Dr Edward Boyer Speaks on Ohio Train Derailment: Exposure Risks, the Nocebo Effect

Individuals with adverse symptoms were most likely exposed to chemicals from the train derailment, but one should also consider other possibilties, such as the "nocebo" effect, says Edward Boyer, MD, PhD, medical toxicologist, emergency medicine physician, and professor of emergency medicine at The Ohio State University..

Transcript

Could toxic exposure from the train derailment in Ohio be causing residents to smell chemicals, feel ill, or develop rashes?

It's difficult to say. I want to be very clear in what I'm about to say here. These individuals likely were exposed; the exposure is known. There was a wonderful paper in The New England Journal of Medicine many years ago, which I think highlighted the value of the nocebo effect, but also provided some indication of how the nocebo effect can manifest after a toxic exposure.

The nocebo effect is: If I tell you that I'm going to do something to you that's very, very painful, your perception of pain is actually going to be greater than if I told you this is not going to be a painful procedure whatsoever. The New England Journal of Medicine publication from several years ago is a little bit different. There was no exposure that happened there. And exposure happened in East Palestine, Ohio—so I want to make sure that I highlight the differences.

But the title of the New England Journal paper was “Mass Psychogenic Illness” in a Tennessee high school. The interesting thing about it was that it started off with, I believe, a teacher saying that she smelled something bad. Then other people smelled bad things. Pretty soon, there were large numbers of individuals who developed complaints. Everybody was sent home, nobody would go back into the building, the Centers for Disease Control did a very deep dive into everything in this school and found absolutely nothing. So again, to highlight the difference, there was no exposure at this Tennessee School, there was exposure in East Palestine, Ohio. But that provides us with some information on how we should move forward.

Individuals who have rashes should see a dermatologist so that an independent objective observer can see the rash for themselves and determine if it's potentially associated with a chemical exposure vs something else. For people who experience chemical smells, I can see why there's a chemical smell there in East Palestine, Ohio. They burned off tons of material, so I have no doubt that there could be a smell lingering around the town.

But the take home message here is that if there is a medical complaint, if there is a cough, shortness of breath, rash, headache, abdominal pain, it's important to see an expert so that independent objective testing can be done. Because in the Tennessee case, every complaint that people had was purely subjective and not validated, or at least not verified by anybody in almost real time. Even the rashes couldn't be observed by anybody independently.

It pays—because we don't know what we're looking for necessarily after exposure—to cast a wide net and have people see their physician, have people referred to a specialist if their physician cannot or lacks the clinical expertise to evaluate a condition, and then move forward from there.