I was reading an article about a real life Dr house in nyc, he takes on cases nobody else can figure out. In the article several people ended up having environmental causes to their illnesses. One woman has a small gas leak in her apartment, one lived in a trailer built on an oil petroleum plant, one had heavy metal poisoning, etc. After correcting those issues their health improved.
Is there a type of physician devoted to things like environmental toxins and how they relate to disease? Is toxicologist a medical residency program and a recognized field of Medicine?
In Canada, at least, there is a Royal College recognized specialty of, and postgraduate training program in, Clinical Pharmacology and Toxicology (to be clear, this is one speciality, not two). Although most graduates of the program tend to be more focused on the ‘pharmacology’ aspect, many will also function as the de facto toxicologist when the need arises.
Real world practice in the specialty tends to involve drug interactions, drug allergy and sensitivity, and the entire spectrum of poisonings. Less often would specialists in the area manage people with venomous bites and stings, and, as you wondered, environmental exposures (e.g. carbon monoxide, lead).
Here is a website to certification board for medical tox.
Not many tox MDs around, usually only in big cities. I suspect it is not that profitable a specialty. Also I think a huge number of exposure cases go undiagnosed. The are a large number of idiopathic pancytopenia cases in my area, and nobody seems to really care why. Just treat the symptoms and hope it goes away.
Forensic Tox is another matter. When people are dead, then everybody gets interested.
Are we talking about Thomas Bolte? He’s simply an Internist. And a little crazy. And more than a little self-promoting. But I’d love to hang out with him.
I guess part of the issue is that once you figure out what the toxin is, treatment is fairly straightforward. Just stop the exposure and wait for your body to remove the built up toxins. I don’t know if any treatments exist to speed the removal of the toxins (maybe soluble fiber, I don’t know) However finding out what hte toxin is is the hard part and you’d assume there would be a medical field devoted to checking for various kinds of poisoning (metals, various organic compounds, black mold, etc).
Most of the problem with treatment is getting an accurate diagnosis.
If the disease isn’t diagnosed , then who are you going to get treatment from ?
Basically, if you work in industry, and turn up at the local doctors or hospital with a serious illness, they will try diagnosis , and then screening, for the toxins that you might be exposed to.
If your work place was a dioxin risk, they’d know to test for dioxin.
A true case of poisoning would probably result in wider goverment (eg USA’s CDC) becoming involved …at least to supervise treatment protocol.
There seems to be a world of difference between trained toxicologists and internists who are knowledgeable about true environmental toxins (carbon monoxide, industrial chemicals etc.) and (on the other hand) “environmental medicine specialists”.
The latter include docs certified by a board that is not affiliated with the American Board of Medical Specialties, and which has been criticized for promoting questionable therapies.
“The poster boy for environmental medicine is Dr. William Rea, who was profiled on “Nightline” in 2008. They interviewed Rea and toured his clinic, seeing the detoxification saunas, the ceramic walls chosen because they are nonreactive, and the exercise machines that were cleaned of the lubricants that were putting fumes into the air. He claimed to have successfully treated 30,000 patients. They asked him about allegations that he had injected jet fuel into patients, and he explained that he only injected jet fuel antigens as a skin test for allergy. They asked him where his research was published and he evaded a direct answer, saying things like “The New England Journal of Medicine is a drug company journal.” (!?)”