Credit: The Korean Academy of Medical Sciences
This story reports on a group of researchers who have derived a compound from hookworm spit that they have tested with some success as a treatment for asthmatic mice. Scientists have observed for several years now that rates of autoimmune disorders and allergies are lower in some low-income nations. The idea is that hygienic practices in high-income nations may have robbed people’s immune systems of natural checks provided by parasites or other microorganisms in their environments. The result, according to this theory, is higher rates of diseases like asthma, Crohn’s disease, and ulcerative colitis. The researchers quoted in this article first tried infecting patients with celiac disease with live hookworms, then in a more recent study synthesized a compound from hookworm spit for the mouse experiment.
The problem is that the article overstates the potential benefits of a treatment that has not yet been tested in humans (a problem we see fairly often in news stories). Given that limitation, we would expect the story would at least provide testimony by independent experts who could weigh in on whether this new finding is important or not, but it doesn’t. The results of existing and ongoing research on the same topic are mixed at this point, but the article doesn’t say so. In sum, this story doesn’t give readers to tools to assess either quality or impact of the research described.
This story is careful to convey the message that ingesting parasites on your own from an unregulated overseas market is not safe. What it doesn’t do is to provide a balanced picture of what the results of this study mean. We argue that patients who are struggling with these health issues in themselves or their children deserve to get a thoughtful contextualization of what these findings mean in the current state of knowledge on the topic.
The story speculates at length about potential benefits of this treatment, before ever establishing that this is preliminary research. Our guideline is “if it’s not too early to talk about benefits, then it’s not too early to talk about costs.” This story didn’t do so.
The heading of the article is eye catching: blood-sucking parasitic worms! The health of millions improved! It’s not until about two-thirds of the way through the article that it becomes clear these claims are based on the findings of a laboratory study of asthmatic mice, and so there are no actual benefits to report on. The treatment hasn’t yet been tested in humans. The article does make an attempt to explain how similarities in mouse and human anatomy suggest that humans might benefit from the same treatment. It also notes that “their [the researchers’] next step is a phase one clinical trial, which would test the effectiveness of an AIP-2 pill.” Actually, phase I trials assess safety and appropriate dosage for new medications. Final effectiveness of new treatments is not assessed until much later, in phase III trials. Any possible benefits of this treatment to the public, therefore, are considerably farther down the road than the article implies. Furthermore, findings from other studies in the line of research are mixed. All in all, the statement that AIP-2 “may make millions of people healthier” is premature.
As we’ve stated many times, mouse research is usually not newsworthy because of these challenges.
The article provides some explanation of the potential harms of ingesting live hookworms for therapeutic purposes. It warns against readers “trying this at home,” especially in the cases of young children and pregnant women. No statement is made about the potential harms of treatments derived from hookworm spit or similar compounds, but at least most readers probably won’t leave this article with the impression that buying hookworms overseas and self-infecting is a great idea.
Two studies from the same lab are mentioned in the article. The first involved 12 patients with celiac disease. The article reports that their tolerance for gluten “improved” after ingesting live hookworms, but it is very short on details. There is no explanation of how long they were treated, how much they improved, or even whether there was a control group. The story states that it is “difficult to scale” that kind of study because of the challenges in finding patients who are willing to be infected with live parasites. It does not mention that the small sample size would also make it impossible to generalize any findings to the larger population.
More information is provided about the study that is the main focus of the article, a laboratory experiment in which mice were treated with a compound synthesized from hookworm spit. But the story provides no sense of how challenging it will be to translate these results to humans, a very important caveat that should have been discussed.
The article does not engage in disease mongering.
No independent sources are cited.
Although the article talks about 235 million asthma sufferers across the world, it provides no description of the challenges they face or the limitations of current treatment options. It’s not clear, therefore, why or for what types of people an alternative treatment is needed and what this treatment might have to offer over the status quo.
The story does’t address availability. As we explain in the quantified benefits criterion above, the most readers get is an erroneous statement about the next steps: “Navarro said their next step is a phase one clinical trial, which would test the effectiveness of an AIP-2 pill.” A phase one trial is actually to test safety–not effectiveness–and this error may have the effect of making this pill seem closer to reality than it is.
Research about therapeutic use of hookworms and other parasitic worms (helminths) has been around since the 1990s, although it has entered into the public consciousness within the past five years at most. So in one sense, the material in this article is novel. The beginning of the story describes the genesis of this line of research in questions about the connection between the dramatic success of deworming programs around the world and the rise of immune system problems like asthma and celiac disease. However, the article makes no mention of multiple previous and ongoing studies investigating the effects of “worm therapy” on auto-immune diseases like Crohn’s disease, multiple sclerosis, and asthma. The idea that parasites may play a role in the development of the human immune system is still surprising for most of us, but not as novel as this report on the findings of a single research group would suggest–just a few months ago we reviewed an NPR story on worms for allergies. The article should have provided more context.
The story appears to include novel quotes from the researchers that were not taken from the news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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