of the Countess of Mar
The contents of this report are almost exactly as I foresaw they would be. Whilst there appears to be an acknowledgement that some sheep farmers, who have used OP sheep dips, have become ill, there are repeated statements to the effect that no causation has been established. Careful reading of the report indicates that there is a remarkable reluctance on the part of its authors to acknowledge anything more than that the farmers are ill and that there have been substantial flaws in their treatment by NHS medical practitioners. The recommendations on management are almost a direct lift from the report of the Royal Colleges on ME/CFS (CR54), October, 1996. The concentration on prescription of anti-depressants with cognitive therapy is exactly that recommended for ME/CFS patients. There is no attempt to address the cause of the many symptoms this group of patients present, apart from depression, neurological symptoms and sleeplessness. They seem to expect the patients to accept that there is a lack of knowledge in this field and to do as they are told, although the bitter pill is wrapped in a coat of sweet words.
Unfortunately, or maybe fortunately, human nature does not work this way. People not only want to know what is wrong with them when they are ill; they want to know what caused their illness.
The report repeatedly acknowledges that there is a lack of knowledge about the causes and mechanisms underlying the condition, but then makes no recommendation for causal research.
The development of this relatively new philosophy is apparent in recommendations to the Government by its scientific advisory committees and the Royal Colleges in the case of ME/CFS, Multiple Chemical Sensitivity and Gulf War Illnesses, as well as illness resulting from organophosphate exposure. There are too many questions left hanging in the air. If the same doctrine had been applied to infectious disease, for example, patients with TB would still be sent to Switzerland to see out their lives on open balconies in freezing conditions and many thousands would be dying from contaminated water supplies, unhygienic surgery and obstetric practises. Why does not the same curiosity, which led researchers to discover the causes of older diseases and infections, apply in these new illnesses? Why is it that applications to the MRC and to government departments for research funding from independent clinicians working in this field are so consistently refused? The original request to the Minister was for research into clinical diagnosis and treatment. Therefore, why was it that the chairmen of two government scientific advisory committees responsible for licensing OP products were appointed to this working group? There is no acknowledgement in the report of the reasons why those who refused to give evidence to the working group did so - that the membership of the group was known to be biased.
Unless we know the cause and effect of a disease, it is not going to be treated correctly and it is unlikely to be prevented. Further epidemiology will only serve to say that there is, or is not, a greater incidence of symptoms in a specific population. In the case of OP's, it would be extraordinarily difficult to determine the dose relationship. Farmers have probably been exposed to a range of OP's because of the widespread use of this group of chemicals in agriculture and domestic situations. Research subjects are unlikely to have total recall! Epidemiology will not say why or how those symptoms occur. It is yet another wonderful proposal for further delay.