In the mid-1990's, US medical experts made a far-reaching decision. A number of physicians and scientists had identified Blastocystis, a single-celled gastrointestinal parasite, as the cause of disease in patients. But some other physicians contested this claim. There were a few things they could have done. They could have arranged for a neutral third-party to obtain some samples of the organism, infect animals, and see what happened. They could have funded a small effort to perform an investigation and try to determine why there was a difference of opinion. But there was a third choice - shut down all research in the US, and teach medical students to avoid Blastocystis at all costs.
It turns out that we took the third option. Officials at the CDC wholly embraced this path, and until 2006, the only studies they would quote on their official information page were from the small number of US physicians who had identified Blastocystis as harmless. In the intervening years from 1995 to 2010, a lot happened. Overseas, researchers started looking more closely at Blastocystis, and found that is wasn't much different from the other organisms which cause disease in humans, like Giardia and E. histolytica. They showed it caused illness in animals, sometimes very severe illness. They worked to develop treatments. They approached the infection as previous infections had been approached.
It's not clear why, but in the United States, the most reasonable course of action to our medical experts appeared to be to do nothing. In fact, doing absolutely nothing about an infectious disease appears to be a respected trait in US medicine, much in the way citizens of the UK are advised to keep a "stiff upper lip" in the face of adversity. Indeed, articles by US medical experts on many diseases often begin by describing how mild and inconsequential the malady is, and how they are just looking at it because patients are so bothersome about vomiting blood or having to use the toilet 50 times a day.
But this decision is coming back to haunt the hallowed halls inhabited by our residential experts. Between 1995 and 2000, the rate of Blastocystis infection on the wet coast increased from about 2.5% to over 20%. And as those people got sick, they were unable to find any assistance from conventional medical case. So they began flocking to alternative medicine.
Every week, I answer questions from patients who want to use a variety of bizarre treatments to address Blastocystis infection. These inquiries come only from patients in the United States and the UK. In other countries, they have come to terms with the existence of microbial infections which cause chronic illness. They have full time parasitologists in mode medical schools, and these people are able to explain diseases like Blastocystis, even if they can not cure all the cases. The United States and the UK are the only countries in the world to wholly shut down the scientific study of this class of infection.
The lack of scientific information on Blastocystis is a tremendous boon to the field of alternative medicine, which includes anything from herbalism, which might actually work sometimes, to blatant quakery. And these people aren't just graduates of 2-year alternative therapy programs. Many fully accredited medical doctors are using treatments that the parasitologists I work with would consider nuttier than a fruitcake. Here's how one patients described how a medical doctor (yes, MD) in Oregon diagnosed food allergies:
"He put his hand on my shoulder, and I would hold different foods in my hand.
If my arm fell down, that meant I was allergic to the food. If it rose, then
I was not allergic."
The Web Of Science
When I was getting my undergraduate degree at Stanford, I took a class called "Philosphy 51: Introduction to Logic." It was unusual, at least in 1987, in that it was almost entirely computer based. You started out from a set of logical axioms, and constructed proofs that became progressively more complex. For example, given that A implies B, and B implies C, you could prove that A implices C, and that NOT C implies NOT A. One lesson was particularly interesting. In that lesson, the system allowed you to assert that something that was false was in fact true. Once this was done, everything about logic unraveled, and it became possible to prove anything was true.
What's happened in US medicine with Blastocystis is similar. The premise is that Blastocystis should be ignored, that it doesn't cause chronic illness, despite what over 100 full-time scientists at most of the world's leading medical research institutions have written. When people get sick, their illness can't be explained by the mainstream family practitioner, so they go outside of the system.
The money they spend is changing US medicine forever, these new consumers are ripping apart the medical system that was created by the same US "experts" who shut down Blastocystis research.
For example, a 1991 NIH study had already noted that metronidazole was failing to cure many infections, and a new drug would be needed. Several drug possibilities were mentioned. But after the 1995 shutdown, the NIH refused to investigate any of them. Even in 2006, despite letters from Congress, they still refuse to work to identify any drug to treat patients.
So what do patients hear when they go to the doctor? Heavy metals are causing their Blastocystis infection to be difficult to treat. The metals are from dental fillings and vaccines. They should avoid vaccination and go on chelation therapy to rid their body of toxins.
This isn't just happening for Blastocysits. I wrote a very conventional article for athe newsleter of a charity called the "Gut Trust" in the UK in 2007 about Blastocystis infection underlying many cases of what Western doctors are calling IBS. Dr. Nick Read, a leading advisor to the charity, and a major figure in gastrointestinal research corrected me, indicating that microbes do not cause disease by themselves. As proof of this, he noted that many people carry TB without showing symptoms. Also, we are mistaken in the current medical belief that H pylori causes stomach ulcers, even though the Nobel Committee awarded a prize to the pair that made this discovery in the 1980's. That is because some people have H pylori but do not have symptoms.
This is true of most infectious disease, and mainstream infectious disease researchers now link variability in symptomatic presentation to host genetic factors. They can now reproduce the genetic factors in mice and create animals which will get sick or not get sick. Think of Typhoid Mary - she carried typhoid fever her whole life, had no symptoms, but infected many other people. But this kind of stuff is "conventional science" It is reductive. It does not allow for personal creativity.
So what does cause illness? According to Dr. Read, "stress and toxins."
Return to the Middle Ages
What we're seeing in the US and UK is the jettison of mainstream science, in favor of what advocates claim is a "wholistic earth-centered view of medicine" that doesn't rely on harsh antibiotics, vaccines, and treatments.
So the curmudgeons who shut down Blastocystis research now have about ten different things to content with. They have mainstream doctors advising patients not to vaccinate themselves. They have professionals arguing that vaccines and antibioitics are unnecessary and harmful. And they have a half dozen new "alternative" treatments in their place.
Judging from their writings, these alternative treatments are causing much more heartburn than would have ever been caused by just doing the science of Blastocystis. Let this be a lesson for future generations. If being conservative means being responsible, that that means taking appropriate action.
So are these things silly? Yes. As Blastocystis spreads, we'll see patients spending more on these things, and we'll see less interest in funding conventional medicine.
US spending on alternative medicine, at around $18 billion/year, already exceeds the budget of the NIH.
Here's a list of what Blastocystis patients are ploughing their family's savings into:
Chelation - This treatment involves consuming specific drugs, like EDTA, to "rid the body of heavy metal toxins" which accumulate from dental fillings, pollution, and vaccines. NUTTY FACTOR: I've worked with parasitologists in 7 countries for over 5 years, and not one has ever mentioned chelation as a direction for treating enteric parasitic infections. There may be some value in treating malaria, but the chelation in this case gets rid of the body's iron, and has nothing to do with heavy metals.
Sputnik - This is a $300 pill which the patient swallows, and it supposedly emits an electromagnetic pulse which cures the patients of any bacterial or parasitic infection.
Rife Machine - This is a $80 machine the patient buys, and it emits electromagnetic waves at a specific frequency, which kills certain parasites, viruses, and bacteria, depending on the frequency of course. Patients have written me asking for the frequency for Blastocystis.
Colloidal Silver - This is a concoction made by dissolving silver in water. Patients drink it to address infections. There is actually some evidence that silver has antimicrobial properties, but it also accumulates in human tissues, and at therapeutic levels may turn skin blue permanently. Again, after years of working with parasitologists around the world, I have never heard anyone talk about colloidal silver.
Hyperbaric Oxygen - This involves going into a chamber, having it pressurized, and letting the oxygen treat the disease. This actually may work, but it is very expensive (cost per treatment > $1000) and it doesn't cure the disease, so patients have to come back over and over. Again, it might be better just to identify a reliable treatment, and treat the patient once, as we do with other infectious diseases.
Wednesday, August 25, 2010
Sunday, August 22, 2010
Immunology 101: Why some diseases never go away
Many Blastocystis patients write BRF with accounts of long-term infections, some lasting as long as 20 years. When some Western physicians hear this, they say, "That's impossible unless the person has AIDS or cancer." After all, in high school, we all learned about the immune system, and how it acts like a little army to attack invading pathogens. So if somebody isn't getting better, they must have some kind of problem, right?
Wrong - it turns out everything they taught you about the immune system in high school was wrong, or at least a huge oversimplification. Defending your body against incoming threats is a complex task. The most basic problem is, "How do you recognize an invading organism?"
That sounds like an easy problem, and maybe it is if you're a human being and you can find it under a microscope, and then "google" it. But our immune systems were developed long before google. In fact, the human immunological system isn't too different from that of many other bird and mammalian species. Many of the things that go on in our immune system were developed millions of years ago.
To complicate things, the immune system must not only recognize invading organisms, but also avoid recognizing innocuous things. For example, if you developed an immune reaction to chicken, beef, and vegetables, you would die. So how does your body know the difference between a carrot and the anthrax bacteria? There are, in fact, a half dozen little tricks that immune cells use to identify potential pathogens. Many pathogens have certain chemicals in their cell membranes that are not found in human or other mammals. Others have patterns in their DNA which the human body can trigger off of.
But it gets more complex than that, because sometimes those patterns show up in innocuous things, like pollen. This is one reason people get allergies - their body keeps putting up an immune reaction to an antigen, thinking it is a pathogen, when it's just a little bit of pollen. Plus if the body over-reacts to an antigen, it could wind up killing the big, and also killing the host. And finally, the body has the ability to identify new compounds as targets of the immune system, which is how vaccines work. But it also has to make sure not to identify a compound that is present in the human body naturally, or the host will develop an auto-immune disease.
In order to accomplish all of this, your body has developed a large number of chemicals which cells use to signal eachother. These chemicals turn on immune functions, and can also turn them off. Many of them do both - they turn on one function, and turn off another, which acts as a kind of stop-gap against your body ever going too crazy to the point of killing itself.
Infectious diseases, and many parasites, take advantage of this signaling system. The ones that are successful have learned to manufacture chemicals that activate or shut down specific processes in the host. The organisms may not have learned this in humans - for example, malaria infects cattle, and cattle use the same immunological markers that humans use, so what malaria can use in a cow will also work in humans.
This is why some people will develop infections that never go away. It's also why many of the most prevalent protozoa also cause symptoms. In the world of germs, good guys really do finish last. To win this game, a bug has to know how to generate a lot of chemicals, and some of those cause side effects. Here are a few examples:
In 2006, scientists found out that Leishmania is able to shut down one of the processes that the body uses to recognize and defend against new antigens. Leishmania is a nasty parasitic disease transmitted by sandflies - in many patients symptoms resolve spontaneously, but other patients develop long-term illness, which can be severe. Researchers found that Leishmania is able to shut down antigen responsive CD4 T-cells.
But another kind of CD4 cells can cause reactivation of Leishmania in patients who have developed chronic illness. A type of CD4 cell called a CD4+CD25+ cell can actually act to reduce some of your immune functions. When these cells become too numerous, Leishmania infection is re-activated. In some individuals, malaria is a temporary infection, but in others it turns into a chronic illness. The same mechanism is responsible for a process that turns malaria into a chronic illness.
Cellular interactions don't always work against the host. In the parasitic infection toxoplasmosis, a compound present on the invader stimulates host cells to produce a compound called interleukin-12 (IL-12), which acts as a signal for other cells to begin producing interferon-gamma (IFN-gamma). IFN-gamma is kind of like an espresso for your white blood cells - it send them into overdrive, and they begin finding and killing things more actively.
References:
Ramer AE, Vanloubbeeck YF, Jones DE. Antigen-responsive CD4+ T cells from C3H mice chronically infected with Leishmania amazonensis are impaired in the transition to an effector phenotype. Infect Immun. 2006 Mar;74(3):1547-54.PMID: 16495525
Mendez S, Reckling SK, Piccirillo CA, Sacks D, Belkaid Y. Role for CD4(+) CD25(+) regulatory T cells in reactivation of persistent leishmaniasis and control of concomitant immunity. J Exp Med. 2004 Jul 19;200(2):201-10.PMID: 15263027
Gazzinelli RT, Wysocka M, Hayashi S, Denkers EY, Hieny S, Caspar P, Trinchieri G, Sher A.
Parasite-induced IL-12 stimulates early IFN-gamma synthesis and resistance during acute infection with Toxoplasma gondii. J Immunol. 1994 Sep 15;153(6):2533-43.PMID: 7915739
Hisaeda H, Maekawa Y, Iwakawa D, Okada H, Himeno K, Kishihara K, Tsukumo S, Yasutomo K. Escape of malaria parasites from host immunity requires CD4+ CD25+ regulatory T cells. Nat Med. 2004 Jan;10(1):29-30. Epub 2003 Dec 21.PMID: 14702631
Wrong - it turns out everything they taught you about the immune system in high school was wrong, or at least a huge oversimplification. Defending your body against incoming threats is a complex task. The most basic problem is, "How do you recognize an invading organism?"
That sounds like an easy problem, and maybe it is if you're a human being and you can find it under a microscope, and then "google" it. But our immune systems were developed long before google. In fact, the human immunological system isn't too different from that of many other bird and mammalian species. Many of the things that go on in our immune system were developed millions of years ago.
To complicate things, the immune system must not only recognize invading organisms, but also avoid recognizing innocuous things. For example, if you developed an immune reaction to chicken, beef, and vegetables, you would die. So how does your body know the difference between a carrot and the anthrax bacteria? There are, in fact, a half dozen little tricks that immune cells use to identify potential pathogens. Many pathogens have certain chemicals in their cell membranes that are not found in human or other mammals. Others have patterns in their DNA which the human body can trigger off of.
But it gets more complex than that, because sometimes those patterns show up in innocuous things, like pollen. This is one reason people get allergies - their body keeps putting up an immune reaction to an antigen, thinking it is a pathogen, when it's just a little bit of pollen. Plus if the body over-reacts to an antigen, it could wind up killing the big, and also killing the host. And finally, the body has the ability to identify new compounds as targets of the immune system, which is how vaccines work. But it also has to make sure not to identify a compound that is present in the human body naturally, or the host will develop an auto-immune disease.
In order to accomplish all of this, your body has developed a large number of chemicals which cells use to signal eachother. These chemicals turn on immune functions, and can also turn them off. Many of them do both - they turn on one function, and turn off another, which acts as a kind of stop-gap against your body ever going too crazy to the point of killing itself.
Infectious diseases, and many parasites, take advantage of this signaling system. The ones that are successful have learned to manufacture chemicals that activate or shut down specific processes in the host. The organisms may not have learned this in humans - for example, malaria infects cattle, and cattle use the same immunological markers that humans use, so what malaria can use in a cow will also work in humans.
This is why some people will develop infections that never go away. It's also why many of the most prevalent protozoa also cause symptoms. In the world of germs, good guys really do finish last. To win this game, a bug has to know how to generate a lot of chemicals, and some of those cause side effects. Here are a few examples:
In 2006, scientists found out that Leishmania is able to shut down one of the processes that the body uses to recognize and defend against new antigens. Leishmania is a nasty parasitic disease transmitted by sandflies - in many patients symptoms resolve spontaneously, but other patients develop long-term illness, which can be severe. Researchers found that Leishmania is able to shut down antigen responsive CD4 T-cells.
But another kind of CD4 cells can cause reactivation of Leishmania in patients who have developed chronic illness. A type of CD4 cell called a CD4+CD25+ cell can actually act to reduce some of your immune functions. When these cells become too numerous, Leishmania infection is re-activated. In some individuals, malaria is a temporary infection, but in others it turns into a chronic illness. The same mechanism is responsible for a process that turns malaria into a chronic illness.
Cellular interactions don't always work against the host. In the parasitic infection toxoplasmosis, a compound present on the invader stimulates host cells to produce a compound called interleukin-12 (IL-12), which acts as a signal for other cells to begin producing interferon-gamma (IFN-gamma). IFN-gamma is kind of like an espresso for your white blood cells - it send them into overdrive, and they begin finding and killing things more actively.
References:
Ramer AE, Vanloubbeeck YF, Jones DE. Antigen-responsive CD4+ T cells from C3H mice chronically infected with Leishmania amazonensis are impaired in the transition to an effector phenotype. Infect Immun. 2006 Mar;74(3):1547-54.PMID: 16495525
Mendez S, Reckling SK, Piccirillo CA, Sacks D, Belkaid Y. Role for CD4(+) CD25(+) regulatory T cells in reactivation of persistent leishmaniasis and control of concomitant immunity. J Exp Med. 2004 Jul 19;200(2):201-10.PMID: 15263027
Gazzinelli RT, Wysocka M, Hayashi S, Denkers EY, Hieny S, Caspar P, Trinchieri G, Sher A.
Parasite-induced IL-12 stimulates early IFN-gamma synthesis and resistance during acute infection with Toxoplasma gondii. J Immunol. 1994 Sep 15;153(6):2533-43.PMID: 7915739
Hisaeda H, Maekawa Y, Iwakawa D, Okada H, Himeno K, Kishihara K, Tsukumo S, Yasutomo K. Escape of malaria parasites from host immunity requires CD4+ CD25+ regulatory T cells. Nat Med. 2004 Jan;10(1):29-30. Epub 2003 Dec 21.PMID: 14702631
Tuesday, August 17, 2010
Why do Blastocystis patients kill themselves?
Last year, someone relayed an account to me about several Blastocystis patients who had committed suicide after a lengthy illness, and multiple attempts to treat it. Many patients find the severe fatigue, diarrhea, pain, and other symptoms too much to deal with.
If you're a US physician reading this, I'm sure you're thinking that Blastocystis infection can't get that severe, and the patients must had some other disease. That's what has been taught in some US medical schools. But that information doesn't match what's reported in peer reviewed medical literature. In fact, most of what is taught in the US appears to be based on 3 or 4 studies performed in the US in the 1980's and early 1990's by health care workers with no background in infectious diseases or parasitology. In the mid-1990's, the field started attracting higher quality researchers, the observational and anecdotal studies disappeared, and have been replaced by studies which resemble those performed to assess the impact of other infectious diseases.
But US medical schools don't want to hear that, so we're stuck with a 1993 view of the world, which means many doctors have no idea of what they are dealing with, and even if they do, they are getting little support in how to manage the infection clinically. These people had seen some of the best gastrointestinal specialists in the world -- Blastocystis infection was their only problem.
In the US, most of the country's medical research spending goes into research for AIDS and cancer. People with these diseases want to live. In fact, when cancer patients "beat cancer", they now go onto write books, appear on talk shows, producing standing ovations in the crowd when they recount their personal struggle. According to doctors, Blastocystis patients just have a little diarrhea. And many of them don't even have that. So why are they killing themselves?
Theory #1: Nobody wants to have permanent diarrhea Many Blastocystis patients wind up with severe diarrhea - as frequently as 20 times per day. In this state, it is difficult to hold down a job, or do anything productive. Others also have severe fatigue on top of that. So even if the diarrhea is controllable, the fatigue can make it difficult to participate in any meaningful human activity.
Based on the most recent studies from multiple sites, most people with what Western doctors called "irritable bowel syndrome" (IBS) are infected with Blastocystis. And researchers have been following the suicidal habits of IBS patients for some time. IBS patients report a lowering in their quality of life that is similar to that reported by patients with congestive heart failure. And they contemplate suicide, and engage in suicidal acts three times more often than their healthy counterparts. So one possibility is simply that Blastocystis infection lowers the quality of life of patients to the point that they do not want to keep on living.
Theory #2: Societal attitudes toward illness. Scientists studying Blastocystis infection have trouble understanding why the medical community is making such a big deal about treating it. From the viewpoint of a lab, the organism is no different from a half-dozen other intestinal protozoa that we treat all the time, like Giardia, E. hisolytica, and D. fragilis. The major difference appears to be that Blastocystis is more difficult to treat, so doctors would have to use different drugs, or prescribe them for a longer period of time.
Faced with this situation, many doctors in the 1990's simply stated that Blastocystis patients have irritable bowel syndrome (IBS). IBS represents the only case where an infectious disease was first treated by doctors, and then redefined as a "syndrome." As Blastocystis spread, and more patients developed IBS, researchers sought an explanation for why so many individuals would show up at the doctor's office with a syndrome.
Their answer is called "learned illness behavior." The current theory, fully supported by research grants from the NIH, states that people who have Blastocystis infection are not really sick. Rather, they are perfectly healthy, and they choose to have diarrhea, severe fatigue, and other symptoms because (and I am not making this up) they like going to the doctor.
It isn't unusual for society to attack individuals with an infectious disease. In the Middle Ages, infectious diseases were considered a judgment from God. If you got sick with a disease, it was a punishment for wrongdoing. Other primitive societies considered sick people to be bad omens. One would have hoped that with the development of the microbial theory of disease, these attitudes would have faded, but they haven't. In fact, the NIH has done more to stigmatize patients with Blastocystis infection than any other organization in the world.
According to microbial research, if an individual in a family develops diarrhea and other symptoms, others may develop the same symptom due to "contagion." The new NIH indicates that microbes don't really cause these symptoms, but they are rather the personal choice of the sick individual, who choose to be sick because they get benefits from this. If you watch Oprah, you will see how similar this is to New Age thought, in the form of the book called the "Secret", which teaches that people who do positive things live positive lives, while negative things happen due to people's negative attitudes. So how does the NIH explain contagion in a family? Their research called this "Learned Illness Behavior." That is, children develop diarrhea and other symptoms after their parents, because they see their parents being sick, and decide this is such a great thing, they should be sick too (really, I'm not making this up).
As such, you see that cancer patients have a different reception from Blastocystis patients, and this may explain the difference in suicide rates. Cancer patients get support from the community, their families, and physicians. Blastocystis patients are told they are making up the symptoms to avoid work or get some kind of benefit. That is, they are weak, despicable people, and their disease is their own fault. So many of them kill themselves.
Theory #3: Organic Causes. Blastocystis and other gastrointestinal protozoal infections are different from viral and bacterial infections, in that they don't usually cause symptoms by "attacking" the host. Chronic illness is produced when these organisms turn off specific host immune responses. One of the side effects of turning off certain immune responses is that others kick in, and some of these can cause substantial organic changes to a patient's physiology. And these changes can produce neurological and psychiatric symptoms. As such, a third reason that Blastocystis patients kill themselves may be because they develop psychiatric disease as a result of their infection.
Because Blastocystis infection rates have increases in some states substantially over the last 15 years, we can look to see if suicide rates have risen along with that. In Oregon, this has certainly been the case. In the early 1990's, the Blastocystis infection rate measured in West Coast labs was less than 2.5%. It rose to over 20% by 2000, and now is in the 10-20% range, as measured from Oregon's Public Health Laboratory. Oregon's suicide rate kept pace with this change, and is now among the highest in the nation.
So why do Blastocystis patients kill themselves? There may be several reasons, or a combination of reasons. Societies can be judged by how they treat their most vulnerable citizens, and what the medical community in the US is doing to Blastocystis patients today is unforgivable.
References:
Levy RL, Whitehead WE, Von Korff MR, Feld AD. Intergenerational transmission of gastrointestinal illness behavior. Am J Gastroenterol. 2000 Feb;95(2):451-6.PMID: 10685749 [
Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2004 Dec;2(12):1064-8.PMID: 15625650
Spiegel B, Schoenfeld P, Naliboff B. Systematic review: the prevalence of suicidal behaviour in patients with chronic abdominal pain and irritable bowel syndrome. Aliment Pharmacol Ther. 2007 Jul 15;26(2):183-93. Review.PMID: 17593064
Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R. Blastocystis hominis and Dientamoeba fragilis in patients fulfilling irritable bowel syndrome criteria. Parasitol Res. 2010 Aug;107(3):679-84. Epub 2010 Jun 8.PMID: 20532564
Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R. Irritable bowel syndrome: is it associated with genotypes of Blastocystis hominis. Parasitol Res. 2010 Apr;106(5):1033-8. Epub 2010 Feb 23.PMID: 20177906
Dogruman-Al F, Kustimur S, Yoshikawa H, Tuncer C, Simsek Z, Tanyuksel M, Araz E, Boorom K Blastocystis subtypes in irritable bowel syndrome and inflammatory bowel disease in Ankara, Turkey. Mem Inst Oswaldo Cruz. 2009 Aug;104(5):724-7.PMID: 19820833
Boorom KF, Smith H, Nimri L, Viscogliosi E, Spanakos G, Parkar U, Li LH, Zhou XN, Ok UZ, Leelayoova S, Jones MS. Oh my aching gut: irritable bowel syndrome, Blastocystis, and asymptomatic infection. Parasit Vectors. 2008 Oct 21;1(1):40.PMID: 18937874
Hussain R, Jaferi W, Zuberi S, Baqai R, Abrar N, Ahmed A, Zaman V. Significantly increased IgG2 subclass antibody levels to Blastocystis hominis in patients with irritable bowel syndrome. Am J Trop Med Hyg. 1997 Mar;56(3):301-6.PMID: 9129532
If you're a US physician reading this, I'm sure you're thinking that Blastocystis infection can't get that severe, and the patients must had some other disease. That's what has been taught in some US medical schools. But that information doesn't match what's reported in peer reviewed medical literature. In fact, most of what is taught in the US appears to be based on 3 or 4 studies performed in the US in the 1980's and early 1990's by health care workers with no background in infectious diseases or parasitology. In the mid-1990's, the field started attracting higher quality researchers, the observational and anecdotal studies disappeared, and have been replaced by studies which resemble those performed to assess the impact of other infectious diseases.
But US medical schools don't want to hear that, so we're stuck with a 1993 view of the world, which means many doctors have no idea of what they are dealing with, and even if they do, they are getting little support in how to manage the infection clinically. These people had seen some of the best gastrointestinal specialists in the world -- Blastocystis infection was their only problem.
In the US, most of the country's medical research spending goes into research for AIDS and cancer. People with these diseases want to live. In fact, when cancer patients "beat cancer", they now go onto write books, appear on talk shows, producing standing ovations in the crowd when they recount their personal struggle. According to doctors, Blastocystis patients just have a little diarrhea. And many of them don't even have that. So why are they killing themselves?
Theory #1: Nobody wants to have permanent diarrhea Many Blastocystis patients wind up with severe diarrhea - as frequently as 20 times per day. In this state, it is difficult to hold down a job, or do anything productive. Others also have severe fatigue on top of that. So even if the diarrhea is controllable, the fatigue can make it difficult to participate in any meaningful human activity.
Based on the most recent studies from multiple sites, most people with what Western doctors called "irritable bowel syndrome" (IBS) are infected with Blastocystis. And researchers have been following the suicidal habits of IBS patients for some time. IBS patients report a lowering in their quality of life that is similar to that reported by patients with congestive heart failure. And they contemplate suicide, and engage in suicidal acts three times more often than their healthy counterparts. So one possibility is simply that Blastocystis infection lowers the quality of life of patients to the point that they do not want to keep on living.
Theory #2: Societal attitudes toward illness. Scientists studying Blastocystis infection have trouble understanding why the medical community is making such a big deal about treating it. From the viewpoint of a lab, the organism is no different from a half-dozen other intestinal protozoa that we treat all the time, like Giardia, E. hisolytica, and D. fragilis. The major difference appears to be that Blastocystis is more difficult to treat, so doctors would have to use different drugs, or prescribe them for a longer period of time.
Faced with this situation, many doctors in the 1990's simply stated that Blastocystis patients have irritable bowel syndrome (IBS). IBS represents the only case where an infectious disease was first treated by doctors, and then redefined as a "syndrome." As Blastocystis spread, and more patients developed IBS, researchers sought an explanation for why so many individuals would show up at the doctor's office with a syndrome.
Their answer is called "learned illness behavior." The current theory, fully supported by research grants from the NIH, states that people who have Blastocystis infection are not really sick. Rather, they are perfectly healthy, and they choose to have diarrhea, severe fatigue, and other symptoms because (and I am not making this up) they like going to the doctor.
It isn't unusual for society to attack individuals with an infectious disease. In the Middle Ages, infectious diseases were considered a judgment from God. If you got sick with a disease, it was a punishment for wrongdoing. Other primitive societies considered sick people to be bad omens. One would have hoped that with the development of the microbial theory of disease, these attitudes would have faded, but they haven't. In fact, the NIH has done more to stigmatize patients with Blastocystis infection than any other organization in the world.
According to microbial research, if an individual in a family develops diarrhea and other symptoms, others may develop the same symptom due to "contagion." The new NIH indicates that microbes don't really cause these symptoms, but they are rather the personal choice of the sick individual, who choose to be sick because they get benefits from this. If you watch Oprah, you will see how similar this is to New Age thought, in the form of the book called the "Secret", which teaches that people who do positive things live positive lives, while negative things happen due to people's negative attitudes. So how does the NIH explain contagion in a family? Their research called this "Learned Illness Behavior." That is, children develop diarrhea and other symptoms after their parents, because they see their parents being sick, and decide this is such a great thing, they should be sick too (really, I'm not making this up).
As such, you see that cancer patients have a different reception from Blastocystis patients, and this may explain the difference in suicide rates. Cancer patients get support from the community, their families, and physicians. Blastocystis patients are told they are making up the symptoms to avoid work or get some kind of benefit. That is, they are weak, despicable people, and their disease is their own fault. So many of them kill themselves.
Theory #3: Organic Causes. Blastocystis and other gastrointestinal protozoal infections are different from viral and bacterial infections, in that they don't usually cause symptoms by "attacking" the host. Chronic illness is produced when these organisms turn off specific host immune responses. One of the side effects of turning off certain immune responses is that others kick in, and some of these can cause substantial organic changes to a patient's physiology. And these changes can produce neurological and psychiatric symptoms. As such, a third reason that Blastocystis patients kill themselves may be because they develop psychiatric disease as a result of their infection.
Because Blastocystis infection rates have increases in some states substantially over the last 15 years, we can look to see if suicide rates have risen along with that. In Oregon, this has certainly been the case. In the early 1990's, the Blastocystis infection rate measured in West Coast labs was less than 2.5%. It rose to over 20% by 2000, and now is in the 10-20% range, as measured from Oregon's Public Health Laboratory. Oregon's suicide rate kept pace with this change, and is now among the highest in the nation.
So why do Blastocystis patients kill themselves? There may be several reasons, or a combination of reasons. Societies can be judged by how they treat their most vulnerable citizens, and what the medical community in the US is doing to Blastocystis patients today is unforgivable.
References:
Levy RL, Whitehead WE, Von Korff MR, Feld AD. Intergenerational transmission of gastrointestinal illness behavior. Am J Gastroenterol. 2000 Feb;95(2):451-6.PMID: 10685749 [
Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2004 Dec;2(12):1064-8.PMID: 15625650
Spiegel B, Schoenfeld P, Naliboff B. Systematic review: the prevalence of suicidal behaviour in patients with chronic abdominal pain and irritable bowel syndrome. Aliment Pharmacol Ther. 2007 Jul 15;26(2):183-93. Review.PMID: 17593064
Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R. Blastocystis hominis and Dientamoeba fragilis in patients fulfilling irritable bowel syndrome criteria. Parasitol Res. 2010 Aug;107(3):679-84. Epub 2010 Jun 8.PMID: 20532564
Yakoob J, Jafri W, Beg MA, Abbas Z, Naz S, Islam M, Khan R. Irritable bowel syndrome: is it associated with genotypes of Blastocystis hominis. Parasitol Res. 2010 Apr;106(5):1033-8. Epub 2010 Feb 23.PMID: 20177906
Dogruman-Al F, Kustimur S, Yoshikawa H, Tuncer C, Simsek Z, Tanyuksel M, Araz E, Boorom K Blastocystis subtypes in irritable bowel syndrome and inflammatory bowel disease in Ankara, Turkey. Mem Inst Oswaldo Cruz. 2009 Aug;104(5):724-7.PMID: 19820833
Boorom KF, Smith H, Nimri L, Viscogliosi E, Spanakos G, Parkar U, Li LH, Zhou XN, Ok UZ, Leelayoova S, Jones MS. Oh my aching gut: irritable bowel syndrome, Blastocystis, and asymptomatic infection. Parasit Vectors. 2008 Oct 21;1(1):40.PMID: 18937874
Hussain R, Jaferi W, Zuberi S, Baqai R, Abrar N, Ahmed A, Zaman V. Significantly increased IgG2 subclass antibody levels to Blastocystis hominis in patients with irritable bowel syndrome. Am J Trop Med Hyg. 1997 Mar;56(3):301-6.PMID: 9129532
America turns to potions and spells to cure its ills
As we enter the fall season, I can't help but think about Halloween, and all the trick-or-treaters who will be dressed up like Harry Potter and his colleagues. The idea of magic has a lasting hold on American society, and apparently many others. Indeed, for much of history, medicine has incorporated an element of magic. Native Americans used shaman, for example, to cure their diseases.
While I'll get some flack for cultural insensitivity, this approach didn't work very well, especially when smallpox got imported into the US. While Native Americans were dying of this disease, seeking spiritual redemption, Europeans were pursuing a different approach - science. They were developing vaccines. At first you might say that the comparison is unfair, because Europeans had microscopes and things, but this didn't really help the development of vaccines for smallpox, because it's a virus, and too small to see. In fact, the process of vaccinating people for smallpox may go back even farther than the 1800's. Some papers suggest people were making crude vaccines from the scabs of infected patients centuries earlier.
The things that differentiates science from magic is the controlled study. When I bring this up to New Agers, I hear moans and complaints, but let's not forget that science was the first form of consumer protection against medical quackery instituted in modern society. You don't need high-tech to do science. For example, doctors believed that bleeding people was a good idea for centuries, and they performed this process (and charged patients for it), without ever verifying that it would work. With animals getting sick on farms all the time, it would have been a simple matter to "bleed" half the animals, and leave the other half be, and see if it really cured disease.
Magic isn't about controlled trials - it's about believing. And this, unfortunately, has captured the imagination of the American populace in the last 10 years, to the point that new infectious diseases like Blastocystis are being addressed almost entirely with unproven treatments - the equivalent of spells and potions.
The fault isn't entirely with the patients, since the scientific establishment has also broken its own rules, or more accurately, let loud-mouthed physicians run rampant. Science has two aspects - first, you discount things that are disproven by experiment. Second, you advocate things that can be proven by experiments. In the case of Blastocystis, scientists - real scientists who work at the NIH - had done careful experiments that showed Blastocystis was causing disease by the early 1990's. But these experiments conflicted with a small number of "observational studies" written by doctors at a health maintenance organization in California. Rather than defending the scientists at the NIH, NIH management chose to shut down all US research in the 1990's, and to begin telling scientists not to apply for grants to study the disease. In the 1990's, the prevalence of Blastocystis in many states in the US took off, rising from 2.5% in the 1980's to over 22% by 2000.
The NIH's refusal to participate in any kind of research may be forgivable, if it weren't for the dozen countries outside the US that now have research groups publishing large numbers of studies on the disease. At some point, the NIH should have realized its mistake. Hence, they broke a cardinal rule of science - repeatability. Mainly, the laws of science apply everywhere, so when you have a large number of scientists from different areas of the world reporting the same thing, there is probably something going on.
Nature Abhors a Vacuum
So you now have a large portion of the population developing chronic gastrointestinal illness in Oregon, California, and elsewhere. Their regular doctors, informed by the CDC and NIH, knew nothing about the disease. In fact, based on the studies the CDC has been advocating, patients should told that they have 'irritable bowel syndrome' and kicked out of their office for taking up the physicians time. There is actually an entire line of research now being funded at the NIH that seeks to "prove" that such patients just go to the doctor because they like attention.
So what did newly infected patients in Oregon, California, and elsewhere do? They looked for potions and spells. Based on what I hear from patients, the Blastocystis epidemic on the West Coast has been a key factor in driving the demand for alternative medicine.
In the US, the market for AM has exploded. One study indicated that 62% of US adults use some kind of AM (Med Ad News, October 2005). The CDC states that 74.6% of Americans have used CAM, and that the average American spent $60 on various remedies in 2005.
It's remarkable that in an age where science is delivering most of our advancements, such as cell phones and computers, medicine is turning back the clock. People in scientific fields should take note of this. Science isn't just about ignoring things which are disproven. It's about acting on things that are proven with scientific methods. By refusing to speak up for the scientists who were attacked by loud-mouthed doctors, science has lost a major battle for the public's trust. The most prevalent chronic gastrointestinal infection in the US today is being addressed using philosophies from the Middle Ages because of this.
A study from Australia, published in Melbourne Age, highlighted the issue. Authored byAlastair MacLennan, from Adelaide University's Department of Obstetrics and Gynaecology, the paper reported that:
"Australians now spend four times as much on unproven therapies as on prescribed pharmaceuticals. While a few alternative medicines and therapies are proven to help some patients, what concerns me is the increased usage of unproven alternative therapies, many of which are costing the public more and more each year."
Trick or Treatment?
References:
http://www.scribd.com/doc/32851838/Alternative-Medicine-A-Free-Market-Example-of-Health-Care-by-Barry-Krakov-MD
While I'll get some flack for cultural insensitivity, this approach didn't work very well, especially when smallpox got imported into the US. While Native Americans were dying of this disease, seeking spiritual redemption, Europeans were pursuing a different approach - science. They were developing vaccines. At first you might say that the comparison is unfair, because Europeans had microscopes and things, but this didn't really help the development of vaccines for smallpox, because it's a virus, and too small to see. In fact, the process of vaccinating people for smallpox may go back even farther than the 1800's. Some papers suggest people were making crude vaccines from the scabs of infected patients centuries earlier.
The things that differentiates science from magic is the controlled study. When I bring this up to New Agers, I hear moans and complaints, but let's not forget that science was the first form of consumer protection against medical quackery instituted in modern society. You don't need high-tech to do science. For example, doctors believed that bleeding people was a good idea for centuries, and they performed this process (and charged patients for it), without ever verifying that it would work. With animals getting sick on farms all the time, it would have been a simple matter to "bleed" half the animals, and leave the other half be, and see if it really cured disease.
Magic isn't about controlled trials - it's about believing. And this, unfortunately, has captured the imagination of the American populace in the last 10 years, to the point that new infectious diseases like Blastocystis are being addressed almost entirely with unproven treatments - the equivalent of spells and potions.
The fault isn't entirely with the patients, since the scientific establishment has also broken its own rules, or more accurately, let loud-mouthed physicians run rampant. Science has two aspects - first, you discount things that are disproven by experiment. Second, you advocate things that can be proven by experiments. In the case of Blastocystis, scientists - real scientists who work at the NIH - had done careful experiments that showed Blastocystis was causing disease by the early 1990's. But these experiments conflicted with a small number of "observational studies" written by doctors at a health maintenance organization in California. Rather than defending the scientists at the NIH, NIH management chose to shut down all US research in the 1990's, and to begin telling scientists not to apply for grants to study the disease. In the 1990's, the prevalence of Blastocystis in many states in the US took off, rising from 2.5% in the 1980's to over 22% by 2000.
The NIH's refusal to participate in any kind of research may be forgivable, if it weren't for the dozen countries outside the US that now have research groups publishing large numbers of studies on the disease. At some point, the NIH should have realized its mistake. Hence, they broke a cardinal rule of science - repeatability. Mainly, the laws of science apply everywhere, so when you have a large number of scientists from different areas of the world reporting the same thing, there is probably something going on.
Nature Abhors a Vacuum
So you now have a large portion of the population developing chronic gastrointestinal illness in Oregon, California, and elsewhere. Their regular doctors, informed by the CDC and NIH, knew nothing about the disease. In fact, based on the studies the CDC has been advocating, patients should told that they have 'irritable bowel syndrome' and kicked out of their office for taking up the physicians time. There is actually an entire line of research now being funded at the NIH that seeks to "prove" that such patients just go to the doctor because they like attention.
So what did newly infected patients in Oregon, California, and elsewhere do? They looked for potions and spells. Based on what I hear from patients, the Blastocystis epidemic on the West Coast has been a key factor in driving the demand for alternative medicine.
In the US, the market for AM has exploded. One study indicated that 62% of US adults use some kind of AM (Med Ad News, October 2005). The CDC states that 74.6% of Americans have used CAM, and that the average American spent $60 on various remedies in 2005.
It's remarkable that in an age where science is delivering most of our advancements, such as cell phones and computers, medicine is turning back the clock. People in scientific fields should take note of this. Science isn't just about ignoring things which are disproven. It's about acting on things that are proven with scientific methods. By refusing to speak up for the scientists who were attacked by loud-mouthed doctors, science has lost a major battle for the public's trust. The most prevalent chronic gastrointestinal infection in the US today is being addressed using philosophies from the Middle Ages because of this.
A study from Australia, published in Melbourne Age, highlighted the issue. Authored byAlastair MacLennan, from Adelaide University's Department of Obstetrics and Gynaecology, the paper reported that:
"Australians now spend four times as much on unproven therapies as on prescribed pharmaceuticals. While a few alternative medicines and therapies are proven to help some patients, what concerns me is the increased usage of unproven alternative therapies, many of which are costing the public more and more each year."
The study was conducted on 3000 Australians, and it compared the use of alternative therapies in 2000 and 1993. Over that time, allowing for inflation, the cost of alternative therapies had increased over 120%. The paper estimated that Australians spend $2.3 billion a year on such therapies. In the US, a similar trend exists, and it won't be long before spending on alternative unproven therapies exceeds US investment in scientific research.
Trick or Treatment?
References:
http://www.scribd.com/doc/32851838/Alternative-Medicine-A-Free-Market-Example-of-Health-Care-by-Barry-Krakov-MD
Tuesday, August 10, 2010
What if we treated NIH employees the way they are treating us?
A fair number of people who contact BRF are policemen, firemen, and veterans. We hear from a lot of veterans who contracted Blastocystis infection overseas, and can't find a reliable treatment in the United States.
I'm always struck by how little the NIH and CDC are willing to do for these people. Many of them got sent half way around the world to fight in the Middle East. Others are fighting crime and fires at home. These are people who wouldn't think twice about risking their lives for an NIH or CDC employee, yet those organizations won't even move a piece of paperwork to help cure this disease. Because of their inaction, Blastocystis is now the number one protozoal infection in the United States.
The reason for the colossal indecision? In the 1990's, a number of prominent physicians in the United States took public stands on Blastocystis, before there was any real research available. The ones that sided with the "denialist" crowd - the people who insist that it can't cause illness - could have found themselves eating crow a few years later. Once the scientific community figured out what was going on, University research groups sprang up in Asia and then the Middle East and began publishing study after study showing how sick this disease will make patients. Most of these studies were predicted by the work of our own NIH scientist, Dr. Charles Zierdt, who retired in 1995. And there are now close to a dozen new groups in Europe, Mexico, and even the US that are all looking at the same problem.
Unfortunately, Today, being a denialist is as much a part of these people as being a doctor or an American. And they have scared employees at the CDC and NIH into doing nothing. This is why 2010 will make the fifteenth consecutive year that the NIH has rejected every Blastocystis grant proposal sent to it, and the CDC still insists no action can be taken in the disease because "experts disagree." (read the CDC letter for yourself)
So I got to thinking.....if turnabout is fair play, what if firemen and police began treating NIH and CDC employees the way those employees have treated them:
"Hi, I've been in an accident dirivng to my job at the NIH. Can you send an ambulance?"
"Oh, you work for the NIH. Let me transfer you to our special department......" (new operator) "How do you know you've been in an accident."
"Well, a car drove into the back of my car on I5 just south of Seattle."
"You know, tens of thousands of cars drive over that stretch of road every day. The probability that you had an accident there is very small. Are you sure you aren't jumping to conclusions?"
"The back of my car is caved in. I am bleeding from my forehead"
"OK, you have a bleeding disorder. You should see a specialist about this. But I'm just saying the probability of your actually having had an accident is small. Many people bleed without having accidents, and many people have accidents without bleeding. So saying that you are bleeding because you were in a car accident is really jumping to conclusions."
"But why is the back of my care caved in?"
"Well, we really can't verify you car is caved in. Has this been determined by a professional? But even if it is, that doesn't prove you've been in an accident. It's possible your car caved in some other time, and then once the bleeding started, you looked to see if it was caved in, and you noticed it. When was the last time you had a mechanic check to see if your care was caved in?"
"You are an idiot."
"...and bleeding can be caused by many things. There was just a study that found many people get nosebleeds due to stressful life events. This is called a conversion disorder. You sound like you are under stress. Maybe you should see a psychiatrist about the bleeding."
"I am under stress because I'm bleeding from my forward. Would you just send an ambulance?"
"Well, we really can't know if you've been in an accident or not, or what the exact cause of your bleeding is. We can give you the web address of a patient support group for hemophiliacs. You could work with them to raise awareness about your bleeding problem."
Tuesday, August 3, 2010
Why do we invest all our infectious disease resources on bioterrorism?
The American Society of Microbiology (ASM) is a non-profit professional organization of scientists and researchers with an interest in microbiology in the US. This organization has helped to shape US policy toward infectious diseases directly, and also indirectly by fostering communication among its members.
The ASM tracks congressional legislation, and last month I took a look at the bills it was tracking in Congress. You would think these would be dealing with things like MRSA, which is killing around 40,000 people each year in the US. Or pneumonia, which kills even more. But the diseases that you and I contract are barely represented in legislation. Here's what Congress is working on:
You may notice a pattern - almost all Congressional attention (and much of our funding) is going to combat bioterrorism.
While security is always a good thing, I have to ask, just how dangerous is this problem? We have already had multiple attacks which have succeeded in killing....about 5 people. That's fewer people who die in car accidents on a busy labor day weekend in New England. People have joked that the best way to get our medical community to address infectious diseases is to have al-Queda try to weaponize them. Who knows, maybe they have done this already, and that's why so many people are dying of MRSA, and developing chronic illness from Blastocystis.
Yes, what if somebody did something that killed 40,000 people. Oh, wait. We already have a bunch of diseases like that. And the ones we know about are just the tip of the iceberg. For every MRSA-like disease, there's another one out there producing chronic illness, sapping the economy, and our country's strength.
The ASM tracks congressional legislation, and last month I took a look at the bills it was tracking in Congress. You would think these would be dealing with things like MRSA, which is killing around 40,000 people each year in the US. Or pneumonia, which kills even more. But the diseases that you and I contract are barely represented in legislation. Here's what Congress is working on:
You may notice a pattern - almost all Congressional attention (and much of our funding) is going to combat bioterrorism.
While security is always a good thing, I have to ask, just how dangerous is this problem? We have already had multiple attacks which have succeeded in killing....about 5 people. That's fewer people who die in car accidents on a busy labor day weekend in New England. People have joked that the best way to get our medical community to address infectious diseases is to have al-Queda try to weaponize them. Who knows, maybe they have done this already, and that's why so many people are dying of MRSA, and developing chronic illness from Blastocystis.
Yes, what if somebody did something that killed 40,000 people. Oh, wait. We already have a bunch of diseases like that. And the ones we know about are just the tip of the iceberg. For every MRSA-like disease, there's another one out there producing chronic illness, sapping the economy, and our country's strength.
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