A Critique of Dr. Sherry Rogers' Chapter 29
Environmental Medicine for Veterinary Practitioners
 

By Rosalind Dalefield BVSc, PhD, DABVT, DABT*

The author of this chapter, Dr Sherry Rogers, is a MD. It is hard to see how she is qualified to write a chapter for what is purportedly a veterinary textbook. Indeed much of the chapter appears to have little or no relevance to veterinary science, and this reader was left with the impression that Dr Rogers seldom recalled, while writing it, that it was intended for a veterinary readership. In particular, the repeated use of the term "symptom" is irritating, since veterinary patients do not have symptoms; they have clinical signs.
 
 

Introduction

The assertions related to urea foam formaldehyde in homes in the 1970s made in this section should be referenced. We are told that "hundreds of thousands of people" developed symptoms but that "no two patients had the same symptoms." It is hard to imagine that so many disorders exist! At any rate this should be referenced; surely by now there is a review article in the peer-reviewed literature?

The "conventional assumption that everyone reacting to one chemical would have the same symptoms" is a straw man argument. No competent clinician would claim this. On the contrary, I think most clinicians, both medical and veterinary, would agree that many cases are not "textbook cases." However we would expect clinical signs in different individuals to overlap somewhat and to fall within a set of possible clinical signs for any given disease.

What is Environmental Medicine?

This section attacks 'conventional' medicine on spurious grounds. History taking is a vital part of conventional medicine and most definitely covers environmental factors. A conventional diagnostic approach can certainly cover any or all of the disciplines of nutrition, allergy, endocrinology and toxicology, and is certainly capable of diagnosing genuine "environmental food, chemical or mold sensitivities" as well as genuine "deficiencies of vitamins, minerals, essential fatty acids, amino acids and hormones." To suggest that conventional physicians and veterinarians are unable to consider or diagnose disorders with these aetiologies is to gravely insult both the medical and the veterinary medical professions.

The assertion that in conventional medicine "aside from the use of antibiotics for infections, cure is rarely established" is a ludicrous claim, yet Dr Rogers makes this claim while providing no grounds for this assertion whatsoever. She follows this with the extraordinary assertion that "very seldom is medication temporary", again without providing any date to show that this is the case.

Dr Rogers claims that when "properly trained" (presumably in environmental medicine), physicians can induce reversal of coronary artery plaque, regression of metastatic end-stage cancer, and reversal of rheumatoid arthritis, but provides no references to case histories of these events occurring. Incidentally, surely it has long been recognised that metastatic cancer that has been considered terminal may sometimes regress for no known reason?

Definitions

Most of this section (up to and including the Klaassen citation) is a brief synopsis of detoxification, which is simplistic but essentially correct.

At the end of this section Dr Rogers claims that there are "scores" of papers showing that "hidden" food sensitivities are the cause of bloody diarrhea. It is a pity she does not reference a single one of them. A reference to a review article would be even better. It is also a pity that although this claim is found in a section titled "Definitions", she fails to explain what a "hidden" food sensitivity is. Aren't all food sensitivities "hidden"? Peanuts do not grow with allergy warnings on them.

An Environmental Medicine Scenario

In this section Dr Rogers attacks the use of NSAIDs and steroids, citing theorized toxic effects of NSAIDs via magnesium deficiency. She lists a number of toxic effects of magnesium deficiency up to and including cardiac arrest, but fails to present any evidence that any human or veterinary patient has even suffered clinically significant magnesium deficiency as a result of using NSAIDs at the therapeutic dose.

The section continues in this scare-mongering tone. Dr Rogers raises the spectre of "intestinal hyperpermeability" but again fails to provide any reference to the frequency of this condition in NSAID users. Likewise she uses the logical fallacy known as the "Slippery Slope" to progress from "nutrient imbalance" to cholesterol-lowering drugs, to cholesterol deficiency, to clinical endocrinopathy, and finally to suicide and cancer. Furthermore, cholesterol-lowering drugs appear to be of no relevance in a veterinary textbook.

Rogers cites a single publication which asserts that "numerous "undiagnosable" and "untreatable" arthritic, musculoskeletal, metabolic, renal, hepatic and malignant diseases occur because of the ingestion of hydrogenated polyunsaturated oils containing trans-fatty acids." If these are the diagnoses, and "trans-fatty-acids" are the cause, then surely they are not "undiagnosable diseases" at all? However, examination of this reference shows that it is not in the peer-reviewed literature but has been published by the author. It is of no apparent veterinary relevance.

On the other hand the sweeping assertion that "many people and animals have a total package of food, chemical (e.g. pesticide, hydrocarbon) and inhalant (e.g. pollen, dust, mold, dander) overloads... goes completely unreferenced and unjustified, so perhaps any reference is better than none. Similarly the startling claim that "very common causes of arthritis, which in many cases can be completely eliminated without drugs or surgery, are unsuspected food, chemical and mold sensitivities, as well as undiagnosed nutrient deficiencies" is made without any data or references to support it.

Environmental Medicine: A Paradigm Shift

In this section, among the "causes of ubiquitous symptoms" Dr Rogers lists electromagnetic fields, although the alleged deleterious effects of these have been thoroughly debunked. However since "ubiquitous symptoms" are symptoms we all have, and are therefore presumably symptoms of normal health and life, perhaps this is not inappropriate.

Dr Rogers complains that the American Academy of Allergy has failed to alter its policy on the basis of one study. I think most scientists would be dismayed if they did. It is a guiding principle of medical science that results must be repeatable and the only way to establish that is for other researchers to repeat them.

Dr Rogers criticizes professionals who do not believe that "everyday chemicals cause disease states such as lupus", citing the fact that hydrazine toxicosis may cause lupus-like symptoms. In fact according to Casarett and Doull, the standard textbook of toxicology, only two of the hydrazines, hydralazine and isoniazid, have been linked to a lupus-like syndrome. Dr Rogers fails to establish that exposure to hydralazine or isoniazid, sufficient to cause lupus-like symptoms, can be described as "everyday chemical" exposure. Where is the evidence that lupus is epidemic among people using hydralazine as an antihypertensive? Isoniazid, although well known to have a number of dangerous side effects, is used against tuberculosis. Surely this is hardly an "everyday" chemical exposure, at least in the Western world?

Dr Rogers states that "environmental medicine can identify environmental triggers, metabolic defects and biochemical deficiencies." I trust she does not mean to imply that conventional medicine cannot. It was not a practitioner of "environmental medicine" who identified phenylketonuria, as just one example.

Total Load

Here we encounter the "laundry list phenomenon", in the shape of the unreferenced assertions that nutrient deficiencies and chemical sensitivities can "mimic any symptom." How convenient for the environmental physician! No matter what their patient complains of, they can find a cause! In this reviewer's experience, the laundry list phenomenon is a consistent hallmark of quackery.

Intestinal Dysbiosis and Intestinal Hyperpermeability

A Medline search reveals only 28 publications about intestinal dysbiosis, of which only 6 are in English and of those only one involves veterinary medicine. In writing this chapter for a veterinary textbook, Dr Rogers seems unaware that intestinal dysbiosis is not a major issue in veterinary science. A search for "intestinal hyperpermeability" reveals a grand total of 39 publications of which 14 mention animal studies. Virtually all of these are about intestinal hyperpermeability due to endotoxins or ischaemia.

Dr Rogers frequently refers to allergens in this section but seems unaware that allergy is one of the branches of toxicology in which animal studies are least relevant, and suitable animal models are the most difficult to find.

I find the wording of these two sentences rather misleading: "Likewise, a major part of the detoxification pathway of the body lies in the lining of the intestine. This includes phase I pathways of the cytochrome P-450 system and conjugates of phase II" While it is certainly true that enzymes of the cytochrome P-450 system are active in the intestinal lining, a person with little prior knowledge might infer from this phrasing that that the cytochrome P-450 system, which is indeed "a major part of the detoxification pathway" is found exclusively or largely in the intestinal lining. This is of course wholly incorrect. Dr Rogers asserts that inflammation of the intestinal lining destroys the detoxification capability. Again, a person lacking prior knowledge might infer from this that intestinal inflammation destroys most or all of the body's detoxification capability. While one might expect most modern veterinary practitioners to understand that the intestine is not the only, or even the major, site of cytochrome P-450 enzyme activity, older practitioners may not have kept abreast of the burgeoning understanding of this system.

Dr Rogers then asserts that intestinal inflammation, by destroying the detoxification pathway, leads to chemical sensitivity, arthritis, autoimmune diseases and other conditions. This assertion is unreferenced and seems hard to believe since virtually everyone gets enteritis at some stage in his or her life.

Much of the discussion of bacteria and fungi is based on human medicine; H. pylori and C. albicans are significant in humans but evidence is lacking that they are of any veterinary significance.

In the section Nutritional Deficiencies Are Common we once again encounter the laundry list phenomenon, this time in association with the evils of trans-fatty acids. The references appear to be relevant only to the human species.

The explanations of cell biology are so simplistic and vague that it appears that Dr Rogers forgot, when writing this chapter, that she was writing for veterinary professionals rather than members of the general public.

We are told, in this and the next section, that detoxification depletes us of "nutrients" such as glutathione, magnesium, and phosphatidyl choline. In fact the body makes its own glutathione and phosphatidyl choline. Dr Rogers appears to ignore the fact that these substances are replenished by the body and that magnesium is ingested and recycled. The scare-mongering assertions about "depletion" by detoxification are, not surprisingly, unreferenced.

The next section is titled Correction of Nutrient Deficiencies Treat Symptoms but in fact does not discuss or present any evidence concerning that claim at all.

In this section Dr Rogers provides a very brief, simplistic synopsis of detoxification in which she strongly implies that all xenobiotics undergo Phase II metabolism. This is, of course, quite wrong.

Dr Rogers asserts that neurologic and dermatologic diseases are increasing in prevalence and that this is due to sequestration of xenobiotics in lipid stores. She fails to provide any evidence that disorders of these systems are increasing (particularly when age is adjusted for) let alone that xenobiotics are the cause. She also refers darkly to pesticides that cause cancer, but fails to name them. There are an enormous number of pesticides, of which very few are carcinogenic.

The next section Magnesium as an Example of the Diverse Symptoms One Mineral Deficiency Can Cause is of no apparent relevance to veterinary science. This section is well referenced, which is unusual for this chapter, but the references are wholly medical. Mineral requirements of domestic animals are very, very well understood, a fact that seems to have escaped Dr Rogers who is not, after all, a veterinary professional. The clinical signs of magnesium deficiency are well defined and easy to find in the veterinary literature, yet Dr Rogers does not seem to have checked the veterinary literature.

It is not clear why diagnosis and treatment magnesium deficiency, even if such deficiency does exist, is "environmental medicine" rather than clinical nutrition. It may come as news to specialists in buiatrics that when they prevent and treat hypomagnesemia in dairy cattle, as they have done for decades, they are practicing "environmental medicine"!

The next section is entitled Other Nutrients and continues in the same vein, discussing human requirements for such things as copper, zinc, vitamins and amino acids. Again, I would have supposed that these were issues of clinical nutrition.

Dr Rogers states that "Chemical sensitivity reflects an inability to metabolize everyday chemicals as efficiently as the average person. People with chemical sensitivities have this problem because they are deficient in the nutrients that control the detoxification pathways." These extraordinary assertions are totally unreferenced. A quick Medline search suggests that most genuine chemical sensitivities are IgE-moderated reactions or, in layman's terms, types of allergies, while there is a sizable body of evidence that "multiple chemical sensitivity" is a psychosomatic disorder. While there are some recognized genetically-based chemical sensitivities which are due to differences in detoxification, such as favism, the claim that all or most people with chemical sensitivity have problems with detoxification appears to be without foundation.

Another startling claim is that "researchers have noted increasing infertility in humans and animals during the last few decades." The only reference to this is a book titled "Chemical Sensitivity." A claim such as this should be backed by citation to original research papers in the peer-reviewed literature.

As a person with a keen interest in analytical toxicology and a great admiration for the information that can be gleaned by clinical pathologists, I cannot dispute Dr Rogers' statement that "a biochemical approach to symptoms can lead to vastly improved health." However, tests must be validated and it should be remembered that correlation does not prove causation. Derangements in blood and serum mineral levels are very often secondary to other problems and it is simplistic to suppose that the answer to illness is simply to correct those "deficiencies."

Dr Rogers claims that "In many humans and animals, end-stage metastatic cancers that had foiled all that medicine can offer have been completely cleared as a result of inexpensive, easily accessible environmental medicine principles." This would be wonderful news were there any evidence that it is true. However a Medline search for "environmental medicine"+"metastatic" reveals no hits while a search of "environmental medicine"+"neoplasia" reveals no case reports. It seems surprising that none of the physicians or veterinarians who treated the "many humans and animals" with "end-stage metastatic cancers" which were "completely cleared," thought to write up such stunning cases. In fact the two references given are both books by Dr Rogers herself and neither appear to be peer-reviewed.

In the summary to this section Dr Rogers boldly asserts that "Deficiencies are so common that they are the rule, not the exception" but there is no evidence anywhere in the forgoing section that this is the case, particularly as far as domestic animals are concerned. She further alleges that "the average processed diet and daily exposure to chemicals are among the primary causes of deficiencies" having provided no evidence whatsoever that this is the case. I very much doubt that her claim that "Drugs are often unnecessarily prescribed over a subject's lifetime" is true in veterinary medicine. Owners tend to resist the notion of lifelong medication for pets. Her claim that "Ignoring the cause of symptoms invariably causes further symptoms and disease" immediately repeated as "In the current drug-oriented system, the sick get sicker... is quite simply nonsense. Is there any veterinary graduate who has not heard the adage that "70% of things get better whatever you do"? Is there any veterinary practitioner who has never given a course of antibiotics to a febrile animal while waiting for organ-specific clinical signs to develop, and seen a complete recovery, leaving the animal healthy, the owner happy and the veterinarian relieved but wondering what on earth had caused that fever?

A number of short sections follow which seem to somewhat unconnected. There is the illogical assertion that "if humans are generally deficient [in magnesium], animals are also likely to experience similar deficiencies." I don't see why. Dr Rogers refers darkly to food processors altering food in "a myriad of secret ways" but fails to acknowledge that the reputable proprietary petfood manufacturers have committed, and continue to commit, a great deal of time and money to identifying and formulating ideally balanced diets for domestic pets. The obsession with "leaky gut syndrome" continues. I would be curious to know how often veterinary pathologists recognize "leaky gut syndrome." It sounds as if it should be obvious on histopathology and veterinary pathologists very often examine sections of intestine. Yet there are few animal studies on this syndrome on Medline and even fewer that attribute the problem to bacterial toxins rather than ischemia.

These short sections are followed by a summary titled Nutrient Deficiencies Should Be Explored for Every Symptom and Disease which contains more sweeping generalizations such as "nutrient deficiencies are the rule, not the exception" and "taking medication" depletes nutrients."

While I consider that clinical nutrition certainly has its place, I am left with the impression that Dr Rogers has elevated it beyond its true priority. For example, as a toxicologist myself, I would hope that clinicians treating toxicoses would consider nutrient deficiencies only after preserving life, undertaking detoxification, instituting antidotal therapy and appropriate supportive therapy. Likewise if I had multiple fractures, or an acute fulminating infection, I would hope the physicians treating me would not get distracted by wondering about my nutrient status.

The next section, Food Allergy, begins with the remarkable statement that "many problems, including arthritis, allergies, angina, diabetes, nephrotic syndrome, migraine, colitis and metastatic end-stage cancers, have been resolved with a mere diet change." This sentence is referenced, but perusal of the references reveals that they do not, in fact, provide supportive evidence that is remotely sufficient to support such an extravagant collection of claims. Some of the claims are made again, and further references provided, later in the section.

I must confess to some mystification about Dr Rogers' discussion of food allergy in a chapter dealing with environmental medicine. Why do we need environmental medicine practitioners to treat conditions that are well recognized to exist by conventional allergists? Why, indeed, is food allergy included in a book about "complementary and alternative veterinary medicine," and in a chapter written by someone who is hostile to conventional medicine, when identification and treatment of food allergies has been a standard part of conventional medicine and veterinary medicine for many years? For that matter, nutritional deficiencies are not outside the scope of conventional medicine and certainly not an unfamiliar concept to conventional veterinary practitioners.

In the next section, Therapeutic Diets, Dr Rogers implies that organic food is free of pesticides, which is of course a myth since plants under attack from insects make their own pesticides, which may be more toxic and/or carcinogenic that manmade pesticides. Organic food cannot be assumed to be "chemically less contaminated." Dr Rogers fails to provide any evidence whatsoever that pesticide residues or preservatives have ever caused food allergies in domestic animals. She cites one reference that "groups" (human or animal?) eating organic foods had higher sperm counts than those eating "pesticide-treated foods" but the reference she cites is missing from the references section at the end of the chapter.

Dr Rogers asserts that "a host of daily chemical exposures in air, food, and water has reduced the nutrient base" without providing any evidence that this is so, and the only reference cited is one of her own publications which is, furthermore, missing from the references section. Dr Rogers also asserts that anyone who understands biochemistry should be able to appreciate that a change in diet can reverse diseases "not thought to be reversible." On the contrary, an understanding of the biochemical changes that occur in, for example, neoplastic transformation, helps to underscore that the disease may not be reversible. Likewise, an appreciation of the very limited or absent regenerative potential of some tissue types helps in understanding that complete recovery of such tissues as articular cartilage is not a realistic expectation.

Dr Rogers strongly implies that prostatectomy inevitably leads to impotence and urinary incontinence. I was surprised to read this in such a recent publication as Schoen and Wynn, since I first read about nerve-sparing surgery for prostate cancer in an Atlantic Monthly issue in 1993. Since magazines for the general public are generally behind the times relative to the peer-reviewed literature, this technique has probably been well-known to urologists for much longer than that. Rogers cites a single reference for the claim that a macrobiotic diet offers better prognosis than conventional therapy for prostate cancer; hardly grounds strong enough for a man to stake his life upon.

We are told that the "macrobiotic" diet has helped "many people with multiple chemical sensitivities, asthma, eczema, chronic sinusitis, and many undiagnosable or seemingly untreatable conditions such as chronic fatigue, fibromyalgia, lupus, rheumatoid arthritis and sarcoiditis." No references whatsoever are cited. Furthermore, if the conditions are undiagnosable, how did they come to be given those names?

Rogers further claims that macrobiotic diets have cured many cases of cancer, but the references she cites are all non-edited books rather than peer-reviewed publications, and of the five, three are her own. Rogers is very fond of self-citation. Self-citation is not necessarily a bad thing; it is quite legitimate to cite one's key research publications that have appeared in the peer-reviewed literature. However, to extensively cite one's books is tantamount to saying "I've written this before, so it must be true."

Dr Rogers then includes several sections on allergy, but makes only passing reference to the place of allergy in veterinary medicine. Extensive discussions of skin testing for allergy in human patients, and why Dr Rogers advocates a method that is not endorsed by the policies of the American Academy of Allergy, are of little relevance to the veterinary medical situation. Dr Rogers cites a "published case" of a horse that was alleged treated successfully for COPD, but neglects to provide details of when and where the case was published.

In the section titled Chemical Sensitivity Dr Rogers claims that malignancies and autoimmune phenomena have become more common in domestic animals over the last few decades, but fails to cite any evidence whatsoever for that claim. The last few decades have seen enormous advances in veterinary diagnostic capability and it is probable that if there is indeed any apparent increase in malignancies or autoimmune disorders in domestic animals, it merely reflects improved diagnosis.

In the next section, Organic Solvents, Dr Rogers claims that there is a rising cancer rate in the United States. In fact the National Cancer Institute issued a press release on May 14, 2000, that stated: "The rate of new cancer cases and deaths for all cancers combined as well as for most of the top 10 cancer sites declined between 1990 and 1997 in the United States"

Cancer Decline

Perhaps low-level solvent exposure is not the hazard Dr Rogers would have us believe?

Several sections follow in which a variety of synthetic chemicals including perchloroethylene, toluene, trichloroethylene, formaldehyde and organophosphate insecticides are discussed. Apparently the practitioner of "environmental medicine" is not only a wannabe nutritionist and a wannabe allergist, but a wannabe toxicologist as well. The give-away flaw in these sections, to this toxicologist, is that Dr Rogers never discusses the issue of dose. Dose is all-critical to the properly trained toxicologist, but apparently irrelevant to the "environmental medicine" practitioner. Such is the difference between a legitimate science and quackery.

Dr Roger's claim that "Anyone can react to any chemical and any target organ can be affected "at any time" is simply absurd. Some chemicals are totally inert. Those that are biologically active have target organs determined by the properties of the substance.

Predictably, "pesticides" (a term that covers a colossal range of chemicals, both natural and synthetic) are villainized, but the scare-mongering is unreferenced, with the exception of one of Dr Rogers' own publications. Dr Rogers is particularly fond of claiming that pesticides can cause "undiagnosable symptoms." How convenient; whatever you have or imagine you have, you can always blame it on pesticides! The notion that a three-year-old child can develop "mysterious behavior problems" as a result of a pet's flea collar is blatant and groundless scare-mongering of the worst kind. Dr Rogers also insults one branch of her own profession, as well as people who are suffering from short-term depressive illness, by implying that psychiatrists routinely condemn patients to "a lifetime prescription of antidepressants."

Dr Rogers is much given to sensationalizing. She likes to use the word "host"; over and over one reads about "a host of diseases" or "a host of symptoms." There are the predictable dark hints of conspiracies by latex manufacturers and other industries. There are the predictable, oh-so-convenient "undiagnosable symptoms." Dr Rogers seems disinclined to believe that any illness could be psychiatric in origin. She is not fond of references or of the peer-reviewed literature. Perusal of the references section shows an inappropriate emphasis of books over original research papers. Anyone can write a book; you can write and publish a book claiming that the moon is made of green cheese if you wish to. Original research papers in the peer-reviewed literature are far more reliable, although not, of course, infallible.

From this chapter it appears that an environmental medicine practitioner is a person who picks and chooses what they want from nutrition, allergy and toxicology, while ignoring anything in any of those disciplines that contradicts their preconceived notions. Based on this chapter, there appears to be very little scientific thought, and a great deal of scare-mongering, in environmental medicine.
 

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*Rosalind Dalefield BVSc MRCVS PhD
Diplomate, American Board of Veterinary Toxicology http://www.abvt.org
Diplomate, American Board of Toxicology http://www.abtox.org
URL: http://www.dalefield.com/toxicology