PARASITIC WORMS’ EFFICACY
A Parasitic worms, like hookworms, whipworms, pinworms and flukes that plague humans are enough to make most of us shudder, except John Turton. In the middle of 1970s, whilst working at the UK’s Medical Research Council Laboratories in Surrey, he intentionally infected himself with hookworms in an attempt to alleviate his chronic hay fever. It worked. During two summer seasons whilst he held the parasites, his allergy diminished.
B In regions where parasitic worm infections are rife, when the remedy emerged, Turton’s vital experiment came. In 1913 W. Herrick, a doctor from Columbia University in New York found a very different link between parasitic worms, or helminths, and allergies. Lab workers analysed the gut-dwelling roundworm Ascaris that often caused tenderness and swelling around the fingers and more severe asthma after longer exposure.
C Researchers have been trying to make sense of these contradicting findings since the 1970s in the hope of being able to use the power of parasites to help free people of their allergies, without making things worse. They know they are playing with fire. After all, helminths are responsible for some truly horrible diseases and cause great suffering around the world. However, as the effects of helminths on the human body become clearer, it looks like their healing powers may have potential benefits.
D Not surprisingly, no researchers have been willing to take the risk of deliberately infecting themselves as Turton had done. Instead, most studies are dependent on populations in countries where people are already infected. This research tends to emphasize three commonly diagnosed allergic conditions: asthma, eczema and hay fever. The results have been confusing, but now researchers are beginning to have a better understanding.
E For instance, a study conducted in Taiwan showed that people infected with Enterobius vermicularis, a pinworm that is one of the most common gut parasites in the world, were less likely to have hay fever than the rest of the general population. But the results from Ecuador show a different story. Hay fever was not more common in children living in urban areas than it was in children living in rural areas. The parasite was equally common in both groups, so the researchers concluded that something else must be responsible for the prevalence of hay fever.
F Knowing about eczema has proved as difficult to interpret. For instance, a study in Uganda discovered that eczema was less common among babies whose mothers had been infected with helminths whilst being pregnant. But, another study this time in Ethiopia discovered that children with Trichuris worms, and whipworms that infest the large intestine, were more likely to have eczema than uninfected children.
G Regarding asthma, Herrick’s discovery that it can be started by contact with the Ascaris was confirmed in the 1970s. But, hookworms decreased the extremity of asthma in a group of Ethiopians and similar benefits have been seen in Brazilian asthma sufferers infected with the Schistosoma Mansoni, the flatworm responsible for schistosomiasis, which damages internal organs. What are we to make of all this? The outstanding link between allergies and parasites is the human immune system. Allergies are caused by an overactive immune response, and helminths have strategies to dampen down our immune response to stimulate their survival. After all, they have evolved alongside humans for several thousands of years.
H In people with no allergies, foreign material entering the body stimulates the release of cytokines, molecules that sound the alarm to get the attention of other immune cells. As immune cells set to attack the intruder, another set of molecules is released to prohibit the immune response from overreacting. One of the main molecules responsible for keeping reactions in check is interleukin-10, which inhibits the release of certain cytokines. People with allergies tend to have lower than normal levels of interleukin-10, so their immune responses frequently get out of hand. In contrast, people infected with helminths have above-average levels of the molecule, and research on schistosomiasis patients indicates that this is at least partially because of the worms that set free chemicals that trigger the production of interleukin-10 in their host.
THE NAGYMAROS DAM
When Janos Vargha, a biologist from the Hungarian Academy of Sciences, began a new career as a writer with a small monthly nature magazine called Buvar, it was 9 years after the story behind the fall of the Berlin Wall had started to unfold. During his early research, he went to a beauty spot on the river Danube outside Budapest known as the Danube Bend to interview local officials about plans to build a small park on the site of an ancient Hungarian capital.
One official mentioned that passing this tree-lined curve in the river, a popular tourism spot for Hungarians was monotonous. Also, it was to be submerged by a giant hydroelectric dam in secret by a much-feared state agency known simply as the Water Management.
Vargha investigated and learned that the Nagymaros dam (pronounced “nosh-marosh”) would cause pollution, destroy underground water reserves, dry out wetlands and wreck the unique ecosystem of central Europe’s longest river. Unfortunately, nobody objected. “Of course, I wrote an article. But there was a director of the Water Management on the magazine’s editorial board. The last time, he went to the printers and stopped the presses, the article was never published. I was frustrated and angry, but I was ultimately interested in why they cared to ban my article,” he remembers today.
He found that the Nagymaros dam was part of a joint project with neighbouring Czechoslovakia to produce hydroelectricity, irrigate farms and enhance navigation. They would build two dams and re-engineer the Danube for 200 kilometres where it created the border between them. “The Russians were working together, too. They wanted to take their big ships from the Black Sea right up the Danube to the border with Austria.”
Vargha was soon under vigorous investigation, and some of his articles got past the censors. He gathered supporters for some years, but he was one of only a few people who believed the dam should be stopped. He was hardly surprised when the Water Management refused to debate the project in public. After a public meeting, the bureaucrats had pulled out at the last minute. Vargha knew he had to take the next step. “We decided it wasn’t enough to talk and write, so we set up an organization, the Danube Circle. We announced that we didn’t agree with censorship. We would act as if we were living in a democracy.” he says.
The Danube Circle was illegal and the secret publications it produced turned out to be samizdat leaflets. In an extraordinary act of defiance, it gathered 10,000 signatures for a petition objecting to the dam and made links with environmentalists in the west, inviting them to Budapest for a press conference.
The Hungarian government enforced a news blackout on the dam, but articles about the Danube Circle began to be published and appear in the western media. In 1985, the Circle and Vargha, a public spokesman, won the Right Livelihood award known as the alternative Nobel prize. Officials told Vargha he should not take the prize but he ignored them. The following year when Austrian environmentalists joined a protest in Budapest, they were met with tear gas and batons. Then the Politburo had Vargha taken from his new job as editor of the Hungarian version of Scientific American.
The dam became a focus for opposition to the hated regime. Communists tried to hold back the waters in the Danube and resist the will of the people. Vargha says, “Opposing the state directly was still hard.” “Objecting to the dam was less of a hazard, but it was still considered a resistance to the state.”
Under increasing pressure from the anti-dam movement, the Hungarian Communist Party was divided. Vargha says, “Reformists found that the dam was not very popular and economical. It would be cheaper to generate electricity by burning coal or nuclear power.” “But hardliners were standing for Stalinist ideas of large dams which mean symbols of progress.” Environmental issues seemed to be a weak point of east European communism in its final years. During the 1970s under the support of the Young Communist Leagues, a host of environmental groups had been founded. Party officials saw them as a harmless product of youthful idealism created by Boy Scouts and natural history societies.
Green idealism steadily became a focal point for political opposition. In Czechoslovakia, the human rights of Charter 77 took up environmentalism. The green-minded people of both Poland and Estonia participated in the Friends of the Earth International to protest against air pollution. Bulgarian environmentalists built a resistance group, called Ecoglasnost, which held huge rallies in 1989. Big water engineering projects were potent symbols of the old Stalinism.
HUMAN GUINEA PIG
There are 50 million people in the world being used as guinea pigs in clinical trials testing experimental drugs. Apart from potentially risking part of their lives, applicants must pass a severe series of tests just to be able to participate in some trials. However, acceptance means more tests, negative side effects and a considerable disturbance to their daily lives. So what’s in it for them? As journalist Alex O’Meara explains in Chasing Medical Miracles, some participate out of genuine altruism, whilst some are looking for cures for their own disorders. O’Meara having diabetes himself volunteered for a risky transplant of insulin-producing cells from the liver, and his story spread through the book.
O’Meara knows people choose to participate for life’s great motivator: money. Clinical trials are a huge business, making up to $24 billion annually, and the cash they offer as compensation has become a sought-after way to make extra money. This exchange of money often involves people who are sick and vulnerable and emphasises the dark ethical waters in which current clinical trials are mired.
At intervals, the ill feel compelled to join a trial to get medical care. Some unethical researchers, desperate to recruit the large numbers needed to make their researchers statistically valid, take advantage of this. It can be difficult for ill people to take that, at best, they are taking experimental medicine and at worst they are taking nothing at all.
Desperation for money or medicine is never a basis for unbiased decision-making. How can a researcher be sure a person is giving their true consent? And if a person gets better as a result of taking an experimental drug, what happens when their drug supply finishes after the trial?
These ethical quandaries have influenced healthcare in develop countries where clinical trials are a prospering industry. According to Adriana Petryna in When Experiments Travel, in spite of the fact that drug companies are moving their trials to developing countries, only 10% of drug research addresses disorders that influence the world’s poor. Such diseases make up to 90% of the global disease burden. Establishing ethical and legal responsibilities is also becoming harder, she reports. With an increased number of subcontractors included in trials, it is clear that no one is overly concerned about patient welfare.
From this theory, international human rights frameworks such as the Nuremberg Code should ensure that participants are not taking any positive effect. In reality, largely poor and illiterate populations are being exploited. Besides, ethical regulations in poor countries are rarely strict, therefore researchers can get away with recruiting people into HIV trials knowing that they will die without the experimental drug.
O’ Meara also reports about drug company’s greed and the inability of regulators to control the rapidly increasing number of trials. The US Food and Drug Administration inspects less than 1% of the 350,000 registered trial sites. Drug firms are managing non-profit organizations that are undertaking just 30% of trials. However, in spite of their faults, clinical trials are still an essential tool of modern medicine.