Revised 7/23/09 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.
- 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
- Nat Clin Pract Rheumatol. 2008 Aug;4(8):404-12. Control of autoimmune diseases by the vitamin D endocrine system.