maggot therapy: healing wounds with worms
ian dawe, the peak

If you've seen the film Gladiator, you may recall a scene in which actor Russell Crowe's injured arm is subjected to hordes of squishy maggots, which clean and disinfect the wound. Gross, you say? Well, that was his first reaction, too. But it worked - his arm healed. This was fine for ancient Rome, but surely today we have better ideas.

Well, it seems that sometimes the old tricks are the best tricks. Maggot therapy is making a comeback in modern medicine, and one of its leading experts, Dr. Ron Sherman of the University of California, Irvine, visited SFU last week to talk about it.

What is maggot therapy? Dr. Sherman describes it as "The therapeutic use of specific types of fly larvae [maggots], for treating chronic illness." Maggots are actually placed upon open wounds and allowed to colonize it.

The maggots remove the dead, infected tissue from a wound, a process called "debridement". Maggots actually feed on the dead tissue because of the way their bodies work. "They begin to digest their food extra-corporally [outside of the body] because they don't have a mouthful of teeth to actually bite off chunks," explains Dr. Sherman.

Thus dead tissue is broken down, and maggots grow using the nutrients provided. The maggots also seem to somehow promote the growth of new tissue.

Secondly, the maggots kill bacteria in the wound, actually disinfecting it like commercial antibiotics like penicillin. "I would propose, purely conjecturally, that because these particular species live in environments filled with bacteria (garbage, feces, corpses), they are ingesting bacteria and need some form of defense to prevent themselves from being invaded by those bacteria," says Dr. Sherman. The maggots therefore have a natural antibacterial power, which is taken advantage of in maggot therapy.

Naturally, it would be nice to isolate the aspect of the maggot that makes it antibacterial, and administer that. Dr. Sherman says that this is a current research goal of his: "I would hope that there are specific compounds that can be isolated." But as he also points out, these efforts have been "fraught with difficulty."

Maggot therapy works. It's as simple as that. But, as Dr. Sherman explains, "Measurements of the efficacy of maggot therapy are a bit difficult." It's not enough in clinical medicine to say "90 per cent of the patients got better," or simply observe that something "works". In order to gain wide acceptance, a new approach must be studied in a very methodical way, involving control groups and robust statistics. Dr. Sherman admits that these types of studies are simply not yet available in the case of maggot therapy.

However, time and time again maggot therapy has given rise to dramatic clinical successes. Dr. Sherman recalls that in 12 cases in which wounds were so severe that they would have caused the loss of the affected limbs, and in which all conventional treatments had failed, maggot therapy managed to rescue six of the patients' limbs. Although this isn't enough to convince the medical world, it's probably fair to say that to those six people a difference was made.

In fact, as Dr. Sherman notes, patients will gladly accept maggot therapy if it's offered; indeed, many request it. But here the problems begin, because some of these patients' families find the idea of putting live maggots on their loved one's wounds so repulsive that they, when given responsibility for the decision, decline the therapy. But the public at large, as it hears more and more about the success of maggot therapy, is warming to the idea, says Sherman.

The toughest people to convince are the doctors. On Dr. Sherman's Web site, he includes a list of physicians who actively practice maggot therapy. But there are many other practitioners of the therapy who declined to be listed on the site for fear of damaging their reputation. Dr. Sherman wryly notes, "that should, perhaps, set the scene ... the major impediment to making maggot therapy available is really the health care institution."

Many doctors view surgery as the only viable option for dying tissue, and recoil at the thought of embracing a therapy that they see as a competitor with surgical techniques. But surgery is not always appropriate, and sometimes a combination of maggot therapy and surgery has been shown to be more effective. "I'm hoping to overcome those obstacles by illuminating maggot therapy not as a competitor, but as a tool that's not replacing the surgeon," says Dr. Sherman.

Maggot therapy has been gaining acceptance worldwide, with a British maggot supply company shipping over 3000 maggot orders to European practitioners. North America has been much slower to accept the technique, but Dr. Sherman notes that even his small maggot supply company receives approximately 5-10 orders per week from U.S. customers.

Maggots: creepy, slimy, writhing critters. And maybe our new best friends. Have a good fight, Russell. If you want to keep abreast of the current developments in maggot therapy, check out Dr. Sherman's Web site:

www.ucihs.uci.edu/path/sherman/home_pg.htm.

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