Comments; Scott does his usual thorough, easy to read job of reviewing the basics of ERMI vs. HERTSMI2 in a manner that is easy to comprehend (hopefully including those suffering from “mold brain”)
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.
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.
(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.)
Additionally, HERTSMI is limited in some ways. Shoemaker is very confident that HERTSMI
scores higher than 15 will have very poor outcomes. In other words, the patient will not respond to
the cholestyramine detox treatment and will remain ill. This is very important. It suggests
that it is very important for the patient to avoid a mold contaminated environment.
There are only two ways to do this: leave the contaminated building and do not return, or properly
and completely remediate and clean the environment to eliminate the mold exposure. Scores
under 15 do not provide strong significant statistical confidence for predicting recovery outcome.
So here is my advice: don’t sweat the lower numbers, and don’t use ERMI unless you have a very
good assessor who knows how to inspect for signs of water and mold, etc.
(NOTE: remediation and cleaning are very different from “disinfecting” – please see the principles
of mold remediation in the IICRC-S520 Professional Mold Remediation Standard.)
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 assessment :
1. physical inspection of every nook and cranny of the home,
2. building history of damage, water, repairs,
3. building function/operations assessment, and
4. occupant health.
Putting these 4 things in place before sampling will get you more and better info. There are so
many reasons not to do a home test of any kind. There are equally so many 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