July 14, 2010. We hear a lot today about how we are part of a global community. Whether it has to do with free trade legislation like NAFTA, immigration policies, or the internet, distant parts of the world have been brought a lot closer to towns and communities in the United States. Most of what Walmart sells now comes from China. At my job, it's common for us to work with engineers in the United Kingdom, Israel, and Singapore in one day.
The down-side of this is that diseases from overseas are brought a lot closer to us as well. West Nile virus, a disease named after a river in Africa, now shows up in Colorado. About 5% of the population of Key West Florida has been exposed to Dengue fever. And Blastocystis, a protozoal disease which was once uncommon in the United States, now infects 10-20% of the population in California and Oregon.
West Nile and Dengue are viral diseases which make some people very sick for a short time, then most people get better. These diseases can tax the medical system by sending lots of people to doctors are the same time, but most people who are infected with the diseases get better without treatment. But once someone is infected with Blastocystis, they will probably carry it for a lifetime if they aren't treated. Because of this, diseases like Blastocystis produce a high economic cost to communities and families. In the United States, patients with Blastocystis infection are usually told that they have IBS, food allergies, or an auto-immune disease.
A Federal Disease
In order for Blastocystis to become a problem, people in the US need to be exposed, and they need to stay sick for years without treatment. Federal policies today are ensuring this is happening. Here's how.
In analyzing Blastocystis infection trends in the United States, there is some evidence that the major source of the disease is immigration from Mexico. About 50% of the food handlers in Mexico are effected. The prevalence of the disease in US residents has risen in fallen based on the rate at which illegal immigrants are apprehended crossing the border. The states in the US that have the highest rate of infection are those that have the largest Mexican immigrant communities.
In some countries, immigrants are screened for infections like Blastocystis, and treated if they are infected. Both Taiwan and Singapore screen immigrants, many of whom come from Southeast Asia and carry a variety of diseases. Studies from those countries indicate that immigrants often go to work in the food service and medical care industries, and as such may expose a large number of residents to infection. In the United States, we don't screen immigrants, and we haven't done a good job of controlling immigration either. Employers, especially in the farming industry, insist they need migrant workers from Mexico because US citizens won't take the jobs.
So the first part of the equation is there: US citizens are being exposed to Blastocystis infection as a direct result of Federal immigration policies.
But what about the next part? Blastocystis is one of about a dozen protozoal diseases which humans can contract, and which will produce life-long symptoms without treatment. But scientists have been able to identify treatments for virtually every protozoal disease that can infect humans. The treatments are often very specific - in many cases, there is only one drug that will work.
The United States was well on its way to identifying a reliable treatment for Blastocystis in the mid-1990's. An NIH lab had performed a 15-year study that showed Blastocytis was making people sick in the US, and that the old drugs were not working. The lab had even started looking at alternative drugs, many of which were described in a 1993 review in the journal Clinical Microbiology Reviews by the NIH researcher, Dr. Charles Zierdt.
But then something happened. A small number of physicians in California working at Kaiser Permanente insisted that these patients should be diagnosed with "irritable bowel syndrome." That's another way of saying that they were insane and faking diarrhea to get attention from doctors. It's not clear why they were so insistent. One of the doctors had published a study in the 1980's that said Blastocystis was harmless, so he have been upset at the possibility of being contradicted by the NIH research. Kaiser is also an HMO, and the doctors may have been trying to save money by telling patients they had IBS, so they would not have to be treated.
Whatever the reason, the NIH shut down all research following these objections. Employees from the NIH began telling US researchers there was no proof Blastocystis caused illness, and they discouraged them from applying for grants. All Blastocystis grants that were submitted to the NIH from 1995 to 2010 have been rejected. There are over a dozen countries around the world with labs that are working to help patients, and not one of them is in the US.
So the second part of the equation was also met by the Federal government. First, we had a huge amount of unregulated immigration in the 1990's, and next, the Fed shut down all research into this disease, ensuring that US residents who became infected would never get diagnosed or treated.
This is Your Home Town On Globalization
Last year, one patient who had developed chronic diarrhea wrote to me, and said that her doctor told her to ignore the Blastocystis test results. "If you go to a developing country, you'll probably find half the people there are infected."
That's true. Blastocystis is common in impoverished communities. So is chronic illness. That's one reason why those communities are impoverished. Here's a map from an article in the journal Science, entitled, "Do Parasites Make You Dumber?" which describes research published at the University of Virgina and elsewhere that related the wealth of countries to the level of parasitism:
We can talk about Blastocystis bankrupting families at the individual level. About parents who can't care for children, who have spent their life savings and retirement money on useless treatments from alternative health care providers. We can talk about people in their 20's who have fatigue so severe they can't go to college.
Experimenting on US Citizens
Last year, researchers from Pakistan published a study on children in an urban slum in Karachi, and found that the rate of Blastocystis infection was around 10% - that's comparable to the infection rate in Oregon today. Corvallis, and many other towns in the US are now part of a big experiment. We've known for a long time that impoverished communities have high rates of chronic infections, and that when we provide medical care, the standard of living rises and those infections go away. But what is the cause and effect? Did the infections cause the poverty? Or were they the result of the poverty?
In the case of Blastocystis, we are infecting large numbers of US residents, and then making sure they don't get treatment by restricting research and access to antiprotozoal drugs. So far, the results in Corvallis suggest that chronic diseases will produce poverty.
Corvallis is one good example. It's a small town - about 50,000 people - with the unusual distinction of having more residents with advanced degrees per capita than any other town in the US. That may be because the employers are engineering companies (Hewlett-Packard and CH2MHILL) and the local University. The salaries from those jobs help keep the local economy afloat.
But when I started interviewing people about Blastocystis in 2006, I was amazed at the economic costs of the disease to families. A engineering or professional job may pay $60,000-$80,000 a year, but many families were describing yearly medical bills that ran into the five figures to manage the disease. In the more severe cases, patients develop neurological and psychiatric problems, and one of the larger recurring costs involved weekly sessions at the psychiatrist (see interesting side note below*).
It doesn't take a lot of math to figure out that employers might not be happy about spending $70,000 in salary in an employee, and then having to fork out an additional $20,000 in medical expenses. In some cases, multiple members of the same family were impacted, so an employer may have to support 3 or 4 sick people. And the disease turns many patients into basket cases, so in addition to spending more, employers get workers who are sick more often, and have a much lower productivity even when they show up for work.
One of the first indications that Blastocystis might be changing the economy came when HP began laying off employees, even while the local medical center started expanding their center for performing endoscopies/colonoscopies. That's what US doctors do to patients when they get Blastocystis - the procedure costs around $4000. Blastocystis patients also get MRI scans ($2000), barium enemas with contrast ($2500), and a host of other tests.
As HP is shutting down its Corvallis site, it is expanding its sites in Singapore and Asia. Singapore is that country that tests immigrants to make sure they don't have Blastocystis. If you hire people in Singapore, 10-20% of them are not infected with Blastocsystis. The country tests immigrants. They also did not shut down their Blastocystis research lab in the 1990's when US doctors objected. They now have one of the world's leading Blastocystis research efforts, and the rate of infection in their population is less than 3%, about what the US had in the 1980's.
A "new" Corvallis is emerging, and it looks a lot like a slum from Brazil or Mexico than what we think would be a middle-class community. In addition to producing a loss of jobs to the local economy, HP's pullout is threatening to bankrupt the town of Corvallis, since a large portion of the town's taxbase came from HP. Even though they still have their site, most of the buildings are now empty, and HP has contested their tax assessment in court. The company is reportedly considering demolishing the buildings on the site to reduce their tax burden.
With HP's loss, some other high tech companies have arrived in Corvallis, but the way they employ people is very different. I work at one of those companies. High tech companies with employees in the US will commonly have design centers both in the United States and overseas, often in Korea, Singapore and China. When business picks up, the companies can choose to hire workers in either Asia or the United States. US workers have always been more expensive than overseas counterparts, but they were worth it because they could get the job done faster. The "Blastocystis tax" changes that formula, when you are considering hiring in a state that has been hit by Blastocystis (California, Oregon, Texas, Florida, New York, Ohio). If you hire in Beijing, Singapore, or Taipei, you are hiring a population where less than 2% is infected, but hiring from Santa Clara, Corvallis, or Portland gives you a population where the infection rate is ten times that. The result is you have to pay more medical costs for both the employee and dependents. And the productivity benefit is much lower. So it's not surprising to hear from high tech employees in Corvallis that the size of their company has grown substantially, but nobody has been hired locally in years.
* As an interesting note, in the 1980's, United States researchers insisted that stomach ulcers were a psychiatric disease, and that patients should attend weekly therapy sessions for 18 months to try to cure their ulcers. Later, researchers in Australia discovered that the ulcers were caused by an infectious disease, and could be cured for about $20 of antibiotics.
What happened to those US researchers who were sending patients to psychiatrists for expensive and useless therapy? They continue to insist that gastrointestinal disease is caused by psychiatric problems, and they are now being bankrolled by the NIH to run the largest research effort into "IBS" patients. BRF has contacted that group many times to see if it would be possible to test US citizens with this disease for Blastocystis infection, as has been done overseas. All requests have been refused.