Permission to repost. In December, the "Journal of the Royal Society of Medicine" published an article titled "Taking refuge from modernity: 21st century hermits" authored by I Boyd, G J Rubin and S Wessely (see abstract below) In response, Professor Martin Pall submitted the following letter to the editor but it was rejected. Here is Professor Pall's letter: Taking refuge from modernity: 21st century travesty? Wessely and colleagues argue that multiple chemical sensitivity (MCS) and electromagnetic field (EMF) hypersensitivity (EHS) are simply contemporary ways that allow people to isolate themselves from society, arguing that these are not true sensitivities to chemicals or EMFs1. I was honored to be chosen to write an authoritative review on MCS, by three eminent toxicologists (the editors2). It was clear that they thought that MCS was a disease of toxic exposure. Why else ask for such a paper? Among the papers that convincingly show that are studies of Schnakenberg3,4, showing that four polymorphic genes involved in the metabolism of chemicals implicated in MCS had highly significant roles in determining MCS susceptibility (p<10-15 for all four occurring by chance!). These followed studies by McKeown-Eyssen, implicating three such chemical metabolism genes and by Haley implicating one such gene. In all, seven such genes were implicated, all having roles in chemical metabolism. How can all this be true if chemicals have nothing to do with MCS? Wessely has no answers1. The seven classes of MCS-implicated chemicals act to produce elevated NMDA activity2. Six other types of evidence suggest NMDA elevation has roles in MCS2,5 ; one of these involves two genetic polymorphism studies, both showing that alleles of the CCK-B receptor gene that produce an elevated NMDA response are associated with increased MCS susceptibility. There are many other studies showing real physiology in MCS, including 25 studies on objectively measurable changes in response to chemical exposure, where MCS patients differ from normals. 24 of these are completely incompatible with psychological interpretations2. Many human studies and 38 animal model studies show physiological changes with apparent causal roles2. Shouldn’t Wessely inform readers of the vast evidence that argues against his hypothesis? Reference 2 is 50 pages, containing 427 citations. Letters limited to 300 words, 5 citations. Martin L. Pall, Professor Emeritus of Biochemistry and Basic Medical Sciences, Washington State University, 638 NE 41st Ave., Portland, OR 97232-3312 USA; Email: firstname.lastname@example.org Competing interests: none declared. References 1. Boyd I, Rubin GJ, Wessely S. Taking refuge from modernity: 21st century hermits. J R Soc Med 2012:105:523-529. 2. Pall ML. Multiple chemical sensitivity: toxicological questions and mechanisms. In: Bryan Ballantyne, Timothy C. Marrs, Tore Syversen, editors. General and Applied Toxicology, 3rd Edition. London: John Wiley and Sons, Ltd., 2009 p. 2303-2352. 3. Schnakenberg E, Fabig KR, Stanula M, et al. A cross-sectional study of self-reported chemical-related sensitivity is associated with gene variants of drug metabolizing enzymes. Environ Health 2007;6:6 . 4. Müller KE, Schnakenberg E. Die Bedeutung de Glukuronidierung bei unweltmedizinischen Erkrankungen am Beirspeil der UDP-Glukuronosyltransferase 1A1. Umwelt-Medizin-Gesellschaft 2008;21:295-300. 5. Pall ML. NMDA sensitization and stimulation by peroxynitrite, nitric oxide and organic solvents as the mechanism of chemical sensitivity in multiple chemical sensitivity. FASEB J 2002;16:1407-1417. .................................................... http://jrsm.rsmjournals.com/gca?gca=jrsm;105/12/523&submit=Get All Checked Abstracts Abstract Review: I Boyd, GJ Rubin, and S Wessely Taking refuge from modernity: 21st century hermits J R Soc Med December 2012 105:523—529; doi:10.1258/jrsm.2012.120060 Idiopathic environmental intolerances, such as ‘multiple chemical sensitivity’ and ‘electrosensitivity,’ can drastically affect the quality of life of those affected. A proportion of severely affected patients remove themselves from modern society, to live in isolation away from the purported causal agent of their ill health. This is not a new phenomenon; reports of hermits extend back to the 3rd century AD. We conducted a literature review of case reports relating to ancient hermits and modern day reclusion resulting from idiopathic environmental intolerance, in order to explore whether there are similarities between these two groups and whether the symptoms of these ‘illnesses of modernity’ are simply a present-day way of reaching the end-point of reclusion. Whilst there were some differences between the cases, recurring themes in ancient and modern cases included: dissatisfaction with society, a compulsion to flee, reports of a constant struggle and a feeling of fighting against the establishment. The similarities which exist between the modern-day cases and the historical hermits may provide some insight into the extreme behaviours exhibited by this population. The desire to retreat from society in order to escape from harm has existed for many centuries, but in different guises.