• Federal Mold Bill to Be Reintroduced
• Word on the Street
• IEQ Presidential Political Primer 2008
• Vets Link Pet Deaths to Toxic Mold
• Breaking the Mold -- Tales of a Road Warrior
• Ask Dr. Burge -- How Important Is the Mold Investigation/Remediation Field?
• Radon Corner -- ABC Takes Extreme Approach to Radon Reduction
• Sampling -- The Ever-Expanding Data Base on Pathophysiology of Illness Caused by Exposure to Water-Damaged Buildings

A federal bill seeking to protect the public from mold-infested homes is intended to be reintroduced by its original sponsor, John Conyers (D-Mich.) “probably in late January,” according to Conyers staff member Mustafa Ali.

The United States Toxic Mold Safety and Protection Act, named the Melina Act after the daughter of a Conyers staffer who first brought the issue to the representative’s attention has been introduced in each Congressional session since first submitted June 27, 2002, but has yet to meet a vote before the House.

The bill is technically a series of amendments to the Toxic Substances Control Act, the Internal Revenue Code of 1986 and the Public Buildings Act of 1959 “to protect human health from toxic mold, and for other purposes.”

According to Rep. Conyers’ Web site, the bill’s Title I will “[direct] the Environmental Protection Agency and Centers for Disease Control to examine the effects of different molds on human health and develop accurate scientific information on the hazards presented by indoor mold.” It also directs the EPA and the Department of Housing and Urban Development to “establish guidelines that identify conditions that facilitate mold growth” and also address assessment, testing and remediation, “and measures that can be implemented to prevent such growth.” The EPA and HUD will also be charged with establishing certification guidelines for mold inspectors and remediators, including hazard identification and health risks.

Title I also “authorizes programs to educate the public about the dangers of indoor mold.”

Inspections of multi-unit housing and all property purchased by federally guaranteed funds are required in Title II. The modification of building codes “to minimize mold hazards in new constructions” completes the second section.

Title III requires the development of industry standards. Grants for mold removal in public buildings and tax credits for inspection and/or remediation are covered respectively in Titles IV and V.

Title VI “creates a National Toxic Mold Insurance Program administered by the Federal Emergency Management Agency to protect homeowners from catastrophic losses” to supplement lacking insurance coverage and Title VII “enables states to provide Medicaid coverage to mold victims who are unable to secure adequate health care.”

Conyers staffer Karen Morgan told IE Connections that the only significant change to the bill for this introduction is that it would allow cities to apply directly to the federal government for funds for mold-remediation projects. When asked if Conyers feels optimistic about the bill’s chances, Morgan said, “He’s always felt good about it. He feels good about giving people options.”

INDUSTRY LEADERS JOIN FORCES
A Dec. 10 press release from II Rep-Z, better known as Microban Systems Inc. and Unsmoke Systems, announced the immediately effective merger of the company with Dri-Eaz Products Inc.

Under the agreement, II Rep-Z’s Unsmoke and Microban Systems brands will be joined to the Dri-Eaz brand under a new corporate entity – Legend Brands. Cliff Zlotnik, current chairman of II Rep-Z and co-host of IAQ Radio, will participate on the Legend board of directors.

“We firmly believe the synergy between Microban Systems, Unsmoke and Dri-Eaz will produce a stronger, more dynamic company for today and well into the future,” Zlotnick is quoted as saying in the press release. “We’re extraordinarily pleased about the merger and the opportunities it creates to capitalize on the talents of the newly combined team and provide customers with the most comprehensive line of product offerings in the industry.”

Dri-Eaz president Bill Bruders’ sentiments echoed Zlotnik’s. “The strategic combination of II Rep-Z’s specialty chemical business with Dri-Eaz’s drying equipment manufacturing business creates an ideal platform for providing customers with a full range of advanced property loss reduction solutions.

“The structure of this transaction, including the significant equity stake II Rep-Z shareholders are taking in Dri-Eaz and the caliber and experience of this management team, demonstrate our commitment to bring together the unique strengths of both organizations to serve the evolving needs of disaster restoration, cleaning and facilities professionals.”

Dri-Eaz will continue to operate out of its Burlington, Wash. headquarters, with satellite offices in Nashville, Tenn. and Newport Pagnell, U.K. II Rep-Z will continue operations in its current headquarters in Coraopolis, Pa.

BBJ GOING BELLY UP?
In late November, 2007, BBJ Environmental Solutions Inc. filed a petition for relief under Chapter 11 of the U.S. bankruptcy code. According to company sources granted interview anonymity, the move was largely to prevent the eviction of BBJ from its Tampa, Fla. office.

In a notice sent to creditors (including Indoor Environment Communications, publisher of this newspaper), the United States Bankruptcy Court, Middle Division of Florida, Tampa Division, will hold a status conference on Jan. 24 to make preliminary determinations and establish schedules for the company’s reorganization plan.

Meanwhile, a committee of unsecured creditors to BBJ is being formed and a meeting of creditors was scheduled for Jan. 2 in Tampa.

SHUTTING UP, SHUTTING DOWN MRSA
From the American Chemical Society comes news of a potential new means of tackling antibiotic-resistant bacteria, the so-called superbugs, including Methicillin-resistant Staphylococcus aureus.

In a commentary article printed in the November issue of the journal ACS Chemical Biology, British researchers reported being very close to decoding the special chemical language of bacteria.

In an ACS PressPac, it was reported that David Spring, Martin Welch and James T. Hodgkinson “[explained] that researchers have long known that bacteria communicate with each other. Microbes release small molecules that enable millions of individuals in a population to coordinate their behavior. Disease-causing bacteria use this language to decide when to infect a person or other host. Decoding the [structures] and [functions] of compounds involved in this elaborate signaling process, known as ‘quorum sensing,’ could lead to new medicines to block the signals and prevent infections.”

So how does it work? By using “‘some of the most potent synthetic modulators of quorum sensing’ identified to date,” the newly developed N-acylated homoserine lactone analogues, which are “effective against a broad range of bacterial types.”

As impressive as that and the chance to render MRSA and its kin relatively harmless might sound, the scientists’ report included another, tangential benefit. As ACS’s abstract notes, “In addition to showing promise for fighting antibiotic-resistant infections, the compounds may help prevent the growth of biofilms that foul medical implants and cause tooth decay and gum disease.”

FEDERAL SUPPORT FOR BUILDING CODES
A new bill introduced Dec. 12 in the U.S. House of Representatives and Senate by Rep. Dennis Moore of Kansas and Louisiana Sen. Mary Landrieu, respectively, titled the Community Building Code Administration Grant Act of 2007, aims to provide $100 million over five years to help local governments hire, train and equip code officials.
Landrieu said, “Currently, no federal funds are designated for building code administration, and as a result, there is widespread lack of enforcement, presenting a major threat to public safety.”

Moore cited his experience with the Congressional Hazards Caucus. “Our government is supposed to set priorities and invest taxpayer money wisely,” he said. “I firmly believe that this legislation will help ensure the safety of buildings across the country and ultimately will reduce the cost to the American taxpayer after a disaster.”

According to an International Code Council press release, “If approved by Congress, the Community Building Code Administration Grant Act would support hiring and training code officials to save lives and protect property. ... Studies show that every dollar invested to building stronger and safer results in savings of $4 to $7 in reduced damages when a disaster occurs.”

ICC CEO Rick Weiland applauded the bill. “Too often, especially in smaller communities, there simply aren’t sufficient resources for building safety,” he is quoted as saying in the release. “Better building through better code enforcement is clearly in the best interests of our country and every community in it.”

WHEN ONLY ROACHES SURVIVE
Homeowners looking to evict insect pests frequently turn to total release foggers, the ominous “bug bombs” that require total evacuation and possession protection. But it’s what they don’t know that might cause the most damage.

According to the Pennsylvania Integrated Pest Management Program, over 500 fires and explosions are annually caused in the United States when those using the powerful tools don’t eliminate ignition sources – pilot lights and other open flames.

PA IPM recommends that homeowners turn to professional exterminators to use any type of fogger. Otherwise, not only might a home be lost, but the desired effects left lacking – IPM notes that in one 2003 case from San Diego, a house was blown apart when 19 bombs were accidentally ignited by a wall heater’s pilot light. “No one was hurt,” reads IPM’s report, “although several cockroaches survived the blast.”

With an American presidential election looming later this year and primary season already underway, IE Connections sought the positions of candidates from both major parties.

With an eye toward indoor environmental issues and pertinent scientific policy, this compilation is neither exhaustive nor authoritative. The body of a candidate’s profile depended entirely on the information provided. Not all candidates offered policy information; some offered more than others. In terms of legislative records, it is important to note that bills may be voted for or against based on amendments unrelated to the bill’s original intent. In this case, most amendments are ignored in favor of the main bills themselves.

Web sites and campaign headquarters can provide more information; full voting records can be obtained from the Library of Congress and watchdog organizations. For the purposes of this guide, only those bills sponsored by a candidate or voted on, signed or vetoed are included.

Senators Joseph Biden (D-Del.) and Christopher Dodd (D-Conn.) withdrew after the Iowa caucuses. The field presented is current as of press time.

Additionally, although IE Connections offers no official endorsement and urges readers to find the candidate who best speaks to them and vote accordingly, an editorial about this project and the editor’s take on it can be found on page 15.

Senator Hillary Rodham Clinton (D-N.Y.)
Sen. Clinton has embraced a broad plan to upgrade the nation’s scientific efforts. Her nine points include a 50 percent spending increase over five years for the National Institutes of Health, including
emphasis on biotechnology; a plan to triple the number of fellowships at the National Science Foundation while likewise tripling the funding for each; and the creation of awards from federal agencies to “accomplish specific innovation goals.”

Energy efficiency is a focus of Sen. Clinton’s – she wants to reduce electricity consumption 20 percent by 2020; to “catalyze a thriving green building industry;” to initiate a “Connie Mae” program for low- and middle-income Americans to afford green homes and make green improvements; and to require all federal
buildings designed after Jan. 20, 2009 to become carbon neutral. In 2006, she co-sponsored the High-Performance Green Buildings Act, which was later added to the Energy Act. As part of her agenda, she plans to restore the Office of Technology Assessment.

Sen. Clinton introduced in 2005 the Home Lead Safety Tax Credit Act. She was also a sponsor of the Combat Meth Act that same year. She recently introduced the LEAPP Act, Family Asthma Act and Secondhand Smoke Education and Outreach Act, and co-sponsored the Lead Poisoning Reduction Act, Lead Free Toys Act and Ban Asbestos in America Act. She voted against the Low-Income Home Energy Assistance Funding Amendment and did not vote on the Energy Act of 2007.

For more information, visit www.hillaryclinton.com.

Former senator John Edwards
For former senator and vice presidential candidate Edwards (D-N.C.), a new-energy economy figures prominently in his policy plans. He hopes to create a million new jobs by “[putting] new energy-saving technologies to work in buildings, transportation and industry.” He also seeks to restore American leadership in science by emphasizing research and education and respecting scientific findings. Additionally, he intends to modernize patent law and restore the White House Office of Science and Technology Policy, and would make permanent research and development tax credits.

As he has not held offi ce since 2004, Edwards’ record is incomplete. A request to his campaign for more information was not answered by press time. For more information, visit johnedwards.com.

Former New York City mayor Rudolph Giuliani
Like many prospective opponents in both parties, Republican Rudy Giuliani favors the expanded use of energy-efficient technologies in building infrastructure. He also intends to “promote science and mathematics through technical certification or an associate [sic] degree” and “advance successful training
programs, leading to competitive skills the market demands.”

Giuliani has a unique stake among presidential competitors – a subsidiary of his Giuliani Partners management and consulting firm, Sabre Technical Services, has pioneered the use of chlorine dioxide gas in large-scale fumigation and mold remediation projects. (See “At Press Time,” IE Connections, Sept., 2007)

Shortly after leaving the mayor’s office, Giuliani spoke out against current mayor Michael Bloomberg’s city-wide smoking band. He has also come under fire for his role in declaring the air safe around the former World Trade Center site in New York following the Sept. 11 terrorist attacks. Abnormally high rates of asthma and other ailments, attributed to asbestos and other hazardous materials released when the towers collapsed, have been reported by those living, working and going to school in the area, especially cleanup and rescue workers at the site. However, while running for mayor in 1993, he attacked incumbent David Dinkins for overseeing failures in an asbestos testing program for schools.

For more information, visit www.joinrudy2008.com.

Former Alaska senator Maurice Gravel
Although out of public office for over 25 years, Democrat Mike Gravel sees his candidacy as an opportunity to highlight issues important to him. Among his proposals is greater emphasis and flexibility in secondary education.
Requests for fuller details to the Gravel campaign were not answered by press time. For more information, visit www.gravel2008.us.

Former Arkansas governor Michael Huckabee
Saying “our future economy depends on a creative generation,” Republican Mike Huckabee intends to model federal education standards on the model he provided as governor of Arkansas. His plan includes research and development in the technical sector, especially regarding energy.

As governor, Huckabee supported permanent tax incentives and increased funding for scientific research and development. Additionally, he cut capital gains taxes for businesses and individuals and provided tax credits for education and job training. The Club for Growth notes that he also signed a bill to prevent companies from raising prices ahead of a natural disaster, restoration and similar firms the main targets of the legislation.

He pledges an aggressive approach to energy independence, to include the removal of “red tape that slows innovation. We will set aside a federal research and development budget that will be matched by the private sector to seek the best new products.”

For more information, visit www.mikehuckabee.com.

Representative Duncan Hunter (R-Calif.)
Rep. Hunter’s campaign materials do not include information on indoor environmental and similar issues – his campaign appears to be geared primarily toward key conservative issues – nor did his staff respond to queries. However, his voting history in the House of Representatives reveals a mixed bag.

Hunter sponsored the CLEAN-UP of Methamphetamines Act of 2002 and its re-introduction in 2003 and voted for the Consumer Product Safety Modernization Act, the Methamphetamine Remediation Research Act and the Kids in Disasters Well-being, Safety and Health Act. Most recently, he voted against the Energy Independence and Security Act.

For more information, visit www.gohunter08.com.

Former ambassador Alan Keyes
Primarily an activist, Keyes’ only political offices were appointed positions in the Reagan administration. Like Hunter, he has primarily geared his campaign toward conservative social and political goals, including across-the-board tax cuts.

A request to the Keyes campaign for information on pertinent issues did not receive a response by press time. For more information, visit www.alankeyes.com.

Representative Dennis Kucinich (D-Ohio)
Boasting perhaps the most ambitious environmental plan among the presidential aspirants, Rep. Kucinich’s campaign materials focus on sustainability, efficiency and pollution reduction efforts. As part of his agenda, he includes a Works Green Administration under the aegis of the Environmental Protection Agency to “[combine] the infrastructure and energy needs of our country.” He would also “provide universal education to all Americans from preschool through college.” He also aims to create an even playing field between small and large businesses.
During his long tenure in the House, Kucinich has demonstrated commitment to reducing indoor exposure to toxic substances. Most recently, he sponsored the Energy Independence and Security Act, the Environmental Justice Access and Implementation Act, the Kids in Disasters Well-being, Safety and
Health Act, the Addressing the Disaster Needs of Children Act and the Toxic Right-to-Know Protection Act. He also voted for the Methamphetamine Remediation Research Act.

For more information, visit www.dennis4president.com.

Senator John McCain (R-Ariz.)
Sen. McCain, like many Republicans, aims to decrease capital gains taxes and keep them low. He also aims to make permanent research and development tax credits. To burnish economic growth, he would “overhaul unemployment insurance and make it a program for retraining, relocating and assisting workers,”
including strengthened technical training.

But unlike a number of other Republican candidates, he unabashedly touts an environmental plan centered on “common sense stewardship.” His campaign materials call such issues as sustainability
and clean air and water “a patriotic responsibility.” Sustainable use of resources also places highly.

To reflect these priorities, he has in the past voted for passage of the EPA’s clean air mercury rule and the Safe Drinking Water Act. He also sponsored the Comprehensive Methamphetamine Control Act of 1996. However, campaigning has recently prevented him from voting on the Renewable Fuels, Consumer
Protection and Energy Efficiency Act, the Energy Act or for clean energy achievement criteria.

Requests for more information were not answered by press time. For more information, visit www.johnmccain.com.

Senator Barack Obama (D-Ill.)
Sen. Obama touts among his environmental concerns an efficiency plan to reduce American energy use 50 percent by 2030. As with a number of his competitors, he has pledged to increase the number of science and engineering graduates of American universities. He also intends to make permanent research
and development tax credits and invest in technology development.

For professionals, Obama intends to reduce self-employment taxes, eliminate capital gains taxes on start-ups and expand loan programs for small businesses. He feels “a robust regulatory system” will protect consumers without preventing entrepreneurship and can help ensure competitive markets. For job seekers, he intends to boost the renewable energy sector and create new job training programs for the green sector, including a Green Jobs Corps. This would be supported by a Clean Technologies Deployment Venture Capital Fund.

In regards to the indoor environment, he has taken a leading role in reducing lead in homes and child care facilities, helping to block appointees to the EPA until previously mandated regulations are made and promising to continue to do so in the future, personally urging the U.S. Trade Representative to take up the issue of leaded toys with the Chinese government, joining Sen. Clinton in 2005 to propose tax credits to families seeking to abate and control lead in their homes and, earlier this year, introducing the Lead Free Toys Act. With the presidency in mind, he intends to create new energy efficiency goals for buildings and appliances.

Obama has also sponsored the Combat Meth Act of 2005 and the High-Performance Green Buildings Act, and introduced the Lead Poisoning Reduction Act. He did not vote on the final draft of the Energy Act after originally voting for it.

For more information, visit www.barackobama.com.

Representative Ron Paul (R-Texas)
Rep. Paul, favoring state over federal bodies, prefers to leave government out of regulatory issues as much as possible, but has reiterated his stance that government-protected private-property rights would prevent any one entity from polluting or harming another. “Individuals, businesses, localities and states must be free to negotiate environmental standards,” he has said. “The key to sound environmental policy is respect for private property rights.” He also favors low taxes across the board.

As a reflection of his hands-off approach for the federal government, he voted against the Renewable Fuels, Consumer Protection and Energy Efficiency Act of 2007 and the Methamphetamine Remediation Research Act. He did not vote on the Energy Act. He has, however, supported tax credits for alternative energy and energy efficiency research and is a member of the Congressional Green Scissors Coalition.

For more information, visit www.ronpaul2008.com.

New Mexico governor William Richardson
As a former Congressman, executive branch secretary, diplomat and educator, Democrat Bill Richardson carries with him an array of positions. Part of his presidential agenda includes increasing new energy efficiencies 50 percent by 2040, a political facet that reflects his recent signing of laws requiring new green-building codes in New Mexico.

He has stated that “the public’s right to know about toxic pollution must be restored by reversing the EPA’s lax position on corporate reporting. Polluting facilities must report on the release of toxic chemicals at least once a year.” Richardson would also seek to employ 100,000 new science and math teachers and build 250 math, science and innovation academies by 2012, as well as expand financial aid for education and increase access to career and vocational education.

Inquiries to the Richardson campaign were not answered by press time. For more information, visit www.richardsonforpresident.com.

Former Massachusetts governor Willard Mitt Romney
Mitt Romney enters the Republican fray by pledging to “invest substantially in technologies [including] materials science.” He also supports energy efficiency and sustainable planning. Like other candidates, he would emphasize math and science education, streamline federal worker training programs, eliminate taxes on capital gains and “eliminate cumbersome and unnecessary regulations.”

During his Massachusetts governorship, Romney cut funding for the state’s environmental law enforcement, clean water protections and hazardous-waste cleanup. His energy plan called for efficiency requirements for state buildings and a rewards lottery for energy-efficient consumers.

For more information, visit www.mittromney.com

Former Tennessee senator Fred Thompson
With backgrounds in law and lobbying, Republican Fred Thompson favors less regulation and, environmentally, policies stressing investment, research and development in fields related to energy efficiency. He would “encourage students and teachers to pursue careers in science, technology, engineering and math.”

Thompson’s record in the Senate reflects little in the way of indoor environmental quality issues,
but his brief work as a lobbyist brings one key issue to the fore: On behalf of London-based reinsurance company Equitas Ltd., he was paid to lobby against asbestos claims legislation.

For more information, visit www.Fred08.com.

Deanna Thomas contributed to this report.

Finding a concrete link between mycotoxin exposure and illness or even death has proven a difficult task for even the most devoted researchers. A new research study, though, may provide concrete data toward establishing a causal relationship and highlights potential dangers for non-human occupants of flood-damaged buildings.

“Acute pulmonary hemorrhage during isoflurane anesthesia in two cats exposed to toxic black mold,” published in the Sept. 1 issue of the Journal of the American Veterinary Medical Association, details the plight of two Himalayan cats who underwent “routine dental cleaning and prophylaxis” and, despite seeming fine coming out of the procedure, died soon thereafter, as described in the report’s abstract. Pathology indicated toxins related to Stachybtorys chartarum, the so-called “toxic black mold,” as the likely cause of hemorrhage and death.

The report was published by Douglas R. Mader, MS, DVM, DABVP of Marathon Veterinary Hospital in Marathon, Fla.; Iwona Yike, PhD; Anne M. Distler, PhD; and Dorr G. Dearborn, PhD, MD at the Mary Ann Swetland Center of Environmental Health at the Case Western Reserve University School of Medicine.

According to the abstract, the two cats, siblings living together, were unremarkable prior to their procedures. Blood was noticed in the endotracheal tubes during the procedures, but both cats emerged from anesthesia and were allowed to recover. “Importantly, there was no clinical evidence of a problem in these
cats prior to the hemorrhagic episodes during anesthesia,” reads the report.

“Bleeding from the lungs is not a complication of anesthesia, so we knew there had to be some very unusual cause,” Mader wrote to IE Connections.

The report’s abstract reads, “One cat initially responded to supportive care but developed a second episode of spontaneous pulmonary hemorrhage approximately 30 hours later and died.” Its sibling was discharged from care four days later, only to have its condition deteriorate and likewise die after 10 days at home, during which time symptoms included lack of appetite, listlessness and vomiting, including blood. Its owners ultimately sought a second and third opinion, chartering a flight for the latter, but death followed several hours post flight.

Both cats were examined to determine the causes of their afflictions. Findings for the first cat showed “severe, diffuse pulmonary edema and hemorrhage in both lungs. ... There were no other gross abnormalities and no other evidence of hemorrhage anywhere else in the cat.” Examinations of the lung tissue included “large numbers of mixed inflammatory cells” and “a pure growth of Pasteurella spp.”

In the case of the second cat, examination revealed bronchopneumonia. The pathologist indicated that the “lung lesions appeared to be acute,” of no more than three days’ duration, “and secondary to aspiration.”

Serum collected from each cat prior to the anesthesia, but which had been stored, was then sent to the Swetland Center for mold toxin analysis. Both samples tested positive for satratoxin G adducts, biomarkers for the toxin found in S. chartarum.

As control, serum samples from six healthy cats in the Denver, Colo. area that had never been exposed to mold were evaluated using the same mold assays. All the control cats were negative for satratoxin G adducts.

The study team found the situation unique, as acute pulmonary hemorrhage had not been previously reported in veterinary literature save for exercise-induced hemorrhages in horses. Furthermore, no procedural cause was evident from an examination of practices during the dental procedures and cats that underwent anesthesia immediately before and after the pair in question suffered no such maladies.

In searching for causes, the doctors considered incidents of pulmonary hemorrhage in humans and found links to S. chartarum. Recent hurricane activity hinted at potential water damage, which led to an inspection of the owners’ home and the revelation of mold growth “so substantial as to require replacement of the walls.” Mader indicated that mold testing took place in the house.

The report closes: “Findings for the two cats ... highlight a potential risk for animals living in an environment contaminated with mold following flood damage.”

Mader pointed out the risks to humans as well, including a number of pulmonary hemorrhage cases in the Cleveland area “all associated with flooding. ... There are several dozen cases of pulmonary bleeding in humans,” he wrote, “including one of a human infant that developed pulmonary bleeding during anesthesia,
just like the type the cats experienced.”

“Children [and] older individuals are more susceptible,” he wrote. “Anyone with chronic exposure or those [who] smoke are at risk.”

I’ve been traveling a bit lately. I’ve also been watching one too many movies like “Beowolf” and “300,” so you’ll have to excuse the drama exemplified in the photo. Although I didn’t ultimately lose the battle to the giant dust mite, I lost my head for a while. By the way, despite what you’ve learned about dust
mite feces being the problem, in this case, it was the least of mine.

My problem is curiosity. I love new ideas. I’m intrigued by innovation or simply a new way of looking at an old problem – in short, expressions of creativity.

Which is what lead to my meeting Jeffrey Miller, MD, president of Mission:Allergy and his taking my picture at his booth. Not only does he have this giant inflatable mite to attract attention, but he has dust mite paper weights and a VW Beetle modified to look like a dust mite.

He also has a binocular microscope for spying on a nest of mites. I thought mites were rather sedentary, along the lines of a three-toed sloth in the Amazon rainforest. Boy, was I wrong. They are in constant motion, busy like bees in a hive; always eating, always pooping and always reproducing. Just thinking about all that activity in my mattress – or pillow! – makes me squirm. Fortunately, mites don’t survive in Colorado, so I only have to worry about them when I travel.

Speaking of traveling, in June I attended the national conference of the American Holistic Medical Association in Portland, Ore. According to their Web site, www.holisticmedicine.org, the association has about 1,000 members “seeking to practice in a broader form of medicine than what was (and is) currently taught in allopathic (MD and DO) medical schools.”

They would gently protest the word “alternative” in describing what they do, just as they would for using “traditional” for Western medicine. They correctly point out that the “other types” have existed for thousands of years, long before Westerners invented their particular methods. Theirs would more accurately fit the description of traditional, based on thousands of years of history.

Once we get past that particular terminological barrier, we encounter others like “integrative” and “complementary,” descriptive of the various combinations of the new and old. They feel strongly they can more effectively treat their patients by expanding the options and combining the best of many modalities.

The focus of their conference was the effect of exposures on the health of people. This represents a dramatic shift of focus even for them. Doctors of most persuasions concentrate on symptoms that people exhibit for their diagnosis. The goal of treatment is to reduce the symptoms. The assumptions include the belief that if symptoms decrease, then the health has also (which can lead to rather absurd statements,
which I will relate below). They don’t consider it critical to know whether the cause comes from outside or inside the body. Most doctors only treat the body based on what they see in front of them.

The AHMA conference, as I said, had a focus on exposures. There were excellent presentations on pesticides in foods and mercury in rivers and fouled air were discussed. But what struck me was that, except for one speaker, they were discussing outdoor exposures. There was almost nothing about exposures where people spend most of their time – indoors. But I won’t fault them too much because they are at least exploring something new and doing so with creativity. Besides, they were interested in my perspective as an IEQ consultant.

My next stop was Palm Springs for the annual conference of the American Academy of Environmental Medicine. With a name like that, I anticipated a greater understanding about indoor sources of exposure. And I was right. They, too, are fairly young (1965) and small. The mission of the AAEM (www.aaemonline.org) states they are “interested in expanding the knowledge of interactions between human individuals and their environment, as these may be demonstrated to be reflected in their total health.” And that includes the indoor environment.

Like AHMA, the AAEM leans more toward the “liberal,” or non-traditional (but historically
traditional), side of medicine.

While they comprehend deeply the effects of indoor exposures on people, they didn’t dwell on sources, measurements and removal as most of us do. This conference was heavy on how exposures affect the immune system and how to counter them through treatment. The assumption with which we are all familiar, of course, is first the source has to be removed. They get it!

I was quite encouraged by the forward thinking of both groups, but not that surprised considering they are both considered practicing “outside the envelope,” or at least pushing its edges – which gave me pause about the next group, known as one of the more conservative ones for “evidence-based medicine.”

“Evidence-based” means, in the strictest sense, that you don’t diagnose or treat beyond the evidence, the “evidence” being a mature body of science as represented in peer-reviewed scientific studies.

I can understand the need for practicing according to the evidence. I don’t want quacks risking my life and well-being. But the negative side means you’d better have an illness or condition that has been well-studied, or you won’t receive treatment. At the extreme, a strict reliance on evidence carries with it the assumption that medicine already knows all there is to know. Or, at least, all that is worth treating.

Here is where “traditional” Western or allopathic medicine tends to fail us, and it is on this point where medical practice directly impacts those of us in the indoor environment.

As we’ve been discovering, especially since many began getting sick while working in damp, moldy buildings, not all symptoms and complaints can be medically diagnosed. Yet, as we also know, the effects can be just as debilitating and often require treatment.

When we try to help our clients by directing them to seek the advice of doctors, we experience the uneasy knowledge that most doctors won’t be able to help them. Most have little comprehension of how exposures affect people.

So it was with more than a little trepidation that I entered the Gaylord Texan Hotel in Grapevine, Texas (home of the store where Marcie McGovern became ill – see the July, 2007 issue of IE Connections) for the conference of the more traditional American College of Allergy, Asthma & Immunology.

What a surprise. The pre-conference workshop was titled Healthy Indoor Environments. Their goal included educating “practicing allergists to better deal with their patients’ concerns related to indoor environmental health.”
Topics included neither immune dysfunction nor how to diagnose allergies nor how to separate the real from the hypochondria, but building science, home inspection and indoor air quality. Although two of the three co-chairs were MDs, the third was a member of IAQA and held a CIEC certification from AmIAQ. The best speaker knew his building science and effectively communicated the nuances to the audience.

I was stunned by the high level of the speakers’ knowledge and pleasantly surprised by the experience and interest of the 200-plus in attendance for the workshop. The doctors expressed serious concerns, some strongly, about what they considered to be the poor quality of inspections by environmental consultants. They also had many questions about the reports their patients were bringing them, not so much about how to interpret them, but about poor language skills, inspections that were too narrow in scope and conclusions with little supporting evidence. In other words, not much they could rely on.

The recurring theme in private conversations was how to find qualified consultants. Referring to certifications was not acceptable because they didn’t know which were legitimate and which were not. Besides, of the few certifications they recognized, they reported just as many bad experiences. Who was training these people, they asked? This led to conversations about what doctors need to know about the home environment compared to what it is possible for us to provide.

To emphasize how seriously the ACAAI is, and how willing some are to push the envelope themselves, consider the incoming President, Jay Portnoy, MD. He was one of the original signers of the American College of Occupational and Environmental Medicine mold position statement. He was then one of the first to demand his signature be withdrawn once more of the background was revealed. (See the Kramer vs. Corruption column in the Nov., 2006 issue of IE Connections for details). Not only was he in full support of the Healthy Indoor Environment workshop, he has dedicated the coming year to better medicine, which includes environmental exposures. Here is what he wrote in the conference program guide:

The title of this year’s ACAAI Annual Meeting is “Across the Quality Chasm.” This title, from the Institute of Medicine’s 2001 report on quality of healthcare in the United States, was chosen in response to new requirements that healthcare providers prove that they deliver care that is safe, effective, timely, patient-centered, efficient and equitable. Though we all believe that members of our specialty provide the highest quality of care to out patients, the onus now is on us to prove it.

The program begins with a day-long course on indoor environmental assessment and remediation.
As more of us see patients who have had home assessments, it is important that we learn how to interpret those reports and provide appropriate recommendations.

This position is much more than strictly held evidenced-based medicine. First, the emphasis
is on patient success rather than just verification of a process. Second, little evidence exists for indoor exposures causing illness.

Just to demonstrate that not all was up-to-date and fantastic, there was one incident in which the discussion reverted to old ways. One speaker claimed the quantity and severity of symptoms often decreased on high pollution days, only to increase when the air cleared. He therefore cautioned against going overboard by creating overly clean environments. When he was asked to clarify what appeared to be a contradiction and a disregard for the phenomena of masking of symptoms, he responded that of course health, rather than just symptoms, is much harder to observe, so there was no good answer at this time.

Finally, the primary focus was on asthma and whether home assessments and interventions are helpful. This is a key point because the latest asthma protocols require home inspections. Tom Kelly, director of the U.S. Environmental Protection Agency’s Indoor Environments Division, presented compelling evidence during his keynote speech. An analysis of several hundred asthma protocols across the country that included home assessments and intervention clearly demonstrated that the goals for the year 2010 by the Healthy People program were already being met or exceeded. Home inspections are critical!

What might all this mean to us? First, doctors need people qualified to conduct home inspections for their asthma patients. Patients sometimes need qualified contractors to remove the allergen triggers. Who better than those of us already in IEQ?

Before we all hang a new shingle above our doors and risk losing our heads by fighting the mite, what is needed is for medical and IEQ professionals to begin a dialog by sitting down together to identify what doctors need, how we can provide it, who develops the curriculum and who conducts the training.

Ask Dr. Burge – How Important Is the Mold Investigation/Remediation Field?
Dr. Harriet Burge
Directory of Aerobiology
EmLab P&K
San Bruno, Calif.

I believe that access to professionals in this field is essential. I know I often say that homeowners
and maintenance personnel can clean up mold on their own and, of course, they often do. Even sewage spills resulting from backed-up domestic toilets can be safely remediated by whoever routinely maintains the home. On the other hand, there are conditions in which expert advice is essential if problems are not to return and/or cause further damage to the building and its occupants. Here are a few examples.

Let’s start with sewage, which has been the subject of several recent seminars. In this case, I can use my own home as an example. More than 50 feet of sewage pipe began leaking into our crawl space last winter. It was old pipe installed during World War II, and it had developed tiny holes throughout its length. Needless to say, I called a plumber, who came in and replaced the pipe. Interestingly, he slogged through the sewage with no protection whatsoever other than his rubber boots. After finishing the pipe replacement, he spread lime on the dirt floor of the crawl space to get rid of the odor.

It is now obvious that I was wrong in allowing that, pointing to the fact that we all have our areas of expertise, and mine is not in sewage remediation. I should have called in a professional remediator to remove the smelly mess and to make sure the crawl space was dry.

Now consider the situation in which a new home is built and, within months, the occupants notice mold growing on the ceiling at the corner of the outside walls. There are two problems here that require expert advice: First, why is the mold growing and why at those particular spots; second, did the contractor make the mistake that caused the condition allowing the mold, or was it the homeowners or the architect?

These answers can only be provided by a professional with experience in why water penetrates or (in this case) condenses in a particular spot. This professional also provides the “disinterested” third party who can make the assessment of who is responsible without bias. Note that this role is one of the reasons why I think investigators should not be remediators.

What about public buildings that develop problems? Building maintenance personnel should be responsible for preventing problems and for quickly addressing problems that arise in buildings. However, it is too often true that building management hires maintenance firms with little or no real interest in how well the building operates. When problems occur, building occupants generally feel helpless – building management, if they have any sense at all, will call in the best professional investigator they can find to study the problem and recommend remediation.

These are only a very few examples of the important roles that mold investigators and remediators play in the indoor air quality field. I have emphasized over and over that what is needed are experienced, unbiased professionals. The vast majority of you are just that. However, there are a few people out there who do not have the best interests of their clients in mind. Unfortunately, it is the problems these people cause that usually end up in my voice and email files, and in court. I congratulate those of you working hard toward developing standards for the mold investigation and remediation field and look forward to the end of my IAQ legal consulting business.

Dr. Harriet Burge is director of aerobiology at Environmental Microbiology Laboratory Inc. and associate professor and director of the microbiology laboratory at the Harvard School of Public Health. Widely considered the leading expert in IAQ, Burge pioneered the field more than 30 years ago. She has served as a member of three National Academy of Sciences committees for IAQ, including as vice chair of the Committee on the Health Effects of Indoor Allergens.
To submit a question to Dr. Burge, write to her by e-mail at askdrburge@emlab.com. All questions posed to Burge will receive a reply, although space limitations prevent us from publishing them all. By submitting a question, you agree to have your question and its answer published in a future edition of IE Connections.

Douglas Kladder
Director
Center for Environmental Research & Training
Colorado Springs, Colo

“Fire in the hole” is not an expression commonly used by radon mitigation contractors, but was one shouted out by Ty Pennington of ABC’s “Extreme Makeover: Home Edition” moments before over a hundred sticks of dynamite blew a Cheyenne, Wyoming home sky high. Why was the home blown up? As indicated during the November 4, 2007 airing of the program, it was because the family was being poisoned by the presence of radon gas.

For those who read this column and are not intimately involved with radon, let me point out that C-4, nitroglycerine or even wrecking balls are not normal tools of the radon mitigation trade. There are less drastic approaches available to the mitigation contractor than tearing a home down and starting over. In fact, qualified radon contractors would advise a homeowner that, if a home was demolished and a new one constructed in its place, the radon gas source would remain since it typically comes from the underlying geology or soil. On the other hand, control measures that would reduce indoor radon levels could certainly be incorporated and presumably were so during the reconstruction of the home as part of ABC’s involvement.

Radon Experts Wave Flags
Both before and after the program, a number of radon industry folks posted blogs about how easy it would be to fi x this home for a few thousand dollars. Officials from both the U.S. Environmental Protection Agency and the state of Wyoming, fearing the public might over-react, were quick to point out that “radon problems can be taken care of without resorting to the detonation button.” (Wyoming Tribune Eagle, Aug. 22, 2007)

Although it is true that homes can be fixed fairly easily, including earthberm homes as this particular property was, it sure doesn’t make for interesting TV. I can hardly imagine a radon program, showing the breathtaking details of a concrete slab being cored or a four-inch pipe being routed up through the roof, would capture a number 11 spot on the Nielson ratings for the week the program was aired. Let’s face it: The show’s name contains the word “extreme” and I suspect most seasoned viewers, after 100 episodes of the show in which homes are destroyed, understand that such approaches are more theatrical than necessary.

On the other hand, viewers of reality programs produced by major networks who also
bring us national news might expect some reliable facts being presented, especially when it may impact the viewers directly. After all, according to the EPA, 6 percent of all U.S. homes are believed to have elevated radon levels similar to the one that was the subject of this program, which means a lot of viewers could either be dealing with radon or will be dealing with radon sometime in their future.

Fact or Fiction?
Apart from the obvious unnecessary demolition of the property, there were several portions of the program that bear discussion, especially for those who might mistakenly view programs such as this as vehicles of unequivocal truth.

Radon Exacerbating Asthma
Early in the program, it was indicated that the children’s asthma condition had worsened after the family had moved into the home. This apparently had developed to the point that the young daughter could no longer play the clarinet and the son had to curtail his soccer activities.

Radon is a chemically inert gas and has no interaction with the body that would trigger respiratory distress, such as worsened asthma. It does, however, break down into radon decay products that can enter the lungs and irradiate the lung tissue. However, even this undesirable interaction does not cause any immediate effects, such as triggering asthma attacks. This fact was echoed by Cornelia Maes of Region 8 EPA, when she was quoted in the Wyoming Tribune Eagle – “It is not possible that radon is making the family sick.”

This is not to say the radon shouldn’t be reduced. In fact, reducing radon in the home
would reduce the potential for developing radon-induced lung cancer for both the children and parents. So being concerned about radon is good, but not likely the cause of increased asthmatic stress.

There are a number of conditions that can trigger asthma attacks – mold, dust, VOCs, cockroaches, pet dander, etc. Without more exhaustive air sampling than what was revealed on the program, it would be irresponsible to suggest any one of these triggers as being responsible. However, during the program it was apparent that the family was generous enough to take in a variety of homeless animals. In fact, one of the goals of the makeover of their home was to provide an indoor area where the family could care for animals. Although it cannot be stated unequivocally that the presence of animals was a cause of the children’s asthma attacks, it is well known that animal dander can exacerbate asthma. I can only hope the designers of the new home took this into account, or the owners may need to acquire a new batch of dynamite.

Radon as a Poisonous Gas
Although, for the most part, the show’s script writers got it right. Radon is a naturally occurring gas that comes from the soil and can cause lung cancer. However, Ty Pennington’s characterization of radon as a poisonous gas may be a bit of a stretch. The effects of radon are chronic, requiring long duration of exposure when exposure levels are relatively low, rather than acute, in which the lethal effect is more immediate.

On the other hand, Webster’s Dictionary defines poisonous as “capable of injuring or killing by or as by poison; containing or having the effects of a poison” with no indication as to the time period necessary for the effects of the poison to be seen. Radon is considered to be a Group A carcinogen that causes lung cancer. Lung cancer is considered fatal. So perhaps ABC got it right and the reluctance of public health officials to scare the public has not properly characterized radon as it should be – as a slow-acting poison.

What Was Done to the Home?
As I watched the program, I was expecting to see some details on what was done during construction to reduce the radon concern. After all, elevated radon was the primary reason put forth for the makeover and logically one would expect a little discussion about the methodology for averting the presence of this “poison.” What I did see was an approximately 10-second shot of some gravel in what appeared to be a crawlspace or the subgrade before a slab was poured, a free edge of polyethylene and a perforated, rigid pipe. Pennington also indicated that a pipe would vent the soil gas to the roof.

Based on this brief comment, one might assume that this was a passive radon system in which a perforated pipe is laid under a vapor barrier and connected to a vertical run of PVC pipe that would exit out the roof. However, other specifics were not provided, such as how the plastic or concrete slab was sealed, or if an active fan was installed to depressurize the sub grade, or even if the property was tested after completion to determine if additional measures, such as a powered exhaust, were needed to adequately reduce the radon.

In attempting to obtain more specifics on what was done, e-mails and phone calls were made to individuals involved in the project. Unfortunately, e-mails to the architectural firm that designed the new home have gone unanswered. An e-mail response from the builder indicated that they were unaware of what was done as this was the responsibility of the mechanical contractor. Subsequent e-mails and phone calls to the mechanical contractor have also yielded no additional information as personnel have forwarded the requests to the owner, who as of this date has not returned repeated phone calls or emails.

We would like to think that a proper mitigation system was installed in this property. However, based on the reluctance of those involved to share details or return phone calls, there may be cause for doubt.

A concern for a proper system exists not only for the occupants of the property but also for ABC, whose liability and credibility could be at risk. This is especially true in light of Ty Pennington’s statement to the occupants after the project was completed, that there is a system that “seals away any radon gas,” implying their home is now radon-free. First, those in the industry know that reducing radon to zero is impossible since there is measurable radon even in the ambient air. Furthermore, the only means to gauge the success of a system is to conduct a radon measurement after the home is completed. Since post-construction radon testing, or results that would have come from testing, was not discussed on the program, there may also be some doubt if this simple verification procedure was performed.

The airing of this show was probably a good thing for public awareness. Sure, blowing up the house may have been extreme, but what mitigator hasn’t had a difficult house that he/she would have preferred using a little dynamite to resolve? Sure, there may have been a few exaggerations or conveniences used to create viewer empathy when connecting sick children to radon. Many radon professionals can probably overlook these exaggerations for the sake of entertainment. But what is of perhaps a larger concern is whether the system was correctly installed and effective. Otherwise, the occupants will continue to live in a home with elevated levels of a gas that is indeed cancer-causing with a false sense of security imparted to them by both ABC and the contractors involved. We urge ABC, the builders and especially the occupants to retest this home to fully determine if the radon levels have truly been reduced and, if not, to take positive steps to fully reduce it through qualified mitigation professionals.
As always, who says there is nothing new in radon?

Douglas Kladder is director of the Center for Environmental Research and Technology Inc. He can be reached by e-mail at dougkladdr@aol.com or by phone at (719) 477-1714.

There has been a predictable scientific evolution over the past 10 years in thinking about public health concerns created by exposure to indoor environments in water-damaged buildings (WDB). What a difference passage of time and presence of good science makes!

At one time, some consultants said that while WDB certainly might have a little bit of mold growing, and maybe more than what grew outside, that mold never hurt anyone unless eaten as a feed. And besides, just look at the air samples showing the spore counts inside wet buildings: There just weren’t enough spores to hurt a normal, non-immunosuppressed person.

Anecdotal medical data clearly showed, however, that there was an association between exposure to WDB and health effects. The associations weren’t convincing enough to conclude causation of illness because there were no interventions that could correct the putative illness, thereby permitting re-exposure trials to show reacquisition of illness in treated patients.

Even worse, there were no parameters that demonstrated in large populations the same consistent mechanism of illness acquisition seen in the anecdotal cases. There wasn’t even a case definition of illness associated with exposure to WDB such that properly identified cases could be separated from noncases. No, there just weren’t enough studies that carried enough epidemiologic weight to convince a skeptic that being inside WDB caused adverse health effects. And there certainly weren’t any tools of molecular biology that would unveil the hidden nature of so-called mold illness.

Those days of non-science are long gone.

Now, even if we thought being in a moldy building wasn’t a good idea, and every federal agency (because the mold might make someone sick?) said being exposed to mold wasn’t a good idea, how could we show a unit dose of mold created a unit of illness? We couldn’t – there would be too much difference in individual susceptibility. Some people get really sick really fast after being exposed to WDB and others act like nothing is wrong at all.

Said another way, dose-response relationships seen in illness caused by exposure of genetically susceptible patients to interior environments of water-damaged buildings are not linear “unit in equals unit out.” There are so many observed variables of exposure and response that the idea of a 1:1 relationship of total mass or number of spores required for a threshold exposure is nonsensical.

Consider that an effect (X) is equal to the sum of routes of exposure (A) plus contaminants beyond spores (B) plus length of time of exposure (C) plus individual genetic susceptibility (D) plus individual prior exposure and change of susceptibility from that exposure (E) plus amounts of other microbes, like actinomycetes, bacteria and mycobacteria, (F) plus the amount of inflammagens, such as beta glucans and VOCs (G). X then is equal to the combined effects of A through G, each of which can cause amplification of effects of innate immune responses.

The elements A through G are each themselves variable. Moreover, there are interactions of A through G, some of which are synergistic and some involve differential gene activation as well as epigenetic phenomena. It is impossible to assume that response or effect X will be linearly related to variables, each simultaneously expressed A through G. We cannot analyze one component of exposure, namely mold spores, and come to any meaningful conclusions from classical monotonic dose-response relationships.

If only we had one measure that would cut through all the countless possible variables
involved in exposure to WDB. It might just be that we do.

Perhaps the most important scientific breakthrough in the WDB field was the confirmation that mold exposure in WDB was just one part of the inflammatory gauntlet some people faced when they walked into WDB. Toxigenic actinomycetes, endotoxin-forming bacteria and unusual mycobacteria all have been identified as contributing to human illness associated with WDB.

Added to these insights was the numbing realization that counting spores was essentially a worthless endeavor when over 99 percent of the toxin-carrying elements capable of hurting people in WDB were fragments of fungal organisms. Moreover, the emerging literature confirms that additional sources of adverse inflammatory effects found in patients with illness from WDB are products of secondary fungal metabolism, especially beta glucans. Beta glucans, as well as sugar-laden proteins (glycopeptides, especially mannosepeptides), can activate a variety of c-type lectin receptors, including dectin receptors that were scarcely even described two years ago. These receptors rapidly turn on markedly increased pro-inflammatory responses.

New therapies, shown to be effective in clinical trials, including ABB`AB-type, prospective and repetitive exposure trials not only showed that illness from WDB followed all known characteristics of other biotoxin-associated illnesses, but that sequential therapies, based on the documentation of abnormalities in innate immune responses seen routinely in other biotoxin-associated illnesses, led to resolution of complex respiratory, neurologic and cognitive symptoms that hadn’t been confirmed to be part of the WDB illness. Large population-based studies, as well as a double-blinded, placebo-controlled clinical trial beginning with cholestyramine (CSM), showed convincing improvement in symptoms, neurotoxicologic measures (such as visual contrast sensitivity, VCS) and laboratory studies coinciding with therapy in patients who hadn’t responded to any interventions before use of CSM.

Two additional recent advances came from the Environmental Protection Agency in April, 2006 and the Indoor Air Quality Association’s annual meeting in Las Vegas, October, 2007. Dr. Steve Vesper’s EPA Microbial Exposure Group brought us the Environmental Relative Mold Index, a diagnostic method that analyzes settled house dust for fungal DNA, categorizing a home as being in a certain percentile for moldiness based on the DNA present in vacuum dust samples (IE Connections, June, 2007).

ERMI is a mold index. At the IAQA meetings, Ritchie C. Shoemaker, MD, a treating physician and biotoxin researcher from Pocomoke, Md., presented data on sequential activation of innate immune elements (SAIIE) that, taken in cases and controls, identified that buildings with a high ERMI were associated with patients having a high SAIIE index. Buildings that didn’t have a high ERMI didn’t have patients with a high SAIIE.

Shoemaker’s study involved 100 patients in 100 buildings, documenting that in patients with prior illness associated with exposure to WDB who were re-exposed under controlled situations after treatment, when their lab parameters and symptoms were no different from controls, that their entire illness presentation was reproduced within 72 hours after re-exposure. Levels of the anaphylatoxin C4a rose to 115 percent of baseline in less than 24 hours; leptin levels rose maximally at 48 hours; MMP9 levels rose between 48 and 72 hours after exposure and VEGF initially rose at 24 hours, crashing to low levels at 72 hours. This pattern of innate immune response was consistently seen
such that a number, or index value, could be assigned to changes of unknown patients at each time interval, demonstrating an additional diagnostic approach to the question: “Will this building make me sick?”

Preliminary work by Shoemaker and others working with the Center for Research on Biotoxin Associated Illnesses has consistently linked an elevated SAIIE to an elevated ERMI, raising the possibility that a combined mold/health index could become available for use in the coming years as a standard for answering the causation question.

Let’s hold on just a moment. There are drawbacks to ERMI and SAIIE. ERMI only records fungal DNA; our ongoing research may bring similar DNA data on actinomycetes, bacteria and mycobacteria to commercial use soon. SAIIE is based on clinical and laboratory observations of hundreds of patients before 2007, but has only been formally tested in 100 buildings to date. Moreover, SAIIE can only be obtained when previously affected patients are treated effectively and then are willing to provide informed consent to be re-exposed and undergo daily testing for their first three days of re-exposure without use of protective medications. Those patients are rapidly re-treated after re-exposure should they become ill. SAIIE doesn’t apply to patients who weren’t made ill by a WDB earlier.

Finding that patients sickened by exposure to WDB demonstrate a reproducibly observed pattern of laboratory changes identical in three days of exposure to what might have resulted from, say, three years of exposure, suggests that classic monotonic dose-response relationships seen in toxicology don’t apply to illness caused by exposure to WDB. Indeed, the participation of multiple amplifying biological cascades of the innate
immune response system provides for an exponential response that becomes steeper with subsequent re-exposures.

This phenomenon, called “sicker, quicker,” provides pause to wide-spread use of re-exposure trials. For example, if C4a at baseline is over 20,000 ng/ml (normal is <2830 ng/ml; RIA performed by National Jewish Center, Denver, Colo.), the patient should not be allowed to perform a re-exposure trial, as his likelihood of irreversible injury from even a three-day exposure is increased. If the ERMI in a building scheduled for re-exposure is over 2, a patient with any level of C4a must be warned that having a prior illness predisposes him to a significant increased risk of reacquisition of illness with re-exposure.

Keep in mind that not all patients become ill with exposure to WDB. Particular kinds (haplotypes) of immune response genes, called HLA DR and found on chromosome 6, when analyzed by PCR, show an increased statistical relative risk associated with illness compared to controls. In total, having reviewed HLA DR haplotypes in over 5,000 patients, we know the risk of illness acquisition caused by exposure to WDB is largely confined to patients with six separate HLA DR haplotypes, comprising 24 percent of the population. In that group, there are two separate haplotypes (4-3-53 and 11-3-52B) that have a 22-fold enrichment in those patients who develop a much more disabling syndrome seen following acquisition of illness. These two haplotypes fortunately are relatively rare, comprising only 4 percent of the population.

A particularly sobering association is found by comparing ERMI to metabolic changes in the central nervous system (CNS), analyzed by magnetic resonance spectroscopy (MRS) in patients with illness acquired following exposure to WDB. MRS can document capillary hypoperfusion, manifested by elevated levels of lactate in the frontal lobes and hippocampus and consequent development of abnormalities in the ratio of the excitatory neurotransmitter glutamate to that of the inhibitory neurotransmitter glutamine in those same areas.

Elevation of C4a, as well as increased numbers and intensity of health symptoms, refractory to all treatments, are highly associated with these CNS metabolic disturbances which in turn follow ERMI almost linearly (unpublished observations). The CNS metabolic changes disappear following treatment of elevated C4a, as do symptoms. With re-exposure, however, the pathological CNS effects, demonstrated by repeat MRS, rise in C4a and recrudesce in symptoms are apparent simultaneously within 24 hours. Retreatment again corrects the brain chemistry, C4a and symptom problems.

The current state of the science of diagnosis and treatment of mold illness begins with knowing that not just molds make people in WDB sick. Following a careful history, including recording multiple health symptoms from multiple health systems, the diagnostic process extends to documenting ERMI and elements of the innate immune response, including C4a, MMP9, MSH, VEGF, VIP and more. We use the results of these blood tests to be part of the “proteomics” of WDB illness. We see the results of gene activation by virtue of protein/cytokine production according to a logical scheme.

We now are looking at the genomics of WDB illness, with an array of 124 genes to be analyzed for mRNA. Based on the similar effects of toxin exposure on mRNA production in vitro, we will look for similar changes in mRNA levels in vivo in patients with prospective exposure to WDB. Data on our first 150 patients could be ready for presentation as early as spring 2008.

We don’t have to wait for exciting research on genes to be presented next year or later to use the science of WDB illness now: We can identify patients by a case definition, show their physiologic changes with therapy, document their changes with re-exposure and then show them that treatment will let them “have a life.”

Hopefully, that life won’t include refractory fatigue, cognitive and respiratory symptoms, together with a host of others We hope to be able to first confirm and then correct the putative removal of HLA DR molecules from surface membranes in macrophages and monocytes that provides a mechanism for immune paralysis-failure to identify foreign antigens adequately to mount an acquired immune response that may underlie the “sicker, quicker” phenomenon, especially in the 4-3-53 and 11-3-52B HLA DR haplotype patients.

We hope, in the end, that all this progress in science doesn’t leave the patient behind, as patient care remains the main goal of all treating physicians and academic researchers who care about their fellow man.

Examples of How to Use ERMI and SAIIE:
Example 1. JK thought he had Lyme disease. He had been treated with antibiotics following an acute illness acquired in his hometown near Wilmington, Del. His home was pristine, sitting high above the Chesapeake Canal. Well, maybe the basement was a little musty back in the corner where his office was. And maybe the wife was feeling a bit run down, too, but she worked two jobs with JK being out of work and all. Besides, she had a sick mom and church activities and the PTA, so of course she was tired.

JK had the mold susceptible haplotypes of his DNA – his C4a was over 15,000, with C3a under 1,000 (essentially ruling out Lyme); MSH and VIP were dead-low and his visual contrast testing showed a typical biotoxin deficit. ERMI was over 18. He was treated with removal from exposure; meanwhile, his wife was tested, too. Her labs were
worse than his.

He cleaned up his basement, finding multiple areas of hidden water intrusion. All water-damaged materials were removed and the walls washed down with a 10 percent bleach solution. Repeat ERMI fell to 11. His SAIIE was over 18 with a diagnostic re-exposure.

Obviously, his cleaning wasn’t rigorous enough.

Professional help was obtained, with vacuuming of all dust and cleaning of all remnant materials with Sporicidin. Further investigation showed wet walls initially missed. The home was vacated and thoroughly cleaned. Repeat ERMI was 1.2, with repeat SAIIE 6.7. JK was re-treated, as was his wife. They spent over $30,000 to fix their home and basement, but that amount was less than what JK had spent on fruitless searches for restoration of health.

The example of JK is not unusual. Instead of spending money on multiple air samples, he simply used a building health index, ERMI, with a health index, SAIIE as a final answer of building safety (or not).

ERMI leads you to SAIIE-confirmed human illness and improved remediation, even if the scope of work was greater than what anyone thought.

Example 2.
A rising college freshman, known to have HLA DR 4-3-53 and low MSH from a prior mold illness has a C4a of 2245. She feels well and would like to know your advice regarding what buildings would be safe for her while away from home. The school isn’t too keen to release any information that would suggest shoddy maintenance.
You suggest taking samples for ERMI from her proposed dorm room and a variety of classrooms. Six samples are analyzed, with the maximum ERMI being 1.7. You say, based on those data, those areas are safe.

Her mother calls you urgently three weeks later. Her daughter has now relapsed: How could ERMI have missed the moldy danger areas? C4a is now 15,000 and she has over 22 health symptoms.

You go to the school, following the girl from one exposure area to another. Everything looks fine. You need to take a break, so she takes you to the basement vending area, right next to the dorm laundry room. She spends a lot of time there with her friends, having a Coke and playing spades while the laundry finishes. The dryers aren’t vented properly – there is condensation on the cold-water pipes and the in-ground wall of the room is wet. A week later, the ERMI comes back at 12.

In this case, human illness leads you to the source, guided by ERMI.

Summary
We now have reliable, inexpensive tools to show the potential for human illness, the presence of human illness and the potential for increased risk for illness reacquired following re-exposure. When we have the genomics of this illness worked out, we should be able to screen multiple individuals inexpensively with a high degree of accuracy for
untoward effects of WDB on health.

Ritchie Shoemaker, MD is a family practice physician who has treated over 4,500 patients with illnesses acquired following exposure to water-damaged buildings. He has written six books, including “Mold Warriors.” He has published multiple academic papers and has lectured widely to lay and academic audiences alike.

King-Teh Lin, PhD is laboratory director for Mycometrics LLC. He earned a doctorate degree from Robert Wood Johnson Medical School and, soon after his postdoctoral fellowship, continued as a faculty member until being recruited by P&K Microbiology Services as a director of research and development. There, he pioneered commercialization of MSQPCR and invented the new DNA testing for wood-decaying fungi. In 2005, he established Mycometrics to provide microbiology testing services. Lin can be reached by e-mail at kingteh@mycometrics.com or by phone at (732) 355-9018.