Donna Jackson Nakazawa has written a prophetic book, but not an entirely objective book. She is truly passionate about the topic of autoimmune disease and its potential links to environmental degradation and the lax regulation of foods and consumer products containing harmful substances. Given that she suffers from an autoimmune condition, one can understand her motives. However, the reader must account for that fact and take a step back from what she presents. There are legitimate reasons to suspect that many Americans are increasingly at risk of developing chronic autoimmunity because of "better living through chemistry". But much of the data and research needed to support this theory is incomplete. This is certainly a topic that needs public attention, but one that could be discredited if embraced too quickly.
The author interweaves human stories regarding the angst of having a strange and not fully understood medical condition with a bevy of facts and concepts about autoimmune disease. She also throws in a pinch of politics, as she narrates the struggles of communities seeking bureaucratic acknowledgment of disease clusters occurring near toxic waste sites. Her stories are compelling, and her knowledge of the processes of the immune system and its interactions with harmful substances such as mercury and TCE is extensive. Unfortunately, she fails give her readers "the big picture" of immunity and autoimmunity. As such, her references to CD44 proteins, toll-like receptors and other mechanisms of the immune system are scattered and disjointed.
Ms. Nakazawa provides an extensive notes section that backs up much of what she asserts. However, there are curious gaps for some of her more important and interesting claims. For example, on page 53 she talks of the "education process" in the thymus for T-cells, without any references that might assist the interested reader. On page 75, she says "if you were to look today at a chart detailing increasing rates of autoimmune disease . . " However, no citation follows. It would be nice to know where to find those charts or even see them in the book! Then on page 150, she talks about the process by which mercury forms hybrid proteins in the body, without any citation.
Regarding the studies listed in the notes about the influence of toxins on autoimmune response, one sees that most are mouse studies. Most of the supporting materials regarding disease clusters are small studies or local reports from about 12 cities. Nakazawa does not list any national studies comparing incident rates across a large number of toxic sites, and offers no references to investigations seeking common etiological factors across cluster victims. She focuses on a lupus cluster in the city of Buffalo and an academic study that was started after much bureaucratic footdragging. However, Ms. Nakazawa leaves us hanging, as the study was "not yet wrapped up" at the time of publication.
Furthermore, most of the autoimmune incidence studies that Nakazawa cites are time-limited and based on small geographic areas (sometimes in foreign nations). The only nationwide study cited regards lupus over the years 1950 to 1992. Nakazawa does not provide any sources concluding that all or most autoimmune conditions have an increasing incidence trend (although many studies show an increasing PREVALANCE, partly because of better recognition of autoimmune disease by medical workers in recent years). The author herself admits that reliable nationwide information regarding autoimmune conditions is not collected, as with AIDS and cancer.
Two more points: in several places, Nakazawa indicates that autoimmune diseases are primarily triggered by the process of viral molecular mimicry. Other sources, including The Merck Manual and William Clark's In Defense of Self, say that mimicry is one of several possible autoimmune "vectors", which may be relevant in different proportions to different diseases. I.e., one size does not fit all. Ms. Nakazawa does acknowledge these other factors, but conflates them under her "barrel" theory (which might be better described as a "tipping point" or "transition from order to chaos"). By putting everything into her allegorical barrel, environmental toxins always get in on the act. Also, Nakazawa gets behind the autism / thimerosal theory despite recent studies that conclude against it. Thimerosal, a mercury-based substance added to vaccines as a preservative, was removed from infant vaccines in California in 2001; however, studies there show that the child autism rate continued to climb.
The central premise of "The Autoimmune Epidemic" raises an obvious question: why now? Before the formation of the EPA in 1970, US citizens were exposed to many toxic pollutants that have since been eliminated or controlled. Also, since the late 1980s our economy has deindustrialized, and much of the toxic residue from our industrial past has been contained in Superfund cleanups (if imperfectly). Our paints and gasoline no longer have lead, we no longer dust our gardens with DDT, we no longer clean our paintbrushes with benzene. I feel that Ms. Nakazawa owes us a more careful analysis of whether the average American is now exposed to greater or fewer toxins. Perhaps we are exposed to different ones; but why should that set our immune systems reeling, when the old ones didn't?
In my opinion, the immune system and its disorders are an extremely important health topic. Many important discoveries are expected which will greatly increase our knowledge of the body's workings and its complicated responses to disease and injury. This will set the groundwork for therapeutic advances rivaling the antibiotics revolution of early 20th century. Toxic chemical exposure from the environment and from home products and the food chain could well be a contributor to the increasing incidence of certain autoimmune conditions. However, commercial interests having high levels of resources will challenge any public policy response. Recall how long they dragged out the global warming debate. Donna Jackson Nakazawa has taken a brave first step in garnering public attention, but carefully developed scientific evidence will be needed if her "epidemic" contention is to hold.