Dyer R S, Sexton K
National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA.
Regul Toxicol Pharmacol. 1996 Aug;24(1 Pt 2):S139-51. doi: 10.1006/rtph.1996.0090.
Multiple Chemical Sensitivity (MCS), which may not be caused by chemicals at all, is a serious medical problem of unknown origin and uncertain etiology that raises many fundamental science and policy questions. Regulators, for example, are confronted with a dilemma: what, if anything, should be done to protect people from the scientifically uncertain health risks of exposures to extremely low levels of environmental chemicals. Regulatory agencies, such as the Environmental Protection Agency, do not have the luxury of waiting until conclusive scientific evidence is available before making a decision; however, our present lack of scientific understanding about MCS is so acute that it is not possible to ascertain whether the cause of MCS-related symptoms is chemical, biological, physical, psychosocial, or some combination thereof. Nevertheless, many MCS sufferers and advocates for the chemically induced hypothesis are clamoring for regulatory action to reduce putative health risks from very-low-level exposures to chemicals in the environment. Unless steps are taken to improve the quantity and quality of the existing scientific data base, we cannot, with any acceptable degree of certainty, evaluate the extent to which regulatory decisions about MCS are either protective of public health or cost-effective. This article examines how research can strengthen the scientific basis for risk-related decisions about MCS, and proposes a framework for establishing research directions and priorities. It is argued that high-priority research on MCS is distinguishable by four attributes: (1) results are valuable for risk-related decisions; (2) findings significantly advance scientific knowledge and understanding; and the hypothesis being tested is both (3) biologically plausible and (4) readily testable.
多重化学敏感性（MCS）可能根本不是由化学物质引起的，它是一个起源不明、病因不确定的严重医学问题，引发了许多基础科学和政策问题。例如，监管机构面临着一个两难境地：对于极低水平环境化学物质暴露所带来的科学上不确定的健康风险，应该采取什么措施（如果有的话）来保护人们。像环境保护局这样的监管机构没有等到确凿的科学证据出现后再做决定的奢侈条件；然而，我们目前对MCS缺乏科学理解的情况非常严重，以至于无法确定与MCS相关症状的原因是化学的、生物的、物理的、心理社会的，还是它们的某种组合。尽管如此，许多MCS患者和化学诱导假说的支持者仍在强烈要求采取监管行动，以降低极低水平环境化学物质暴露带来的假定健康风险。除非采取措施提高现有科学数据库的数量和质量，否则我们无法以任何可接受的确定性程度评估关于MCS的监管决策在多大程度上既能保护公众健康又具有成本效益。本文探讨了研究如何能够加强关于MCS的与风险相关决策的科学基础，并提出了一个建立研究方向和优先事项的框架。有人认为，关于MCS的高优先级研究具有四个特征：（1）结果对于与风险相关的决策有价值；（2）研究结果能显著推进科学知识和理解；并且所检验的假设同时具备（3）生物学上的合理性和（4）易于检验性。
