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Bee Venom Therapy – Grassroots Medicine

Pat Wagner (or “The Bee Lady,” as she likes to be called) treats herself for multiple sclerosis (MS) by allowing bees to sting her. She calls this bee-venom therapy (BVT) and believes it has saved her from MS.

There are now thousands of people who administer BVT to themselves or others, mostly in private homes by unlicensed practitioners. BVT is not prescribed by a doctor, yet it is used like any other drug, given in regular doses at regular intervals. There is no scientific evidence to support its use, and yet thousands of multiple sclerosis sufferers and others tout its effectiveness.

BVT, which is one modality within Apitherapy, or the use of various bee products as a medical treatment, is still a relatively small phenomenon. It is largely an unrecognized grassroots or folk medicine treatment – but like all such phenomena has been given a huge boost recently by the easy spread of information via the internet. It has also been adopted by many so-called alternative medicine (CAM) practitioners, and has been increasingly wrapped in the typical marketing jargon of CAM. So, in a way, this grassroots treatment has been corporatized by the CAM industry.

And yet, there if no convincing evidence that it is an effective treatment for any of the conditions for which it is used. Apitherapy.com claims it can be used to treat over 500 conditions (always a red flag for quackery), but I will focus on one – multiple sclerosis.

Multiple Sclerosis

In order to fully understand how apitherapy arose, one needs to understand the disease at which it is primarily targeted: multiple sclerosis. MS is a disease of the central nervous system, resulting in a variety of neurological symptoms. The cause of MS is still unclear, but what is known is that in patients with the disease the immune system attacks the brain and spinal cord, which are normally isolated from the immune system. The resulting inflammation causes areas of demyelination (myelin is the insulation around nerve fibers) which results in a plaque, an area where normal conduction is slowed or blocked. The location of the plaque determines the neurological deficit which results.

The important feature of MS, however, is its unpredictability. New plaques arise at random times and locations, and 90% of plaques are silent (without noticeable symptoms). Plaques can also vary in size and severity, and also in their potential to heal. Most new lesions will resolve spontaneously, either partially or even completely. Also, even in a person with stable MS, with no new lesions forming, symptoms can vary significantly and rapidly based on other factors, such as body temperature.

The end result is that nobody, not the patient nor the physician, can predict the course of MS in any individual. The MS sufferer must live with the uncertainty of what the future will bring, as they are buffeted by unpredictable exacerbations and remissions. It is for this reason that MS patients are especially susceptible to the claims of new miracle cures, and why anecdotal information regarding such therapies are all but worthless in terms of forming reliable scientific conclusions. In this way, MS is typical of diseases which are favorite targets of folk medicine: it is unpredictable, susceptible to spontaneous remissions, and cannot be cured by mainstream medicine.

Anecdotes and Human Nature

How, then, does the existence of MS result in the American Apitherapy Society, which claims to be tracking over 6,000 patients receiving regular bee-sting therapy (for MS and arthritis). Often times such a phenomenon begins with a single observation, one patient who, for example, receives bee sting for another ailment, or even accidentally, and then experiences a remission of their symptoms. Human psychology does the rest.

It is human nature to associate two events which are temporally related and assume cause and effect. Eat a roast beef sandwich and then get sick, and most people will assume that the roast beef was bad, even though they may be sick from a virus they were exposed to a day earlier. It is important to realize that coincidences are much more common than one would naively believe, and that the assumption of cause and effect is perhaps the most common logical mistake that people make.

So, once the story that a person was cured, or even helped, by bee venom gets around, many MS patients will seek out this new therapy out of desperation and hope. This is a reasonable and, one might even argue, rational response. Out of this self-selected (not random) assortment of MS sufferers who will try apitherapy, many are destined to have spontaneous remissions. Those that do are likely to spread the praises of this new therapy at MS support group meeting and other public venues and will give stunning testimonials at apitherapy meetings. The rare patient with a dramatic remission is likely to become a crusader for their miracle savior. Those without a response are likely to abandon therapy and not be heard from. They will probably move onto the next potential cure, and will not spend their time spreading the word that apitherapy did not work for them.

In fact this is exactly what I see in my practice. Patients with chronic neurological diseases with often try many therapies, even unconventional ones. If these treatments did not work, they do not talk about them much, and often will only report them if I directly ask about specific prior treatments. If, however, they feel they were helped by a treatment, they will shout it from the roof tops.

This process described above is the essence of anecdotal evidence, and is the reason why it is unreliable – because it is not controlled. The waxing and waning potential of MS symptoms makes it especially difficult to draw conclusions from uncontrolled observations.

It is also possible, although unlikely, that apitherapy is effective in the treatment of MS. Bee venom contains many biologically active chemicals. One or more may have anti-inflammatory or immune modulating effects. We will never learn this from anecdotal clinical evidence alone, however.

BVT Research

Until well designed and reliable clinical trials are completed which demonstrate honey bee venom’s safety and effectiveness, there is no rational basis for using it to treat MS. Many will argue, however, that those patients with severe progressive MS have nothing to lose and therefore they should not be denied any hope of a treatment. The use of unproved therapy in otherwise untreatable illnesses is a complex ethical issue, beyond the scope of this article. There are a few points I would like to discuss, however.

First, MS patients do have something to lose. Apitherapy certainly has its risks. All drugs have side effects and toxicity, which need to be weighed against their therapeutic effect. Bee stings commonly cause allergic reactions, which may result in anaphylaxis and death. Also, patients who put their hopes in an unproved treatment may be kept from mainstream treatment.

In the last decade several effective drugs for the treatment of relapsing remitting MS have emerged: Avonex (interferon beta-1a), Betaseron (interferon beta-1b), Copaxone (copolymer I), and Rebif (interferon beta-1b). More recently Tysabri has come on the market. This is an extremely effective drug and reduces MS exacerbations dramatically.

These are all powerful drugs, and not without their side effects, but they are useful in the treatment of MS and there is a large and growing body of data to support their use and to inform doctors and patients about their risks and benefits.

No such information exists for BVT. It is also impossible to regulated the dose of BVT with the precision that pharmaceuticals can.

In addition to risk of side effects, and potentially distracting patients from mainstream therapy, there is also the more subtle psychological harm of being given false hope in a treatment that may not work.

Second, compassionate use of experimental drugs is already built into the system. Drug trials are conducted in multiple phases. Before human testing can occur, potential new drugs are tested in animals to see if they are safe, and then to see if they have any potential benefit on the disease in question (or a close animal model of the disease). A phase I human trial may then be performed simply to test for safety in humans, and learn about the pharmacology of the drug – how it affects the body and how the body metabolizes it. A phase II trial is a placebo controlled human trial conducted in a small number of patients (dozens to a few hundred), tracking side effects and dosage response, but now also therapeutic effect. These trials involve too few patients to achieve reliable results, and are used to screen drugs for safety and possible benefit before they are given to a large number of patients. A phase III trial is a large, usually multicenter placebo controlled trial involving many patients (hundreds to thousands) over a longer period of time. This trial is designed to answer definitively the question of whether or not a drug is safe and effective, two of which are required for FDA approval. A phase IV trial is uncontrolled and simply tracks the side effects of a new drug once it is in wide-spread use (post FDA approval and marketing).

After a successful phase II trial, drugs can be given to patients as part of an open label trial on a compassionate basis. Also – treatments that are considered unproved or experimental can and should be given in the context of a clinical trial. One could argue that every patient getting BVT should be part of a trial until such time that we can confidently conclude that it either works or does not work.

Proponents of apitherapy will often point to basic science research which indicates that honey bee venom contains several compounds with powerful anti-inflammatory properties. There is a rationale to believe that anti-inflammatory drugs, like those currently used to treat MS, may have some benefit. There is also interest in a wide variety of venom therapies (snake venom, and anemones, for example) as potential sources of pharmaceuticals, including as anti-inflammatories.

This sort of basic science information, however, is pre-phase I, meaning that it is useful for picking a drug to study as a possible treatment for a particular disease, but it is a long way from concluding that the drug should be used to treat that disease. A very small percentage of drugs which enter phase I trials ultimately achieve FDA approval, most because the balance of risks and side effects to potential benefit is unfavorable.

Current Research

The National Multiple Sclerosis Society (NMSS) sponsored a study and published the following reports: Preliminary Test Results Of Bee Venom In Mice With Ms-Like Disease May 8, 1998. They studied the effect of bee venom on mice with experimental allergic encephalitis (EAE), the standard animal model of MS. They conclude:

In their initial series of small experiments, honey bee venom had no beneficial effect against the course of EAE, and some of the mice treated with bee venom experienced a worse course than those that received inactive placebo.
Honey bee venom contains a mixture of toxins and other biologically active compounds. Additional studies are underway to determine whether any of these individual components may have potential benefit for treating symptoms of MS.
The investigators caution that their finding that some mice experienced a worse course of disease after receiving honey bee venom raises possible safety concerns for the use of honey bee venom therapy in humans.(3)

A recent randomized cross-over (unblinded) study published in Neurology in 2005 found absolutely no effect by any measure for relapsing-remitting MS (the most treatable form) from BVT.  Another small Phase I study showed no effect.

At this time the animal data and the preliminary (phase I and II) clinical data for BVT in MS is negative. Of course, this is not definitive, but strongly argues against an effect, and at the very least rules out a large clinical effect.

Conclusion

Unfortunately, as we often see with grassroots or folk medicine in general – practice and belief are completely disconnected from scientific research. Apitherapy has evolved into another CAM belief system – one with an almost spiritual belief in the power of the honey bee to “heal”. Evidence is irrelevant.

Posted in: Herbs & Supplements, Neuroscience/Mental Health, Science and Medicine

Leave a Comment (15) ↓

15 thoughts on “Bee Venom Therapy – Grassroots Medicine

  1. Jules says:

    Well, the fact that honey is a rather powerful antiseptic agent probably contributes to this idea that bees are “healing”. Personally, I think you’ve got to be thirteen shades of desperate to let a bee crawl around on you and then sting you. Not to mention something of a sadist, since they die afterwards*.

    But could the lack of evidence for this come from issues similar to herbal medicines? The fact that bees are not uniform chemistry factories, that their health might contribute to their panel of venom? As far as I know, CCD is currently decimating hives all over the Northern Hemisphere, which may or may not contribute to the already-complicated brew of poisons these bees are cooking up. And then possibly, too, there are individual variations in sensitivities to the venom, though I think the 26-person study was perhaps large enough to compensate for that.

    I’m not discounting the negative studies, but I think the story is more complicated that “it doesn’t work”. Apitherapy (I’m really have problems with that word) is most definitely doing something–you can’t expose yourself to that kind of venom load and not expect something to happen–but we just don’t know what.

    *Yes, I know, they’re “just” bugs, but needless death is something I find reprehensible.

  2. Fifi says:

    Honey is antiseptic but “powerful” is overstating it. Most of the tests have been done in New Zealand, and the government and industry are busy promoting Manuka honey (it’s quite the fad at the moment and has made it’s way into the food industry mainstream). The claim being made is that the hydrogen peroxide that naturally occurs in honey – the antiseptic element – degrades in other types of honey but is preserved in Manuka honey.

  3. Harriet Hall says:

    The fluctuating course of MS makes it an ideal quack magnet. I met an MS patient who was absolutely convinced her chiropractor had cured her optic neuritis by spinal manipulations. I tried to tell her there were no connections between the spine and the optic nerve and I tried to get her to at least admit that the symptoms might have resolved anyway, but there was no room in her mind for even the slightest doubt. It’s easy to understand why: she needs to believe she has some control over her disease.

  4. IR says:

    First, just want to say I love what all of you are doing here with the blog. A much needed candle, to borrow a phrase from Carl Sagan.

    My mother has MS, she was diagnosed when I was 12(1985), just entering high school. From the beginning she has had a fairly aggressive and debilitating progression of the disease. She was a very active, beautiful woman, always encouraging me to explore and question. Neither she nor my father had a college education, but she was very supportive of my intense curiosity, whether it had to do with reading anything I could get my hands on or investigating the natural world. It was a devastating shock to my family to watch her decline. To go from this athletic, engaging mother, to a cripple who could barely leave the house in the summer because of the heat and how it would exacerbate her symptoms. No more going to the river, camping, road trips.
    I’m sure it didn’t help that we lived in a small town in rural Illinois and the doctor who was overseeing her care had little experience with treating MS. So when she heard about BVT and went to her doctor with the info, he couldn’t really provide her with any information. At the time (late 80′s) he hadn’t even heard of it.
    So we decided to try it out since every other treatment she underwent had no positive effect. I had a friend whose father was a beekeeper and he agreed to supply us with the honey bees.

    For Jules, you don’t just let the bees crawl around on you until one stings you. At the time (I have no idea if this is still the case) another person would actually catch the bee, and apply it to specific points on the patients body, say, along the spine. I was maybe 16, and would go capture the bees, inevitably getting stung more than a few times, and place them in the designated area until they stung my mother.

    Needless to say, the therapy had no effect, and we eventually stopped. When I look back on that time now, at 36 years old, it’s somewhat embarrassing that we thought it might work. At the same time, I take some comfort in knowing that, unlike say, homeopathy, at least there is some sort of basic biological underpinning to the hopes of BVT. It isn’t Reiki.

    And as much as I am frustrated by parents who won’t vaccinate, or cancer patients who seek out Gerson protocol treatment, I applaud your approach here, which is to try and educate the people who are often brought to even more harm and misery as a result of quackery, and to save the venom and anger for those who perpetrate the fraud.

    Also, I guess I’m just trying to say to Jules, that, yes, often the people who try these things are “thirteen shades of desperate”. As to being sadists, well, I’ll bite my tongue for once in my life as to what I think about this opinion.

  5. Scepticon says:

    Fifi,
    I’d like to clarify that with regard to Manuka Honey antibacterial properties that this most definitly not the claim being made.
    The actual claim is that there is compound that is found only in Manuka honey, and ony certain types of Manuka honey that is referred to as UMF. UMF merely stands for Unique Manuka Factor and is used as a proxy measure of antibacterial effectiveness in the absence of being able to measure tha ctive ingredient directly. There is growing evidence that the active compound is Methylglyoxal*, while hydrogen peroxide is unquestionably important in the antimicrobial activity of other honeys (along with other factors such as water availibilty) it is not the prime contributing factor when considering Manuka Honeys.

    In interests of disclosure the lab I work at is deveoping tests to look for Methylglyoxal in honey but I am not directly involved with the work.

    *Reference- http://cat.inist.fr/?aModele=afficheN&cpsidt=20257962

  6. Fredeliot2 says:

    There is a site http://www.patientslikeme.com that has a forum on the subject. Though the site seems to be well intended, I believe there is a bias on what people report that will always give some credibility to ineffective treatments. Although there have been some articles on Medscape about a possible benefit of taking Prozac along with a standard therapy for MS, it is not mentioned on the site. Since Prozac has a known safety profile and is potentially more effective, it would be a more fruitful area to study than bee venom. Of course maybe it is and one of you doctors can comment on it.

  7. Fizzizist says:

    So I assume that they are extracting the venom from the bees then administering it because if not, its like who in their right mind would intentionally let a bunch of bees sting them to try and cure a disease like this. I myself have a phobia of bees so maybe I am biased about the whole getting stung by bees being bad thing. Personally I would rather have MS than get stung by a bee, believe it or not. But the point is that it just seems so absurd to me how someone even discovers something like this. I’m guessing they were working in the bee farm one day and got swarmed and then a few weeks later said “hey my MS is getting better it must have been all the toxins that were pumped into me from that swarm the other day.” I mean I am no expert but it just seems very out there to me.

  8. daedalus2u says:

    I suspect that MS is a disease of low nitric oxide (as are many diseases). If so, then any counter-irritant that stimulates the immune system and causes expression of iNOS may provide temporary relief. Long term relief requires long term NO production. To do that in a “natural” way, there are a number of parasites that come to mind. Schistosomiasis reportedly protects against MS.

    http ://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762004000900006&lng=en&nrm=iso&tlng=en

    Other parasitic worms might work too. I suspect that a long term infestation would provide long term therapy, if it did work.

    A number of disorders were treated with fever therapy, which was the deliberate infection with malaria which caused periodic fevers. I suspect that the periodic fevers occur to prevent the malaria parasite from attaching to the wall of a blood vessel where they do much more damage than floating along in the blood stream. High NO levels do reduce the stickiness of erythrocytes and are coincident with high fevers caused by immune system stimulation.

  9. MedsVsTherapy says:

    i have been stung by bees plenty of times, starting in childhood.
    most recently 1995, with maybe 20 yellow-jacket bites.

    i don’t have ms.

    hey – maybe this really works! ;)

    do i need a booster? X p

    IR: great story. I don’t think anyone would fault you for giving it a try, and helping your mom. I would endure many bee stings for my mom if I thought it would help her with ms or any other health problem.

  10. Calli Arcale says:

    Fizzizist:

    So I assume that they are extracting the venom from the bees then administering it because if not, its like who in their right mind would intentionally let a bunch of bees sting them to try and cure a disease like this.

    The easiest way to extract venom from a bee and inject it into a human is to apply the bee to the human and then really piss it off. So yeah, people really do let the bees sting them, and then let the stingers stay in long enough to empty their venom sacks.

    MedsVsTherapy, yellowjackets don’t bite — like bees, they sting. The difference is that their stingers are not barbed, so they can sting repeatedly. One time last summer, I got a yellowjacket under my skirt. It stung me three times in the knee before I figured out what was going on and let it go.

  11. hatch_xanadu says:

    I believe they grab the bee with tweezers and then hold it against the person’s forearm. (Being grabbed with tweezers is definitely enough to prompt a sting.)

    The article implies, though, that they’re now also pre-extracting venom and injecting it with a syringe. That certainly seems easier than keeping a colony of bees around the house.

    Excellent entry, Steve.

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