 An
excerpt from The
Autoimmune Epidemic
Bodies Gone Haywire in a World out of Balance and the Cutting Edge Science that
Promises Hope
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Foreword to
The Autoimmune Epidemic
by Douglas Kerr, M.D., Ph.D.
As a faculty neurologist and neuroscientist at the Johns Hopkins Hospital in
Baltimore Maryland, I have spent the last decade evaluating and treating
patients with autoimmune disorders of the nervous system. I founded and continue
to direct the Johns Hopkins Transverse Myelitis (TM) Center, the only center in
the world dedicated to developing new therapies for this paralyzing autoimmune
disorder. Increasingly, I see that more and more patients are being felled by
this devastating disorder. Infants as young as five months old can get TM and
some are left permanently paralyzed and dependent upon a ventilator to breathe.
But this is supposed to be a rare disorder, reportedly affecting only one in a
million people. Prior to the 1950s, there were a grand total of four cases
reported in the medical literature. Currently, my colleagues at the Johns
Hopkins Hospital and I hear about or treat hundreds of new cases every year. In
the multiple sclerosis clinic, where I also see patients, the number of cases
likewise continues to climb.
Autoimmune diseases have not always been this common. The prevalence of
autoimmune diseases like systemic lupus erythematosus, or lupus, multiple
sclerosis, and type 1 diabetes is on the rise. In some cases, autoimmune
diseases are three times more common now than they were several decades ago.
These changes are not due to increased recognition of these disorders or altered
diagnostic criteria. Rather, more people are getting autoimmune disorders than
ever before.
Something in our
environment is creating this crisis. What you will read about in the following
pages is a powerful and touching and scholarly exposé of what those things may
be. The
immune system in our bodies is charged with an amazingly complex task: to
recognize and ignore all the cells and tissues within our body and—at the same
time—to attack any and all “invaders,” foreign cells, viruses, bacteria, or
fungi. Our wondrously complex immune system can successfully protect our bodies
while recognizing and eliminating billions of distinct infections with which we
come in contact. When functioning well, the immune system immediately recognizes
a virus or bacteria that has gotten into our body and initiates a spirited and
robust attack on the invader, allowing us to recover from a cold after only a
few days. But this precisely choreographed dance between the immune system and
the tissues it is designed to protect goes badly awry in autoimmune diseases. In
such diseases, the immune system mistakes friend for foe and begins to attack
the very tissues it was designed to protect. The soldiers guarding the castle
turn and attack it.
But what triggers autoimmunity to occur? Throughout human history, our exposure
to such myriad infectious agents has triggered an evolutionary arms race. Our
immune system has evolved increasingly sophisticated countermeasures and
recognition systems to combat the increasing diversity of the infectious agents
with which we come in contact. But this increasing sophistication comes with a
cost: an increased chance of the system breaking down. We have evolved right to
the edge of the immune system’s capacity.
Now, over the
last 40 years, something has been pushing that system over the edge. Something
is causing the immune system to increasingly make mistakes in which the line
becomes blurred, the immune system attacks the body itself, and autoimmune
disease occurs. In all likelihood, much of the reason for this often
catastrophic mistake of the immune system comes from the countless environmental
toxins to which we are currently exposed—toxins that interfere with the way the
immune system communicates with the rest of the body. To paraphrase W. B. Yeats,
when that communication is lost “things fall apart, the centre cannot hold.”
The numbers are
staggering: one in twelve Americans—and one in nine women—will develop an
autoimmune disorder. And since it is clear that not every patient with an
autoimmune disease is correctly diagnosed, the prevalence is certainly higher
than that. The American Heart Association estimates that by comparison, only one
in twenty Americans will have coronary heart disease. Similarly, according to
the National Center for Health Statistics, one in fourteen American adults will
have cancer at some time in their life. This means that an American is more
likely to get an autoimmune disease than either cancer or heart disease. Yet we
hear much more in the press about heart disease and cancer than we do about
autoimmunity. And this silence is mirrored in relative funding by the National
Institutes of Health, the major funding agency for biomedical research in the
United States. Though the NIH has expanded funding for autoimmunity
significantly over the last several years, the 2003 expenditure of $591.2
million is still only a fraction of the money spent for heart disease and
cancer. The NIH budget for cancer is over 5 billion dollars, ten times that of
autoimmune diseases. The NIH budget for cardiovascular disease is over 2 billion
dollars, four times that of autoimmune diseases. We have not yet recognized the
urgency of the autoimmune epidemic.
Why is the prevalence of autoimmunity increasing at such alarming rates? There
is almost universal agreement among scientists and physicians that the
environmental toxins and chemicals to which we are increasingly exposed are
interfering with the immune system’s ability to distinguish self from non-self.
Most of the risk of autoimmunity comes from environmental exposures rather than
from genetic susceptibilities. So, have those environmental exposures changed
over time? The answer is clearly yes. One example of this comes from a 2003
study in which blood and urine samples from Americans were tested for 210
substances, including industrial compounds, pollutants, PCBs, insecticides,
dioxins, mercury, cadmium and benzene. The volunteers, none of whom had any
occupational or residential risks for such exposure, had detectable levels of 91
of these. In other words, these are ordinary people with ordinary lives who have
numerous toxins in their body from ordinary exposure. In a 2005 study,
researchers found 287 industrial chemicals, including pesticides, phthalates,
dioxins, flame-retardants, and the breakdown chemicals of Teflon, in the fetal
cord blood of ten newborn infants from around the country—transmitted to the
infants by their mothers’ exposures before and during pregnancy.
We are facing
both an increasing prevalence of autoimmunity and an increasing exposure to
environmental toxins. Is it clear that the increased exposure of environmental
toxins is causing the increase in autoimmunity? Several lines of evidence
suggest that this jury, too, has issued the verdict — “guilty.” Researchers
recently showed that when added to the diets of rats, PFOA (perfluorooctanoic
acid, a breakdown chemical of Teflon and one of the chemicals found in the blood
panel screenings mentioned above), causes significant impairments in the ability
of rats to develop an appropriate immune response. Similarly, other researchers
showed that mice given organochlorine pesticides were much more susceptible to
getting the autoimmune disease lupus than control mice.
Are these data
absolutely definitive? It’s not clear that the type of exposure these animals
had is the same type that humans have. It’s not clear that lupus in animals is
the same thing as lupus in humans. It’s not clear that a rodent’s immune system
is the same as a human’s. Much more research needs to be done on this subject —
in the form of both epidemiologic (human population studies correlated with
exposures) and animal studies. Meanwhile, the difficulty in finding the smoking
gun/definitive evidence of causality is increased exponentially by the number of
chemicals to which we are exposed. Do we have to give animals the 287 compounds
found in the fetal-blood-cord study cited above to examine their combinatorial
effect on the immune system? Not only is such research impractical, it is
unethical and probably still wouldn’t be viewed by some as definitive.
There are some who
might say that this is nothing more than another case of ranting “the sky is
falling” when it’s really not. I suspect those might be the same people who
believe that the undeniable warming of the planet is simply a geological cycle
that has nothing to do with human activity. But taking these positions—that
environmental exposures are not adversely affecting our bodies’ health or that
we are not causing our planet to get hotter—is dangerous. To miss the
opportunity to change is to not only deny the evidence and miss what may be a
fleeting opportunity to reverse these trends, but also, ultimately, a selfish
position. What about our children and their children? If we have the opportunity
to make a healthier future for them but fail to act either because of
indifference or denial, what will tomorrow hold for them?
What is just as
disturbing is that only 5.4 percent of the NIH budget for autoimmunity is
dedicated to environmental factors that underlie autoimmunity. We need to
recognize the urgency of the autoimmune epidemic. And we need to take steps to
combat it. Future research is unlikely to define a single cause for
autoimmunity, but rather varied triggers that include environmental exposures
and infectious agents interacting in complex ways with an individual’s immune
system. This research will, in all likelihood, clearly establish the link
between these exposures and autoimmunity and will begin to define how these
exposures cause autoimmunity. We won’t be able to eliminate autoimmunity in the
future. Genetic predisposition and infectious triggers will always be with us.
But the fight against autoimmunity needs to be fought on several levels: more
extensive research, development of better therapies that more effectively treat
these diseases, and action to decrease our environmental exposures. The last
action will require personal responsibility, political action, and corporate
accountability. If we do these things, autoimmunity will be a cluster of rare
diseases that we treat with effective medicines. If we don’t, autoimmune
diseases will increasingly devastate families, including five-month-old babies,
and will increasingly tax our health-care system. If we don’t act now, it will
be too late.
The book that follows is astounding. It is a combination of touching personal
stories about individuals affected by autoimmune diseases and rigorous research
of the medical and scientific literature. It is the kind of book that will scare
you. It will make you angry. It will amaze you with the courage of some of the
people described in the book. Ms. Nakazawa examines all of the theories about
autoimmunity in detail, from heavy metals to toxic chemicals to viruses to
vaccines and finally to the hygiene hypothesis. The Autoimmune Epidemic
is every bit as compelling as Upton Sinclair’s groundbreaking novel The
Jungle and every bit as necessary as An Inconvenient Truth, the
startling movie featuring Al Gore and directed by Davis Guggenheim, that shows
us that global warming is upon us and may at some point in the near future be
irreversible.
You will leave this book with no reservations about the veracity of the
conclusions: put simply, there is no doubt that autoimmune diseases are on the
rise and our increasing environmental exposure to toxins and chemicals is
fueling this rise. The research is sound. The conclusions unassailable.
Ms. Nakazawa
introduces a term, “autogen,” used to describe chemical triggers of autoimmune
disease, drawing upon the term “carcinogen,” which denotes chemical triggers of
cancer. This term, which should become part of our society’s lexicon, may serve
as the clarion call for change that emerges from this book. The change needs to
take the forms of personal responsibility and societal change. Companies should
have to determine the effect of chemicals in developing autoimmunity as well as
cancer, and state and federal legislation is needed to compel corporations to
make this happen. This book will inspire you to want to do something to protect
yourselves and your loved ones; to do what you can to restore a healthy balance
between our environment and our bodies. What that something is will vary
depending on the individual. At a personal level, no single recommendation fits
all individuals and the degree to which an individual alters his/her environment
will depend on the levels of exposures and his or her susceptibility to
autoimmunity. The Autoimmune Epidemic ends with a logical and empowering
solution to protect yourself and your family and, in so doing, to begin the
process of cleaning up our environment in order to help reestablish a balanced
immune system in our bodies.
Reading The
Autoimmune Epidemic is a necessary first step. Reading The Autoimmune
Epidemic is a life-altering event. It needs to be.
Copyright © 2007 Donna
Jackson Nakazawa |
