For worms, brave Percy

I may have to reconsider my opinion about worms. Not the kind that burrow through the soil -I’ve never had a thing about them- and certainly not the kind you find squirming around under things that weren’t meant to be lifted up. They remain disgusting. No, I mean the ones that somehow find cozy homes in our intestines.

You can’t believe everything you read, of course -I never really accepted the idea that eating boiled spinach replenished your iron stores, or that Marmite was palatable- but some things are just too horrid to be wrong. I mean, why would anybody want you to believe that some parasitic worms are not what they seem -parasitic, that is? And, other than in a required university text book of comparative biology, what would make the authors think they might have an audience? Or am I just showing my age here? Maybe the Gen Zs are really into this kind of stuff.

All I have to fall back on are my own Biology classes dissecting repulsive nightmare creatures and having to draw portraits of their appearance as seen through various magnifications of a microscope. Believe me: when you see a Taenia solium scolex on a microscope slide, even if you desperately try to believe it will stay put and doesn’t have your name on it, you’re scarred forever.

Still, I suppose it’s seldom too late to change parasites mid-stream. I would never have guessed that peptic ulcers could be a bacterial infection, or that what we carried around in our bowels was useful to anything other than the laxative market, either. Nevertheless, it was a shock to learn that, not only were the bacteria in there useful, but so were other invaders that I’d been warned about since medical school. It’s hard to keep up with these things.

It’s also hard to resist them, and I think that an essay with the tag-line: gut worms were once the cause of disease, now they are a cure is  uncomfortably seductive: https://aeon.co/essays/gut-worms-were-once-a-cause-of-disease-now-they-are-a-cure

‘Modern medicine does not often bother to ask why,’ observes the author, Dr. William Parker, associate professor of surgery at Duke University in North Carolina. ‘Modern medicine asks what and how: what conditions do you have, and how do we treat them? But we should be asking why – this is the first critical step toward prevention.’

‘Intestinal worms, called ‘helminths’, have caused untold human suffering, killing the weak and disabling the strong. Labelled uniformly as disease-causing parasites by biologists, they have inspired fear and hate, leading to major campaigns aimed at their eradication… But what if we erred? … A barrage of scientific evidence points toward helminths as being important regulators of immune function.’

I still remember eosinophils (specialized immune cells)  from medical school, because they were so beautifully coloured when subjected to the usual H&E stains the labs use for identification -colour was really important in those days for memorization, I think. Anyway, I can recall being puzzled as to why an increase in the blood’s eosinophils could sometimes be a sign of parasitic infections. Strangely, the eosinophils are also often found to be increased with allergies, so I figured parasites can probably cause allergies and left it there.

But now there seems to be evidence of wrongful conviction: ‘[E]arly observations led to numerous additional studies, summarized in 2004 by Rick Maizels at the University of Edinburgh, showing inverse relationships between helminths and allergies in various human populations. At the same time, Maizels also compiled an impressive list of studies using laboratory mice, showing that helminths attenuate a multiple sclerosis (MS)-like syndrome, a Type 1 diabetes-like condition, inflammatory bowel disease, gastric ulcers and allergic reactions, including allergic reactions to peanuts.’

Hold on, though -worms are starting to sound like those all-purpose medicines that were hawked from the backs of wagons in the Old Days. They were supposed to cure pretty well everything, but alas, although the wagon left, the ailment didn’t. Oh yes, and then ‘people and their doctors were reporting that helminths were helping to treat neuropsychiatric problems such as anxiety disorders and migraine headaches.’ Uhmm…

An old aphorism -commonly attributed to Carl Sagan, but actually far older- suggests that extraordinary claims require extraordinary evidence and this seems to apply here. I realize that we’re probably in the middle of a paradigm shift, and that it’s still too early in the process to accept or reject the idea, but I think we need to be careful, not cavalier.

Even if there are non-harmful -albethey still disgusting- intestinal parasites, I think we have to beware of the unintended consequences of intentionally instilling ‘friendlies’ into unsuspecting bowels (perhaps analogous to the fecal transplants that have been tried as a treatment for, among other things, infections with drug-resistant C. difficile -an inflammatory bacterial infection of the large bowel). Still, I cannot help but remember Hamlet’s observation ‘That one may smile, and smile, and be a villain.’

And yet, I suppose that, strictly defined, the ‘good worms’ would not be so much parasitic as therapeutic, and commensals rather than infestations. But even so, the helminths still need to eat -and they’re a lot bigger than the competition. Some of them like Vit B12, I understand; some like iron; and I imagine some of them might even be rather picky eaters. And then, of course, some cause diarrhea, bloating, and irritate the bowel in ways I’d rather not think about. And sometimes they even get into the blood stream or lymphatic system. Anyway, unless they come up with sterilized versions, they’re all going to want to produce eggs. So, what do we do about those? Do the treated people then become vectors surreptitiously spreading their treasures to all and sundry?

Okay, okay -I guess I’ve painted a rather unfair portrait of helminths, and I realize it’s important to keep an open mind about these kinds of things -so the article I’ve linked is definitely worth reading. Still, I can’t help but think that while some of the claims are definitely promising, they undoubtedly will require a lot of additional verification, and replication, not to mention some really clever PR before becoming anything like mainstream.

So in summary, is the concept of friendly worms really too good to be true? Or does it all come down to ‘garbage in, garbage out’? Well, part of me thinks so: the part south of my lips, at any rate…

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