Committed to Halting Bleeding-Lung Disease

While the Centers for Disease Control and Prevention has raised some questions about definitive proof linking a toxic black mold to deaths in Cleveland infants ("CDC reports flows in mold study, " March 12), researchers at Case Western Reserve University School of Medicine will continue their studies into links because the consequences of inhaling the mold are potentially so dire. More importantly, physicians and scientists at CWRU and Rainbow Babies & Children's Hospital will continue to advocate for elimination of this deadly mold from the environment. Local efforts during the last five years to address this apparent toxic mold connection are to be commended. With support from the National Institutes of Health and initial, partial funding from the CDC, CWRU researchers have been able to reproduce the bleeding-lung disorder in infant rats and are attempting to find ways to detect early toxic mold exposure and effectively treat the disorder. Researchers have developed a new test to determine how much of these toxins are in home environments. In collaboration with a U. S. Environmental Protection Agency laboratory in Cincinnati, they are applying new molecular biology techniques to quantitatively identify a number of molds, toxic and nontoxic, in home environments. These tests are key components of a new cooperative research program by the Cuyahoga County Board of Health, the county's Development Office and the CWRU School of Medicine, supported by the U. S. Department of Housing and Urban Development and the EPA on the impact of moisture and mold on the health of infants and children, including asthmatics. Meanwhile and most importantly, local researchers at CWRU and Rainbow continue working with local and public health agencies to protect infants of our community from this often fatal bleeding-lung disorder. Cases occurring subsequent the initial CDC-led investigation have continued to come from homes with water damage and toxic mold (more than 90 percent of the patients involved). With support from the Rainbow Babies & Children's Board of Trustees, the Cleveland, Gund and Abington foundations and the state legislature, a program of inspecting the homes of newborns for mold and water damage has been at least partially responsible for decreased incidence of this disorder in our community. I urge parents and public officials to continue their efforts to give local infants a safe environment, free of water-damaged walls where this toxic black mold can grow. While definitive proof has not yet been produced, there is enough evidence for us to continue these efforts in the hope of preventing more illness and deaths.

NATHAN A. BERGER, M.D.

Cleveland

Berger is dean of the School of Medicine and vice president of medical affairs at Case Western Reserve University.

In 1993 and 1994, when the initial outbreak of bleeding-lung disease was recognized in Greater Cleveland, a remarkable combination of local, state and federal experts convened to investigate causes and to develop a protection and prevention program. The Centers for Disease Control and Prevention in Atlanta recently published a report that raised concerns about the statistical accuracy of the original study. Ever since that first study was initiated, there has been severe criticism and tremendous skepticism about whether it could definitively link a toxic mold to the presence of an acute, sometimes fatal disorder. Scientific "proof" of such a linkage has liability implications that affect people and property owners far beyond out issue of bleeding-lung disease in Cleveland. Due to this nationwide concern regarding liability, the level of proof and assurance assigned to the original study has proved to be beyond what an initial pioneering effort could provide. This is unfortunate. The study and the work within it were a shining example of scientific cooperation and would be better served by more support from the CDC. To the credit of our community, out physicians and institutions, we have continued with our research efforts to provide more definitive information. Residents of Greater Cleveland can be assured that the work done here since 1994 has continued to support the hypothesis that toxic molds are the most likely factor in bleeding-lung disease. We welcome the CDC's interest in moving forward with us to protect children in Greater Cleveland and have hopes that our pioneering efforts may eventually save lives and reduce illness for everyone.

TIMOTHY E. HORGAN

Cleveland