Logjam at CDC – School Mold Help.org request for CDC to update mold information to correspond with that produced by the World Health Organization – July 2009
UPDATE ON NOVEMBER 4TH, 2009
LETTER RECEIVED FROM DR. HOWARD FRUMKIN, DIRECTOR NATIONAL CENTER FOR ENVIRONMENTAL HEALTH/AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY REGARDING SMH COMMUNICATIONS WITH THE CDC ABOUT IMPROVING MOLD AND HEALTH INFO. See below…
Since January, 2009, The Center for School Mold Help has engaged in a writing campaign to alert President Obama and the Centers for Disease Control and Prevention about the need to recognize the national public health problems associated with indoor dampness and mold, and for the CDC to update its information related to mold and health. This has resulted in direct communications with the (former) Acting Director of the CDC and a phone conference with the Chief of Air Pollution and Respiratory Branch of the CDC, Dr. Paul L. Garbe, who is ultimately responsible for the current information on the CDC website about mold and health. As of 10/9/2009, Dr. Garbe has admitted the information falls short and promised to improve it, to add the IOM’s (2004) full findings including the effects associated with mold and dampness, which include (new) asthma development and lower respiratory disease in otherwise healthy children. Further, he promised to insert the WHO findings on dampness and mold (2009). As of 10/27/09, the CDC information remains the same. We are waiting and have alerted President Obama, CDC Director Thomas Frieden, MD, and Senator Barbara Boxer (Chairperson of the Senate Committee on Environment and Public Works) of this meeting and promises. On November 4th, 2009, a letter was received from Dr. Howard Frumkin, revealing that the CDC is reviewing its mold and health information and has made several changes, as a result of these communications. (SMH)
The text of the letter:
Dear Mrs. Brinchman,
Thank you for your letter of September 15, 2009.
I understand that you have spoken with Dr. Paul Garbe, Chief of the Air Pollution and Respiratory Health Branch at the National Center for Environmental Health. As Dr. Garbe stated, the CDC recognizes the importance of mold as a public health concern, particularly for vulnerable individuals, such as individuals with asthma and other respiratory diseases or with other underlying conditions. We appreciate that you share this concern, and thank you for bringing your specific suggestions to our attention.
As Dr. Garbe explained on your October 9 call, we are reviewing the new World Health Organization (WHO) guidelines on indoor air quality, dampness, and mold to determine if those findings are at significant variance with the Institute of Medicine (IOM) review/Damp Indoor Spaces and Health that CDC sponsored in 2004. We feel the WHO authors’ conclusions and their recommendation for “prevention or remediation of dampness and mold-related problems to significantly reduce harm to health” are in agreement with the IOM report and with what we have posted on our website. We are still reviewing the evidence for WHO’s characterization of mold as a “major cause of morbidity and mortality” and will adjust our recommendations as needed based on that review.
In the meantime, we have provided a link to the WHO report on our mold website, www.cdc.gov/mold, as a “Key resource” (on the right side of the page), and as a “Nonfederal” resource on our mold “resources” page (http://www.cdc.gov/mold/links.htm), as you suggested. Also, in response to one of your emails on this matter, we have clarified some of the recent redesign of our website to improve our links to the IOM report. Thank you for bringing this oversight to our attention. We are reviewing how to more clearly represent the IOM findings related to exposures and health effects. In particular we will review our presentation of the IOM findings regarding “Limited or suggestive evidence” and “Sufficient evidence of an association”. (page 1)
I would also like to respond to two additional concerns you have raised.
1. The US Government Accountability Office (GAO) Audit on Mold, found inconsistencies among federal agencies addressing mold. This problem is being addressed by the Federal Interagency Committee on Indoor Air quality (CIAQ), which is chaired by the U.S. Environmental Protection Agency. Inquiries on the CIAQ process should be addressed to the CIAQ. You may contact the CIAQ at the following address: Philip Jalbert, Executive Secretary, Federal Interagency Committee on Indoor Air quality (CIAQ) U.S. EPA, Indoor Environments Division (6609J), 1200 Pennsylvania Avenue, N.W., Washington, D.C. 20460 or via email at firstname.lastname@example.org.
2. You asked about email correspondence from Vangent Inc. CDC has used Vangent Inc. to assist with public inquiry responses since 2005. The information provided by Vangent in response to question about is prepared by the CDC’s Air Pollution and Respiratory Health Branch.
Again, thank you for sharing your concerns with us.
Howard Frumkin, M.D., Dr.P.H.
Director, National Center for Environmental Health/Agency for Toxic Substances and Disease Registry
The sequence of communications has been as follows, in Chronological Order, culminating in the receipt of the letter above. We have not yet responded, but will, shortly.(SMH)
1. Several letters were sent, in Jan and March 09 to HHS Secretary-Nominee Thomas Daschle regarding The Center for School Mold Help’s concerns about the impact of damp buildings and mold on health in the United States, particularly on the economy and deriving in great part, from the schools. It was mentioned that physicians are largely uninformed, the gov’t agencies are not consistent in their information, conflicts of interest have been noted, and we felt the CDC may have been playing politics with the mold issue. We asked that Secretary-Nominee Daschle inform President Obama and contact our organization for more information. Letters were also sent to President Obama, various members of Congress and the US Surgeon General.
2. We received a letter, in March, 2009, from Dr. Richard E. Besser, Acting Director, Centers for Disease Control and Prevention, and Acting Administrator, Agency for Toxic Substances and Disease Registry, at the request of Mr. Daschle. This letter summarized the CDC’s actions to date on mold research and education (which we felt to be inadequate). We waited as a new directors of agencies were appointed by the Obama administration. Meanwhile, the World Health Organization published its WHO Guide to Indoor Air Quality: Dampness and Mould, in July, 2009, a very welcome, extensive document that pronounced indoor mold and dampness to be major public health threats, worldwide.
2. The following email was sent to the CDC on Sept. 8, 2009 – a request for the United States Centers for Disease Control to update its mold information to correspond with that produced by the World Health Organization, July, 2009. Previous communications with the CDC have resulted in the receipt of a listing of the CDC’s information links, all of which are inadequately describing the health effects of mold. Since the WHO is doing the work, we want the CDC to report it and inform the nation’s healthcare professionals, health departments, and the general public regarding the serious health threat caused by dampness and mold. Our site visitors may wish to add their voices and emails to this effort, by writing the CDC at email@example.com
Subject: URGENT request for CDC to update mold and health info re: WHO mold info
From: SMH Director
Dear CDC Info Administrator, I am writing, as the Director of The Center for School Mold Help, a national, 501c3, educational nonprofit, to request that the Centers for Disease Control website information on mold and health be updated to correspond with and include the WHO guidelines for indoor air quality: dampness and mould (July 16, 2009).
Millions of Americans are unnecessarily subjected to and sickened by dampness and mold, without help or recognition of the environmental illnesses that often develop. School children suffer in moldy, leaky, damp schools throughout the United States – chronically sickened while trying to obtain an education. The school staff suffer and may die from exposures within these buildings. Homeowners and renters alike find their health and finances destroyed by preventable mold exposures. Physicians, health departments, and the public are misinformed by your current information, which is dated and inaccurate – the CDC is, sadly, the primary source of the poor information.
This misinformation, in turn, helps overwhelm our healthcare system and damages our nation’s economy and productivity by causing millions to be sickened by a preventable cause. Now that the WHO has provided the vital planning and improved information regarding the very harmful health effects and mortality caused by mold and dampness, this should be included in an improved, updated informational section on mold and health on your website. The CDC must not continue to downplay this public health threat. The CDC must fully inform and warn physicians and the public about the health effects of mold and dampness.
The US GAO Audit on Mold (Sept., 2008) found that the US gov’t health agencies were not consistent in their information on mold. In fact, the US EPA and Federal OSHA both warn the public far more about the health effects of dampness and mold. This report, a year ago, has not yet improved your website information. I trust that the WHO Guidelines will assist in providing that which is missing, going beyond what any of our United States agencies have provided.
Mold and Your Health (from your website today)
Exposure to damp and moldy environments may cause a variety of health effects, or none at all. Some people are sensitive to molds. For these people, molds can cause nasal stuffiness, throat irritation, coughing or wheezing, eye irritation, or, in some cases, skin irritation. People with mold allergies may have more severe reactions. Immune-compromised people and people with chronic lung illnesses, such as obstructive lung disease, may get serious infections in their lungs when they are exposed to mold. These people should stay away from areas that are likely to have mold, such as compost piles, cut grass, and wooded areas.
A link between other adverse health effects, such as acute idiopathic pulmonary hemorrhage among infants, memory loss, or lethargy, and molds, including the mold Stachybotrys chartarum (Stachybotrys atra), has not been proven. Further studies are needed to find out what causes acute idiopathic hemorrhage and other adverse health effects. (CDC, Mold) Note the contrast with the WHO information, below:
WHO guidelines for indoor air quality: dampness and mould
Published July, 2009
From the WHO Foreward
“Indoor air pollution – such as from dampness and mould, chemicals and other biological agents – is a major cause of morbidity and mortality worldwide.”
“The guidelines were developed and peer reviewed by scientists from all over the world, and the recommendations provided were informed by a rigorous review of all currently available scientific knowledge on this subject.”
From the WHO Executive summary
“Exposure to microbial contaminants is clinically associated with respiratory symptoms, allergies, asthma and immunological reactions.”
“There is strong evidence regarding the hazards posed by several biological agents that pollute indoor air; however, the WHO working group convened in October 2006 concluded that the individual species of microbes and other biological agents that are responsible for health effects cannot be identified. This is due to the fact that people are often exposed to multiple agents simultaneously, to complexities in accurately estimating exposure and to the large numbers of symptoms and health outcomes due to exposure. ”
“The presence of many biological agents in the indoor environment is due to dampness and inadequate ventilation. Excess moisture on almost all indoor materials leads to growth of microbes, such as mould, fungi and bacteria, which subsequently emit spores, cells, fragments and volatile organic compounds into
indoor air. Moreover, dampness initiates chemical or biological degradation of materials, which also pollutes indoor air. Dampness has therefore been suggested to be a strong, consistent indicator of risk of asthma and respiratory symptoms (e.g. cough and wheeze). The health risks of biological contaminants of indoor air could thus be addressed by considering dampness as the risk indicator.”
“Sufficient epidemiological evidence is available from studies conducted in different countries and under different climatic conditions to show that the occupants of damp or mouldy buildings, both houses and public buildings, are at increased risk of respiratory symptoms, respiratory infections and exacerbation of asthma. Some evidence suggests increased risks of allergic rhinitis and asthma. Although few intervention studies were available, their results show that remediation of dampness can reduce adverse health outcomes. There is clinical evidence that exposure to mould and other dampness-related microbial agents increases the risks of rare conditions, such as hypersensitivity pneumonitis, allergic alveolitis, chronic rhinosinusitis and allergic fungal sinusitis.”
“Toxicological evidence obtained in vivo and in vitro supports these findings, showing the occurrence of diverse inflammatory and toxic responses after exposure to microorganisms isolated from damp buildings, including their spores, metabolites and components.”
“Microbial growth may result in greater numbers of spores, cell fragments, allergens, mycotoxins, endotoxins, β-glucans and volatile organic compounds in indoor air. The causative agents of adverse health effects have not been identified conclusively, but an excess level of any of these agents in the indoor environment is a potential health hazard.”
“Microbial interactions and moisture-related physical and chemical emissions from building materials may also play a role in dampness-related health effects.”
“The authors conclude that occupants of damp or mouldy buildings, both private and public, have up to a 75% greater risk of respiratory symptoms and asthma. The guidelines recommend the prevention or remediation of dampness- and mould-related problems to significantly reduce harm to health…In damp conditions, hundreds of species of bacteria and fungi grow indoors and emit spores, cell fragments and chemicals into the air. Exposure to these contaminants is associated with the incidence or worsening of respiratory symptoms, allergies, asthma and immunological reactions. Children are particularly susceptible.” (WHO Press Release, 7/16/09)
This World Health Organization report, published July 16, 2009, verifies that which suffering millions and The Center for School Mold Help have been reporting, which the United States Centers for Disease Control, health departments, and most US physicians have downplayed and denied – that mold and dampness cause serious health problems, including respiratory and immunological. The WHO emphasizes that mold should be avoided as a major health risk, explains how to prevent and address indoor mold, and points out that building owners have the responsibility to provide healthy indoor air. This document will begin the changes needed to rescue the world population from the devastating impact of indoor mold (mould) and dampness, especially within our schools and homes. We expect that the United States Centers for Disease Control will quickly follow with a position on mold and dampness, in step with the WHO. There is no more doubt – mold and dampness harms and can kill. We cannot tolerate this in our schools and buildings.
I would like to be informed about your plans to update your mold and health information, on an urgent basis.
Founder and Executive Director,
The Center for School Mold Help
P.O. Box 655
La Mesa, CA 91944
Cc: President Barack Obama; Kathleen Sebelius, Secretary of HHS; Dr. Steven K. Galson, US Surgeon General; Senator Barbara Boxer
The following email was sent on Sept. 15, 2009 to Dr. Thomas Frieden, newly appointed Director, Centers for Disease Control, with the Sept 9th email (see above) attached:
The Center for School Mold Help
P.O. Box 655
La Mesa, CA 91944-0655
Dr. Thomas Frieden
Director, Centers for Disease Control and Prevention
Centers for Disease Control
Atlanta, Georgia 30333
Dear Dr. Frieden,
I am writing to ask you to help facilitate my request that the CDC update its public information on mold (located on the CDC website), a vital necessity, especially in light of the public health threats described within the WHO Guidelines for Indoor Air Quality: Dampness and Mould, released in July, 2009. I recently sent the following letter, below, on this topic to the CDC Info Administrator. I ask for your assistance in improving the information provided to the general public, which is most important, as the CDC sets the tone of the nation with regard to prevention of mold problems and resulting health impacts.
Director, The Center for School Mold Help
La Mesa, CA
Several replies followed, and a meeting was set up by Dr. Paul L. Garbe, Chief of the CDC’s Air Pollution and Respiratory Branch, DVM, MPH to speak with me by phone. The result of that meeting is summarized below:
The Center for School Mold Help
P.O. Box 655
La Mesa, CA 91944-0655
Paul L.Garbe, DVM, MPH
Chief, Air Pollution and Respiratory Health Branch
Division of Environmental Hazards and Health Effects
National Center for Environmental Health
Centers for Disease Control and Prevention
Oct. 23, 2009
Dear Dr. Garbe:
Thank you for meeting with me on Oct. 9, 2009, regarding my concerns relating to the information that your division of the CDC is disseminating on mold and health. During that fifty minute discussion the following was determined, according to my notes:
1. The Centers for Disease Control Air Pollution and Respiratory division, of which you are Chief, is responsible for what appears on the CDC web site with regard to indoor air pollution and mold.
2. Information from the IOM Damp Indoor Spaces and Health (2004) has been shared with the public via the website, on a very limited and selective basis. For instance, I brought to your attention that the IOM findings related to health effects associated with mold and/or (indoor) dampness, such as development of (new) asthma and lower respiratory disease in otherwise healthy children DO NOT appear on the Mold and Health section of the CDC website – yet the minor associated health effects did, such as skin irritation, wheezing, etc.. You agreed. The IOM report link was “buried” under many layers of information in the web site, where most would never look. You agreed.
3. Your division was unaware of the 250 page WHO Guide to Indoor Air Quality: Dampness and Mould (July 16, 2009) because there is “no coordination whatsoever” with WHO on this topic of mold and dampness. You said you were glad to learn of its publication and will include a link to it, with summary of the WHO findings on the CDC web site, with permissions as needed from WHO.
4. You will be contacting your web designers to adjust the Mold and Health information to include all the important associated effects of mold (IOM) and the WHO findings, immediately.
5. You expressed concern that you are not given even “a dollar” for mold per se, and do not have “unlimited webspace”.
I was very pleased that we were able to speak and clarify all of the above. I have to say that I am disappointed in the performance of the CDC, to date, on this important health topic that impacts the entire American population, healthcare industry, and economy, ultimately. I believe that this is an important area of accountability and prioritizing that needs to be delved into further. We need the CDC to be current, transparent, science-based, and non-political regarding disease prevention.
The changes in the CDC information on Mold and Health, described above, will help prevent mold and dampness-related illness and chronic disease in millions of Americans. It is imperative that, without need for further research or passage of time for any reason, these current scientific findings are published prominently on the Mold and Health section of the web site. As of today, the old, inaccurate information still appears, two weeks after our phone conversation. Further, it is very hard to find the Mold and Health section.
The reason I am being so persistent on this matter is that I see a direct connection to the lack of current, comprehensive information by the CDC and the illness of many tens of millions. This is, quite definitely, a failure to protect the public and can readily be remedied, overnight, if the political will exists. The information is already published by the most authoritative sources, all CDC has to do is share it prominently and start applying this information in all its programs related to asthma, respiratory, and immunological disease prevention. Our nation’s school children and staff (20% of the US population) are frequently exposed to indoor mold and dampness, with much misunderstanding about the health effects – thus, school districts, health departments, state and local lawmakers do not make it a priority to provide dry and sanitary buildings. Physicians often deny the health effects described in the IOM and WHO documents, as they are unaware, getting their information, ultimately, from that which the CDC publishes on its website and emphasizes in its communications. This is something that can be fixed immediately, within our easy reach.
I thank you for taking the time to speak with me, and for your promise to correct the matter.
I would like to be notified of the changes to the CDC Mold and Health web site, on an urgent basis.
The Center for School Mold Help
Cc: President Barack Obama; Dr. Thomas Frieden; Senator Barbara Boxer; Rep. Bart Gordon, Committee on Science and Technology
WHAT OUR SMH SUPPORTERS AND CONCERNED CITIZENS CAN DO:
1. Monitor the CDC’s Mold and Health information, frequently – note inconsistencies and any areas of scientific misinformation. Also, please monitor the public information on mold,dampness, and health posted by the other US agencies – EPA, federal OSHA, NIOSH (part of CDC and federal OSHA).
Pages to monitor:
CDC section on mold: www.cdc.gov/mold
Mold and Your Health (CDC): http://www.cdc.gov/mold/dampness_facts.htm
Mold Resources (CDC): http://www.cdc.gov/mold/links.htm
2. This is a new administration with new heads of agencies. Write them. Send your own educational communications to those gatekeepers of health information in America and their overseers, including President Obama, your Senators and Representatives in Congress, and Dr. Thomas Frieden of the CDC. Several other key Obama appointees are Kathleen Sebelius, Secretary of Health and Human Services and US EPA Administrator, Lisa Jackson. One person, one organization can make a difference. With many, the voices joined together are more effectively heard. You can make help make a difference with our nation’s public health policies and information by helping to monitor and write your concerns about dampness, mold and health to those above.
3. Important: Support The Center for School Mold Help with your subscription or donation today!
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“Changes in construction methods have caused US buildings to become perfect petri dishes for mold and bacteria to flourish when water is added. Instead of warning the public and teaching physicians that the buildings were causing illness; in 2003 the US Chamber of Commerce Institute for Legal Reform, a think-tank, and a workers comp physician trade organization mass marketed an unscientific nonsequitor to the courts to disclaim the adverse health effects to stave off liability for financial stakeholders of moldy buildings. Although publicly exposed many times over the years, the deceit lingers in US courts to this very day.” Sharon Noonan Kramer