A long, agonizing month has passed since 300,000 Charleston-area residents were told not to drink their water, which was contaminated with MCHM, a chemical that, like so many others, has been under-studied for its short- and long-term effects on human health.
At a congressional hearing, members of the public found it hard to get a firm answer about MCHM concentrations in their water, and what, exactly constitutes a safe level.
"Everybody has a different definition of safe," said Letitia Tierney, commissioner of the state Bureau for Public Health. "I believe the water, based on the standards we have, is usable."
Officials say drinking water with levels under one part-per-million is OK. But as critics point out, just because the government's "definition of safe" permits consumption of Elk River water, that doesn't mean it's safe for every individual. Some people have intolerances to even the minutest amounts of certain chemicals. And notably, a single past exposure to an organic chemical like MCHM, whether ingested in water or absorbed through the skin in the shower, can have profound and unexpected long-term consequences in susceptible people.
Government officials are proposing a 10-year study of the long-term health effects of MCHM exposure, however, local residents need answers quickly. But are researchers asking the right questions?
Health-care professionals in the area should be looking for signs of Toxicant Induced Loss of Tolerance, or TILT -- a groundbreaking theory of disease based on worldwide observations that chemical exposures can initiate new onset intolerances to a wide variety of chemicals, foods, and drugs -- such as air pollutants, caffeine, cleaning products, alcohol, pesticides, cigarette smoke, lactose, gluten and even new carpeting.
TILT may develop following a single, high-level exposure or repeated, lower-level exposures to one or more synthetic organic chemicals. Affected individuals battle a host of mysterious chronic symptoms involving multiple organ systems even as they're unable to connect their suffering with the exposures causing it.
There is a tool used by researchers and health professionals internationally that can help identify TILT: the Quick Environmental Exposure and Sensitivity Inventory, or QEESI, a free, online self-evaluation. Unfortunately, too few are aware of it.
The QEESI/TILT Test helps people determine their own baseline chemical intolerances and track symptom severity. It also helps medical professionals identify those individuals and families most susceptible to the effects of TILT.
The test has already proven an invaluable tool. In a study of 421 people, it offered sensitivity of 92 percent and specificity of 95 percent in discerning between those with chemical intolerances and the general population. It has been employed to identify chemical intolerances in Gulf War Veterans, World Trade Center recovery workers, and thousands of ordinary Americans exposed to a wide range of indoor and outdoor toxicants, particularly pesticides and chemicals involved in remodeling.
This test may prove vitally important to the people of Charleston. Doctors and patients can visit www.qeesi.org. In addition, policymakers need to establish Environmental Medical Units (EMUs) to diagnose and treat symptoms caused by TILT, by avoiding the offending substances.
Just as the "germ theory" emerged after the Civil War explaining the role of microbes in infectious disease and the "immune theory" was introduced in the 1930s, explaining how people develop allergies or autoimmunity due to exposure to biological antigens, TILT may well be the 21st century theory of disease explaining how petrochemical exposures affect human health.
Is Charleston's water safe to drink? I am not in a position to say. But I know that even if concentrations fall below detectable levels, past exposures to MCHM could continue to threaten the health and well-being of susceptible residents. The QEESI or TILT test can help people gauge whether their health is at risk.
Miller, M.D., is an allergist, immunologist and tenured professor at the University of Texas School of Medicine at San Antonio.