Re: More Pres of ACOEM responds to WSJ Article

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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
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: 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