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Sunday, October 27, 2013

Maggots as Medicine

Experts estimate that we spend more than 20 billion dollars each year trying to treat non-healing wounds like pressure ulcers and diabetic foot ulcers. Each year there are more than 1.5 million cases of diabetic foot ulcers alone, and they're responsible for at least 70,000 amputations.

These non-healing wounds, along with the rise of antibiotic resistance and life-threatening infections, has prompted scientists and doctors alike to revisit an age-old therapy: maggots.

Maggot therapy, also referred to as maggot debridement therapy (MDT), larval therapy, or biodebridement, is the application of live, sterilized fly larvae to wounds. The larvae do not feed on live tissue and they do not reproduce. Maggots secrete an enzyme that disinfects the wound, dissolves dead tissue, and promotes healing. They've even been shown to be effective against MRSA (methicillin-resistant Staphylococcus aureus infection) and other resistant germs.

Controlled clinical and laboratory studies show that compared to conventional medical and surgical care, maggot therapy is safer, faster, cheaper, more accurate, and more effective. Patients who use MDT require fewer days of antibiotics and their wounds heal an average of 4 weeks earlier. And it's 100% natural.

Used as a last resort, maggot therapy has reportedly saved 40 to 50 percent of limbs that would otherwise have been amputated. Researchers attribute the limb-saving success to increased oxygen supply, cell regeneration, and tissue remodeling triggered by maggot secretions.

Maggot therapy costs about half as much as conventional therapy, and sometimes much less. A study in the UK found that treating a patient with maggot therapy cost £92 while treating a patient with antibiotics cost £319, making MDT almost three and a half times less expensive than antibiotic therapy.

Maggot therapy was so popular in the 1930s that hospitals kept their own insectaries, where they reared and sterilized their own larvae.  As antibiotics became available and surgical techniques improved, MDT lost popularity in the 1940s and virtually disappeared in the 1950s.

Now it's making a comeback. As of  2009, at least 24 laboratories supplied medical-grade maggots to doctors and patients in more than 50 medical centers in North America and more than 850 in the United Kingdom. Maggot therapy is being used in at least than 30 countries around the world. 

In the United States, maggots were the first live organisms recognized as medical devices by the Food and Drug Administration in 2004. MDT requires a prescription but it's reimbursable by Medicare and many insurance companies.

References:

Dente KM. 2007. Alternative Treatments for Wounds: Leeches, Maggots, and Bees. Medscape. http://www.medscape.com/viewarticle/563656.

Ryan R. Why maggots and leeches are good for your health. Daily Mail. http://www.dailymail.co.uk/health/article-130983/Why-maggots-leeches-good-health.html.

Sherman RA. 2009. Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century. Journal of Diabetes Science and Technology 3(2):336-44.

Monday, October 21, 2013

Can Daylight Savings be Dangerous?

Our circadian rhythms are dictated by the light and dark cycles in our environment. Every one of our cells has an internal clock that responds to changes in daylight. Special proteins called cryptochromes in our skin cells are sensitive to light’s blue spectrum, so whenever we’re bathed in light, our bodies get the message to wake up.

Light and dark cycles influence levels of key hormones like cortisol and melatonin that help regulate bodily processes including inflammation and immunity, which help determine our resistance to disease.

When the light and dark cycles in our environment suddenly change, even by only an hour, this change can disrupt the way our bodies work. It also slows reaction time and has been linked to an increase in traffic accidents.

Researchers in Michigan analyzed a decade of national traffic statistics and found that during the week before the daylight savings time change, 65 fatal crashes were reported. The week after the time change, 227 were reported. The Insurance Institute for Highway Safety of Arlington, Virginia calculated that using daylight savings time year-round could save approximately 200 deaths each year.

References:

Plainis S, Murray IJ, and Pallikaris IG. Road traffic casualties: understanding the night‐time death toll. Injury Prevention. 2006; 12(2): 125–128.

Sullivan JM and Flannagan MJ. The role of ambient light level in fatal crashes: inferences from daylight saving time transitions. Accident, Analysis and Prevention. 2002;34(4):487-98.

Sunday, October 6, 2013

Discussing Childhood Vaccines on Fox News


Last weekend I discussed the risks and benefits of childhood immunizations with Dr. Mark Seigel and host Carol Alt in a segment called "To vaccinate or not to vaccinate" on the new Fox News show A Healthy You. Amidst the excitement, I misquoted an important statistic. I meant to say:

In the United States we give kids 70 doses of 16 different vaccines during childhood and babies receive 26 doses during their first year of life.

Why is this statistic so important?
  • Because we give kids more vaccines than any other country in the world
  • Because we have the highest rate of infant mortality among 34 industrialized nations
  • And because research studies confirm that increasing doses of vaccines are associated with increasing rates of infant mortality (Miller 2011)

Countries with the lowest rates of infant mortality are also among those who give their kids the fewest immunizations, notably Sweden, Japan, and Iceland, where kids get only 12 shots total.

Instead of vaccinating more, we should be vaccinating more selectively. We should start with shots against the most dangerous diseases for babies, like Haemophilus influenzae type B, pertussis, and pneumococcal infections. Whenever possible we should delay vaccines that have a higher risk of adverse effects when given before the age of two, like hepatitis A, and those that are ineffective in babies, like injected live-virus vaccines. We should also consider delaying vaccines against illnesses that are rare in the United States, or rare in babies, or usually mild in babies, until infants' immune systems are more mature. In many cases, delaying vaccines also reduces the total number of doses required to achieve immunity.

We also need to practice harm reduction. Here are my top strategies to reduce the risks associated with childhood immunizations: 

#1  Weigh the risks and benefits of each vaccine on a case-by-case basis. 

#2  Avoid unnecessary immunizations by checking titers before giving MMR, varicella, and hepatitis A vaccines.

#3  Some vaccines are made by more than one manufacturer, so whenever possible, choose shots with the fewest additives. Ingredients of concern include mercury (in the form of thimerosal), aluminum, monosodium glutamate (MSG), antibiotics, and tissues from animals and humans. Fortunately, all childhood immunizations are available in mercury-free forms.

#4  Give vaccines in single doses rather than multiple doses whenever possible and never give more than one aluminum-containing shot at a time.

#5  Do not give live-virus vaccines to babies less than one year old. When they are administered, live-virus vaccines should be spaced at least 3 months apart with the exception of the MMR and varicella vaccines, which should be spaced at least 6 months apart.

#6  Before and after immunization, consider giving supplements to support a healthy immune response. Probiotics have been shown to increase the effectiveness of vaccines while reducing the risk of adverse events (Youngster 2011). Probiotics also minimize the chance of allergic reactions and make our bodies more resistant to disease.

#7  Keep kids healthy with a whole foods diet, daily exercise, outdoor play, and plenty of sleep. 

#8  Never vaccinate kids (or adults) with the following:
  • Previous serious reaction to a vaccine 
  • Signs of illness or infection during the past week
  • Autoimmune disease 
  • Developmental or neurological disorders
  • History of surgery, transplant, transfusion, or cancer treatment within the previous 3 months
  • Medications and treatments that suppress natural immunity like antibiotics, steroids, chemotherapy, and radiation

It's time to recognize that the current standards of care aren't working well enough and if we want to protect babies better, immunization schedules have to change.

Alternative vaccine schedules can minimize the risk of adverse events and increase compliance while keeping cases of dangerous diseases extremely rare. Offering options other than the current one-size-fits-all approach can actually increase immunization rates, especially among families who would otherwise opt out of vaccines altogether.

Talk to your doctor about the best immunization schedule for your child. If he or she isn't open to alternatives, find a "vaccine friendly" doctor on Dr. Sears' list.

References:

Miller NZ and Goldman GS. 2011. Infant mortality rates regressed against number of vaccine doses routinely given: is there a biochemical or synergistic toxicity? Human and Experimental Toxicology 30(9):1420-8.

Youngster I, Kozer E, Lazarovitch Z, et. al. 2011. Probiotics and the immunological response to infant vaccinations: a prospective, placebo controlled pilot study. Archives of Disease in Childhood 96(4):345-9.