Dr. Guidotti, President of ACOEM makes statement re: WSJ on the ACOEM Chatboard

[Guest guest]

On 9 January 2006, the Wall Street Journal ran a front-page story on the

ACOEM Statement on Adverse Human Health Effects Associated with Molds in the

Indoor Environment. The College would like to address points raised in the three

or four postings to the List in response.

What is lost in the WSJ article is the technical accuracy of the statement.

The contentious issue at hand is not damp spaces or the association of mold

and mold spores with allergic, infectious, or irritating conditions. It is

whether the metabolic products of mold known as mycotoxins, absorbed through

biological particle inhalation in indoor air, is responsible for systemic human

disease under conditions encountered in normal life, an unproven theory

called “toxic mold†in the vernacular. The weight of evidence to date,

despite

years of investigation, does not support that it is and seems unlikely to shift

with new findings.

ACOEM is not alone in its interpretation of the evidence. For reasons that

are unclear, Mr. Armstrong, the WSJ reporter, chose to imply that the

ACOEM statement is at odds with the report of the Institute of Medicine, Damp

Indoor Spaces. (See below.) A careful reading of both will show that the two

are compatible, as are both with the recent statements of the American Academy

of Asthma, Allergy, and Immunology, and the American Academy of Pediatrics.

The reason that the ACOEM statement has attracted so much attention is that it

was issued relatively early and was put to use by litigants. The IOM, AAAI

and AAP statements are now probably cited in testimony as or more often.

The article includes an indirect quote attributed to me that “no disclosure

is needed because the paper represents the consensus of its membership and is

a statement of the society, not the individual authors.†That is a correct

description of the policy in force at the time the statement was released but

it has to be read in the context of what Mr. Armstrong, unfortunately, chose

to place much later in the article: the description of the formal and

accountable process by which the statement was prepared and fnally approved.

The statement was initiated by the College precisely because the topic is

important in environmental medicine. The lead author who was chosen (a retired

Assistant Surgeon General) had no conflict of interest at the time. The

statement was substantively revised four times, in a process closely managed by

the chair of our Council of Scientific Affairs. It then underwent three levels

of review (Council, Board committee, full Board) before finally being

approved by the elected representative governing body, the Board of Directors

of the

College.

Two correspondents stated that the membership had no opportunity to comment

on the statement. In fact, a notice was published on the front page of the

fall 2002 issue of ACOEM Report, a newsletter (now replaced by ACOEM eNews)

then distributed to all ACOEM members. A well-attended session on mold, which

featured the statement and the rationale behind it, was held at the 2003

American Occupational Health Conference, with lots of opportunity for open

discussion.

The WSJ article implies that there is an extensive scientific debate on this

topic. The reality is that there are rather few scientists who embrace the

theory of “toxic mold.†The mainstream of medical opinion does not. We

stand

behind the conclusions of the statement while remaining open to new evidence

in the future.

Tee L. Guidotti, MD, MPH

President

American College of Occupational and Environmental Medicine

Addendum

Summary of Findings [of the Institute of Medicine] Regarding the Association

Between Health Outcomes and the Presence of Mold or Other Agents in Damp

Indoor Environments. (Reformatted from Table ES-2 and slightly abridged.)

Sufficient Evidence of a Causal Relationship

(no outcomes met this definition)

Sufficient Evidence of an Association

Upper respiratory tract symptoms, asthma in a sensitized person,

hypersensitivity pneumonitis, wheeze, cough

Limited or Suggestive Evidence of an Association

Lower respiratory illness in otherwise-healthy children

Inadequate or Insufficient Evidence to Determine Whether an Association

Exists

Dyspnea, airflow obstruction (in otherwise-healthy person), mucous membrane

irritation syndrome, chronic obstructive pulmonary disease, inhalation fevers

(nonoccupational exposures), lower respiratory illness in otherwise-healthy

adults, rheumatologic and other immune diseases, acute idiopathic pulmonary

hemorrhage in infants, skin symptoms, asthma development [other than

sensitization], gastrointestinal tract problems, fatigue, neuropsychiatric

symptoms,

cancer, reproductive effects

Note that the IOM’s summary does not apply to immunocompromised individuals,

who are susceptible to colonization and infection.