Re: [] Re: [Flood Relief Aid List] ACOEM Statement on Adverse HumanH...

[Guest guest]

More on the subject. Questions being asked of ACOEM President, Dr. Tee

Guidotti's & his rebuttals regarding the WSJ article.

>>> " Don Weekes " <_don.weekes@...@do_

(mailto: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.

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. 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. 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. 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 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

Hardin and Bruce Kelman and UCLA's 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. 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.

nne Dreger, Communications Director of ACOEM blasted an email to

all the member of ACOEM

on behalf of the then President, 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 on Nov 28, 2006 Dr. Saxon says ACOEM

was told of his Conflicts of Interest.

Testimony of ACOEM author, Saxon, Nov 28, 2006

15 Q. And testifying in mold cases on the defense

16 side started sometime in 1999. Is that approximately

17 correct, according to your testimony?

Page 174

15 Q. And when that paper was published by ACOEM,

16 there is no conflict-of-interest advisory regarding you

17 in that paper, is there?

18 A. I think it had been filed, but they didn't

19 publish it. I think it says something to the effect

20 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 colleaguesâ€

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. "