Top Reasons You Should NEVER Use the HERTSMI-2 test method from Surviving Mold

Summary of the original Recommendations

There are no data or evidence that relates the ERMI score to any illness.

When looking at the graph of the ERMI scores, the colors are simply quartiles of the data - this means, green is the 25% of homes with an ERMI score under negative 4 (these are the lowest scoring homes). Yellow range is the middle 50% of scores (between -4 and 6), and red is the last 25% of homes, which had an ERMI score above 6 (the highest scoring homes). The numbers do not correlate to any quantification such as species or amount of mold growth, or water damage, or illness. The EPA research did not follow up on any of its findings or methods - it was a one time study but EPA stopped it and did not do any others like it. So, your interpretation of your ERMI score should be based on more than just the index number - you should focus on three things:

1. A thorough understanding of the building conditions using a visual inspection,

2. A damage/construction/repair history, focused of course on water and vapor, and

3. The operations/functions of the building.

HERTSMI-2

This score is only for the Shoemaker medical protocols when a physician prescribes cholestyramine to "remove mycotoxins". It is based on his own single piece of research that he says predicts whether a patient will respond positively to one part of his treatment protocol. Additionally, HERTSMI is limited in some very important ways.

The patients in this study had three factors in common.

1. They had the HLA genotype that Shoemaker suggests is partly responsible for CIRS.

2. They were diagnosed with CIRS using the Shoemaker diagnostic protocol (very strict requirements).

3. They had been treated with cholestyramine as a “toxin binder”, aka “detox” treatment.

This is very limiting. But it shows a clear understanding of controlling the research.

It also means that using HERTSMI can ONLY be used for people with these three factors. Do you have those three factors? And no others?

Unfortunately, there was no alternative (“control” or “comparison”) group in his study, or in any subsequent studies. It was not, as commonly required of good evidence-based medical research, a “double blind” study.

Also, unfortunately, no other researcher has attempted to replicate this study; not even a modified approach has been attempted.

In the world of science, this “one-off” is merely a suggestion of what might exist. It is by no means proof that a HERTSMI score is predictive of treatment outcome. It certainly is not predictive of mold growth and water damage contamination in a building.

The single conclusion Shoemaker claimed the research “proved” was clear and simple: the patients did not “improve” if they remained in a home with a HERTSMI score higher than 15.

Figure 1. Cholestyramine is an ion-exchange polymer and bile acid sequestrant (Figure). It can exchange its chloride anions with anionic bile acids in the gastrointestinal tract and bind them in the polymer matrix. From Dessislava Lazarova, et al. (2019): Imaging of redox-imbalance and oxidative stress in kidney in vivo, induced by dietary cholesterol, Biotechnology & Biotechnological Equipment.

====================================================================

There is no discussion about actual mold growth or water damage conditions.

There is no discussion of confounding factors - these are the other possible environmental or medical or physiological or pharmaceutical factors that could have prevented recovery.

Nor is there a discussion of the sampling and design methods used to arrive at the HERTSMI-2 score. There is no discussion of the important methodological factors such as selection of dust sample locations, limitations of the lab analysis, the arbitrary decision to use only five species from the entire 36 species ERMI panel, the arbitrary ranking and score assignment of these five species, or actual mold growth in the building or space where the dust was collected.

A search for this information, including direct personal requests to at least three of the “survivingmold’ professionals, has not been able to find any data that was collected with regard to the actual environmental conditions of these patients’ homes or workplaces.

(NOTE: very few medical doctors use cholestyramine for this purpose. It has not been validated or approved by FDA for this treatment - talk to your physician about these details.)

Shoemaker is very confident that his patients with HERTSMI-2 scores higher than 15 (and who have the genotype and the CIRS diagnosis and treated with cholestyramine) will have very poor outcomes.

In other words, the patient will not respond to the cholestyramine detox treatment and will remain ill.

The study conclusions do not show nor can they even suggest that staying in a home with a HERTSMI-2 score over 15 will cause new disease or worsen existing disease. This applies not just to the conditions of “disease” but also to the symptoms being reported by the patients (there simply is no discussion of this in the Shoemaker study or subsequent discussions).

He claims a “higher than 15 score” is very important. He recommends that it is very important for the patient to avoid a mold contaminated environment. This is not a novel idea – avoidance of the cause of illness is a millennia old technique; somewhat along the lines of “Hey Doc, my elbow hurts when I bend it like this”. Doctor, “Don’t bend it like that.”

What he does not do, is discuss what to do if your score is lower, such as 14, or very higher, such as 25. Or middle ground scores, like 4 or 8 or 11. What to do? There is no answer. There is no way he could discuss these concerns because he did not collect the correct and adequate data.

There are only two ways to do “avoid” living in a moldy environment:

1. Leave the contaminated building and do not return and find a mold-free environment, which is burdensome, stressful, expensive and often simply impossible; or

2. Properly and completely remediate and clean the environment to eliminate the mold growth and any possible likely exposure.

It is important to understand that for HERTSMI scores under 15 the Shoemaker study did not find evidence with strong significantly statistical confidence for predicting disease recovery outcome. In other words, as HERTSMI went lower, the ability to predict disease outcome became less clear. In these cases, arguments could be made that the treatment (cholestyramine) was helpful for some patients and at some point for some patients it was no more helpful than a placebo or a non-treatment. Given the length and difficulty of treatments, this could be understood as saying, for half the patients, the treatment will not work after many months. Note: these treatments are not short term; they often take months to attain results; or non-results -- the patients must be patient. In addition, the patients must accept the fact the treatment just might not work at all.

So here is my advice: if you have already taken the ERMI/HERTSMI sample don't sweat the lower numbers, in fact, don’t sweat the high scores either. It is best to simply don't use ERMI unless you have a very good assessor who will first inspect for signs of water and mold, analyze the building functions and history, knows water science, etc, and who uses sampling only has a secondary “tool”. ERMI and HERTSMI are NOT primary assessment tools.

It is important to note that for 90% of all the health assessments I’ve performed, I did not need one single sample, not air, not ERMI, not HERTSMI, not tape-lift, to find mold the growth and solve the mold problem; building types include single family homes, apartments, condos, townhomes, offices, schools, government buildings, and manufacturing facilities. Not one sample in 90% of them.

(NOTE: remediation and cleaning are very different from “disinfecting” – please see the principles of mold remediation in the IICRC-S520 Professional Mold Remediation Standard. We Remove Mold - We Do Not Kill Mold!)

Testing and Sampling

Lab testing for mold is very complex - the interpretation requires more than just the lab results. The most important thing is the actual building mold assessment, including three important steps, and sometimes, if an environmental health professional is involved (i.e., IH, EHS, etc), it can include an equally important fourth step, as follows:

1. Physical inspection of every nook and cranny of the home;

2. Review of the building history of water damage, water leaks, and repairs;

3. A building function/operations assessment using building science; and

4. Review of occupant health and illness.

Putting these three or four things in place before sampling will get more and better info. There are so many reasons not to do a mold test of any kind. There are equally so many reasons not to pay an inspector to do tests of any kind. Once you do the other four steps, then you can figure out a "hypothesis", which is a question, for the sampling: if you can't predict the sample will provide a useful answer to your question, you should not take it.

All sampling must increase the power of your decision-making.

As always, if you need more info, please sign up to get automatic notifications of new emails and helpful articles about mold, environmental acquired illness, mold remediation, and water damage restoration.

To contact Scott, please go to Armour Applied Science - Scott's Bio and Contact Info

Thank You and I Sincerely Hope You Get Well Soon…