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The Marshall Protocol

Revised 7/23/9 to correct an error.

While there are many taxonomies of alternative medicines, one thing almost all alternative therapies have in common is they are originally the de novo discovery of one lone individual. Working outside of the mainstream, they are the gadflies who see farther because those around them are midgets.

  • Hanneman conceives of homeopathy, the treatment of all disease.
  • Palmer conceives the cause of all disease and its treatment in chiropractic
  • Mikao Usui, while having a mid-life crisis, conceives Reiki.

Virgin births all. These pioneers boldly go where no man has gone before.

Others have been less acclaimed after seeking out new life. An example is Virginia Livingston, MD, the discoverer of the cause of all cancer (1). She discovered a bacterium, the cause of cancer, she called Progenitor cryptocides, which, unfortunately only she could grow. Her therapies include an autogenous ‘vaccine” made from your own urine, which will probably preclude widespread use even in alternative therapies circles. I wonder if Jenny would object to vaccines if there were naturally derived from the patients urine?

Discovering a new form of pathogenic microbiology that no one else can see or grow is not uncommon, since people seem to be unable to recognise artifact on slides, be it Oscillococcinum being seen by Joseph Roy 200 years ago or Virginia Livingston in the 1960s. Sometimes I regret the discovery of H. pylori as a cause of gastritis as it gives the alternative microbiologists a medical Galileo to point at. H. pylori is used as an example, erroneously, of a bacteria causing disease that was laughed at by the medical establishment (Parenthetically, as my flawed memory has it, while I was an Infectious Disease Fellow the data for H. pylori came trickling in. I remember discussing the papers with one of my attendings who was an expert in GI infections. We all thought it was an interesting hypothesis and waited further data with interest. I cannot remember anyone dismissing the idea out of hand with derisive laughter. But then, I remain convinced that infections are the cause of all disease, at least the diseases that matter).

A letter from a reader lead me another lone researcher who has discovered the cause and treatment of many, if not all, diseases. So may I introduce to you, Trevor Marshall, the developer of the Marshall Protocol. (As I have said many times, I want something in medicine named after me, and it is not the glove breaking during an exam. “Damn, I just had a Crislip. I need to go and clean my nails.” If Swan or Groshong can get some silly little catheter named after them, well, I should be good for some eponym). You have not heard of Trevor Marshall? Often the fate of originality is to languish in obscurity.

The Marshall Protocol has all the characteristics of modern alternative therapy: a single discoverer, a hitherto undiscovered biology, an unproven therapeutic intervention and one of the most aggravating issues in alternative medicines: Taking a scientific truth the size of a molehill and transmogrifying it into a Cascade Range of exaggerated disease etiology and treatment. Unlike most alternative proponents, however, as best as I can tell Dr. Marshall does not seem to be in the business of making a business from his discovery, although he does have patent applications for his protocol.

Dr. Marshall has a PhD in electrical engineering and was diagnosed years ago with sarcoidosis. It was his diagnosis with what is often a fatal disease that lead to his insights into diseases. One cannot help but think of Linus Pauling and his vitamin C epiphany after almost dying of kidney failure. Staring into the eyes of your own mortality almost always leads to personal epiphanies. Most people learn to appreciate the little things in life they had hitherto ignored. Others aim higher.

Sarcoid is an interesting disease whose etiology is unknown but is characterized by noncaseating granulomas. Granulomas are an immunologic response to infections, often fungal or mycobacterial, and I will not be surprised if some day an infectious cause of sarcoid is discovered. Same, I will bet, for Crohn’s, another disease of uncertain origin that has granulomas. For as of today, no definite infection has been found to cause sarcoid or Crohn’s.

However, Dr. Marshall was intrigued by studies that demonstrated Rickettsia DNA in two patients with sarcoid and by the fact that his disease was worsened by sunlight. He then developed a hypothesis, unproven, but interesting, as to the cause of many chronic illnesses. And from there he developed a protocol to treat diseases.

Marshall suggests that autoimmune diseases are due to a correctable defect in innate immunity from a dysregulation of vitamin D. This immunologic defect allows L-form (cell wall-deficient) bacteria, to proliferate. In an interview he points to ‘bacteria” on electron micrographs that are living happily in white cells. How does he know they are bacteria 100 times smaller than usual? Can he grow them? No. It appears that they are bacteria because, well, they look like bacteria. To him. Not to me. But underlying all of the diseases treated by the Marshall Protocol are colonies of:

intraphagocytic, metagenomic microbiota… The term intraphagocytic refers to the fact that these bacteria have developed the ability to remain alive and proliferate undetected inside the cytoplasm of the cells they infect. These cells include macrophages, the very cells of the immune system that the body uses to kill invading pathogens…The term metagenomic indicates that there is a tremendous number of different species of these chronic bacterial forms. Finally, the term microbiota refers to the fact that these bacteria are also hypothesized to sustain themselves by grouping into communities called biofilms. The bacteria inside a biofilm produce a protective matrix that allows them to more effectively evade the immune system and develop resistance to antibiotics.

It is nice that at least they use the term hypothesis, although redundant, but should also include the adjectives untested and unproven.
He refers to these infections as Th-1 infections, “after T-helper Type 1 (Th1) immune response. The T-helper Type 1 (Th1) immune response is usually defined as one which generates significant quantities of the cytokine Interferon-gamma (3).” Th1 is the humoral wing of the immune system, Th2 is the B cell, or antibody wing of the immune system. Many infections are attacked with both Th1 and Th2 and to call pathogens Th1 is false dichotomy and a term only used by Dr. Marshall et. al. It does sound nice and sciency, although no one in the closed minded field of infectious diseases has ever used the term Th-1 infections around me that I can remember.

These bacteria then interfere with the vitamin D receptor to shut down the immunologic modulation of vitamin D:

Recent molecular modeling research (which has been confirmed by a large amount of clinical data) has shown that levels of 25-D over 20 ng/ml can bind and inactivate the VDR [vitamin D receptor], which subsequently shuts down the innate immune system. Certain species of bacteria also produce substances that can bind and inactivate the VDR in a manner similar to 25-D. Consequently, people who are infected with the Th1 pathogens and consuming vitamin D are no longer able to produce the AMPs or turn on the innate immune response. This allows their bacteria to proliferate and spread. (5)

Bacteria and vitamin D act together to shut down the immune system and the bacteria take off.

Vitamin D is an important immunomodulator and a pubmed search will reveal a growing and interesting literature that vitamin D deficiency increases, note increases, the risk of a variety of infections. There is a concomitant SCAM literature to suggest that all you need to treat influenza and other infections is to increase your vitamin D intake. As found in the Weekly World – er, I mean, the Natural News, taking vitamin D helps treat or prevents cancer, stroke, psoriasis, schizophrenia, and depression (8). Who are you gonna believe? One (or both) of these approaches should be wrong, although I suppose that influenza is a Th-2 pathogen and as such doesn’t count.

From this untested hypothesis, there is a therapy.

1) Kill the bacteria with long term (years) of antibiotics like doxycycline like minocycline. This is to eradicate the supposed L forms found in the granuloma. Unfortunately, the L forms, or even pathogens, have not yet been discovered in most of the diseases treated by the Marshall Protocol. And when bacteria have been found in rheumatoid arthritis or sarcoidosis, the studies have not been replicated, which is most annoying.

2) Use of angiotensin receptor antagonists. They recommend olmesartan which is said to be able to bind to and activate the vitamin D receptor and block vitamin D’s effects.

This has never been shown to occur either in the test tube or in humans or animals. The data to support this, and please read it slowly so it sinks in, is based on a computer model (3). Computer simulations, not experiments. As the FDA has said “The FDA-approved prescribing information for Valsartan states “Valsartan does not bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation (3).” Again, as a closed-minded arrogant tool of the medical-industrial complex, I worry about going straight from computer models to treating patients. Wouldn’t do it with an airplane, wouldn’t do it with a medication.

3) Avoid vitamin D. This is interesting. Vitamin D does more than build strong bones and has wide-ranging effects on immune regulation. Given the growing literature demonstrating a deficiency of vitamin D increases risks for a variety of infections, from viruses to tuberculosis, I am uncertain of the wisdom of suggesting this intervention without supporting clinical trials. I would worry more if there is a history of osteoporosis in the family.

Some collagen vascular diseases, like lupus, worsen as vitamin D levels decline. Multiple sclerosis is improved with vitamin D. A recent review suggests “Epidemiological evidence indicates a significant association between vitamin D deficiency and an increased incidence of several autoimmune diseases (4).”

Sarcoid has dysregulation of vitamin D with increased levels in the blood, the vitamin D being made in the granulomas. Maybe avoiding vitamin D in sarcoid is not completely without reason, but I would not extrapolate to other diseases that have nothing in common except for unproven Th-1 pathogens.

Generally speaking the problem for patients, especially in the northern latitudes, are diseases made worse by vitamin D deficiencies.
What diseases are treated with this protocol?

Th1 inflammatory diseases and symptoms currently being treated with the Marshall Protocol include:
ALS (Lou Gehrig’s), Ankylosing Spondylitis, Asperger’s, Back pain, Barrett’s esophagus, Bipolar disorder, Candidiasis, Cardiac Arrythmia, Celiac disease, CFS / CFIDS / ME, Chronic Lyme/Borreliosis, Crohn’s Disease, Diabetes insipidus, Diabetes type I, Diabetes type II, Dementia, Depression, Epilepsy, FM (Fibromyalgia), Gastroesophageal reflux disease, Hashimoto’s Thyroiditis, IBS (Irritable Bowel Syndrome), Interstitial cystitis (IC), Inflammatory bowel disease, Irritable bowel syndrome, Kidney stones, Lofgren’s syndrome, Lupus In ‘Overlap’ With Other Connective Tissue Diseases, Mania, MCS (Multiple Chemical Sensitivity), Migraine headache, Morgellon’s, Multiple Sclerosis, Myasthenia gravis, Neuropathy, OCD(Obsessive Compulsive Disorder), Osteoarthritis, Panic attacks, Parkinsons [sic], Pervasive Developmental Disorders- Not Otherwise Specified, POTS (Postural Orthostatic Tachycardia Syndrome), Prostatitis, Psoriasis, Psoriatic arthritis, Raynaud’s syndrome/phenomenon, Reactive Arthritis (Reiter Syndrome), Restless leg syndrome, RSD (Reflex Sympathetic Dystrophy), Rheumatoid Arthritis, Sarcoidosis, Scleroderma, Sinusitis, Seasonal affective disease (SAD), Sjogren’s, Ulcerative colitis, Uveitis, Vertigo , Other Th1 diseases which should respond to the Marshall Protocol: Alzheimer’s, Anorexia Nervosa, Bulbous pemphigus, Cystic fibrosis, Macular degeneration, Polymyalgia rhuematica, Polymyositis, Schizophrenia (5)

That’s a good list. Back pain, mania, osteoarthritis, vertigo, and kidney stones all have the same pathogenesis and treatment. I went to medical school for what? And it is good to see a treatment for Morgellon’s.
And there may be no end to diseases that could fall to the Marshall Protocoll:

I disagree that Th1 patients each have different illnesses. I have seen no data to confirm this. Everything I see is that all the Th1 diagnoses spring from a common pathogenesis, a special adaptation of intra-phagocytic bacteria which allows them to evade phagocytosis by stimulating a Th1 response in the parasitized phagocytes.
I personally believe that ALL the Th1 diseases result from the same bacterial pathogenesis. This belief is grounded in my understanding of how the bacteria directly drive the phagocytic biochemistry, causing the Th1 cytokine release.
IMO, it is important for everybody to stop thinking about these Th1 syndromes as being separate and discrete diagnoses. IMO, all Th1 illness has a common pathogenesis, only the mix of symptoms varies from person to person, depending on bacterial species present, and the sequence of infection/coinfection.
We are not all different. Th1 disease overrides ALL the issues of diet, location, exposure to pathogens, etc. We can see that by standing back and looking at ALL the folks on the Marshall Protocol. There are more similarities than differences, and it does not help recovery to focus on perceived differences. (7)

Emphasis mine. So what do I make of the Marshall Protocal?
Unproven. Based on hypotheses that are almost certainly not true. Potentially harmful if it induces side effects from unneeded antibiotic uses or, more worrisome, from vitamin deficiency.

====

  1. http://www.rense.com/general72/cancer.htm
  2. Waterhouse, J.; Perez, T.; Albert, P.; “VDR Receptor Competence Induces recovery from Chronic Autoimmune Disease.” 6th International Congress on Autoimmunity. Porto, Portugal. 2008 Sept 10-14. Retrieved 2008-12-31 from http://AutoimmunityResearch.org/transcripts/ICA2008_Transcript_TomPerez.pdf
  3. http://www.tbiomed.com/content/3/1/1#IDA0SVWF
  4. Nat Clin Pract Rheumatol. 2008 Aug;4(8):404-12. Control of autoimmune diseases by the vitamin D endocrine system.
  5. http://www.marshallprotocol.com/forum32/1263.html
  6. http://www.marshallprotocol.com/forum2/1071.html
  7. http://www.marshallprotocol.com/forum32/1263.html
  8. http://www.naturalnews.com/003069.html


Posted in: General, Herbs & Supplements

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75 thoughts on “The Marshall Protocol

  1. amyr says:

    Hey Dr. Crislip, I see that the Marshall Protocol treats mania. Is it effective in the treatment of Harry Potter-mania? :)

  2. weing says:

    To prevent a Crislip, I always double glove.

  3. Joe says:

    Okay, I am confused- Virginia Livingston found a bacterium that causes all cancer. I thought Hulda Clark http://www.quackwatch.org/01QuackeryRelatedTopics/Cancer/clark.html determined that all cancer was caused by “parasites, toxins, and pollutants” (mostly parasites). Whom is one to believe? Can they both be right? What about the feldspar-deficiency hypothesis? I think more research is needed.

    Not to make you jealous; but there is a chemical (a “diene”) named after me. Back in the 1970s Danishefski developed a diene that was enormously useful in organic synthesis. In the 1980s, I went through a laborious, muti-step synthesis of a steroid. Near the end, the critical reaction (that I was studying/developing) produced “Joe’s diene,” rather than the steroid skeleton. Unlike Danishefski’s diene, nobody has found a use for mine …

  4. happyhumanist says:

    I have a friend with sarcoid, so read this with interest. What started to happen was I was hoping this Marshall Protocol was possible. Imagine if I had the disease? How hopeful I’d be if I heard about this treatment without the benefit of your analysis.

    That’s the danger of these things. That people who are really sick get a little (false) hope. I’m glad you guys are around to pull us non-scientists back from the brink!

  5. PaulM says:

    Well, I have sarcoidosis and I have to admit I’d never heard of the Marshall Protocol even though I did a fair amount of reading online when I was diagnosed in January 2008. I know some people really suffer from this disease, and so might be tempted to try almost anything to get relief.

    I’ve been fortunate in that I responded very well to the conventional treatment, but if it hadn’t worked I wonder how tempted I would have been to try anything else. I suspect I wouldn’t have done anything my doctor didn’t recommend, as I’m one of those science-based patients who likes facts behind his treatment options.

    I’ll be seeing my doctor next month, and if all goes well that should mark the beginning of me coming off my medication. I’ll ask what he thinks of this Marshall Protocol. I’m sure he’ll know something about it. I’ve asked him in the past how he deals with patients who’ve read stuff online that misinforms them about their treatment, and he said he tries to read all of the same sources so that he has answers for them when they present him with the other claims.

  6. overshoot says:

    I thought that a Crislip was a mechanism of injury. Probably named by the anonymous individual who suffered one and yelled “Chri<thud>!” when it happened.

    Reputed to be much more common in locales such as the Pacific Northwest with both cold winters and plentiful precipitation.

  7. Joe says:

    Okay, I am confused- Virginia Livingston found a bacterium that causes all cancer. I thought Hulda Clark http://www.quackwatch.org/01QuackeryRelatedTopics/Cancer/clark.html determined that all cancer was caused by “parasites, toxins, and pollutants” (mostly parasites). Whom is one to believe? Can they both be right? What about the feldspar-deficiency hypothesis? I think more research is needed.

    Not to make you jealous; but there is a chemical (a “diene”) named after me. Back in the 1970s Danishefski developed a diene that was enormously useful in organic synthesis. In the 1980s, I went through a laborious, multi-step synthesis of a steroid. Near the end, the critical reaction (that I was studying/developing) produced “Joe’s diene,” rather than the steroid skeleton. Unlike Danishefski’s diene, nobody has found a use for mine …

  8. Peter Lipson says:

    Yeast…you forgot yeast, the ONE TRUE CAUSE!!11!

  9. Harriet Hall says:

    I listed 68 one true causes of all disease at http://www.sciencebasedmedicine.org/?p=123

  10. Mark Crislip says:

    one of these days I am going to do a review of alternative microbiology; might be a good talk if there is ever another SBM conference

  11. overshoot says:

    one of these days I am going to do a review of alternative microbiology; might be a good talk if there is ever another SBM conference

    Oooh, oooohh! Dr. Crislip, can I help with the research on MHA?

    I promise I know the territory (and yes, I know what that implies about my sanity.)

    Although after that comment about MOI, I can understand …

  12. Edj2001 says:

    I have been successfully treating my Sarcoidosis with the Marshall Protocol (MP) and my symptoms have resolved/improved. The sarc had invaded all systems of my body and my life was threatened. The standard medical treatment of prednisone palliated symptoms but the disease continued to progress and eventually even that did not help. I have been on the MP 3 years and will continue for as long as it takes to achieve cure.

    The MP is not easy and requires a lot of discipline and commitment. When the ARB Olmesartan activates the vitamin D nuclear receptor as an agnostic it allows the VDR to transcribe over 900+ genes many of which are necessary for a healthy immune system When that happens an active immune system is able to “see” the infection and eliminate it. The result is an exacerbation of symptoms called a herxheimer reaction. This herx is the gold standard to the MP as you know you are killing bacteria. No pain, no gain applies here.

    Take a look at the late Dr Lida Mattman’s, PhD. text book: “Cell Wall Deficient Forms – Stealth Pathogens, 3rd,. Edition. This is a text book on the topic of Plemorphic forms and their relationship to disease. In this text book she has slides showing CWD bacteria and chronic disease. Also, for those interested, here is a link to Amy Proal’s web site with more information about the MP. Amy was seriously ill with chronic fatigue and has had dramatic improvement on the MP in 4 years of treatment. She has written many articles discussing it.

    http://bacteriality.com/about-the-mp/

  13. nokomarie says:

    Now here I get confused. The entire vitamin D thing sounds silly, I would believe this more in scleroderma (which is not mentioned) than sarcoidosis. But then, I tend to think people shouldn’t take vitamins at all but rather eat a healthy diet unless an actual deficiency is found. Nope, didn’t give my kids their baby vitamins, bad mommy, I just breast fed them until they weaned onto table food.

    I wonder if part of the whole problem with the crack theories isn’t the medical tradition of clapping a scientific name on everything. Gastritis is a diagnosis actually handed out to patients who have spent a night or two in the hospital with unexplained stomach pain and vomiting. It is not unknown for those patients to return several times over a year or two until the pop up one fine day with acute appendicitis. Surely it would be better to not hand out these ill-defined diagnoses as patients almost inevitably become frustrated and look to take medicine into their own hands as modern medicine has ‘failed them’. Just like in sarcoidosis, at what point does an nodular, intrusive, growth become considered a cancer as opposed to a nodular, intrusive growth involving many systems which may well subside? Basically, nobody likes to be told they have a rash. Of course they expect to be able to take a pill for it.

  14. qetzal says:

    I realize many people who believe stuff like this won’t be persuaded by evidence. However, if we were all truly infested by these “intraphagocytic, metagenomic microbiota,” we would have found their genomes during the human genome project. They would have appeared as sequences belonging to separate linkage groups (i.e. not connected to any human chromosome) and not related to mtDNA.

    If they were there, the HGP researchers would have fallen all over themselves to report it in Nature, Science, etc. Unless they’re all involved in a conspiracy to cover it up!

    ;-)

  15. Edj2001 says:

    Check out the Human Microbiome Project being conducted by the NIH the same group this did the Human Genome Project:

    http://nihroadmap.nih.gov/hmp/

    Here is what the NIH web site says:

    “Within the body of a healthy adult, microbial cells are estimated to outnumber human cells by a factor of ten to one. These communities, however, remain largely unstudied, leaving almost entirely unknown their influence upon human development, physiology, immunity, and nutrition. To take advantage of recent technological advances and to develop new ones, the NIH Roadmap has initiated the Human Microbiome Project (HMP) with the mission of generating resources enabling comprehensive characterization of the human microbiota and analysis of its role in human health and disease…”

  16. qetzal says:

    Yes, but please note that they’re talking about microbes found on our surfaces or in cavities with direct access to the external environment (mouth, nose, GI tract, etc.). They are not talking about microbes that are supposedly present systemically, parenterally, and intracellularly.

  17. LovleAnjel says:

    “What about the feldspar-deficiency hypothesis? ”

    Feldspar? Really? What kind?

    This I must hear more about.

  18. Edj2001 says:

    The following papers describe how the beta lactam antibiotic cefsuloden can change E coli into the L form “over night” as demonstrated by D’Ari et al.

    http://jb.asm.org/cgi/content/short/189/18/6509

    http://www.ncbi.nlm.nih.gov/pubmed/18008373

    http://jb.asm.org/cgi/content/abstract/189/18/6512

  19. Heard about this a year or so ago when I was doing some lectures out of town. A primary care physician who was very interested in this was telling me about it. Here are some links about it:
    http://www.marshallprotocol.com/forum2/2274.html

  20. qetzal says:

    @Edj2001

    What’s your point? L-forms exist, therefore the Marshall Protocol must really work?

    Are you familiar with the term “non sequitur?”

  21. Chris says:

    (trying to not be stalker-like, but I saw you on the TAM7 stream… Dr. Bojrab, you have a great voice and it was awesome the way you used your phone app)

  22. abetterjulie says:

    Could I get some feedback on this article? It seems someone is taking it seriously enough to fund research.

    http://www.medicalnewstoday.com/articles/158430.php

    I am reading more and more research online that deals with our “microbiome”. I am assuming this pertains only to the flora that permeate our GI tract. Is this correct? Is this separate from what is being studied by the NIH Human Microbiome Project or the same?

  23. Edj2001 says:

    Here are some recent peer reviewed papers that discuss the MP

    Proal AD, Albert PJ, Marshall TG. Autoimmunity in the Era of the Metagenome. Autoimmunity Reviews, in press.
    http://dx.doi.org/10.1016/j.autrev.2009.02.016

    A full-text preprint is available from:
    http://AutoimmunityResearch.org/transcripts/AR-Proal-Metagenome.pdf

    and

    Albert PJ, Proal AD, Marshall TG. Vitamin D: The alternative hypothesis. Autoimmunity Reviews, in press.
    http://dx.doi.org/10.1016/j.autrev.2009.02.011

    A full-text preprint is available from:
    http://AutoimmunityResearch.org/transcripts/AR-Albert-VitD.pdf

    and

    Marshall TG: Vitamin D Discovery outpaces FDA decision making.
    BioEssays Volume 30, Issue 2, Pages 173-182, February 2008
    Online ISSN: 1521-1878 Print ISSN: 0265-9247
    Copyright 2008 Wiley Periodicals, Inc., A Wiley Company
    http://www3.interscience.wiley.com/cgi-bin/abstract/117885976/ABSTRACT

    In accordance with the copyright assignment agreement I have put a free copy of the preprint of the Full Text on my personal website at
    http://TrevorMarshall.com/BioEssays-Feb08-Marshall-Preprint.pdf

  24. Edj2001 says:

    Here are some recent peer reviewed papers discussion the MP:

    Proal AD, Albert PJ, Marshall TG. Autoimmunity in the Era of the Metagenome. Autoimmunity Reviews, in press.
    http://dx.doi.org/10.1016/j.autrev.2009.02.016

    A full-text preprint is available from:
    http://AutoimmunityResearch.org/transcripts/AR-Proal-Metagenome.pdf
    and

    Albert PJ, Proal AD, Marshall TG. Vitamin D: The alternative hypothesis. Autoimmunity Reviews, in press.
    http://dx.doi.org/10.1016/j.autrev.2009.02.011

    A full-text preprint is available from:
    http://AutoimmunityResearch.org/transcripts/AR-Albert-VitD.pdf
    and

    Marshall TG: Vitamin D Discovery outpaces FDA decision making.
    BioEssays Volume 30, Issue 2, Pages 173-182, February 2008
    Online ISSN: 1521-1878 Print ISSN: 0265-9247
    Copyright 2008 Wiley Periodicals, Inc., A Wiley Company
    http://www3.interscience.wiley.com/cgi-bin/abstract/117885976/ABSTRACT

    ”In accordance with the copyright assignment agreement I have put a free copy of the preprint of the Full Text on my personal website at:”
    http://TrevorMarshall.com/BioEssays-Feb08-Marshall-Preprint.pdf

  25. Mark Crislip says:

    probably in three weeks I will cover this.

  26. Claironess says:

    People die from sarcoidosis. It’s not just a rash.

    Speaking of that, I have watched friends who are seriously ill with sarcoidosis make amazing strides on the MP.

    I was bedridden and felt near death and now feel better than I have felt since becoming totally disabled six years ago. Some symptoms with a 30-year history have disappeared with the MP thus far. But, hey, that is no doubt the placebo effect in operation. You know, the effect that never seemed to work on me before no matter what I tried. Now, all of a sudden it is working. Imagine that. I’m a blithering idiot. Finally, I’ve succumbed to magical thinking.

    However, all the folk who read this site and feel assured that Marshall is on the wrong track all because this infectious disease specialist wonders why he went to med school, are brilliant, eh?

    Sorry, but I’m a little ticked off by the condescending remarks that get made about the folk who have decided to try the MP. And how easily people listen to folk who may have failed to fully research the topic. Suffice it to say, from my own research, I don’t take much stock in the conclusions reached above.

    There are quite a few people on the MP who are health professionals and many with science backgrounds. I doubt many of these people jumped into the doing the MP without researching the literature to see if they could find support for Marshall’s work. Frankly, I have never seen a theory about chronic illness that so makes sense of so much of the medical research that leaves researchers scratching their heads and stretching for possible explanations for their results (poorly designed research, including research that has people running to take mega doses of “vitamin” D). In fact, most of the time, I end up laughing when news reports about medical research reveal outcomes that could be predicted by Marshall’s “theory, er, hypothesis” regarding the pathogenesis of chronic illness. Most of the time, I am reminded of the story where a dozen folk with blindfolds on are touching the same elephant but in different places and form hypothesis about the thing they are touching without ever comparing their conclusions or seriously considering that theirs may not be the entire picture.

    At least Marshall doesn’t claim to have the entire picture, though he at least knows it is in the pachyderm family. He also has enough of the picture to interest West China Hospital–a major research hospital–, as they are beginning an extensive study on the effectiveness of the MP.

    And the nature of this writer’s attack? Yeah, very funny, clever. He should take up political campaigning. He has a real gift for spin.

    In closing, I want to thank God that we have never ever, no never ever, benefitted from some development from someone not specifically trained in a particular field. If you believe that, I know where you can buy the London Bridge.

  27. rocko says:

    Here’s more evidence of SCAM:

    Interviews with MP patients:
    http://bacteriality.com/category/interview-patient/

    Success stories of patients on the MP:
    http://tinyurl.com/2pm37t

    2006 LAX Conference: Recovery Panel:
    http://www.carouselcharts.com/TranscriptRecoveryLAX2.pdf

    MP Case Histories from Townsend Letter:
    http://winmlm.neostrada.pl/mp/townsend/Townsend_Letter_May2007.Part2.pdf

    2006 Sarcoidosis Conference in Japan (Neurology case history):
    http://autoimmunityresearch.org/transcripts/arasaki_jssog_2006.pdf

    MP Study Results: Autoimmnuity Conference 2008:
    http://AutoimmunityResearch.org/transcripts/ICA2008_Transcript_TomPerez.pdf

    Physician’s experience with MP:
    http://bacteriality.com/2007/10/31/blaney/

    Largest Clinical Center in the world interested in the MP:
    http://www.eurekalert.org/pub_releases/2009-07/arf-sat072109.php

    More to come over the next few years – stay tuned…

  28. Russ says:

    “one thing almost all alternative therapies have in common is they are originally the de novo discovery of one lone individual.”

    In the course of history there have certainly been many individuals who advanced some sort of crazy theory that has since been proven false. But also remember that many of the most important scientific discoveries in history started largely as the theory of one man (or woman) and at the time seemed crazy, illogical, and in violation of current scientific thought.

    As an infectious disease specialist I’m sure you know that germ theory, when originally conceived, was extremely controversial. I’m sure many skeptics asked “Where are these germs? We can’t see them. How could they have gone undetected by science for all these years?”

    One “quack” in the 19th century named Ignaz Semmelweis claimed to have observed that babies delivered by doctors coming directly from autopsies were more likely to die of fever. He wanted all the doctors to start washing their hands before deliveries…as though in all the years of doctors delivering babies this guy alone was smart enough to make this observation. According to the article below, his ideas were viciously attacked by the medical establishment. Can you imagine a bunch of busy doctors wasting their time to constantly scrub their hands because some quack says it will magically make the babies they deliver healthier?

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

    As for the idea that so many diseases could have the same basic pathogenesis, it does seem like too simple and elegant a solution for such complex diseases. But remember that there was a 17th century “quack” named Isaac Newton who thought that every object on earth and in the heavens above were governed by the same physical laws, and that the same simple mathematical formulas could precisely define the motion of a rock rolling down a hill, a leaf blowing in the wind, a wave crashing on a beach, and a star shooting thru the sky. I’m sure at the time this seemed even crazier than the idea that a number of chronic diseases could have a similar cause.

    To a non-medical professional, the Marshall Protocol seems very logical:

    - Autoimmune diseases (and many other diseases) have inflammation as a key component
    - Inflammation is an immune response
    - The role of the immune system is to protect us against pathogens.
    - Could the immune system be trying to respond to an infection but the pathogens have evolved a mechanism for disrupting it, thus resulting in chronic inflammation but no resolution of the infection? Have 50+ years of research come up with any better theories?
    - Vitamin D seems to be a magic bullet for all these diseases
    - Vitamin D is now known to be a prohormone/steroid
    - Steroids reduce inflammation
    - Could the positive effect Vitamin D has in these diseases be an anti-inflammatory one? And like other steroids, could this come at the cost of immunosuppression?

    It seems like a logical theory to me. It might seem too simple too, but then again, gravity is a fairly simple concept once it is explained.

  29. ralph says:

    Dr Crislip,

    Your comments and view are no different to the rest of the medical thinking in the age of profound technology and breakthroughs. The current thinking of you and your collegues is not about curing people, just pushing your own self interests and leaving your patients seriously ill and prescribing drugs for these diseases which add profoundly to a life of misery.

    As a Sarcoidosis patient on the MP who has turned this disease around to be on a path of full recovery you can state what you want. The facts, results and science are there and cannot be disputed. You quote many of the reported articles from Dr Marshall. Please read them….if you really care about helping people.

  30. abetterjulie says:

    After briefly reading over the first two phases, it sounds pretty scary. Vit D deficiency is a serious matter. I can’t comprehend why it would be encouraged. My autoimmune symptoms get worse when my Vit D level drops, and I have difficulty keeping a normal level in my system. Is it possible that per Dr. Fasano’s research, the antibiotic therapy is altering the gut flora, and thereby creating a new “microbiome” that is less of a trigger to the lining of the intestine to cause gaps that result in the immune system being stimulated by large proteins?
    Is it possible that the antibiotic therapy has less to do with the level of Vit D and more to do with altering the chemistry of the bacteria that does directly affect health and immunity?
    Just my non-scientist two cents…

  31. Lloyd Finch says:

    I am a retired (1992) biochemist who worked a lot with mycoplasmas (Lloyd Finch mycoplasma brings up some papers on Google). A lot of my research and teaching was also on the regulation of metabolic pathways. I have also had arthritis in most joints since the 1970s. In 1998, after establishing by PCR assay that I had Mycoplasma fermentans and Chlamydia pneumoniae DNA in my white blood cells, I started taking doxycycline and later minocycline 50mg 2 times per week, in a version of the MacPherson-Brown arthritis treatment. After a few weeks I was pretty well pain free. By 2004 I had increased to 3X50mg per week. By 2006, pain was fairly endemic in my neck and lumbar spine, and my knees and hips would go off from time to time. Still better than pre-antibiotics.
    In May 2006, I was told about the Marshall Protocol. Reading it was a Eureka moment, like others that I have had over 60 years of science. The excitement of seeing something new that that explains those puzzles in a logically satisfying way, with missing pieces that can be expected to slot in as they are found. In the 3 years since a lot of pieces have slotted in.
    I am unhappy that I have still seen no in vitro studies that reflect on Dr Marshall’s computer generated (in silico) data for ligand/receptor binding for vitaminD derivatives, sartans and other drugs and metabolites. Perhaps this gap arises because his work has not had much exposure in the mainline science literature. I am in awe of the way in which he has used computing to throw light on his ideas when he has lacked the traditional laboratory based resources.
    On the question of the role of vitaminD, my extensive background in the field of metabolic regulation leaves me in little doubt. A high concentration of the effective end product of a pathway (1,25-dihydroxyvitaminD in this case) will lead to a lowered concentration of an earlier intermediate in the pathway (25- monohydroxyvitaminD which is what is measured in serum as an indicator of VitD status). Mechanisms by which this happens have been documented. 1,25-dihydroxyvitaminD levels are increased by interferon gamma. This is why sick people have low levels of 25-monohydroxyvitaminD (so-called VitD deficiency). Anyone wanting to claim otherwise is obligated to show that such low levels are correlated with low levels of the functional 1,25-dihydroxyvitamin if they wish to be considered other than sloppy pot-boilers.
    With lab access long since unavailable to me, I felt that my only way to test out Marshall’s ideas was to try them on myself. I have been astonished at how well my responses could be explained or predicted from what I read on the MP site. What has happened to me is consistent with an activation of the immune system by olmesartan, increased by lowering vitaminD status and initial increased immunopathology with increased doses of antibiotics. With my extreme vitaminD deficiency my bone density has increased. My arthritis is now limited to knees and hips occasionally, usually only one joint at a time. Spine has been totally pain free for over 12 months. Several sites of long-standing irritation (nose, ears, back of throat, anus) have cleared up. This is some of the benefit of
    2&1/2 years of malaise ‘fighting off an infection’. The major thing I am still looking for resolution of is impaired kidney function. This was incipient as far back as 1998, but became more overt with the angiotensin blocking effects of olmesartan.
    From 12 months ago it has shown some improvement and I looking hopefully to further tests in a couple of weeks.
    I hope that your interest can help generate some real testing of the MP and Dr Marshall’s ideas rather just cursory disparagement of it. I know that there are alot of SCAMs around that don’t warrant anything other than disparagement. The MP isn’t one of them.

  32. rocko says:

    abetterjulie, you have missed the point altogether. Have you read through Dr Marshall’s latest publications as posted by Edj2001?

    Vitamin D is a secosteroid. As with corticosteroids, it can temporarily help people feel better. This is why some people benefit from increased Vitamin D intake. However, there is no evidence that anyone has been cured of anything long-term with this approach.

    Lowering your Vitamin D level will help allow the L-form biofilm pathogens to be killed once the VDR is activated (this is where Olmesartan is key) permitting the immune system to do its job. Granted, there is discomfort in this process, but the conventional model of making people feel better with all sorts of medications, surgeries, etc, has produced very little cure for anything. In fact, the only thing that is certain today is that we are witnessnig a rise in chronic disease.

  33. pmoran says:

    “So what do I make of the Marshall Protocal?
    Unproven. Based of hypothesis that are almost certainly not true. Potentially harmful if it induces side effects from unneeded antibiotic uses or, more worrisome, from vitamin deficiency.”

    I would have to agree with Dr Crislip’s summary, despite the personal belief some have expressed in the worth of the Marshal protocol.

    Note one striking difference between this and the H. Pylori affair. Despite initial skepticism, I, along with thousands of other doctors throughout the world, was immediately able to confirm the presence of the organism in biopsies from ulcer patients. It then took some time to confirm its causal role, this mainly depending upon showing that the ulcers healed and remained healed if the organism could be eliminated.

    Why has this kind of thing not been possible with Marshal’s organisms? There is obviously something missing, or unconvincing in the chain of evidence, and only Marshal and his supporters can deal with that.

  34. Claironess says:

    Fine. Don’t investigate. Don’t do the research needed to answer the questions you pose.

    In the meantime, people are getting better. Just tell yourself that their improvement is all coincidental and save yourself the effort.

    By the way, strides are being made (at Duke University I believe) at culturing Cell Wall Deficient bacteria outside of the human body. Only a few other researchers have been able to do this, but their work is often doubted because of the high level of difficulty (the “I can’t do it and I’m a great scientist and so it must not be possible” ego-driven drivel) and because CWD are very very tiny. “If it is too small to see well (with the current technology), then it must be nothing” sort of thinking. Advancements have also been made to show how CWD’s reproduce absent cell walls (they have just enough to do the trick). And so on.

    But hey, I guess you’ll believe it when there is a general consensus, which is what it generally what it takes to create a paradigm shift.

    No need to thoroughly research the literature yourself or learn molecular biology.

    One of the biggest mistakes Marshall has made is believing that people becoming well would prove that he is on to something important. I have always known that no matter the person’s expertise, her/his claims of wellness as a result of the MP will be doubted as long as folk in the medical community believe the poorly designed “Vitamin D studies” and don’t bother to investigate the evidence. In regard to evidence, in addition to Marshall’s work, research from others that gives credence to his model as well as how well the model explains chronic illness.

    How do I know this? Having suffered from multiple chemical sensitivities for years (until my immune system shut down so far that I was reacting to nothing), I remember reading about a doctor who developed MCS and was literally trapped in her home. After developing MCS she was treated as a lunatic by other doctors. It’s the whole, “If we don’t understand it and don’t believe in it,” then the patient must be crazy or wrong sort of thinking.

    Well, doctors… a witch doctor swinging a dead chicken over his head could have done more for me than all the doctors I saw combined until my doctor agreed to try the MP with me.

    Thank you Dr. Marshall for helping me get my life back.

  35. Deedee says:

    I was diagnosed with sarcoidosis in my lymph nodes last year. Faced with the diagnosis, I had the option to “wait and watch” and take steroids if the symptoms got too bad. I found there was little research on steroids and sarcoidosis except for some recent studies that indicate it may actually make the disease worse and it does not cure sarcoidosis. This is the standard mainstream medical treatment for sarcoidosis. Note there are no clinical trials to show it works.

    During my search for info on sarcoidosis, I learned that what little research there is on this “rare” disease. I found that there was a considerable amount of research into the bacterial links of sarcoidosis and unaffilliated researcher had found evidence of bacteria in the tissue and blood of sarcoidosis patients, but not in control groups. Dr. Moller and Dr. Wonder Drake (infectious disease) of Vanderbilt have very strong studies on the bacterial links to sarcoidosis and you can google their research. Invariably, the studies conclude “more research is needed.” Yet we all know that money for research on rare diseases is elusive.

    Examples:
    http://www.ncbi.nlm.nih.gov/pubmed/12233062?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedreviews&logdbfrom=pubmed
    http://www.mrsnv.com/uploads/evt/stp/2165/uploads/InfectiousEtiologySarcoid-Tilley.pdf
    http://www.cdc.gov/ncidod/eid/vol8no11/02-0318.htm
    http://erj.ersjournals.com/cgi/content/abstract/30/3/508
    http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224278&ArtikelNr=90991&filename=90991.pdf
    https://profreg.medscape.com/px/getlogin.do;meddomainjsession=8n5BKtdSh2S6bYH1NY1nLQCkDGsqHNpstRdDcpqGTDksvkYvsWB2!-910073330?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZS5jb20vdmlld2FydGljbGUvNTQ1MTY4XzU=
    http://archderm.ama-assn.org/cgi/content/abstract/137/1/69

    There are more studies if you want to search google. Just put in “bacteria and sarcoidosis.”

    I then found the MP, based on the theory that sarcoidosis is caused by a biofilm or community of bacteria. Central to the MP treatment is the reactivation of the Vitamin D receptor by reducing Vitamin D consumption and the use of Benicar. Interestingly, I had been given Vitamin D by my doctor the year prior to the diagnosis, which likely aggravated my condition and was also responsible for high calcium levels. Antibiotics on the MP are low-dose and pulsated to weaken the bacteria.

    It bother me, Dr. Crislip, that you do not seem to understand that Vitamin D is toxic to people with granuloma disease. This information is even listed on the Vitamin D bottles now, and even the Vitamin D guru Mercola has a warning on his website. People with Vitamin D typically have low D25 because the D25 is quickly converted to D1,25, which supports the formation of granulomas, which in return produce more D 1,25. The high D1,25 also blocks the Vitamin D receptor, which is responsible for our innate immune system. For the sake of your patients and any other patients of physicians reading this, please learn about Vitamin D and granuloma disease so you are not prescribing Vitamin D to people with sarcoidosis. This pre-dates the MP, so you will be more accepting on the facts of this problem. You might start by reading these articles:

    http://pmj.bmj.com/cgi/content/abstract/66/774/307
    http://www.chestjournal.org/content/109/2/535.abstract?ck=nck
    http://www.chestjournal.org/content/109/2/535.full.pdf+html

    Faced with this disease, and having been a Registered Respiratory Therapist and seen people die from this disease, and I was very motivated to find out if there was anything I could do to control the disease. I learned that being a health care provider is a risk factor for sarcoidosis (NIH ACCESS Report.) Being the spouse of a sarcoidosis patient also increases your risk. All of this points to a communicable nature to sarcoidosis. My husband was an RN who worked at Duke for years in the intensive care unit and I also worked in major medical centers in ICUs. He was diagnosed with sarcoidosis 26 years ago. I was diagnosed last year after taking Vitamin D for a year.

    I consulted with my family practice doctor, my pulmonologist, my integrated medicine doctor, my surgeon, and even my daughter’s psychiatrist who was once a neurosurgeon at Boston U before I decided to try the MP. The psychaitrist told me had tried to help people with neuro-sarc and that the disease certainty “acts” like an infection. All of these doctors told me that they did not think the treatment would hurt me and the integrated medicine, family practice, and psychiatrist docs were enthusiastic about my trying the protocol. The protocol is, after all, not nearly as toxic as steroids, Dr. Crislip, which was my other option should the symptoms become intolerable. I am also motivated because my husband suffers with SOB, hearing loss and has had kidney stones from the sarcoidosis. We are both on the MP protocol now.

    I started the MP with a healthy bit of skeptism thinking that if it didn’t work, I could stop the protocol. Over the last year, I have had the following improvements:

    My sed rate is now normal.
    All of my blood work (except lipids) is normal.
    My CXR is now normal except for a small area where a lymph node was removed during the mediastinoscopy.
    My neck lymph nodes are no longer swollen.
    My plantar fasciitis is gone.
    The knot is my thumb is 1/2 the size it was last year.
    My spleen no longer hurts.
    My sinus drainage is almost gone.
    A knot in my right arch is gone.
    My”asthma” is gone.
    All of my PFTS are now above 100% of predicted, except my TLC which is 99% of predicted.
    I can breathe.

    Sarcoidosis is a rare disease, by definition. There is little research on this disease and with funding issues, it is not likely there will be funding in the future. The MP researchers were motivated, as you noted, because they have the disease. They charge nothing, sell nothing. (Compare this to the Vitamin D pushers websites.) When one encounters a scam there is usually profit being made by someone. This is not the case with the Marshall Protocol. No one is scamming anyone. All of the advice and help is provided without charge. Dr. Marshall has even consulted with my personal physicians without charge. No one has ever asked me for a cent.

    Sometimes, Dr. Crislip, people with rare diseases can’t wait for the orphan drug program to find a cure for a disease (which will also guarantee them a patent and profit) or for a University to adopt a disease as some kind of charity work. It just isn’t going to happen. I am very thankful that this group of scientists and health care professionals came together to develop a theory and treatment for sarcoidosis, even though it had to be done outside of the mainstream. This is because, Dr. Crislip, there are few opportunities for such research on rare diseases within our Universities, and even less for funding for individual researchers through the NIH or private grants. The MP is unconventional and out of the mainstream, but it is not a scam, Dr. Crislip.

  36. Russ says:

    pmoran said: “Note one striking difference between this and the H. Pylori affair. Despite initial skepticism, I, along with thousands of other doctors throughout the world, was immediately able to confirm the presence of the organism in biopsies from ulcer patients.”

    The difficulty of detecting the organisms Dr. Marshall has impllicated in chronic disease was addressed in a presentation of his at the 6th International Conference on Autoimmunity in Portugal. Here’s what he said:

    “the microbiota is only stable in-vivo. It defies extraction using standard techniques. You saw how that cell had disintegrated after about 6 hours of aging. You can imagine what it does under centrifuge. Further, most of these species in the biofilm microbiota defies attempts at in-vitro (culture).”

    In the same segment of that presentation he also discusses a study by Dempsey et. all, which was a study of biofilm from prosthetic hip joints which were removed during revision arthroplasties. He discusses the results of the gene sequencing from the DNA extracted from the biofilms and I believe the implication is that prosthetic hip joints may not be the only place in a human body that these microbiota are living in biofilms…they are just easier to detect when they are living on an artificial surface that can be extracted from the body.

    The full presentation is available from the link below. This particular segment of the presentation starts at 13:43.

    http://vimeo.com/1787405

    Some might say it is “convenient” that the microbiota that Dr. Marshall implicates in these diseases are so difficult to detect. However, there are certainly many many instances in the history of medicine when something we can now easily detect was not detectable with the tools available at that time. It would be foolish to think that we are so advanced scientifically that there is nothing we can’t detect. In fact, I would argue that the fact that so many chronic diseases remain idiopathic despite decades of research means that there *must* be something involved in these diseases that science is missing. A previously undetected microbiota would explain a lot and should be at the top of the list of what scientists are looking for going forward.

  37. pmoran says:

    Claironess:-
    “In the meantime, people are getting better. Just tell yourself that their improvement is all coincidental and save yourself the effort.”

    And

    “One of the biggest mistakes Marshall has made is believing that people becoming well would prove that he is on to something important.”

    Should not be a problem for some of the conditions that the Marshal protocol is said to treat. Many have chracteristic lesions that can be biopsied, and cultured, and rummaged through otherwise for organisms, and other objective tests by which their progress can be measured. It should not be difficult to show the Marshall protocol working in these if enough cases are collected.

    MCS is unfortunately a highly subjective condition that does tend to improve for some with time, or with a variety of other treatment programs.

  38. figlet says:

    Like the author of this article, Mark Crislip, I am also a physician. Unlike Dr. Crislip, I prefer not to cast myself first and foremost as a skeptic.

    Dr. Crislip mentions that Vitamin D deficiency increases the risk of certain infections. In fact, it would be more accurate to say that low Vitamin D-25 levels are “associated” with certain disease states – but an association does not prove causation. That would be like noting that cancer patients are often anemic, and thus concluding that anemia causes cancer.

    My understanding of Dr. Marshall’s claim is that Vitamin D-25 is preferentially converted to Vitamin D 1-25 in a number of disease states. The idea behind this, I believe, is that the causative organism – if there is one – converts the inactive vitamin (D-25) into the active seco-steroid (D-125) which, like other steroid hormones, might have the ability to suppress the immune system and allow an infectious agent to flourish.

    I decided to check this out with several of my own patients. Indeed, I did notice a high proportion of my patients suffering with autoimmune diseases had low levels of Vitamin D-25. However, when I bothered to check their Vitamin D-125 status (the active form of the hormone) which few people do, I was surprised to find it elevated in nearly every case – just as Dr. Marshall predicted it would be.

    At this point, I am not drawing any firm conclusions. However, I would urge other physicians diagnosing patients as “vitamin D-deficient” to check levels of BOTH D-25 and D-125 – I have been amazed to find that nearly every study linking disease states to Vitamin D-deficiency does so on the basis of the D-25 level alone.

    As an infectious disease specialist, I very much doubt that Dr. Crislip deals much with patients suffering from conditions such as chronic fatigue and fibromyalgia. If he did, he would know that there is very little that “the great men of medicine” have to offer them. In fact, the longer I am in medicine, the more frankly embarrassed I am by how little we offer patients with chronic disease. Small wonder such patients look “outside the mainstream” for help.

    It is not my intention to defend Dr. Marshall’s claims here. I’m simply critical of Dr. Crislip’s reactions to them. I find his comments sarcastic and glib, and this is sadly common in medicine, where so many practitioners are really frustrated writers who equate sounding “clever” with being truly wise.

    As they say – everyone’s a critic – and indeed, how much easier to spend one’s time discrediting the efforts of others than to bother generating new ideas yourself.

    I intend to remain open-minded to the ideas of others – whether they are MDs or PhDs in other disciplines – matters less to me than it seems to Dr. Crislip. Personally, I think science can benefit from the kind of creativity found in other fields, especially in considering approaches to conditions which continue to confound us.

    Respectfully,

    Dr. J. Rae

  39. David Gorski says:

    Dr. Crislip mentions that Vitamin D deficiency increases the risk of certain infections. In fact, it would be more accurate to say that low Vitamin D-25 levels are “associated” with certain disease states – but an association does not prove causation. That would be like noting that cancer patients are often anemic, and thus concluding that anemia causes cancer.

    Cancer patients also have low vitamin D levels. Indeed, there are an increasing number of studies that suggest that low vitamin D levels are associated with various cancers. The weight of the evidence hints at a strong enough correlation that it very well may be causation, and randomized trials are under way now.

    So, let’s say Marshall’s right (and there’s a lot there that makes me doubt him). You’re going to have a battle between whether to have a high-normal vitamin D level and be at risk for infection or a low vitamin D level and be at risk for cancer.

  40. David Gorski says:

    Some might say it is “convenient” that the microbiota that Dr. Marshall implicates in these diseases are so difficult to detect. However, there are certainly many many instances in the history of medicine when something we can now easily detect was not detectable with the tools available at that time. It would be foolish to think that we are so advanced scientifically that there is nothing we can’t detect. In fact, I would argue that the fact that so many chronic diseases remain idiopathic despite decades of research means that there *must* be something involved in these diseases that science is missing. A previously undetected microbiota would explain a lot and should be at the top of the list of what scientists are looking for going forward.

    Here’s the problem with that argument. The diseases you are referring to range from bacterial disease (before microscopes became powerful enough to detect bacteria we had a hard time); TB (before special stains and even more powerful microscopes, we had a hard time identifying the organism); and viruses (before electron microscopy we could only infer the existence of viruses by filtering out the bacteria and observing infectious processes; e.g. the tobacco mosaic virus).

    The point is that whatever the organism form Marshall postulates, it’s clearly not something that should be beyond the ability of current scientific technology to detect. Thus it is rather convenient. It’s possible that Marshall is right, but he needs to show better evidence than that before he’ll convince me.

  41. daedalus2u says:

    I find this discussion quite interesting, and related to my NO research. Essentially every disorder on the list of disorders reported to be treatable via the MP is something I consider to have some connection to low NO (with the exception of kidney stones). However, many of the disorders are non-descript and likely have multiple causes. I think a final common pathway in many (if not most) of them is low systemic NO.

    The fundamental premise of the MP, that multiple different types of “bacteria” each evolved a new phenotype so as to evade the immune system is completely non-credible. Multiple different organisms can’t evolve the same physiological pathways except via horizontal exchange of DNA. Bacterial DNA would be trivial to detect and characterize in pathology specimens with PCR. If there are multiple bacteria per cell, that means there are many more copies of bacterial DNA than human DNA. If bacterial DNA is not detectable in tissue samples, then bacteria are not present, certainly there are none capable of reproducing. Minocycline like doxycycline inhibit protein synthesis in bacteria by binding to the bacterial protein for protein synthesis coded by bacterial DNA. The DNA that codes for that gene is the normal target for PCR when looking for bacteria. If that DNA is not present, then what ever is present can’t make the protein and antibiotics that work by inhibiting that protein would have no anti-bacterial effects.

    It turns out that Valsartan (and the other angiotensin II receptor antagonists) do have the effect of raising blood levels of NO.

    http://www.jstage.jst.go.jp/article/circj/71/9/71_1473/_article

    most likely by reducing eNOS uncoupling.

    http://atvb.ahajournals.org/cgi/content/full/27/12/2569

    Increasing NO might be the mechanism by which Valsartan has effects on relieving these symptoms. NO is an excellent anti-inflammatory agent and has multiple effects on the immune system. NO signaling is important in triggering macrophages to kill intracellular TB organisms. The original work implicating vitamin D and TB used artificial UV light to induce vitamin D production with the endpoint being a slight sunburn. The reddening of the skin in sunburn is due to NO production in the skin.

    1 alpha,25-Dihydroxyvitamin D3 suppresses NO production following interferon gamma-mediated macrophage activation

    http://www.fasebj.org/cgi/content/full/21/12/3208

    I think the mechanism for NO mediated enhanced killing of intracellular organisms is via increased autophagy and not necessarily reactive NOx species. Autophagy is the generic mechanism for recycling internal contents. Everything coded for by nuclear DNA can be replaced by de novo synthesis. This is how cells can rid themselves of internal parasites.

  42. Edj2001 says:

    Here is what I said in an earlier post:

    “Take a look at the late Dr Lida Mattman’s, PhD. text book: “Cell Wall Deficient Forms – Stealth Pathogens, 3rd,. Edition. This is a text book on the topic of Plemorphic forms and their relationship to disease. In this text book she has slides showing CWD bacteria and many chronic disease conditions.”

  43. figlet says:

    Dr. Gorski,

    The point I’m making in my earlier post is that vitamin D deficiency may not be as widespread as is currently believed – in regular folks, in those with autoimmune disease, or in those with cancer.

    I don’t accept that someone is vitamin D deficient until I have measurements of both D-25 and D-125 – and I can absolutely guarantee you that the studies you’re referring to about cancer and vitamin D measured only the former. Why this is happening is a complete mystery to me – especially as the D-125 is the active hormone, and for my money, the more interesting value. I suspect it is believed that D-25 and -125 should be in lock-step with each other, however in my experience, this hasn’t been the case.

    I see that you are an oncologist – I would urge you to measure your patients D-125 if/when you are measuring their D-25. I would be interested to know how many patients with low D-25 in fact have very high levels of D-125 – I personally have been very surprised by the results.

    Regard,

    J. Rae, MD

  44. pmoran says:

    Russ: “Some might say it is “convenient” that the microbiota that Dr. Marshall implicates in these diseases are so difficult to detect. However, there are certainly many many instances in the history of medicine when something we can now easily detect was not detectable with the tools available at that time. ”

    Agreed. Like Dr Crislip, I have no difficulty in accepting that as yet undiscovered organisms may be the cause of SOME unexplained chronic illnesses such as sarcoid or Crohn’s disease.

    It is simply very off-putting when an exceptionally elaborate series of poorly supported and barely connected hypotheses are being used to explain an extraordinary variety of illnesses. It does not inspire confidence that these theories are based upon the usually careful standards of scientific observation and cautious interpretation of evidence. Rightly or wrongly, it does look more like a bee in someone’s bonnet.

    I say again that only the patient accrual of reproducible evidence can overcome any reluctance of the wider scientific community to accept such new ideas.

    Difficulty in reproducing evidence may simply mean that it IS irreproducible. As you imply yourself, that excuse simply adds to inadequately founded hypotheses without answering the key question “how can you be sure this is true?”.

  45. My understanding of Dr. Marshall’s claim is that Vitamin D-25 is preferentially converted to Vitamin D 1-25 in a number of disease states. The idea behind this, I believe, is that the causative organism – if there is one – converts the inactive vitamin (D-25) into the active seco-steroid (D-125) which, like other steroid hormones, might have the ability to suppress the immune system and allow an infectious agent to flourish.

    (emphasis mine)
    Are you really a doctor?

    What I bolded makes me doubt that you’re really a doctor. If you are, you aren’t a very good one, because you’ve accepted Marshall’s assertion without reading a basic science textbook.

    Epithelioid histiocytes (cells of the macrophage lineage) present in the granulumas that characterize sarcoidosis convert vitamin D to it’s active form.

    This is basic stuff, it’s not cutting edge research, and you should have understood it to graduate from medical school.

    As an infectious disease specialist, I very much doubt that Dr. Crislip deals much with patients suffering from conditions such as chronic fatigue and fibromyalgia. If he did, he would know that there is very little that “the great men of medicine” have to offer them. In fact, the longer I am in medicine, the more frankly embarrassed I am by how little we offer patients with chronic disease. Small wonder such patients look “outside the mainstream” for help.

    We have quite a bit to offer people with fibromyalgia, and chronic fatigue. I’ve been treating patients with both conditions all month. These conditions have a significant psychological component, and respond well to acknowledging and helping the patient gain insight into that aspect of the process. Additionally, we’ve had alot of success in fibromyalgia using the neuropathic pain medications, especially gabapentin, often in combination with SSRIs. I recommend a quick pubmed search on the subject before you abandon your patients to the Marshall protocol

    http://www.ncbi.nlm.nih.gov/pubmed/19141768?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed
    http://www.ncbi.nlm.nih.gov/pubmed/19539427?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    (Links are to review articles in JAMA and Pain respectively)

  46. Claironess says:

    Just thought I’d mention that being chemically sensitive is a symptom that lots of folk who are chronically ill have. Many just don’t label it MCS probably because it was not the most predominant symptom or symptom trigger early in their illness and it may not have altered their lives quite as much as someone whose life has been dominated by reactions to chemical exposures.

    If doctors quizzed their chronically ill patients, they might note this to be a fairly common symptom as well. (One of the problems is that reactions can be delayed and people often do not make the connection between exposure and symptoms. I can’t tell you the number of times I’ve seen folk tell me that they have a cold when a sentence or two before, they mention that they’ve just finished painting a room in their home or renovations are underway at work.) I only know this because so many people on the MP report being sensitive to chemicals and yet they would not label it MCS.

    I simply provided that example to illustrate that subjective symptoms make one less believable no matter how competent one was thought to be prior to the onset of a chronic illness. Also, improvements in illnesses or symptoms that are more easily measured/varied could be written off with “Well, some patients would improve on their own.”

    No one disagrees that more proof is needed for the medical community as a whole to accept Marshall’s work. For those of us on the MP–those of us who don’t try to rush through it or adapt it and stick with it (not to mention tolerate the initial immunopathology, which can be quite intolerable if we started the MP in a very bad physical state)–, we have proof enough.

  47. Edj2001 says:

    In the paper referenced below, Dr Marshall explains the pathways that directly and indirectly regulate the concentrations of both 1,25-D and 25-D. The vitamin D nuclear receptor is responsible for the transcription of 900+ genes including the genes that produce the enzymes that control these vitamin D concentrations. If the VDR is blocked by an antagonist produced by intracellular bacteria the VDR will not be able to transcribe the genes that control these concentrations. Neither will the VDR be able to transcribe many of the genes necessary for a healthy immune system.

    Marshall TG: Vitamin D Discovery outpaces FDA decision making.
    BioEssays Volume 30, Issue 2, Pages 173-182, February 2008
    Online ISSN: 1521-1878 Print ISSN: 0265-9247
    Copyright 2008 Wiley Periodicals, Inc., A Wiley Company
    http://www3.interscience.wiley.com/cgi-bin/abstract/117885976/ABSTRACT

    ”In accordance with the copyright assignment agreement I have put a free copy of the preprint of the Full Text on my personal website at”
    http://TrevorMarshall.com/BioEssays-Feb08-Marshall-Preprint.pdf

  48. If doctors quizzed their chronically ill patients, they might note this to be a fairly common symptom as well. (One of the problems is that reactions can be delayed and people often do not make the connection between exposure and symptoms. I can’t tell you the number of times I’ve seen folk tell me that they have a cold when a sentence or two before, they mention that they’ve just finished painting a room in their home or renovations are underway at work

    Because that’s proof of chemical sensitivity?
    Cold’s are incredibly common, that’s likely a false correlation.

    simply provided that example to illustrate that subjective symptoms make one less believable no matter how competent one was thought to be prior to the onset of a chronic illness. Also, improvements in illnesses or symptoms that are more easily measured/varied could be written off with “Well, some patients would improve on their own.”

    No, you’re doing it wrong. Science would show you that correlation. That’s why you do controlled trials. If some patients improve on their own, or with placebo, and MORE patients improve, consistently and predicatably, with your intervention, with statistically significant numbers, you’d have an argument.
    its not glibly writing someone off, it’s demanding proof of new treatments, and that’s the same thing I demand of every drug or treatment anyone suggests I institute.

    I spent an hour today grilling a pharma rep when he suggested I suggest be prescribing a very expensive newer beta blocker over the generic, very effective 4 dollar drug, for some beautiful pathophysiologic just so story, and when he said “well patients just like it better,” I grilled him about trials, about the numbers. I held him responsble for the arguments he was making, and on some points, he had a little evidence. On some, he didn’t, and the balance of evidence said I was on solid ground prescribing the 4 dollar beta blocker.

    That’s what we demand of any new treatment. And our patients deserve nothing less than our best efforts to find the legitimate, best treatments.

    We’re doing no different when we hold an alternate explanation like MCS to fire for evidence. Produce some, and we’ll consider it. Just claim that we’re wrong, and I have no reason to take you seriously.

  49. Edj2001 says:

    Whitecoattails,

    If you prescribe supplemental vitamin D, please demand the same controlled test requirements of supplemental vitamin D that you are asking be made for the MP.

    Vitamin D is a secosteroid with 1,25-D as the active hormone. It is not a single order vitamin-in benefit-out situation; it is a complex hormone controlled metabolism with multiple pathways.

    Evidence for the effectiveness of vitamin D supplementation has been made with subjective epidemiological studies fraught with inconsistencies. Every study claiming evidence for the benefit of vitamin D in preventing disease is based on correlation not controlled variable tests. You know what happens to your data if you can’t control the independent variable.

  50. …And yet nowhere did I advocate for vitamin D supplementation under normal circumstances. I think it’s important with calcium in osteoporosis, which objective, not subjective studies indicate.

    Nor is that relevant to your point.

    The Marshall protocol stands or falls on it’s own two feet.
    Either it works or it doesn’t.
    Either there is evidence, or their isn’t.

  51. Edj2001 says:

    The following study to be conducted by West China Hospital using the MP to treat ankylosing spondylitis will begin next month. See following press release:

    “Study aims to induce recovery from ankylosing spondylitis

    Chinese patients will soon have the opportunity to take part in a study of a novel therapy aimed at reversing the autoimmune disease, ankylosing spondylitis. Approximately 200 patients will be chosen to participate in a clinical trial that aims to merge the latest molecular discoveries published by the California non-profit Autoimmunity Research Foundation (ARF) with the medical expertise of physicians and researchers at West China Hospital…”

    http://www.eurekalert.org/pub_releases/2009-07/arf-sat072109.php

  52. antipodean says:

    Sarcoidosis is not that rare. It’s also hard to treat and it’s a chronic condition.

    It really shouldn’t be that hard to do a small but properly designed randomised clinical trial in S. or other chronic diseases to test this protocol.

    Endless citation of biological pathways will not convince the so-called establishment that this works. Clinical trials will.

  53. figlet says:

    Whitecoattales,

    I find discussions on these forums lively and thought-provoking, and for the most part, polite. Your post would be an exception.

    Your comments – and not just the ones in response to my post – would be considered arrogant by most, and examples of flaming by many, and for a fourth-year medical student who enjoys posting on blogs I would caution you that your unique brand of antagonistic repartee could see you ousted from sites such as these – though, of course, you remain free to continue on with your mostly-critical line of discourse on your own site.

    Yes, I am a physician. Whether I am a good one or not isn’t for me to say; having said that, it isn’t for you to say, either. If you took the time to read over my comment with even a modicum of clinical acumen, you would read that I say “the idea behind this, I believe…” this, being Dr. Marshall’s controversial claim about the conversion of D-25 to D-125. That is why I say “the causative organism – if there is one.” I’m not even talking about sarcoidosis. And nowhere am I “accepting Marshall’s assertion.” Read it again. See if you can “get it.”

    And my goodness – you’ve treated patients with fibromyalgia and CFS for a whole month. A month you say? The moment you said “we have quite a bit to offer patients with [these conditions]” I suspected you were new to the field – nothing wrong with that, but I doubt you’ll say the same ten years into treating folks with these conditions. More importantly, I doubt THEY would say you have “quite a bit to offer” them – or appreciate the by-now-tired assertion that their condition is a largely psychological one that should “respond well” to your “helping [them] gain insight.”

    How very like patients with ulcers who, until recently (though perhaps not in your lifetime) were encouraged to “relax and stop giving themselves an ulcer.” Is it possible that even we don’t know everything yet?

    I am well-familiar with the treatments you mention for FM and CFS – as most practicing physicians would be. Thus, your recommendation that I do a quick tour of pubmed is insulting, as is your suggestion that I have abandoned my patients to anything. I don’t have any patients on the Marshall Protocol. I’m merely interested in his line of inquiry because of the my own contrary findings with regard to D-25 vs D-125 levels.

    Some collegial advice: drop the sarcasm if you want to be taken seriously. It adds nothing to what you say. Clever people and their clever comments are a dime a dozen in medicine, and they rarely get you laughs – or respect. I’m signing off from this forum, as I feel the tone has turned rather caustic, so you’ll have to save your insults and quips for someone else.

    I only hope your colleagues don’t recognize your moniker.

    Good luck in your career.

    J. Rae, MD

  54. Claironess says:

    Right on Dr. Rae! Wow how the comment about the psychological component to CFS and FMS ticked me off given all the evidence there is to physiological abnormalities. Indeed, I am entirely fed up with this line of thinking (and lack of knowledge about the research by doctors in general) given that I am emotionally well balanced (of course getting ticked off at this foolishness could be used against me), self aware, and joyful.

    Indeed, I doubt most “healthy” people have had to go through what I have had and managed to do so with such a positive attitude. However, my self report cannot be true! No! I must be psychologically compromised somehow to have CFS and FMS. Yes, master, whatever you say master, er, doctor.

    Let me tell you, Th1 illness takes over the stress pathways. I found that as I got more physically ill, the more difficult it was to recover from stress. If I became anxious, it was difficult to calm my body back down. (This from someone who could at one time regulate her own heartbeat… official, documented… because of my experience with yoga and meditation. No doubt had I been hooked up to a brain wave machine, I could have demonstrated the ability to change my state of consciousness with ease as well.) On the MP, like many people on the MP, I find myself becoming more myself again. Whoa, no Claire that can’t be true (because you can’t prove it)! Yes. It is.

    Controlled studies? Well, clinical studies are underway at WCH. But tell me, if you know how the MP operates, how do you entirely control for the variation in meds on the MP when everyone has to work to keep their immunopathology tolerable? How would any results that allowed such variation in med usage convince anyone who was not willing to be convinced? Even changes in lab tests that are objective could be written off by someone determined to do so. Not to mention the fact that folk who dropped out would be pointed to as failures in the MP instead of the person’s inability to understand or manage their IP or tolerate the IP. (Most people just do not want to feel worse to get better.)

    And what was/is the ethical decision that’s been made about releasing certain AIDS drugs on the market without long-term controlled studies?

    And for someone like me for whom no objective tests are yet available to diagnose my illness beyond the research labs (and surveys, which many doctors have not believed anyway), do I wait until such testing is available before taking my health into my own hands?

    You see, I know my word will never be taken by you or people like you, or by people who are sick and in denial or people who are sick and are frightened by the demands of the MP and who are looking for that magic bullet, much in the same way that medical science still relies on the one germ per illness theory if germs are thought to apply at all.

    And in regard to your question about my proof of MCS (was I calling it proof?… I think I was calling attention to its existence NOT AT ALL CONCERNED ABOUT PROOF, as obviously MCS is a mass hallucination as is CFS and FMS), I guess what I have to say about that is that, according to your reasoning, colds also did not exist until humans were able to “see” viruses.

    What can’t you not see now because of a lack of understanding (or imagination) or the inability of technology to see for you?

    Also, please note that if anyone cared to search (I don’t have the cites… I’m not a doctor and haven’t been collecting the studies), one would find a relatively long-term study of calcium and Vitamin D versus calcium alone that shows that Vitamin D did nothing to improve bone health over calcium alone. (A similar shorter term–I believe–study showed that vitamin D did nothing to help heart attack sufferers recover.) Note, from what I’ve seen Vit D is often just included with calcium in bone studies based on the assumption that it is necessary. Doesn’t sound very controlled to me.

    Yes, getting clinical trials will show whether the MP works or not.

    Now tell me, how do you go about doing that? It costs money. And someone has to listen and fund it. Right now, everyone acts like Marshall can just pull the money out of his butt and presto change-o create the level of clinical studies that everyone is demanding. This is why the partnership with WCH is so important (and another hospital, which is also going to run clinical trials). Meanwhile, he put his ideas out there and people signed up to participate in a less than ideal trial. And whether you believe it or not, based on my experience and that of others, people are regaining their lives.

    However, instead of seeing us as pioneers willing to risk our lives to try something that makes sense to us, instead of seeing both the humanitarian effort on Marshall’s part and his attempt to demonstrate that the ideas hold water, he is and we are often vilified.

    Instead of reading about what Marshall has postulated and making an effort to understand it and then perhaps getting behind the possibilities behind the ideas and trying to help raise funds or find a school or hospital to fund the research, Doctors just demand that the clinical trials be in place, as perfect as you please.

    This is particularly annoying given the poor state of medical research in general, not to mention the sometimes inane suppositions and (sometimes not even) tentative conclusions that are drawn from merely correlative studies.

    Woo hoo, most doctors are so smart and up to date on the research (and yet a fairly recent study supposedly showed that doctors tend to be 15 to 20 years behind on the medical research). Yeah, in general, they know all about the experimental design of the studies that they accept as gospel. They know how fraught the world of publish or perish is in regard to researchers rushing to get anything into publication. They understand the politics of getting papers into Journals. They know how much medical research is now driven by the pharmaceutical (or other) companies.

    Yeah, it’s a pure system and my 130 year old grandfather is still alive.

    When it comes to scientific research, I have suspect that good bits of psychological and medical research, particularly that which makes for great news reporting (the news is all about the latest magic bullet… no one has time in this culture for a slow cure, like slow food) scrapes the bottom of the barrel in the publish or perish world and in the race for funding (e.g., grants, etc.). Of all the sciences, I am most doubtful about the claims of these two fields as their is way too much money to be made off of human suffering.

  55. th1gal says:

    Hello, I am a veteran of the Marshall Protocol. I am generally inclined in favor of Dr. Marshall’s work, but I am also substantially disappointed by the manner in which Marshall and his adherents have circled their wagons and handled the understandable challenges to his biomedical theories (his contribution is a composite one).

    Here is the problem in a nutshell: It is clear to anyone who has thoroughly reviewed the MP study site over time that there are people who have realized remarkable recoveries under the MP, and other people who have not been helped at all, and a great variety of experiences that fall in between these two poles. But Dr. Marshall has been very quick to shut down efforts to gain an understanding about this wide range of experience, and he has shut down attempts to understand why some are helped more than others.

    It seems to me that what Marshall’s supporters have trouble understanding is this– it is not the orthodoxy-challenging theories that have caused Dr. Marshall to lack credibility among many knowledgeable scientists– it is the absolutism that has accompanied these theories. The portrait painted on the MP website is one of Marshall being open and his detractors closed, but the MP-boosters don’t understand well why they frequently aren’t taken seriously– it is because Dr. Marshall is, in fact, the one who is closed– the one who rejects alternative explanations– the one who limits discussion– the one who insists on a zero-sum competition between theories– the one who rejects pluralism– the one who demands absolute adherence to his propositions. Suggestions of variation, alternative explanations for like symptoms, diversity of pathologies, biochemical individuality, genetic predisposition to disease — such explanations are avoided by Dr. Marshall just as extremely as the ‘Wicked Witch of the West’ avoided water.

    But biology is not like a mathematical proof or an electric circuit– it is messy and profoundly complex– characterized by nuance, contingency, idiosyncrasy, individuality, and pluralism– not absolutism.

    It would be nice if those who really and genuinely wish to see Dr. Marshall’s ideas more seriously considered by the medical community stop behaving as if they belong to a cult and begin offering thoughtful and respectful answers to the many scientific questions that have been raised. There is no real effort by Marshall to provide careful thoughtful point-by-point refutation of arguments made against the Marshall model of pathogenesis. Instead, we find on the MP website the repeated diminishing and dismissal of criticism, along with a variety of attacks made against the authors of the claims. One author, we are led to believe, is corrupt, another is rude, all appear to have ulterior motives, in fact, every argument against the MP is discussed in terms of the questionable motivations of its author. (But I do not mean to suggest that all of those critical of the MP have been above this type of engagement).

    Dr. Marshall might consider explaining on message boards such as this one whether/why he believes in the following absolute claims that have been made by himself or on his behalf:

    1) There is no possibility that anyone suffering from TH1 disease could ever experience healing without severely restricting the intake of exogenous vitamin D– are you sure this is absolutely true, Dr. Marshall?

    2) Any person, apparently healthy or not, who makes the substantial Marshall Protocol lifestyle changes and takes the MP medications, and subsequently experiences some/any degree of change in health– improvement or decline– is considered to have responded positively to the protocol. Such a person will surely become sick (if apparently healthy) or sicker (if already sick), unless they continue with the MP– are you sure this is absolutely true, Dr. Marshall?

    3) Anyone with a blood test that has revealed a relatively high level of 125-D is without any doubt suffering from chronic disease and will definitely not get better without going on the Marshall Protocol– are you sure this is absolutely true, Dr. Marshall?

    4) There is no possibility that the symptoms experienced by the patient on the MP–after she makes dramatic lifestyle and dietary changes and begins to take large doses of benicar–are due to various complex factors. The reported symptoms are without question always due to immunopathology resulting from bacteria die-off– are you sure this is absolutely true, Dr. Marshall?

    5) All those who have ever criticized any aspect of the Marshall Pathogenesis model are either unintelligent, dishonest, or have had questionable motives. There is zero possibility of finding any fault with the MP based upon research that is well-intentioned, honest, and intelligently structured and carried out– are you sure this is absolutely true, Dr. Marshall?

    Clearly, to those biologists on the fence, assertion #2 is of concern: The MP criteria, at very least, appear to be cleverly rigged to hide any and all failure– no matter how disappointing the results, the MP will not be considered by Dr. Marshall to have failed. Its impossible. Any increase in symptoms is indication of immunopathology, which is good. And, of course, a decrease in symptoms is also good. Once on the MP, all symptoms that were previously measures of disease progression are now measures of the opposite. If one stops the MP before symptoms improve, then this is never considered a failure— the patient didn’t stick it out long enough. And the length of time it should take to realize improvement?— this has increased from one to two to three to four to five or more years; interestingly, these changes of expectation have been announced by Dr. Marshall as many people have remained sick for one, then two, then three, then four, and now, five or more years.

    In summary, I will remind his supporters that Dr. Marshall has yet to present any evidence that the MP is killing bacteria. There are clearly some people who have benefited tremendously from the MP—most of them have accepted Dr. Marshall’s forceful explanations for their improved health. There are many more who have realized slight improvements—this group is hoping against hope, usually desperate to join the ranks of the “cured,” so its not surprising that they are willingly sycophantic, Dr. Marshall usually representing their only hope. And there are many people who are not being helped at all, rather quite the opposite—but they are never cited as evidence of problems with the MP, as evidence that the MP may not be helpful for many people, and as a group from which some explanations might be derived as to who will and who will not benefit from the MP; instead they are told to hush hush, not to ask questions meant to explore and understand the full range of experiences that people are having on the MP.

    It would be nice if everyone would accept that the science here is complicated– intelligent respectful debate is a good thing–lets all be open to new ideas– and also open to the possibility that the new ideas in question here may, at very least, need some refinement.

  56. trevorjharris says:

    I hope Dr Crislip that after reading these comments you realise that the Marshall Protocol should not be consigned as quackery.

    A clinical study of MP is to start at the West China Hospital which is one of the biggest hosplitals in the world.

    http://www.eurekalert.org/pub_releases/2009-07/arf-sat072109.php

    Clearly the doctors at West China Hospital do take MP seriously.

  57. Lloyd Finch says:

    To th1gal. I think what you interpret as absolutism really results from a rigorous exercise of a duty of care towards those who are undertaking or might be tempted to undertake the MP. As I see it Dr Marshall has found a protocol that worked for him, made available to others with sarcoidosis who also found it worked for them and then with an internet connection its use started to spread. Again as I see it, DR Marshall knows what has worked. He knows that it involves increased immunopathology. He knows that the IP must be controlled and some ways to control it within the context of the MP as it is currently constituted. He can’t know the effect of all the variations that people might like to try,or see tried, with it. His duty of care is to say, ” Do it this way or you are not doing the Marshall Protocol”. Nor can he appear to be implying to a potentially naive audience, “This may be OK”.
    He is doing what he can, with awesome effect, to develop a base for understanding reasons for the successes of the Protocol. As a scientist, what I want to see are experiments by others to support or contradict his ideas and observations. For a start, someone with a VDR-activated gene expression system could test whether, or not, it is activated by olmesartan.

  58. th1gal says:

    Dear Lloyd Finch,

    I appreciate your post, and I think that you made a couple of good points. Yet you also seem to be seduced by some of the MP (absolutist) sophistry, which you repeat, and as a scientist, you should be aware that you are doing this:

    “Dr Marshall has found a protocol that worked for him.” No argument there. And few would find fault with Marshall for wishing to share…

    “Dr. Marshall knows what has worked…” “He is doing what he can, with awesome effect…” By these statements, you suggest that the MP is working generally for the cohort who are trying it. This is not evident. Not even close. And when we get into the nuts-and-bolts of how we are to take measure of the MP success rate, all the problems, some of which I referenced in my last post, come to the fore.

    “He knows that it involves increased immunopathology.” Most scientists will identify this as an assumption, yet you write this as if it were a statement of fact. This distortion is also a kind of absolutism. And again, when we get into the nuts-and-bolts of the contention about immunopathology, the various problems with Marshall’s arguments become evident.

    In my opinion, most MP advocates display a myopic picture– its Marshall against the medical orthodoxy– but in reality, the MP is only one of a myriad approaches to healing chronic diseases, for which hundreds of testimonials are scattered across the internet. In a crowded arena of ideas, scientists will naturally take measure of which to ignore and which to explore.

    Lloyd, I completely share your expressed desire to see scientific research based upon Marshall’s contributions. But what I think you and other MP advocates miss is how Marshall and sycophantic supporters of the MP do damage to the cause by their wildly absolutist (and thereby distorting) claims. You made a couple of these yourself. These sorts of claims, of which I listed several (there are many more) in my last post, drain credibility from the entire suite of MP arguments. That’s why I find the absolutism, in addition to being intellectually distasteful, to be so disappointing– for they have the effect of making many good scientists turn their heads and look elsewhere.

  59. Lloyd Finch says:

    To Th1gal
    My comment “with awesome effect” related to his use of computer-modelling of ligand-receptor binding to elucidate possible effects of agents related to the MP and his integration of new data from the literature into his ideas. Being 17 years out of date and used to working with test tubes I am uncertain of the credibility of computer modelling. My limited access to the literature has uncovered some examples its use in a similar way to that by Dr Marshall so it probably has credence. However I should like to see it tested in test tubes and feel that there are simple and very informative experiments that can be performed by labs with the right systems in place.
    To remove the assumption about “immunopathology” replace it by “the occurrence of nasty and potentially dangerous effects”. Whatever one calls it, he is exercising a duty of care to prevent people straying into an area of risk beyond the established protocol’
    We’ll have to stop meeting this way!

  60. th1gal says:

    Lloyd, I think you raise a fascinating aspect of the story– really, its the conversation that the MP should be igniting– the issue of computer modeling vs. evidence-based medicine. (My personal assessment is that Marshall is drunk-in-love with numbers, and has some difficulty with the idiosyncratic nature of biology).

  61. daedalus2u says:

    Loyd, the MP isn’t an “established protocol”. To me, an “established protocol” in medicine is one that has been clinically tested at multiple sites and shows to be safe and effective multiple times. Marshall isn’t an MD; his PhD is in electrical engineering. A “duty of care” requires medical treatments to be provided by a medically trained and medically licensed provider acting within his/her area of competence. This is spelled out in the Declaration of Helsinki.

    th1gal, to me, a computer model involving a couple of aspects of incompletely understood physiological pathways is a very low level of evidence. The critical parameters are the binding coefficients, and these are very strongly affected by the medium the proteins and substrates are in. To me, an anecdote is a higher level of evidence than a computer model.

  62. bengalo says:

    The Mp may not be an established protocol, but it has to be provided by a medically trained and medcally licenced provider. Marshall only provides his scientific findings, what’s the problem?

    the meds arent snake-oil or anything, its commonly used meds like minocycline and benicar. which has vast scientific implictions in conventional litterature for use in the various autoimmune diseases in question.

    Whats wrong with using computer modeling as an aid in research? Max planck institute does this alot to model how antibiotics block bacterial protein synthesis. its used to guide research, not as proof.

    I dont see the problem here – Marshall and ARF-crew has found something potentially groundbreaking with no financial support from big-pharma or government (when did that ever help anyone but big business?) but only with intellect, persistence, and a desire to get well.

    The fact that it didnt go through the conventional channels should be applauded, not looked down upon.

    What all critics are asking for is on its way in china, so why not give it some time before throwing tomatoes at Marshall and ARF?

    please chill folks! :)

  63. th1gal says:

    I, for one, am chillin, bengalo. Why do you have a problem with critiques of the MP? Perhaps you are the one who could stand to chill? Is anyone trying to shut Marshall down? There are literally hundreds (maybe thousands?) of pages on the 4-5 MP websites boosting the MP in heavy-handed fashion. Many many sick people are very hungry to learn different points of view. (I’ve been one and I know many others). So… this page is one of the few pages where a few criticisms can be found. What’s the problem? And, your comment about bypassing Big Pharma is a red-herring– who has a problem with that? Please chill, bengalo!

  64. bengalo says:

    Ok Th1gal, i’ll chill, and you’re right

    Criticism is good, including this article. But still, it seems that most criticism is aimed at the fact that marshall is an electrical engeneer and that the danger of vitamin D deficiency is a universal truth. And placing the MP in the quack category doesn’t seem right…

    I’d love to see some real in depth criticism from a different point of view, from someone not just scratching the surface. Like the questions you brought up in one of you’re previous posts.

  65. Delrettico says:

    Dr. Crislip,

    “Why did [you] go to medical school?” you ask, in jest. Please note that the mainstream Vitamin-D enthusiasts have much the same list of diseases they think are affected by Vitamin-D as does the Marshall Protocol group! You can pick this list out in a number of articles on the web, including the Wikipedia article on Vitamin-D, at http://en.wikipedia.org/wiki/Vitamin-D

    I’m not not a doctor, nor a medical researcher, just someone who’s had some biochemistry courses in college, whose sister was cured of her sarcoidosis by the MP, and who has been looking for common-ground between mainstream Vitamin-D research and Dr. Marshall’s scientific findings.

    nokomarie, scleroderma is one of the conditions which the MP treats.

    abetterjulie, you can have a “surplus” of active Vitamin-D (i.e. 1,25-D), even when you have a supposed “deficiency” of pre-hormone Vitamin-D (i.e. 25-D). Perhaps you could get both blood levels tested, and see what your condition really is. Be sure your lab tests your (1,25-D) correctly. The Marshall website has helpful guidelines (and is unaffiliated with any lab) – see http://www.marshallprotocol.com/forum2/366.html

    This has been a very interesting article blog. There are a lot of first-hand personal experiences, and there are a lot of new links to look up that I didn’t have before.

    The authors of the Wikipedia article are almost certainly not MP advocates, because the article favors widespread public supplementation with “D”, whereas the MP does not. Nevertheless, the article seems to agree with the MP under “Role in immunomodulation” where it says “…ligands with the potential to activate the VDR, including … a number of synthetic modulators, may have therapeutic clinical applications in the treatment of; inflammatory diseases (rheumatoid arthritis, psoriatic arthritis), dermatological conditions (psoriasis, actinic keratosis), osteoporosis, cancers (prostate, colon, breast, myelodysplasia, leukemia, head and neck squamous cell carcinoma, and basal cell carcinoma), and autoimmune diseases (systemic lupus erythematosus, type I diabetes); central nervous systems diseases (multiple sclerosis); and in preventing organ transplant rejection.”

    One closing, but important, observation. The science of Vitamin-D is indeed complex, but many mainstream Vitamin-D researchers need to be called to account for, or justify, their widespread practice of measuring only (25-D) concentrations in the blood. At one time this might have been a reasonable pragmatic practice, based on seemingly reasonable hypotheses, but now we know better. Several thoughtful responses to your article on the Marshall Protocol have already alluded to this practice. It seems to have become so ingrained in mainstream thinking, that even researchers seldom question it.

    Of it, the Wikipedia article (Aug. 4, 2009) simply says:

    /***
    “A blood calcidiol (25-hydroxy-vitamin D) level is the accepted way to determine vitamin D nutritional status.”
    ***/

    The term “Vitamin-D” has generally come to refer to not just one chemical species, but a family of related molecules. The “active” form is generally acknowledged to be (1,25-D). Although this form is derived from (25-D), which is derived through sunlight and from ingested vitamins D2 or D3, there is no guarantee that by measuring (25-D), we can infer levels of the active form (1,25-D). In fact, the disease sarcoidosis alone disproves the premise that you can reliably infer active Vitamin-D levels from (25-D) levels.

    As Dr. J. Rae says in her post “… Indeed, I did notice a high proportion of my patients suffering with autoimmune diseases had low levels of Vitamin D-25. However, when I bothered to check their Vitamin D-125 status (the active form of the hormone) which few people do, I was surprised to find it elevated in nearly every case …”

    This phenomenon seems to virtually undisputed with regard to sarcoidosis. You, Dr. Crislip, even said: “Sarcoid has dysregulation of vitamin D with increased levels in the blood, the vitamin D being made in the granulomas.”

    Researchers tell us that various diseases are often “associated” with what they call low Vitamin-D levels. Usually, this means low (25-D) levels. If (25-D) is depressed, the researchers tend to call this a “deficiency”. Governments and the public are constantly being urged to up supplementation to avoid supposed “deficiencies”.

    In the light of the disproof, low levels of (25-D) alone do not necessarily mean there’s a Vitamin-D deficiency. The fact is, the relationships of the concentrations of the various forms of Vitamin-D are “not” lock-step. You can’t measure just one and think you know about them all. Strictly speaking, such research conclusions seem unjustified and unscientific. So we need to ask seriously, is this practice “good” science? Should public health, and public policy, hang by such a questionable thread?

    Vitamin-D science is complex enough to understand, without the incorrect hoopla that is arising from the failed assumptions of this method. A lot of confusion about Vitamin-D can be laid at its door. The Marshall Protocol’s practice of cutting-back on Vitamin-D intake will be a lot easier for people to understand, once they know that the patients have a “surplus” of active Vitamin-D, not a “deficiency”.

  66. woo-fu says:

    If I’m understanding this correctly, these are the basic concerns regarding the Marshall Protocol:

    (boiled down to 10 for ease of discussion–apologies for repetition from prior comments)

    1) whether or not low levels of vitamin D are causative or simply correlative to autoimmune diseases and other conditions

    2) whether or not low levels of inactive D correspond with low levels of active D

    3) how D levels actually impact the immune system (whether the MP model works)

    4) how variable these impacts are across populations (whether the MP model works for all)

    5) whether previously undetected microorganisms (what are now referred to as L-form, cell-wall deficient or stealth pathogens) account for disease expression

    6) whether these microorganisms have the capacity to interfere with vitamin D metabolism

    7) whether lowering D intake assists the body in detecting these stealth pathogens

    8) how the antibiotics work in the mix and exactly what the risks of their use may be

    9) whether the high-dose Benicar is necessary to protect against immunopathology

    10) whether symptoms presented on the MP represent predictable immunopathology, expected exacerbations or remissions of the disease process itself, or simply side-effects of the protocol

    Aside from issues of personality and background, this seems to be the debate in a nutshell. If I’m missing a major concern, please advise.

  67. woo-fu says:

    That should be an 8) rather than a smiley face in my prior comment. I’m not sure how that happened. It’s been a strange morning.

  68. th1gal says:

    woo-fu, although I think your listing might stand a small amount of fine-tuning, I think your contribution of this listing is an excellent one that should support productive discussion. Advocates and critics alike should keep in mind that the MP is a composite theory. The different components of the theory do not necessarily hang together. One of the disappointments about Marshall’s administration of the MP websites is that no one is permitted to openly tease apart the different elements of the composite theory. Those that have tried have been banned. In my opinion, certain of Marshall’s contributions are quite powerful, seeming to ring truer and truer upon investigative research and experience, while other of his contributions are doubtfully correct– Vitamin D metabolism being the former, while suggestions of widespread microbial-caused disregulation of the VDR that can only be cured with olmesarten being the latter.

  69. Delrettico says:

    Woo-fu, the idea of listing points or issues seems good.

    th1gal, the idea that the MP is suceptable of enlargement and further proofs seems okay.

    I find it’s hard to write a post that doesn’t contain some little unintended mistake or other, be it spelling or something slightly more serious — so I hope we’ll all be generous in giving each other some slack. Even peer-reviewed papers and dissertations can have mistakes.

    Lloyd Finchon’s first post carries the weight of a researcher and one who has tried the MP personally. I hesitate to make it sound like there are only a few posts that are important. I have read “all” of them, and there are some points that will appeal to some people in some discussions, and some that will appeal to others. I don’t mean to minimizine anyone’s honest contribution. Lloyd is frank in his delight of some of the Marshall science, and also in his anticipation that more may be verified (for instance, in-vitro) as the MP gains more mainstream exposure.

    However, one of the problems blocking such exposure is the tendency for mainstream people to turn away from reading about the MP in depth, as soon as they run into statements about VitD that seem to fly in the face of what is accepted as mainstream.

    Although we like to think the mainstream represents science whose flaws will eventually fade away, we need to recognize that at any point in time, there can be some residual flaws that have yet to be lopped-off. Like those who laughed Columbus to scorn when he tried to get funding for sailing on the round earth, we have today a mainstream mentality that needs to come face to face with one of the flawed assumptions that is stifling the progress of vitD research. I am referring to the practice of measuring only (25-D), then assuming that (1,25-D) follows suit.

    This is not a Marshall Protocol problem, and therefore doesn’t really belong in Woo-fu’s list of points, but is germane anyway to the present state of MP investigation. It seems the public and much of the VitD research world is being lead along by ignoring the flaws in that assumption.

    Perhaps there would be more in-vitro research into Dr. Marshall’s discoveries, and its implications, if the stumbling block received more attention. There would probably be fewer claims that Dr. Marshall’s papers contain “untrue” information. If there are people who want to talk about science-based medicine, and un-science based, there is grist for the writing mill.

    The burden of proof for the practice needs to be pushed off Dr. Marshall, and put back on the shoulders of those whose who are clinging to it, and whose eyes need to be opened to its flaws. We the public need to be aware of “why” we should question more studies that say taking more VitD is the answer to our chronic health problems.

    Lloyd refers to this situation:

    /***

    On the question of the role of vitaminD, my extensive background in the field of metabolic regulation leaves me in little doubt. A high concentration of the effective end product of a pathway (1,25-dihydroxyvitaminD in this case) will lead to a lowered concentration of an earlier intermediate in the pathway (25- monohydroxyvitaminD which is what is measured in serum as an indicator of VitD status). Mechanisms by which this happens have been documented. 1,25-dihydroxyvitaminD levels are increased by interferon gamma. This is why sick people have low levels of 25-monohydroxyvitaminD (so-called VitD deficiency). Anyone wanting to claim otherwise is obligated to show that such low levels are correlated with low levels of the functional 1,25-dihydroxyvitamin if they wish to be considered other than sloppy pot-boilers.

    ***/

    As he says, there is an “obligation” to show that low levels of (25-D) are correlated with low levels of the functional (1,25-D).

    Folks, there is a big flaw in mainstream Vitamin-D research, which is largely being overlooked! Any perfect logical argument is subject to the “garbage-in, garbage-out” phenomenon. The MP won’t receive proper scientific attention it deserves until there is a mop-up of past misconceptions that are flooding the world with misinformation about VitD.

    It would be great to hear a truly scientific recounting of the history of this “accepted practice”, how it got started, and to explain why it has endured to the present day, and how it “can” lead to research blindness, unhealthy goverment policies, and a few actual VitD scams. Or… showing “clearly” on what basis it can still be used as a useful tool.

  70. skepticg says:

    Could the Mass Hysteria of today, and recent times, about “vitamin” D / cholecalciferol be because the patent for the synthesis was / is owned by WARF, which stands for (University of ) Wisconsin Alumni Research Foundation, and like all foundations, WARF is most interested in raising MONEY for their projects, such as erecting buildings for their beloved University?

    From WARF, comes warfarin, a rodent poison.

    From WARF, comes QUINTOX, a rodent poison, whose active ingredient is cholecalciferol. QUINTOX is tauted to kill a Norway rat in two to four days time. The mode of action is to pull calcium from the bones, and deposit it in the arterial/cardiac system. How many diagnoses of human ailments are based upon those actions, that we readily know about, much less haven’t really thought of yet?

    From untold numbers of unknowledgeable promoters, jumping on the Mass Hysteria of today, come all kinds of products, doing the same thing as WARF… raising money? and poisoning people?

    Hmmmm! could cholecalciferol act like arsenic, lead and mercury? In large enough quantities, it will kill a human rather fast. In even very small quantities, it will take longer, but with mean results in the meantime.

    The EPA protects us from even being able to buy a mercury based thermometer today at the corner pharmacy store, for fear the thermometer will break and poison us.

    At the very least, might not cholecalciferol be a highly controlled substance, until such time as truly LONG-term true studies, not just “studies” based upon correlations, tell us what the full, meaningful effects of this product are?

  71. Hmm... says:

    Crislip,

    I think your summary is just and your advice sound…

    “So what do I make of the Marshall Protocal?
    Unproven. Based of hypothesis that are almost certainly not true. Potentially harmful if it induces side effects from unneeded antibiotic uses or, more worrisome, from vitamin deficiency.”

    …except that vitamin D is not a vitamin and cannot cause vitamin deficiency. An intelligent medical professional such as yourself should know at least recognise this.

  72. shonya says:

    I consider myself a layperson with only a BSN in nursing, a few other degrees, a nose for good science and perhaps most advantageous, a keen understanding of human nature. I certainly cannot add to this forum on any competent scientific level.

    That said, I have a plethora of experience with a number of severe health problems and their allopathic treatment approaches. I came to this site to read about the Marshall Protocol because I, like so many others, continue to suffer from two decades of ongoing autoimmune disease in spite of having had my entire colon and mucosa removed for UC. I am left with little recourse other than to pursue alternative approaches.

    Mostly, I want to say that I have found this post to be very stimulating. I am encouraged by the thoughtfulness, knowledge and, generally, by the motivations of those who are contributing. I thank all of you for widening my knowledge base.

    Dr. Rae, I would like to specifically address a comment to you. Please do not give up on a post like this because of the hostility of one individual (which clearly has little to do with the actual subject matter). I found your posts to be thoughtful, open-minded, informative and incredibly well-intentioned. People like me rely on people like you to help us make well-informed decisions.

    The fact that you routinely test your patients for Vitamin D-125 tells me more about you as a physician than the vast majority of your colleagues can discern. It tells me about your approach to information, research, and let us not forget the most important detail that so often gets lost in discussions such as these, your desire to help your patients. Any physician who discounts a patient’s experience because it doesn’t fit with current dogma, it hasn’t been proven in clinical trials, or merely because it is subjective is truly a King or Queen of Fools.

    There are two types of doctors: those who listen and those who don’t. You are the former, and my extensive experience as a patient and professional experience working with physicians has led me to the conclusion that you are too rare a commodity to allow yourself to be silenced. Please reconsider your decision to withdraw from this (and other?) posts. You are too needed to bow out.

    The world if full of “whitecoattails.” That is why medicine (or any scientific field) hasn’t advanced more than it has. The most myopic thing about science is its insistence that only science can explain all phenomena. My only hope for recovery is to know that there are at least some professionals in the field that can get beyond their own egos and the all-too-often rigid indoctrination of their respective professional training and work environments to advance patient care. (Notice that I said patient care and not science? The advancement of science is all too often curtailed by human frailty.) Most of the posters in this forum are making sincere efforts to try to leave their human frailties at the door. I am eternally grateful to each of you.

  73. qetzal says:

    The most myopic thing about science is its insistence that only science can explain all phenomena.

    shonya,

    Science insists on no such thing. Perhaps your nose for science isn’t nearly as good as you think it is.

  74. Baba says:

    I would like to know how many patients are now healthy and without antibiotics after treating with MP. I have not read about one single case since the Trevor Marshall started his project.

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