Health complaints related to low-dose environmental exposures : analysis and evaluation of an interdisciplinary environmental medicine pilot project in the Basel area

BACKGROUND: Over the last decades, adverse effects of the environment on human health
have become a major concern both for the scientific community and the general public. Many
people suspect that environmental exposures cause their health problems. According to
some self-help groups, there are thousands of individuals in Switzerland who are affected by
multiple chemical sensitivities or electromagnetic hypersensitivity. The number of people who
believe that they are affected, and who will eventually seek medical help and/ or environmental
counselling, could thus be an important factor in the availment of health care.
Concerned persons generally either consult their general practitioner or environmental
protection agencies responsible for chemical safety or air hygiene. However, both physicians
and the environmental agencies are hindered by inadequate knowledge of each other's area
of specialisation. Furthermore, it is well known that psychological factors can contribute to
the development or maintenance of unspecific health complaints.
AIM: To assess the need, the feasibility and the efficacy of environmental medicine
counselling in Switzerland. To discuss the implications of the research results for the Swiss
health care system.
METHODS: Environmental medicine consultations in general practice were assessed with the
help of nearly 250 physicians who participate in the "Swiss Sentinel Surveillance Network". In
2002, the physicians were asked to record the number of patients who reported health
problems attributed to environmental exposures.
During 2001, persons who attributed their health problems to environmental exposures were
counselled in an interdisciplinary environmental medicine pilot project. Sixty-three
participants, living in the Basel area, had a medical and a psychological-psychiatric
examination and were visited at home by an environmental hygienist. Electromagnetic field
(EMF) measurements were conducted at the homes of 25 participants who attributed their
health complaints specifically to EMF. The results of all the investigations were discussed in
joint case conferences, and were followed by counselling of the participants. The project
was evaluated approximately half a year after participation, using telephone interviews.
RESULTS: Environmental-exposure related consultations in general practice in Switzerland
were rare; comprising 0.03 % of all consultations.
The majority of participants in the environmental medicine project had sought help from a
wide range of health care providers before enrolling in the study. Participants had also spent
more money on health care not covered by health insurance than a representative
(symptomatic) sample of the population. Presented problems were complex: The proportion
of participants with psychological-psychiatric problems proved to be high; however 40 % of
participants had a plausible theory for the environmental aetiology of at least one of their
health problems. Overall, psychiatric diagnoses did not exclude environmentally caused
symptoms and vice versa.
The evaluation of the EMF-cases indicated that few persons were particularly susceptible to
EMF. Legal threshold values for EMF were not exceeded in any of the homes.
More than a third of the participants reported that they benefited from the project and their
long lasting health problems improved following participation.
CONCLUSIONS: The results of the environmental medicine project strongly suggest that only
an interdisciplinary structure including medical, psychologic-psychiatric and environmental
expertise is likely to be able to adequately diagnose environmental related health problems
and provide suitable advice to persons who attribute health complaints to environmental
exposures. Although the proportion of the population affected is low, those affected cannot
obtain adequate advice from existing health care structures. The implementation of an
environmental medicine counselling service in the Basel area is currently under discussion
(April 2004).