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To the Editor: The article by Dr Dominici and colleagues¹ is intended as scientific evidence that can provide a rationale for setting a PM_2.5 National Ambient Air Quality Standard by the EPA. Although this study is carefully constructed, it does not consider several problems that should be addressed before these results can coherently be used for establishing public policy.

First, individuals spend about 85% of their time indoors² so it is important to account for indoor exposure risk factors for the diseases considered. Aside from smoking (which was apparently not included either as passive or direct), there are etiologically relevant (inflammatory) risk factors that have not been included in the exposure-response model. For example, exposure to molds is associated with respiratory tract infections, one of the end points in the study. Similarly, there are no controls for body mass index and income.

Second, the authors report negative percentage changes in . . . [Full Text of this Article]

Paolo F. Ricci, PhD, LLM
Department of Environmental Sciences
College of Arts and Sciences
University of San Francisco
San Francisco, Calif

Sorin R. Straja, PhD
straja@nars.org
Institute for Regulatory Science
Columbia, Md

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