Mold Neurotoxicity:Validity, Reliability and Baloney

[Guest guest]

Now this is the REAL BS that is still running rampet by the defense.

Even though this article is a few years old it is still current. But

what can you expect from someone who works closely with GOTS and

Barrett.....

Mold Neurotoxicity:

Validity, Reliability and Baloney

Quackwatch

R. Lees-Haley, Ph.D., ABPP

http://www.quackwatch.com/01QuackeryRelatedTopics/toxicmold.html

" Mold neurotoxicity " is an increasingly common allegation in

personal injury litigation, although it is conspicuously absent from

day-to-day medical practice. The current controversy on this subject

is driven more by lawyers than by scientific disagreements. The

alleged injuries are variously referred to as brain damage, toxic

encephalopathy, cognitive deficits, neurobehavioral deficits,

neuropsychological impairment, and as facets of sick building

syndrome or environmental illness. The alleged symptoms include

memory deficits, difficulty concentrating, problems with language

and reasoning, mental fatigue, depression, and anxiety. Last year, a

Time Magazine article warned: " Like some sort of biblical plague,

toxic mold has been creeping through homes, schools and other

buildings across the U.S. . . . The biggest winners are the

industries feeding off mold mania. " (Hamilton 2001)

Despite all this, there is no consistent pattern of symptoms or test

results through which a diagnosis of " mold neurotoxicity " can be

defined. Nor is there any scientific basis for the allegation that

breathing mold spores or mycotoxins in household and commercial

office settings causes neuropsychological impairment. The

neuropsychological effects of these exposures are unknown. But

supposed experts are using naïve and empty arguments, such as saying

they cannot think of any other reason why a person suing for

millions of dollars might make subjective complaints and that the

scientific literature does not disprove their speculative opinions.

These are " junk science " arguments.

The so-called " study " most often cited as evidence of

neuropsychological impairment due to mold neurotoxicity is not

actually a scientific study and was not peer reviewed in any

conventional sense. The methodology was so weak that it will never

be accepted for publication in a high-quality scientific journal and—

as of this writing—has not been published in any scientific journal,

regardless of quality. The study purports to have evaluated persons

exposed to the mold stachybotrys atra, but it included no control

group or standardized test battery administered to all the

participants. Alternative toxic exposures were not investigated --

not even other mold exposures. The participants did not all take the

same tests, and the author has testified that he only reported data

from a few tests he selected as more likely to produce what he was

looking for. The neuropsychological test scores of the people

studied were notable for being normal, not impaired, but lawyers and

a few of their experts refer to these findings as evidence of mold

neurotoxicity. Furthermore, an examination of the data employed in

preparing the manuscript shows that the paper did not accurately

reflect what was actually done. In the only other relevant study

involving objective testing, as distinct from subjective reports (a

study that was published in a peer-reviewed journal), the briefly

mentioned finding was that the mold cases performed better on

cognitive testing than the controls (Hodgson et al., 1998). Sudakin

(1998) found an increase in self-reported neurobehavioral symptoms

in a case report but cautioned readers that these individuals had

been exposed to reports of adverse health effects of toxigenic fungi

exposure prior to making their subjective complaints in hindsight

after a delay. These symptoms improved substantially after leaving

the building. Many of the people Sudakin studied were making claims

for compensation.

Establishing Proof without Evidence

Because their methodology is devoid of objective evidence that mold

or mycotoxin inhalation has caused brain injury, so-called " toxic

mold " experts are relying heavily on subjective symptom reporting

and on tests that are affected by response biases associated with

litigation. Their approach is problematic at least three reasons:

As noted above, there is no known pattern of complaints that

constitutes a neuropsychological or psychological syndrome or

diagnosable mental disorder associated with mycotoxin inhalation or

inhalation of mold spores.

Experts in litigated cases are ignoring the growing abundance of

research showing that patients in litigation behave differently than

other persons in important ways that directly affect expert

examinations of the patient's condition. Plaintiffs often report

their pre-injury history in unusually benign terms, and discount

alternative explanations for their complaints, such as important

stressors in their lives, to an implausible degree. They respond to

neuropsychological tests more frequently in an impaired range even

when no one is claiming they have brain damage—not their lawyers,

their doctors, or the plaintiffs themselves. In other words,

artifacts associated with litigation are affecting

neuropsychological test results. Plaintiffs making mild brain injury

claims often respond to psychological tests in a more impaired way

than persons with documented severe brain injury .

The test results are contaminated by the biases arising from

litigation rather than being a true reflection of the extent of

injury. There is growing evidence that attorneys and other advocates

associated with litigated claims influence the psychological and

neuropsychological evidence in ways that cause misleading and

erroneous results.

The amount of effort the patient makes during neuropsychological

testing has a greater impact on the test results than the degree of

injury, even when including severe brain injuries among the persons

studied (e.g., see Green et al., 2001).

Genuinely troubled people become involved in these matters, at times

to their detriment. For example, individuals with somatoform

characteristics and histrionic personalities tend to be suggestible

and therefore vulnerable to zealots and advocates who tell them they

are brain-damaged and doomed to suffer permanent deficits caused by

their toxic environment. Most of us more or less ignore, or notice

and discount common " symptoms of life " such as transient aches and

pains, fluctuating ability to concentrate, temporary fatigue,

feeling stressed, or inability to recall all sorts of information

such as a word or name or where we left something. However, when a

health professional claims these are symptoms of mold neurotoxicity,

a gullible person may focus more attention on these experiences,

become alarmed, and become involved in a vicious cycle of over

interpreting mild symptoms, becoming anxious, developing more

symptoms caused by the anxiety, and becoming even more alarmed,

sometimes to the point of virtually obsessing over the symptoms. It

is an easy next step to conclude that because these feelings are

more noticeable and more frequent lately, they must have been caused

by mold exposure.

Although most of us think of ourselves as not presently suffering

the effects of mild brain injury due to mold or anything else,

empirical investigations have repeatedly shown that surprisingly

high rates of mild brain injury symptoms and psychological symptoms

are normal in the general adult population and among student and

medical patient populations (e.g., see Dunn, Lees-Haley, Brown,

, & English, 1995; Gouvier, Cubic, , Brantley, &

Cutlip, 1992; Gouvier, Uddo-Crane, & Brown, 1988; Fox, Lees-Haley,

Earnest, & Dolezal-Wood, 1995a, 1995b; Lees-Haley, 1992; Lees-Haley

& Brown, 1993). Likewise, prevalence studies show that rates of

psychiatric illness are " greater than previously thought to be the

case " (Kessler, McGonagle, Zhao, , , Eshleman, Wittchen,

& Kendler, 1994, p. 8; see also Regier, Boyd, Burke, Rae, Myers,

Kramer, Robins, , Karno, & Locke, 1988; and Robins, Helzer,

Weissman, Orvascel, Gruenberg, Burke, & Regier, 1984). Thus when

someone directs attention to a search for psychopathology, it is not

hard to find and it is more common than many people imagine.

Administration of diagnostic procedures to a random or non-

complaining population leads to the detection of false positives and

actual pathology that was silent prior to the testing, so it is no

surprise that testing a group of plaintiffs leads to discovery of

apparent injury whether there is any or not. The average person with

no history of brain injury produces scores in the impaired range on

several tests in a detailed neuropsychological test battery but some

experts ignore these base rates ( " normal levels of abnormality " ) and

over interpret these findings as indicative of toxic brain injury.

Teaching Eyewitnesses to See Invisible Phenomena

In ambiguous settings such as controversial legal arguments over

what is known about mold neurotoxicity, psychological influences

assume an increasing importance in determining what is perceived as

real. The information disseminated by media, politicians, activists,

litigating parties, experts, and attorneys may cause important

emotional reactions in the affected people. A claim may be false but

it can cause true alarm and genuine emotional distress to innocent

people if misleading allegations are taken seriously.

It is critically important to weave good science into the mold

neurotoxicity arguments as an antidote to unfounded advocacy.

Interested parties are promoting speculation and making arbitrary

allegations in such an emphatic way that we are tempted to believe

them for illusory reasons. Lawyers and clinicians who cannot wait

for facts are relying largely on propaganda and social influence

techniques such as:

Social proof: If an advocate creates the impression that several

credible people have concluded that mold caused them brain damage,

there is a natural human tendency to agree, and a subtle implication

that you are somehow lacking in credibility if you disagree.

Identifying a few people who believe a proposition, and encouraging

them to go public (especially repeatedly) creates the impression

that there are a lot of people out there discovering something real.

Repeated affirmations: Just saying your claim over and over creates

the impression that the assertion is true. After all, as everyone

knows, where there is smoke, there must be fire.

Appeals to authority: If one or more of the people affirming a

belief is authoritative, e.g., a civic leader or expert, more people

will be persuaded. Sometimes politicians are persuaded to join in

unfounded but politically advantageous rhetoric. If we like the

source of an opinion, we are more likely to believe what is said, so

if a popular actor, media figure, politician or local hero joins the

process, more of us will endorse the perceived reality.

Vivid examples: Dramatic case histories often influence judgments

more than dull but more accurate quantitative examples. Presenting a

dramatic, close up picture of black mold in a scary manner may cause

the observer to conclude that anything that looks this bad must

cause whatever harm is alleged.

In response to recent criticisms of junk science, anti-science

arguments are on the rise. Advocates tell us, " We can't wait on

science. We have to act now! " and " The scientists want us to do

nothing! How many people have to die before the defendants do what

is right? " One such critic ironically declared, " We can't wait on

science, we have to act on the evidence! " Certainly, we make most of

our decisions in life without conducting a scientific study first.

However, the allegation that the mold spores that surround us all

every day are causing brain damage is a factual question that can

only be answered by looking at the data, not by emotional reactions

to speculation, sensationalism, and innuendo.

Plaintiffs Differ from Patients without Claims

Patients pursuing litigation report more intense, frequent, and

persistent symptoms than non-litigating patients do. For example, a

number of prospective studies have found that non-litigating

individuals with mild brain injury typically recover from their

symptoms within a few months. (Barth, Alves, , Macciocchi,

Rimel, Jane, & , 1989; Dikmen, Ross, Machammer, & Temkin,

1995; Dikmen, McLean, & Temkin, 1986; Gronwall & son, 1974;

Hugenholtz, Stuss, Stethem, & , 1988; Levin, Mattis, Ruff,

Eisenberg, Marshall, Tabaddor, High, & owski, 1987). However,

recovery of patients in litigation commonly does not conform to

expectations, as complaints including memory loss, headache,

dizziness, concentration difficulty, blurred vision, photophobia,

ringing in the ears, irritability, fatigue, anxiety, and depression

(World Health Organization, 1978) continue long after such symptoms

normally resolve (Binder, Rohling, & Larrabee, 1997). Many empirical

investigations have documented discrepancies between patients in

litigation and patients not seeking compensation (see e.g., Berry,

Wetter, & Youngjohn, 1995; Levin et al., 1987; Youngjohn, , &

Wolf, 1997). Fee and Rutherford (1988) compared the frequency of

reported symptoms among mild brain injury patients in litigation

with those not in litigation. After equating for severity of initial

injury, reporting rates were assessed for various symptoms including

headache, anxiety, irritability, dizziness, depression, and

insomnia. On follow-up, litigating patients reported nearly twice as

many symptoms as non-litigating patients.

The differences between self-reported symptoms of litigants and non-

litigants have been established with respect to psychological as

well as neuropsychological injuries, where compensation-seeking

patients have been found to report more persistent psychological

symptoms than patients with similar injuries not seeking

compensation. Frueh, , and Barker (1996), for example, found

that combat veterans seeking service-connected disability for

posttraumatic stress disorder (PTSD) obtained significantly more

pathological scores on a wide range of psychological inventories and

on MMPI-2 validity indices than did combat veterans with equivalent

PTSD diagnoses not seeking compensation. Pope, Butcher and Seelen

(1993) noted that MMPI profiles of patients with pending disability

evaluations exhibit more exaggeration and pathology. Their research

also indicated that persons who are genuinely disabled but not

awaiting a disability determination tend to produce MMPI profiles

with normal scale scores. Patient compensation seeking has been

cited as one of the most serious obstacles to successful treatment

of PTSD within the VA system (Richman, Frueh, & Libert, 1994).

and Tueth (1997) reported that the system of compensation

payments creates a disincentive for recovery and noted

that, " Rewarding individuals for pain and disability, particularly

on a long-term basis, can have numerous negative consequences, and

ultimately may be a disservice to the patient " (p. 42).

Health-care providers have noted fundamental differences between

litigating and non-litigating patients, and " have become

increasingly suspicious of the genuineness of symptoms exhibited by

plaintiffs because of the large disparity often found between

subjective complaints and objective findings " (Weissman, 1990,

p.71). Patients seeking financial compensation may find treatment

withheld because they are perceived as resistant and noncompliant

with psychotherapeutic and rehabilitative services. In the context

of litigation or similar applications for compensation where

incentives such as settlement may outweigh incentives such as

getting better, treatment may be postponed or even sought for legal

purposes.

Recent research suggests not only that litigating patients report

current symptoms at higher rates and duration than do non-litigating

patients, but also that litigating patients tend to recall pre-

injury psychological and neuropsychological functioning as superior

to that of non-litigators (Lees-Haley, , & English, 1996;

Lees-Haley, , Zasler, Margulies, English, & s, 1997).

For example, Lees-Haley et al. (1997) asked both to recall how

problematic specific symptoms, behaviors, and aspects of life were

in the past. Patients seeking compensation recalled fewer problems

with concentration, memory, fatigue, depression, anxiety, ability to

attend school or work, irritability, headache, confusion, self-

esteem, marriage, and relationships with children. Because the

apparent severity of injury or loss in functioning is essentially a

comparison of pre- and post-injury functioning, a greater apparent

difference in functioning from pre- to post-injury can create the

impression that more compensation is warranted. Therefore, not

taking into account the tendency of plaintiffs to overestimate their

pre-injury functioning misleads forensic examiners and triers of

fact regarding the severity of the injury.

Exaggeration or Malingering

Malingering is defined as the intentional production of false or

grossly exaggerated physical or psychological symptoms motivated by

external incentives such as financial gain, obtaining drugs,

avoiding work, evading criminal prosecution, etc. (American

Psychiatric Association, 1987, 1994). Contrary to what many of us

used to believe based on our clinical experience, empirical studies

have found that malingering is common in forensic evaluations.

However, the courts have been wiser than clinicians and have long

recognized this challenge. References to fraudulent claims and false

testimony recur in published cases and legal commentary throughout

the history of law. In the oldest known code of laws, the Code of

Hammurabi, participants in the legal system were already addressing

the problem (Hammurabi's policy was to slay witnesses who testified

falsely) (s, 2000). Indeed, the problem of false testimony is

the first issue addressed with every witness who is asked, " Do you

swear to tell the truth, the whole truth, and nothing but the

truth. . . ? "

Patients seeking compensation have more incentives to produce false

or exaggerated symptom reports than do patients seeking treatment.

Published estimates of the proportion of plaintiffs feigning

psychological deficits range from a low of 1% (Keiser, 1968) to over

50% ( & Cartlidge, 1972). In personal injury cases, feigned

cognitive deficits have been estimated at 64% (Heaton, ,

Lehman, & Vogt, 1978) with 47% of workers' compensation possibly

involving malingering (Youngjohn, 1991). Another study estimated the

percentage of manufactured memory deficits in patients claiming

persistent postconcussive syndrome as being between 33 to 60%

(Greiffenstein, Baker, & Gola, 1994). Such studies are relevant

because the complaints made by persistent postconcussive plaintiffs

are remarkably similar to those of many " toxic mold " plaintiffs, and

both often appear to be exhibiting litigation-related response

biases. Research by Binder (1993) indicates that 33% of mild brain-

injured subjects seeking compensation malingered deficits on

psychometric testing. Forensic examiners should consider and rule

out the possibility that symptom reports and test results are the

product of false presentation by plaintiffs during interviews and

exaggeration of symptoms through self-report inventories or tests.

It has become the standard in forensic cases to consider the

possibility of malingering in the differential diagnosis.

Some psychologists and psychiatrists claim that plaintiffs are

unable to malinger mental disorders or neuropsychological deficits

without detection by psychological experts. However, there is

substantial support for the idea that naïve individuals can fake

psychological and neuropsychological symptoms successfully when

provided minimal information about disorders (e.g., Albert, Fox, &

Kahn, 1980; Faust, Hart, & Guilmette, 1988; Lamb, Berry, Wetter, &

Baer, 1994; , Bagby, & Chakraborty, 1993; , Ornduff, &

Sewell, 1993; Wetter, Baer, Berry, Robison, & Sumpter, 1993). An

early study demonstrated the ability of university students to

successfully fake schizophrenia on the Rorschach test (Albert et

al., 1980). After watching a 25-minute film on schizophrenia, 72% of

university students were successful in feigning the disorder

compared to 46% who were naïve. In another analog investigation,

participants asked to fake brain injury were provided detailed

information on the type of validity scales on the MMPI-2 and were

given information on how to avoid getting caught. Results showed

that this information enabled subjects to produce clinically

elevated profiles without significantly elevated validity scales

(Lamb et al., 1994).

Individuals not provided with information were able to identify

symptoms similar to those of genuine patients on certain kinds of

inventories, such as symptom checklists (Lees-Haley, 1989a, 1989b).

Research indicates that untrained individuals are able to endorse

accurately symptoms and experiences of post-concussion syndrome

(Mittenberg, DiGiulio, Perrin, & Bass, 1992) as well as major

depression, generalized anxiety disorder, and PTSD (Lees-Haley &

Dunn, 1994). The research showing that naïve individuals can

simulate psychopathology without raising suspicion of malingering is

problematic for evaluators. Information about some psychological and

neuropsychological disorders is readily accessible to plaintiffs

motivated to deceive. Berry (1995) points out that " Fabricators may

become familiar with psychiatric symptoms through personal

acquaintances, perusal of volumes such as the DSM-IV (APA, 1994),

textbooks in psychiatry, or even through exposure to lay sources

such as magazine articles and movies about individuals with mental

disorders " (p. 88).

Attorney Influence

The influence of lawyers provides another confound to the evaluation

of patients involved in litigation. Although psychological experts

have been slow to realize the extent of the problem, concern about

attorneys affecting examinations is not a novel concept in legal

circles. In California, the problem is salient enough that the

California Code of Civil Procedure does not permit lawyers to sit in

on psychological evaluations (See CCCP 2032(g). In Ragge v

MCA/Universal Studios 165 F. 605 (Cal. 1995), the federal judge

decided that a third-party observer should not be present during the

evaluation and that the psychologist should not be required to

disclose in advance what tests would be used. Such disclosures are

an invitation to fraud as well as to innocent causes of invalid

results.

Lawyers are supposed to learn facts from their clients, not engage

in invention. But, as University of Pennsylvania law professor

Geoffrey Hazard, who is a member of the American Bar Association

Ethics 2000 Commission, has noted, " Lawyers do tell their clients

what to do, indirectly . . . . How artificial they are, how artful,

varies. " (cited in Dolan, 1994, p. A17). Resnick noted that, " Once

an individual becomes a litigant in a personal injury suit . . . the

efforts of attorneys for both the plaintiff and defendant may alter

the patient's attitudes and the course of the illness " (1988, p. 88).

Attorneys influence psychological data by several means. They advise

clients how to respond to psychological tests, make suggestions of

what to tell examining psychologists and what to emphasize, and lead

patients not to disclose certain information important to

psychologists. Attorneys can prompt their clients to take actions

that affect the clinical history and create misleading data

concerning the impact of an injury, e.g., telling them that

it " would look better " if they not return to work, and that " it

might be worth their while to see a doctor every week " (Rosen, 1995,

p. 84).

Some attorneys supply claimants with information not only about

symptom inventories but also about psychological tests for detecting

malingering (see, e.g., Baer, Wetter, & Berry, 1995; Dolan, 1994;

Legate, 1996; Lees-Haley, 1997; Platt & Husband, 1986; Rosen, 1995;

, Harp, & Elliott, 1992; Wetter & Corrigan, 1995; Youngjohn,

1995). As Youngjohn (1995) observed, " Psychologists and

neuropsychologists performing forensic examinations typically assume

that their patients have not been prepared or 'educated' prior to

examination " (p. 282). Baer, Wetter, & Berry (1995) note that " given

the increasing likelihood that coaching of test-takers may be

occurring in a variety of settings, it is important for clinicians

to understand its impact " (p. 198).

Further evidence of the willingness of attorneys to interfere with

psychological assessment was offered by Wetter and Corrigan (1995).

These researchers conducted a survey in which 63% of attorneys

surveyed felt they should provide plaintiffs with information about

psychological test validity measures (47% of attorneys surveyed said

they should " always or usually " provide such information to their

client (the plaintiff) before the testing, and another 16% said they

should " sometimes " do so). Of the 63% of attorneys who believed they

should provide such information, 42% said they should provide " as

much [information] as possible " and another 42% said they believed

they should provide a " moderate amount of information, " for a total

of 84%. Youngjohn (1995) reported an attorney who argued that not

counseling a plaintiff prior to psychological testing is legal

malpractice. Other research with plaintiffs in personal injury

litigation confirms the existence of coaching, specifically in cases

related to the psychological sequelae of traumatic events (Rosen,

1995).

When plaintiffs undergoing neuropsychological evaluations are asked

whether anyone has talked to them about their evaluation, they

almost always say no, but commonly add that their attorney told them

to tell the truth. However, later in the evaluation, it is common

for a question to be answered with variations of " My attorney said I

don't have to answer that. " In some evaluations this reply is made

several times, despite the denial of having talked with anyone prior

to the evaluation. Since attorney-client communications are

privileged unless the attorney and client are conspiring to commit

fraud, e.g., if the attorney is helping a plaintiff malinger,

psychologists usually do not explore attorney coaching directly in

the interview. However, spontaneous comments like these indicate

that many plaintiffs are counseled about how to conduct themselves

in a psychological evaluation. University of Michigan Law School

attorney Larry Cohen (personal communication, March, 1997) reported

that some attorneys consider it part of attorney-client privilege to

instruct the client to deny that the coaching ever took place.

Although attorneys are reluctant to discuss privileged

communications with specific clients, they publicly share relevant

information in continuing legal education courses. Consider for

example the advice offered in one national meeting of attorneys, in

which attendees were advised to talk to the psychologists they

retain " about what kind of history they will want to take. " (Bureau

of National Affairs, 1994, p. 52). An attorney on the panel of this

conference said she talks to psychologists before their evaluations

and " I tell them what areas I don't want them to probe " (p. 52). In

another continuing legal education program attorneys were taught to

prepare clients for their independent evaluations (IMEs) (Legate,

1996). In this course they were discouraged from sending clients to

independent examinations without advance preparation by counsel.

They were advised to review and " clarify " the client's symptoms

before the IME, and cautioned not to assume the unprepared client

would be consistent. One suggestion was to " Consider the creation of

a symptoms list that you will review with your client on a regular

basis " (Legate, 1996, p 5). Do plaintiffs really need lawyers to

tell them where it hurts? A two-year-old can tell you that. Do

lawyers think people in serious pain do not notice it and forget

that they are hurting in the absence of protection and assistance

from legal counsel?

In a widely circulated legal journal, , Harp and Elliott

(1992) published an article on " preparing " the mild-brain-injury

plaintiff. These attorneys suggest taking " steps to enhance the

client's ability to remember key facts " (p. 67). They recommend

that " counsel should begin to prepare the plaintiff to testify from

the outset of the case " and provide a list of steps to follow prior

to depositions and prior to trial (p. 68). Noting that brain-injured

clients " tend to be somewhat uncomfortable with the process [of

testifying (Does anyone find it comfortable?)] " they suggest

that " attorneys must take great care in getting them ready to

testify " (p. 68). They recommend providing " instructions regarding

presentation, demeanor, and dress " when testifying. It is difficult

to imagine there being no effects at all on a plaintiff's perception

after prolonged exposure to a persuasive advocate repeatedly

reframing the data from a litigator's special perspective, in a

litigator's convincing language.

If attorneys go to these lengths to prepare a client for a

deposition or trial, it is reasonable to assume that they give

similar advice before medical and psychological examinations that

could have a major impact on the value of the case. Guidance such as

instructions on demeanor, presentation, dress, and memory all may

affect the mental status examination by the psychological expert. A

histrionic, hypochondriacal, or deceitful plaintiff provided with

the coaching proposed in this article could learn to behave in a

misleading fashion. The effects of such instructions on a borderline

or delusional patient are unpredictable but a matter of concern.

Influence of Health-Care Professionals

Psychological experts can also contaminate the data in personal

injury litigation. For example, in the unpublished case of

Lailhengue v Mobil (Civil Action No. 90-4425, United States District

Court for the Eastern District of Louisiana), a psychiatrist

interviewed the plaintiffs with an attorney present and then gave

them copies of the diagnostic criteria from the Diagnostic and

Statistical Manual to review before a second interview to

investigate whether they were suffering Posttraumatic Stress

Disorder. In another unpublished case sealed by the court, a fairly

prominent psychologist and an attorney stood before an audience of

plaintiffs while the psychologist described symptoms of

Posttraumatic Stress Disorder, immediately after which plaintiffs

were administered a Posttraumatic Stress Disorder scale of the MMPI

with no accompanying validity scales.

Even honest litigants can be induced to unintentionally magnify

existing complaints or discover new ones. Repeated physical and

psychological examinations by health-care professionals can have

these unintended effects. As Lishman noted, " The repeated rehearsal

of symptoms before a variety of audiences, some encouraging, some

skeptical, does not help the patient to be clear about what he is

truly experiencing " (1986, p. 463). Platt and Husband (1986)

observed :

By the time the patient/litigant arrives at the clinician's office,

he or she often has consulted not only an attorney but a host of

medical and allied health professionals as well Patients may well

pick up cues from their attorneys or treating professionals as to

the symptoms they might be expected to have. The questions asked and

the messages communicated by these professionals regarding the

patient's physical and mental condition can have the effect of

covertly or even overtly alerting the patient to additional symptoms

he or she had not reported or had not emphasized in previous

evaluations, as well as potentially serving to reinforce existing

symptoms (p. 35).

Experts' expectations in assessment are important to consider

because they can have important unintended effects. There is a

substantial and growing literature on the nature and consequences of

clinician expectations on psychological assessment (see e.g., Arkes,

1981; Blank, 1993; Chapman & Chapman, 1967; 1969; Dawes, 1994;

Golding & Rorer, 1972; Salovey & Turk, 1991; , 1988; Snyder,

1981; Snyder & Thomsen, 1988; Starr & Katkin, 1969; Turk & Salovey,

1988). For example, Temerlin (1968) showed how expectations can

influence behavior in a clinical setting. Before listening to a

recording of a benign interview with a normal man, psychiatrists

overheard a prestigious colleague characterize the stimulus person

as mentally ill. Even though the interview revealed no signs of

psychopathology, 60% of the psychiatrists judged the man psychotic,

with the remaining 40% diagnosing him with a neurotic or character

disorder. None of the control judges (not given a diagnostic

category) characterized the target as psychotic. In a related study,

clinicians expecting to observe a " patient " judged the person as

more disturbed than did clinicians expecting to observe a " job

applicant " (Langer & Abelson, 1974), based upon otherwise identical

data.

These studies have important implications for evaluators.

Preconceived beliefs and prior expectations can shape behavior in

ways that support what evaluators expect (see e.g., Snyder &

Thomsen, 1988). Both the gathering and interpretation of data can be

affected by these preconceptions. For example, clinicians convinced

that mold exposure causes cognitive deficits may inadvertently or

intentionally communicate their expectancies to patients and thereby

reinforce self-reports. Plaintiffs, in turn, often minimize data

related to alternative explanations for deficits (e.g., reported

consumption of drugs and alcohol and important stressors), thereby

increasing the salience of causative factors deemed relevant by

evaluators and attorneys. Assumptions that patients' injuries were

caused by factors identified in the legal claims can become a self-

fulfilling prophecy in which relationships between the supposed

cause and the deficits are perceived where none actually exist. (For

a discussion of self-fulfilling prophecy see Rosenthal & son,

1968).

Finally, the intellectually bankrupt tactics of some experts in mold

cases deserve to be exposed for what they are. Instead of arguing

from facts and reason, they use junk science arguments. In one case,

an expert characterized the opinions of skeptics of mold

neurotoxicity claims as " tobacco industry " tactics when he could not

refute criticism with evidence and logic. He thus asserted that

defendant's experts actually knew that mold is injurious but would

not tell anyone. Some experts involved in these cases are using

alarmist language that is more likely than not to cause emotional

distress to a patient who takes the expert seriously, while the true

effects of molds remain unknown.

Internet Promotion

Many plaintiffs perform Internet searches that expose them to claims

and opinions of wildly varying reliability and validity. At this

writing (December 2002), searching Google.com with the phrase " toxic

mold " yields about 36,000 links. Last March, the list was topped by

a link sponsored by the Personal Injury LawyerShop and

headlined, " Learn about the side effects of toxic mold! " which led

me to the Toxic Mold InfoCenter, a site offering " Toxic Mold info

and access to attorneys who specialize in Mold litigation. " During

the same month, the Doctor Fungus Web site contained news about

someone suing for $65 million.

The Toxic Mold and Tort News Online Safety, Prevention, and

Information site states, " The Toxic Mold Website is a comprehensive

guide to information regarding mold, toxic mold, safety, and

prevention. Our site also provides important legal rights and

information for those who have been adversely affected by Toxic Mold

in their home, workplace, and elsewhere. " Its introductory

paragraphs about " potentially fatal dangers " and legal rights are

followed by summaries of four mold cases in which plaintiff won more

than $1 million.

The Mold Source contained a list of medical and legal experts

intorduced with the following statement:

The following professionals have established themselves, through

their dedication, commitment and their overwhelming concern for

mankind, as the experts. They are the best the world has to

offer " us " , the fungi contaminated. Collectively, they retain the

majority of all known knowledge on fungi and fungal poisoning

related illnesses. If knowledge is power, then my prayer in

providing this list is to give you the " power " to make a difference

in your life or the life of your " exposed " loved ones.

The list includes Rae, M.D., and several leading promoters

of the bogus " multiple chemical sensitivity " diagnosis.

The Toxic Mold Survivors Information and Support Group home page

states:

Poisoned by Toxic Molds?

Stachybotrys, Aspergillus & Penicillium.

Potential adverse health effects include: Allergies & allergic

asthma, allergic rhinitis/sinusitis, allergic conjunctivitis,

cancer, mycotoxicosis, aspergillosis, hypersensitivity pneumonitis,

neurotoxic:-toxic encephalopathy: headache, memory and verbal

problems, fatigue, malaise, vertigo, dizziness, depression, burning-

sore throat (laryngitis), irritant cough, nose bleeds, tremors,

tachycardia (fast heart beat), exertional shortness of breath, chest

tightness, wheezing, (bronchitis and pneumonitis) respiratory tract

ciliary damage, (clearing of air ways impaired), bleeding from the

lungs (hemoptysis) immunotoxic (higher incidence of infection),

dermotoxic (dermatitis, rash), hair loss, enterotoxic (nausea,

vomiting, diarrhea, gallbladder-like-colic pain). Toxic to the

liver, brain, kidneys and heart, and with chronic exposure, are

potent carcinogens of the liver.

The list of adverse health effects goes on . . . as those poisoned,

try to survive after toxic mold exposure.

Although ostensibly a website for a support group, litigation

appears to be a major interest of these " survivors. " For example,

the home page provides links to " Litigation, " an article

entitled " Toxic mold: The Next Asbestos? " by Sylvia Hsieh of Lawyers

Weekly USA), and the websites of lawyers and expert witnesses who

testify in toxic tort litigation.

Conclusion

Toxic tort attorneys and a handful of experts they favor would like

you to believe that " toxic mold " is disabling people in epidemic

proportions by damaging their brains. In order for this to be

correct, the overwhelming mjaority of physicians, toxicologists, and

mental health professionals who have studied this issue would have

to be completely wrong, and doctors in day-to-day practice would

have to be overlooking the diagnosis. If a problem exists, I doubt

that it is common. One expert estimated that there are close to

100,000 recognized species of fungi (Terr, 2001). Given the number

of possible exposures under different environmental circumstances to

persons in dramatically different mental and physical condition, one

can speculate about anything. But speculation is not evidence.

The mold neurotoxicity debate is not simply about health care and

science—a focus on money and litigation is pervasive in the

communications of the toxic mold promoters. As noted by

Scroggins, an environmental engineer with the U.S. Environmental

Protection Agency " toxic mold " is a term that " sells. " (Scroggins,

2002) The campaign being waged to convince people of the dangers

of " toxic mold " is not merely an amusing example of folly in modern

society. The people who are bypassing scientific evidence and

engaging in wholesale dissemination of " toxic mold " rhetoric are not

neutral forces. If it turns out that these exposures are

neuropsychologically harmless, the hysterical claims and unfounded

alarms sounded by lawyers, doctors and others will nonetheless have

harmed many victims. Who will be responsible for their pain and

suffering or emotional distress at being told they are going to die

or be permanently brain damaged? On the other hand if we discover

evidence of causation of neuropsychological deficits in this area,

the findings should be presented widely in a style most helpful to

affected patients, not in sensationalized hyperbole. Further

exploration of the effects of inhaling mycotoxins and mold spores

should be through high-quality, well controlled, scientific studies,

not speculation in adversarial settings.

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___________

Dr. Lees-Haley is a psychologist with offices in Huntsville,

Alabama. This article was adapted from Lees-Haley, P.R. (2002). Mold

neurotoxicity: validity, reliability and baloney, presented at the

conference " Mold Medicine and Mold Science: Its Practical

Applications for Patient Care, Remediation and Claims, " hosted by

the International Center for Toxicology and Medicine and the

town University Department of Pharmacology. May 13-14, 2002.

The expression " validity, reliability and baloney " was coined by the

late Professor E. Cureton, Ph.D. Researchers conducting

studies on related issues can contact Dr. Lees-Haley at 2915 Bob

Wallace Avenue, Huntsville, AL 35805; telephone: (256) 551-1024; or

by email paullh@....

This article was posted on Decembr 23, 2002