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Parasite purge

Health | Aid groups are launching an all-out effort against a plague of intestinal worms in poor countries around the world

Issue: "Unify and conquer," June 14, 2008

Former New York Yankees pitcher Kevin Brown was puzzled by his sudden loss of strength. For several months during the spring and summer of 2004 he struggled to get out of bed and often took a nap at the ballpark before a game. Adding to his frustration, he had lost 15 pounds since the beginning of the season despite increasing his food intake.

Doctors eventually diagnosed Brown with intestinal parasites after learning that teammate Jason Giambi had similar symptoms and tested positive for the invaders. After medicine and rest, both players returned to the field.

But most of the 2 billion people across the globe who are infected with intestinal parasites have far fewer options. These intestinal worms-or helminths-are commonplace in most developing countries and can wreak havoc on the systems of children in particular.

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Nonprofit organizations around the globe are now teaming up to change those statistics: The recent removal of patent restrictions on de-worming medication has made the pills surprisingly inexpensive, and a number of organizations are promoting this medication as a low-cost and high-impact way to improve quality of life.

Children seem to be hit the hardest by these parasites. Close to 400 million children ages 5 to 15 are infected with roundworm, whipworm, and hookworm-parasites that can suck the nutrients out of kids already plagued with malnutrition. Studies cited by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) list abdominal pain, diarrhea, intestinal obstruction, anemia, and ulcers as some of the side effects and claim there is a link between parasite infestations and both stunted growth and cognitive development.

Andrew Crawford, a director at Food for the Hungry, said his organization decided to get involved in de-worming efforts several years ago as a way to maximize the nutritional benefit of the food being consumed in developing countries: "These are countries where the food sources aren't that plentiful, and the portions aren't that great. A child may, if they're lucky, get a cup of rice in one day. Well, a quarter of that is going to feed the parasite," he said.

Because of its access to suppliers, Food for the Hungry is able to purchase the medicine for as little as 2 cents per pill, allowing it to ship millions of doses to its country directors. The low cost has enabled the group to step up its efforts globally this past year and increase the quantity of medicine that is being shipped. The pills are typically effective for six months.

A major portion of the group's efforts involves education, including the after-effects of taking the medication. "It's like letting off a giant stink bomb in the body: The worms try to escape," Crawford said. "They come out obviously through the bottom, through the nose and through the mouth. We've even heard reports of them coming out through the eyes. They want to escape, and that's a good thing. But it's not a pleasant experience."

The results are encouraging. One study cited by WHO concluded that children in India who were de-wormed every six months over a period of two years showed a 35 percent weight gain. Height gains were also reported.

Organizations such as UNICEF that are involved in the de-worming initiatives emphasize the importance of long-term solutions as well. Improving access to clean water supplies is at the top of the list but can take years to come to fruition. Educating the local population about good health practices-such as hand washing and wearing shoes to prevent certain parasites from entering the body through the feet-have also contributed positively to the efforts.

Crawford says the enormous scope of need is at times discouraging, but he emphasizes the importance of each life that is improved. "You really can have an impact," he said. "We sent a million doses to Bolivia, and we know that a million children will-for six months of their lives-realize the full measure of value of the food that they're eating. They'll enjoy a better quality of life, their minds will be sharper, their bodies will be more energetic, and they won't feel so lethargic."

And the opportunities to draw spiritual parallels generate an added enthusiasm: "In the end we talk about how our hearts are unclean. And for that we don't need medicine. We need a Savior."

A dissenting view

By Jill Nelson

The prospect of intestinal worms setting up camp in our bodies can send any mother into a hand-washing, sterilizing frenzy. But one cutting-edge immunologist has what he believes is good news for panicked parents: "It's OK for kids to play in the dirt, and it's OK for kids to have dirty hands," Joel Weinstock said. "If they swallow a little dirt, it's not going to hurt them, and frankly, it might help them."

In fact, Weinstock believes helminths-or intestinal worms-may help equip our bodies to fight off immunological diseases such as hay fever, childhood diabetes, asthma, and multiple sclerosis. His theory earned him a spot among Esquire magazine's "Best and Brightest 2007" and has challenged the notion that parasites are always the bad guys.

Immunological diseases are a rarity in less developed countries, a reality that pointed Weinstock-the chief of gastroenterology and hepatology at Tufts-New England Medical Center-to the worms.

"What people don't realize is that having summer sniffles is a disease of industrialized countries. Most people in less developed countries don't get hay fever," Weinstock said. Developing countries such as India and China are experiencing drastic increases in these diseases as they adopt Western lifestyles, he added. "The light bulb went on, and I said, 'Well, it's possible that de-worming the population leaves them more vulnerable to immunological diseases.'"

The low rate of these diseases on Indian reservations in Canada also provides support for his theory: The reservations are one of the only places in the country that have a high rate of parasitic worms.

"There are some helminthes that are bad actors, and you're better off not having them," Weinstock told WORLD. "But what I would say is that most of them don't have much pathological potential. It could be that you're better off with them than without them."

Although he hesitates to issue a blanket condemnation of de-worming programs across the globe, he does note the necessity of being exposed to organisms. "If your gut was sterile, you would die," he cautions. "Half the weight of your stool is living organisms."

Weinstock's theory is currently being tested in laboratory trials, and he acknowledges that it's not a "slam dunk, absolute, we've got it." His hope is that his research will lead to better ways to treat and even prevent these diseases either through helminths or drugs made from these parasites.

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