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Purpose: Critique of the 1998 article published by Hodgson and colleagues and the authors' reply.
Design: Letter to the Editor and Authors' Reply.
Outcome: Two scientists from the Center for Disease Control used the Letter to the Editor format to review the limitations of the courthouse-related study conducted by Hodgson and colleagues. Page and Trout did not agree with Hodgson et al., who concluded that mycotoxins from fungi growing on water-damaged building material were the most likely cause of individual complaints in the Florida buildings that were evaluated. Page and Trout opined that there was a lack of objective evidence documenting pulmonary illness in the building occupants, a lack of information demonstrating actual exposure to mycotoxins, and limited evidence from the literature suggesting that mycotoxins are related to illness caused by the indoor environment. Page and Trout stated that the studies cited by Hodgson and colleagues failed to make up for these shortcomings. Hodgson et al., responded to Page and Trout by explaining their approach to assessing whether or not mycotoxins were the culprit. Hodgson et al., believed that they had ruled out the possibility that the cases had either type I allergy or hypersensitivity pneumonitis induced by an allergen from fungi. They claimed that a reaction to allergens could not explain the lung function abnormalities because there was not sufficient evidence that the appropriate antibodies were correlated with the observed symptoms. They also attempted to rule out airborne endotoxins from sources other than fungi because they felt there wasn't enough evidence of a water reservoir from which endotoxins might derive. Hodgson and colleagues reiterated their original view that mycotoxins were the most likely candidate that they could identify.
Significant Quotes: "Most scientists recognize that case reports and outbreak investigations cannot provide generalizable knowledge, as the population to which they may be extrapolated is controversial. The purpose of such reports is generally to make the medical and scientific community aware of discussions, theories, and concerns they should be aware of, could keep their eyes open for, and perhaps recognize again if encountered elsewhere." (p. 763).
Defendants' Perspective: Page and Trout's Letter to the Editor provides useful comments that may be used to cross-examine Plaintiffs' experts relying on the original Hodgson article. Defense experts may chose to rely on the observations of Page and Trout.
Plaintiffs' Perspective: Plaintiffs' expert may use the reply from Hodgson and colleagues to illustrate that differential diagnosis is sometimes the only obvious means to identifying a causal relationship between unquantifiable exposure and health complaints.
Peer Review: Yes.
Relevance to Ongoing Cases: This article may be used to cross-examine plaintiffs' experts relying on the original article by Hodgson and colleagues.
How to Obtain the Article: http://www.joem.org/