SPOOF OF GUIDOTTI'S RESPONSE TO THE WSJ ARTICLE.

[Guest guest]

THIS IS A SPOOF.

THE ACTUAL WRITING OF DR. GUIDOTTI IS

BELOW.

From Your President: Ambush of the Mold Victims

The American College of Occupational and Environmental

Medicine (ACOEM) performs a great deal of unrecognized

disservice to medicine and a service to the litigation

community as a first line of defense while promoting

questionable practice. Because people tend to project their

fears and beliefs about financial liability of health

threats of their poorly maintained environment, our

practices and clinics disproportionately attract the

worried, the obsessed, people who disagree with science and

medicine, and “true believers.†This comes with the

territory, given our commitment to environmental medicine

in conjunction with the financial liability for the Fortune

500 companies many of us are employed by. Our thankless

role, when confronted with unsupportable beliefs, is to

review the evidence, to explain patiently, to say “no†when

it is required or we are on the witness stand, and not

infrequently, to promote abuse of true science. We took a

lot of justified abuse last month. We are anticipating much

more in the months to come.

On 9 January 2007, the Wall Street Journal ran a front-page

story on the 2002 ACOEM statement on Adverse Human Health

Effects Associated with Molds in the Indoor Environment.

The article was highly accurate. The reporter,

Armstrong, reported key facts, illuminated a conflict of

interest, and represented similar statements by other

groups with which ACOEM was compared. Within hours, blogs

and legal web sites had picked up the story in what bore

all the earmarks of a coordinated, and very effective,

campaign. Your College officers answered as best we could,

posting after posting. Remarkably, interest in the story

has caught the attention of national legislators. Within

mold litigation, several cases around the US settled within

days of the Wall Street Journal article. Of course, the

seeds of distrust were sown widely on the Internet for

future eruptions.

Your officers submitted a letter to the editor (posted on

the ACOEM web site) well within the time the WSJ allowed,

but they declined to publish it. No reason was given. Last

week we filed a complaint. Our prediction is that they will

ignore it because it is full of false and rambling

diatribes.

By now, it should be obvious that there is an agenda at

work. The ACOEM statement is poorly researched and dated.

Over the last five years, it has been introduced many times

into evidence in court cases and (we now realize...and have

from it's inception) became perceived by the plaintiff bar

and the sick who are unable to receive proper medical

treatment, as a major obstacle. What we experienced in

January was a campaign to discredit the statement by

bringing the truth to light (and by extension ACOEM) so

that it could not be used in court. This is because the

courts have been driving the medical science. We helped

extensively with that. An activist in the “toxic moldâ€

community has, in fact, now taken credit for first making

the Wall Street Journal aware of the insidious story of the

Conflict of Interest within ACOEM. The reporter spoke with

myself and many who were involved in the fiasco, including

all three authors and the overseer of the peer review

process.

We feel sure that our statement was the focus of the attack

because it has an unscientific non-sequetur finding that we

legitimized as science. This finding has been quite useful

for defendants in mold litigation. ACOEM probably seemed an

easier target for exposing the truth than the American

Academy of Pediatrics and the Institute of Medicine (part

of the National Academy of Sciences), each of which

produced their reports after ours, because their reports do

not promote the same concept that we promote. These

organizations do not feel it is sound science to take

limited data from a rodent study and deduce absence of all

human illness like ours does.

However ACOEM, as a professional organization, is proving

to be no pushover. Quite similar to when President Bush got

caught lying about the weapons of mass destruction, we are

vigorously defending the statement within the professional

community. We are currently pushing out our message in

every way we can. Our backs are against the wall now that

we have been outed as such an industry friendly bunch. We

have fully documented the statement development process (if

needed for discovery, which happens occasionally when ACOEM

is subpoenaed in lawsuits where the statement is

introduced). However, we seem to have a little glitch in

exactly what we did regarding conflict of interest

disclosures and why we brought in three individuals with no

backgrounds in mold research to write our mold position

paper.

Turning to substantive issues, let me remind ACOEM members

of the background to the statement. We are not talking

about the association of mold and mold spores with

invasive, allergic, infectious, or irritating conditions.

The statement is perfectly clear that these are known and

accepted medical conditions. Likewise, the statement,

although it was written well before the Institute of

Medicine’s report Damp Indoor Spaces, does not suggest that

damp or moldy living environments are acceptable. Not at

all. It just falsely suggests that we have been able to

scientifically prove people cannot plausibly become ill

from mycotoxin exposure indoors. We are pretty proud of

this, as NO ONE else has been able to scientifically make

this claim. The insurance industry loves us.

The issue at hand is whether we have really been able to

prove the implausibility that the metabolic products of

mold known as mycotoxins, absorbed through inhalation of

spores and vegetative fragments in indoor air, are

responsible for systemic human disease under conditions

encountered in homes and offices, an unproven theory

called “toxic mold†in the vernacular. The WSJ article

denotes that there is an extensive scientific debate on

this topic. The reality is that few scientists associated

with ACOEM embrace the theory of “toxic mold†and many who

do are interested in it as a theory to be tested, not as a

belief, because these gentlemen are scientists who were

very disappointed with what ACOEM promoted as science with

regard to mold induced illnesses. The mainstream of medical

opinion, thanks to ACOEM, has decided that so far the

weight of evidence, in light of years of ignoring state of

the art investigation, does not support the theory.

The WSJ reporter, Armstrong, used selective quotes in

context from the Institute of Medicine’s report, Damp

Indoor Spaces, to demonstrate that the Institute’s

statement is at odds with ACOEM’s statement. That is

provably right and the Institute of Medicine report as been

used within the courts to discredit the methods ACOEM used

to make the unscientific finding of " not plausible " . Put

the two side by side and it is clear that one concludes

that the evidence for the existence of a “toxic moldâ€

effect needs further study and the other just added some

math to rodent data to make the finding of " not plausible " .

The WSJ also denoted that the statement was created for

purposes of litigation. It was. The statement was initiated

by your College precisely because the topic is important in

environmental medicine and mold lawsuits were of great fear

to those with financial liability of the matter.

The WSJ article proved that the “authors†of the ACOEM

statement were in conflict of interest. Let’s set the

record straight – The lead author chosen to develop the

statement was a retired Assistant Surgeon General, who

admits under oath that he was already involved in

supporting defendants in mold litigation when we brought

him in to author the ACOEM Mold Statement. He had much

conflict of interest at the time. In the course of

developing various drafts, he asked two colleagues

experienced in mold litigation support for the defense, to

supply information and analysis he needed to develop some

of his points – nothing unusual in that at ACOEM. He was

generous enough to acknowledge them with authorship credit

and it is actually their history of sometimes testifying in

mold litigation that is being attacked because this paper

really helped their businesses of expert witness testimony

quite a bit. For the record, however, the lead author was

always the responsible party. Authorship of an ACOEM

statement is not the same as authorship of a paper: the end

product is not the author’s property and can be – and often

is – changed without the author’s agreement. Yet, it was

the property of the authors when they were paid by the

think-tank, the Manhattan Institute to translate the

document into lay terms of stating that toxic mold

illnesses are simply a result of trial lawyers, media hype

and junk science. ACOEM credits authorship of statements

for the purpose of giving recognition for work done on its

behalf because we know these papers have " currency for them

in other ways, other places " , not to assign responsibility

or for disclosure. Incidentally, all this is

documented...ummm? somewhere.

In this case, your College adhered to its own rigorous

statement development process (developed in 2000 and

available on the ACOEM web site). And since we feel we are

above reproach, we do not really care what standards others

adhere to. The mold statement was substantially revised

four times to " tone " it down and get rid of " buzz words " ,

in a process closely managed by the chair of our Council on

Scientific Affairs. It then underwent three levels of

review (Council, Board committee, full Board) before barely

being approved by your elected representative governing

body, the Board of Directors of the College. All this is

also documented.

We take allegations and insinuations against the integrity

of the College and you, our members, very seriously. We

know many of you are quite embarassed by what your

governing body did over the mold issue. We hope you are not

mad at us for causing this to reflect on your personal

integrity. This whole episode has made us realize just how

important a role we play in promoting unscientific medical

beliefs. Seen another way, this attack was a backhanded

tribute to the growing industry influence of your College

and its despairation to being able to be the ones who

decide what is evidence-based medicine. It would not have

happened if your College had not taken an industry

friendly, yet unscientific stand on something important. It

would not have failed if your College had done the right

thing and backed it up with documentation and rigor..and of

course, legitimate science.

SPOOF OF Tee L. Guidotti, MD, MPH, FACOEM

ACOEM President'S WRITING.

ACTUAL WRITING BELOW:

From Your President: Ambush Above the Fold

The American College of Occupational and Environmental

Medicine (ACOEM) performs a great, unrecognized service to

medicine and to the community as a first line of defense

against questionable practice. Because people tend to

project their fears and beliefs about health onto

perceptions of their environment, our practices and clinics

disproportionately attract the worried, the obsessed,

people who disagree with science and medicine, and “true

believers.†This comes with the territory, given our

commitment to environmental medicine and to evidence-based

medical practice. Our thankless role, when confronted with

unsupportable beliefs, is to review the evidence, to

explain patiently, to say “no†when it is required, and not

infrequently, to take abuse. We took a lot of abuse last

month.

On 9 January 2007, the Wall Street Journal ran a front-page

story on the 2002 ACOEM statement on Adverse Human Health

Effects Associated with Molds in the Indoor Environment.

The article was highly misleading. The reporter,

Armstrong, misreported key facts, insinuated a conflict of

interest, and misrepresented similar statements by other

groups with which ACOEM was compared. Within hours, blogs

and legal web sites had picked up the story in what bore

all the earmarks of a coordinated, but not very effective,

campaign. Your College officers answered as best we could,

posting after posting. Remarkably, interest in the story

did not last long, even on the web. Of course, the seeds of

distrust were sown widely, if not deeply, on the Internet

for future eruptions.

Your officers submitted a letter to the editor (posted on

the ACOEM web site) well within the time the WSJ allowed,

but they declined to publish it. No reason was given. Last

week we filed a complaint. Our prediction is that they will

ignore it.

By now, it should be obvious that there is an agenda at

work and that the WSJ was, in fact, used. The ACOEM

statement is well-researched, well-written, and clear in

its conclusions, although it is becoming dated. Over the

last five years, it has been introduced many times into

evidence in court cases and (we now realize) became

perceived by the plaintiff bar as a major obstacle. What we

experienced in January was a campaign to discredit the

statement (and by extension ACOEM) so that it could not be

used in court. An activist in the “toxic mold†community

has, in fact, now taken credit for planting the story.

We feel sure that our statement was the focus of the attack

because it was the first and most detailed of four

statements that have come to similar conclusions regarding

the lack of evidence behind “toxic mold†as a theory. ACOEM

probably seemed an easier target than the American Academy

of Asthma, Allergy and Immunology, the American Academy of

Pediatrics, and the Institute of Medicine (part of the

National Academy of Sciences), each of which produced their

reports after ours.

However ACOEM, as a professional organization, is proving

to be no pushover. We are vigorously defending the

statement within the professional community. We are

currently pushing out our message in every way we can. We

have fully documented the statement development process (if

needed for discovery, which happens occasionally when ACOEM

is subpoenaed in lawsuits where the statement is

introduced).

Turning to substantive issues, let me remind ACOEM members

of the background to the statement. We are not talking

about the association of mold and mold spores with

invasive, allergic, infectious, or irritating conditions.

The statement is perfectly clear that these are known and

accepted medical conditions. Likewise, the statement,

although it was written well before the Institute of

Medicine’s report Damp Indoor Spaces, does not suggest that

damp or moldy living environments are acceptable. Not at

all.

The issue at hand is whether the metabolic products of mold

known as mycotoxins, absorbed through inhalation of spores

and vegetative fragments in indoor air, are responsible for

systemic human disease under conditions encountered in

homes and offices, an unproven theory called “toxic moldâ€

in the vernacular. The WSJ article implies that there is an

extensive scientific debate on this topic. The reality is

that few scientists embrace the theory of “toxic mold†and

many who do (including some of our members) are interested

in it as a theory to be tested, not as a belief. The

mainstream of medical opinion, ACOEM included, has decided

that so far the weight of evidence, despite years of

investigation, does not support the theory.

The WSJ reporter, Armstrong, used selective quotes

out of context from the Institute of Medicine’s report,

Damp Indoor Spaces, to give the impression that the

Institute’s statement is at odds with ACOEM’s statement.

However, that is simply wrong. Put the two side by side and

it is clear that they both conclude that the evidence for

the existence of a “toxic mold†effect is “inadequate or

insufficient,†to use the IOM’s term of art.

The WSJ also implied that the statement was created for

purposes of litigation. It was not. The statement was

initiated by your College precisely because the topic is

important in environmental medicine.

The WSJ article insinuated that the “authors†of the ACOEM

statement were in conflict of interest. Let’s set the

record straight – The lead author chosen to develop the

statement was a retired Assistant Surgeon General,

eminently credible. He had no conflict of interest at the

time – none. In the course of developing various drafts, he

asked two colleagues experienced in the issue to supply

information and analysis he needed to develop some of his

points – nothing wrong or unusual in that. He was generous

enough to acknowledge them with authorship credit and it is

actually their history of sometimes testifying in mold

litigation that is being attacked. For the record, however,

the lead author was always the responsible party.

Authorship of an ACOEM statement is not the same as

authorship of a paper: the end product is not the author’s

property and can be – and often is – changed without the

author’s agreement. ACOEM credits authorship of statements

for the purpose of giving recognition for work done on its

behalf, not to assign responsibility or for disclosure.

Incidentally, all this is documented.

In this case, your College adhered to its own rigorous

statement development process (developed in 2000 and

available on the ACOEM web site). The mold statement was

substantially revised four times, in a process closely

managed by the chair of our Council on Scientific Affairs.

It then underwent three levels of review (Council, Board

committee, full Board) before finally being approved by

your elected representative governing body, the Board of

Directors of the College. All this is also documented.

We take allegations and insinuations against the integrity

of the College and you, our members, very seriously. This

whole episode has made us realize just how important a role

we play in challenging unscientific medical beliefs. Seen

another way, this attack was a backhanded tribute to the

growing influence of your College and its dedication to

evidence-based medicine. It would not have happened if your

College had not taken a stand on something important. It

would not have failed if your College had not done the

right thing and backed it up with documentation and rigor.

Tee L. Guidotti, MD, MPH, FACOEM

ACOEM President

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