クリニックを受診する患者が増えるだけではない。The American Environmental Health Foundation（AEHF, アメリカ環境健康財団）という組織はRea医師によって作られた。（ttp://www.aehf.com/, 私の環境では"qualify for the discount（割引の資格）"に関するポップアップが出る。アクセスする方は自己責任で）。AEHFでは、食品、衣類、サプリメント、浄水器、ベッド、本などの商品が売られている。化学物質過敏症の患者が増えればAEHFの売り上げも増える、というのは明らかであると私には思われる。AEHFそのものは非営利と称されているが、AEHFで売られている商品をつくっているメーカーは非営利ではない。「化学物質過敏症の患者を作っていけば、もうけになる」という主張が、「事実でもなく、根拠もない、根も葉もない嘘」であるという根拠こそ、示してもらいたい。
（注：以下の文章はゲノミクス、分子生物学、化学物質過敏症や精神医学等に対し素人が記述しています）
１．論文：「Factors in genetic susceptibility in a chemical sensitive population using QEESI」、Environ Health Prev Med. 2012 Sep;17(5):357-63
遺伝子：GSTM1、GSTT1、ALDH2、PON1 の４つに限定して分析 日本人を対象にしたことが新規の後追い研究か？
最先端の研究ならば、遺伝子は限定しないはず。
QEESIを使用して "chemical sensitive populations (CSP)." を
定義との要旨の文書があるが、A total of 1,084 employees of Japanese companiesに対してQEESIは実用的？
（二重盲検化学物質負荷試験結果を考慮して）そもそも一般論としてMCSに対してQEESIは実用的なのか？
結論：「Our findings suggest that the common genotypes of GSTM1, GSTT1, ALDH2, and PON1 are of little importance to CSP in a Japanese population」
Environ Health Prev Med. （学会）って、このような論文でも掲載されるのですね。
（超微量）化学物質過敏症と主張する人々は、このような研究の在り方については、問題意識はないのでしょうか？
ブログの記事のみならず、化学物質過敏症の研究の在り方についても着目した方が良いのかもしれない。
ttp://kaken.nii.ac.jp/pdf/2009/seika/jsps-2/31311/19510074seika.pdf によると、２００９年に「日本のMCS患者の診断やスクリーニングに役立つ問診票（QEESI日本語改訂版）が作成できた」とある。
関係論文：「Evaluation of subjective symptoms of Japanese patients with multiple chemical sensitivity using QEESI」、Environ Health Prev Med. 2009 September; 14(5): 267–275
先ず論文の題名が理解できない。題名が「Revision of Japanese QEESI for diagnosis and screening of MCS patients」（ブロークンだなぁ）ならば理解可能か？
AbstractのConclusionsが、「Our results suggest that subjects meeting two out of three subscale criteria can be screened as “patients suffering from a low level of environmental chemicals such as MCS” in Japan」
suggest で良いの？ どんどん読む気が薄れていく。
本文中、Methodsで、「In addition, patients suspected of having psychological disorders were examined by a qualified psychiatrist or practitioner of psychosomatic medicine, and those patients diagnosed with mental health disorders based on DSM-III or ICD-10 were also excluded from the study」
２００９年作成の論文なのにDSM-III（１９８０年改訂）を使うのはなぜ？
化学物質に対する知識に乏しい人やリテラシーに乏しい人は研究から除外しなくて良いのか？
最後に、QEESIを使用してMCSと診断（スクリーニング）した人に対して、
二重盲検化学物質負荷試験をしてQEESIの有効性を確認したとの記述が無いのは、私の見落としなのか？
＜＜脱線（その３）＞＞
ttp://www.nicnas.gov.au/__data/assets/pdf_file/0005/4946/MCS_Final_Report_Nov_2010_PDF.pdf
オーストラリアの Scientific Review Report 「Multiple Chemical Sensitivity: identifying key research needs」
この文書の５ページ：1.1 OVERVIEW 項において、「Presently, a diagnosis of MCS is based commonly on self-reported symptoms and chemical exposure histories. The symptom profile of MCS is indistinguishable from other multi-symptom disorders. No laboratory tests currently exist for diagnosing MCS. Different case definitions and the lack of a characteristic symptom profile and objective laboratory biomarkers for MCS have impeded recognition of the disorder as a distinct clinical entity.」
「There are no standardised treatments for MCS. Current treatments advocated for MCS include dietary changes, nutritional supplements, detoxification and desensitisation techniques, holistic or body therapies, as well as prescription medicines and behavioural therapies. The most common management regime for MCS is avoidance of agents that trigger symptoms.」 の両文は味わい深い。
Current treatmentsの一部はどんなものか想像がつかない。
＜＜脱線（その３）終わり＞＞
①表題：「Multiple Chemical Sensitivity and the Workplace: Current Position and Need for an Occupational Health Surveillance Protocol」
この文書は労働衛生を指向していて、ネット上での化学物質過敏症論争とは多少話題が違うのかもしれない。治療の話題は含まれないようだ。
②2.Case Definition項の「In February 1996, the invited experts forming a workshop organized by the International Program on Chemical Safety (IPCS) of the WHO, the United Nations Environment Program (UNEP), and the International Labor Organization (ILO) recommended a new name: idiopathic environmental intolerances (IEI) because the term MCS “makes an unsupported judgment on causation” (i.e., environmental chemicals). This concept was taken from Sparks (2000), who defined IEI as a chronic recurrent condition, caused by a person’s inability to tolerate an environmental chemical or a class of exogenous chemicals [23–26]. 」
「IEI, according to the proponents, is a complex gene-environment interaction, whose real cause is not known, for which it is possible—though not always—to identify a triggering event (e.g., sniffing a substance) and a response involving one or more organs or systems. Depending on its characteristics (i.e., the prevalence of somatic or psychological disorders) it can be confused with allergic reactions or psychiatric illness [27, 28]. 」
「However, multiple chemical sensitivities (MCS) is still the term most widely used to describe the complex syndrome; it presents as a chain of symptoms linked to a wide variety of environmental agents and components, at levels normally tolerated by most people [11].」
「The wide range of symptoms with which MCS manifests and the difficulties of differentiating them from other pathologies—immunologic, digestive, cardiac, respiratory, psychiatric, neurologic, endocrine, and so forth—make it hard to develop a diagnostic tool that specifically identifies patients with MCS. The 1999 Consensus Document suggests using the Environmental Exposure and Sensitivity Inventory (EESI) to investigate patients for MCS. The authors subsequently modified this for faster, more widespread use, as the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Some investigators have used the questionnaire in its original form but modified or adapted to take account of geographical differences [3, 33–41].」
これらの文章は味わい深い。
＜＜脱線（その２）の補足説明終わり＞＞
Pubmedで"tobacco allergy"を検索すると17件。うち16件は1983年以前の論文でなかには[Tobacco allergy--does it exist?]なんていうタイトルの論文もあり不安になりますが、
Tobacco allergy: demonstration of cross-reactivity with other members of Solanaceae family and mugwort pollen.
ttp://www.ncbi.nlm.nih.gov/pubmed/10071524
資料を置いときます。
英語版Wikipedia、「Gold standard (test)」より。
ttp://en.wikipedia.org/wiki/Gold_standard_(test)
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A hypothetical ideal "gold standard" test has a sensitivity of 100% with respect to the presence of the disease (it identifies all individuals with a well defined disease process; it does not have any false-negative results) and a specificity of 100% (it does not falsely identify someone with a condition that does not have the condition; it does not have any false-positive results). In practice, there are sometimes no true "gold standard" tests. Sometimes they are called "perfect" and "alloyed" gold standard.
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『Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation』より。
ttp://books.google.co.jp/books?id=59K2W0axcVYC&pg=PA560#v=onepage&q&f=fals （google books）
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The perfect diagnostic test is the gold standard with which all other tests are then compared. Gold standards, by definition, have a sensitivity of 100% and a specificity of 100%.
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ttp://cran.cnr.berkeley.edu/web/packages/HSROC/vignettes/Tutorial.pdf
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We start with the simplest mode, where the reference test is assumed to be a gold standard
(i.e. sensitivity and specificity of the reference test both equal to 100%).
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ttp://www.siue.edu/~sumbaug/RetinalProjectPapers/A%20comparison%20of%20computer%20based%20classification%20methods%20applied%20to%20the%20detection%20of%20microaneurysms%20in%20ophthalmic%20fluorescein%20angiograms.pdf
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An ideal classifier would give 100% sensitivity and 100% specificity, when tested against the
gold standard.
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ttp://calder.med.miami.edu/pages/EBMGlossary.pdf
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For diagnosis, it refers to a reference standard for the evaluation of a diagnostic test. For the purposes of a study, the "gold standard" test is assumed to have 100% sensitivity and specificity. This may well constitute an exaggerated estimate of the reference test.
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ttp://kaken.nii.ac.jp/d/p/14570481
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Unfortunately, however, there is so far no "gold standard" assay (i.e., with 100% sensitivity and 100% specificity) for the detection of AMA in PBC.
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ttp://mice.tropmedres.ac/model103_104.aspx?model_code=MODEL104&showtab=0
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This assumes that the gold standard is perfect (100% sensitive and specific), but this is not always the case.
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ttp://www.chemistrydaily.com/chemistry/Gold_standard_(test)
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An ideal gold standard test has a sensitivity of 100% (it identifies all individuals with a disease process, and it does not have any false-negative results) and a specificity of 100% (it does not falsely identify someone with a condition that does not have the condition; it does not have any false-positive results). There are no ideal gold standard tests.
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ttp://ebem.org/definitions.html#Gold standard
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For the purposes of a study, the "gold standard" test is assumed to have 100% sensitivity and specificity.
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>Despite extensive clinical evidence to support the veracity of this clinical state, many members of the medical community are reluctant to accept this condition as a pathophysiologic disorder.
ttp://www.ncbi.nlm.nih.gov/pubmed/23642291
って書いてあるんですけどね。"many members of the medical community"って、要するに、"the American Academy of Allergy and Immunology, the American Medical Association, the California Medical Association, the American College of Physicians, and the International Society of Regulatory Toxicology and Pharmacology"とかのことでしょう。ちなみにこの総説では私の判断する限りでは"extensive clinical evidence "は述べられていません。"many members of the medical community"の多くのメンバーも私と同じ判断をしたのでしょう。Uptodateの記載も"many members of the medical community"の意見が反映されます。
The following hypothesis can be put forward: The illness mechanism behind MCS involves both physiological and psychological impacts on certain brain centres in particularly predisposed persons.
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The gold standard test is the single diagnostic test that is considered to be definitive for a certain disease process and should ideally be close to 100% sensitive and 100% specific.
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ttp://books.google.co.jp/books?id=UqGF3RW6NYAC&pg=PA42#v=onepage&q=gold%20standard&f=false
『Clinical Wards Secrets』
runが原文を持っているがやはり慎重論としか思えない。
それよりもAmerican Medical Association Council on Scientific Affairs, 1992以後AMAは現在、MCSに関して見解声明をしていないので慎重論のままだと判断する方が妥当。
自分の都合の良い事古い物しか採用していないNATROMさんには納得できないだろうが最終的に出した物が優先されるのは当然だろう。
