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    Re: More Pres of ACOEM responds to WSJ Article

    Posted by Yumyum Stachylicious on 2/05/07

    Some very interesting quotes from Tee Guidotti in 2004 regarding
    silicosis, especially considering his looney defense of the ACOEM
    poisiton paper on mold:

    "I know from personal experience lots of silicosis is
    misdiagnosed or not recognized," says Tee Guidotti, M.D., Ph.D.,
    director of the division of occupational medicine and toxicology
    in the School of Medicine at George Washington University.

    "Because of their training, physicians typically don't ascribe
    diseases to work," explains Guidotti. "If you've been taught
    occupational diseases aren't common, you put them at the bottom
    of your list."

    Second, Guidotti believes that "in the field of occupational
    health, we are very quick to pat ourselves on the back for
    solving problems that haven't been solved at all."

    Gee. Ya think, Tee?

    On 1/25/07, Sharon wrote:
    > More on the subject. Questions being asked of ACOEM President,
    > Dr. Tee Guidotti's & his rebuttals regarding the WSJ article.
    >>>> "Don Weekes" 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: ;
    > Cc: ; ;
    > 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.
    > 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:
    >> 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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