To the editors:
I thought that Bob McClory's article on Candida-associated illness ["The Yeast of Our Problems," January 22] was interesting and well-written, but quite slanted, and I would like to offer a dissenting view. It seemed to me that Mr. McClory was wholeheartedly endorsing the validity of the concepts underlying the so-called Yeast Connection, with barely a reluctant nod to the great majority of physicians and scientists who take a very dim view of these unproven theories. The portrayal of a grand conspiracy involving greedy and unethical pharmaceutical companies, agribusiness and physicians in a cover-up to foster and then deny the existence of this alleged epidemic was particularly annoying and totally unsupported by facts.
I am an infectious diseases specialist practicing in Chicago and have had the opportunity to see half a dozen patients with this so-called syndrome in my practice. These individuals were all self-referred after receiving a diagnosis of yeast-associated illness elsewhere. These patients reported a very wide variety of nonspecific symptoms, but prominent among them were fatigue, malaise, difficulty concentrating and a variety of other psychomotor symptoms. Two of them were clearly suffering from severe depression and subsequently benefited from psychiatric intervention. None of these patients had any demonstrable abnormality on physical examination or screening laboratory studies that might explain their illness. I read the Bible of this field, Dr. Crook's book, The Yeast Connection, and found it an amusing collection of anecdotes and wild speculation. I advised each of my patients to discontinue their antifungal therapy.
Experienced clinicians know that a substantial number of patients presenting with physical complaints have no demonstrable organic basis for their symptoms. Some of these individuals have an underlying emotional disturbance which is responsible for their vague physical symptoms. This extremely common clinical entity is beginning to gain attention in the medical literature under the sobriquet "somatization disorder."
Many of these patients are extremely resistant to the suggestion that their symptoms have a psychological basis and cling ferociously to any oddball theory emanating from the pages of the National Enquirer which may ascribe their illness to an organic process. There are striking similarities between the "Yeast Connection" and another trendy nondisease, chronic Epstein Barr Virus (EBV) infection. Both "diseases" are so vague, nonspecific and utterly nondiagnosable by conventional medical tests that virtually anyone with any symptom can justly lay claim to a bad case of yeast connected illness, environmental illness, CEBV, or any combination of these afflictions.
There are several pitfalls in uncritically endorsing these seat-of-the-pants theories. The first is that if these patients are not seen by a competent physician, they may harbor an undiagnosed and hence untreated legitimate physical ailment while baking their newspapers to remove mystery toxins and attending their support groups. The second is that those individuals who suffer from treatable psychiatric illnesses are also being steered down the wrong path. Lastly, specific antifungal therapy for yeast sufferers is expensive and potentially toxic.
I heartily endorse Mr. McClory's call for more research into these nebulous entities, although their ephemeral nature will make them difficult to study in a rigorous manner. However, his endorsement of the peril of the "yeast epidemic" strikes me as uncritical, very premature and potentially harmful.
John P. Quinn, M.D.
Michael Reese Hospital