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Parasites

I saw a patient recently for parasites.

I get a sinking feeling when I see that diagnosis on the schedule, as it rarely means a real parasite.  The great Pacific NW is mostly parasite free, so either it is a traveler or someone with delusions of parasitism.

The latter comes in two forms: the classic form and Morgellons. Neither are likely to lead to a meaningful patient-doctor interaction, since it usually means conflict between my assessment of the problem and the patients assessment of the problem.  There is rarely a middle ground upon which to meet. The most memorable case of delusions of parasitism I have seen was a patient who  I saw in clinic who, while we talked, ate a raw garlic clove about every minute.

“Why the garlic?” I asked.

“To keep the parasites at bay,” he told me.

I asked him to describe the parasite.  He told me they floated in the air, fell on his skin, and then burrowed in.  Then he later plucked them out of his nose.

At this point he took out a large bottle that rattled as he shook it.

“I keep them in here,” he said as he screwed off the lid and dumped about 3 cups with of dried boogers on the exam table.

To my credit I neither screamed nor vomited, although for a year I could not eat garlic.  It was during this time I was attacked by a vampire, and joined the ranks of the undead.

I have seen the occasional earthworm thought to be an intestinal parasite. Sometimes people start to pay attention to their stool, often for the first time, and note  tube like structures  that move in the water.  Most likely mucous or undigested fiber wafting in the gentle currents of the toilet water.  Doesn’t that sound romantic? The contents of the average stool, like hot dogs and laws, are better left unexamined.  In those patients, an examination of the stool for worms and worm eggs is usually unrevealing and makes me glad I am not a microbiology technician.

Morgellons is, as best I can tell, a variant of delusions of parasitism.

Here is a thing about germs in general and parasites specifically: they have patterns and can be seen. There are patterns of disease and patterns of their life cycle.  You can tell when a disease is probably delusional because the “organisms” have no understandable pattern in the life cycle, the disease, the physiology, the anatomy or the epidemiology.

And germs can be seen. Well, most germs.  Single celled organisms can be tricky and may require special stains to be seen under the microscope.  Viruses are, of course, too small to be seen by a lab microscope. But parasites? Worms? These wee beasties are multicellular.  They are big. Not a long way to the chemists big, but sizable, not hard to see with a microscope unless they have Romulan cloaking technology.

So what is Morgellons?

Before we continue, I would like to clarify one thing. I see patients self diagnosed with Chronic Candida Syndrome or Morgellons or Chronic Lyme or some other process.  I do not doubt these people are ill and have symptoms that can be severe and life altering.  What I may disagree with the patient is the reason for these symptoms.  As best I can tell none of the above are due to an infectious disease.

Unfortunately when the patient is convinced they have an etiology for their symptoms and I think that their reason is nonsense, it does not lead to a therapeutic physician-patient interaction.  I try and phrase it as gently and non-judgmentally  as possible, but it rarely leads to a good time in the clinic.

Morgellons has existed as a disease since about 2002 and is an internet phenomena right up there with Rebecca Black.  See.  For a 54 year old man, I am hip. Morgellons received its name from a paper from 1935 called SIR THOMAS BROWNE AND THE DISEASE CALLED THE MORGELLONS By C.E. KELLETT, M.D., M.R.C.P. and published in Annals of Medical History, n.s., VII (1935), 467-479,  where it refers to a disease from the 1600′s (yes 1600′s) described by said Thomas Browne.

“Hairs which have most amused me have not been in the face or head, but on the Back, and not in Men but Children, as I long ago observed in that endemial Distemper of little Children in Languedock, called the Morgellons, wherein they critically break out with harsh Hairs on their Backs, which takes off the unquiet symptoms of the Disease, and delivers them from Coughs and Convulsions.”

Who know what these hairs/worms really were; the 1600′s were not a time noted for its diagnostic accuracy. Unlike the modern disease, it was usually a disease of children and often fatal, so whether these “hairs”  had anything to do with the disease or were actual living creatures, one cannot say.

In  1715 when the first microscopist, Leuvenhoeck, took a look at the bristles and thought them “inanimate”, starting a long tradition of looking at the detritus presented by Morgellons patients and seeing nothing.  I, for one, always look at the fluff brought in by Morgellons patients and have yet to see anything resembling a living creature. Diseases have come and gone in the past, like the English Sweating Sickness, so maybe there was a plague of virulent hairs (that’s hair not hare, it was not a virulent bunny, for which Hef is undoubtedly grateful), but no longer.

Fast forward 400 years.  Round about 2002 this disease was described on the net in regards a child with the symptoms now referred to as Morgellons, and since others have had the disease.  It is transmissible as an internet meme, but not spread person to person.

What are the distinguishing characteristics of Morgellons?  Here are features as noted from the Morgellons Research Foundation

1. “Filaments” are reported in and on skin lesions and at times extruding from intact-appearing skin. White, blue, red, and black are common among described fiber colors. Size is near microscopic, and good clinical visualization requires 10-30 X. Patients frequently describe ultraviolet light generated fluorescence. They also report black or white granules, similar in size and shape to sand grains, on or in their skin or on clothing. Most clinicians willing to invest in a simple hand held commercial microscope have thus far been able to consistently document the filaments.
2. Movement sensations, both beneath and on the skin surface. Sensations are often described by the patient as intermittently moving, stinging or biting. Involved areas can include any skin region (such as over limbs or trunk), but may be limited to the scalp, nasal passages, ear canals, or face…and curiously, legs below the knees.
3. Skin lesions, both (a) spontaneously appearing and (b) self-generated, often with pain or intense itching. The former (a) may initially appear as “hive-like”, or as “pimple-like” with or without a white center. The latter (b) appear as linear or “picking” excoriations. Even when not self-generated (as in unreachable regions of babies’ skin), lesions often progress to open wounds that heal incompletely (e.g., heal very slowly with discolored epidermis or seal over with a thick gelatinous outer layer.). Evidence of lesions persists visually for years.
4. Musculoskeletal Effects and Pain is usually present, manifest in several ways. Pain distribution is broad, and can include joint(s), muscles, tendons and connective tissue. Both vascular and “pressure” headaches and vertebral pain are particularly common, the latter usually with premature (e.g., age 20) signs of degeneration of both discs and vertebrae.
5. Aerobic limitation is universal and significant enough to interfere with the activities of daily living. Most patients meet the Fukuda Criteria for Chronic Fatigue Syndrome as well (Fukuda, Ann. Int. Med., 1994). Cardiology data and consistently elevated heart rates suggest a persistent myocarditis creating lowered cardiac output that has been partially compensated for by Starling’s Law.
6. Cognitive dysfunction, includes frontal lobe processing signs interfering with logical thinking as well as short-term memory and attention deficit. All are measurable by Standard Psychometric Test batteries.
7. Emotional effects are present in most patients. Character typically includes loss or limitation of boundary control (as in bipolar illness) and intermittent obsessional state. Degree varies greatly from virtually absent to seriously life altering. “

It is the filaments.  Over the years I have  seen a smattering of Morgellons and they bring in the filaments and I look at them under the microscope. I see hairs, and threads, and non-specific detritus, but never anything that resembles the results of a living creature. I have looked carefully at the skin of these patients, and have never seen an intradermal fiber.

So you can see why I am skeptical that this is anything but a version of delusions of parasitism.  In one series of 25 patients

Most patients in this study (23 out of 25) had prior psychiatric diagnoses (most determined by specialists) as follows: 11 out of 25 bipolar disease; 7 out of 25 Adult ADD; 4 out of 25 Obsessive Compulsive Disorder (OCD); and 1 out of 25 Schizophrenia.

The same study had a hodgepodge of lab abnormalities, but there were not compared to matched controls. It may well be that the patients have some underlying inflammatory process that causes skin lesions and a feeling of the creepy crawlies and are misidentifying standard environmental material as associated with the diseases.  But I am skeptical.

Against this hypothesis are the case reports where Morgellons is cured with Pimozide, an antipsychotic.  Delusions of parasitism is often treated with olanzapine, another antipsychotic, but others have suggested pimozide is superior.  Most infections would be unlikely to respond to antipsychotics, but I have never been satisfied with response to treatment as a means for confirming a diagnosis, that is a path better not followed without good reason. In my world docs often think if patients are improving on antibiotics the response is considered evidence of infection.  I know better. But given the lack of a demonstrable parasite, a response to psychiatric medications is certainly suggestive.

So response to anti-psychotics would suggest patients with Morgellons could have  a psychosis, but I keep in mind it does not necessarily extrapolate to all patients.  I try to bear in mind that when patients present with odd symptoms that they attribute to worms and parasites, it may be simple misunderstanding.

As of this entry, no one has fulfilled Kochs postulates with Morgellons.

For those not immersed in infectious diseases, Koccs postulates were a series of criteria to demonstrate the causality of infections,  Here there are, with the word filament substituted for microorganisms:

1) The filament must be found in abundance in all organisms suffering from the disease, but should not be found in healthy organisms.
2) The micro filaments must be isolated from a diseased organism and grown in pure culture.
3) The cultured filament should cause disease when introduced into a healthy organism.
4) The filament must be re isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.

So far proponents of the disease are 0 for 4.

But if this disease is due something that can be visualized with the naked eye or a magnifying glass, it should be simple enough to characterize.  Lets say you are a DNP and a member of ILADS. Well, I have to admit that you have lost some credibility with me.  But lets say you saw a series of patients with Morgellons and you could see the fibersThere, right there. You can see them.  Would you not biopsy the fibers?  Would you not try to characterize them?  Nope.  So aggravating. It boggles the mind that someone could have a diagnostic coup right in front of them and let it pass.

Delusions of parasitism can be nosocomial. Well, not truly delusions, but patients can be convinced they have parasites when, in fact, they do not, and waste serious amounts of time and cash in pursuit of an imaginary diagnoses.

I recently saw a patient who had unexplained abdominal pain for a year and a half.  The patient had an extensive evaluation and no explanation for the symptoms, and,  looking for answers,  eventually wandered into the arms of a naturopath.

One of the shows my eldest liked to watch was I Love the 80′s on VH1.  The 80′s was the decade I was in medical school, residency and fellowship.  When I watched I Love the 80′s I recognized virtually nothing of popular culture of time.  Not the TV shows, the hair styles, the music. Nothing.   It really brought home how consuming becoming a doc and a subspecialist is.  A decade of my life was spent understanding medicine and infectious diseases. I am not complaining, mind you.  There are lots of reasons people go to an alt med provider, but I do not think gullibility is on the list.

The patient with the abdominal pain and their spouse are educated people, why would they see a naturopath?

Looking for answers.  Their areas of knowledge are totally removed from medicine and science, and while it is popular to bemoan the science illiteracy of the US population, and it is sorry, if your career arc was law, or finance or auto repair, or stoner at the 7/11,  are you going to find time to become literate in medicine?  Doubt it.  I can’t design a bridge or fly a jet.  Why would I expect someone who has mastered these tasks to understand medicine?  There are just so many hours in a day to accomplish tasks.

I have, as a further example, zero idea if my mechanic is giving me good diagnostic and repair advice on my car.  I have to take everything he says on faith.  I have neither the time or inclination to become expert in car repair, and most people do not have the time to become fluent in medicine.  Am I gullible?  I do not think so.

I had my epiphany years ago when I told a father of a meningitis patient, your daughter has an infection in the fluid that surrounds her brain and he replied, could you phrase that in a way I can understand it?  He had no idea of basic brain anatomy or infections, and why would he? So I drew him a picture.  It helped.

So anyway, the patient wandered  into the lair of a naturopath and was diagnosed with parasites.  Now mind you, the patient did not have symptoms that could be reasonably ascribed to parasites or worms, and, more importantly, had no risks for parasites or worms.  The industrialized West is reasonably free of worms and their brethren.  The naturopath did not do serology or blood work or even a simple stool study looking for the eggs of various worms.  It is how I, along with a history and physical looking for the pattern of disease that marks a parasite, come to a diagnosis. No, he or she (I do not remember the pronoun used at the time) proudly used electrodiagnosis.

Proudly.  As my patient related it to me, the naturopath, a graduate of Bastyr, (if there is an legitimate opportunity for a deliberate mispronunciation, it is with Bastyr) considered herself to be an expert in parasite treatment and diagnosis.

What is electrodiagnosis you ask?

There are many devices out there, so I do not know precisely which one the patient used.

My patient said they held an electrode in each hand, the naturopathic expert in parasitology twirled a dial, and told them that the reading indicated parasites. Really.  I am proud that I did not burst out laughing during the interview, as from my perspective it was a  ludicrous joke.  But, as I mentioned, not everyone knows what I do, and EEG’s and EKG’s can also diagnoses a variety of medical problems, so why not parasite infestation?

Electrodiagnosis are said to measure disturbances in the body’s flow of “electro-magnetic energy” along “acupuncture meridians” but are expensive galvanometers that measure electrical resistance of the patient’s skin when touched by a probe. Two pseudosciences in one.  I have seen better.   It is sometimes called electroacupuncture according to Voll, or EAV, and was pulled out of Dr. Volls backside in the 1950′s.

“The basic concept for all of the ElectroDermal screening devices, was the invention of Dr. Reinhardt Voll[1], who in the 1940s, discovered that the electrical resistance of the human body is not homogenous and that meridians existed over the body which may be demonstrated as electrical fields. Furthermore, he showed that the skin is a semi-insulator to the outside environment. By the 1950s Voll had learned that the body had at least 1000 points on the skin which followed the 12 lines of the classical Chinese meridians. Each of these points, Voll[2] called a Measurement Point (MP). Working with an engineer, Fritz Werner, Voll created an instrument to measure the skin resistance at each of the acupuncture points, patterned after a technique called Galvanic Skin Resistance (GSR). This was named Point Testing. In 1953, Voll had established the procedure that became known as Electro-Acupuncture according to Voll.”

There is zero validity to making any diagnosis this way. Except, of course, the E-Meter of Scientology.  I wouldn’t want to cross the them there Scientologists. Oh no, uh uh. No way.  E-meter forever. But those other electronic diagnostic devices? Pure bunkum.  I could not say it better than Quackwatch:

“The devices  are used to diagnose nonexistent health problems, select inappropriate treatment, and defraud insurance companies. The practitioners who use them are either delusional, dishonest, or both.”

That the  American Association of Naturopathic Physicians has a position statement on electrodiagnosis that considers it experimental is another sign that naturopaths have no business taking care of people.  To quote their position paper

“There are three levels of electro-diagnosis:
a. Meridian testing: Readings are interpreted in indicate strength of specific meridians, organ strength or physiologic function.
b. Remedy testing: Variations in readings are interpreted when remedies are given to the patient either orally, to hold or put on a “testing plate” wired to the electrodiagnostic equipment. Interpretations may include sensitivities, nutritional enhancement, or improved function.
c. Energy medicines: Electrodiagnostic equipment interprets information and manufactures an energy medicine which is given to the patient to take orally.
THEREFORE IT IS THE POSITION OF THE AANP THAT:
It is appropriate that the naturopathic profession pursue scientific research regarding the reproducibility and reliability .”

There is nothing on the Pubmeds on the validity of electrodiagnosis, and, on basic principals and prior probability, to suspect that electrodiagnosis would have any utility in the diagnosis of parasites  or anything other disease.

Despite this, my patient received prolonged courses of mebendazole, thiabendazole and praziquantel, all at half doses, and all out of pocket.

Uncertain of which parasite to kill, the naturopath tried to kill them all with under-dosed medications.  Good thing, come to think of it, that he did not use his infernal contraption to diagnose cancer, who knows how many anticancer treatments would have been prescribed.

And what is an energy medication and how does one manufacture them? Besides a triple shot of espresso?  The principals of EAV have been expanded for

“BioScan (remote DNA resonant testing) – This procedure utilizes extremely sensitive EAV computerized equipment to accurately measure stressors in the body. It bombards the clients sample DNA (usually hair) with up to 10,000 frequencies to locate bacteria, viruses, pesticides, heavy metals, industrial pollutants, chemicals, parasites, foods, allergies, dental materials, trees, weeds, pollens, inhalants, molds, yeast, fungus and many other substances that poison the environment today. These stressors and related deficiencies are identified in print form for the client along with the organs and glands affected by the stressors. Supplements are suggested that resonate with the test subject and homeopathics are customized to support the body to remove the stressors and return to homeostasis.”

Only 275 dollars, plus 5 dollars shipping and handling.  And they recommend a minimum of 4 evaluations.

Try as I might, I cannot write a satisfying concluding paragraph to this entry, so I will just stop.

Posted in: Energy Medicine, Naturopathy, Science and Medicine

Leave a Comment (91) ↓

91 thoughts on “Parasites

  1. BillyJoe says:

    “Try as I might, I cannot write a satisfying concluding paragraph to this entry, so I will just stop.”

    Despair. :(

    I had ther same idea, but try as I might, I could not help writing a reply instead of just letting it stop.

  2. majkinetor says:

    “There is nothing on the Pubmeds on the validity of electrodiagnosis”
    Some information is presented in the paper “Electromagnetic Signals from Bacterial DNA”

    Its not about parasites nor electrodiagnosis, however, in future, there might be some diagnostic techniques that use this phenomena as authors concluded:

    The electromagnetic signals between different bacteria within a community is a “wireless” version of intercellular communication found in bacterial communities connected by “nanowires”. The wireless broadcasts can in principle be of both the AM and FM variety due to the magnetic flux periodicity in electron energy spectra in bacterial DNA orbital motions. AM signals can arise
    from the Bohr transition frequencies between different electronic energy orbitals about the DNA loops. FM modulation signals can arise from the Faraday law voltage controlled signal modulation frequency in Eq.(24). There is considerable work required to extract the bioinformation contained in these electromagnetic signals.

  3. Jan Willem Nienhuys says:

    “the first microscopist, Leuvenhoeck,”

    It was Antoni van Leeuwenhoeck , see

    http://en.wikipedia.org/wiki/Antonie_van_Leeuwenhoek

    (the spelling of his first name varies, but I take this one because a Dutch cancer hospital is called Antoni van Leeuwenhoek Ziekenhuis )

  4. hat_eater says:

    Do the parasite infestations fulfill the Koch criteria as a general rule? I’m genuinely curious, because I didn’t thought so.
    Note: I’m NOT saying the Morgellon’s disease is caused by parasites. Sometimes I too can feel distinctive crawling sensation on my skin, especially after I go to bed. If I just expelled a spider from the house, the sensation is virtually guaranteed to manifest itself. I learned to ignore it until it ceases. So I conclude it’s mostly in the brain, magnifying whatever noise there is in the signal.

  5. GLaDOS says:

    Speaking of clueless, I remember when I first had a patient who was under the care of a naturopath. This was circa 1996-97. I asked what that was and my patient explained that it was an MD with some specialized training in nutrition and herbalism. I new that “naturopathy” was not one of the 24 approved medical specialty boards nor any of their sub-specialty areas, so I figured it was one of those extra-credit type “boards” or areas of focus some doctors take an interest in. I had two other patients later also seeing naturopaths. Both assured me the naturopaths were MDs.

    Only after reading this web site did I learn that naturopaths were NDs, not MDs (although a few MDs do seek ND degrees, due to acquired brain injury).

    Only after reading Dr. Atwood’s account of the move to license NDs in Massachusetts did I learn that naturopathy was anti-medicine.

  6. superdave says:

    There was so much to comment on here but I’ll choose the communication angle. One of the lessons I have learned from my PhD studies is how easy it is to forget what common knowledge people have when most of the people you interact with on a daily basis (other grad students and professors) has the same core knowledge as you.

  7. windriven says:

    @majkinetor

    “The wireless broadcasts can in principle be of both the AM and FM variety due to the magnetic flux periodicity in electron energy spectra in bacterial DNA orbital motions.”

    I understand that one hypothesis is that bacterial communities tuned to AM turn pathogenic by too much exposure to Rush Limbaugh while those tuned to certain FM bands resonate in a healthy groove. It is speculated that these bacterial communities respond especially well to hash oil (see H Hall earlier this week).

  8. Jan Willem Nienhuys says:

    Oops: Leeuwenhoeck -> Leeuwenhoek (without the c). It’s pronounced something like lay-when-hook.

    One version of EAV (ElectroAcupuncture according to Voll) has (as explained under b in the position paper of the AANP) a holder in which one places small vials with homeopathic remedies.

    The idea of EAV is that any reading of an acupuncture point that is (A) too high or (B) too low or (C) shows an anomalous Zeigerabfall indicates that the acupuncture point, or rather the organ connected to it has something wrong.

    Zeigerabfall is the phenomonon that the resistance of the acupuncturepunt first seems to be low, but then, over the course of about a minute during which the measuring elektrode is firmly pressed against the acupuncture point, the current indicator falls back (i.e. resistance increases).

    However, if the measurement is repeated by putting a bunch of vials in the holder, the healing rays will somehow affect the measurement, and if the measurement ‘normalises’ then one knows that the required medicine is in the holder. One then identifies the active vial, I suppose, by a process of successively halving the number of vials.

    Some research into EAV has been done. I only quote:

    M.A. Klein Breteler & J.J. Schipperheyn
    De diagnostische waarde van elektroacupunctuur volgens Voll bij
    hartaandoeningen
    Huisarts en wetenschap 1990, vol. 33 (7), p. 268-272.

    In a blinded investigation 37 heart patients and 13 healthy volunteers were examined. 600 acupuncture points were measured. Because of the presence of cardiac abnormalities 69 of these points should have shown deviant values. They didn’t.

    The points (12 per test subject) were all on the hand. The values of the measurements were corrected for differences of skin thickness between patients.

    Here is the table. The column ‘bad’ means the measured value was either too low, or too high or the Zeigerabfall too large.
    ………….bad……… good……….all
    sick……….35………….34……….69
    healthy…227………..304……..531
    Total…….262………..338…….600

    I hope you don’t need any calculation to see that this indeed is a wothless method.

    Later an electroacupuncturist complained that this research was no good, becasue the patient got medication. But that is nonsense: damaged valves, infarction scars etc. don’t go away by medication.

    There are older researches too, from around 1975, and lots of articles in the superstitious literature.

  9. Ed Uthman says:

    I am a pathologist in a community hospital-based practice. I actually saw a Morgellons patient before it was redescribed in the recent medical literature. It was a middle-aged, well-to-do lady who insisted that she had some sort of tiny bugs crawling on her and causing sores. She insisted on being admitted as an inpatient, cost being no object. Since she was a VIP, I went up and did an exam myself, collecting scrapings from what she described as “sores.” (I couldn’t see any skin lesions.) Under the microscope, the scrapings showed skeins of blue and black fibers, best characterized as “lint.” Imagine my surprise when I saw the same exact type of case on the Internet a few years later. Finally I was able to give a definitive diagnosis. Better late than never!

  10. BillyJoe says:

    majkinetor,

    ““Electromagnetic Signals from Bacterial DNA”’

    Luc Montagnier anyone?
    How to go from noble to ignoble in a single twist.

    Majkinetor, you need to learn how to recognise BS when you see it.

  11. daijiyobu says:

    This is, by the way, “Naturopathy Awareness Month” in New York State,

    http://naturocrit.blogspot.com/2011/05/nyanp-reminds-me-that-may-2011-is.html .

    -r.c.

  12. WilliamLawrenceUtridge says:

    From the abstract:

    …electromagnetic signals hold true for muck lower frequencies

    Proofreading fail. Must be some editorial board they have there.

    The wireless broadcasts can in principle be of both the AM and FM variety due to the magnetic flux periodicity in electron energy spectra in bacterial DNA orbital motions. AM signals can arise from the Bohr transition frequencies between different electronic energy orbitals about the DNA loops.

    What do these “nanowires” transmit? What evolutionary purpose do they serve? How are the signals interpreted? The key words, I think, are “in principle”. It seems like having electrons changing orbitals around DNA would be a bad idea. Correct me if I’m wrong, but wouldn’t that make the likelyhood of mutations much higher? And DNA is a fairly chaotic, heterogeneous mass of molecules, I have a hard time seeing it broadcast anything coherent. It would be like unspooling a magnetic tape, waving a radio over it and expecting Beethoven.

    Do you know the supplier of their equipment? Was it perhaps Rockwell Automations?

    http://www.youtube.com/watch?v=PnkT6C9Ose8

  13. tanha says:

    “the American Association of Naturopathic Physicians has a position statement on electrodiagnosis”

    I looked on the AANP website and couldn’t find links to “position statements” — how can I look up other position statements rather than take Stephen Barret’s word for it.

  14. TsuDhoNimh says:

    “Endemial distemper” in those days merely meant a widespread affliction of some sort that was not a contagious distemper … poverty, drunkenness, and this children’s “disease” with the hairy eruptions were “endemial” and plague was a contagious distemper.

    It’s been overlooked or ignored that morgellons was a disease of “coughs and convulsions” and the hairy eruption was a good sign: “as I long ago observed in that endemial distemper of little children in Languedoc, called the morgellons, wherein they critically break out with harsh hairs on their backs, which takes off the unquiet symptoms of the disease, and delivers them from coughs and convulsions.” … it was a “crisis” sign and indicated a favourable prognosis with an end to the coughing and convulsing.

    I was the med tech you sent those samples to, and there’s a lot of UFLC (unidentifiable funny-looking crap) in stool and skin specimens. 99% of the task in teaching students how to do O&P was teaching them what was not a parasite.

  15. daijiyobu says:

    @tanha:

    The AANP has quite ‘buried’ some of their more embarrassing position statements.

    Try this web search parameter through google.com,

    site:naturopathic.org “position paper”

    for what can be publicly accessed, with the quotes.

    AANP hasn’t ‘buried’ their position statement on homeopathy yet, and all this while c2011 their licensure exam still labels science-ejected homeopathy a “clinical science”.

    Perhaps you’d have to log on to their site to likely gain access to other nonpublic AANP position statements.

    Let me hazard this ‘science position statement’ / summation of what AANP regards as scientific, too:

    “anything we please”.

    If you want troves of NDs doing EAV look to Canada and Australia, where they love it. Australia also throws in a lot of iridology.

    -r.c.

  16. Zetetic says:

    If you want a gigantic eyeful of this kind of delusion, trek on over to the Curezone, it’s highly entertaining! And sad too.

  17. Grioarvolr says:

    My favorite part of the article that Mark cited above by the DNP/ILADS member (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047951/?tool=pubmed#b7-ccid-3-067%29) is that all of the mentions in the paper about electronic microscopic examination of the Morgellon’s fibers, including the claim that they were looked at by the FBI forensics laboratory and that they “do not resemble textiles or any other manmade substance. In fact, the fibers are virtually indestructible by heat or chemical means, making analysis difficult by conventional methods”, all are cited from the same source in the reference section of the paper…

    …and that source is a “personal communication.”

    Talk about failing both the science-based medicine AND evidence-based medicine tests.

  18. Jan Willem Nienhuys says:

    I couldn’t find the AANP pp in their site, but on archive.org I found how it looked like a long time ago:

    http://replay.web.archive.org/20010212034917/http://www.naturopathic.org/position.papers/PP.electrodiagnosis.html

  19. Skin parasites? Real or delusional, yuck. I had scabies once when I was a kid, wouldn’t care to repeat that.

    Drat, now I’m all itchy.

    Thought I had heard something about this before. Here’s another doctor’s account in Discover.

    http://discovermagazine.com/2006/dec/vital-signs-sore-mystery/article_view?b_start:int=1&-C=

    Similar but with an interest little twist of the source of the sores (in that particular patient.)

  20. Zetetic says:

    majkinetor:

    You’re sounding more and more like “Doc” Emmett Brown from “Back to the Future”!

  21. Calli Arcale says:

    While Morgellons seems to have become an Internet meme as of 2002, I remember encountering someone around that time or possibly a bit earlier who had a different variation on the idea, with an interesting twist that the fibers he extracted were apparently able to fluoresce under UV light. He actually saw a doctor who specialized in diagnosing and removing these things, which he said were actually secretly implanted by aliens working in cahoots with the US government. (Of course, it is entirely possible that this doctor was deceiving his patients. Such a thing is not particularly novel, and it’s of course interesting that nobody else seemed able to see these things.) I believe he thought the objects were alien parasites, but it’s been a few years; he might’ve thought they were devices of some kind.

    Still, having the sensation of movement under the skin when there is nothing to produce the movement is not new, and neither is people producing things they’ve picked off of themselves and attributed to the movements. These people may not be actually psychotic; they could have a signal processing issue in the brain that has driven them beyond distraction, forcing them to look for an explanation and any hope of relief. Might the anti-psychotics be acting on that processing issue, relieving the phantom sensations of movement? Without that distraction, they may stop looking for causes and thus stop noticing apparent fibers.

  22. @ windriven – lol

    just another danger of talk radio, I guess.

  23. Watcher says:

    The fact that the people all exhibit some form of mental disability, and that people observe less “parasitism” when treated with an antipsychotic is enough for me.

  24. windriven says:

    @WilliamLawrenceUtridge

    “Proofreading fail. Must be some editorial board they have there. ”

    Dr. Gorski assures me that technical journals don’t have the resources to edit for spelling, grammar or punctuation. But to me it makes it look as if both the authors and the editors lack respect for their work.

    Addressing the content of the article majkinetor linked to, I wonder if it isn’t a joke or spoof? I am a physicist by education and while I readily admit that this article is well afield from my area of expertise, at 6 this morning the article struck me as utter nonsense – and pieces of it as gibberish. The characterization of electrons looping around DNA helices like so many children sliding down a playground slide strikes me as ludicrous. From whence do the potential differences that move these electrons arise? Electrons do not willy-nilly abandon the nuclei that they orbit and march hand in hand down the helix for a picnic in the telomeres.

    More to the point, there was no detailed description of the experimental apparatus, no discussion of how their coil-around-the-test-tube was shielded from extraneous sources of electromagnetic radiation, nothing to describe the preparation of the sample to eliminate potential sources of contamination.

    Were Fleischmann or Pons listed as authors?

  25. The intense focus and repetitive examining of the skin sounds a bit obsessive compulsive to me. Anyone know if patients experience any relief with the SSRI’s that are commonly prescribed with OCD?

  26. S.C. former shruggie says:

    Two comments on this.

    Number one, I have woo-succeptible family, some previously in the care of naturopaths, distrustful of doctors and sometimes asking the unprofessional, inexpert opinion of me, a mere undergrad, instead. It’s a bad situation, and it’s why I’m here. The stuff they tell me needs debunking.

    My experience with Morgellons disease under the microscope: the fibers are 100% cotton. Zero acryllic or polyester. I’m thinking t-shirts abrade on skin while people wear ‘em.

    Second, I’ve had personal experience with delusional parasitism. It’s not fun. It started about two weeks after my first sleepless night of calling the police about a neighbour’s extremely violent abusive husband. It ended months later, shortly after she had finally pressed charges, shortly after I had moved, and around the same time the nightmares ended.

    Post hoc ergo propter hoc? Maybe. But it’s much more likely than drug-resistant biting insects that couldn’t be diagnosed by doctors and vanished spontaneously.

    Do depressed people sometimes get skin itch? Are they just more likely to pay close attention to every minor irritant? Not sure, but the topical insecticides did list skin drying and itch as consequences, so once I got started, it was sure to continue. Did endless violence and less than ten hours of sleep a week basically drive me crazy? I can’t be sure with anything like scientific rigor, but it’s my best guess.

  27. Jan Willem Nienhuys says:

    Actually morgellons has a wikipedia article dedicated to it:

    http://en.wikipedia.org/wiki/Morgellons

    One way of studying the disease is examining its international distribution. Diseases of such a mysterious nature often stop at the border (namely where people are not reached by the patient associations).

    The March/April 2011 issue of Skeptical Inquirer (35.2) had a one page article on it.

  28. stb says:

    “with an interesting twist that the fibers he extracted were apparently able to fluoresce under UV light.”

    I work for a clothing company and a large part of my job is evaluating fabric samples in a light box. I can tell you that a great many fabrics (fibers) will fluoresce under UV light because they have been treated with finishes to enhance brightness. Most laundry detergents will produce the same effect. If you look closely at the label on your detergent, it will likely mention “optical brighteners” in the ingredients. Wash your white t-shirt with ordinary laundry detergent and then look at it under a UV light and you too can witness the interesting twist.

  29. Oh well, I’m deep into procrastination mode right now, so here’s a run down on Psychodermatology.

    Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders
    Mohammad Jafferany, M.D.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911167/

  30. LovleAnjel says:

    I remember, after reading about Morgellons for the first time, cooking with my stovetop light on and seeing fibers gently waft off my arms under the fan. I freaked out until I remember how shitty the carpets in our apartment were.

    I read a story about a woman who discovered she had Morgellons, and nothing worked…except moving to an apartment with all hardwood floors. She didn’t make the connection.

    As for the erupting hairs on those poor children, isn’t hair growth a result of some malnutrition? Anorexics often grow extra body hair as their bodies try to retain warmth.

  31. daedalus2u says:

    I once had a terrible parasite scare with my ~1 year old son. We found a worm in his diaper in his car seat. After suitably freaking out, we took the diaper plus worm to the clinic where they identified it as a meal moth larva. I was completely relieved with the diagnosis, his mother was not, until I explained that a meal moth larva could not survive passage through his gut, it had to have come from somewhere else, such as the meal moth larva infestation we were having at the time, and which were also living in the rice cakes that she gave to him while driving to keep him amused and busy, bits of which ended up in his car seat which he was able to hunt for and find on his own.

    I have a blog post on Morgellons.

    http://daedalus2u.blogspot.com/2008/02/morgellons-disease-hallucinatory.html

    I think the skin sensations are real, but do to low NO in the skin potentiating mast cells to degranulate, sort of like what happens after you have taken too much cocaine or when you have liver failure. I think that SSRIs help, but not because there is a “mental” problem, but because what triggers mast cell degranulation is serotonin, and if you whack mast cells with an SSRI, they have to respond by better regulating their serotonin uptake and release.

  32. WilliamLawrenceUtridge says:

    I gotta say daedalus2u, the whole NO thing may be brilliantly supported and fully supported by a multitude of references but your comments always bring to mind Maslow’s Hammer. One of these days I should probably click on that link in your name and do some reading…

    Anyway, when I was briefly interested in Morgellons a while back, I stumbled on http://morgellonswatch.com/ and that pretty much ended my interest. Good website. Finding out that it overlaps with CFS has doubled-down my disinterest. I realize it’s complicated, it’s not well understood, it’s contentious, but much like placebo medicines (acupuncture, homeopathy, etc.) no-one seems to want to admit CFS might be psychogenic, at least in part. If we ever do figure it out, I bet a shiny dollar that it’ll turn out to be at least two different “diseases”, if not a dozen.

  33. Ali771 says:

    Really enjoyed this, thanks. Fascinating.
    I think a lot of this is due to misplaced anxiety (at least in the instances where there isn’t a much more serious psychosis). I had to do my years looking at “alternative cures” too. What a sense of control they give us. Often in cases like this, both the problem and the cure are illusions. As a recovered hypochondraic, I finally accepted the healing I most needed was in the mind and not the body.

  34. BillyJoe says:

    windriven,

    “Addressing the content of the article majkinetor linked to, I wonder if it isn’t a joke or spoof? ”

    Believe it or not, it is not a spoof.
    But it certainly is a joke, if you know what I mean.
    Perhaps you don’t remember Luc Montagnier? I referenced him in my second reply here. He won the Nobel prize for his role in the discovery of HIV. And then promptly joined a few other Nobel prize winners by turning from real science to pseudoscience. The ideas expressed in the article linked to by majkinetor orginated with Luc Montagnier. To get some idea to the depths to which this Nobel prize winner has slid, he uses his ideas to explain how homoeopathy works.

  35. BillyJoe says:

    WLU,

    “I gotta say daedalus2u, the whole NO thing may be brilliantly supported and fully supported by a multitude of references but your comments always bring to mind Maslow’s Hammer.”

    I don’t think you’re the only one. :D

    (Though I’m not going to believe a word of his NOnsence, I still enjoy reading his posts. Maybe one day, it will come out that he was right all along, but until then…)

  36. daedalus2u says:

    WLU, I appreciate that to many, my NO ideas are not yet compelling. That does not make them wrong. What makes them wrong is if they don’t match reality. So far I have not been able to find or obtain data that they do not match reality. If or when I do, I will change my ideas until they do match reality.

    All disorders are mediated by physiology, even disorders that are psychogenic because all psychological effects are mediated by physiology too. Disorders that are called psychogenic are closely coupled to mental activity, but that coupling is through physiology because mental activity is only physiology too. Much of that coupling is mediated through NO, and when you perturb basal NO/NOx/RSNO status, you perturb the NO signaling that couples and regulates the physiology of the brain to mental activity.

    A major stress response is low NO, and so perturbed NO/NOx status perturbs physiology such that it mimics high stress. That is why stress makes essentially all neuropsychiactric disorders worse including things like Morgellons, depression, PTSD, anxiety, OCD, and psychosis. Sufficient stress of the right type can cause all of these things in otherwise healthy people.

  37. WilliamLawrenceUtridge says:

    All disorders are mediated by physiology, but not all physiology is mediated by NO. Your comments don’t have the single-focus unmediated lunacy of say, that guy who thinks breathing can cure diabetes, but the regularity with which NO pops up suggests singular focus. It’s not that I think you’re wrong, it’s just that my eyes glaze over every time I see an angry negation. NO may be involved in nearly all chemical reactions in the body (I have no idea) but that doesn’t mean it’s the Mother of All Dysfunctions.

    Fortunately your NO-unrelated comments are usually interesting, so I forgive you :)

  38. ccbowers says:

    “That does not make them wrong. What makes them wrong is if they don’t match reality.”

    The problem is that they go way beyond the evidence. Sure physiology is involved in disorders, but there could be another person who wants to relate everything to the pH of microenvironments or another person to the action of ion pumps, etc. Sure these are all everywhere, but they are everywhere because they are part of normal physiology…. you tend to see causes in places that are more likely the resulting pathophysiology that results from a more-likely cause.

  39. kirkmc says:

    Interestingly, the Guardian published a long article about this today:

    http://www.guardian.co.uk/lifeandstyle/2011/may/07/morgellons-mysterious-illness

  40. daedalus2u says:

    WLU not everything in physiology is NO, but NO is used in a great many of the control pathways that regulate physiology. NO is used as much in physiology as a control parameter as electricity is used in a computer to control information flow. The analogy is not that good because computers are digital and physiology is mostly analog (at least most of the control mediated by NO is analog, a lot of information processing in the brain is quasi-digital). At a fine enough scale nothing is analog because we are comprised of discrete molecules. NO works on both scales, analog and digital, so it is complicated and extremely difficult to work with experimentally. NO can’t be measured on the time, concentration and length scales that it is important. You can’t measure what electricity is doing inside the latest Pentium chip using an analog volt meter either. That doesn’t prove electricity is not important inside those chips.

    Cc, you don’t know what the evidence is, so you can’t know if what I am saying goes way beyond it. You are simply asserting that because you don’t know what the evidence is and so you don’t appreciate how what I am saying is consistent with that evidence. You can’t be a skeptic and argue from other than facts and logic. If you don’t know the NO literature, you can’t argue that what I am saying is inconsistent with it.

  41. colli037 says:

    As a neurologist at a pain center, I have seen similar patients, usually to “rule out” a neurologic cause (which is easy most of the time).

    The feeling of “itch” is a funny topic, there area apparently specific receptors (can’t locate my reference) for the “itch” sensation, but not much is known about them, and unfortunately we don’t have a specific blocker for the “itch” like we do with pain (opioid receptors and opioid agonists).

    There is currently research looking for this, as so many diseases cause itch as a symptom/side effect. The current meds (antihistamines) only work if histamine is the cause for itch.

    tim

  42. ccbowers says:

    “Cc, you don’t know what the evidence is, so you can’t know if what I am saying goes way beyond it.”

    I do not need to know all of the basic research in NO physiology in order to realize that you go beyond the eivdence with respect certain disease states. You tend to imply an arrow of causality from basic research in NO into disease states that perhaps you don’t fully understand outside of the contributions of NO physiology. Where are all of the clinical applications of your assertions?

  43. ccbowers says:

    What I mean to say daedalus, is that I am taking your comments about NO physiology at face value, and I am saying that your conclusions are beyond the evidence regarding various disease states. Whenever anyone takes a bit of basic research and implies a specific clinical effect, it is going beyond the evidence to some degree. I assume that you are knowingly doing this most of the time (educated speculation), but occasionally it appears that you do not. Maybe it is simply my misinterpretation of what you are saying, because generally you are good at seeing the logical flaws in others.

  44. Newcoaster says:

    I haven’t seen a Morgellon’s patient yet, but I expect I will eventually, as the nutters of the world have internet access, and this meme is spread online. I suspect I will have as much success as I do with the Chronic Lyme Disease, and EMF Sensitives that have crossed my door.

    In my ER career, I remember a particular cocaine addict who had delusional parasitism. Bit of a sad case, as he was a very successful realtor who had developed a taste for the white powder as his commissions rose with the stock market bubble of a decade ago.

    He presented one evening covered in sores…and like your “booger saver”, he had saved the scabs he’d picked off his excoriated body in an old baby food jar for me to examine. The thing that made him most memorable was his “cure” for the problem. For unknown reasons he had decided that pouring alcohol into his ears could keep things under control. He had a 7-11 Big Gulp container filled with overproof rum, and he periodically tilted his head, and attempted to pour this in his ear canals. Needless to say, his aim wasn’t the best, and his clothing was soaked with rum, as was the exam room where he had been waiting.

  45. WaltFrench says:

    @Jan Willem Nienhuys, your description of the tests is at odds with the tabular data, so I can’t assess the utility of the test. As shown, it looks like it could be suggestive. Could you include a chi-square stat with the correction?

  46. daedalus2u says:

    cc, you do appreciate that you are arguing from personal incredulity don’t you? You may think that experience on other areas “holds over” into this one too, but it doesn’t. You are not taking my statements at face value, and you shouldn’t. The only way you can verify them is to learn the details themselves. If you don’t want to do that, then you shouldn’t, but there aren’t any shortcuts. You can’t understand if I am right or not without understanding the details and you can’t understand the details without understanding the details. If you don’t know the details, you can’t assume that the details fit some preconceived idea.

    Newcaster, cocaine causes symptoms just like Morgellons because of the hyper-potentiation of mast cells by the low NO that cocaine causes. They become so sensitive that they degranulate spontaneously and that degranulation propagates. When you have a propagating itchy creepy crawly feeling in your skin, the pattern recognition that has evolved over millions of years interprets that as insects crawling on or under the skin. That is why I call it a hallucination and not a delusion.

  47. TsuDhoNimh says:

    Read the Guardian article … it sounds like a rash or excema that originally had organic causes has been maintained by over-treatment and scratching and abuse of the skin.

    “Paul … has four showers a day and steam-cleans his clothes” Four showers a day will remove EVERY bit of skin oil you have, resulting in dry, itching skin with lesions.

    His original problem was probably contact dermatitis from cleaning solutions used on theater seats.

    The “spines”? Body hairs held erect by the swollen rash.

    “I meet Margot, a midwife from Ramsgate who has resorted to bathing in bleach to rid herself of morgellons.” And what does bathing in bleach do to normal skin?

    “I put a sweatshirt I’d been wearing in the garden over my arm and there was this intense burning, sticking sensation. I thought it was cactus spines. I began picking to get them out, but it wasn’t long before it was all over my body. A number of insects, especially caterpillars, have toxin-filled hairs that cause painful burning and itching. It’s a hazard of gardening.

    One of the cases at the Morgellon’s support site reported seeing moving “orange” specks and an intense itching … sounds like harvest mite larvae to me. Her response was to scrub herself raw in the shower and she has had “morgellons” ever since.

  48. Bogeymama says:

    After I browsed through this post yesterday, I turned on the TV while I was preparing dinner – and it was an episode of Mystery ER devoted to Morgellan’s. I didn’t have a chance to see the whole thing, but I do remember it was a nurse who they tested for lupus / shingles, etc, before she started showing them the filaments. In the end she is still on extended stress leave and is unable to return to work. I didn’t see how they treated her, but I remember hearing some discussion of anti-parasitics. Very interesting post!

  49. Jan Willem Nienhuys says:

    @ WaltFrench

    There were 50 subjects, with each 12 acupuncture points on the hand(s) related to the heart or parts thereof. If you wish, I can look up for you which ones exactly.

    So together 600 points. According to acupuncture lore some of the points on the hands of the 37 patients with problems should procedure the verdict ‘sick’. As a matter of fact these 37 patients had precisely 69 such points. Of course someone having infarction scars will have different such points from someone with valve defects or pericarditis. As you can see, from the 600 points tested, actually 262 tested ‘bad’, and among the 69 points that should have tested ‘bad’ (according to the cardiological diagnosis), only 35 did.

    If you insist, Fisher’s exact test yields p=0.13 (one tailed). The test yields 49% false negatives, and 43% false negatives. That’s ludicrous for a test.

  50. I find it fascinating that no one has talked about little kids getting intestinal parasites. I grew up on a farm, and parasites were indeed an issue. I’ve had animals die of liver fluke, for example. To automatically dismiss intestinal parasites as being all in someone’s head bespeaks a certain contempt for the patient.

  51. Harriet Hall says:

    @ Courtney Ostaff “To automatically dismiss intestinal parasites as being all in someone’s head bespeaks a certain contempt for the patient.”

    No one has dismissed intestinal parasites. Please read again. The discussion is not about real verifiable parasites.

  52. shadowmouse says:

    @ Courtney Ostaff (and everyone else):

    Most parasites are species-specific and will not produce any infestations in a non-standard host.

    An example: cat ear mites won’t make a home in your ears if your feline brings ‘em home.

    Pinworms ARE passed from human to human, often in a daycare situations that keep reinfesting everyone. Stop blaming your pets, and don’t call your vet when your child gets diagnosed.(yes, this is a common problem…)

  53. @shadowmouseon

    Some parasites effect one species only, some parasites can be passed from pets or other animal to human (or vise versa, I assume).

    It’s unlikely that the common pet owner is going to keep a list of which is which, so why not ask their Vet?

    Here’s a list of diseases (including parasites) which can be passed from other animals to our species.

    http://www.cdc.gov/healthypets/browse_by_diseases.htm

  54. Jan Willem Nienhuys says:

    @ WaltFrench
    I calculated chi-squared, this gives 1.578834 with one degeree of freedom, so p=0.21; however witth continuity correction we get chi-schared = 1.2713204, yielding p=0.26; as a chi-squared test more or less by defintion is two-tailed, this matches the previously mentioned one-tailed p=0.13 from the Fisher’s Exact Test.

  55. shadowmouse says:

    @ michelinmichigan:

    That list is mostly fungi/bacteria/viral vectors, I was talking about actual parasites like nemotodes.

    If you or a family member gets diagnosed with a zoonotic illness, you need to consult a human physician (or just ring up Dr Crislip anytime…) for information and treatment. If your pet is potentially implicated in causing the infection that’s when you consult your vet.

    FYI – cats are blamed for passing on Toxoplasmosis when in fact most people have already been exposed (and have a resulting immunity) through eating infected beef.

  56. LMA says:

    I just read the linked article from the British papers and then three pages of the related posts and the only appropriate response seems to be: OMG! Virtually every comment there that didn’t 1. link to *this* article or 2. talk about how they started itching when reading the story about people with terrible itches was 3. a textbook example of what I think we should heretofore name “Internet Assisted Psychosis.” So many seemingly literate yet completely crazy references to Lyme disease (it’s a place people, not a person; no apostrophe-S), petrochemicals, nuclear radiation, government/physician/pharmaceutical corporation collusion, etc. It’s surprising I didn’t see mention of Biblical/Mayan/Nostrdamemean prophecy. It’s gotta be *anything* ANYTHING except something psychiatric because that would mean I’m “crazy” rather than being a perfectly rational person except for this one weird tic I have that involves idiopathic itching!

    Last week at this time, I was pulling on a sweater and a thirty year old Mets cap, demanding my husband pull down the flag from the front porch and plugging my iPod with Springsteen’s “The Rising” on it into my Prius before racing down Route 29 heading for the District. By the time I came back at 4 in the morning and turned back on my computer, I was already reading how my spontaneous need to join in celebration with other Americans at the White House *had* to be a conspiracy organized by the CIA, NSA, Military-Industrial Complex, because it was simply *implausible* that a thousand people abruptly “knew” where to gather when Obama got Osama. Mind you, I’m a leftist, feminist, environmentalist, agnostic Jew, but my actions *had* to have been controlled by the government I rail against on a daily basis. This too is Internet Assisted Psychosis.

    I’ve got this terrible itching on my elbow. Time to get the tweezers and magnifier out, right?

  57. Jim Laidler says:

    I had my own (brief) experience of delusional parasitism the day I found head lice in my son’s hair. After tearing down to the store to get the anti-lice shampoo, washing his hair (twice), combing out nits and washing all his bedding in hot water, I found myself with a distressing itchy/crawly feeling all over my body. It passed, fortunately, but I can well imagine the torment of people who have this problem.

    I looked at the Morgellons paper you cited and was profoundly disappointed by their electron microscope “evaluation” – no image, no elemental analysis, just this one sentence:

    “Examination of the black specks by electron
    microscopy reveals that they consist of a tightly woven ball
    of black fibers.”

    Electron microscopes aren’t available in color, yet, it would appear. A true electron microscopist, seeing a “black” image in the ‘scope, would describe it as “electron dense” rather than “black”. Color is a phenomenon limited to photons (well, quarks and gluons, too, but let’s not go there).

    It’s not that the people suffering from “Morgellons” or delusional parasitism aren’t truly suffering, it’s just that their idea of what is causing the suffering is incorrect.

    Jim Laidler

  58. @Harriet Hall: I read the entire article, and then went back and read it again.

    He starts out with this:

    “I saw a patient recently for parasites. I get a sinking feeling when I see that diagnosis on the schedule, as it rarely means a real parasite. The great Pacific NW is mostly parasite free, so either it is a traveler or someone with delusions of parasitism.”

    Automatically, he dismisses local children entirely.

  59. # Courtney_Ostaff.”
    Automatically, he dismisses local children entirely.

    I assumed that children who had typical parasites were generally treated by their local pediatrician, not referred to a specialist in infectious diseases. Also, one would also think that the patients chart included the patient’s age.

    Also, doesn’t the phrase “So anyway, the patient wandered  into the lair of a naturopath and was diagnosed with parasites.  Now mind you, the patient did not have symptoms that could be reasonably ascribed to parasites or worms, and, more importantly, had no risks for parasites or worms.  The industrialized West is reasonably free of worms and their brethren.  The naturopath did not do serology or blood work or even a simple stool study looking for the eggs of various worms.  It is how I, along with a history and physical looking for the pattern of disease that marks a parasite, come to a diagnosis.” suggest that Mark Crislip does, in practice, consider real parasites when the symptoms and or risks suggest them?

  60. Harriet Hall says:

    @ Courtney

    ” it rarely means a real parasite”

    That means sometimes it is a real parasite, but that real parasites are rare in his practice area. That is a statement of fact, not a judgment that dismisses local children. Dr. Crislip always starts by doing a history and physical to either diagnose parasites or to rule them out. You are reading something into his words that simply is not there.

  61. Mark Crislip says:

    As an internest I do not take care of anyone under age 18. Every day in every way, I dismiss local children entirely. I also am not a vet, so I am pretty sure there will be no cows in the office. I dismiss them entirely. I also am not an arborist, ditto for trees. I do take care of a pooka named Harvey and keep him dewormed with homeopathic preps.

  62. “I also am not a vet, so I am pretty sure there will be no cows in the office.”

    Oy,, never say such a thing, the gods’ll be determined to send a cow around to your office now.

    Also, What is a puka? Are they contagious?

  63. Mark Crislip says:

    Sorry. Pooka. I changed the spelling in the comment; my spell checker is getting a little Dowd-y.

  64. omakii says:

    How does one ethically get a patient under delusion of parasites to take an antipsychotic?

    I imagine it must be a difficult pill to swallow. :)

  65. Just in my defense, that wasn’t a crack about spelling, I was genuinely curious about a puka, thought it might be some sort of exotic pet popular in the NW… I course, I also didn’t know what a pooka was, but that was googleable (googable?).

  66. Shoelia says:

    Well – I enjoyed your article Mark Crislip, and I love your ‘car in the garage’ analogy but…

    I have to ask you this – if you took your broken car to a garage and they couldn’t fix it, what would you do?

    Just because you spent all of the 80s studying medicine does not mean you know it all if you still can’t fix everyone!

  67. Calli Arcale says:

    stb:

    I work for a clothing company and a large part of my job is evaluating fabric samples in a light box. I can tell you that a great many fabrics (fibers) will fluoresce under UV light because they have been treated with finishes to enhance brightness. Most laundry detergents will produce the same effect.

    Absolutely. Brighteners work because our eyes can pick up a little bit of UV. Not much, but enough to notice. The sun puts out a lot of UV, so it gets reflected off our bright white shirts. I like to play with black lights; it’s fun to see how brilliantly some things glow. ;-)

    What I find interesting about the glowing fibers claimed by the government/alien implant dude was that I haven’t seen that claim made by Morgellon’s sufferers. Perhaps the glowing makes it seem more technological and alien or something, and that isn’t something that would occur to someone biased towards a terrestrial parasite as the explanation. I haven’t run into any alien-implant fiber theorists since Morgellon’s became fashionable, but I may simply be mixing with the wrong crowds. ;-)

    shadowmouse:

    Most parasites are species-specific and will not produce any infestations in a non-standard host.

    Well, most parasites will not produce a *successful*, reproducing infestation in the wrong host. Many worms will infect the wrong host; they just won’t successfully complete their life cycles. They can still cause misery in the meantime. Canine roundworms are one example. They cannot reproduce in humans (they’re hoping to be ingested by dogs so they can complete their life cycle) and typically are not fatal to humans, but it all depends on where they decide to go after entering the person’s system via the gut. Nasty places they can end up include the eye, the brain, and the liver. The parasite is doomed and cannot set up an infestation, but it can do serious harm anyway.

    Parasites are pretty cool. They have amazingly inventive life cycles, and the most interesting (in my opinion) are the ones that require multiple hosts in order to complete their cycle.

    My brother did get pinworms once, when he was in preschool. Right before we had to go on a long car trip. THAT was fun.

    BTW, re “puka” versus “pooka” — I believe “Harvey” used the spelling pooka, but both are actually legitimate spellings. I have also seen puca. They all mean a spirit which is either a large animal or capable of turning into one. Harvey was an invisible giant rabbit; other pukas in literature have been various other creatures, often visible, and not always benign. They originate in Gaelic folklore, IIRC.

  68. Calli Arcale says:

    Reading the linked Guardian article now…

    The Tulsa PD tried to figure out what the fibers were, though honestly, the methods described make me very frightened of ever being accused of a crime in Tulsa — they don’t sound like anything a scientist would come up with and more something a 10th-grade home ec student might think. Random prodding rather than a systematic evaluation. They tried burning the fibers but, notably, stopped just shy of the burning point of wool (a famously flame-resistant material which is extremely common in clothing manufacture).

    It’s also puzzling that of all the specimens collected and sent in by individuals and investigated by the Tusla PD, not one of them was identifiable. Surely even if Morgellons is real, you’d expect at least a few false diagnoses, or environmental detritus gathered along with bona fide Morgellons fibers. To have identified absolutely none of the specimens seems suspicious.

  69. Josie says:

    I have to wonder how many Morgellons patients have previously had to endure an actual parasitic infection.

    They tend to be more interesting than lil fibres in the skin –hell I had boring ol’ fibres in scabs a few weeks ago when I lopped off the tops of my fingertips with a knife (preparing the evening meal, the fibres were from the gauze I used to stop the blood from spurting out).

    Nature gives us so many interesting things to creep us out.
    Some of them give me the heebie jeebies way more than a fibre on my skin, for example, Bot Flies. Those little guys get dropped on your skin as babies, burrow their way in and feast on your flesh as they grow. When the time comes they burst forth in a magnificent display of the circle of life, flying off into the sunset to make more.

    And that’s a pretty innocuous parasite compared to the burden some populations experience around the world.

    Of course it’s only innocuous if you have just one…

  70. Shoelia “I have to ask you this – if you took your broken car to a garage and they couldn’t fix it, what would you do?
    Just because you spent all of the 80s studying medicine does not mean you know it all if you still can’t fix everyone”

    As someone who has mostly bought used cars, I can assure you that even an excellent mechanic can’t fix every car problem.

    This does not meant that they won’t do a better job diagnosing and fixing most cars than you, a non-mechanic, can do.

    It also doesn’t mean that the excellent mechanic who can’t fix all car problem, is wrong when he tells you that the transmission needs to be replace, even though you really want it to be the clutch.

  71. Just an observation. My brother was diagnosed with szizophrenia when I was a kid. At the time and at other points in his life, when his is off medication, he has had various delusions; people can read his thoughts, he can read people’s thoughts, he’s being poisoned, he’s Jesus or has Godlike power, etc.

    My father was in the habit of trying to reason or argue with my brother, thinking, I guess that my brother should just see reason or at least respect my father’s superior grasp of reality.

    This habit ended when my brother, in a fit of paranoia and anger, broke his rib.

    It is pointless to decide that a paralyzed person should be able to walk. It is also pointless to decide that a person who has a disease that effects how they sense and comprehend reality will be able to see things as you do.

    The idea, in my mind, is not just to figure out when a person is wrong about their parasite theory. That is the easy part. The idea is to figure out why they are wrong and how to help them, sometimes in spite of themselves.

  72. Prometheus says:

    Re: fabric “brighteners” – they are actually fluorescent chemicals; they absorb light energy in the near UV and fluoresce blue-white. This tends to cancel out the yellowing that occurs as white fabrics age.

    The same compounds are in the majority of white typing/printing paper, for much the same reason.

    As for Shoelia, who asks:

    I have to ask you this – if you took your broken car to a garage and they couldn’t fix it, what would you do? Just because you spent all of the 80s studying medicine does not mean you know it all if you still can’t fix everyone!

    To begin with, I don’t think Dr. Crislip is claiming to “know everything” – his claim was that he knows as much or more than almost everyone about infectious diseases and parasitic infections. In fact, I believe he specifically mentioned his weakness in the field of automotive repair.

    Secondly, not knowing what a problem is doesn’t prevent him from knowing what it isn’t. To use the car analogy, my mechanic may not know what is causing that annoying noise, but he can tell me that it’s not the transmission or the tires.

    Similarly, Dr. Crislip has seen enough parasitic infections to know that what the Morgellons patients are complaining of isn’t a parasitic infection. He may not know what the problem is (although he may strongly suspect a psychiatric disorder), but he can certainly say that it isn’t a parasitic infection.

    I am but a humble microbiologist, but this topic is within my area of expertise, in a fashion. Human parasitic infections (as opposed to bacterial or viral infections) are caused by eukaryotic organisms ranging in size and complexity from a single cell (e.g. malaria) that can only be seen under a light microscope to multicellular organisms that can be seen across the room (ick!).

    Here’s my point – NONE of those is so small that an electron microscope (EM) couldn’t resolve them as anything more than “fibres”. Even viruses (my area of interest) can be clearly resolved under an electron microscope. Yet these “parasites” show no organismal structure under the EM.

    Curious.

    Prometheus

  73. tanha says:

    Mark, I think this post would have been more effective if instead of providing a case of one naturopath “poorly treating pretend parasites” in one patient, you looked at big centers (Parisitology Center) where MDs “treat pretend parasites” in hundreds of patients.

    http://www.parasitetesting.com/index.cfm

    I really enjoyed how funny the beginning of your post was but then it got weak with your case and the 2001 Stephen Barrett reference.

  74. GLaDOS says:

    Eh Stephen Barrett is pretty cool. Takes on alt med and doesn’t afraid of anybody.

  75. Chris says:

    Courtney_Ostaff:

    Automatically, he dismisses local children entirely.

    Perhaps it is because I have teenagers that I interpreted Ms. Ostaff comment that the children are also parasites! The type of parasites that need a ride somewhere, or more cash, or find their dad’s secret stash of chocolate (not mine, I have better hiding places). ;-)

    On a more serious note, there is a fascinating podcast on parasites: This Week in Parasitism. Professor Despommier, who is semi-retired, is a mesmerizing story teller. The podcast on hookworm, with a look at the American Civil War was incredible. Six lectures from his last class can be downloaded here (I haven’t seen them, yet).

  76. Chris, hehe, I’ve certainly had days where the kids made we want to pull out my hair, they’ve never made me pick at my skin or see strange blue fibers, but they’re not teenagers yet, so that may come.

  77. Chris says:

    Here is an example of what you have to look forward to:
    http://www.arcamax.com/thefunnies/zits/s-873924

  78. sharon says:

    Ok so Morgellons is a type of psychiatric illness. Fair enough. But doctors need to know why patients seek alternative practitioners. “Ignorant ” patients run to naturopaths because doctors are lazy, rude, don’t listen and have put their cases in the “too hard basket” and ignored and humiliated them. Doctors have not the energy or will to play detective and use logical old fashioned reasoning to arrive at diagnoses. 2 examples: A friend of mine and her daughter both started itching terribly. They had scratched themselves to bits, taken antihistamines, used steroid creams etc to no avail. Several GPs said they had scabies- due to the mother teaching at a school in a low income area.Multiple applications of anti-scabies lotions did nothing. They dismissed it as “environmental allergies” No other history was taken. She came to see me in desperation. On taking a history, she had recently acquired 2 kittens from a breeder. In the recesses of my mind, I remembered a passage in an old dermatology textbook about a mite found in cats-Cheyletiella. A visit to a specialised cat vet with scrapings and microscopy confirmed the diagnosis. The vet also had never seen it before. Treatment and curing of the cats resulted in instant relief.
    Another tale: my son went to Central America to work in an orphanage and returned with chronic diarrhoea,malabsorption and a 10kg weight loss.. A gastroenterologist sat on him for 3 years telling him he had “pancreatic problems’-even when I suggested a parasite, he wouldn’t test him. Referral to another gastroenterologist resulted in a diagnosis of Blastocysitis Hominis-(mentioned by me to the first one and not regarded by the first one as a problem).It took a YEAR of new and innovative antibiotic combinations to get rid of this debilitating parasite.
    I have more examples of this type of negligence but won’t elaborate. AS a doctor myself, I have totally lost faith in local doctors.They are lazy and arrogant.
    Lost is the old fashioned art of carefully listening. Doctors need to be taught-as I was- “listen to the patient, he/she is telling you the diagnosis.”

  79. windriven says:

    @Shoelia

    “Just because you spent all of the 80s studying medicine does not mean you know it all if you still can’t fix everyone!”

    1. I’ve read most of Crislip’s posts here and I just can’t seem to recall him claiming to “know it all,” though he does have a recurring tongue-in-cheek reference to Mr. Know-It-All in one of his podcasts.

    2. I would rather entrust my health to someone who spent all of the 80s studying medicine than someone who spent the 80s studying, say, yoga, acupuncture or amateur psilocybin pharmacology.

    3. I presume he would take his car to another garage. Or despairing of that, he might purchase a new car.

  80. windriven says:

    @tanha

    “if instead of providing a case of one naturopath “poorly treating pretend parasites” in one patient, you looked at big centers (Parisitology Center) where MDs “treat pretend parasites” in hundreds of patients. ”

    Parisitology Center is the handiwork of one Omar Amin, an Egyptian parasitologist with a doctorate in parasitology from Arizona State. He is not an M.D.

    Dr. Amin seems to be of the opinion that dental toxins are the one true cause of Morgellons so he may well be a crank. If you’re picking blue wormies out of your skin, you aren’t flossing properly.

  81. Artour says:

    About 200 Soviet and Russian MDs have been teaching the Buteyko breathing technique for other 40 years and accumulated rich clinical experience in relation to those parasites that require special attention (like mechanical removal or chemical demolition). Most parasites (like Candia, H Pylori, and many others) can be defeated with breathing retraining and higher body oxygen levels, but some are now. (The progress in this therapy is measured by patient’s stress-free breath holding time test done after usual exhalation It is often called the body oxygen test.)
    They found that there are 4 classical focal infections:
    - cavities in teeth
    - degenerated tonsils
    - athlete’s feet
    - intestinal worms.
    These are the real health problems. If they present, one cannot get a clinical remission for asthma, hypertension, and other conditions. More detail:
    http://www.normalbreathing.com/l-buteyko-focal-infections.php

  82. Chris says:

    Can we classify Artour as a true spamming parasite?

  83. Scott says:

    Yes, I think so. d2u at least often posts interesting/insightful/thought-provoking comments in addition to his NO fixation. Artour never adds anything of note to any discussion.

  84. Oh Scott, that was unfair, …d2u and Artour are not even comparable, IMO.

    You guys can pick on d2u for his facination with NO, but I have more than once noticed that many posters here have a tendency to fixate on CAM as the root of all evil in health care.

    If you are the pot, it’s often easier to see the blackness of the kettle…and we are all pots or kettles, brother, amen : )

  85. In addition, just to be clear, Artour is actively selling something and D2u and is not.

    So Artour is an entirely different kettle of spam.

  86. daedalus2u says:

    In the interest of full disclosure, I will be trying to sell something once I can get the data to demonstrate that it will actually help people.

  87. tsk, tsk, Du2

    Are you just the world’s most organized spammer then, in your pre-release promotion mode?

    Maybe you should get kickstart account. :)

    http://www.kickstarter.com/start

  88. I would like to make a similar disclosure. I will be selling something, at a secret location, as soon as the demand* comes in.

    Get your magic mirror! Buy two and get a 10% discount! Get your wonderful, splendorous magic mirrors!

    *data? I don’t need no stinking data!

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