Hookworm attached to the intestinal mucosa. (CDC’s Public Health Image Library via Wikimedia Commons)
First he hooked me with the hookworms. Who knew there was a whole underground network of people who, in hopes of curing allergies or Crohns disease, go to great lengths — such as stomping about in outhouse offal — to get themselves infected with nasty parasites?
Then he arrested me with the alopecia. I’d glanced at the author photo on the jacket, and something looked a bit off: He wasn’t just completely bald, he also lacked eyebrows and eyelashes. On page 2, he explained that he had alopecia universalis, an auto-immune disease that left virtually no hair on his entire body.
Moises Velasquez-Manoff, author of “An Epidemic of Absence”
But what kept me reading all through vacation — and really, I’d rather not spend my leisure time with whipworms and “orofecal” bacteria — is that in his new book, An Epidemic Of Absence, author Moises Velasquez-Manoff turned my head around. Ah, the pleasing sound of mental gears grinding as the paradigm shifts!
To me, as a mother and as a health reporter who has written too many sad stories of infection, germs and parasites have ever been the enemy. But now they suddenly looked more like old friends, who could help us more than hurt us — as Velasquez-Manoff sought to test when he went to Tijuana to get infected with his own colony of hookworms.
The book is subtitled “A new way of understanding allergies and autoimmune diseases,” but my summary subtitle would be “A new ‘Theory of Everything‘ about the diseases that now plague modern humans, particularly children: Allergies, asthma, autism, obesity, and more.”
You may have heard of the Hygiene Hypothesis, the theory that allergies are rising so dramatically because modern society is too clean, and our under-challenged immune systems tend to over-react. Velasquez-Manoff takes it many steps further. He argues that without the parasites and bacteria that we co-evolved with for millennia, our immune systems become poorly regulated — in particular, unable to tamp down inappropriate inflammation. And chronic inflammation is linked not just to allergies and asthma but to obesity, cancer, depression — possibly even autism, as he wrote in the New York Times last week. (There’s also an excerpt and a Q&A in Wired this month.)
“An Epidemic Of Absence” is a first-class job of science-writing. It takes studies and turns them into riveting stories, moving from the how to the why or the correlation to the causation. But to fully appreciate them, you need to read the book. For now, let’s be ruthless pragmatists: If you accept this theory — and I guarantee that you will by page 300 — what do you do about it?
‘We don’t need to be fastidious. Routine hygiene is okay; excessive hygiene may be detrimental.’
The author asks that very question on page 303, but then gets a bit futuristic, imagining farm gardens inside high-rises and doctors who genotype pregnant women and adjust their microbe population accordingly. He mentions that he’s the father of a young daughter, and that he would never purposely infect her with hookworms as he did himself — but if he knew that it was a sure preventive treatment, and that she was destined for Crohn’s disease and horrible allergies, he might think differently. I wanted to press him about how — if at all — his work translates into health decisions now, in his own family’s life. But first, a word from a scientist.
One of the heroes in “An Epidemic of Absence” is Dr. Joel Weinstock, chief of gastroenterology/hepatology at Tufts Medical Center and a leading researcher on using worms to treat inflammatory diseases.
Dr. Joel Weinstock (Courtesy of Tufts Medical Center)
(He’s currently enrolling patients for a major trial using pig whipworms — which die off automatically after two months — in Crohns disease. Earlier studies have found the worms to be safe, he said, and initial results look promising. Later this fall, he said, whipworm studies will begin on ulcerative colitis, and within a few months, on psoriasis and Type 1 diabetes. Contact: 617-636-4593.)
I asked for his practical advice, and took away two main lessons: We must be patient and wait for more solid science. And for the meanwhile, his opinion, which he emphasized is not backed up by data, is “We don’t need to be fastidious.” (Music to my ears! That’s an adjective never once applied to me in my entire life.)
How does that translate?
“It’s okay to have pets in the house. Kids don’t have to wash their hands every time they touch something. If food falls on the floor you don’t have to worry if someone picks it up and puts it in their mouth. Playing in the mud around the house is safe. Everyday, routine exposures to things around us may be helpful. And there’s already data suggesting that if you have multiple animals in the house, you’re less likely to get immune-mediated disease. Continue reading