has attracted the interest of many, including some clinicians who may be insufficiently trained to address epidemiologic and toxicologic aspects of causation and prevention. Untested diagnostic and therapeutic regimens may become attractive to a few health care providers and their patients in the face of major deficiencies in information concerning environmental impacts upon health. Misdiagnosis of conditions related to the environment is as serious a problem as misdiagnosis of other conditions. For example, questions of untested and otherwise problematic aspects of clinical ecology have been noted by allergists and immunologists[5-7], internists[8,9], psychiatrists[10-12], government agencies and advisory panels[13,14], state medical societies where "clinical ecologists" practice[15] and consumer advocates[16-17]. Recently, trial courts also have expressed concern with the "subjective and conjectural" nature of clinical ecology testimony[18-21].

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In these matters, we join other medical and scientific bodies in recommending, first, that all physicians must refrain from untested, unproven[22], or needlessly debilitating[23] diagnoses and treatments. Second, we ask that physicians recognize that the symptoms often leading to the diagnosis of "multiple chemical sensitivity" are real to the patient, even if the validity of the diagnosis and its proposed mechanisms are conjectural. Patients with multiple sensitivities need the same supportive, tolerant, and encouraging care that all patients deserve. Third, despite initial impressions that these patients may have simple misdiagnoses of other better known problems[7] or else learned psychologic reactions[10,11,24,25], occupational physicians should support and participate in scientifically designed studies of the phenomenon now characterized as multiple chemical sensitivity.

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5 American Academy of Allergy, J. Allergy Clin. Immunol., 1981, 67, 333.
6 American Academy of Allergy and Immunology,  J. Allergy Clin. Immunol., 1986, 78, 269.
7 Terr, AI, Arch Intern. Med., 1986, 146, 145-149.
8 American College of Physicians, Ann. Intern. Med, 1989, 111, 168-178.
9 Kahn E. and Letz G, Ann. Intern. Med, 1989, 111, 104-106.
10 Brodsky CM, Psychosomatics, 1983, 24, 731-742.
11 Stewart DE and Raskin J, Can. Med Assoc J., 1985, 133, 1001-1006.
12 Schottenfels RS, in Cullen MR (ed) Workers with Multiple Sensitivities, State of the Art Reviews, vol II, 1987, 739-753.
13 Health Care Financing Administration, Fed. Reg., 1983, 48, 37716-37722.
14 Committee on Environmental Hypersensitivities, Report of the ad hoc Committee on Environmental Hypersensitivity Disorders, Toronto, Ontario, Ministry of Health, 1985.
15 Calforna Medical Association Scientific Board Taskforce on Clinical Ecology, West. J. Med., 1986, 144, 239-245.
16 Barrett, S. Nutrition Today, 1984, Mar/Apr 6-11.
17 Consumers Union, Consumer Reports, 1988, 53, 96-109.
18 Whitehead GM and Espel LD,  Toxics. Law Rep., 1988, 2, 1040-1047.
19 Keszbom A. and Goldman AV, Toxics. Law Rep., 1988, 3, 884-892.
20 Rothman RA and Maskin A, Toxics. Law Rep., 1989, 3, 1219-1231.
21 Miller, DR, Lancet, 1987, ii, 1283-1284.
22 Cullen, MR, N. Engl. J. Med, 1990, 322, 576-683.
23 Frumkin, H., Ann. Intern. Med, 1989, 111, 542.
24 Shusterman D. et al., J. Occup. Med., 1988, 30, 565-567.
25 Bolla-Willson K,  J. Occup. Med., 1988, 30, 684-686.

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