1/18/2007
2:02 PM
>>>
RE: [Flood Relief Aid List] ACOEM Statement on Adverse Human
Health Effects Associated with MoldsOne additional problem with
the ACOEM rebuttal is that it does not address the issue of the
ACOEM's authors'conflict of interest when they wrote the
statement. As noted by Mr.Prezant, the fact that the primary
authors of the statement work almost exclusively for the
defense bar should have been disclosed in 2002, and any update
of the 2002 ACOEM statement should include such a disclosure.
This would have been helpful to all who read the statement in
understanding the lack of neutrality of the authors regarding
the health effects associated with mold exposure.It would helpful that, as a policy, ACOEM disclose the
affiliation of the authors of any such statement in the future.
After the AAAI statement came out, the disclosure of the
authors' work affiliations was published. This should be done
by ACOEM, even at this late date, so that judges and juries can
understand who wrote this material.
----- Original Message -----
From: Brad Prezant
To: flood_relief_aid_2002@yahoogroups.com ;
flood_relief_aid_2002@yahoogroups.com
Cc: iequality@yahoogroups.com ; eohtlg@gwumc.edu ;
jholland@u.washington.edu
Sent: Wednesday, January 17, 2007 3:40 AM
Subject: RE: [Flood Relief Aid List] ACOEM Statement on Adverse
Human
Health Effects Associated with Molds
It is appropriate and appreciated that the ACOEM seeks to
clarify the compatibility of their Statement with the published
literature and the IOM mold document. There however remains the
issue that the lead authors of the article and their associates
have consistently, and intentionally, sought to confuse the
issues of mycotoxin toxicity with irritant and allergenic
effects associated with damp environments. It is no coincidence
that these individuals work almost exclusively for the
defense bar. When queried under deposition, these individuals
do not seek to clarify this relationship, but conveniently
leave out the portion related to allergenic and irritant
effects. In one deposition taken prior to the issuance of the
IOM mold document, the expert was "unfamiliar" with the 2000
IOM document (Clearing the Air) on asthma which included
virtually identical conclusions as the later document
addressing mold. At the time, this document was familiar to all
individuals who took a professional interest in health effects
associated with damp and/or moldy environments. I personally
consider this somewhat unethical (telling part of but not the
entire story). I have read many such depositions, and attended
presentations to professional peer groups where a similar
approach was taken. Unfortunately, the manner in which the
ACOEM document is drafted, and the consistency with which it is
summarized by the authors and their associates, is compatible
with this approach.
The distinction between health effects from one causation
mechanism versus another (local verus systemic) are typically
lost on the general public, and unfortunately, often on the
attorneys and judges who are responsible parties in the legal
system. A strong statement from an expert that mold is not
toxic (although I would question the assumption that irritant
and/or allergenic effects are neither systemic nor within
the definition of toxicity) is interpreted as meaning that the
plaintiff's claims of health effects associated with mold are
not valid. I have seen this happen repeatedly in the legal
system.
It would be appropriate for ACOEM to issue an update to the
Statement in which this issue is clarified, drafted by
disinterested and qualified parties (a Ph.D toxicologist is not
necessarily competent and experienced in evaluating the
epidemiologic literature, although some do have qualifications
and experience in epidemiology) . A major goal of such a
document would be to correct the perception in the general
public and perhaps among professionals who did not read the
document carefully that ACOEM does not recognize health effects
associated with mold.
Guidotti reply:
This message has come to my attention. The statements are
incorrect, which may reflect an uncritical reading of the story
in WSJ.
The lead/responsible author (who, by the way, is a former
Assistant Surgeon General) did not have a personal conflict at
the time he was commissioned to write the draft statement. On
what grounds, exactly, would disclosure have been required in
2002?
Another is that the statement went through five drafts (four
revisions) and was reviewed at three levels within the
organization, ultimately by the duly-elected governing body.
Further, by the end of the process the document was
substantially changed from the product of the original
author. At all stages, members familiar with the issue read it
carefully and approved it.
The WSJ also suggested, incorrectly, in the story that an email
from 2002 impugned the balance of the statement. The email
referred to the second draft only prior to the third revision,
and documented what needed to be done to improve it. If
anything, this is an example of balance that was achieved by
ACOEM on the issue by careful management of the process.
Dr. Amman, the IOM committee member quoted as critical of the
statement, was herself the subject of a disclosure on the WSJ
website the day following the story, having understated her
paid expert witness service.
Your comment does not address the accuracy of the statement.
The ACOEM document does not, in fact, contradict the IOM,
AAAAI, or AAP statements. The document is very clear in
referring to mycotoxin-induced disease in its conclusions.
Finally, we note that Mr. Prezant and Mr. Weekes serve as expert
witnesses in such mold-related cases. Potential conflicts of
interest were not disclosed in the email exchange on which I
was copied. I am sure that this was just an oversight.
Your message was my first contact with the "Flood Relief Aid
List." This appears to be a list of people genuinely concerned
about and engaged in flood relief and aid to people who must
desperately need it. I expect that list members rely on this
List for professional and humanitarian information. They have
now been given a false impression of the integrity of our
organization, one that they might otherwise rely upon
for the evaluation of relevant evidence and, critically, in the
protection of workers involved in flood-related emergency
preparedness, health protection of first responders, and health
protection of workers engaged in recovery.
All this is not to impugn the motives or minimize the
legitimacy of the concern expressed by Messrs. Prezant and
Weekes. However, before broadcasting misinformation to list
members engaged in such important and serious work, would it
not have been a good idea to get the facts straight?
Tee L. Guidotti, MD, MPH
President, ACOEM
Dr. Guidotti,
The ACOEM Mold Statement has been a point of contention over
the mold issue from it's inception. This is primarily for two
reasons:
1. ALL scientific papers have come to the conclusion it is
indeterminable at what dose humans exhibit
illness from mycotoxin exposure within an indoor
environment. Only ACOEM and papers that cite ACOEM make the
finding that it is implausible a human could ever be
exposed to enough mycotoxins within an indoor environment
to elicit symptoms of ill health. In other words, only
ACOEM professes to be able to determine dose/threshold from
the matter. This finding of ACOEM does not reflect the
serious illnesses many complain of after excessive
mold/toxin exposure within a water damaged building. Nor is
the manner in which the authors came to this conclusion
based upon accepted scientific methodology.
The authors applied extrapolated math to the data from a
single, high dose, acute rodent study and then directly
correlated it to be indicative of human exposure from
indoor mycotoxin exposure. This is not accepted scientific
protocol, nor has it ever been. It is a non-sequitured
conclusion that has never been replicated before or after
the ACOEM mold statement. None of the 83 papers supposed
referenced for this review piece make this finding.
In addition, it is specifically spelled out within the IOM
Damp Indoor Spaces Report that one cannot scientifically do
what ACOEM did to determine absence of human illness
from indoor mold/mycotoxin exposure. Therefore the ACOEM
Mold Statement is NOT consistent with the findings of the
IOM or (any scientific research regarding human illness
from indoor mold/mycotoxin exposure, for that matter). And
even though this concept has been broadly marketed by
commerce and copied by other associations, ACOEM does
indeed stand alone in professing to be able to make this
significant finding that is causing much of the continued
contention over the mold issue.
2. There seems to be some discrepancies regarding what ACOEM
knew of the backgrounds of those they specifically brought
in to their organization to author the mold statement:
GlobalTox (Veritox) Principals Bryan Hardin and Bruce
Kelman and UCLA's Andrew Saxon. It is not logical that
ACOEM would specifically bring in three gentlemen to author
an important paper such as this, without knowing the
chosen authors' backgrounds. GlobalTox had been doing
expert testimony for the defense in mold litigation since
1999, as had Dr. Saxon. To say Dr. Hardin had no conflict
of interest at the time he authored the mold statement
would not be correct. He is a principal of GlobalTox. T
the time he was an employee of GlobalTox. As such, he
generates income by having a defense argument strengthened
by the imprimatur of an esteemed medical association.
Dr Borak even acknowledged this fact when he wrote in an email,
9/10/02 that the ACOEM mold statement would have "currency in
other ways other places" for the GlobalTox authors.
Marianne Dreger, Communications Director of ACOEM blasted
an email to all the member of ACOEM on behalf of the then
President, Edward Bernacki on Nov 6, 2002. The email
said: "Your Board of Directors recognizes that mold is a
potentially controversial topic. Because of that
potential for controversy, this evidence based paper
faced strenuous and extensive peer-review and a "Conflict
of Interest" statement was obtained from the authors of
the paper."
In addition, when testifying under oath in 2006 Dr. Saxon says
ACOEM was told of his Conflicts of Interest.
Testimony of ACOEM author, Andrew Saxon, 2006
Q. And testifying in mold cases on the defense
side started sometime in 1999. Is that approximately
correct, according to your testimony?
Q. And when that paper was published by ACOEM, there is no
conflict-of-interest advisory regarding you in that paper,
is there?
A. I think it had been filed, but they didn't publish it. I
think it says something to the effect they're on file. We
provided them for sure.
So I am certain, Dr. Guidotti, you can understand people's
concerns with validity and genesis of the ACOEM Mold Statement.
1. It has a non-sequitured conclusion that has been used
extensively within the courtroom to deny financial liability
for defendents in mold litigation by denying the severity of
illness for those exposed.
2. It was authored by known expert witnesses for the defense in
mold litigation..who were specifically brought into ACOEM to
write it.
If one reads the WSJ article carefully, it is easy to
understand that these are the two points that would cause the
story of the ACOEM mold statement, to make front page news.
Strong indications are that the ACOEM Mold Statement is not
borne of sound science. It was penned, legitimized and
promoted by Conflicts of Interest.
online.wsj.com/article/SB116831654647871083.html?
mod=hpp_us_pageone
Sharon Kramer
Addendum: Statement of a friend.
"He keeps saying Dr. Hardin was free of conflict. He was a
defense expert during the time the draft was being written; it
is clear from the start that he was associated with GlobalTox
and that he and “his GlobalTox colleagues” would be doing the
work on the draft; and there is no question GlobalTox was an
expert firm for the defense in mold cases. Also, still
unanswered, is why ACOEM turned to an “expert” to lead this
effort who was neither a member of ACOEM nor an expert in mold
issues."
Sharon
On 1/25/07, MBobMean wrote:
> Actually Sharon, the NSC published a brief review that echos
> teh findings of the ACOEM. I have never found the NSC to be
> corporate shills or doubters, simply people concerned with
> what could and could not be established. See it at:
>
> https://secure.nsc.org/public/issues/mold.pdf
>
> Also, the ACOEM acknowledges some potential health effects
> from mold exposure:
>
> "A growing body of literature associates a variety of
> diagnosable respiratory illnesses (asthma, wheezing, cough,
> phlegm, etc.), particularly in children, with residence in
> damp or water-damaged homes (see reviews 3-5). Recent
> studies have documented increased inflammatory mediators in
> the nasal fluids of persons in damp buildings, but found
> that mold spores themselves were not responsible for these
> changes.6,7 While dampness may indicate potential mold
> growth, it is also a likely indicator of dust mite
> infestation and bacterial growth. The relative contribution
> of each is unknown, but mold, bacteria, bacterial
> endotoxins, and dust mites can all play a role in the
> reported spectrum of illnesses, and can all be minimized by
> control of relative humidity and water intrusion."
>
> Why are you being so hard on them? They're simply
> explaining the state of the available evidence. I wasn't
> impressed with the WSJ piece, I don't think newspaper
> reporters typicall--regardless of how exhaustive they say
> their reserach is--are terribly accurate or qualified, and I
> certainly agree that the evidence to date is lacking for
> many of the cause and effect associations that have
> been "hinted at" in many case reports, but that molds are
> certainly, or certainly can be, allergens and sensitizers
> and make people sick.
>
> What's so terribly wrong with that?
>
> mbobmean
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