Medieval remedies undergo a renaissance
Maggot therapy is just one form of old-fashioned medicine finding uses
in the 21st century.
By
Victoria Stagg Elliott, AMNews staff. Oct. 7, 2002.
Additional information
Leeches to improve blood flow after surgery. Bee stings to alleviate
the symptoms of multiple sclerosis or arthritis. Maggots for bedsores.
How is it that these old-fashioned remedies have, for some, found a
place in the midst of 21st-century medicine -- the age of stem cells,
surgical robots and genetics? It may seem strange, but it appears that
some of the very treatments that fell out of favor because of the
development of antibiotics and other medical marvels are now coming back
into vogue.
"Doctors are becoming aware that all this modern stuff we do isn't
really cutting it, and we're looking for alternatives," said Edgar Maeyens
Jr., MD, a Coos Bay, Ore., dermatologist who uses maggots regularly in his
practice. "And society is looking for alternatives."
Leeches re-emerged a while ago and now have a well-established role in
plastic and reconstructive surgery. Research into a nonbiological
substance that mirrors their active ingredient has thus far been
unsuccessful. Maggots are being considered more often for treatment of
chronic wounds that do not heal. But bee venom is still considered
alternative medicine.
These age-old preparations are drawing interest and being subjected to
scientific rigor.
Beyond the "ick" factor, results
A paper published in the Sept. 9 Archives of Internal Medicine
described six patients in Austria with refractory skin ulcers effectively
debrided with maggots. A much larger study of patients with chronic wounds
in California was published in Wound Repair and Regeneration in
August. That paper concluded that maggots did a better job than more
conservative therapy for pressure ulcer treatment.
In both studies, patients tolerated the creatures, although the
Austrians did report that some complained of a "tickling sensation." In
general, it appeared that wounds healed more quickly and with less pain.
Maggots do not eat living flesh.
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"Most other products or procedures either debride at the expense of
viable tissue as well or kill bacteria along with young proliferating
cells or promote healing but also promote bacterial proliferation," said
Ronald A. Sherman, MD, author of the paper in Wound Repair and
assistant professor of medicine at the University of California, Irvine.
"Maggot therapy debrides more quickly than nonsurgical methods, and more
specifically than any other product or procedure."
Physicians who use maggots in their practices say they like them
because they work. They go into a wound devouring the dead flesh and have
no taste for the living.
"There are ulcers that are just necrotic and unresponsive to these
fancy, expensive $400 tubes of genetically engineered creams," said Dr.
Maeyens. "I am enamored with the little creatures."
But they do have their challenges. The creatures must be handled
delicately or they will die, and they are sometimes damaged in shipping.
They must also be used within a few days before they grow up and become
flies.
"Sometimes they seem livelier than other times when you get them
because of the variations in handling procedures," said Terence McDonald,
MD, a chronic wound care specialist in Wichita, Kan. "But in general they
do fairly well."
Reimbursement can sometimes be a fight. Maggots take days rather than
minutes to get the job done, although this is less important for chronic
wounds. Also, the "ick factor" can get in the way. Still, doctors say this
is more likely a problem for caretakers than for patients.
"Patients are usually a little unnerved by the idea at first, but most
of them are OK with it," Dr. McDonald said. "Some patients' families also
get really upset if they get loose."
But 21st-century technology may ultimately help reduce this response.
Experts speculate that the emerging science of genetics may make maggots
better, smarter and stronger.
"It is conceivable that someday they might be able to genetically alter
these guys so that they would be faster and much more efficient and not
have the unpleasant fly aspect," said Eric Mooney, MD, an attending
plastic surgeon at Bassett Healthcare in Cooperstown, NY.
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ADDITIONAL INFORMATION:
Good bugs
Study question: How does maggot debridement therapy compare with
conservative nonsurgical debridement of pressure ulcers?
Method: Over 5 years, researchers studied 103 patients with 143
pressure ulcers who received either maggot or conventional therapy for
treatment of their wounds. The study was prospective but nonblinded and
not randomized.
Results: Eighty percent of maggot-treated wounds were completely
debrided compared with 48% of the conventionally treated ones. Wounds
treated with maggots at some point in therapy took eight weeks to
completely debride while a wound treated only with more conventional
methods took 17 weeks.
Conclusion: Maggot therapy was more effective and efficient in
treating chronic pressure ulcers than more conventional treatments.
Source: "Maggot versus conservative debridement therapy for the
treatment of pressure ulcers," Wound Repair and Regeneration, July
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Weblink
Abstract, "Maggot versus conservative debridement therapy for the
treatment of pressure ulcers," Wound Repair and Regeneration, July
(volume 10, issue 4)
Article, "Biosurgical Debridement Facilitates Healing of Chronic Skin
Ulcers," Archives of Internal Medicine, Sept. 9 (volume 162, issue
16) (http://archinte.ama-assn.org/issues/v162n16/rfull/ibr20011-1.html)
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Copyright 2002 American Medical Association. All
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