edocCR_2008_E Conference Environment & Health, Strasbourg, 5 Dec 2008

Mr Bill Etherington, Member of the Committee on the Environment, Agriculture and Local and Regional Affairs of the Parliamentary Assembly, Council of Europe (PACE), and

Mr Jean Huss, Rapporteur of the Committee on the Environment, Agriculture and Local and Regional Affairs of the PACE

Mr ETHERINGTON apologised on behalf of Mr Meale, Chair of the Committee on the Environment, who had been due to chair that morning's meeting but had unfortunately fallen off a ladder while working in his garden and had been admitted to hospital. The injury was not too serious. Mr Etherington wished Mr Meale a speedy recovery and said that, if everyone agreed, he would take the chair in his place.

The subject for debate was relatively well known, but little discussed. In the United Kingdom, the term used was “sick building syndrome”, whereas French-speakers described it as “unhealthy building syndrome”. Whole buildings had had to be demolished because of their adverse effects on the health of the people living or working in them.

Mr Etherington welcomed Mr Huss and thanked him for initiating the conference and doing a great deal of work on its preparation. As a member of the Parliamentary Assembly since 1996, he was also trying to sound the alarm bells himself. The Assembly was working on a report on the environment and health that would be entitled “Environment and health: towards better prevention of environment-related health hazards”. The rapporteur was Mr Huss. The role and even duty of members of parliaments would then be to move quickly to propose and pass legislation that would help to solve the problem of indoor pollution, about which too little was still known. There was currently very little literature on the subject.

Mr Etherington wished everyone a good conference and gave the floor to Mr Huss.

Mr HUSS, rapporteur, thanked the participants for coming in such large numbers to this socially relevant scientific and medical conference on environment-related issues, environmental health and medicine. It was taking place as he was in the closing stages of writing his report for the Assembly’s Committee on the Environment and Agriculture, which was due to be put to the vote early the following year. The report was entitled “Environment and health: towards better prevention of environment-related health hazards”. As was clear from the title, the prevention of such hazards was still very inadequate.

Human beings had stepped up their assaults on their environment since the start of the industrial era, but it had been mainly since the Second World War, with the further advance of industrialisation and the advent of the consumer society, that the threats to the environment had become clearer. The air we breathed, water, soil and vegetation were being increasingly degraded by the many forms of pollution caused by human activity: urban pollution, transfrontier air pollution, chemical pollution, radioactive pollution, emissions from everyday consumer products, electromagnetic pollution, noise, etc.

Throughout the 1960s, the population and politicians had for the most part reacted to the gradual degradation of natural environments themselves: air that smelt of industrial activity, irritant dusts, rivers changing colour, stinking waste that was a blot on the landscape, etc.

It was only later on, in fact only in the past twenty years or so, that people had also begun to wonder about the risks posed by a polluted environment to human health itself. Pollution had been slowly accumulating and spreading in the air, the water and the soil for decades. Insidious and harmful, it was seriously affecting not only the environment but also human beings.

Pollution was currently affecting all environments, and since human beings were the last link in the chain they were themselves accumulating all kinds of pollutants or chemical products in their tissues and organs, their fat and their cells. Despite a number of scientific uncertainties about the impact on health of this pollution of our bodies, an increasing number of scientific studies were confirming that there were links between certain pollutants and some diseases or health problems.

For example, it was no longer just the growing impact of certain types of cancer, including cancers in children, but also that of allergies, respiratory disorders, asthma, reproductive disorders and certain degenerative diseases of the central nervous system – not to mention a number of "new syndromes" with a chemical or environmental component – that were increasingly being recognised as public health problems.

In addition, new, insidious and extremely worrying risks were emerging: endocrine disrupters and, controversially, electromagnetic radiation, potential risks posed by some nanotechnology products, mercury and dental fillings, etc.

So, how could pollution be addressed, how could we react to the omnipresent “cocktail” of chemical, physical and biological agents surrounding us, other than by realising the magnitude of the crisis threatening us, responding bravely, quickly and comprehensively to the new challenges and focusing on the prevention of pollution and health hazards and on protecting an environment and a society that would also give future generations a chance?

Links between our polluted environment and threats to health had been recognised not only by leading scientists but also by the WHO, the European Commission and the conferences of Environment and Health Ministers.

In his report, Mr Huss would give a brief reminder of the history of relevant European and international conferences and conventions and of action programmes relating to the environment and health. He would obviously be stressing policy guidelines, official statements and certain positive steps regarding the protection of the environment. It nevertheless remained the case that the overall quality of the environment had hardly improved and that translation into action of all the fine words and declarations of intent often took a back seat when powerful economic interests were involved.

Although the quality of our environment was generally a cause for concern, it was obvious that the risks to human health, especially that of our children, were increasingly worrying and required our attention. In that context, the report would discuss not only the environment and health action programmes decided on in Budapest in June 2004 and the new REACH Regulation, but also the exemplary action taken by some NGOs to warn the public, politicians and policy-makers.

It would therefore sketch out the demands being made by civil society, ecological associations, patients’ associations, doctors’ associations or associations of scientists working in the fields of environmental health and environmental medicine and their requests to be involved.

Finally, the report would endeavour to go into detail about a number of key aspects of an overall strategy to improve the prevention of environment-related health risks.

Mr Huss once again thanked all who were present for attending the conference, which he hoped would be instructive and interesting for all.

SESSION 1

INDOOR POLLUTION

Charing by Mr Bill Etherington,

Member of the Committee on the Environment, Agriculture and

Local and Regional Affairs of the Parliamentary Assembly of the Council of Europe

Speakers:

- Mr Ralph BADEN, Ministry of Health of Luxembourg

- Mr Gerd OBERFELD, Sanitary Land Directorate for Environmental Medicine, Austria

- Professor Frédéric de BLAY, Responsible for the training programme on indoor pollution, University Hospitals of Strasbourg, France

Mr ETHERINGTON introduced Mr Ralph Baden from the Luxembourg Ministry of Health, who would be speaking about the experience of his country’s environmental health diagnostic service (ambulances vertes).

Mr BADEN, who based his address on a series of tables and graphs which are appended to this document, explained that private individuals in Luxembourg who suspected their health problems were due to the stressors present in their home could contact the health services, either directly or through their doctor, and request a check of their home. He emphasised that his examples were not representative of all homes in Luxembourg.

There were three types of symptoms that led people to call for an ambulance verte check: nose, eye, mouth or skin irritations; respiratory problems and allergies; headaches, dizziness, nausea and joint and muscular pains.

The investigative services analysed various types of stressor: chemicals, mould and humidity, and physical stressors, including both high and low frequency electromagnetic fields. An analysis of the results of the past four years revealed that the stressors most often identified were DDT and PCP, which were both well-known, permethrin, a more recent stressor, flame retardants, volatile organic compounds, formaldehyde, mould and electromagnetic fields.

The stressors had changed from over the years. For example, formaldehyde contamination had been steadily declining for seven years, which was no doubt both because its use was now regulated and the result of an information campaign in the media. There was also a decline in associated volatile organic compounds such as benzene or toluene, but that decline was much less significant. Unfortunately, those classic volatile organic compounds had been replaced by lemonene, the use of which was growing even though it was carcinogenic and had a longer life. In a room that had just been repainted, for example, it took two years for the level to fall below the acceptable thresholds, which were doses fatal to rats. Lemonene was therefore just as toxic as, or even more toxic than, the products it had replaced. In that respect, regulation had therefore been insufficient.

With regard to biocides, it was surprising that contamination with DDT, which had after all been banned for thirty years, had not gone down over the years, any more than had contamination with PCP, which had been prohibited since 1994 in Luxembourg, Belgium and Germany but was still used in other European countries. That proved that national legislation was not enough, given the existence of a European market.

There was another family of stressors, namely flame retardants, which were mainly to be found in bedding. They were chemically similar to sarin, a toxic gas developed in the 1930s. 40% of the households tested were contaminated by flame retardants, either chlorine or non-chlorine based, and 34% of the mattresses tested were highly contaminated by either flame retardants or biocides such as permethrin or PCP. People affected by those very high concentrations suffered from mucous membrane or eye irritations, headaches, dizziness, respiratory problems, etc.

Mr Baden then mentioned a number of examples. First of all, that of a two-year-old boy, who coughed, spat and suffered from a runny nose when at home, but felt better outside his home. An analysis of his mattress had revealed a concentration of flame retardants and PCP. He had inhaled those substances every night for two years. His parents had followed the health services’ recommendations and changed the mattress, and he was now much better.

The next case was that of a four-year-old girl who had suffered from nasal congestion at night and in the morning. The health services had established the presence of formaldehyde in the air inside the home, especially in the mattress. The board underneath the mattress had been the source of the concentration, and removing it had been enough to bring about an improvement.

The third example was caused by the shiny floor of a school classroom. A varnish containing cypermethrin, a flame retardant, had been applied. After a two-hour meeting in the room, teachers had suffered from skin and eye irritations, headaches, dizziness, etc, but had felt better again after leaving. On the health services’ recommendations, the varnish had been removed, cypermethrin levels had fallen, both in the air and on the floor, and teachers and pupils alike no longer suffered from the symptoms described.

Another example was that of a woman who had begun to suffer from insomnia after moving house and had started to take sleeping tablets. The health services had detected the presence of very strong electrical and magnetic fields in her bedroom. The bed had been standing between two halogen lamps, which had permanently plugged-in transformers located behind the wooden headboard. These had simply been unplugged, and the woman had been able to stop taking sleeping tablets some time afterwards.

Yet another example was that of a woman aged 42 who had been suffering from headaches and dizziness. He doctor had asked her to keep a migraine diary, which had revealed the disappearance of the symptoms during a week when she had not been at home. The services that had visited the home had established that a significant electrical field was emanating from her bedside lamp and that its effects were amplified by a metal structure. On the floor, there had been a cordless DECT telephone base station, which was creating a field of 24 volts per metre. The woman had been advised to unplug the two devices, and a month later her migraine diary had revealed that the symptoms had completely disappeared.

Then there had been the case of a man aged 39 who was suffering from pins and needles in his right arm and a loss of feeling in his hands. A concentration of 1.6 mg/kg of pentachlorophenol, which had come from the insecticide sprayed on an old cupboard, was found in his bedroom. The cupboard had been removed from the bedroom, and the symptoms had disappeared a few months later.

The last case was that of a woman aged over 60 suffering from migraine, coughing and a loss of feeling in her hands. Her symptoms had only started two years before, but she had been living in the same flat for a long time. It had been two years before that she had repainted her balcony, and the problem had no doubt been triggered by the mixture of biocides, including propiconazole, contained in the paint.

Mr Baden said that those were enough examples, but concluded by pointing to the need to carry on with this kind of action. As Jean Rostand had said, waiting to know enough to act in full knowledge of all the facts was to condemn oneself to inaction.

Mr ETHERINGTON thanked Mr Baden for his interesting statement and gave the floor to Dr Gerd Oberfeld, from the Salzburg Land Directorate of Environmental Medicine, Austria, who would be speaking about electromagnetic fields and other forms of radiation, as well as noise.

Dr OBERFELD said he was delighted to be taking part in such an important conference. He had been an expert in environmental medicine since 1996, and was also a member of the Austrian Medical Council.

(See the appendix for the diagrams on which Dr Oberfeld based his address.)

One of the main sources of indoor radioactivity was radon, a rare gas that emitted alpha radiation and emanated from rock in the subsoil, passed through permeable areas of cellars and penetrated the living areas or offices above. That of course happened mainly in buildings with insufficiently watertight foundations and without concrete walls, i.e. old buildings. For people occupying such buildings, radon contamination could constitute a major hazard that, in particular, might lead to lung cancer. The gas combined with particles found inside houses, and the combination could accumulate in the lungs. However, the problem was receding, as the concrete used for foundations for several decades sealed cellars relatively well. The trend could also be explained by the fact that more and more high-rise buildings were being constructed – people were less exposed to radon on upper storeys. Nonetheless, it could not be said that the problem had finally been solved, and the departments responsible were still measuring radon levels with a view to carrying out sealing work if necessary.

Measures had also been taken against noise. Noise standards were being raised all the time, quiet lorries had been built and traffic had been prohibited during certain hours, but there was still traffic and aircraft noise, and it all clearly caused stress.

However Dr Oberfeld mainly wished to speak about electromagnetic fields, sometimes described as "electrosmog", which had been intensifying for the past ten years. For example, there were mobile telephone aerials more or less everywhere, and most homes had base stations for cordless telephones and internet modems. That resulted in constant microwave radiation, to which we were all exposed for hours or even whole days at a time.

In addition to electric power, which created a field of 50Hz, there was a more or less all-pervasive indoor circular magnetic field created by household circuits, motors and transformers. Then there were the 920 to 960MHz electromagnetic waves produced by mobile telephone base stations. That led to a series of phenomena familiar in the field of optics: reflection, refraction and diffraction. All the waves bounced off the walls, which, incidentally, explained, why it was possible to telephone from further along the street.

High-voltage power lines obviously also created a very strong magnetic field. The surrounding areas were unequally exposed. The major issue was the distance at which people could consider themselves safe. The reply to that question depended on the extent to which the line was used and the threshold limit laid down. In the case of 380,000 volt power lines, which were increasingly frequent in Europe, a distance of 70 metres should be maintained if – as in Switzerland – a level of 1 microtesla was stipulated, and 240 metres if the level of 0.1 microtesla recommended by Bioinitiative was stipulated.

Then there were local magnetic fields, such as that created by a television set. Too many televisions could be seen in children’s bedrooms, sometimes even next to the bed. In some cases, the television was in another room but was in reality just the other side of the wall from the child’s bed. A partition was not enough to eliminate electrical fields completely, and they could reach high levels in some cases.

Depending on where people slept, they could also be contaminated by their own or even their neighbour’s refrigerator. Mention should also be made of the small devices often to be found close to people’s beds. Just a few centimetres from the sleeping person’s head, such as CD players or clock-radios. These should be placed at least 50 centimetres to 1 metre away from the bed; otherwise filters should be fitted.

In 2002, the Lyon-based International Agency for Research on Cancer had carried out a study that had shown that low-frequency magnetic fields could trigger cancer, especially leukaemia in children. Studies conducted in California in 2002 had produced similar findings and had also concluded that there was a possible risk of brain tumours, miscarriages, amyotrophic lateral sclerosis and other conditions.

In 2006, a study had shown that 5% of Swiss people believed themselves to be hypersensitive to electromagnetic waves. Another Swiss study, carried out by Röösli in 2004, had identified a number of symptoms such as sleeping difficulties, migraine, nervousness, fatigue and concentration problems. In most cases, the causes of those disorders had been cordless telephone base stations, mobile telephones and other electrical devices. Dr Oberfeld displayed a graph showing the increasing prevalence of this electrosensitivity. If the curve continued on the same line, half the population would be affected by 2017, so it seemed necessary to take rapid countermeasures. But how could people protect themselves? A start could be made by burying high-voltage cables, which was feasible and simply required the necessary political will.

Dr Oberfeld then referred to what he considered a very important report: the Bioinitiative Report, drawn up in 2007 by fourteen experts, who had tried to establish the upper limits for high and low-frequency electromagnetic fields. The limit they had established for dwellings was 0.1µT.

Wave contamination naturally depended on the age of the subject and the duration of the exposure, for example the time spent using a mobile telephone. A slide showed the comparative effect on the brain of a child of five, a child of ten and an adult. At the age of five, a considerable amount of radiation was absorbed. A Swedish study had stressed the dangers of mobile phones for young people. Other studies had shown that mobile telephone use increased the risk of a tumour threefold over a period of 2,000 to 3,000 hours, which corresponded to about an hour a day over ten years. Given the number of mobile telephone subscribers, it could reasonably be assumed that the frequency of brain tumours would rise considerably. And it was certain that children were not being sufficiently protected.

Doctors in Vienna had distributed a booklet to warn the public. They recommended that the use of a mobile phone be reserved for emergencies, and that it should not be used in a car, bus or train, all of which were places where the metallic environment enhanced the contamination, which also affected all the passengers.

The widespread installation of mobile telephone antennas and the use of wireless internet and DECT base stations represented a worrying development. There was no longer any place that was not affected, including schools and hospitals. It was hard for an individual to know the level of radiation to which they were exposed, as that really depended on their exact location. The symptoms experienced by sensitive people – fatigue, depression, concentration problems – varied considerably according to their distance from the source of the radiation.

All the experts involved in the Bioinitiative Report agreed that the current threshold limits were obsolete and that more draconian measures should be taken. As a precaution, they recommended not exceeding 0.1µW/cm2 – or 0.614 volts per metre – outdoor cumulative RF exposure. Liechtenstein had passed legislation on the subject requiring a threshold limit of 0.6 volts per metre to be observed by 2012.

Dr Oberfeld concluded by offering his own recommendations: at both European and national levels, advisory councils should be set up comprising scientists, environmental medicine specialists, epidemiologists, specialists in the biology of buildings, representatives of civil society, etc. More research was needed and there needed to be more monitoring of these issues. Studies should be carried out and stress markers, such as cortisol or serotonin, should be monitored, as should oxidative stress markers. People should be informed and educated about the risks associated with electromagnetic fields. Prevention plans were needed and, finally, threshold limits based on health considerations should be laid down.

Professor Frédéric de BLAY said that allergies had become a real public health problem. 30% of French people born after 1980 were clinically allergic, suffering from runny noses, asthma, food allergies, etc. That was in itself a significant number, but France was no more than average as far as prevalence was concerned: in the United Kingdom, 30% of young people aged 13-14 had asthma, and the averages were similar in Canada, the United States and the former member states of the British Empire. On the other hand, the prevalence was lower in northern and southern Europe (the Scandinavian countries, Portugal, Spain and Italy), where only 8 to 10% in the same age group had asthma, with the lowest prevalence of all recorded in Albania. The individuals concerned, who suffered from a chronic inflammation of the respiratory mucous membranes, reacted more to pollutants in their environment. The other at-risk population was the socially deprived, who were subjected to a considerable amount of mould, humidity and outdoor pollution.

According to the WHO, prevention could be considered from three points of view. Primary prevention involved preventing allergies in children who were at risk because both parents were allergic, for instance. Secondary prevention aimed to ensure that children who already had allergy antibodies did not develop the condition. Tertiary prevention was concerned with non-drug-based solutions, such as environmental methods. In environmental medicine, the starting point for the diagnosis was the patient’s clinical history. For example, if the patient was one of the many people in the north of France who had a runny nose in May or June, it would be necessary both to look for a biological marker – i.e., IgE antibodies – in their body and to measure their exposure to the allergen. If the three elements coincided, and the marker was found in their environment, an environmental diagnosis could be made. That also applied to diseases other than the allergy. In a case involving pneumopathy hypersensitivity, for instance, if the patient had antibodies against something to be found in their environment – they might breed pigeons, for example – that would indicate the presence of an environmental disease. It was accordingly very important to measure the allergen level, as that would enable an environmental approach to be taken to the disease. Having antibodies – cats or dust mites, for example – and being exposed to the allergen increased the risks of getting asthma, and that increase was proportional to the level of antibodies.

In the indoor environment, not only allergens but also chemical pollutants were to be found. In a study published the previous year on patients allergic to dust mites, Professor de Blay had shown that, while they reported an asthma attack after inhaling 73 nanograms of dust mites under normal conditions, the figure fell to 54 nanograms if they had previously inhaled formaldehyde. The presence of that substance thus resulted in their reacting to lower allergen doses. Apart from allergens and chemical pollutants, there were also types of mould to which a person might be allergic, but which also released microtoxins or volatile organic compounds. Sound data were now available demonstrating that mould fostered the emergence of respiratory diseases in children and adolescents.

No study had yet demonstrated the effectiveness of primary prevention. The suppression of the allergen in early life was a long way from blocking the disease: not only did skin tests continue to be positive, but the better the allergen was suppressed, the more children became allergic, a fact that had not yet been explained. The focus of the action taken was accordingly on tertiary prevention, i.e. in the case of individuals who had already reported having the disease. It consisted of sending, at the doctor’s request, medical advisers specialising in indoor environments to the patient’s home or place of work to examine the environment there. Professor de Blay had carried out a study on two groups of asthma patients allergic to dust mites, one consisting of people who had only been monitored by an allergologist and the other of people who had also called in an adviser. Measurement of exposure to the allergen – in mattresses, pillows or carpets for example – had produced a significantly different result for the two groups. When an adviser went to their home, patients followed their advice better. Doctors in particular, who did not know their patients’ environment, could only give general, and sometimes inappropriate, advice.

That work had been complemented by an American study (which had, incidentally, cost three million euros) involving 937 children with severe asthma in seven towns. Advisers had visited their homes at the beginning of the study, then after six, twelve, eighteen and twenty-four months, and tried to remove as many allergens as possible, aware that the most common among disadvantaged children in the United States were cockroaches, dust mites, rats and mice. The results had revealed a 19% reduction in the symptoms, which was by no means negligible, as the best drugs only achieved 30%. There had also been a 20% drop in the number of school days lost and a 13% drop in emergency hospital admissions. The children were therefore in better health, and their exposure to allergens had gone down significantly. The main finding of the study had been the importance of an overall reduction in allergenic exposure for the children’s condition. Some questions had been raised about the cost-effectiveness of that method, which some people considered too expensive, but its overall cost corresponded to the treatment of moderate to persistent asthma, and that did not include the indirect costs – for example, asthma was the primary cause of absenteeism among mothers.

Measuring exposure was very important. When a child was visited for the first time, if the first two elements of allergy diagnosis– the symptoms and the antibodies – coincided, an indoor environment adviser was sent to the patient’s home to test it. If the test was positive, the adviser provided advice on how to remove allergens. If the result was negative, i.e. there was no evidence of exposure, it was necessary to review the diagnosis.

In primary prevention, it was known that the fullest possible removal of allergens led to an improvement in the asthma, but not to a reduction in allergic diseases. There was no scientific work on secondary prevention, but three studies on tertiary prevention had shown that a proportional reduction in the symptoms was obtained when allergens were removed. The work of the indoor environment adviser had thus been scientifically validated – something never done for that of the medical profession or the members of the European Parliament! The profession was developing apace: there were more and more cases involving chemical pollution (formaldehyde, phthalates) or mould, and there was a rise in the number of conditions caused by the indoor environment, for example neurological disorders, so the scope of the advisers’ work would broaden. The profession had developed in France from 1991 onwards, and around forty such advisers were now operating. Three had been trained in Belgium, and one each in Switzerland and Portugal. The profession was set to become vitally necessary and would no doubt be high up on the list of new environment-related professions.

EXCHANGE OF VIEWS

Mr HUSS wondered if the room in which the conference was being held could cause health problems, and how a medical adviser could find out.

Dr Peter OHNSORGE, European Academy for Environmental Medicine, Germany, wondered about schools, where growing children spent a third of their time.

Professor de BLAY replied that schools were a key issue. In Strasbourg, very high levels of formaldehyde had been found in some classrooms, and the problem was all the more serious given the tendency to open windows less and less often; old ventilation systems could also be inefficient. A new awareness was now taking hold and should be reinforced. The problem of ventilation was, incidentally, common in Europe: because people wanted to save energy, homes were being turned into pressure cookers.

Replying to Mr Huss’s question, he said that he personally would not have laid fitted carpets and hoped that the ventilation systems met the required standards and were regularly checked. It would also be necessary to verify that there were no thermal bridges. However, he thought that much less healthy places than that particular room existed.

Mr BADEN said that an accurate reply to Mr Huss’s question could not be given without calling in a specialised service. Suspicions could, of course, be voiced about the carpeting and textile wall coverings, for example, but whether the materials used were of the traditional type or organic products, their health impact could not be assumed without carrying out analyses. Some fitted carpets were full of flame retardants, others were not. Similarly, he had noticed a GSM aerial on the roof, but no conclusions could be drawn from that without knowing whether the window-panes were metal-coated. As far as schools were concerned, it was necessary to realise that most solvents had narcotic effects and could therefore cause drowsiness and concentration difficulties, so schools should be furnished accordingly.

Dr OBERFELD drew attention to the importance of measuring electromagnetic fields. A low-voltage field certainly existed in the room, since there were cables running across the floor – people were sometimes subjected to a sizeable electromagnetic field by simply sitting at a desk connected by such cables. The current did not have to be strong, and a cable on the floor could be sufficient. A fault in a cable could create significant contamination. It would be necessary to know if any MPs had complained of symptoms.

Ms Gisela GROTE, Association of victims of environment-related health problems, Germany, regretted that conference participants had not been asked to refrain from using deodorants and perfumes.

Mr HUSS said he was aware of the problem, but it would have been difficult to ask everyone not to use such products.

Ms GROTE said that many other people must suffer from the same allergy.

Ms Martine OTT, Interior environement adviser, University Hospitals of Strasbourg, France, said that when the City of Strasbourg had wished to use materials and furnishings for its schools that gave off as few volatile organic compounds as possible, it had had been virtually unable to find any. The only suitable products had been so heavy that they could not be moved, so it had been necessary to make do with a compromise that involved ensuring that only low-toxicity cleaning products were used and that, crucially, a ventilation procedure was introduced.

Mr John Feargal DUFF, Irish Doctors’ Environmental Association (IDEA) had been surprised to hear Mr Baden say that certain pollutants, such as DDT, were still around despite the legislation on the subject. Many countries had joined the Stockholm Convention, but it was not being properly implemented. The United Nations Environment Programme and the Stockholm Convention secretariat, among others, should ensure much stricter monitoring.

Mr Christophe ROUSSELLE, French Agency for the Security of Environment and Work (AFSSET), France, assumed that Mr Baden had taken several different samples in dwellings to compare them according to seasonal factors or other parameters. What methods had he used? Also, he had compared benzene, toluene and lemonene, which were, to varying degrees, proven carcinogens, to LD50 insecticide toxicity rates, which were more an indication of acute poisoning than of a long-term impact. Admittedly, the immediate symptoms were significant, but if it was intended to measure health benefits, it was also necessary to consider the long term. Regulatory measures on benzene needed to be applied for public health reasons. He believed that such comparisons would be difficult.

Ms Aida INFANTE, Journalist of the Environmental magazine: Free network of victims of environment-related illnesses, Germany, introduced herself as a journalist who was herself unwell and had decided to champion the cause of others who were ill. She thanked Dr Oberfeld for having had the courage to speak about electromagnetic fields. She was electrosensitive herself after working on aircraft, where levels of exposure were high, for eleven years. She was surprised that Professor de Blay had only spoken about IgE antibodies. Allergologists should use other diagnosis methods, such as the lymphocyte transformation test. With regard to schools, the situation was so catastrophic that it was not surprising to observe attention deficit problems and hyperactivity. Ms Infante had been forced to move her son to another school: she herself had been unable to breathe in his previous one. It was, however, possible to prohibit deodorants, pesticides and telephone masts.

Dr Hedda SÜTZL-KLEIN, European Society for Integrative Health Sciences, Austria, said that she conducted environmental health studies in Austria, and her big problem was to know what a healthy indoor environment was. It was necessary to identify both stress factors and harmful components and study their effects, especially on children and other vulnerable people. It was also necessary to collate as much information as possible at European level and to carry out comprehensive studies of schools and public buildings, the first essential step being to agree on a diagnosis.

With regard to allergology diagnoses, Professor de BLAY replied that IgE antibodies were best for that purpose. The lymphoblastic transformation test, which was too sensitive and insufficiently specific, could lead to misdiagnosis of an allergy and was only used in very specific cases. As far as schools were concerned, an attempt was being made in France to set up a kind of pollution scale, i.e. to find the right markers. He believed that in order to take action it was necessary to begin by identifying the populations at risk – allergic people, children, the disadvantaged – and agreeing on a minimum number of markers. He believed that such a minimalist approach was pragmatic: a reduced list was easier to draw up, and all European countries would be able to use it.

Dr OBERFELD stressed that a great deal of knowledge about harmful factors had already been accumulated in Europe. That knowledge needed to be better turned to account and better communicated to the media, so that they could inform the public and raise the awareness of decision-makers. The information currently available was in fact of very poor quality, and the European institutions should get to grips with the problem.

Mr BADEN acknowledged that there were seasonal variations, especially regarding volatile products, but the specialised services aimed to find solutions on the ground to help people, rather than produce extremely precise scientific results. Some people present in the room needed to wear masks, while others did not, the reason being that individuals reacted differently, so there was no absolute standard. The scientific aspects should be left to the scientists themselves, and we should avoid getting too involved in those aspects. On the other hand, it would always be helpful to reduce the amounts of biocides and flame retardants.

Regarding the comparison between lemonene, benzene and toluene, the experiment had consisted of feeding the substance to a rat, not making it inhale the substance over a long period. The aim had been to demonstrate that the comparative toxicity of the substitute molecule and the original molecule was not very different. However, it would have been difficult to carry out long-term experiments on rats, as their natural lifespan was only eighteen months.

Mr Baden also thought it worthwhile to gather information and improve regulation, because insufficient consideration was given to pollutants, especially organic substances. However, he reminded the meeting that they would remain in the environment for years even if they were prohibited straightaway, so the problem would not be resolved. Finally, it was true that when the materials were known it was always possible to make changes at reasonable cost, but it would be necessary to extend the conference for an extra day to discuss that subject alone.

Mr HUSS said that information and communication were very important, especially vis-à-vis politicians and businesses. The REACH strategy, although incomplete, was at least a good beginning, and the approach should be intensified. However, it would not enable all the problems to be resolved, especially the issue of combinations of chemicals.

Mr ETHERINGTON thanked the authors of the three fascinating papers, which had provided much food for thought, and gave the floor to Mr Flynn.

SESSION 2

ENVIRONMENTALLY CAUSED MULTISYSTEMIC ILLNESSES

Chaired by Mr Paul Flynn,

Member of the Social, Health and Family Affairs Committee

of the Parliamentary Assembly of the Council of Europe

Speakers:

- Mme Kathrin OTTE, Leader of the Association of victims of environment-related health problems (MCS Selbsthilfegruppe Umweltgeschädigter ), Germany

- Dr Juliette DUFF, Health Educator (Ecohealth), Irish Doctors’ Environmental Association (IDEA), Lecturer at University College Cork on Ecosystems Approach to Human Health

- Dr Kurt MÜLLER, Chairman of the European Academy for Environmental Medicine, Germany

Mr FLYNN pointed out that the Council of Europe building had been used many years ago by members of the European Parliament, many of whom had complained about respiratory problems. The air-conditioning system had been responsible. Since then, no problem had been reported.

Ms OTTE said how happy she, as a sick person, was to speak at the conference. It was a really special moment for her personally, but she also represented thousands of sick people who could never make their voices heard. There were now more environmentally ill people in Germany than diabetics!

Ms Otte said that she had over a period of twenty years experienced some terrible times when it would have been out of the question for her to go to a conference. She was a survivor, a witness to the war being conducted to preserve so-called progress come what may, even if that meant society casting aside its weakest members by applying the philosophy of the neoliberal Friedrich von Hayek that it was not possible to save everyone. The priority given to the economy would bring about disaster. The man-made substances that were increasingly, and totally irresponsibly, being released into the environment were no doubt leading not only to a climate disaster, but also to a gradual implosion of organisms. The number of diseases caused by chemicals was rising everywhere, even in China. It was necessary to devote as much effort to that problem as to reducing greenhouse gases. Multisystemic diseases already accounted for 70% of health expenditure, and it was known that life expectancy was beginning to level out, and people had to expect to get numerous diseases after the age of sixty. Another form of progress was needed, a form compatible with the natural environment and health – a different model of civilisation from the present one, which was causing considerable damage and costing a great deal. All our seminal texts stressed the physical health of individuals and gave the government the responsibility for protecting human dignity. Those lofty principles seemed rather ironic to the individuals with environment-related diseases: their rights and physical integrity were not protected like those of other people. The state did not give them a guarantee of effective medical care. They were suffering despite their innocence, but society tolerated their illnesses.

Multiple chemical sensitivity had been known about since 1948 and had been medically established since the publication of a study in 1966. The WHO had declared them physiological disorders and included them in its International Classification of Diseases (ICD-10). Since then, between fifteen and twenty thousand specialised studies had been carried out. American disability legislation mentioned them, and several US states, as well as Canada, recognised them as diseases. Ms Otte was a living witness to their effects. While still an embryo, she had suffered mercury poisoning – due to her mother’s amalgam dental fillings – and her mother had worked in the hairdressing salon that she owned until giving birth. After her birth, her tuberculosis vaccine had contained mercury, and her smallpox vaccination three years later had triggered an epileptic fit. She had spent her childhood in her parents’ orchards, in a mist of pesticides – during the euphoric 1960s! – resulting in kidney problems and a rash all over her body, which, incidentally, had also been linked to detergents. At the age of thirteen, she had suffered from mercury poisoning and various disorders that had had an adverse effect on her schooling. After her school-leaving examination, she had begun a carpentry training course, where her cognitive functions had been adversely affected by solvents, paint strippers and varnishes. She had suffered from a paralysing weakness, a constant infection, a change in her skin, and cancer. She had had her nine lead-containing amalgam fillings removed, but mistakes by the dentist had resulted in other serious consequences – general poisoning, respiratory and coordination problems, pain, etc. She had then been exposed to cat flea treatments, available from every supermarket, which had caused aphasia, reading and writing difficulties and co-ordination disorder, until she had finally become bedridden.

Only when she was 34 had she started to be correctly treated. Her condition had improved when the heavy metals had been removed from her body, which had taken three years. However, an operation had taken her back to square one by causing chemical shock, with serious consequences. Primary biliary cirrhosis of the liver had been diagnosed. Ms Otte said that she was exceptional in that she had ended up being well cared for, while many cases had tragic outcomes. It should be pointed out that the amount of lead in her body had been 25 times higher than the acceptable level, and that her heavy metal antibodies had fallen in two years from 25,000 to 500. The appropriate therapy had enabled her reaction threshold to be lowered, but only at the age of 41 had she been able to enter working life – in a specially adapted office.

Multiple chemical sensitivity was classified by the WHO as an allergy, but it was neither an allergy nor a problem of classical toxicology. Even in low doses, the chemical triggers caused extremely diverse effects, but the symptoms were treated separately, whereas a holistic approach was required. However, the WHO had classified those diseases as physiological rather than psychiatric disorders. But there was no tailored care in Germany, where the specialised field of environmental medicine had even been abolished in 2004. International studies of the physical damage associated with pollutants were ignored in that country, or even refuted by the medical associations. Questionable epidemiological studies were directed more to psychiatry. Attempts were made to deny the extent of the threat and to reduce the figures for the number of sick people. Like the tobacco manufacturers’ lobbies which had demonstrated that smoking was not dangerous, the chemical industries had applied pressure: in 1996, a meeting made out to be a gathering of NGOs, but with an 80% attendance of employees of Bayer, BASF, Monsanto or Coca Cola, had included multiple chemical sensitivity in the idiopathic environmental illness (IEI) code – and thus among the psychological disorders. That had been blatant manipulation, but Italy’s occupational health doctors had adopted the same conclusions word for word in 2005. The WHO had condemned that use of the IEI concept.

The fact that doctors adopted the positions taken up by industry and that there was no neutral scientific position led to significant consequences: multiple chemical sensitivity, chronic fatigue syndrome, fibromyalgia or toxic encephalopathies were not properly classified. Doctors did not genuinely listen to their patients and lumped them together with people suffering from psychiatric disorders – in short, patients were not treated as they should be. For example, there were no appropriate facilities where they could be housed. A few days ago, Ms Otte had tried to get a person suffering from multiple chemical sensitivity and electrosmog urgently admitted to hospital in Hamburg. She had received four refusals before a doctor had replied that there were no suitable facilities available. When she had protested that the sick were being allowed to die, the response had been a smile and the reply that a little electrosmog had never killed anyone. That was a flagrant violation of the Hippocratic Oath. Those sick people were pariahs. Doctors refused to treat them and issued false information that resulted in the health insurance funds refusing to pay for their treatment. Their lives were a misery, their rights were denied, and no level of occupational incapacity was recognised in their case – it was even difficult to get asbestosis classified as an occupational disease. That was why they ended up allowing themselves to be classified as psychiatric patients, since that was their only chance of obtaining care.

It was surprising that conduct guided by the self-interest of a few individuals did not entail criminal penalties. When testifying before the social insurance tribunals, the experts were invariably on the side of the professional associations and with one voice denied that there could be any cause linked to toxic substances. Or sometimes sensitive patients were forced to undergo tests with tragic consequences. Were the European institutions going to help the sick? Most of them did not have the same chance that Ms Otte had had to obtain care. With an allowance of 351 euros a month, how could they not only obtain care, but also pay for the decontamination of their home, buy expensive organic food and travel hundreds of kilometres to visit a medical specialist? Environmentally ill people were calling for the WHO criteria to be applied, for irrefutable scientific knowledge to be taken into consideration, and for the practice of considering them to be psychiatric patients to cease. They had to be protected from the lobbies, and the health insurance funds should pay for their treatment. Grants should be made available for decontaminating buildings and constructing hospitals tailored to their needs. All future doctors should be given training in environmental medicine, and specialised hospital departments should be set up. There was also a need to develop the REACH principles, prohibit amalgam fillings and require the contents of all products, even imported ones, to be declared. The burden of proof should be reversed: it should be up to manufacturers to prove their products harmless. Finally, European civil society should play a part in the work of all the bodies concerned.

Mr FLYNN thanked Ms Otte for sharing her experience with participants and highlighting the problems involved.

Dr Cicolella had been due to speak on the subject but had unfortunately been unable to attend, for health reasons.

The floor was given to Dr Juliet Duff, a health educator, a member of the Irish Doctors’ Environmental Association, and a lecturer at the University of Cork, to speak about the relationship between the ecosystem and human health. Her contribution would focus on the need for a scientific paradigm shift.

Dr DUFF said that modern science, which had been born out of the scientific revolution, encompassed a number of hypotheses that could be described as Cartesian. It studied systems considered predictable, in which one plus one equalled two and two plus two equalled four; systems in which there was a logical progression and everything was the sum of its parts, which meant that if the system could be broken up into each of its constituent elements, it could be fully understood and could then be repaired, replaced or reproduced. That Cartesian paradigm had led to considerable technological advances.

However, questions had begun to be asked when it had been established that a living being did not behave like a simple mechanism, but formed a complex system. It was impossible to adopt the same approach to a complex system as to a mechanical system. A complex system had very different properties from those of a simple system. First of all, there were semi-permeable boundaries, such as the skin: when you went to the swimming-pool or bathed in the sea, you did not dissolve. The semi-permeable boundary represented by the skin retained certain elements, while allowing others to escape. Another property was homeostasis, i.e. the permanent effort to remain balanced. For example, the body always sought to maintain the same temperature, whether it was at the North Pole or in the tropics. It also sought to maintain its pH, its health, etc. Homeostasis was not a fixed status quo but, rather, something dynamic.

A complex system was capable of regeneration. In a complex system, one plus one was more than two, and the whole was always more than the sum of its parts. There were interdependent relationships not only between the elements of the system but also between the system and its environment. At a certain level, new properties appeared. Taking the example of the human voice, it could not be said that the sound was located at any given point in the body, not even the larynx. It was the result of the harmony of the entire body.

Combined with homeostasis, those new properties made a complex system like a human being unpredictable, so a new approach was necessary. There needed to be a paradigm shift. That needed to be done when questions arose to which the assumptions that had given rise to them did not enable a reply to be given.

The ecosystem was a complex system with such properties as a semi-permeable boundary, homeostasis, etc, and we might wonder whether the Earth would be capable of finding a balance again after even a minimal global temperature change. That change would affect every part of the system, and the whole of homeostasis would be put in jeopardy. Social systems were also complex systems. Finally, the human being was the very best example of a complex system, in physical as well as psychological and emotional terms.

Stress was an internal or external pressure that was more than a system could cope with. In that respect it was regarded as a precursor of change. Complex systems survived because they were resistant, but they died if a certain aggression threshold was exceeded. Faces could be changed by means of plastic surgery, and people could change their sex or lose arms or legs, but the body remained and continued to live. But anyone whose throat was cut would die.

Human beings possessed several defence mechanisms: the immune system, the endocrine system, the genes, a healthy lifestyle, knowledge, psychology, etc. For example, it was the endocrine system that enabled war pilots to react when faced by acute danger, but that type of demand should not occur too often. Human beings were subjected to chronic stress, which was exhausting for the body.

First of all, there was ecological stress: air, water, soil and food were polluted, biodiversity was on the decrease, and new diseases, such as avian flu, were emerging. Then there was socio-economic stress: violence, poverty, crime, exclusion, social inequalities, injustices, uncertain food supplies, etc. Was good health possible on a sick planet that was growing ever sicker? Our changing world required us to understand the complexity of systems and their synergies. A linear approach was no longer possible and a paradigm shift was required.

In particular, such a shift was needed in order to understand multisystemic diseases. Doctors were surprised when one person reacted in a certain way and another reacted differently. Standard medical tools were inappropriate for diagnosing and treating such complex diseases.

Dr Duff concluded by emphasising that human beings and the environment were complex systems. There was a dynamic interdependence between them. The cumulative effects of changes affecting our environment were a stress factor not only for it, but also for individuals. Our mechanisms for reacting to danger could not cope with the increase in stress.

Unless modern science and medicine changed their approach, they would remain incapable of responding to the complexity of the problems faced. Clearly, a paradigm shift really would take place.

Mr FLYNN thanked Dr Duff for her very interesting presentation and gave the floor to Dr Kurt Müller, President of the European Academy for Environmental Medicine, Germany.

Dr MÜLLER said he would be focusing on multiple chemical sensitivity, or MCS, which was said to be a modern disease, but was not really, as Theron Randolph had identified it fifty years ago. Randolph had been a unique figure in the American medical world. In the period just after the Second World War, his movement had not had many followers, as people had had other things on their minds and hardly paid any attention to those who pointed out that human beings were part of the ecosystem and that caution should be exercised. It had been Randolph who created the discipline of clinical ecology, but his school of thought had not spread very far in the United States. However, the fact remained that scientific progress had often been made thanks to people outside the mainstream who were unafraid of departing from dogma and custom.

As far as MCS was concerned, the expression first used had been “chemical hypersensitivity syndrome”, which was an appropriate term. Other expressions used over the years had been less satisfactory: “universal allergy”, “20th century disease”, “total allergy syndrome” or “environmental allergy” were all unsuitable, as MCS was not an allergic disorder. In Germany, the terms “idiopathic environmental disease” and “ecosyndrome” were used, which suggested that patients were cranky Greens.

Dr Müller based his definition of MCS on the criteria laid down in the 1992 Atlanta consensus: MCS was a chronic disease; the symptoms could be reproduced by renewing the patients’ exposure to chemicals; even low exposure levels – lower than the previous triggers or even lower than those tolerated hitherto – could cause the syndrome to manifest itself; the symptoms disappeared or eased when the causes were eliminated; the patient reacted to chemical substances that had no relation to one another; and, finally, different organs were affected.

If those criteria were accepted, it was clear that MCS was not an allergy, as it had no specificity. Nor was it a toxicological problem, since doses tolerated by some people were not tolerated by others, and doses tolerated in the past might suddenly become intolerable.

There was little documentation on the prevalence of the disease. According to a study carried out by Kreutzer in 1999, the proportion of chemically sensitive individuals was 16% in the United States and that of MCS sufferers 6.3%. In Germany, a study by Hausteiner dating from 2005 had revealed respective figures of 9% and 0.5%. The low level of the second figure should not be misinterpreted: the study’s author had only included cases medically diagnosed as MCS. The fact of the matter was that, in the south of Germany, where the study had been carried out, no hospitals made such a diagnosis, and only five practices had the medical competence to do so. In Japan, a study had recorded a percentage of 3.8% for MCS. In Sweden, a study had shown that 3.7% of young people were affected, which was rather worrying.

What were the basic mechanisms of MCS? In immunological terms, they were chronic inflammation in which gamma interferon and a molecule known as NF-kB played a role. A part was also played by interleukin and tumour necrosis factor alpha (TNF alpha), which had an impact on the brain and the cognitive faculties. Metabolically, they were characterised by the strong presence of free radicals, the effects of which were not compensated for. We all produced free radicals, even if we were in good health. That was quite natural, but a healthy body had the ability to compensate to some extent for their effects, whereas it seemed that the body could no longer cope in the case of environmental diseases. Another important feature was the role played by peroxynitrite.

The symptoms of MCS included damage to various membranes. Membranes played an important role in the human body as they protected us from outside influences and divided our bodies internally. Certain pollutants made holes in the membranes – which mainly consisted of fat – and then spread more or less everywhere. Other problems associated with MCS were mitochondropathies, neurotransmitter dysfunction, endocrine disorders, endothelial inflammation (inflammation inside blood vessels), and a reduction in the irrigation of the brain.

MCS was triggered either by chronic exposure to low doses of chemicals or brief exposure to high doses. It would be impossible to give the names of all the different products – organochlorine pesticides, herbicides, phthalates, etc – that could cause the disease, as the list would run to several pages. It was now a known fact that there were eight to ten chemical products in any vegetable, but no one knew the effect of such a combination on the human body. The heavy metals attacked the body’s enzymes and changed its metabolism. There were interactions between chemicals. Everything also depended, of course, on our genetic predispositions: our detoxification mechanisms did not all work in the same way. It was also necessary to mention among the triggers and promoters of the disease chronic inflammation linked to chronic infection, post-traumatic inflammation and post-operative effects. The anaesthetic often had more critical effects than the operation itself.

The patient could suffer from several diseases at the same time: MCS, chronic fatigue syndrome, fibromyalgia, post-traumatic disorders, etc. Some people had, on occasion, tried to pass MCS off as a mental illness, but a German study had shown that the symptom curve of patients with MCS did not match that of patients with mental disorders.

It should therefore be accepted that MCS was not an allergy, because there was no allergic specificity, and it should be agreed that it was not a toxicity issue either, since there was no relationship between dose and effect. Moreover, there was nothing to suggest that it was a psychosomatic or psychiatric disorder, a form of hysteria, a phobia or hypochondria.

Dr Müller then projected a series of images (see appendix) illustrating the biological mechanisms at work in MCS. In particular, they showed that gamma interferon made cells abnormally susceptible to intracellular pathogens. It was also possible to see that a flow of cytokine in the brain was a cause of disturbance. A chronic inflammation accompanied by the activation of NF-kB and gamma interferon – as occurred in MCS – led to the metabolisation of kynurenine and, at the same time, a reduction in serotonin. That explained why fatigue was one of the manifestations of the disease. Noradrenaline brought about an increase in free radicals and energy needs. It fostered inflammation and increased cell reactivity and, finally, activated the nervous system.

Researchers thought that many MCS patients had a genetic predisposition, with the result that even brief exposure created lasting stress coupled with a significant rise in free radicals, a loss of energy, inflammation and difficulties in activating the nervous system. Those patients did not offset stress hormones very well. It was clear that, when the metabolism was altered, the person concerned was more vulnerable to chemicals. However, not all MCS patients reacted to mixtures of chemicals in the same way.

The treatment of those patients would require much greater numbers of specialised practices and hospital units. It would also be necessary to create areas where people who no longer had anywhere safe to go to could be offered shelter. Diagnosis methods and therapeutic trials should be co-ordinated. Moreover, there needed to be a political and social awareness of the problem. MCS was very serious; in fact, there were few diseases as serious. Society and medicine had a duty towards those suffering from MCS, a duty to produce scientifically reliable work and provide proper medical care and social protection. Society should demonstrate an understanding for those patients, and it was beginning to do so.

Mr FLYNN thanked Dr Müller for his excellent presentation and said that the discussion would continue that afternoon.

The session was closed at 12.40 pm.

SESSION 2 – resumed debate

Chaired by Mr Jean Huss,

Rapporteur of the Committee on the Environment, Agriculture and

Local and Regional Affairs of the Council of Europe Parliamentary Assembly

The session was opened at 2.20 pm.

ECHANGE OF VIEWS

Mr HUSS asked if there were any questions from the floor for that morning’s speakers, Ms Otte, Dr Duff and Dr Müller.

Mr Bernard MARQUET, Deputy, Monaco, Member of the Committee on the Environment, Agriculture and Local and Regional Affairs of the PACE, said he had been very interested by everything that had been said that morning. He thanked the conference organisers. As a dental surgeon, he had been particularly interested by the comments on amalgam fillings, a subject on which a Swedish scientist, Mr Ulf Bengtsson, who had been invited to the conference but had been unable to come, had wanted to ask a question. He was therefore speaking on Mr Bengtsson’s behalf.

Mr Bengtsson had told him that an EU group led by Professor David Williams, from the Scientific Committee on Emerging and Newly Identified Health Risks, had recently issued a report on the safety of amalgam fillings. Not only did it conclude that the fillings were harmless, but it also recommended ending all research work on the subject. That was surprising, given that France’s Health Safety Agency recommended not using amalgam in the teeth of children and pregnant women.

Professor Williams, an engineer, was a well-known expert on biomaterials and was also editor-in-chief of Biomaterials, the leading scientific journal in that particular field. Like other journals of its type, its purpose was to inform its readers about the undesirable effects of products and the risks associated with their incorrect handling, as well as about the shortness of their life, their quality level or any other issues. However, Professor Williams was also a managing partner of Morgan & Masterson, a Brussels-based company that worked in close co-operation with manufacturers, to which it mainly provided crisis management advice, representation of their interests and expert testimony for lawsuits involving product liability and patents. The journal and the company shared the same registered office, and Professor Williams’ associate at Morgan & Masterson, Peggy O’Donnell, was also managing editor of Biomaterials.

It therefore seemed that the “independent” journal Biomaterials was mainly in the hands of Morgan & Masterson, a company that worked closely with the biomaterials industry. It also appeared that Professor Williams was extremely well placed to obtain the adoption of decisions favourable to the companies that made up his clientele, and to provide an ecological seal of approval. Moreover, the EU’s Directorate General for Health and Consumers was apparently about to give its support to Professor Williams’ proposal concerning amalgam fillings. How could the EU task someone linked so closely to industry with conducting investigations into the most controversial of dental materials?

It should be reiterated that dental amalgam – used for what are commonly called “fillings” – was a mixture of mercury and silver, i.e. two heavy metals. Speaking for both Mr Bengtsson and himself, Mr Marquet said that he would like to know if the experts present were familiar with those recent developments.

Mr HUSS did not give an opinion about that particular case, but said that he was convinced that there were scientists who had links with industry in certain agencies or on certain committees. He personally intended to propose that a report be written on the general problem of dental materials. It was his opinion that mercury fillings could cause health problems for many people.

Dr MÜLLER pointed out that there was a great amount of literature providing evidence of the danger posed by heavy metals in general, and therefore by amalgam. There was a book on the toxicology of metals which provided a very clear explanation occupying 400 pages, so there was no lack of information. The problem lay more in the composition of the decision-making bodies. If the European committee responsible for taking the relevant decision mainly consisted of people who backed the use of amalgam in their own economic interest, there would unfortunately be no move towards banning them. NGOs should have a greater say in Brussels.

It was, however, strange that there was a desire to limit the use of heavy metals everywhere except in dentistry. There was no longer any mercury in thermometers and barometers, but it could still be put into people’s mouths.

Mr Elef KARKALIS, Dentist, Germany, expressed great regret that experts were now very often involved in the process to which Ms Otte referred, a process that deprived people of their rights. Acting like “aggressive ignoramuses”, decision-makers had an increasing tendency to refer matters to technocrats and, Pontius Pilate-style, wash their hands of them. However, who was responsible for verifying the independence of the experts concerned?

Mr HUSS replied that, in a democracy, arrangements should be made for a second opinion to be obtained, and for citizens to be allowed to appoint experts themselves. In Denmark, citizens’ conferences were organised. He had also attended a similar kind of conference in France.

Dr MÜLLER pointed out that, if a task entrusted to certain persons was not carried out, it was ultimately the community that paid the price for their shirking of their responsibilities, since it was the social insurance budget that lost out at the end of the day, as he had pointed out to the German health insurance funds. It was better to prevent problems and have the courage to take the necessary decisions than simply to pay up once the damage was done.

Ms Anne CLUZEAU-HERBERICH, Association OXYGENE for Sustainable Development, France, a medical adviser on indoor environments who also gives general advice on environments, said that providing expert opinions was the core aspect of her profession. Like her colleagues, she was confronted with people’s anxieties and questions and needed to be able to rely on information based on irrefutable scientific evidence. It was essential for the experts to provide their information to environment professionals, but the question was how that could be done.

Dr MÜLLER said that it was sometimes impossible to provide scientific evidence to prove the statements made. On many subjects, there was still no certainty, but only opinions, so the problem was the “hierarchy” of opinions. Some institutes claimed that they were right, and, logically, all the others were wrong, so it was often the case that studies were censored and swept under the carpet. Another problem was lack of funds. The most critical researchers did not obtain any budgetary resources, while others obtained sponsorship of their studies from industry.

Mr HUSS quoted Mr Cicolella, a well-known toxicologist, who had spoken at a conference in Paris on scientific expertise and given the example of the artificial sweetener aspartame: “We have 155 scientific studies that show that aspartame can cause health problems, but there are another 130 saying that it poses no problem, so who is right? It is hard to know. All we can say is that the 155 critical studies were all financed by public bodies, whereas the 130 favourable studies were funded by private agencies, which were in turn financed by manufacturers”.

The situation was well known. How long had it taken for the whole of the scientific community to agree about the dangers of tobacco? It was a well-known fact that scientists had for 20 years been paid by the big companies concerned to deny the risks associated with tobacco addiction, and the same technique had been used in relation to asbestos danger.

There were powerful economic interests at work. That had been clear in the case of the REACH Regulation, the first version of which had offered a fairly good compromise between manufacturers’ interests and public health needs. Unfortunately, there had been a massive lobbying of MEPs by the chemical companies. Der Spiegel had, moreover, claimed that BASF had dictated its own amendments to Hartmut Nassauer, a CDU member of the European Parliament.

That was why it was imperative for expert opinions and second opinions to be obtained in a fully transparent manner on subjects of interest to society as a whole.

Ms OTTE said that the current situation of impotence had to be overcome. That was the aim of the networks of victims of environmental diseases that had been set up in Germany and were hoping to spread throughout Europe. They would be monitoring publications by doctors and experts and would take legal action where necessary. It was clear that considerable efforts would be required, so Ms Otte appealed to all who could do so to contribute their own experience as individuals or organisations. It was essential that everyone concerned joined forces and made their voices heard.

Some breakthroughs had already been achieved: two weeks earlier, the US Congress had finally recognised Gulf War Syndrome. Out of the 700,000 coalition soldiers deployed, 150,000 were very ill, suffering from MCS, chronic fatigue and multisystemic diseases. Congress had allocated 60 million dollars to research on the subject, to which it was to be hoped that European researchers would also turn their attention.

SESSION 3

ENVIRONMENTAL POLLUTION: EFFECTS ON ORGANISMS

Chaired by Mr Jean Huss,

Rapporteur of the Committee on the Environment, Agriculture

and Local and Regional Affairs of the Council of Europe Parliamentary Assembly

Speakers:

- Professor Charles SULTAN, Endocrinology and Pediatric Gynecology, Hormonology Development and Reproduction, Lapeyronie Hospital of Montpellier, France

- Dr S.c. Jean-Marc MICHELS, Laboratory of the Clinic Ste Thérèse, Luxembourg

- Professor Martin PALL, Biochemical and Basic Medical Sciences, Washington State University, USA

- Dr Eckart SCHNAKENBERG, Institute for pharmacogenetic and genetic disposition, Germany

Mr HUSS asked the next speakers to come onto the platform, and gave the floor first to Professor Charles Sultan.

Professor SULTAN thanked Mr Huss for his invitation to what was a very interesting symposium. Environmental pollution now posed serious problems, and the situation had deteriorated significantly since the previous conference, in which he had participated two years previously. When a child was born, there were 250 chemicals in the cord blood, and the meconium contained dozens of trace chemicals. How would it be possible to reduce that contamination and prevent pollutants in the environment from making it worse?

For ten years or so, a body of evidence had led to the conclusion that there was a link between environmental pollution and endocrine diseases in children. Firstly, all wildlife, from fish, quail and polar bears to hyenas, showed signs of demasculinisation, those affected having a pesticide concentration in their fatty tissue five to ten times higher than the norm. The second piece of evidence was a study of the effects of diethylstilbestrol (DES), which had been prescribed to pregnant women a few years earlier and which had a structure and action similar to those of many pesticides. When administered during the foetal stage, DES had caused genital malformations and, in particular, led to a significant prevalence of vaginal cancer in girls when they reached the age of thirteen or fourteen. There were thus both immediate and medium-term effects. DES had accordingly introduced a new concept into medicine, namely the foetal origin of an adult disorder. The third piece of evidence was the increase in genital malformations in boys – the prevalence of hypospadias, for example, had doubled in thirty years. The fourth had come from an animal experiment in which pesticides had been administered to a gestating monkey and caused genital malformations in the male to which she gave birth. At the same time, cellular models had shown that a very large number of chemicals showed oestrogen-mimicking or anti-androgenic activity. Those four pieces of evidence had resulted in the emergence of the concept of endocrine disrupters, causes of disorders in both children and adults.

Endocrine disrupters were everywhere: in air, water, soil and foodstuffs. They were capable of altering the endocrine balance and, in particular, modifying DNA. Those environmental pollutants were found in chemicals, pesticides and herbicides, as well as in the home (phthalates, bisphenols) and in medication residues (especially oestrogens). Domestic pollution was at least as worrying as outdoor pollution, and could be caused just as much by carpets or curtains full of flame retardants as by toys (especially soft toys) or detergents.

That pollution caused significant health problems for several reasons. Firstly, the majority of those products were stored in the fatty tissues, from which they were released by an unknown process. Secondly, the foetus or, indeed, the newborn baby, did not have a mature detoxification system. And there were extremely large numbers of such products, which could have an additive effect, so the problem of mixtures should be looked at. Thirdly, the products had their own metabolism: for example, the anti-androgenic effect of certain pesticides was ten times greater in human beings. Finally, in addition to their immediate effects, those products affected the genome in the medium and longer term.

There were various methods of assessing pesticides. Highly reliable cellular models had been developed in Montpellier and had shown that a very large number of pesticides had oestrogen-mimicking effects (they illegitimately activated the oestrogen receptor) or anti-androgenic effects. Bisphenols, which were to be found in baby’s bottles and in tins of food, for example, combined the two, and the impact they might have could well be imagined.

What most worried scientists was the impact of chemical pollutants on DNA. For the past two years, data had been accumulating which showed irrefutably that pesticides could, among other things, modulate the expression of key genes. Eighteen months ago, a study had shown that diethylstilbestrol (DES) was capable of regulating certain genes involved in the development of uterine structures, for example. Foetal contamination by DES modified the expression of genes during the foetal stage and could lead to vaginal cancer at puberty. A recent study had also shown that pesticides could modify thirteen genes involved in cell growth.

Another worrying development was that it had been observed for several years that male children of mothers who had taken DES had genital malformations, and their grandchildren also showed a prevalence of genital malformation four times higher than the norm. The hypothesis that DES had a transgenerational effect was therefore put forward. A team led by Skinner in the United States had shown that when pesticides were administered to female rats, genital malformations could be seen in newborn rats down to the fourth generation. It had suggested that an epigenetic mechanism might be responsible for that transgenerational effect of pesticides.

Since it was aware of not only the impact of chemical products on our genome, but also their transgenerational effects, Europe was duty-bound to initiate a debate on the issue; as Henri Bergson had said, it was necessary to “think like a man of action and act like a man of thought”. That was a huge challenge as, without going so far as to say that the human race was an endangered species, the health of our children and grandchildren was at stake. There was considerable evidence that at least four endocrine diseases in children were environment-related. Firstly, the malformation of boys’ genital organs. Secondly, it seemed increasingly certain that pesticides impeded foetal development. Next, there was consistent evidence that pesticides, heavy metals and chemical products were likely to impair psychomotor development. Finally, hyperoestrogenia caused by chemicals could be responsible for some girls’ early development of breasts and early puberty, which many epidemiologists considered to be factors in breast cancer. It could thus be contributing to the increase in the prevalence of that disease in young women.

Of fifty newborn boys that the professor’s department had examined in a five-year period for inadequate virilisation, some had indeed shown genetic abnormalities, but the majority had normal endocrine functions and differentiation genes. An environmental cause was thus possible. A quarter of those patients had been children of farmers, which meant they had been living in an at-risk environment. That was, of course, not an argument, but merely a basis for an assumption. At the same time, however, a European project tasked with assessing the prevalence of genital malformations had not only produced figures ten times higher than expected, but also shown that the risk of malformation was four to five times higher among farmers’ children than other children. Finally, it seemed that foetal contamination impaired the two components of the foetal testicle, by both disrupting sexual differentiation and causing genetic abnormalities that would later be manifested in reduced sperm production and in testicular cancer – another example of foetal origin of an adult disorder.

That endocrine disorder had been observed in all European countries. The reason why polar bears in Alaska were of so much concern to paediatricians was that they had been contaminated there by pesticides applied in the Midwest. Admittedly, not all fruits and vegetables contained poison, and not all children needed to start wearing a mask, but a golden mean had to be found. How could an unborn child be protected against thousands of chemical products? Jean Rostand had said that waiting to know enough to act in full knowledge of all the facts was to condemn oneself to inaction, and if we failed to act, we would be bequeathing to our children an Earth full of toxic products.

Mr ROUSSELLE, French Agency for the Security of Environment and Work (AFSSET), as a toxicologist, was aware that there was no easy answer, and asked if it was possible to list endocrine disrupters according to the extent of their effects on the body. The information being made available on the subject sometimes gave the impression that there were so many substances with that effect, and that they were so widespread, that the problem was insurmountable from the outset. Sometimes entire families of products – pesticides, flame retardants and others – were lumped together, even though not all the substances that were members of those families had the same impact. Could the risks be placed in order of severity, so that a start could be made on doing something about the most active substances?

Professor SULTAN thought that question entirely relevant and replied in the affirmative: there were cellular models – especially stably transfected lines – that could enable the short-term oestrogen-mimicking and anti-androgenic activity to be assessed. However, many substances – hormones, anti-hormones – also had medium and long-term effects that should also be assessed before a guarantee could be given that they were harmless. Here, “medium term” was to be understood as the period from the foetal stage to puberty, and “long term” as the period from the foetal stage to adulthood, since some cancers were now found to be developing after foetal contamination.

Dr MÜLLER thanked Professor Sultan for his frank and clear reply and said that the most dangerous products were now well known. They included the phthalates, of which Germany produced hundreds of thousands of tonnes that were subsequently discharged into the environment. That might be the cause of some disasters, especially from the endocrine point of view. He had been able to establish that, at critical stages of their development, some children had excessive levels of those hazardous substances in their bodies. Would it be possible to regain control one day?

Professor SULTAN described Dr Müller as even more alarmist than himself, and thanked him for his comments. France unfortunately used the highest rate of pesticides per hectare of farmland in Europe. If those pesticides were coupled with phthalates, bisphenols and PCBs, what was the end result going to be? He drew attention to the fact that PCBs were being released into the Rhône, which was then used for irrigating crops, with concentrations 10 to 100 times higher than those normally accepted. There really were reasons to be worried about the future of our children and grandchildren.

Dr OHNSORGE, European Academy for Environmental Medicine, Germany, pointed out that some of those hazardous substances were used as substitutes in amalgams, and that catheters were full of phthalates. It was often observed that used catheters were brown and brittle, indicating that the phthalates had migrated into patients’ bodies. Children and others were thus being infected even inside the operating theatre.

Professor SULTAN said that participants were all contributing their own share of alarming information.

Mr Dimosthenis SARGIANNIS, Research Action Leader, European Commission – Joint Research Centre, asked Professor Sultan whether he thought that it would be worth taking political action on the issues that he had discussed.

Professor SULTAN replied that political action was, of course, important. Citizens were becoming increasingly aware of environment-related health problems, and doctors were taking an ever greater interest in environmental health. If politicians played their role as an interface, and particularly if the European Commission and the European Parliament tackled the problem, exceptional progress would be made. The public were ready, as were doctors, who would be prepared to approve the creation of a new medical specialism: environmental medicine. It was now necessary for politicians to play their part, especially at European level. Professor Sultan was therefore very much relying on Mr Huss.

Ms INFANTE said that the manufacturers of masks also made pesticides, thus completing a full circle.

People who were ill certainly hoped that more would be done, as simply carrying out studies was not enough (the walls of entire buildings could be papered with all those that had already been written), and hoped that action would finally be taken, especially political action.

Mr HUSS thanked Professor Sultan and those who had asked questions and gave the floor to Dr Jean-Marc Michels, from the laboratory of the Sainte-Thérèse Clinic, Luxembourg.

Dr Michels thanked Mr Huss for inviting him to the conference to explain the function of an “organ” that everyone trusted, namely the immune system, which not only had the capacity to defend us, but could also destroy us. This was why different people reacted differently to the same antigen.

The immune system defended us by means of two main functions, one “innate”, the other “adaptive”. The former was represented in the white blood cells by the polynuclear neutrophils, monocytes or macrophages, for example, while the latter used mainly T lymphocytes and devised all the solutions necessary to ward off any attack. All living beings had a system to protect them from an environment which could be harmful or toxic. While a simple plant or perfume, for example, might be pleasant, it might also damage human health, and some individuals were more sensitive to it than others.

The immune system could only produce inflammatory reactions, most commonly to a bacterial or viral attack. Dr Michels wanted to focus on the more specialised reactions, which were divided into four types. The first was the reaction to common allergies like asthma or wasp stings, followed by that which occurred in the event of incompatible transfusions and, finally, those associated with circulating immune complexes or long-term immunity, the two types leading to autoimmune diseases. In order for an inflammatory reaction to occur, it was necessary for the cells to communicate with one another: our immune system was not a well-structured mass of cells like the heart or liver but was made up of circulating cells. The connection was made through cytokines, which were synthesised for particular needs and specific action. There were several types of cytokine, which were synthesised by different cells – T lymphocytes, fibroblasts and epithelial cells, for example – and their effects could be redundant.

When an immune response was required, our T lymphocytes swung into action. It was the TH cells that assumed direct responsibility for that response, which took place in several stages: the TH precursor cell differentiated into a TH0 and then, according to the specific features of the case, into a TH1 or TH2 cell, one being exclusive of the other. At the end of the immune response, some of those cells became memory cells, which enabled the immune system to respond very quickly to a second attack by the same antigen – for example, the reaction to a booster hepatitis B vaccine was significantly faster and more violent than the first. The existence of those memory cells was the basis of all the diseases that arose following chronic exposure to low doses of pollutants. The TH cells were typed, which meant they preferentially produced certain interleukins, such as gamma interferon in the case of the TH1. When a TH1-type response was required, gamma interferon inhibited the response of the TH2 cells. In the opposite case, interleukin 10 produced by the TH2 cells would inhibit the production of gamma interferons. Thus, depending on the response, different cell populations were involved.

Every immune response began with the presentation of an antigen to a T cell, which took place via a T cell receptor (TCR), a very large molecule divided into several sub-units, which were themselves made up of a constant and a variable domain. The entire secret of our antigen sensitivity lay in the magic of the variable domain. In point of fact, the immune system was basically stupid: it was only capable of attack, and it attacked everything, so it had to learn not to set about its host organism. The process was as follows: CD4 or CD8 cells were selected to produce a TCR, which would generate variable regions, with each cell accordingly producing its own variable region. There was thus a huge database of receptors of which the variable regions were likely or unlikely to react to the body’s own antigens. Those antigens, which resulted from our metabolism, were presented to the T cells by the dendritic cells, and the T cells that recognised them were eliminated so as only to leave cells that were essentially neutral vis-à-vis the body, but nonetheless possessed a wide range of receptors in order to be able to react to other situations. However, we only knew what we had learned: the immune system could therefore nonetheless attack one’s own antigens, first of all if they had not been presented to it, for example in the case of an injury to an organ, or through “imitation”, because they attacked foreign molecules that were surprisingly like our body’s own molecules. In those cases, the origin of the pathology would accordingly be external, which gave rise to many autoimmune diseases linked to our environment.

Twenty-four million Americans were affected by an autoimmune disease, compared with the 9 million cases of cancer and 16 million of coronary disease. The incidence of multiple sclerosis was increasing by 3% a year in the Netherlands and Sweden, and type 1 diabetes, which was also an autoimmune disease, had gone up fivefold in the past thirty or forty years – and was advancing among children in particular. That was not due to the failure of a few immune systems, it was an epidemic. Admittedly, there were people with genetic predispositions, but those could not explain everything. Other factors played a role, especially environmental factors to which we were being chronically exposed in weak concentrations. The list of the substances concerned was long, ranging from amalgam fillings to fireproofing materials and biocide molecules. To draw attention to these, Dr Michels said that he had developed a lymphocyte activation test (LAT), which was similar to the lymphoblastic transformation test (LTT), but employed flow cytometry technology instead of cell cultures. The results of the two tests were comparable.

In many cases of indoor pollution, the LAT test identified a sensitivity of the immune system to the same molecules as were found in the patient’s home by the ambulances vertes diagnostic service. The immune system also reacted to many substances derived from heavy metals in people who, for example, had amalgam fillings or wore jewellery. In an interesting clinical case, two LAT tests carried out on a patient before and after the removal of all amalgam fillings revealed initially sensitivity to mercury and other metals and a high production of gamma interferons, and latterly a lowering or disappearance of the sensitivity to all metals other than mercury. However, mercury was different from other substances: it almost invariably triggered sensitivity – only two or three of almost a thousand patients proved insensitive to it. Then there were nickel and gold. The laboratory had also found that, when the immune system initiated an inflammatory reaction, gamma interferon and interleukin 2 were well ahead of the others, and that, as far as cell kinetics was concerned, the NK cells reacted before the others. With regard to current assumptions, a German group had isolated a clone that was specifically sensitive to nickel and had shown how the TCR could trigger an immunological response without a cell presenting the antigen to it. Other studies had shown that gold, palladium, nickel and mercury were capable of crossing the cell membrane and activating the key that regulated certain genes. Other work was being carried out on the NK cell mechanism.

To sum up, the immune system, which was our first line of defence against pathogens, was highly intelligent, but fragile precisely because of its adaptability. As yet, little was known about how the immune system managed to keep us alive, so it was necessary to be committed on all fronts, including climatology, because the moving air masses brought new pollutants with them, and basic research, because we possessed a large amount of data but had few explanations. Our immune system was being subjected to pollutants and to new molecules that were being released into the environment at a fast rate. By continuously overloading it, we were putting it under considerable stress. The only truly terminal condition – and one, incidentally that was sexually transmissible – was life. Why make it even more dangerous through our activities?

Professor Martin PALL thanked the conference organisers for inviting him. He would try to explain how some very different chemical products – solvents and pesticides – could cause multiple chemical sensitivity and other multisystemic disorders.

Several research groups had already put forward the idea that chronic fatigue syndrome (CFS), fibromyalgia (FM), multiple chemical sensitivity (MCS) and post-traumatic stress disorder (PTSD) might have a common cause. People who suffered from them shared a number of symptoms, and it was generally found that a short-term stressor had induced a long-term – i.e. chronic – condition. How could that be explained?

It was generally impossible to make a full recovery from all those diseases, especially MCS, but improvements could be seen if patients were able to consult specialised doctors and avoid the products that triggered their symptoms.

Professor Pall said that much of what he was going to say could be found in his book, “Explaining ‘Unexplained Illnesses’”. For the purposes of the present conference, he would mainly speak about MCS and the diseases caused by the same chemicals.

Epidemiological studies showed that 3.5% of the population of the United States suffered from a serious form of MCS and that 15% were less badly affected. The figures for Canada, Germany, Sweden and Denmark were broadly the same. The situation clearly had economic consequences, although there were very few studies of the subject. Professor Pall himself estimated them at some 200 billion dollars a year in the United States alone, simply because affected individuals could not work, or were only able to do so for a limited period.

The chemical products that could cause MCS were organic solvents and their compounds, organophosphorus pesticides, organochlorine pesticides and pyrethroid pesticides. Mention could also be made of hydrogen sulphide, carbon monoxide and mercury, but his main focus here would be on solvents and pesticides. The mystery was why products that were so different from one another led to one and the same reaction in our bodies.

The answer to the mystery could be seen in the diagram projected by Professor Pall (see all the appended tables, diagrams and graphs) showing that the four groups of chemical products – organic solvents on the one hand and the three classes of pesticides on the other – took different paths, but all ultimately had the same effect of increasing the activity of the NMDA receptor.

Animal experiments had, moreover, shown that the toxicity of those four groups of products could be reduced by using an NMDA antagonist, which was a drug that blocked the reaction of the NMDA receptor. That proved not only that the increase in NMDA activity was brought about by those chemical agents, but also that the increase itself induced greater toxicity for the body.

The findings were the same with the other three chemicals mentioned: hydrogen sulphide, carbon monoxide and mercury also caused an increase in NMDA activity, and in that case too an NMDA antagonist could be used to reduce the toxic reaction to the three products concerned.

Professor Pall did not comment in detail on the next slide, which set out the six arguments suggesting a link between MCS and the activity of the NMDA receptor. He then referred to three studies: one published by Haley in 1999, one by McKeown-Eyssen dating from 2004, and a 2007 study by Professor Schnakenberg, who was present at the conference. They showed that the polyphormism of the genes that determined how those molecules were metabolised influenced the risk of MCS. Dr Müller had spoken that morning about another gene. At any rate, it was clear that some people metabolised those chemical products into even more toxic sub-products.

The activation of the NMDA receptors led to an increase in the presence in the body of nitrous oxide (NO) and its derivative peroxynitrite (ONOO-). The latter seemed to act by triggering a biochemical vicious circle within which several cycles – all well-known to biochemists – interacted. An analysis of all those cycles revealed one that might be called the NO/ONOO-cycle, which had the potential to produce all those chronic diseases from an initial stressor. In the acute phase of the disease, each element of the cycle would be reinforced by the cycle itself. The cycle could be read as “no, oh no!” which certainly reflected the feelings of the people affected by those chronic disorders.

There were at least 47 indications that the NO/ONOO- cycle led to multiple chemical sensitivity. The same mechanisms might also be in play in the case of disorders like Parkinson’s disease, amyotrophic lateral sclerosis, multiple sclerosis and autism. Pesticides and organic solvents might therefore play a very substantial role as triggers.

Professor Pall concluded by making three recommendations. Firstly, biological tests should be developed to verify the role of organic solvents in the process he had described. As those solvents were very numerous, it was necessary to be able to identify the most harmful products. With regard to MCS, it was necessary to identify one or more biomarkers which would enable diagnoses to be objectively confirmed and be very helpful for both researchers and patients. Finally, the Council of Europe Parliamentary Assembly should encourage the creation of a pan-European university degree (an MSc, or even a PhD) in environmental medicine. Well-trained clinicians who could really help their patients were needed.

Mr HUSS thanked Professor Pall and said that training in environmental medicine would be among the recommendations in his report to the Council’s 47 member governments.

Dr Eckart SCHNAKENBERG wished to provide an overview of detoxification from the point of view of genetic polymorphism. Several exogenous factors affected us every day, and it was the straw that broke the camel’s back when the metabolism reached its limits and could no longer cope with exogenous and endogenous pressures. There might also be a genetic reason for that, as in the case of lactose intolerance: if lactose was not split into small molecules it was not digested. In some other cases, calcium was not properly absorbed and that led to osteoporosis. People with lactose intolerance often absorbed fructose poorly, which fostered depression.

Genetic polymorphisms were nothing new. In fact, they were as old as the human race itself. The prevalence of lactose intolerance was as high as 15% in northern Europe. Many Europeans were genetically predisposed to it. Then there were the mitochondrial diseases: animal experiments had shown that polymorphism caused an increase in radicals in the cells. If its mitochondrion was prevented from functioning, a mouse died. Medication could also pose a problem: 25% of German drugs were metabolised by a hepatic enzyme that some people could not tolerate. They did not metabolise the drugs very well, resulting in a high risk of an undesirable side-effect. Some people of course metabolised them properly, but others did so far too quickly for them to have any therapeutic effect.

Then there were a number of other substances such as chlorpyrifos. Three enzymes were involved in its metabolism, and enzyme activity varied from case to case. If one of the enzymes was less active, the chlorpyrifos became more toxic. Only a proportion of the population faced that risk. Metabolism also came into play where the mycotoxins were concerned: genetic variants in the population could lead to differences, and patients exposed to mycotoxins could display much higher or lower frequencies, depending on the case. Mycotoxins were in fact very poorly metabolised. That particular polymorphism could mainly be found in patients who had MCS or fibromyalgia or who displayed a non-specific increase in γ-GT. The risks were much higher in people with that particular allogen.

Those single-nucleotide polymorphisms made up 0.1% of our genome, and it was they that distinguished us from each other. There were studies trying to link them to various diseases. Chronic multisystemic diseases had one characteristic: they involved environmental and behavioural factors and genetic sensitivity. Admittedly, it was likely that an individual had a certain combination of genetic polymorphisms, but he or she was also exposed to something that triggered the disease. A model produced in the early 1990s had shown that, on an innate basis, individuals slowly became susceptible, and then other triggers made them become sensitive, thus leading to the symptoms of the disease.

The question was whether there was a genetic background to those multisystemic disorders. In order to answer it, studies were being carried out on families with several members affected by the same disease. In twins, it was known, for example, that identical twins were 55% more likely than non-identical twins to be victims of chronic fatigue syndrome, so there was definitely a genetic background that explained chronic multisystemic diseases. Some families also displayed a certain frequency of multiple chemical sensitivity. A major study of 203 Caucasian-type women had revealed certain very frequent polymorphisms. Another study, published in 2007, had compared the symptoms of 521 patients with the different chemical products to which they were exposed. It had shown that the risk of diseases caused by the exposure was significant for all the chemicals concerned.

Lifestyle, diet and the environment were thus not the only factors, since genetic variants also played a part. Genetic causes could explain a metabolic disturbance and hypersensitivity. We reacted differently to the substances to which we were exposed. Susceptibility was individual. The truth of the matter was that we did not yet know what would be the result of exposures to low doses of chemical products, especially in combination, and that needed to be studied in the years to come.

Mr HUSS asked if there were any questions.

Ms INFANTE said that she would like an explanation for the uninitiated of whether the diseases concerned affected people who already had a genetic weakness, or whether their genes had been destroyed by the disease.

Dr SCHNAKENBERG replied that he had described some genetic polymorphisms that had not been due to exposure but were doubtless innate, i.e. congenital, variants. The innate variants explained why one person’s enzymes functioned differently from their neighbour’s, and why that person, but not their neighbour, fell ill even though both had been exposed.

That did not rule out the possibility of new genetic mutations taking place after exposure, but these were not passed on to descendants. These somatic mutations did not affect the germ cells. On the other hand, mutations that affected germ cells could be passed on to descendants.

Mr ROUSSELLE asked if it might be hoped that some of these polymorphisms or enzyme activities would one day be identified early enough to warn vulnerable people to avoid exposure.

Dr SCHNAKENBERG replied that such forward-looking analyses would definitely be expensive. What was certain was that some substances – such as certain psychotropic drugs – should not be prescribed without making sure in advance that the patient could metabolise them. That meant that a prior genetic examination would be necessary.

CLOSING SESSION

Chaired by Mr Jean Huss,

Rapporteur of the Committee on the Environment, Agriculture and

Local and Regional Affairs of the Council of Europe Parliamentary Assembly

Speaker:

Dr Peter OHNSORGE, European Academy for Environmental Medicine, Germany

Mr HUSS gave the floor to Dr Ohnsorge, of the European Academy for Environmental Medicine, Germany, to address the question: “What strategy can we implement in Europe?”

Dr OHNSORGE thanked Mr Huss for inviting him and began by stating that environmental medicine did not yet really exist as a discipline: there was beginning to be a realisation that there were more and more cases of multisystemic diseases, but they were not yet accepted as genuine illnesses. That was due both to their complexity and to the poor image of environmental medicine among clinicians and in the scientific world. Not only did prejudices exist, but also false information was put about to counter environmental medicine, and there were so many people claiming to be the sole voice of medical authority. In addition, European health systems focused more on musculoskeletal and therapeutic medicine, on the basis of an economic model that involved costs being covered by a health insurance fund and was subject to political influences.

What was environmental medicine? There were two opposite viewpoints: it was either a discipline that had as its objective the recognition, detection, diagnosis, treatment and prevention of the harmful effects of the interaction between human beings and their environment, or an assessment mechanism that needed to take account of individual susceptibility and complex influences. Environmental medicine was generally the preserve of the universities, but covered only the fields of occupational medicine, hygiene and toxicology. When knowledge increased, however, it had to be accepted that our learning and values needed to be changed, and new experiments needed to be carried out. Although substantiated scientific data proved that more and more multisystemic diseases were environment-related, the community was unaware of this, teachers failed to take it into account, and politicians hushed it up, although they never missed an opportunity to hold forth about protecting the environment. Why did that discrepancy exist? The answer was that doctors were not sufficiently informed: there were not only gaps in the research but it was also sometimes falsified to demonstrate that those diseases belonged to the field of psychiatric or psychosomatic disorders. The debate did not get off the ground because, on the one hand, powerful lobbies devoted large amounts of private money to contradicting the arguments of the public research institutions and, on the other hand, the diseases were extremely complex.

However, there was a high prevalence of environmental diseases. Between 15 and 30% of the population suffered from them, and 4 to 9% were affected by multiple chemical sensitivity, chronic fatigue syndrome or fibromyalgia. The prevalence of diabetes was also between 4 and 9%, but diabetes had a substantial lobby in the fields of insurance, medicine, pharmacy and politics. Five hundred years ago, Paracelsus had established the dose-toxicity relationship, which was one of the major paradigms of toxicology. However from the point of view of environmental medicine, the dose was not enough to define the toxic effect, for it had to be combined with such factors as the sum of all the doses, multitoxicity, the duration of the intoxication and individual sensitivity. Toxicologists were wrong to presuppose that individuals throughout the world would all react in one and the same way – we were not all equal where toxicity was concerned.

A toxic load, even a low dose, could cause serious and prolonged effects. Some people stored it and could not get it out of their system. Information about the effects came too late, when too many people had fallen ill, or even died. There were many examples of irreversible cases: asbestos, wood preservatives, PCP, DDT, etc. Those chemicals were known as the “dirty dozen”. However, formaldehyde was still very much present. No one would knowingly want to have amalgam fillings in their mouth, but no decision to eradicate them was to be expected yet. Then there were phthalates, the products that made plastic pliable. At the end of the day, risks were always assessed without regard to individual sensitivity, long-term effects or the cumulative impact of various toxic sources. Persons with a multisystemic disease had a lot to go through: they suffered from a large number of different illnesses, the interactions of which became worse over time, they lost their jobs, they were refused insurance and their social situation deteriorated until they were completely marginalised. As the population aged, chronic diseases were going to become ever longer and more serious, and we would not be able to cope, because we only treated the symptoms and not the causes. The costs would be so high that social insurance systems were likely to collapse. The only solution was to take account of the environment factor, inform the health professionals, use “green” hospitals and engage in primary prevention. Goethe had said that you only see what you know, so if ignorance was to be overcome it was necessary to start educating people.

In order to raise awareness of environmental diseases, there was an urgent need to develop the training of general practitioners, who were the first links in the chain and saw the emergence of new diseases in their very earliest stages. However, training was also required for architects, for example, to ensure that they knew how to build, equip and operate hospitals, and for nurses, who needed not only to be familiar with treatments, but also to realise that they should refrain from wearing perfume and to know how to carry out preventive activities. Doctors’ training should comprise two components: environment and health on the one hand, and environmental medicine on the other. The basic knowledge required was in the fields of toxicology, occupational medicine, hygiene, epidemiology and public health. Doctors should have both a theoretical and a practical knowledge of environmental diseases, without which the patient would not obtain the best treatment. It was therefore necessary to set up both training courses for students and in-service training for doctors, as well as to create a master’s degree for individuals intending to manage a clinic or work in public health. Knowledge was the key.

What strategy should be adopted in Europe? The first thing to do was to raise awareness of environmental medicine – which should be distinct from public health. It was necessary to launch environment action plans, provide education in schools and the media about the environment, and supply information at conferences. In addition, medical authorities could be involved in networks for recording symptoms: a single case never revealed very much, but if fifty doctors around the world recorded the appearance of an unknown substance, the response would be more rapid. It was at any rate absolutely essential to collect data from European doctors, in order to create a comprehensive epidemiological database. In Budapest, health professionals and policy-makers had agreed on a declaration calling for the development of new ways of processing knowledge and new training courses for all medical professionals, alongside the harmonisation of medical education. Four years had gone by, and nothing had been done. It was also essential to improve medical structures and create more beds. The only hospital in Germany with an environmental disease unit had just six beds. In Paris, four hospitals with six to eight beds each were needed to cater for the city’s 11 million residents. More emphasis needed to be placed on research, which should be carried out using a less linear approach that took account of the complexity of the subject and was financially independent. Scientists should be under no obligation to lobbies, and political advisers should be able to report on environmental diseases. Finally, a system of primary prevention should be set up, with risk assessment warnings and more broadly based risk management, and there should be more open communication in order to inform both those who were suffering and their doctors.

Mr HUSS thanked Dr Ohnsorge for his presentation and invited the participants in the round table on “Information and disinformation” to join him.

ROUND TABLE

Chaired by Mr Jean Huss,

Rapporteur of the Committee on the Environment, Agriculture and

Local and Regional Affairs of the Council of Europe Parliamentary Assembly

Speaker:

Mr Michal KRZYZANOWSKI, WHO Regional Office for Europe, European Centre for Environment and Health, Germany

With the participation of:

Dr Christian FARRAR-HOCKLEY, Health & Environment Alliance

Mr Marco GOETZ, Journalist, Radio-Television-Luxembourg (RTL)

Ms Aida INFANTE, Journalist (Umweltrundschau)

Ms Sylvia KOTTING-UHL, Member of Bundestag, Germany

Mr HUSS began with a general question: what did round table participants think of the presentations they had heard? Had it been their impression that they were hearing new information? Or exaggerations? Had the cause and effect relationships described been sufficiently convincing?

Mr Marco GOETZ said that he had thought about Descartes more than once during the conference, and about the virtues of doubt, which enabled knowledge to progress. Being neither a doctor nor a chemist, he had probably not understood all the processes described, but he now had far fewer doubts after listening to everyone and would, as a general journalist for RTL, pass on the message in the future and try to ensure that the victims of environmental diseases were better understood and treated with respect.

Mr HUSS said that the meeting would come back later to the role of the media, and gave the floor to Dr Michal Krzyzanowski, from the WHO.

Dr KRZYZANOWSKI (his graphs, diagrams, tables, etc, are appended) thanked Mr Huss for his invitation and said that he would like to set out the WHO’s position. First of all, being involved in public health himself, he saw no contradiction between the latter and environmental medicine. The objectives, namely the protection of health and the prevention and curing of diseases, were the same in both cases.

The first concern of everyone who dealt with the links between the environment and health was the exposure of people to different agents that might cause diseases. It was known that some people were genetically predisposed to react more than others to some agents, or even to suffer quite serious reactions. Even so, these people could not be isolated from the rest of the population. Assuming the accuracy of the findings of several studies that half the population had such genetic predispositions, there could be no segregation nor, indeed, would it be possible to organise a partitioning of the population.

Children were a vulnerable group. Figures showed that over half of European children were exposed to tobacco smoke in their family home, with all the consequences that such exposure might have for their respiratory system, including the development of cancer. The dangers of tobacco were known, but not enough was yet being done to prevent the risk.

Other risk factors were damp and mould in homes. Statistics showed that a sizeable proportion of European homes were damp and mould-affected. The people living in them had a 50% higher risk of suffering from respiratory disorders.

There was also an irrefutable correlation between lung cancer and the presence of radon in homes. It was known that part of the population was exposed to radon, and what needed to be done to eliminate it was also known, but unfortunately not enough was being done, as funds were insufficient and there was a lack of information campaigns.

The WHO also estimated that more than two million people a year died of exposure to carbon monoxide in their homes. Even in Western Europe, there were many deaths attributable to that form of indoor pollution.

The WHO therefore believed that there was an air quality problem in homes, and had, in 2000, published a document relating to the right to good quality air in the home. The problem was that of laying down quality criteria. The intention would be to eliminate the main pollutants known to be present at pathogenic levels in homes. The document thus emphasised those pollutants – such as radon, benzene and NO2 – while recognising that there were thousands of combinations of possible factors. For example, it was known that damp in homes fostered the action of certain chemicals, so a holistic approach needed to be adopted.

At the 2004 Budapest Conference on Environment and Health, one of the Health Ministers’ declared objectives had been Goal 3, which was to prevent and reduce respiratory disease caused by outdoor and indoor air pollution, and thereby to contribute to a reduction in the frequency of asthma in children.

Most people believed they were safe from pollution at home, but in reality home environments often exceeded the maximum levels laid down by the WHO for a whole range of pollutants. Indoor pollution was little known, but had definitely led to deaths. It was not nettle rash that we were talking about, but reduced life expectancy. And despite all the fine words, the figures for exposure to risk factors were not going down.

If not enough was being done to reduce the incidences of environmental diseases, this was because both resources and specialists were lacking. Where cardiovascular diseases were concerned, the knowledge was there, and so were the specialised staff and financial resources, but there were not enough specialists in environmental diseases. However, the fight against those diseases should also involve transport companies, energy companies, manufacturers, etc. The WHO had not yet managed to convince all the players that action needed to be taken to protect everyone’s health.

The WHO’s strategy was firstly to draw up guidelines on reducing exposure to agents with a proven negative impact on health, such as tobacco, the products of combustion, damp, mould and radon. Secondly, research should be encouraged into the other risk factors, in order to provide backing for the recommendations to be made to policy-makers. It was essential to gather enough evidence to support those recommendations, since the decisions to be taken were not easy. For example, what should be done about the foam-filled chairs in the room they were all sitting in? Throw them away and sit on the floor?

Mr HUSS asked Ms Sylvia Kotting-Uhl, a member of the Bundestag, for her thoughts on what had been said so far.

Ms KOTTING-UHL thanked Mr Huss for organising the meeting. Health was an area in which she was not a specialist, but she was endeavouring, as health spokeswoman for a small group in the Bundestag, to increase her knowledge. The questions asked were, of course, complex, and the replies to them were often awkward, as they called long-established habits into question and forced us to think again about our economy as a whole and our entire industrial sector, something that was in any case necessary in order to preserve the environment.

Ms Duff had set out in a very interesting way the idea that the environment and the human being were both complex systems, both of which were under attack in their complexity. However, nature could no doubt do without human beings, and could even be more prosperous without them. On the other hand, human beings could not do without nature, which they were nevertheless destroying. Time had almost run out for action to be taken, for example on global warming. There was a growing awareness, but this was still not enough, and we needed to get more actively involved.

Reference had been made several times to REACH. The first draft had been fine, but the final version had unfortunately been toned down. Deadlines had been extended, no one could complain effectively, and manufacturers could continue to produce in the same way as in the past. REACH had thus failed to achieve its objectives.

However, Ms Kotting-Uhl did not think it was necessary to fight one another just to reduce the threshold for one pollutant or another, since all living beings were in any case exposed to combinations of chemicals. Extricating themselves from the situation in which they found themselves would require drastic reductions in overall pollution levels. The first important thing to do would be to reverse the burden of proof, as had been done in the case of GMOs. Farmers who wished to use GMOs first had to prove that they were harmless, with the result that they had opted to give up using them instead. The reversal of the burden of proof would be a very valuable, indeed essential weapon.

Mr HUSS gave the floor to Dr Christian Farrar-Hockley, from the Health and Environment Alliance.

Dr FARRAR-HOCKLEY thanked Mr Huss for his invitation and said that he represented HEAL, the Health and Environment Alliance, which had 59 members, mainly from the European Union, spanning a broad spectrum from environmental movements to patients’ associations. The public health groups in Brussels had realised that the environmental aspect was becoming too wide a field to be managed properly, and that it was necessary to set up a section specialising in environmental health. Initially, this had been an informal coalition made up of ten large groups, such as Greenpeace and the WWF, but the movement had gradually grown. Many discussions were held on the subject of the EU’s Environment Action Programme, and efforts were being made to establish the EU’s priorities. The process was receiving political support from all sides, from left to right and including the Greens, but there was no point in recognition if it did not result in changes in the rules, and in that respect it was hard to obtain tangible results from parliaments. In the context of the action programme, HEAL represented the health community, since the Femmes européennes pour un avenir commun movement focused more on the environmental point of view.

In the area with which we were dealing, the WHO’s action should be welcomed. To be sure, the processes involved relied on the good will of the member states, but highlighting the best practices made it possible gradually to convince people, and that would ultimately be reflected in legislation. With regard to indoor air quality, the basic scientific concepts had been known for forty or fifty years, so who could be held responsible for the situation? The European Parliament had often discussed European obligations in that area and the application of the subsidiarity principle, but MEPs had not passed any legislation that would enable pubic health to be protected. At any rate, there was one piece of good news: even among the most conservative toxicologists the need for a paradigm shift had been accepted. The bad news was that, even if a lot of progress was being made in combating climate change, there was a refusal in Brussels to consider changing all dwellings within fifty years. However, that was what was needed, to deal with both climate change and the health issues involved. It would be necessary to mount a big clean-up operation, impose reasonable ventilation standards and, especially, reduce indoor emissions. Two days ago, the European Commission had agreed to allow some structural funds to be directed to the building industry in order to promote a common policy on energy efficiency. Unfortunately, the bandwagon was already rolling, and it would be hard to convince MPs of the need to take an overall approach to indoor air quality. It would accordingly be necessary to wait for the number of diseases to grow before any action was taken – unless all windows were opened, resulting in wastage of energy.

As for the question of dealing with chemical products, the Alliance had pulled no punches with regard to the REACH Regulation. Chemical substances were admittedly going to be examined, but how much time would it take for that to have an impact in the Construction Products Directive? Nor was it possible to settle for the WHO lists, as the fullest possible list should be drawn up. HEAL could not agree to the limitation of priority measures to just fifteen substances, when three hundred were posing problems that required urgent attention. Dr Farrar-Hockley appealed for new members to join the Alliance, whose aim was to make its voice heard wherever it might count.

Mr HUSS gave the floor to Ms Infante, who, he said, was a victim of environmental diseases and had decided to tell people about this subject, so she had become a specialised journalist and had also set up a website.

Ms INFANTE thanked those present for listening to her as both patient and journalist. She had once worked in the press office of a large airline and had attended a training course in communication, which was in a way her hobby. That was why she had, despite her illness, decided to take action through communication, whether it be via journalism, her website or translation.

People like herself, who were ill, did not have easy access to the media, whose private shareholders, simultaneously holders of shares in powerful industries or private health networks, had no desire to hear certain disturbing truths. Generally speaking, sick people had difficulty in making their voices heard among all the experts (with close ties to industry), who received large sums of money to produce reports. Incidentally, the reports were all alike, as their authors cut and pasted the same material. Patients’ and environmental associations could not afford to pay their experts very much or finance long-term research. Moreover, any statements made by patients were often discredited in advance: those individuals were regarded as mental patients, or half-wits talking about something that they knew nothing about.

There was so much corruption and so much profiteering at all levels – doctors, experts, politicians – that the truth could hardly make itself heard. Fortunately, the sick were coming out of isolation and joining forces in associations and networks. Their movement was growing larger, and they were now, moreover, starting to be a thorn in manufacturers’ flesh.

Six weeks ago, a television channel had wanted to film a piece about MCS. The journalists concerned had wanted to meet sick people and see what chemicals were involved. The channel had then been threatened with a boycott. When it had carried on regardless, its journalists had been subjected to intimidation and threatened with physical violence. In Freiburg, a doctor who had written a rather harsh article about amalgam fillings had been immediately dismissed.

Everyone should make an effort to denounce the scandals that they were aware of. In conclusion, Ms Infante expressed the hope that more and more news outlets would join patients in their fight to protect the health of all citizens.

Mr HUSS said he knew of many censored journalists, such as the very well-known editor of a major German newspaper who had wanted to publish an article on the damaging effects of mobile telephones. The newspaper’s financial department had intervened and, after a big argument in the editorial office, had managed to have the article considerably toned down.

That was one more reason to welcome the presence at the conference of the French television channel Antenne 2. Its journalists had been filming, and a report was to be broadcast on 5 January. RTL was also present in the person of Mr Goetz. Could he perhaps tell the participants if he had noticed any pressure being brought to bear? At any rate, his channel had put out a very interesting report on Monsanto. There was perhaps less pressure in Luxembourg than elsewhere.

Mr GOETZ said that he was intending to broadcast an eight to ten-minute report on the subject of the conference during prime time the following Tuesday. Perhaps he would receive threatening letters beforehand, but under normal circumstances the report would be broadcast, and he had already conducted a number of interviews that day. He did not know whether there were fewer pressures in Luxembourg than elsewhere, but at any rate he did not think RTL’s financial department would intervene to prevent anything.

As a professional sceptic, he always tried to put things in perspective and not get carried away in the heat of the moment, but the subject of environmental diseases certainly aroused a lot of passion.

In his opinion, the problem lay less in resistance to possible pressure than in the difficulty of finding qualified specialists, particularly in a small country like Luxembourg. As a journalist, he was pleased to have made the acquaintance at the conference of so many resource persons to whom he would be able to turn in the coming months for his articles or reports. And let there be no doubt in the minds of those present, he would not let himself be intimidated.

Mr HUSS confirmed that Mr Goetz was not someone who would let himself be intimidated.

Ms KOTTING-UHL added that communication was very much controlled by lobbies and interest groups, which obviously tried to play down or even deny the risks. That was particularly true of the nuclear lobby. On the other hand, the press was unfortunately more likely to run sensational articles, which were easier to understand and would result in higher sales, than to investigate and analyse complex subjects. Having said that, Ms Kotting-Uhl thought that the German press was nonetheless essentially free and objective, as were German MPs, too. The meeting should not think MPs were in the pockets of lobbies and corrupt individuals. It was true that lobbies were influential, but the media were not so easily influenced. Journalists tried to base their articles on reliable sources, and everyone could access a press that did not take orders from anyone.

Mr HUSS opened the general discussion.

Ms Ingrid SHERMANN, « Safer World », International Independent Internet Information Network, Germany, said that she had ten demands to present to policy-makers. Firstly, they should keep an open mind to all the knowledge available on the effects of toxic products, with the aim of drawing up appropriate legislation. Political action should be based on the knowledge of experts who were independent of industry. And the political world should understand that the protection of the environment went hand in hand with the protection of human beings. That was one of its key tasks. Political action should be cross-cutting, and the various ministries should work together to ensure that expertise in every field was taken into account. More funds needed to be invested in combating the use of toxic products and developing independent research. High-profile systematic toxic product databases should be set up. Moreover, a threshold-based policy was no longer enough: a risk assessment should be based on an analysis of the products, not just individually, but also in combination, and the law should be adapted to that new requirement. Policy-makers should promote transparency and inform their fellow citizens about known risks to health. They should not play down the health hazards from certain products or suggest that diseases were psychiatric. Political guidelines were needed to prevent any reduction in the level of knowledge of diseases caused by toxic products. Finally, the political world should seek the broadest possible consensus and urge the medical world and society as a whole to shift away from medicine that focused on treatment to one that emphasised prevention, especially primary prevention.

Mr HUSS said that those lines of thought would feature in the conclusions of his report.

Mr SARGIANNIS pointed out that the European Commission’s Joint Research Centre had been working for some years on combinations of products, and he welcomed the proposals that had just been made. He wondered about the position of the WHO, which was working on guidelines relating to such mixtures.

Dr KRZYZANOWSKI said that the WHO was aware of the impact of combinations of chemicals on health. Even if we did not know all the 4,000 substances contained in cigarette smoke, our response should be to eliminate cigarette smoke itself, and not specific components thereof. Similarly, as far as indoor combustion sources were concerned, the WHO was trying to tackle the problem at its root, rather than eliminate the chemicals involved in combustion one by one. The WHO’s action was based on research and on evidence. Without evidence, it was impossible to issue guidelines, but that did not mean that no one was doing anything: governments and public alike were invited to apply the precautionary principle.

Ms INFANTE said that Dr Krzyzanowski had mentioned genetics, cigarettes, radon and mould, but not pesticides. She had worked in aircraft and had learned in 1990 that 3,000 members of airline staff had already been poisoned, but the WHO had commented that it was more dangerous to be stung by an insect than to use pesticides. And it was virtually impossible to obtain the studies carried out in 2006 showing how dangerous pesticides were. The WHO was expected to do better than that.

Dr KRZYZANOWSKI replied that pesticides were poisons, and all contact with them should be avoided. People were free to use them against insects, but the WHO had clearly established the principle that it was better to avoid any contact with them. The WHO issued recommendations, but it was not its job to issue regulations or enact legislation.

Ms KOTTING-UHL came back to the disappointing nature of the REACH Regulation. The initial intention had been to force the chemical industry to withdraw the most dangerous products from the market and replace them with others that were not toxic. However, the obligation to replace them had been withdrawn at the same time as the deadlines for discontinuing the use of dangerous products, which meant that those products would remain on the market and nothing would change. The European Parliament should have a rethink on the subject. If the developed countries did not make more progress on those issues, they would find it even harder to call on the developing countries to reduce their CO2 emissions.

Mr Jacques REIS, Chairman of the Club on Neurology and Environment, France, who said he was speaking both as a doctor and as the president of the French environmental neurology club, noted that doctors’ interest in environmental issues was very relative, but it had to be said that they had a heavy workload. Public interest varied. What did the journalists who were present think? He personally was in the habit of asking his patients who were smokers whether they knew how to read, as there were clear warnings on cigarette packets stating that “Smoking seriously harms you and others around you” and “Smoking kills”.

Dr MÜLLER said that Ms Kotting-Uhl was right to think that REACH had been a missed opportunity. That had been to a large extent the fault of Germany, which had rejected the excellent Swedish proposal. The German Government at the time had been a “Red-Green” coalition, but had nonetheless given in to pressure from industry and from the 800 or so lobbyists present during the discussions. Dr Müller addressed a critical question to Ms Kotting-Uhl: why had the Greens done nothing? Why had the Red-Green government failed to react?

Under the current REACH Regulation, all research would be funded by manufacturers, so it would be influenced by them, and nothing would come out of it.

Ms MORAS, Secretary, Committee on Sustainable Development, Congress, speaking on behalf of the Congress of Local and Regional Authorities of the Council of Europe, and, in particular, of its rapporteur Mr Rondelli, who had been due to attend but had been unable to travel, said that the Congress was continuing its work, which complemented that of the Council of Europe Parliamentary Assembly. This would result in recommendations concerning buildings and living environments, and would emphasise the role that local and regional authorities could play in that area, both as builders and providers of subsidies and in raising public awareness.

Mr GOETZ said that there was an acute desire for information, and the population wanted to have information that was reliable.

Ms KOTTING-UHL acknowledged that there were many reasons to vilify the Social Democrat-Green coalition government, but she did not feel responsible for the actions of the former Environment Minister. At the time of the “climate package”, the conflicting interests had been the same as they were now: in such cases, companies like Bayer and BASF swung into action and always used the same threats: if standards were adopted that were too strict, there would be an impact on German jobs. However, all the electorate knew which of the parties were beholden to business, and which defended citizens. In a coalition government, the minority partner could rarely impose its own point of view. On the other hand, the public could be informed. Unfortunately, neither the numerous articles on the harmful effects of tobacco nor the warning “Smoking kills” had been enough to cut the numbers of smokers. In such cases, there needed to be a full public debate, initiated by politicians and taken up by the media, to explain that smoking was not “the thing to do”, but was completely stupid. It had unfortunately been necessary to wait for overwhelming proof of the effects of tobacco, not only on smokers’ health, but also on the health of their family and friends. That proved that the lead could only be given by the most senior policy-makers.

Ms INFANTE said that, once a person had been clearly told that some perfumes contained neurotoxic chemicals, they stopped using them. The main thing was to be clear and convincing. A new group of professionals should be created at the patient-doctor interface. Doctors did not have time for such matters when dealing with their patients.

Mr HUSS said that he had been impressed by the excellent presentations to which he had listened during a conference of such high calibre. It was true that there had been some disagreements, but that seemed perfectly normal. The report to be addressed to all 47 Council of Europe member states was not yet quite complete, so there was still time for anyone who had any suggestions to give these to the rapporteur. Diseases due to multiple exposure were much less well-known than the problem of climate change – about which too little was being done, incidentally – although they were at least as important. They presented a challenge which directly affected our children. If prevention was not improved, there was reason to be pessimistic, not only about the future of social security schemes, but also about the future of humankind.

The session was closed at 6 pm.

APPENDIX I

Programme

09.20 – 09.40 OPENING SESSION

Welcome speech by Mr Bill ETHERINGTON, Member of the Committee on the Environment, Agriculture and Local and Regional Affairs of the Parliamentary Assembly of the Council of Europe (PACE)

Introduction by Mr Jean HUSS, Rapporteur of the Committee on the Environment, Agriculture and Local and Regional Affairs of the PACE

“From awareness to prevention”

09.40 – 11.05 SESSION 1:

INDOOR POLLUTION

Chair: Mr Bill ETHERINGTON, Member of the Committee on the Environment, Agriculture and Local and Regional Affairs of the PACE

Speakers: Mr Ralph BADEN, Ministry of Health of Luxembourg

Experiences and information from green ambulances in Luxembourg

Dr Gerd OBERFELD, Sanitary Land Directorate for Environmental Medicine, Austria,

Physical burden: EMF, other radiation, noise

Professor Frédéric de BLAY, Responsible for the training programme on indoor pollution, University Hospitals of Strasbourg, France

Experiences of medical advisors on indoor environment

Exchange of views

11.05 – 12.40 SESSION 2:

ENVIRONMENTALLY CAUSED MULTI SYSTEMIC ILLNESSES

Chair: Mr Paul FLYNN, Vice-Chairman of the Sub-Committee on health, Social, Health and Family Affairs Committee of the PACE

Speakers: Mrs Kathrin OTTE, Leader of the Association of victims of environment-related health problems (MCS Selbsthilfegruppe Umweltgeschädigter ), Germany

Dr Juliet DUFF, Health Educator (Ecohealth), Irish Doctors’ Environmental Association (IDEA), Lecturer at University College Cork on Ecosystems Approach to Human Health

Scientific paradigm change: health effects of chronic long-term, low dose toxic burdening

Dr Kurt E. MÜLLER, Chairman of the European Academy for Environmental Medicine, Germany

Multiple Chemical Sensitivity

12.40 – 14.20 Lunch break

14.20 – 14.40 SESSION 2 – resumed debate

Chair: Mr Jean HUSS, Rapporteur of the Committee on the Environment, Agriculture and Local and Regional Affairs of the PACE

Exchange of views

14.40 – 16.10 SESSION 3:

ENVIRONMENTAL POLLUTION: EFFECTS ON ORGANISMS

Chair: Mr Jean HUSS, Rapporteur of the Committee on the Environment, Agriculture and Local and Regional Affairs of the PACE

Speakers: Professor Charles SULTAN, Endocrinology and Pediatric Gynecology, Hormonology Development and Reproduction, Lapeyronie Hospital of Montpellier, France

Endocrine System: fertility, paranatal disturbances

Dr S.c. Jean-Marc MICHELS, Laboratory of the Clinic Ste Thérèse, Luxembourg

Immune system dysfunction, allergy, pseudo allergy, autoimmunity

Professor Martin PALL, Biochemical and Basic Medical Sciences, Washington State University, USA

Central nervous system: parkinsonism, depression, vertigo, tinnitus explained by biochemical effects

Dr Eckart SCHNAKENBERG, Institute for pharmacogenetic and genetic disposition, Germany

Enzyme system: detoxification, genetical polymorphism

Exchange of views

16.15 – 17.55 CLOSING SESSION

Chair: Mr Jean HUSS, Rapporteur of the Committee on the Environment, Agriculture and Local and Regional Affairs of the PACE

Speaker: Dr Peter OHNSORGE, European Academy for Environmental Medicine, Germany

What strategy can we implement in Europe?

ROUND TABLE

Speaker: Dr Michal KRZYZANOWSKI, WHO Regional Office for Europe, European Centre for Environment and Health

With the participation of:

Dr Christian FARRAR-HOCKLEY, Health & Environment Alliance

Mr Marco GOETZ, Journalist, Radio-Television-Luxembourg (RTL)

Ms Aida INFANTE, Journalist (Umweltrundschau)

Ms Sylvia KOTTING-UHL, Member of Bundestag

17.55 Conclusions by Mr Jean HUSS, Rapporteur of the Committee on the Environment, Agriculture and Local and Regional Affairs

18.00 Close of the conference

APPENDIX II

Final list of participants

COUNCIL OF EUROPE / CONSEIL DE L’EUROPE

1. Parliamentary Assembly / Assemblée Parlementaire

M.	SAWICKI Wojciech	Director General / Directeur général
Mr	FLYNN Paul	Vice-Chair of the Sub-Committee on Health, Committee on Social, Health and Family Affairs / Vice-président de la Sous-commission de la santé, Commission des questions sociales, de la santé et de la famille

Members of the Committee on the Environment, Agriculture and Local and Regional Affairs

Membres de la Commission de l’environnement, de l’agriculture et des questions territoriales

	NAME Surname / *NOM Prénom*	Title / Titre	Country / Pays
Mr	ETHERINGTON Bill	MP / Député	United Kingdom / Royaume-Uni
Mr	EVANS Nigel	MP / Député	United Kingdom / Royaume-Uni
M.	HUSS Jean	Deputy / Député	Luxembourg
M.	IVANOV Ivan	Deputy / Député	Bulgaria / Bulgarie
M.	MARQUET Bernard	Deputy / Député	Monaco
M.	MÜRI Felix	Deputy / Député	Switzerland / Suisse
M.	POPESCU Ivan	Deputy / Député	Ukraine
Mr	VIS Rudi	MP / Député	United Kingdom / Royaume-Uni

2. Congress of Local and Regional Authorities / Congrès des pouvoirs locaux et régionaux

Mme

MORAS Marité

Secretary, Committee on Sustainable Development / Secrétaire, Commission du développement durable

OTHER PARTICIPANTS / AUTRES PARTICIPANTS

	NAME Surname / *NOM Prénom*	Title, Organisation / Titre, Organisation
M.	BADEN Ralph	Ministry of Health, Luxembourg / Ministère de la santé, Luxembourg
Mme	BADEN-CIMA Chantal	AKUT: Environmental Health & Indoor Air Quality Assocation, Luxembourg / AKUT, Association pour la Santé environnementale et la qualité de l’air intérieur, Luxembourg
Prof.	de BLAY Frederic	Professor, University Hospitals of Strasbourg, France / Professeur, Hôpitaux universitaires de Strasbourg, France
Mr	BREIER Heng	AKUT: Environmental Health & Indoor Air Quality Assocation, Luxembourg / AKUT, Association pour la Santé environnementale et la qualité de l’air intérieur, Luxembourg
Mme	CLAIR Pascaline	Association for the Surveillance and Study of Atmospheric Pollution in Alsace (ASPA), France / Association pour la surveillance et l’étude de la pollution atmosphérique en Alsace (ASPA), France
Mme	CLUZEAU-HERBERICH Anne	Association OXYGENE for Sustainable Development / Association OXYGENE pour le développement durable, France
Mme	DELACOUR Marion	SOS MCS Association, France / Association SOS MCS, France
Dr	DONATE Hans-Peter	Vice-Chair, German Association of Environmental Physicians / Vice-Président, Association allemande de médecins environnementales
Mr	DUFF John Feargal	Irish Doctors’ Environmental Association (IDEA) / Association environnementale des médecins irlandais (IDEA)
Mrs	DUFF Juliet	Health Educator (Ecohealth), Irish Doctors’ Environmental Association (IDEA), Lecturer at University College Cork on Ecosystems Approach to Human Health / Educatrice pour la santé (Ecosanté), Association environnementale des médecins irlandais (IDEA), Conférencière à l’Université de Cork sur la relation entre l’écosystème et la santé humaine
Dr	FARRAR-HOCKLEY Christian	Health & Environment Alliance / Alliance pour la santé et l’environnement
Mr	FENSLAU Klaus	Journalist, Environmental Magazine, Germany / Journaliste, Revue environnementale, Allemagne
Mr	GOETZ Marco	Journalist, Radio-Television-Luxembourg (RTL) / Journaliste, Radio-Télévison-Luxembourg (RTL)
Mrs	GROTE Gisela	Association of victims of environment-related health problems, Germany / Association pour les malades environnementaux, Allemagne
Mrs	GUTHMANN Evelyn	Representative of victims of environment-related health problems, Germany / Représentante des malades environnementaux, Allemagne
Mr	GUTHMANN Jürgen	Representative of victims of environment-related health problems, Germany / Représentante des malades environnementaux, Allemagne
Mr	GUTLEB Arno	Project leader, Gabriel Lippmann Research Centre, Luxembourg / Chargé de projet, Centre de Recherche Public Gabriel Lippmann, Luxembourg
Mr	HABERTIG Karl	Doctor, Germany / Docteur en médecine, Allemagne
Ms	INFANTE Aida	Journalist of the Environmental magazine: Free network of victims of environment-related illnesses, Germany / Journaliste de la Revue environnementale: Réseau libre des malades environnementaux, Allemagne
Dr	KARKALIS Elef	Dentist, Germany / Dentiste, Allemagne
Mr	KEPHALOPOULOS Stylianos	Deputy Action Leader of Health & Environment Action, Joint Research Centre, Institute for Health & Consumption Protection (ISPRA), European Commission / Adjoint au responsable de l’Action pour la santé et pour l’environnement, Centre joint de la recherche, Institut pour la santé et la protection du consommateur (ISPRA), Commission européenne
Mrs	KOTTING-UHL Sylvia	Member of the Bundestag and Speaker for Environment Parliamentary Group, Germany / Députée du Bundestag et Porte-parole du groupe parlementaire pour l’environnement, Allemagne
Dr	KREMER Marc	Surgeon, Head of Department of Environmental Medicine, Ministry of Health, Luxembourg / Médecin, Chef du service de la Médecine de l’environnement, Ministère de la Santé, Luxembourg
Mr	KRZYZANOWSKI Michal	WHO Regional Office for Europe, European Centre for Environment and Health, Germany / OMS Bureau régional pour l’Europe, Centre européen pour l’environnement et la santé, Allemagne
Mme	KUSKE Martyna	Project manager, Department of Health prevention, Luxembourg / Chargée de projet, Département prévention-santé, Luxembourg

Mrs	LANCEFIELD-PAUL Judith	Assistant to Professor Martin Pall, Biochemical and Basic Medical Sciences, Washington State University, USA / Assistante du Professeur Martin Pall, Sciences biochimiques et médicales fondamentales, Université d’Etat de Washington, USA
Mr	LAUER Reinhard	Federal Group of Councilllors on environmental and toxic substances (BBFU), Germany / Groupe fédéral des organismes conseillers en matière de l’environnement et de substances toxiques (BBFU), Allemagne
Mme	LECLERC Nathalie	Association for the Surveillance and Study of Atmospheric Pollution in Alsace / Association pour la surveillance et l’étude de la pollution atmosphérique en Alsace (ASPA), France
Mme	LEGEMBRE Valérie	Director of SCULTOS Gallery, France / Directrice de la Gallerie SCULTOS, France
Mme	LEMASSON Catherine	SOS–MCS Association, France / Association SOS-MCS, France
M.	MAYER Ronald	Ambassador, Permanent Representative of Luxembourg to the Council of Europe / Ambassadeur, Représentant permanent du Luxembourg auprès du Conseil de l’Europe
Mr	MEHLIS Frank	President of the Association for Housing Biology, Germany / Président de l’Association pour la biologie de l’habitat, Allemagne
Dr	MENGUS Marianne	Occupational physician, Council of Europe / Médecin du travail, Conseil de l’Europe
Dr S.c.	MICHELS Jean-Marc	Laboratory of the Saint Theresa Clinic, Luxembourg / Laboratoire de la Clinique Sainte Thérèse, Luxembourg
Mme	MUHLMANN Michèle	INGO Committee on Sustainable Development / OING Commission sur le développement durable
Dr	MÜLLER Kurt	President of the European Academy for Environmental Medicine / Président de l’Académie européenne de médecine de l’environnement
Mme	MULLER Marion	Parliamentary Assistant, DÉI GRÉNG, Luxembourg / Attachée parlementaire, DÉI GRÉNG, Luxembourg
Dr	OBERFELD Gerd	Public Health Officer, Salzburg, Austria/ Responsable santé publique, Salzbourg, France
Dr	OHNSORGE Peter	European Academy for Environmental Medicine, Germany / Académie européenne de médecine environnementale, Allemagne
Mr	OHNSORGE Tim	European Academy for Environmental Medicine, Germany / Académie européenne de médecine environnementale, Allemagne
Mr	OLEFIR Valeriy	Secretariat of the Ukrainian parliament / Secrétariat du Parlement ukrainien
Mme	OTT Martine	Interior environement adviser, University Hospitals of Strasbourg / Conseillère médicale pour l’environnement intérieur, Hôpitaux universitaires de Strasbourg, France
Ms	OTTE Kathrin	Leader of the Association of victims of environment-related health problems, Germany / Responsable de l'Association de victimes de maladies liées à l’environnement, Allemagne (MCS, Selbsthilfegruppe Umweltgeschädigter)
Prof	PALL Martin	Biochemical and Basic Medical Sciences, Washington State University, USA / Sciences biochimiques et médicales fondamentales, Université d’Etat de Washington, USA
Mr	PÖHNERT Arnaud	Department of Environmental Medicine, Ministry of Health, Luxembourg / Service de la Médecine de l’environnement, Ministère de la Santé, Luxembourg

Mme	POINCELOT Valérie	Hospital Jean Monnet, Epinal, France / Hôpital Jean Monnet, Epinal, France
M.	REIS Jacques	Chairman of the Club on Neurology and Environment, France / Président du Club de neurologie de l’environnement, France
M.	ROUSSELLE Christophe	French Agency for the Security of Environment and Work (AFSSET), France / Agence française sur la sécurité de l’environnement et du travail (AFSSET), France
Mr	SARGIANNIS Dimosthenis	Research Action Leader, European Commission – Joint Research Centre / Chargé de l’action sur la recherche, Commission européenne – Centre joint de la recherche
Ms	SCHERMANN Ingrid	« Safer World », International Independent Internet Information Network, Germany / « Safer World », Réseau international indépendant d’information sur l’internet, Allemagne
Dr	SCHNAKENBERG Eckart	Institute for Pharmacogenetic and Genetic Disposition, Germany / Institut des prédispositions pharmacogénétiques et génétiques, Allemagne
Mme	SCHOCKMEL Claudine	Zithaklinik Laborarory, Luxembourg / Laboratoire Zithaklinik, Luxembourg
Mrs	STRACK-ZEISER Johanna	Germany / Allemagne
Prof	SULTAN Charles	Endocrinology and Pediatric Gynecology, Hormonology Development and Reproduction, Lapeyronie Hospital of Montpellier, France / Endocrinologie et gynécologie pédiatrique, hormonologie du développement et de la reproduction, Hôpital Lapeyronie de Montpellier, France
Mme	SUTZL-KLEIN Hedda	European Society for Integrative Health Sciences, Austria / Société européenne pour les sciences intégrales sur la santé, Autriche
Mme	TAYOL Marion	SOS-MCS Association, France / Association SOS-MCS, France
Dr	TORCATORIU Andra	General Physician, France / Médecin généraliste, France
Mr	TRIEBEL Arnulf	IVU Germany / Allemagne
Mr	TURPEL Robi	AKUT: Environmental Health & Indoor Air Quality Assocation, Luxembourg / AKUT, Association pour la Santé environnementale et la qualité de l’air intérieur, Luxembourg
Dr	VAN LOO Sandrine	Dentist, AKUT: Environmental Health & Indoor Air Quality Assocation, Luxembourg / Dentiste, AKUT, Association pour la Santé environnementale et la qualité de l’air intérieur, Luxembourg
Mme	Van RINSUM Cornelia	Member of the Steering Committee of IGUMED (Interdisciplinary Society for Environmental Medicin), Germany / Membre du Comité Directeur de l’IGUMED (Société interdisciplinaire pour la médecine de l’environnement), Allemagne
M.	WABNITZ Christophe	Representative of an association of victims of environment-related illnesses, France / Représentant d’une association de malades environnementaux, France
Mme	WABNITZ Stéphanie	Representative of an association of victims of environment-related illnesses, France / Représentante d’une association de malades environnementaux, France
Dr	WILLEMS Georg H.	Vice-President of the Association for Housing Biology, Germany / Vice-Président de l’Association pour la biologie de l’habitat, Allemagne

Committee Secretariat / Secrétariat de la Commission

Mrs Agnès NOLLINGER Head of the Secretariat Tel. +33 3 88 41 22 88

Chef du Secrétariat e-mail: agnes.nollinger@coe.int

Mr Bogdan TORCATORIU Co-Secretary Tel.: +33 3 88 41 32 82

Co-secrétaire e-mail: bogdan.torcatoriu@coe.int

Mrs Dana KARANJAC Co-Secretary Tel.: + 33 3 90 21 48 77

Co-secrétaire e-mail: dana.karanjac@coe.int

Mrs Hazel BASTIER Principal Assistant Tel.: +33 3 88 41 30 93

Assistante principale e-mail: hazel.bastier@coe.int

Mrs Eliza KOPEC Assistant / Assistante Tel: +33 3 90 21 45 95

e-mail elisa.kopec@coe.int

Fax No / N° du Fax.: +33 3 88 41 27 17 or +33 3 90 21 52 97

Press / Presse

Mme Nathalie BARGELLINI Tél. : +33 3 41 22 82

e-mail : nathalie.bargellini@coe.int

V. INTERPRETERS / INTERPRETES

M.	ILIN Kolia
Ms	MACDONELL Penny
Ms	MANNHEIM Raphaela
Ms	MESSMER Karin
Mme	MICHLIN Pascale
M.	MILKO Alexeï
Mme	VACCARI Annamaria
Mr	VALK William
Ms	VON HEONNING Elisabetta
M.	WUNSH Jean-Louis

VI. STENOGRAPHERS / STÉNOGRAPHES

Mme	TORREGROSSA Anne
Mme	MESNIER Pascale