Re: More misconceptions From Sharon Kramer

[Guest guest]

March 3, 2006

Mrs. Sharon Noonan Kramer

Mr. H. Bruce Kruger,

Dr. Leung, JACI Editor

Directors of the Board, AAAAI

American Academy of Allergy, Asthma & Immunology

Authors, Bush et al, AAAAI Mold Position Statement,

555 East Wells Street

Suite 1100

Milwaukee, WI 53202-3823

Re: Bush et al, Mold Paper

Dear Physicians and Mr. Kruger,

As one who advocates for those made ill from mold and mold toxin exposure,

yet are not able to obtain effective medical treatment from their physicians,

I am writing to ask that your organization rethink accepting the paper on the

subject and authored by Bush et al, as a representation of the position of

the AAAAI’s current medical understanding of mold and mold toxin induced

illnesses.

The document will do nothing to promote physician education of the matter,

leaving many still ill and unable to obtain treatment. It will serve to

further stifle true medical understanding of an already young and confusing

science. This document is a defense argument, authored by defense expert

witnesses,

to be used in the courtroom, not to help the sick, but to defeat them in

mold litigation while limiting financial liability for the authors’ clients.

If the AAAAI accepts this document as their position statement, it will be

given unduly deserved elevated status over other more well researched and

unbiased research on the subject by those better educated to illness beyond

simple allergy. It will be a powerful and deceptive courtroom tool to be used

against the sick, much like the American College of Occupational and

Environmental Medicine (ACOEM) Position Paper on the subject has been.

It should be noted that the ACOEM position paper was also authored by one of

your authors, Dr. Saxon. Although not based on a sound scientific

premise, he and many of his associates have used the ACOEM document

successfully

in mold litigation numerous times. One would have to assume this author,

his associates and those within the AAAAI that would allow this situation to

occur, would also know the monetary value of the AAAAI accepting this paper to

be the representative position of approximately 6500 physicians.

I realize this is a very complex issue and that not all physicians can know

every aspect of every illness. Rather than my citing areas of the document

and the process it underwent before it became the position of the AAAAI that I

find to be blatantly erroneous, I would prefer to ask questions that you

may, in turn, also want to ask. It is my hope that these question will allow you

to assure you have made an informed decision of the matter:

Peer Review & Position Statement Acceptance Process

1. Dr. Portnoy authored a section for this paper on irritants. His

writings were edited out.

1. What was Dr. Portnoy’s original writing on the matter?

2. Why was it edited?

3. Who edited Dr. Portnoy’s writings?

4. Why has Dr. Portnoy requested his name be withdrawn from the

document?

5. If this is not the position of one of the named authors, Dr.

Portnoy, then how many others of your members whose positions are supposedly

being

represented is it not the true position?

1. What type of peer review did this document undergo before it was

accepted as the position of 6500 physicians?

1. Who initiated the drafting of this document and the concept that it

would serve as the Position Statement for the AAAAI?

2. What was the intended purpose and usage of the Position Statement?

3. What type of Conflict of Interest statements were obtained from the

authors?

4. Is the Board of the AAAAI aware of the income generated through

expert witness testimony by the authors?

5. How much income has been generated through the authors’ expert

witness testimony for the defense in mold litigation?

6. Dr. Bush is an author of this document. He is also an advisor to the

JACI. What type of safeguards were used by Dr. Bush and others involved in

the JACI to assure the document was based on current science before published,

not just Dr. Bush’s opinion?

7. Who from the JACI reviewed their editorial colleague’s writing?

8. Was the author also involved in the peer review for the JACI?

9. Was the Board of the AAAAI aware of the potential monetary value

attached with this document becoming a position statement?

10. Is the Board of the AAAAI aware that this document has already been

used by the defense in mold litigation?

11. Who peer reviewed this paper for the AAAAI physicians who are

supposedly being represented.

12. Who on the JACI editorial staff reviewed this document before

publication?

13. Who oversaw the peer review process for both the Academy and the

Journal?

14. Who had final edit over this document?

15. What monetary value is there for the authors of the AAAAI position

statement, members of the AAAAI, the Board of the AAAAI, and/or the staff of

the Journal of the AAAAI in accepting this document as a position statement of

the AAAAI and publishing it as such in the JACI?

1. The document clearly states it is not an all encompassing review of

research on the subject of mold and mold toxin induced illnesses.

1. Why would a protocol writing medical association base their position

on only partially encompassing science?

2. What harm could be done to the public by basing a position on only

partially encompassing science?

3. What medical information could be misconstrued by physicians who

treat mold victims, if the information they receive as a position statement is

knowingly based on partial information?

4. What potential liability could these physicians face, if they follow

a treatment protocol based on partial science?

5. What did the Board of the AAAAI do when accepting this document as a

position statement, to assure they were properly educating and protecting

the physicians they represent?

6. What research that is in direct contrast to this document, is

understood to be sound science by the Board?

7. How many research studies on the subject were not included in the

formation of this document?

8. What are the research backgrounds of the authors in regard to mold

toxin induced illnesses that allow them to write authoritatively on the

subject?

9. How many patients have the authors successfully treated that have

experienced illness beyond simple allergy from mold?

10. What steps the Board of Directors of the AAAAI take to assure that

what they were endorsing as a position representative of 6500 physicians was

based on unbiased, non-financially motivated, public interest, sound science?

The Document Itself:

1. The document states its purpose is to provide a “state-of-the-art

review of the role that molds are known to play in human diseaseâ€. (Pg 326

P.1)

1. Given the fact that the authors acknowledge this is not an all

encompassing paper, how can it be projected as “a state of the art

review�

1. (Pg 326, P.2) What new symptoms “have been hypothesized†to be

caused by molds or mold toxins that have not been known to be

symptoms indicative of mycoses and mycotoxicoses for quite

some time?

1. Did the authors mean by the prior statement to say that some of

these illnesses have not been established to be caused by

exposure within an indoor environment based solely on lack of

dose response establishment?

1. Is dose response imperative to understand in establishing treatment

protocol for immunological illness?

2. What would be the benefit in mold litigation if one could not

establish the dose response that causes illness?

1. How would this information, or lack there of, benefit many of the

insurance industry clients of the authors?

2. How would basing so much weight on dose response limit physician

education of proper treatment protocols for those exhibiting symptoms known to

be indicative of mycoses and mycotoxicoses?

3. What epidemiological studies are the authors basing their opinion

that one could not be exposed to enough mold or mold toxins within an indoor

environment to cause symptoms known to be indicative of mycoses or

mycotoxicoses?

4. Besides the ACOEM Mold Statement, also authored by Dr. Saxon and

other prolific expert defense witnesses, on what do the authors base their

opinion that one could not acquire enough mold or mold toxins within an indoor

environment to cause symptoms indicative of those known to be cause by molds or

mold toxins?

5. Besides the known expert defense witnesses’ mathematical

extrapolations from one rodent study, on what scientific premise is it

established by

the ACOEM, (and now the AAAAI), that one could not acquire enough mold or mold

toxins within their system, from an indoor environment to cause symptoms

indicative of mycoses and mycotoxicoses?

6. What did the peer reviewers of the AAAAI do to assure their

position of illnesses caused by mold or mold toxin exposure was based on sound,

unbiased, non-financially motivated and public interest science?

1. (Pg 326 P. 4) The authors state “Given the nature of this document,

key rather than exhaustive citations are provided. The latter can be found

in documents such as the Institute of Medicine reports “Damp indoor spaces

and health†and Clearing the air: asthma and indoor air exposure.†The

implication of this statement is that the IOM Damp Indoor Report is not a

reference to this document. Yet, the authors later cite a DRAFT (Pg 329 P.3)

“We

agree with the ACOEM evidence based statement and the IOM DRAFT which

concludes the evidence does not support the contention that mycotoxin mediated

disease occurs through inhalation in nonoccupational settings.â€

a. Why are the authors citing a DRAFT of a document as opposed to the

final document?

b. What information is within the final IOM document that is not

included in the DRAFT?

c. How can one truthfully make the statement that they support the

ACOEM Mold Statement and the IOM Document within the same sentence, when the

IOM

clearly states it does not support the premise the ACOEM mold statement is

based upon? (Although presented as a review piece, the only aspect of the

ACOEM paper that determined implausibility of mold induced illnesses was based

on

the authors’ own math from one rodent study. “Levels of exposure in the

indoor environment, dose-response data in animals, and dose-rate considerations

suggest that delivery by the inhalation route of a toxic dose of mycotoxins in

the indoor environment is highly unlikely at best, even for the

hypothetically most vulnerable subpopulations.â€The IOM Report states,

“Except for a few

studies on cancer, toxicologic studies of mycotoxins are acute or short-term

studies that use high exposure concentrations to reveal immediate effects in

small populations of animals. Chronic studies that use lower exposure

concentrations and approximate human exposure more closely have not been done

except for a small number of cancer studies.â€

d. Was this an intentional use of partial and misleading information on

the part of the authors?

e. Who determined only the DRAFT of the IOM Report would be cited?

f. What was the purpose of only citing the DRAFT?

g. Was the Board of Directors of the AAAAI aware that the IOM Damp

Indoor Spaces Report does not support the ACOEM Mold Statement as being based

on

acceptable practices?

h. Which document, the ACOEM Mold Statement or the Institute of

Medicine, Damp Indoor Spaces and Mold Report, does the AAAAI choose to

reference as

the most authoritative source of information on the subject of mold or mold

toxin induced illnesses, when the two document are directly contradicting?

i. Was the Board of the AAAAI aware that Dr. Saxon was also an

author of the ACOEM Mold statement?

j. Was the Board aware that the final of the IOM Report does not

support the ACOEM Mold Statement?

k. Was the Board of the AAAAI, aware that the ACOEM mold statement has

been used by the defense expert witnesses in virtually every mold litigation

case in the past four years? (there are reported to be 10,000 of these in the

courts at any given time.)

l. What does the Board of Directors of the AAAAI see as the benefit

to the authors themselves in having the AAAAI support the Mold Position

Statement of the ACOEM?

m. Does the Board of the AAAAI, find it to be current accepted scientific

protocol to deduce the absence of human illness based on one rat study?

n. Is the Board of the AAAAI of the opinion that this method of

deducing lack of human illness will be beneficial in assisting physicians in

the

treatment of ill patients?

o. How many and who are members of both the AAAAI and the ACOEM?

p. How many members of the AAAAI perform Independent Medical Exams of

injured workers on behalf of insurers and employers?

q. What is the pay received by these AAAAI members when they perform

these exams?

1. Anecdotal Information Cited as Science.

1. (Pg329 P.10.) The authors state, “The occurrence of mold-related

toxicity from exposure to inhaled mycotoxins in nonoccupational settings is not

supported by the current data, and its occurrence is improbable†On what

scientific foundation is the statement that its “occurrence is improbableâ€

based?

2. . (Pg 329 P.10) “The occurrence of mold-related irritant reactions

from exposure to fungal irritants in nonoccupational settings are

theoretically possible, although unlikely to occur in the general population

given

exposure and dose considerations.†On what scientific premise is the

statement “

unlikely to occur in the general population†based?

3. (Pg 326 P.4) “It is estimated that approximately 10% of the

population have IgE antibodies to common inhalant moldsâ€

1. One what scientific foundation is this statement based?

2. What are the limitations in skin prick testing to determine IgE

antibodies?

3. What is the relevance of testing not only for species, but genre in

determining IgE antibodies?

4. What is the margin of error of skin prick testing for IgE antibodies?

5. Why does this document downplay the relevance of blood work in

determining IgE antibodies?

6. Which generates more income for allergists, skin prick or blood

testing?

7. What is the AAAAI doing to educated physicians that not all

mold related illness is IgE mediated?

8. How many people does the AAAAI think have tested negative for

IgE that are only relevant for the specific molds tested, and then

been told their illnesses could not be due to mold?

1. How many people does the AAAAI think have been misdiagnosed and left

untreated because of the limitations and lack of physician education as to

the relevance and accuracy of skin prick testing, and the propagation that

illnesses are simply a result of media hype?

1. The authors state that hypersensitivity pneumonitis is a rare

illnesses from mold exposure. They also state that hypersensitivity

pneumonitis is

not an individually tracked illness.

a. If hypersensitivity pneumonitis is not an individually tracked

illness, then on what, besides anecdotal information have the authors

been able to determine the rarity of it’s occurance? It should be

noted, that HP was individually tracked until 2002. The prevalence

of this illness was steadily increasing since approximately 1980.

b. According to the Respiratory Morbidity trackings of NORMS, two

occupations prevalent to die from this disease were teachers and

housewives. How does this information not support that HP is

a serious concern within an indoor environments as most

teachers and housewives work indoors?

There are numerous other areas within this document that are questionable in

their citations, statements and methods of conclusions. In order to

effectively cite them all, I would need to write a letter larger than the

original

AAAAI Mold Position Paper itself.

Hopefully, I and many others who are knowledgeable on the subject, have

pointed out enough areas of concern that would cause the Board of Directors of

the AAAAI to rethink their acceptance of this document as a position statement

representative of 6500 physicians. As allergists and immunologists are the

gatekeepers of treatment procedures for mold and mold toxin induced illness,

how the American Academy of Allergy, Asthma and Immunology handles this

subject matter will have long term ramifications and impact on the lives of

many.

Thank you for allow many to point out some areas of inconsistancies. Thank

you for your consideration of this matter.

In conclusion, my two final questions to the Board of Directors of the

American Academy of Allergy, Asthma, and Immunology are:

For the good of the public and for the proper education and protection of

the physicians your organization represents, will you retract this poorly

written and author biased document as your position statement?

For the good of the public and for the proper education and protection of

the physicians your organization represents, will you invite other disciplines,

besides allergists, to write a new document reflective of the true current

scientific understanding of mold and mold toxin induced illnesses?

Sincerely,

Mrs. Sharon Kramer

*

[Guest guest]

Sorry, that I am a little late in responding, but

thanks for your continued advocacy and for posting the

other letters to the authors of the AAAAI Mold

Position Statement. It is really encouraging and

inspiring to see doctors and other medical

professionals come forward and take positions

challenging the ethics of these financially motivated

organizations that continutinally put out

misinformation.

Judi

--- snk1955@... wrote:

>

> March 3, 2006

> Mrs. Sharon Noonan Kramer

> Mr. H. Bruce Kruger,

> Dr. Leung, JACI Editor

> Directors of the Board, AAAAI

> American Academy of Allergy, Asthma & Immunology

> Authors, Bush et al, AAAAI Mold Position Statement,

>

> 555 East Wells Street

> Suite 1100

> Milwaukee, WI 53202-3823

> Re: Bush et al, Mold Paper

> Dear Physicians and Mr. Kruger,

> As one who advocates for those made ill from mold

> and mold toxin exposure,

> yet are not able to obtain effective medical

> treatment from their physicians,

> I am writing to ask that your organization rethink

> accepting the paper on the

> subject and authored by Bush et al, as a

> representation of the position of

> the AAAAI’s current medical understanding of mold

> and mold toxin induced

> illnesses.

> The document will do nothing to promote physician

> education of the matter,

> leaving many still ill and unable to obtain

> treatment. It will serve to

> further stifle true medical understanding of an

> already young and confusing

> science. This document is a defense argument,

> authored by defense expert witnesses,

> to be used in the courtroom, not to help the sick,

> but to defeat them in

> mold litigation while limiting financial liability

> for the authors’ clients.

> If the AAAAI accepts this document as their

> position statement, it will be

> given unduly deserved elevated status over other

> more well researched and

> unbiased research on the subject by those better

> educated to illness beyond

> simple allergy. It will be a powerful and deceptive

> courtroom tool to be used

> against the sick, much like the American College of

> Occupational and

> Environmental Medicine (ACOEM) Position Paper on

> the subject has been.

> It should be noted that the ACOEM position paper was

> also authored by one of

> your authors, Dr. Saxon. Although not based

> on a sound scientific

> premise, he and many of his associates have used

> the ACOEM document successfully

> in mold litigation numerous times. One would have

> to assume this author,

> his associates and those within the AAAAI that would

> allow this situation to

> occur, would also know the monetary value of the

> AAAAI accepting this paper to

> be the representative position of approximately 6500

> physicians.

> I realize this is a very complex issue and that not

> all physicians can know

> every aspect of every illness. Rather than my

> citing areas of the document

> and the process it underwent before it became the

> position of the AAAAI that I

> find to be blatantly erroneous, I would prefer to

> ask questions that you

> may, in turn, also want to ask. It is my hope that

> these question will allow you

> to assure you have made an informed decision of the

> matter:

> Peer Review & Position Statement Acceptance Process

>

> 1. Dr. Portnoy authored a section for this

> paper on irritants. His

> writings were edited out.

> 1. What was Dr. Portnoy’s original writing on

> the matter?

> 2. Why was it edited?

> 3. Who edited Dr. Portnoy’s writings?

> 4. Why has Dr. Portnoy requested his name be

> withdrawn from the

> document?

> 5. If this is not the position of one of the

> named authors, Dr.

> Portnoy, then how many others of your members whose

> positions are supposedly being

> represented is it not the true position?

>

> 1. What type of peer review did this document

> undergo before it was

> accepted as the position of 6500 physicians?

> 1. Who initiated the drafting of this document

> and the concept that it

> would serve as the Position Statement for the

> AAAAI?

> 2. What was the intended purpose and usage of

> the Position Statement?

> 3. What type of Conflict of Interest

> statements were obtained from the

> authors?

> 4. Is the Board of the AAAAI aware of the

> income generated through

> expert witness testimony by the authors?

> 5. How much income has been generated through

> the authors’ expert

> witness testimony for the defense in mold

> litigation?

> 6. Dr. Bush is an author of this document. He

> is also an advisor to the

> JACI. What type of safeguards were used by Dr. Bush

> and others involved in

> the JACI to assure the document was based on

> current science before published,

> not just Dr. Bush’s opinion?

> 7. Who from the JACI reviewed their editorial

> colleague’s writing?

> 8. Was the author also involved in the peer

> review for the JACI?

> 9. Was the Board of the AAAAI aware of the

> potential monetary value

> attached with this document becoming a position

> statement?

> 10. Is the Board of the AAAAI aware that this

> document has already been

> used by the defense in mold litigation?

> 11. Who peer reviewed this paper for the AAAAI

> physicians who are

> supposedly being represented.

> 12. Who on the JACI editorial staff reviewed

> this document before

> publication?

> 13. Who oversaw the peer review process for

> both the Academy and the

> Journal?

> 14. Who had final edit over this document?

> 15. What monetary value is there for the

> authors of the AAAAI position

> statement, members of the AAAAI, the Board of the

> AAAAI, and/or the staff of

> the Journal of the AAAAI in accepting this document

> as a position statement of

> the AAAAI and publishing it as such in the JACI?

>

> 1. The document clearly states it is not an all

> encompassing review of

> research on the subject of mold and mold toxin

> induced illnesses.

> 1. Why would a protocol writing medical

> association base their position

> on only partially encompassing science?

> 2. What harm could be done to the public by

> basing a position on only

> partially encompassing science?

> 3. What medical information could be

> misconstrued by physicians who

> treat mold victims, if the information they receive

> as a position statement is

> knowingly based on partial information?

> 4. What potential liability could these

> physicians face, if they follow

> a treatment protocol based on partial science?

> 5. What did the Board of the AAAAI do when

> accepting this document as a

> position statement, to assure they were properly

> educating and protecting

> the physicians they represent?

> 6. What research that is in direct contrast to

> this document, is

> understood to be sound science by the Board?

> 7. How many research studies on the subject

> were not included in the

> formation of this document?

> 8. What are the research backgrounds of the

> authors in regard to mold

> toxin induced illnesses that allow them to write

> authoritatively on the

> subject?

> 9. How many patients have the authors

> successfully treated that have

> experienced illness beyond simple allergy from

> mold?

> 10. What steps the Board of Directors of the

> AAAAI take to assure that

> what they were endorsing as a position

> representative of 6500 physicians was

> based on unbiased, non-financially motivated, public

> interest, sound science?

>

> The Document Itself:

> 1. The document states its purpose is to

> provide a “state-of-the-art

> review of the role that molds are known to play in

> human disease�. (Pg 326 P.1)

> 1. Given the fact that the authors acknowledge

> this is not an all

>

>

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