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Posted 7/7/2004 9:14 PM
Updated 7/7/2004 11:46 PM
Maggots and leeches: Good
medicine
By Rita Rubin, USA TODAY
Two medical devices recently approved by the Food
and Drug Administration seem more likely to appear on
Fear Factor than ER.
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Your prescription is ready: Ohio
pharmacist Greg Wellman shows off a
container of medicinal leeches.
By Tim Revell, Columbus Dispatch via AP
Calling them "devices" is a stretch. But just like stimulators and stents, prostheses
and pacemakers, leeches and maggots are now classified as FDA-approved
medical devices — the first live animals to earn that distinction.
No question, the thought of getting up close and personal with leeches or maggots
is enough to make most healthy people feel ill. But patients who have been treated
with these "devices," as well as their doctors, credit them with restoring health to
tissue when high-tech medicine could not.
Although a French firm's leeches were approved only last week and a California
doctor's maggots were cleared in January, the creatures have long medical track
records.
Companies that were already selling leeches before the Food, Drug and Cosmetic
Act became law in 1976 were grandfathered in and did not need FDA approval. The
FDA only recently decided to regulate maggots, says internist Ronald Sherman,
who earned the agency's permission in January to continue supplying the
caterpillar-like fly larvae.
Leeches through history
Medicinal leeches are bloodsucking, aquatic cousins of the earthworm that hail from
Europe. Doctors used leeches for bloodletting — thought to be good for whatever
ailed patients — from Hippocrates' time through the mid-19th century. Leeches fell
out of favor when doctors finally recognized that patients they bled fared no better,
and often worse, than other patients.
BAD TASTING MEDICINE
Here's a remedy being tested for
patients with inflammatory bowel
diseases. It's a
gastroenterologist's experimental
concoction — spiced with 2,000
eggs of intestinal worms.
A new treatment for inflammatory
bowel diseases may be worming
its way into the medical
armamentarium.
It's often trickier to connect veins, which carry
blood back to the heart, than arteries, which carry
blood from the heart. So before grafted tissue gets
new vein growth, it can become congested with
blood. Sometimes surgery can fix the problem, but
if it can't, the graft might fail.
Enter the leech. Not only does it suck out excess
blood, but its saliva contains a powerful blood
thinner. So even after it fills up and drops off,
bleeding continues.
University of Iowa
gastroenterologist Joel Weinstock
developed the concoction, which
consists of a popular beverage —
he declines to name it — and
2,000 pig whipworm eggs per
serving. The worms come from
pigs raised at a local U.S.
Department of Agriculture facility
and then slaughtered.
Weinstock came up with the idea
after observing that inflammatory
bowel diseases are most common
in industrialized countries, where
modern sanitation had virtually
eliminated the chance of people
acquiring intestinal worms.
Though that's generally a good
thing, it might raise the risk of
developing inflammatory bowel
disease in genetically predisposed
people, Weinstock says. That's
because intestinal worms dampen
the immune response, which is in
overdrive in inflammatory bowel
disease, causing persistent
diarrhea, abdominal pain, weight
loss and fever. Medications can
relieve symptoms but aren't a
cure.
Weinstock chose to test pig
whipworms because they don't
venture out of the gut, they don't
survive more than six or eight
weeks and they don't appear to
make people sick. Their eggs are
less than half the size of a grain of
sand, so they're basically
undetectable in Weinstock's drink.
The worms, which are less than
half an inch long and thinner than
a human hair, emerge in the gut.
Douglas Chepeha, an ear, nose and throat
surgeon at the University of Michigan, treats two
or three patients a year with leeches after
rebuilding faces or mouths decimated by cancer.
Typically, leeches are used one at a time and
replaced as they drop off — usually every 20
minutes — for 24 to 48 hours, then intermittently
for a few days afterward, Chepeha says.
"I've never had anybody refuse," Chepeha says.
"They've come in with a serious cancer, they've
had part of a critical organ removed, they want to
get better. You say to them: 'I think this could
help.' People have been amazingly stoic about it."
Normally pretty squeamish, Alyssa Kieff, 22, of
Marrero, La., tolerated five days of leech therapy
in April. Kieff's beagle had snapped at her and
tore off her right upper eyelid, which was
reattached microsurgically by Kamran Khoobehi, a
Louisiana State University Health Sciences Center
plastic surgeon.
Kieff, who returned to her receptionist job a month
after surgery, wasn't quite as enthusiastic. Still,
she says, "I knew it had to be done to help the
eyelid survive. I didn't think about it."
Two U.S. companies sell medicinal leeches for
about $7.50 apiece. They're usually on call in
hospital pharmacy refrigerators.
Compared with leeches, maggots are tiny things.
But their association with rotting flesh may make
them even more off-putting than leeches — until
you talk to someone who's been treated with
them.
Maggots to the rescue
Weinstock has tested worm
therapy in 120 patients with
Crohn's disease or ulcerative
colitis, the two types of
inflammatory bowel disease,
which affect up to 1 million
Americans. The treatment was
tolerated well and appeared to
improve symptoms. "It's likely to
be effective in both diseases,"
Weinstock says. He hopes to
conduct a larger, multicenter trial
of the therapy. By Rita Rubin
Three years ago, a small cut on the bottom of
Pam Mitchell's foot became seriously infected as
a result of diabetes. After surgery to remove
diseased tissue, Mitchell, who had worked as a
waitress for 20 years, was left with a hole in her
foot that was 1 inch deep and 2 inches across.
And still, the infection raged. Antibiotics were
powerless against it.
"They were telling me I should think about
amputation," says Mitchell, who is from Akron,
Ohio.
But then a co-worker told Mitchell of a TV show
she had seen about using maggots to heal
wounds. Desperate to save her foot, Mitchell
found a dermatologist, Eliot Mostow, who thought
maggot therapy was worth a try. Luckily, her
insurance covered the $75-a-session treatments.
Mostow applied disinfected maggots to her wound and covered them with a cagelike
dressing. The maggots liquefied dead tissue, killed harmful bacteria and stimulated
healing. After 48 hours, Mitchell's orthopedist removed the maggot dressing. After
10 treatments, her foot was well on its way to being healed. "It's amazing," she says.
"There's hardly even a scar there."
Today, Mitchell serves on the board of the non-profit Biotherapeutics Education and
Research Foundation, which promotes the medical use of maggots and leeches and
provides them to patients who lack insurance coverage. Sherman, an Irvine, Calif.,
internist, is the group's CEO and only U.S. maggot supplier.
To say Sherman is mad about maggots is like saying Spider-Man 2 is doing OK at
the box office. "He really is Dr. Maggot in my mind," Mostow says. "He knows more
about this than anybody else."
Through the years, Sherman says, military surgeons noticed that soldiers with
maggot-infested wounds did better than similarly wounded soldiers without the
infestation.
Sherman began treating patients with maggots in 1990. By 1993, as word got out
about his success in saving limbs scheduled for amputation, other hospitals began
asking him for maggots. By 1994 or 1995, Sherman says, he was getting so many
requests that he began charging a nominal fee to cover the materials and his time.
Today, Sherman says, he supplies blow fly maggots to 300 sites around the
country, including Washington Hospital Center in Washington, D.C., which used
them to treat victims of the terrorist attack on the Pentagon. "They're lifesaving,"
says James Jeng, a burn specialist at the hospital.
Sherman says relatively few of his customers are willing to go public. "Some
administrators," he says, "have expressed the view that the public will think the
hospital is old-fashioned or, worse, unhygienic."
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