Creepy-Crawly Therapies

Though medicine is rarely pretty, most people find a pill infinitely more attractive than a maggot – or a leech, or a worm, or a bee. But these creatures may provide treatment options when a standard treatment needs help or is not working.

Maggots

Take the lowly maggot, legless larva of the fly. But not just any maggot – for medical purposes, you want sterile greenbottle blowfly larvae, which eat only dead tissue.

According to an article by Dr. Ronald A. Sherman, published in 1998 by the European Tissue Repair Society, maggot therapy works by three main actions: debridement (or liquefaction of necrotic tissue), disinfection, and hastened wound healing. As such, Sherman reports that maggots have been successfully used to treat chronic soft tissue wounds, including neurovascular ulcers, venous stasis wounds, pressure ulcers, traumatic and surgical wounds, burns, and necrotic tumors.

In 1999, Dr. Steve Thomas and researchers at the Princess of Wales Hospital in Bridgend, Wales, reported that maggots were able to clear up methicillin resistant staphylococcus aureus (MRSA) infections, which are major problems in many hospitals. Thomas reported that after 48 hours of maggot therapy, five MRSA-infected lesions that had failed to respond to weeks of conventional treatment were MRSA-negative and healing well.

In a July 2000 article published in the Journal of Tissue Viability, Dr. Michael Walker of West Cumberland Hospital in Whitehaven, England, reported on a randomized, non-masked trial of 12 patients with sloughy venous ulcers. While two of the six hydrogel-treated patients still required dressings several months later, the six patients treated with maggots had their ulcers successfully debrided with a single application.

Sherman, who is assistant professor of medicine and pathology at the University of California, Irvine, says that, unfortunately, the majority of maggot therapy literature is anecdotal, and large-scale studies are lacking. Further, doctors are not sure how maggots distinguish between dead and healthy tissue and why they heal the wound. But since maggots seem to have no negative side effects, they may provide an effective treatment option.

Leeches

At about the same level on the revulsion scale as maggots, one finds leeches, the scourge of the "ol' swimmin' hole." But many patients who have had skin flaps or have had body parts reattached owe the success of their operations, in part, to leeches. Biopharm Leeches, in Hendy, Wales, which has orders for more than 100,000 leeches annually, reports their use in 29 different countries.

The annelid of choice is Hirudo medicinalis – a 32-brained bloodsucker with 100 teeth in each of its three jaws. It produces a small bleeding wound that mimics venous circulation in areas where it is impaired. Its bite is painless, because it includes a local anesthetic as well as an anticoagulant (hirudin) and local vasodilator. The leech can consume up to five times its weight before dropping off the patient. Therapy continues until the tissues have reformed blood vessel connections and can resume draining blood on their own.

There are two problems with leech therapy: the squeamishness factor and the possibility of bacterial infection (since leeches cannot be sterilized). Fortunately, researchers at the University of Wisconsin-Madison and the William S. Middleton Memorial VA Medical Center in Madison, Wisconsin, have designed and tested a mechanical leech. Unlike a real leech, the device is sterile, inoffensive, and insatiable – it can continue removing blood indefinitely.

Worms

How about parasitic worms? They are another repellent organism which we may need more of in our antiseptic, modern lives.

Dr. Joel Weinstock, professor and director of the division of gastroenterology-hepatology and director of the Center for Digestive Diseases at the University of Iowa College of Medicine in Iowa City, notes that the rise in inflammatory bowel disease (IBD) has coincided with the reduction of parasitic worms in humans.

In 1999, Weinstock, along with University of Iowa colleagues, conducted a study with four patients with active Crohn's disease and three with ulcerative colitis. Following doses of microscopic worm (helminth) eggs in liquid, six achieved remission, and the remaining one improved. This study will appear in the American Journal of Gastroenterology later in 2003. Weinstock is currently treating about 80 people and conducting two double-blind studies. [Update: see the article about the results of the double-blind studies in the April 2005 issue of Gastroenterology.]

Bees?

Bees may not disgust us, but they do send us running. Most people who have been stung by a bee believe once is more than enough, but advocates of bee venom therapy (or apitherapy) disagree.

Some individuals claim that allowing live bees to sting them brings relief from arthritis, multiple sclerosis, fibromyalgia, and tendonitis. The American Apitherapy Society (AAS) has collected personal testimonials of efficacy for an even wider range of conditions, including eczema, emphysema, hearing loss, depression, and PMS. Some patients may be stung up to 80 times per day. The number, location, and frequency of stings depend upon the individual and the condition.

There has been little scientific study of the health benefits of apitherapy. However, two reports from studies done in 1988 do show promising results: one for slowing the progress of an arthritis-like disease in rats and the other for slowing production of interleukin-1, which helps fuel arthritic pain and inflammation.

Georgetown University in Washington, DC is currently engaged in a Phase I "Study of the Safety of Honeybee Venom Extract in Patients with Chronic Progressive Multiple Sclerosis." One possible reason for bee venom?s effectiveness could be its most prevalent ingredient, melittin. AAS reports that melittin stimulates the pituitary gland to release ACTH, which in turn stimulates the adrenal glands to produce cortisol. Melittin, when tested in rats with arthritis, was 100 times more potent as an anti-inflammatory agent than hydrocortisol.

Update: An article published in the December 13, 2005 issue of the journal Neurology found that in a trial of bee sting therapy, which used 26 patients with relapsing-remitting or relapsing secondary progressive MS, "treatment with bee venom in patients with relapsing multiple sclerosis did not reduce disease activity, disability, or fatigue and did not improve quality of life."

Get Over It

Although the efficacy of these alternative treatments has not yet been scientifically proven, they are promising and relatively inexpensive. The main drawback appears to be that these creatures, colloquially put, gross us out. In the interests of advancing medicine, we should learn to love them.

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