Spin Doctor Hired To Rebut Asthma Link

ResearchgateAn expert who once helped tobacco companies push back on indoor smoking bans and helped insurers deny reimbursement to car-crash victims has a new mission: testifying that mold at Church Street South didn’t cause widespread health problems.

That toxicologist, Ronald E. Gots, argues that there’s no way to conclusively trace asthma back to mold at Church Street South, the former 301-unit federally subsidized housing complex near Union Station where tenants were vacated after the government declared it uninhabitable.

Northland Investment Corp., the Massachusetts-based owner of Church Street South, is currently demolishing the destroyed complex in hopes of rebuilding a bigger mixed-use project, while defending itself against a class-action lawsuit filed by former tenants that could potentially cost the company millions of dollars. Northland has hired Gots to help make its case.

In a 36-page analysis of medical records, included in a recent motion filed by Northland seeking to break apart the class action, Gots said spores of mold could not be singled out as the cause of respiratory problems and skin conditions. Especially not with pets scampering and neighbors smoking, trains pulling into an active rail yard and cars flying by on a highway nearby.

Gots has been making similar arguments on behalf of industry for decades, saying bureaucrats and lawyers overreact to the chemicals around us.

The putative expertise that allows Gots to make those claims has been called into question in several courtrooms. He served as scientific advisor for a Big Tobacco front group that fought regulations on indoor air quality, and he second-guessed accident victims to help insurance companies deny payouts.

Reached by phone on Thursday evening at his consultancy’s offices in Rockville, Maryland, Gots declined to comment. “I’m sorry, I really can’t talk to you,” he said. “I’m in the middle of this thing. I cannot answer your questions.”

“You can look at my C.V. That’s all public,” he said when asked about his background. “But I can’t do more than that right now.”

He denied ever advising tobacco companies, denied ever meeting lawyers for tobacco companies, declined to explain how his now-shuttered medical-review service worked and hung up. Gots did not challenge any of the specific facts about his work with tobacco companies sent to him in multiple follow-up emails.

In a statement, Northland said that Gots, a “highly qualified and credentialed physician and toxicologist with more than 40 years of experience,” is “recognized as an expert in his field.”

“We look forward to the court’s consideration of Dr. Gots and his testimony,” the company said.

Counting Asthmatics

Court ExhibitCourt ExhibitNorthland brought on Gots to serve as one of its most important expert witnesses.

Even if the plaintiffs can prove that Northland systematically let the buildings at Church Street South plunge into ruin, allowing water leaks to persist for months or even years without adequate repairs, Gots is the person who can question what it all amounts to. He can potentially undercut the argument that tenants developed their asthma, respiratory problems and skin conditions from Church Street South.

“The plaintiffs have proffered a seemingly straightforward theory of this case: the residents had similar exposures and they developed common medical disorders, particularly asthma, and thus represent a class of individuals,” Gots write. “That theory, while appealing on its face, is strikingly simplistic and fundamentally incorrect. The exposure attribution is wrong. The clinical disorder attribution is wrong. The causal analysis is wrong as well.”

Just Like Bridgeport

The plaintiffs, meanwhile, have hired Carrie Redlich, a professor at Yale School of Medicine who researches the effects of surroundings on lung problems like asthma, to survey 268 former tenants at Church Street South. She concluded that the prevalence of asthma was “very high,” even when accounting for the race and class of those interviewed.

Of 170 children, 48 percent reported physician-diagnosed asthma, 41 percent had respiratory problems, and 45 percent had emotional distress. Two-thirds of the kids said they got better after leaving Church Street South.

And of the 98 adults, 37 percent reported physician-diagnosed asthma, 58 percent had respiratory problems, and 85 percent had emotional distress. Three-quarters of the adults said they too got better after moving out.

Gots, who holds a doctorate in pharmacology, said that those rates actually weren’t far off from those in other cities in Connecticut. He cited Amistad Academy, a charter school network in New Haven and Bridgeport, which reported asthma among 44 percent of its students — “comparable,” he said, with what Redlich found.

The defendants then slammed Redlich’s analysis as inaccurate. Marc Kurzman, Northland’s lawyer, said she shouldn’t have taken tenants at their word. Her “complete failure” to look over physicians’ evaluations as corroboration ruined her analysis, he argued. Gots added that her numbers were “inflated,” based on “self-reported data and flawed methodology.”

After looking through doctors’ notes, Gots claimed that only 26 percent of the 268 former tenants had a “definitive medical diagnosis.” (Another 13 percent possibly had asthma.) Of those, only about one-third were diagnosed while they actually lived at Church Street South.

By his count, that brought the number down to just 24 residents who developed asthma at the complex. From there, he said he found “alternative causes” for 18 tenants, mostly pointing to respiratory infections like bronchitis and pneumonia. Only six had no other explanation.

“The inescapable conclusion,” Gots wrote, “is that at least 98 percent of the Church Street South residents (of those I reviewed) do not have asthma with any apparent connection to the residence.”

Researchers often rely on self-reports of doctor-diagnosed asthma, according to a 2011 meta-analysis of mold and dampness studies. Because children are often self-reporting their symptoms (or having their parents do it for them) to non-specialists and because tests have poor predictive value, accurately diagnosing asthma can be fuzzy. Several studies, including among sick kids, have also shown that less severe asthma actually tends to go unreported.

Gots’s testimony pointed out, to the contrary, that people generally over-report exposure to hazards like a toxic waste site or tainted water supply.

Identifying The Culprit

Court ExhibitGots then delved into the controversial science around whether mold can actually cause asthma to develop (outside a small portion of people with a mold allergy) or whether it just exacerbates it.

Traditionally, scientists believed that asthma can develop in people predisposed to have an allergic reaction to mold. Those antibodies, Gots said, are still the “best-known and best elucidated mechanism” for identifying mold as the culprit. More recent research, however, suggests that chronic irritation in a water-logged space can cause asthma to develop, though the proof is strongest for children.

Unlike more conclusive allergy tests, though, those studies have major limitations. Surveys come with reporting bias, where interviewees talk up the suspected cause of their illness, though some researchers have successfully backed up the claims with inspection reports. Data analyses, likewise, come with limitations on what entered a person’s lungs, exactly what type of organism grew on what type of surface and was breathed in for how long.

Gots called that emerging body of research “far from settled.” Without citing any studies, he also argued that growing up in a damp environment filled with microbiological agents might actually protect a kid from asthma. He referred to it as the “hygiene hypothesis.”

That goes against evidence that fungal spores in damp houses, just like cockroach saliva and feces or dust mites, are more likely to trigger respiratory problems than assuage them.

A 2007 study in Finland, for instance, sent trained engineers to 240 homes where kids, ages 2 to 7, had just been diagnosed with asthma. The researchers found that higher levels of moisture damage and visible mold in the living room correlated with higher risk of asthma. Similarly, a 2007 study in Britain found that kids were more likely to stop wheezing within six months after fungicide was sprayed in their house than a control group left in moldy homes.

Still, discounting that, Gots said allergy tests were the only way to prove that mold caused asthma. Just a handful of Church Street South tenants went to get those tests. Of 14 tenants tested, nine of whom were asthmatics, four responded to mold.

That’s higher than what Gots had predicted. Since 1998, as he wrote in his book Toxic Risk and reiterated in his court filing, Gots has said that 6 to 8 percent of the population has antibodies for mold. Yet Church Street South’s rates topped 26 percent.

Gots said all those individuals had gotten tested after moving out, making a “temporally eligible connection” impossible.

In what might be his strongest argument to the court, Gots also pointed out that there’s no way to go back and test the condition of the apartments at the time the tenants claim to have developed symptoms. Whatever the science might suggest, the tenants’ lawyers need to prove mold was a culprit by a preponderance of the evidence.

Despite all of that, if the mold at Church Street South did somehow tighten their throats and inflame their skin, Gots limited the potential damages.

He said few tenants had reported any distress about it. Based on a review of “tens of thousands of pages of psychiatric records,” he said only three individuals told their mental-health provider about their substandard housing.

The rest talked with their psychiatrists about depression and anxiety, past sexual abuse, opiate addiction and mental illnesses like schizophrenia and bipolar disorder. “All of these produce emotional distress,” Gots wrote, “but none is related to mold concerns.”

Standing Up For Industry

Gots has been making similar arguments on behalf of corporations for at least three decades.

Throughout his career, Gots criticized strict regulation of pesticides and asbestos. He questioned why coal miners were being compensated for pneumoconiosis, better known as black lung disease, and he said he doubted Agent Orange had an effect on soldiers in Vietnam.

Studies indeed often cannot link cancers, already rare in the population, to decades-old chemical exposures.

But where most scientists use epidemiological studies and animal tests to understand carcinogens around us, Gots often demands harder proof, like seeing bodies scorched from a plane crash or a chemical explosion —  the two examples he gave to contrast with Church Street South’s mold.

Gots used conspiratorial language to describe the growing number of companies being dragged to court over contaminants in the workplace, telling a gathering of insurers in a 1982 speech that all of society seemed to be lining up against them.

“The leadership by environmentalists and plaintiff attorneys is formidable. It has the full backing of the print and electronic media. Government agencies and the Congress are supportive. Certain vocal spokesmen from the scientific community lend their imprimaturs. The labor movement stands strong behind it. It is financially well-endowed, and it has garnered broad acceptance and support among the American public,” he said. “Unless serious scientists and physicians enter this national legal battle immediately and help direct these actions towards the truth, we will be overrun by false claims which erode billions of very real dollars.”

Early on, Gots often blamed smoking as the true culprit in batting down claims of occupational exposure to other chemicals. Then he switched sides. He joined with the cigarette-makers in pushing back on regulation of secondhand smoke.

This week, Gots denied that he ever worked with tobacco companies or their lawyers. “I have never advised a tobacco company in my life. That’s utter nonsense,” he told the Independent in the brief phone call.

“While I respect freedom of the press, I want to make sure that you are aware that neither I nor any of the consulting companies I have run, including the Center for Toxicology and Medicine, have ever been engaged by or performed services for the tobacco companies,” he wrote in a follow-up email, copying his lawyer. “With that in mind, I would ask you to refrain from stating or suggesting anything to the contrary and appreciate the harm that would be caused to me by inaccurately reporting anything to the contrary.”

But starting in 1985, an employee at the company Gots ran said his boss personally wanted to meet R.J. Reynolds Tobacco executives “for a further introduction to our people and services,” as the employee wrote in a letter. “We look forward to working with you.”

In 1989, Gots met with lawyers for Phillip Morris to discuss pesticides used in growing tobacco, and in 1992, he had another sit-down with lawyers for Brown & Williamson Tobacco Corporation to discuss a government report about secondhand smoke, according to billings kept by those firms. Gots denied that these meetings took place.

That same year, Gots signed on as chairman of the scientific advisory board for the Total Indoor Environmental Quality Coalition, an industry front group assembled by R.J. Reynolds that brought together other businesses like AT&T, BF Goodrich Tires and Dupont Fibers, to oppose “costly, premature and perhaps ineffective” federal legislation.

In a magazine article around that time, which R.J. Reynolds would later use in its marketing materials and in Congressional testimony, Gots said that most people’s concerns over indoor air quality were either a “non-problem” or a “nonidentifiable problem.”

While flirting with the tobacco industry, Gots never did become one of its outspoken defenders.

He joined his Maryland-based consultancy, the International Center of Toxicology and Medicine, with three businessmen and let them carry out most of the tobacco-related work from the same offices under a different company name, as one of the partners testified in a taped 2000 deposition.

Later, Gots went back to working with insurers. He founded Medical Claims Review Service (MCRS), a company to which insurers sent medical files and accident reports for a second opinion. Known informally as a “paper review,” these supposedly-independent assessments were often used to deny claims.

In a Peabody Award-winning investigation about the practice, Dateline NBC reported that it caught Gots in a lie about his company’s practices.

At first, Gots said, “A doctor [at MCRS] looked at every one” of the medical reports. But when the journalist John Larson confronted Gots with contrary statements from a former MCRS doctor, Gots cleared his throat, drank some water and backtracked. He soon admitted that a doctor never looked at the reports in “some small percent of our cases,” about a tenth of the caseload, he estimated, meaning hundreds of reports.

Dateline NBC obtained 79 MCRS reports done for State Farm, every single one of which favored the insurer.

In a subsequent fraud case that ended with a $9.6 million verdict against State Farm, a judge said there’d been “overwhelming evidence” that MCRS was a “completely bogus operation” that prepared “slanted,” “cookie cutter reports.”

Gots told Dateline they were actually “above standards in the industry by far.” MCRS went out of business in 1995.

Since then, Gots has served as an expert witness in trials in 30 states, focused primarily on mold. In his resume, he said he’s met with over a hundred patients in assisted living facilities; residents in apartments, hotels and housing projects; and students and teachers in schools.

“I have seen the breadth of complaints,” Gots said, “some minority of which may have been mold-related, most of which were not, but were perceived to be so” by all the individuals involved.

Previous coverage of Church Street South:
Northland: Disaster Not Our Fault
Church Street South Taxes Cut 20%
The Tear-Down Begins
Finally Empty, Church Street South Ready To Disappear
Northland’s Insurer Sues To Stop Paying
Who Broke Church Street South?
Amid Destruction, Last Tenant Holds On
Survey: 48% Of Complex’s Kids Had Asthma
Families Relocated After Ceiling Collapses
Housing Disaster Spawns 4 Lawsuits
20 Last Families Urged To Move Out
Church St. South Refugees Fight Back
Church St. South Transfers 82 Section 8 Units
Tenants Seek A Ticket Back Home
City Teams With Northland To Rebuild
Church Street South Tenants’ Tickets Have Arrived
Church Street South Demolition Begins
This Time, Harp Gets HUD Face Time
Nightmare In 74B
Surprise! Now HUD Flunks Church St. South
Church St. South Tenants Get A Choice
Home-For-Xmas? Not Happening
Now It’s Christmas, Not Thanksgiving
Pols Enlist In Church Street South Fight
Raze? Preserve? Or Renew?
Church Street South Has A Suitor
Northland Faces Class-Action Lawsuit On Church Street South
First Attempt To Help Tenants Shuts Down
Few Details For Left-Behind Tenants
HUD: Help’s Here. Details To Follow
Mixed Signals For Church Street South Families
Church St. South Families Displaced A 2nd Time — For Yale Family Weekend
Church Street South Getting Cleared Out
200 Apartments Identified For Church Street South Families
Northland Asks Housing Authority For Help
Welcome Home
Shoddy Repairs Raise Alarm — & Northland Offer
Northland Gets Default Order — & A New Offer
HUD, Pike Step In
Northland Ordered To Fix Another 17 Roofs
Church Street South Evacuees Crammed In Hotel
Church Street South Endgame: Raze, Rebuild
Harp Blasts Northland, HUD
Flooding Plagues Once-Condemned Apartment
Church Street South Hit With 30 New Orders
Complaints Mount Against Church Street South
City Cracks Down On Church Street South, Again
Complex Flunks Fed Inspection, Rakes In Fed $$
Welcome Home — To Frozen Pipes
City Spotted Deadly Dangers; Feds Gave OK
No One Called 911 | “Hero” Didn’t Hesitate
“New” Church Street South Goes Nowhere Fast
Church Street South Tenants Organize

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posted by: 1644 on August 3, 2018  3:20pm

The British study citied here supports Northland’s argument that the fact that a tenant had asthma and lived in a moldy apartment does not mean that the tenant’s asthma was caused by the mold.  In the study mold was suppressed in the homes of asthmatics living in previously moldy homes.  The suppression resulted in fewer problems for 50 out of 86, or 52% of participants, and 5 of the 86 reported worse breathing.  This is pretty strong evidence that just because someone lives in a moldy home and has asthma,  there is only about a 50% chance that the mold is causing the asthma. Simply put, correlation does not equal causation.  (BTW, when I lived in Britain, nearly every home I visited was dank and moldy.  Same with Ireland.).

posted by: Kevin McCarthy on August 3, 2018  5:09pm

1644, asthma is a complex disease that can be triggered by several causes. My youngest brother had a severe case of the disease as a kid in a house that was newly constructed and had no mold. But there is good evidence that mold can exacerbate the disease. If mold was unrelated to asthma, you would expect to see equal numbers of asthmatics getting better and worse following mold suppression, not a ten to one ratio of the former to the latter.

BTW, I have lived iand worked in Britain and found mold to be a widespread problem there, particularly in older buildings.

posted by: Russia Exit Crimea on August 3, 2018  7:54pm

I have seen it all. First we have a President who lies. Now we have a doctor who lies.

posted by: 1644 on August 3, 2018  11:49pm

Kevin:  No one, not I, nor Northland, not Gots, is arguing that mold does not cause some asthma.  However, Peak & Rosen seem to have missed the lessons in set theory and Venn diagrams I got in third grade.  Just because some asthma is caused by mold, does not mean that all asthma is caused by mold. In fact, the British study indicates that of all asthmatics living in moldy houses,  only half have asthma that is caused or aggravated by mold.  For the remainder,  their asthma is caused by some other factor, but not mold.  Given this, it is not reasonable for a Northland to be liable for every asthmatic who lived in a moldy apartment, but only for those with sensitivity to mold, as per a RAST, ELISA or other test.

posted by: NHPLEB on August 4, 2018  7:28am

But,  isn’t it amazing that all that mold and crud grew like overnight at Church Street South because the NH Housing Authority surely wouldn’t have let it grow like this unchecked for 40 years;  would they?!?!?

That was sarcasm but seriously—-  does anyone NOT think that living at the junction of 2 major interstate highways and a big sewage treatment plant in NH,  plus another sewage treatment plant in WH   could also have anything to do with respiratory problems?????

posted by: 1644 on August 5, 2018  10:02am

“But where most scientists use epidemiological studies and animal tests to understand carcinogens around us,”
Epidemiology studies diseases in populations,  i.e., epidemics.  The results of epidemiological studies are useful for determining population-wide policies.  They are not dispositive, and should not be substituted for individual diagnoses based on a clinical examination of a patient.  For example,  epidemiological studies tell us that vaccinating a population against measles will, due to herd immunity,  protect that population from a measles epidemic. However, given that a vaccination administered at about age one will only be effective in 95% of individuals (and a booster shot at age 5 will be raise that rate to 98%),  one cannot conclude that any particular individual in a vaccinated population is immune to measles.  To determine an individual’s immunity, one needs a titer, drawing that individual’s blood and examining the concentration of measles antibodies in that individual.

posted by: 1644 on August 5, 2018  4:47pm

” ...including among sick kids, have also shown that less severe asthma actually tends to go unreported.”
The abstract linked with “sick kids” does not say what Peak/NHI claims it says.  Rather, it says that parents who report that their kids have asthma are less likely to seek care for acute illnesses, often caused by microbes, than parents who do not think they have asthmatic kids.  Presumably,  parents of asthmatic children are likely to assume that an acute illness is just another asthma attack, rather than something new which requires care.
Similar to my wife shrugging off a a runny nose to her hay fever or other allergies, while I call EMS to report a man-cold.
” Parents whose children had asthma by report appeared to be less likely to seek medical evaluations (Spearman’s rho: 0.42,p = 0.11) when their children had acute illnesses, compared to those of non-asthmatic children (rho: 0.64,p < 0.001). Concerns that asthmatic patients (rho: 0.62,p < 0.001) are more likely to see health care providers and undergo medical evaluations and laboratory tests when they have acute illnesses than non-asthmatic patients (rho: 0.64,p < 0.001) are not supported by our study.”

posted by: Kevin McCarthy on August 5, 2018  8:16pm

1644, if memory serves, you are a lawyer; I trust you read the original complaint in this case. The complaint does not assert “that all asthma is caused by mold”. In fact, it makes no assertions at all regarding the etiology of asthma. (I don’t believe the word “asthma” occurs in the complaint.) It does allege that Northland was negligent, and this lead to the presence of dust mites and poor indoor air quality (asthma triggers) in the buildings, as well as toxigenic mold. The gist of the complaint is that Northland engaged in “demolition by neglect.”

Russia Exit Crimea, I don’t think Dr. Gots is lying. Presumably his statement was made under oath, and I doubt he made any knowingly false statements. But like the people involved in the second-hand smoke cases, he is sowing doubt on behalf of corporations.

posted by: robn on August 6, 2018  2:01am

Aren’t tenants obliged to try to keep their apartments clean? If so and if there was a repeated reappearance of mold (indicating water infiltration) is there a paper trail of complaints to landlord?
I’m asking because this seems like a more provable thing with an indisputable causation (reemerging mold equals water infiltration equals landlords responsibility).

posted by: 1644 on August 6, 2018  9:54am

Kevin:  Yes, demolition by neglect is part of the plaintiff’s allegations, although Northland contests it, saying they spent $11 million on repairs, including new roofs.  The complaint seems upset that the complex was a not maintained as section 8, although I honestly don’t know what obligation Northland had to do so.  Most contracts between HUD and private owners are time-limited, often for the length of a mortgage loan, after which the owner is free to do what it wants with the complex.
  Overall, you are right that Rosen is not specifically saying that the mold caused all the asthma.  His allegation is much more general:  the complex had a laundry list maintenance problems,  tenants had a laundry list of health problems, some of which can be caused building conditions, therefore, the health problems were caused by the poor maintenance.
  robn: Yes, Northland is trying to say the court should examine each plaintiff’s case individually, to see if, in each case, the landlord breached a duty, that that breach caused health problems. Rosen wants to skip over looking at individual maintenance and health records.

posted by: wendy1 on August 7, 2018  8:21am

Gots no ethics.

posted by: Russia Exit Crimea on August 10, 2018  1:27am

Mr.McCarthy, OK your last sentence is more accurate.