MEMORANDUM
October 10, 2010
TO
New York Mold Task Force
FROM
Jack Thrasher, Ph.D.
Scott McMahon, M.D.
Melinda Ballard
Policyholders of America
Laura Mark, M.D.
Cheryl Wisecup
RE
Draft Report of the New York Mold Task Force
We reviewed your draft report. It was apparent that you spent a lot of time writing the report, and it was
good to see that you included some of the relevant references. However, there are many additional,
important facts and research papers that need to be included. We are providing comments on specific
items mentioned in your report, as well as some general comments for your consideration.
To begin, we focused our attention on the main goals of the Task Force as defined in your draft report.
The main goals of the Task Force were to summarize and assess existing evidence and
information relevant to the tasks listed in the law and to assess the feasibility of possible
recommendations for any further actions to be taken by the state legislature or state agencies
based on its analysis. To achieve these goals, the Task Force activities were organized into four
main areas of inquiry: (1) health effects of molds in indoor environments; (2) exposure limits and
assessment of mold in buildings; (3) approaches to mold mitigation and remediation; (4) building
codes, regulations and other actions taken by other governments and private-sector organizations
that relate to building mold problems.
You state that your main goals were “to summarize and assess existing evidence and information relevant
to the tasks listed in the law.” Although your report includes several good reference materials, there are
many others that are missing from your review and analysis.
One of the most noticeable problems with your report is that you use the 2004 IOM Report as your key
resource for information. On page 25 of the report, you state that the 2004 IOM Report was “the most
current and thorough evaluation conducted to date of the state of the scientific evidence regarding the
public health significance of, and response to, dampness and molds in buildings.” That statement is
incorrect. The 2004 IOM Report is NOT current or thorough. As stated in the IOM report, their literature
review ended in October of 2003 (making it 7 years old), and they excluded many important research
papers. In contrast, you could have relied on the 2009 report by the World Health Organization which is
more current and more thorough. However, in the footnote on page 25, you state that the World Health
Organization’s 2009 report titled Guidelines on Indoor Air Quality “was not thoroughly reviewed for this
Task Force report.” Why not? You had an excellent (and more current) source of information available
to you from the global medical governing body, and you chose to ignore it.
In connection with the 2009 report by the WHO, Cheryl Wisecup gave you a copy of her October 7, 2009,
response to the World Health Organization. Cheryl had conducted an extensive review and analysis of
the 2004 IOM Report and the 2009 WHO Report, and she prepared a list of important research reports
that were excluded from both of those efforts. Another copy of Cheryl’s October 7, 2009, report is
available at the following link:
October 7, 2009 Response to the WHO
We have copies of other comments that have been submitted to the Task Force including the comments
from Dr. Ritchie Shoemaker. In his two responses to the Task Force, Dr. Shoemaker makes very specific
points about the shortcomings of your report and provides valuable insights on how to improve your
report. We agree with and support Dr. Shoemaker’s assessment.
SPECIFIC COMMENTS
We will begin with some specific comments. This is not intended to reflect all of our concerns regarding
your report but is merely an overview of some of the key issues.
Date of the Report
The Review Draft for Public Comment is dated August 2010. Based upon this date and the list of
literature reviewed, a Disclaimer is needed that clearly states that the literature review was limited and not
up to date.
Executive Summary (pages 10-17)
Health Effects
Conclusions (page 11):
• Exposure to building dampness and dampness-related agents including mold has been
recognized nationally and at the state and local level as a potential public health problem.
o Our comments: Exposure has been recognized globally--not just at the national, state
and local level.
• Evidence for associations between non-respiratory effects and mold exposures in buildings is
much more limited and generally does not allow clear conclusions to be drawn one way or
the other.
o Our comments: This statement is incorrect and misleading. There are thousands of
research papers available regarding the multitude of health effects caused by
exposure to molds and other contaminants in water-damaged buildings.
• Molds, along with other organisms such as bacteria, mites and insects that proliferate in damp
buildings, produce volatile compounds, spores and other minute particles that can cause
irritant and allergic responses that range from annoying to serious depending on the amount
of exposure and the immune system of the individual. Although some molds produce toxins,
their contribution to adverse health effects in damp buildings, based on existing scientific
information, is uncertain.
o Our comments: These statements are incorrect and misleading. This public health
threat is not about “irritant and allergic responses,” and it can affect immune
competent and immune compromised individuals. As stated above, there are
thousands of research papers available on this subject.
State and Local Actions
a) Codes
—Recommended Actions (page 12):
• Provide targeted training and education to CEOs to improve understanding of subtle moisture
problems in buildings (e.g., uncontrolled air flows causing condensation) and to enable them
to address potential or existing water and mold problems more effectively.
Our comments:
o The CEOs already know exactly what needs to be done and many are impeding and
intentionally blocking the dissemination of the facts. They are only concerned about
their profits and maintaining the status quo. Their efforts to deny the truth about this
important public health issue are being supported by the U.S. Chamber of Commerce
and funded by insurance companies and other “big money” interests. They are using
the same strategy that was used by the big tobacco companies when they spent 50
years denying the truth about the health effects of tobacco.
o Instead of asking for millions of dollars to “train and educate” CEOs who already
know the truth, you should focus your attention on educating government officials
and law enforcement and code enforcement officials, so that current laws are
enforced and new laws are passed. These naysayers who have been spending their
extensive financial and political resources to deny the truth (while so many are
suffering and dying) need to know that there are consequences for their civil and
criminal actions.
o You should also focus your attention on the medical community at large, so injured
individuals and families can obtain proper medical care.
b) Regulation of Mold Assessment or Remediation Services
—Recommended Actions (page 12):
In regard to Mold Assessment and Remediation (pages 12-13), in order to get a clear picture of the
current state of mold assessment and remediation, you need to read the research and technical guidance.
Most importantly, you need to talk to the people who work in this field. They have concerns about
political bodies who try to make and enforce regulations without understanding the true nature of the
business and the day-to-day challenges. They have additional concerns regarding the inconsistent
application of rules and regulations, especially in regard to working in this industry from one state to the
next. The optimum solution would be a national approach.
You can find information on 1) international, federal, state and local legislative and regulatory efforts, 2)
mold assessment and remediation, 3) moisture content and water damage in buildings, and related topics
on the following website:
http://globalindoorhealthnetwork.com/
II. Task Force Findings
A. Mold Background
2.
What is “toxic mold?” (page 21)
Our comments: There is an attempt to minimize what is or is not considered toxic mold. Certain
species of molds do produce mycotoxins and hemolysins that have been demonstrated in water-
damaged buildings, in sera of occupants and in tissues and body fluids of individuals ill from
exposure to WDB conditions. Although all fungi can cause a toxic exposure as pointed out by the
Task Force, certain fungi, e.g. S. chartarum and A. flavus, add a different dimension to the indoor
contaminants. In this regard, they did cite Brasel et al, 2004. We recommend that the Task Force cite
additional publications on this subject, as follows:
Smoragiewicz W, Cossette B, Boutard A, Krzystyniak K. 1993. Trichothecene mycotoxins in the dust
of ventilation systems in office buildings. Int Arch Occup Environ Health 65:113-7.
Tuomi T, Reijula K, Johnsson T, Hemminki K, et al. 2000. Mycotoxins in crude building materials
from water-damaged buildings. Appl Environ Microbiol 66:1899-1904
Gottschalk C, Bauer J. 2008. Detection of satratoxin G and H in indoor air from a water-damaged
building. Mycopathologia 166:103-107.
Bloom E, Nyman E, Must A, Pehrson C, Larsson L. 2009. Molds and mycotoxins in indoor
environments – a survey in water-damaged buildings. J Occup Environ Hyg 6:671-8.
Hooper DG, Bolton VE, Guilford FT, Straus DC. 2009. Mycotoxins detection in human samples from
patients exposed to environmental molds. Int J Mol Sci 10:1465-75.
Straus DC. 2009. Molds, mycotoxins, and sick building syndrome. Toxicol Indust Health 25:617-35.
Vesper SJ, Varma M, Wymer LJ, Dearborn DG, et al. 2004. Quantitative polymerase chain reaction
analysis of fungi in dust from homes of infants who developed idiopathic pulmonary hemorrhage. J
Occup Environ Med 46:596-601.
Van Emon JM, Reed AW, Yike I, Vesper SJ. 2003. ELISA measurement of Stachylysin in serum to
quantify human exposures to the indoor mold Stachybotrys chartarum. J Occup Environ Med 45:582-
91.
Pieckova E, Wilkins K. 2004. Airway toxicity of house dust and its fungal composition. Ann Agric
Environ Med 11:67-73.
3. Mold Ecology (pages 22-24)
Our comments: It is recognized that fungi are present in the outdoor environment and that their role
is to biodegrade organic matter. The Task Force fails to state that certain species of fungi as well as
Gram positive and negative bacteria are elevated in WDB vs outdoors. Thus, indoor sources of S.
chartarum, A. flavus and versicolor, Chaetomium and certain species of Penicillium must be
identified and eliminated. The most applicable method for detecting these potentially toxic species of
fungi is Real Time PCR DNA testing. Furthermore, the Task Force does recognize that multiple
agents are present in WDB but chose to not focus on individual contaminants. This approach is in
error because different contaminants affect humans via different innate immune responses, e.g.,
endotoxins vs 1, 3-beta-D-glucans.
The most prevalent bacteria that have been identified in WDB include the Actinomycetes. Of these
bacteria, species of Streptomyces and Mycobacterium are associated with human illness ranging from
hypersensitivity pneumonitis through mycobacterium avium complex (MAC). We suggest that the
Task Force add the following references:
Rintala H, Hyvarinen A. Paulin L, Nevalainene A. 2003. Detection of streptomyces in house dust –
comparison of culture and PCR methods. Indoor Air 14:112-9.
Griffith DE, Akasmit T, Brown-Elliott GA, Catanzaro A, et al. 2007. An official ATS/IDSA
statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J
Respir Crit Care Med 175:367-416.
Pessi A-M, Suonketo J, Pentti M, Kurkilahti M, et al. 2002. Microbial growth inside external walls as
an indoor air biocontamination source. Appl Environ Microbiol 68:963-67.
Suihko ML, Priha O, Alakomi HL, Thompson P, et al. 2009. Detection and molecular
characterization of filamentous Actinobacteria and thermo-actinomycetes present in water-damaged
building materials. Indoor Air 19:268-77.
Hirvonen MR, Huttunen K, Roponen M. 2005. Bacterial strains from moldy buildings are highly
potent inducers of inflammatory and cytotoxic effects. Indoor Air 15(Suppl 9):65-70
Rintala H, Nevalainen A, Suutari M. 2002. Diversity of streptomyces in water-damaged building
materials based on 16D rDNA sequences. Lett Appl Microbiol 34:439-43.
B. Health Effects of Mold and Dampness Exposure (page 24)
“Evaluations of weight-of-evidence from epidemiologic studies are often informed by a set of criteria
described by Hill (1965) that include, among other factors, the strength of measured associations, their
biological plausibility, their temporality (i.e., did the exposure precede the health outcome?), the coherence
among studies and how well studies control for factors such as bias, confounding and chance findings.3
Although the Task Force did not conduct a formal weight of evidence evaluation, it relied on expert
reviews that followed these concepts to summarize large bodies of existing evidence and employed the Hill
criteria as an informal conceptual guide when reviewing more recent scientific evidence.”
Our comments: Hill’s Criteria are not a panacea. The Task Force has used Hill’s Criteria as the
panacea for acceptance of epidemiology studies. The Task Force needs to add Dr. Hill’s
qualifications as to the significance of his criteria. The following is a direct quote from his paper on
this subject:
Perhaps the single most important individual in the development of research methods and
analysis in Epidemiology is Sir Austin Bradford Hill (1897-1991). Bradford Hill developed a list
of criteria that continues to be used today. When using them, don’t forget Hill’s advice:
“None of these nine viewpoints can bring indisputable evidence for or against a cause and effect
hypothesis …. What they can do, with greater or less strength, is to help answer the fundamental
question—is there any other way of explaining the set of facts before us, is there any other answer
equally, or more, likely than cause and effect?” (Cited in Doll, 1991).
Our comments: When it comes down to the conditions of water-damaged buildings (WDB) and
exposure to multi-factors in WDB (e.g., fungal species, bacterial species and byproducts of fungi and
bacteria), not all of the criteria can be applied to the illness caused by the exposure. For example,
Criteria: Dose-Response is not applicable when multiple toxins, e.g. mycotoxins, particulates <1
micron, endotoxin, 1, 3-beta-D-glucans, MCVOCS and VOCS, are present and interact. Threshold
values cannot be defined under these conditions because the dose response is non-monotonic, i.e., the
occupants of WDB develop multiple health problems ranging from IgE allergies through chronic
systemic inflammatory responses (hypersensitivity pneumonitis, chronic rhinitis and sinusitis, CNS
decline. A specific factor has not been identified as causative for WDB illness.
Other Criteria that may or may not apply to the conditions of WDB are: Criterion 4 - Consistency (not
everyone develops allergies or asthma, but they do develop inflammatory conditions); and Criterion 8
– Specificity (This criterion requires a single putative cause to produce a specific effect. Since we do
not know what the single putative cause in a multifactor situation is, this criteria cannot be applied to
WDB until the full extent of illnesses are understood.
The most applicable criteria are numbers 1 (Temporal relationship); 2 (Strength); 4 (Consistency) and
7 (Experiment). The publications of Dr. Shoemaker clearly show that these three criteria are the most
applicable when it comes to WDB and chronic inflammatory response of the occupants.
1. Current Scientific Evidence (pages 25-31)
Our comments: The discussion and conclusions in this section are not current. The Task Force relies
upon IOM and NORDDAMP and the California Research Bureau for most of its information. The
following disclaimers should be apparent:
• The IOM panel had a cut-off date of October 2003 for its review of the peer-reviewed
literature. As such, the conclusions of the report are out of date by seven years.
• The NORDDAMP conclusions and discussion meet the same lack of literature search as does
the IOM report.
• The California Research Bureau also lacks the literature search and is not current.
• In addition, other outdated and poorly written and ill-conceived conclusions are included in
the following reference materials included in the Task Force report: ACOEM, 2002 & 2004;
Bush et al, 2006; Khalili and Bardana, 2005; Reinhard et al, 2007; and Stone et al, 2006.
The problems with these citations have been reviewed in the attached POA paper by Shoemaker et al,
2010. Examples of the poor scientific conclusions are: (a) ACOEM position paper, 2002 is based
upon calculations regarding supposed concentrations of mycotoxins in S. chartarum spores. These
data are not consistent with the well designed study of Brasel et al, 2005 a, b who reported
mycotoxins in fine particulates and in sera of exposed symptomatic subjects.; (2) Khalili and Bardana
2005 performed IME on 82 patients. 32 were excluded with no rational given for exclusion. The
other 50 were reported on. However, no clinical data or a detailed assessment of the complex
environments were reported. The authors failed to follow Dr. Portnoy’s recommendations regarding
assessment of the indoor environments; c) Reinhard et al and Stone et al were cited as being critical
of the observations of Gordon et al. However, the Task Force failed to comment on the successful
rebuttal of the criticism published by Gordon et al, 2006.
Dr. Kaye Kilburn has published several papers on neurological and respiratory abnormalities of
individuals ill from exposure to water damaged buildings. We suggest that the Task Force update this
information by including Dr. Kilburn’s latest paper as well as a paper by neurologist, L. D. Empting,
M.D., as follows:
Kilburn KH. 2009. Neurobehavioral and pulmonary impairment in 105 adults with indoor
exposure to molds compared to 100 exposed to chemicals. Toxicol Indus Health 25:681-92.
Empting LD. 2009. Neurologic and neuropsychiatric syndrome of mold and mycotoxin exposure.
Toxicol Indust Health 25:577-82.
The Task Force can also find additional information in the following monographs:
Straus DC, ed. 2004. Sick Building Syndrome. Adv Appl Microbiology. Vol 55.
Kilburn KH, ed. 2004. Molds and Mycotoxins, Heldref Publications, Washington DC
Kilburn KH, ed. 2009. A special issue on mold and mycotoxins: Towards Healthy Homes.
Toxicol Indust Health 25 (No. 9-10).
Block ML, Calderon-Garciduenas L. 2009. Air pollution: mechanisms of neuroinflammation and
CNS disease. Trends Neurosci 32:506-16.
The paper by Block and Calderon-Garciduenas is key to understanding the role of fine particles,
present in both indoor and outdoor air, with the absorbed toxins cause brain inflammation and
subsequent CNS diseases.
Chronic Fungal/Bacterial Sinusitis. This condition has been recognized since the initial
publications of Ponikau and colleagues beginning in 1999. More currently published papers have
demonstrated that involvement of the sinuses can also adversely affect the pituitary axis and also lead
to invasion of the brain and meninges of immune competent patients. We suggest that the Task Force
include the following papers on both fungal and bacterial CRS.:
Dennis DP. 2003. Chronic sinusitis: defective T-cells responding to superantigens, treated by
reduction of fungi in the nose and air. Arch Environ Health 58:433-42.
Dennis DP, Robertson D, Curtis L, Black J. Fungal exposure endocrinopathy in sinusitis with
growth hormone deficiency: Dennis-Robertson syndrome. Toxicol Indust Health 25:669-80.
Siddiqui AA, Shah AA, Bashir SH. 2004. Craniocerebral aspergillosis of sinonasal origin in
immunocompetent patients: clinical spectrum and outcome of 25 cases..
Niederjuhr A, Kirsche H, Riechelmann H, Wellinghausen N. 2009. The bacteriology of chronic
rhinosinusitis with and without nasal polyps. Arch Otolaryng Head Neck Surg 135:131-6.
Chakabarti A, Denning DW, Ferguson BJ, Ponikau J, et al. 2009. Fungal rhinosinusitis: A
categorization and definitional schema addressing current controversies. Laryngoscope 119:1809-
18.
Lee H, Myers A, Kim J. 2009. Vascular endothelial growth factor drives autocrine epithelial cell
proliferation and survival in chronic rhinosinusitis with nasal polyposis. Am J Respir Crit Care
Med 180:1056-67.
D. Mold Exposure Limits and related information (page 63)
Our comments: We agree with the Task Force that exposure limits regarding indoor mold cannot be
established because of the complexity of biocontaminants. Approaches should be developed to
investigate the biocontaminants which include the following:
• PCR DNA identification of fungal species indoors vs outdoors
• Mycotoxins indoors vs outdoors
• Endotoxins indoors vs outdoors.
• 1,3-beta-D-glucans and galactomannans indoors vs outdoors
• Gram Negative and Positive bacteria indoors vs outdoors
• Bacterial exotoxins indoors vs outdoors
• Microbial VOCS and other VOCs indoors vs outdoors
• Particulate matter related to fungi and bacteria from nano particles through spores
For more information on this subject see the following reports. The direct links to these reports are
provided on the following pages.
Thrasher JD, Crawley S. 2009. The biocontaminants and complexity of damp indoor spaces: more
than what meets the eyes. Toxicol Indust Health 25:583-616.
Shoemaker et al. 2010. Research Committee Report on Diagnosis and Treatment of Chronic
Inflammatory Response Syndrome Caused by Exposure to the Interior Environment of Water-
Damaged Buildings. Policyholders of America, July 27, 2009.
GENERAL COMMENTS
As you must know, there are thousands of research papers and technical guidance documents available on
this topic. The following list provides direct links to several additional papers that should be included in
your report. Cheryl previously sent you information about several of these items. There are hundreds of
additional research papers available on the following website:
http://globalindoorhealthnetwork.com/
Toxicology and Industrial Health--Special Issue on Mold and Mycotoxins: Towards Healthy Homes
http://tih.sagepub.com/content/25/9-10.toc
26th Annual International Symposium on Man and his Environment in Health and Disease: Special Focus
on Molds and Mycotoxins, Hidden Connections for Chronic Diseases
http://globalindoorhealthnetwork.com/files/26th_Annual_International_Symposium_on_Man_and_His_E
nvironment_2008.pdf
(The) Biocontaminants and Complexity of Indoor Spaces: More Than What Meets the Eyes (2009) by
Jack D. Thrasher and Sandra Crawley
http://globalindoorhealthnetwork.com/files/Thrasher_paper_The_Biocontaminants_and_complexity_of_d
amp_indoor_spaces_-_more_then_what_meets_the_eyes.pdf
Fungal and Actinobacteria in Moisture-Damaged Building Materials—Concentrations and Diversity
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VG6-44CNNK9-
1&_user=10&_origUdi=B6VG6-3W368R2-
2&_fmt=high&_coverDate=01/31/2002&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_url
Version=0&_userid=10&md5=f7ba86eb04c48874504fb294e11d3758
Canada Mortgage and Housing Corporation—A Selective Bibliography (several resources)
http://globalindoorhealthnetwork.com/files/Canadian_Mortgage_and_Housing_Corporation_Moisture_Pr
oblems_in_Buildings_A_Selective_Bibliography_2006.pdf
Brown University Study Finds Link Between Depression and Household Mold
http://news.brown.edu/pressreleases/2007/08/depression-and-household-mold
Exposure to Interior Environments of Water-Damaged Buildings Causes a CFS-like Illness in Pediatric
Patients: a Case/Control Study
http://www.iacfsme.org/BULLETINSUMMER2009/Summer09ShoemakerExposuretoInterior/tabid/381/
Default.aspx
Guidance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure
and Moisture Indoors (2004) by the University of Connecticut Health Center
http://oehc.uchc.edu/images/PDFs/MOLD%20GUIDE.pdf
Indoor Mold: Better Coordination of Research on Health Effects and More Consistent Guidance Would
Improve Federal Efforts by the GAO--Government Accountability Office (2008)
http://www.gao.gov/new.items/d08980.pdf
Is Indoor Mold Contamination a Threat to Health? (2003) by Dr. Harriet Ammann
http://globalindoorhealthnetwork.com/files/Is_Indoor_Mold_Contamination_a_Threat_to_Health.html
Spectrum of Noninfectious Health Effects from Mold (2007) from Pediatrics: Official Journal of the
American Academy of Pediatrics (2007)
http://globalindoorhealthnetwork.com/files/Pediatrics_Journal_Spectrum_of_Noninfectious_Health_Effec
ts_from_Mold_2007.pdf
What the Primary Care Pediatrician Should Know About Syndromes Associated with Exposures to
Mycotoxins (2006) by Ruth A. Etzel, M.D., Ph.D.
http://globalindoorhealthnetwork.com/files/What_the_Primary_Care_Pediatrician_Should_Know_About_
Syndromes_Associated_with_Exposures_to_Mycotoxins_2006.pdf
The federal government acknowledges illness caused by exposure to mold and indoor contaminants. The
following links provides two examples of mold-related disability claims that have been approved by the
Social Security Administration.
http://globalindoorhealthnetwork.com/files/Social_Security_Disability_approval_for_Kristina_Townsend
.pdf
http://globalindoorhealthnetwork.com/files/Imler_Sherman_Social_Security_Disability_approved.pdf
Acute Inhalation Toxicity of T-2 Mycotoxin in Mice. “Inhalation of T-2 mycotoxin is at least 10 times
more toxic than systemic administration and at least 20 times more toxic than dermal administration…”
http://toxsci.oxfordjournals.org/cgi/content/abstract/8/2/230
World Health Organization report on mold titled “Guidelines for Indoor Air Quality—Dampness and
Mould” (2009)
http://www.euro.who.int/__data/assets/pdf_file/0017/43325/E92645.pdf
Cheryl’s October 7, 2009, response to the World Health Organization which identifies several of the
important research reports that were excluded from the 2009 WHO report and the 2004 IOM report.
http://globalindoorhealthnetwork.com/files/Response_to_WHO_Report_Submission_to_WHO_Oct_7_20
09_complete_report.pdf
A Critique of the (2003) ACOEM Statement on Mold
http://globalindoorhealthnetwork.com/files/A_Critique_of_the_ACOEM_Mold_Statement_2008.pdf
You should also read the letter that ACHEMMIC sent to the EPA on February 16, 2010. This letter
provides many important statistics and facts that are important to this issue. Cheryl previously sent you a
link to this letter.
http://achemmic.com/files/ACHEMMIC_February_2010_Letter_to_EPA_CIAQ4.pdf
Cognitive Impairment Associated With Toxigenic Fungal Exposure: A Replication and Extension of
Previous Findings
http://www.informaworld.com/smpp/content~content=a783682706~db=all
Diseases Caused by Molds in Humans
http://healthandenergy.com/diseases_linked_to_molds.htm
Psychological, Neuropsychological, and Electrocortical Effects of Mixed Mold Exposure
http://globalindoorhealthnetwork.com/files/Psychological_Neuropsychological_and_Electrocortical_Effe
cts_of_Mixed_Mold_Exposure_2004.pdf
Neurobehavioral and Pulmonary Impairment in 105 Adults with Indoor Exposure to Molds Compared to
100 Exposed to Chemicals
http://globalindoorhealthnetwork.com/files/Neurobehavioral_and_Pulmonary_Impairment_in_105_Adult
s_with_Indoor_Exposure_to_Molds_in_Water_Damaged_Buildings_2009.pdf
Toxicology of Mycotoxins
http://tih.sagepub.com/content/25/9-10.toc
Molds and Mycotoxins: Effects on the Neurological and Immune System in Humans
http://globalindoorhealthnetwork.com/files/Mold_and_Mycotoxins_Effects_on_the_Neurological_and_I
mmune_System_in_Humans_2004.pdf
Toxic Effects of Mycotoxins in Humans
http://globalindoorhealthnetwork.com/files/Toxic_Effects_of_Mycotoxins_in_Humans_Peraica_1999.pdf
The Treatment of Patients with Mycotoxin-Induced Disease
http://globalindoorhealthnetwork.com/files/Rea_Treatment_of_Patients_with_Mycotoxin-
Induced_Disease_2009.pdf
Neural Autoantibodies and Neurophysiologic Abnormalities in Patients Exposed to Molds in
Water-Damaged Buildings
http://globalindoorhealthnetwork.com/files/Neural_Autoantibodies_and_Neurophysiologic_Abnormalitie
s_in_Patients_Exposed_to_Molds_in_Water_Damaged_Buildings_2004.pdf
Neurologic and Neuropsychiatric Syndrome Features of Mold and Mycotoxin Exposure (2009)
http://globalindoorhealthnetwork.com/files/Neurologic_and_Neuropsychiatric_Syndrome_Features_of_M
old_and_Mycotoxin_Exposure_2009.pdf
The Validity of Environmental Neurotoxic Effects of Toxigenic Molds and Mycotoxins
http://www.ispub.com/journal/the_internet_journal_of_toxicology/volume_5_number_2_40/article/the_v
alidity_of_the_environmental_neurotoxic_effects_of_toxigenic_molds_and_mycotoxins.html#h1-6
And, most importantly, be sure to read the new research paper that was just announced on July 27, 2010.
The authors of the paper are Ritchie Shoemaker, M.D., Scott McMahon, M.D., Laura Mark, M.D., Jack
Thrasher, Ph.D. and Carl Grimes, HHS, CIEC. The name of the paper is “Research Committee Report on
Diagnosis and Treatment of Chronic Inflammatory Response Syndrome Caused by Exposure to the
Interior Environment of Water-Damaged Buildings.” This research paper was just released in July of this
year, and it could add a lot of value to your report by helping you to present a thorough and up-to-date
perspective. In addition, as Dr. Shoemaker pointed out, this paper contains hundreds of references to
important research papers that cover a time span of many years. Here’s the link for the paper:
http://www.policyholdersofamerica.org/doc/CIRS_PEER_REVIEWED_PAPER.pdf
Thank you for your time and your interest in presenting a thorough and accurate view of this important
public health issue.
