This question came up here recently, or at least the gut worm part of the
below did:
The FDA has approved maggots for medical purposes.
Maggots make medical comeback
By LAURAN NEERGAARD, AP Medical Writer
(Published August 2' 2004)
WASHINGTON (AP) - Think of these wriggly little creatures not as,
well, gross, but as miniature surgeons: Maggots are making a medical
comeback, cleaning out wounds that just won't heal.
Wound-care clinics around the country are giving maggots a try on some
of their sickest patients after high-tech treatments fail.
It's a therapy quietly championed since the early 1990s by a
California physician who's earned the nickname Dr. Maggot. But Dr.
Ronald Sherman's maggots are getting more attention since, in January,
they became the first live animals to win Food and Drug Administration
approval - as a medical device to clean out wounds.
A medical device? They remove the dead tissue that impedes healing
"mechanically," the FDA determined. It's called chewing.
But maggots do more than that, says Sherman, who raises the tiny,
wormlike fly larvae in a laboratory at the University of California,
Irvine. His research shows that in the mere two to three days they
live in a wound, maggots also produce substances that kill bacteria
and stimulate growth of healthy tissue.
Still, "it takes work to convince people" - including hospital
administrators - that "maggots do work very well," said Dr. Robert
Kirsner, who directs the University of Miami Cedars Wound Center.
"They'll probably be easier to use now that they're FDA-approved, and
we'll talk about it more and think about it more," Kirsner said. He
estimates he uses maggots in about one in 50 patients where
conventional therapy alone isn't enough.
This has been quite a year for wormlike critters. In June, FDA also
gave its seal of approval to leeches, those bloodsuckers that help
plastic surgeons save severed body parts by removing pooled blood and
restoring circulation. And in the spring, University of Iowa
researchers reported early evidence that drinking whipworm eggs, which
causes a temporary, harmless infection, might soothe inflammatory
bowel disease by diverting the overactive immune reaction that causes
it.
There's a little more yuck factor with maggots. Most people know of
them from TV crime dramas, where infestations of bodies help determine
time of death.
Actually, maggots' medicinal qualities have long been known. Civil War
surgeons noted that soldiers whose wounds harbored maggots seemed to
fare better. In the 1930s, a Johns Hopkins University surgeon's
research sparked routine maggot therapy, until antibiotics came along
a decade later.
Today, despite precise surgical techniques to cut out dying tissue,
artificial skin and other high-tech treatments, hard-to-heal wounds
remain a huge problem. Diabetic foot ulcers alone strike about 600,000
people annually and lead to thousands of amputations.
It's not unusual to spend two years and $30,000 treating one, says Dr.
David G. Armstrong, a Chicago specialist who first tried maggot
therapy in frustration about seven years ago and says he's now used it
on several hundred patients.
Drop maggots into the wound and cover with a special mesh to keep them
in place. Two to three days later, after the maggots have eaten their
fill, lift them off and dispose.
Wound size determines how many maggots, and how many cycles of
therapy, are needed. It typically costs a few hundred dollars, says
Armstrong, of the Rosalind Franklin University of Medicine and
Science.
One of Sherman's studies found 80 percent of maggot-treated wounds had
all the dead tissue removed, compared with 48 percent of wounds
surgically debrided. Armstrong is about to publish research that
suggests maggot-treated patients also spend fewer days on antibiotics.
Patients say it's not that hard to accept. Pamela Mitchell of Akron,
Ohio, begged to try maggots when surgeons wanted to amputate her left
foot, where infection in an inch deep, 2-inch-wide diabetic ulcer had
penetrated the bone. It took 10 cycles of larvae, but she healed
completely.
How did they feel? On day 2, when the maggots were fat, "I could feel
them moving, because they were ready to come out," she recalls. But,
"if you're faced with amputation or the maggots, I think most people
would try the maggots."