As discussed in class, clinical studies are now underway to determine if helminth-based therapies are effective against IBD. Helminth-based treatments seem to switch the intestinal immune response from Th1 to Th2, thus calming down the symptoms that are associated with IBD. As life with IBD is certainly unpleasant, people are starting to self-diagnose and treat with helminths purchased online (yikes!). However, even though the human body may have evolved in sync with particular helminths, it is important to note that the associated mortality of parasitic infection far outweighs the morbidity that accompanies IBD.
First off, it is shocking to me that nearly 9 million children (ages 0 - 5) die every year. The United Nations' Reduce Child Mortality Fact Sheet notes that these deaths are "related to malnutrition and lack of access to adequate primary health care and infrastructure, such as water and sanitation". Of these 9 million children, it is estimated that 1.5 million die from acute diarrhea, which is still the leading cause of child mortality in developing nations.
Diarrhea has a impressive list of causes but for this discussion let's focus on helminth infections. Trichuriasis and ascariasis infections are the most common chronic diseases that infect the poorest populations of developing nations. Both trichuriasis and ascariasis are caused by roundworms.Trichuriasis is estimated to infect 100 million people annually while there are 84 million cases of ascariasis per year.
Trichuriasis is a roundworm infection that mainly affects children. Symptoms include bloody diarrhea, anemia, fecal incontinence, and rectal prolapse. Ascariasis is also caused by the digestion of roundworm eggs. The larvae start in the small intestine but move through the bloodstream and into the lungs. From the lungs, the parasite moves up and out, is swallowed back into the stomach and the cycle repeats itself (seriously... I think I just puked in my mouth a little...). The symptoms include bloody sputum, vomiting worms, and passing the little guys in your stool. If there is a large number of the roundworms present they can actually cause an intestinal blockage!
It's interesting that in "developed" nations, the environment has become so clean that we've essentially created a new list of problems (case and point: IBD). However, with the excitement of helminth-based therapies for the treatment of IBD, it is important not to forget the true cost of parasitic infections around the world.
In many cases I think the problems that we face when it comes to cures such as Helminth treatments, is too much premature band wagoning. While I think the Helminth treatments have a potential to be of great aid for people, I think we as a society don't arm ourselves with enough facts, and as a result leave ourselves open to potential risks.
ReplyDeleteFor example, we have read enough lay articles in class to know that the average "scientific" article accessible to the average person is not filled with all the necessary information to make a proper logical conclusion about an experiment. Most of the time they will highlight the successes of the treatment and then launch into how the treatment works, and may even have some heart warming story about how the treatment helped someone. However, the one thing that is usually lacking is the potential risks, and problems that certain treatments may have, and as a result you get a population that's excited about a treatment but not well informed.
"The Squeaky Clean World" article you have posted is just one example of an article that gives the reader information, but not enough to make a logical conclusion. Especially when it comes to the story about the man who self diagnosed his autistic son and got worms from the internet to help cure him. Average person reads a story like that reported in a "scientific" article and instantly believes that they too can be cured of whatever ailes them with the same method. Problem is, unless you are an expert in paracitic worms, you don't know what you're getting and as a result open yourself up to potential deadly diseases.
This is why when I see journalists reporting on experiments or treatments that could help advance medicine and cure diseases, the one thing I wish that they did at the end of their article is bring up questions of hazard. Or reminders that the experiments are just that experiments, and that just because good results were obtained once, doesn't mean they can be replicated.
Overall, it comes down to us being too impatient, we want a treatment now and when we hear about one that has shown good results we instantly want to take that treatment without considering the potential risks. Afterall, as has been mentioned in class, it takes time and a lot of long term experiments before we can assess potential long term effects of certain treatments.
I suppose one way to think about it is like this, since the Helminth treatment was newly considered as a potential cure for those with IBD, it will take at least 20-40 years of research, following patients who have been treated with this method to determine if there are any potential harmful effects, if there are none great, but if there are some then what we have is large number of people at risk because they all jumped on the band wagon prematurely and exposed themselves to these harmful affects. Thus, like I said, if we arm ourselves with the proper knowledge we can avoid these types of risks that could potentially put us in even greater harm than what we're already in. Afterall it's bad to have IBD, but it's worse to have IBD and Ascariasis from having injested a worm you got off the internet that you thought could help cure your disease.
Emilio, you bring up some interesting points. The lay articles that are typically available to the public don't always give all the facts, or only give parts of what is really going on to highlight points they are trying to make. But my question is, is not always giving all the detailed information a bad thing?
ReplyDeleteAs a doctor, you are trained to understand medical ailments and treatments, and how these treatments may be detrimental to other parts of the body for those with genetic problems, or taking other medications, for instance. While we may understand a fair amount with our education and training, those who do not take science courses will almost certainly have difficulty understanding information if say, an advertisement or news article goes into detail and depth. If the Lay article Celine posted had information included in our IBD papers last weeks,many people would probably finish reading the article with more questions when they started with. I believe that it is crucial that Lay articles make it a priority to first get the general information right (for example, in Celina's article it said that "T1 cell cytokines proliferate and fight against invaders: I am pretty sure cytokines don't fight, and only attract our body's defenses ie macrophages). Once the general information is presented, if the public has further questions they can look at a website with more detailed information, or ideally, talk to a healthcare professional if it is about a medication, treatment, or problem. If lay articles include too much scientific information, it will lead to more confusion than understanding in the public.
I definitely agree that our society is too impatient. If our generation didn't display the "give it to me now," these articles would be more understandable and presentable.
Ethan Burns
I agree that providing too much information to the public may be confusing, but I think we should give them a little more credit and stop treating them like babies. The public shouldn't have to rely on doctor's to spoon-feed them information (sometimes they don't even know the right answer). That being said, it should be easier to find facts that aren't watered down so much that they've become convoluted. As we've seen in many of the lay articles that we've read--information gets lost in translation. So, where does the public even go to get good information? Well, people need to start writing it in non-watered down form!
ReplyDeleteThis past weekend I went to the eye doctor, was told I have chronic dry eyes (turns out this is an inflammatory problem! Inflammation is everywhere!), and given a prescription for an eye drop called Restasis. After asking the eye doctor enough questions to annoy him, I went home and wanted to do a little reading about the drug as well as the condition. I honestly couldn't find any good information to answer my questions until I started looking into the literature. You could argue that being a scientist I'm inherently more curious than the lay community, which may or may not be true, but it still shouldn't be difficult to find information about a condition and how the treatment works from simply goggling. If everyone is always writing watered-down articles for the lay community, of course they're not going to understand anything.
(My eye doctor also told me that the drops worked by stopping my eyes from making T-cells. I promptly told him that T-cells weren't made in the eye...maybe this is why I annoyed him. --Yay Dr. Cohen's Immuno class!)