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    Re: More Pres of ACOEM responds to WSJ Article

    Posted by Sharon on 1/25/07

    More on the subject. Questions being asked of ACOEM President,
    Dr. Tee Guidotti's & his rebuttals regarding the WSJ article.

    >>> "Don Weekes" [email protected]> 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: [email protected] ;
    [email protected]
    Cc: [email protected] ; [email protected] ;
    [email protected]
    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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