Maggots Make
Medical Comeback
By LAURAN NEERGAARD AP Medical Writer Wound-care clinics around the country are giving
maggots a try on some of their sickest patients after high-tech treatments
fail. It's a therapy quietly championed since the early
1990s by a California physician who's earned the nickname Dr. Maggot. But Dr.
Ronald Sherman's maggots are getting more attention since, in January, they
became the first live animals to win Food and Drug Administration approval -
as a medical device to clean out wounds. A medical device? They remove the dead tissue that
impedes healing "mechanically," FDA determined. It's called
chewing. But maggots do more than that, says Sherman, who
raises the tiny, wormlike fly larvae in a laboratory at the University of
California, Irvine. His research shows that in the mere two to three days
they live in a wound, maggots also produce substances that kill bacteria and
stimulate growth of healthy tissue. Still, "it takes work to convince
people" - including hospital administrators - that "maggots do work
very well," said Dr. Robert Kirsner, who directs the University of Miami
Cedars Wound Center. "They'll probably be easier to use now that
they're FDA-approved, and we'll talk about it more and think about it
more," Kirsner said. He estimates he uses maggots in about one in 50
patients where conventional therapy alone isn't enough. This has been quite a year for wormlike critters.
In June, FDA also gave its seal of approval to leeches, those bloodsuckers
that help plastic surgeons save severed body parts by removing pooled blood
and restoring circulation. And in the spring, University of Iowa researchers
reported early evidence that drinking whipworm eggs, which causes a
temporary, harmless infection, might soothe inflammatory bowel disease by
diverting the overactive immune reaction that causes it. There's a little more yuck factor with maggots.
Most people know of them from TV crime dramas, where infestations of bodies
help determine time of death. Actually, maggots' medicinal qualities have long
been known. Civil War surgeons noted that soldiers whose wounds harbored
maggots seemed to fare better. In the 1930s, a Johns Hopkins University
surgeon's research sparked routine maggot therapy, until antibiotics came
along a decade later. Today, despite precise surgical techniques to cut
out dying tissue, artificial skin and other high-tech treatments,
hard-to-heal wounds remain a huge problem. Diabetic foot ulcers alone strike
about 600,000 people annually and lead to thousands of amputations. It's not unusual to spend two years and $30,000
treating one, says Dr. David G. Armstrong, a Chicago specialist who first
tried maggot therapy in frustration about seven years ago and says he's now
used it on several hundred patients. Drop maggots into the wound and cover with a
special mesh to keep them in place. Two to three days later, after the
maggots have eaten their fill, lift them off and dispose. Wound size determines how many maggots, and how
many cycles of therapy, are needed. It typically costs a few hundred dollars,
says Armstrong, of the Rosalind Franklin University of Medicine and Science. One of Sherman's studies found 80 percent of
maggot-treated wounds had all the dead tissue removed, compared with 48 percent
of wounds surgically debrided. Armstrong is about to publish research that
suggests maggot-treated patients also spend fewer days on antibiotics. Patients say it's not that hard to accept. Pamela
Mitchell of Akron, Ohio, begged to try maggots when surgeons wanted to
amputate her left foot, where infection in an inch deep, 2-inch-wide diabetic
ulcer had penetrated the bone. It took 10 cycles of larvae, but she healed
completely. How did they feel? On day 2, when the maggots were
fat, "I could feel them moving, because they were ready to come
out," she recalls. But, "if you're faced with amputation or the
maggots, I think most people would try the maggots." --- EDITOR'S NOTE - Lauran Neergaard covers health and
medical issues for The Associated Press in Washington. 2004-08-02 18:24:09
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Copyright 2004 |