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    Re: More Pres of ACOEM responds to WSJ Article

    Posted by Clark on 2/18/07

    On 2/05/07, Yumyum Stachylicious wrote:
    > Some very interesting quotes from Tee Guidotti in 2004 regarding
    > silicosis, especially considering his looney defense of the
    > 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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