Review: State of the Art in Mold, Water Damaged Buildings and CIRS Conference. Phoenix, AZ
November 12-15, 2015 By Jonathan Lee Wright
I have just returned from four days of attendance at the State of the Art in Mold, Water Damaged Buildings and CIRS Conference in Phoenix, a symposium organized by groundbreaking medical research practitioner, Ritchie Shoemaker, MD. For those who are unfamiliar with his work, Dr. Shoemaker is known for pioneering causal theory in regards to illnesses stemming from exposure to “Toxic Mold” and other biotoxin forming organisms such as algal blooms, an overall condition being brought under the umbrella diagnosis of Chronic Inflammatory Response Syndrome (CIRS). A Magna Cum Laude graduate of Duke with a subsequent MD from the same school, Dr. Shoemaker is an extremely well published author, not only of peer-reviewed medical research but that of multiple books on the subject of mold, biotoxins and human health.
Shoemaker is now retired from private practice, and is concentrating on collaborative research and physician education in the field. The recent conference in Phoenix was comprised of an international roster of attendees ranging from MDs, PhDs, building science professionals and patient advocates who operate at the national policy level.
To say that the overall standard of research at the Phoenix event was impressive would be a gross understatement, at a minimum. Special features for this conference were attendees from Australia, Iceland and the UK. The CIRS research movement can now be said to be becoming global in thrust.
I have been following this issue as a journalist and patient advocate for over ten years, and I can say without reservation that the state of the science presented at Phoenix 2015 represented a quantum leap in the unraveling of this issue with not only the most hidden components of biology, but also in the elevation of academic involvement across multiple disciplines. For the last several years, Dr. Shoemaker has directed his formidable intellect and energies in successfully engaging some of the most bleeding-edge medical researchers to expand on his work. Perhaps more importantly, he has committed to passing on his knowledge to practicing physicians across the country, instituting a certification program that has resulted in a nationwide network of talented doctors who have been handed the conceptual ball of CIRS, run with it in their own practices, and published their findings.
The result has been that the brain trust representing the work of Dr. Shoemaker now not only has considerable academic equity, but is rapidly gaining in value due to compounding interest.
The conference kicked off with opening remarks from Shoemaker and Tucson-based conference chair Mary Ackerley, MD, Ph.D. who introduced the rest of the itinerary. The remainder of the conference gave a platform to a professional elite of speakers presenting on topics ranging from state of the art genetics analysis and neuroinflammatory pathologies, to physical building envelope science. Summarizing four days of intense presentations is not possible here, but highlights give a sense of the scientific and social commitment that this issue is now attracting.
Initial presenters included patient advocates Rick and Shelly Frey and the Belperron family relating experiences with illness and the recovery process, including strategies for dealing with vexatious insurance and court systems. Patients who have experienced the fallout from having been exposed to water damaged buildings have a history of becoming staunch advocates, owing to the extreme level of politicization inherent in the issue, a dynamic well documented in the press.
Any question as to the level of hard science that is being brought to bear in this field was immediately dispelled when Ph.D. geneticist James Ryan made the first technical presentation of the event with his work in genomics analysis of abnormalities in CIRS patients. Proteomics and genomics have been heralded as the future of these disorders, with potential for targeted therapy turning off inflammatory processes at the genetic level. Among numerous other findings, Ryanʼs work confirmed the role of transforming growth factor beta1 as a master regulator -- an early Shoemaker finding and therapeutic intervention -- and identified TLR4 regulation of inflammation being controllable with introduction of curcuminoids, which in the mind of this writer validates recent popular focus with the use of turmeric in managing chronic pain conditions like rheumatoid arthritis.
Of importance here is the understanding of differential DNA activation that has arrived in diagnosis and treatment of CIRS-WDB. Dr. Ryanʼs research is not just looking at single nucleotide polymorphisms -- testing for which has never confirmed activation of identified relatively common genetic variants that can indicate toxin susceptibilities -- but rather using Next Generation DNA sequencing that allows him to watch, over time, the therapeutic resolution of the fundamental mechanisms of CIRS illnesses via treatment protocols now in clinical practice worldwide. For someone with an illness acquired following exposure to a water damaged building to now NOT know what the genomic basis for their illness is presents a fundamentally incomplete dataset for treating physicians to work from.
Following hot on the heels of Ryan's presentation, Chapel Hill, NC based clinician Sonia Rapaport riveted a very qualified audienceʼs attention with her assessment of mitochondria in CIRS. Underlying mitochondrial dysfunction is being implicated in a wider range of neurodegenerative illnesses like ALS. In a lab environment, Rapaport identified the role of trichothecene mycotoxins (produced by certain molds such as Stachybotrys and Fusarium) in inhibition of mitochondrial function, stimulation of inflammatory cytokines and activation of the complement component of the immune system, a root cause of chronic neuroinflammation. Rapaport also noted that gut microbiome profiles may create susceptibility. Implications of this work in regards to hallmark symptoms of fatigue in CIRS patients are profound, as mitochondrial function is critical to oxygen utilization. The potential significance of these findings relative to the broader issue of Chronic Fatigue Syndrome in terms of causation should not be underestimated.
Numerous other presenters over the next three days gave critically reviewed insight into various facets of the overall topic. Day two saw Harvard educated Mary Ackerley, MD expand on her widely published article “Brain on Fire”, a scientific analysis of the neuroinflammatory implications of exposure to toxins found in water damaged buildings. Ackerley related examples of pathological resolution with patients in her Tucson psychiatry practice who have been removed from biotoxin exposure, yet more evidence of the social implications of the issue.
Pediatric CIRS was brought under scrutiny by Scott McMahon, MD, whose New Mexico practice sees more than its share of patients from substandard housing. HIs data on pediatric illness was the first seen since Dr. Shoemakerʼs case/control talk at the IACFS conference in Nevada in 2009. Pediatric immune systems are much more plastic and programmable than those of adults, with symptom acquisition and therapeutic resolutions typically being on different timeframes than are normally encountered by treating physicians. Dr. McMahon is the author of a soon to be published paper, “NeuroQuant 2,” that has new information on brain injury response to the Shoemaker treatment protocol. Scott was also subjected to a mild interrogation later in the conference by David Wise, Esq., as part of a hands-on legal symposium to help physicians deal with the potential realities of acting as legal expert witnesses on behalf of patients.
Keith Berndtson, MD ventured into the theoretical with a paper regarding the potential role of nanoparticles in CIRS. After citing the insights of patient advocate online bloggers as providing the initial conceptual framework for his model -- notably Erik Johnson and others Johnson collaborates with on social media -- Berndtson went on to outline the potential exposure mechanisms involving biotoxin and nanoparticulate creation by fungal metabolic processes, with potential transport across the blood brain barrier due to particle size. Production of nanoparticulate materials using silver iodide and strains of Aspergillus niger are now common industrial practice -- a biological dynamic that may need to be investigated in the ambient environment at large if the Chicago-based MDʼs premise is correct, to say nothing of regulatory implications.
Dr. Berndtson was also highlighted as the lead author of the seminal Medical Consensus Position Paper of the Professionals Panel of Surviving Mold. This authoritative academic statement is now being made available as a free download on the Surviving Mold website, and will be a valuable resource for patients looking to help direct their own care in educating their physicians to the medical realities of CIRS.
You could practically hear the air leave the room when Vince Neil of Mycotox took the podium with his stunning paper on identification of volatile organic compounds (VOCs) found to be in the expired breath of patients who have long been removed from exposure. What source of these fat soluble compounds are originating from would appear to now be a subject for immediate research, as the implications of metabolic shedding of toxins plays directly into etiological models for illness. In follow-up to this presentation, there has been preliminary discussion on making VOC testing available to patients attending the special Patients Conference to be held ahead of the next CIRS conference in Fall 2016.
No examination of this topic would be complete without referencing the unfortunate role that legal liability from physical buildings has played in shaping policy and debate. Intertwined at a fundamental level in the overall contentiousness of the issue, building science professionals and remediators sometimes walk a very line between providing life-saving counsel and protecting the interests of all parties involved.
Day Two was privileged to host presentations from nationally known members of the building science and remediation industry. Larry Schwartz, conference building science chair, is the lead author of a soon to be released collaborative position paper outlining new consensus between water damage remediation contractors and treating physicians to engage in patient driven, medically sound practices. ERMI and HERTSMI-2 testing results correlated to patient medical profiles are being proposed to standardize best practices industrywide, reduce contractor liability, save client dollars and ultimately, provide demonstrably safe results.
David Lark of Mould Labs AU traveled from Australia to present; he is one of the foremost authorities on environmental microbiology, not just in his homeland of Australia, but also the world. His entertaining lecture focused on fungi found in illness and errors made in assessment of water damaged buildings. International presenters such Mr. Lark underscore not only the scope of this issue, but increasing global acknowledgment as well.
Expanding the breadth of the conference was Erik Johnson, a survivor of the 1986 Incline Village, NV outbreak of Chronic Fatigue Syndrome, and a clinical prototype for the disorder. Johnson related his experiences in Incline during the initial investigation by the CDC, and his ultimate solution in recovering from illness through developing an “Extreme Avoidance” protocol regarding mold. A relentless online commentator and blogger, Johnson related how his protocol is now being successfully practiced by some very credible national level magazine journalists and filmmakers suffering from CFS who are repeatedly writing about the need for research investigation into the phenomenon. Well known in the mold community, Johnson received a standing ovation from a room filled with academics who appear to have now recognized the implications of his work.
Activist Sharon Kramer outlined the political history of the “Toxic Mold” issue and her interactions with the highest levels of the federal legislature in efforts to drive change. Kramer, who holds a degree in marketing, described in detail the political machinations that have unfolded to create the current federal policy environment regarding mold and water damaged buildings. Kramerʼs work behind the scenes has been instrumental in helping to have potentially conflicted position papers from industry think tanks retired from influence in public policy formation.
Wrapping up the conference was a 65-physician joint collaboration on NeuroQuant MRI analysis presented by Dr. Shoemaker himself. NeuroQuant is a volumetric assessment of patient cranial MRI scans that can quantify structural changes in the brain after biotoxin exposure. While clinical lab abnormalities have long been noted by Shoemaker and treated with interpretive pharmacological methods, physiological changes with CIRS patients have been harder to identify. NeuroQuant analysis now shifts the landscape of debate regarding CIRS, with both research and legal implications.
An excellent attendance of vendors who provide services industrywide need to be mentioned as well. Among many others, Hopkinton Drug, longtime providers of compounded medications specifically tailored to CIRS patients was handing out medicinal herb samples at their booth. Mycometrics, Inc. -- suppliers of environmental testing results -- made themselves available for those wanting more information on the state of the science testing like ERMI and HERTSMI-2. Oasis Air Purification had excellent materials explaining the benefits of their product line, and AeroBiological remediation services offered answers on building science.
Finally, and looking to the future, at the Surviving Mold table seven new candidates for physician certification enrolled in the formal testing program. The rapidly expanding growth of physicians who are now recognizing CIRS in their own general practices and who are wanting to be educated in treating their patients shows the scope of the issue. As Dr. Scott McMahon has been quoted, “Every doctor in this country is probably treating mold illness, and doesn’t even know it”.
The conference video is available for an unlimited number of views from the Surviving Mold website at what I consider to be a reasonable cost given the vision that this event represented.
Overall, the 2015 State of the Art in Mold, Water Damaged Buildings and CIRS conference was an astounding display of leading edge science addressing an emerging public health threat that requires a major public response. The level of academic and professional focus in evidence at this event provided more than enough justification for a call for immediate funding of research at the federal level. In the meantime, I urge readers to make tax deductible donations to the sponsoring organization for this event, the IRS approved 501(c)(3) nonprofit Center for Research on Biotoxin Associated Illness (CRBAI).
-- Jonathan Lee Wright
Disclosures: I am an independent journalist, and have no conflicts of interest to disclose that may compromise my ability to report objectively.
Jonathan Lee Wright is a contracted photographer with Getty Images and has had a 25 year career as a magazine assignment photojournalist . A former executive director of a congressionally endorsed 501(c)(3) nonprofit dedicated to public health education, he has written extensively on the subject of mold and environmental illness.