Synthetic Musk Compounds: Luckenbach Responds

Symptoms We read with interest the recent study titled “Neurologic Symptoms in Licensed Private Pesticide Applicators in the Agricultural Health Study” (Kamel et al. 2005). Although this was a hypothesis-generating study, the authors speculated regarding moderate exposure and associations with neurologic symptoms. Substantiation of hypotheses requires meaningful metrics of exposure and effect, and depends on exclusion and analysis of competing hypotheses for the observations. In our opinion, the article by Kamel et al. falls seriously short in several regards and requires additional data in order to provide credible and defensible conclusions. Kamel et al. (2005) analyzed a number of symptoms in those “ever” experiencing one of 23 self-reported symptoms in the preceding 12 months. The biologic significance of the outcome “symptom count” is unknown; also, “multiple symptoms” is not a definable disease or illness. The fact that private applicators report headache, nausea, and fatigue does not establish that each is of neurologic origin, particularly given the physical requirements of farming. Indeed, results of the questions used by Kamel et al. (2005) have been shown to agree poorly with objective tests of neurologic function (Lundberg et al. 1997). Further, Kamel et al. limited the analyses to a single episode rather than symptoms that were reported more than once per year (Kamel et al. (2005); Table 2). As a crosssectional analysis, the data do not permit assessment of the temporal relationship between exposure and symptom onset, and no consideration was given to the transient nature of the reported symptoms. Thus, although the nature of the analysis implies some sort of persistent neurologic condition underlying the reporting of symptoms, no such condition can be established from intermittent symptoms of indeterminate etiology. In addition to other potential causes for these symptoms, researchers have warned about the role of psychosocial factors in the reporting of non-specific symptoms. According to Spurgeon et al. (1996),