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"Will this last forever?" Weinstock asks, warning, "It could be wishful thinking." He thinks the chance that it's a case of the placebo effect isn't high because the volunteers hadn't responded to other treatments. The investigators are now embarking on a double-blind study with 65 patients.

If further studies show that helminth therapy is effective, what will it mean? It's possible that some organisms we find despicable are not that harmful. "They may actually be important for our optimal health and we [may] need exposure to them because of our nature," Weinstock says. "We now live in a unique environment that the human race has never lived in in the history of man. Large segments of the population are living in near sterility -- is that healthy? Maybe we went too far."

Other researchers are poised to jump into the ballgame. The National Multiple Sclerosis Society is funding a pilot study to look at the relationship between the presence of intestinal parasites and the presence of a multiple-sclerosis-like syndrome in mice.

Although the immune system still has its mysteries, the idea is gaining strength that the young immune system needs to encounter certain basic challenges to develop normally.

Will the germ-phobic masses accept treatments that involve breathing bacteria or drinking worm eggs? Sure, says Weinstock. "Patients are not that dumb!" Helminth worms are benign compared with some of the medications prescribed for IBD and Crohn's. (Corticosteroids, for instance, "are bad news.") People adapted quickly to the idea of vaccinations, which entail swallowing or injecting viruses. "We've gotten lots of e-mails and letters from people who've heard about our research," Weinstock says. "There are a lot of very sick people who would like a wonder drug -- yesterday."

If these therapies turn out to be effective, there are ways to make them more acceptable and less risky. Many vaccines consist of killed viruses, fragments of viruses or debilitated viruses. The Iowa team's use of pig whipworms instead of human whipworms could be just the beginning. Maybe just bits of pig whipworms would work as well, as might a piece of pig whipworm DNA or pig whipworm robots.

When supporters of the hygiene hypothesis are asked for child-rearing advice, however, they get nervous. The thought that we'd all stop vaccinating our kids and start encouraging them to eat out of dumpsters clearly haunts them. But maybe everything need not and should not be so antibacterial; maybe we need to start making the tedious distinctions between good and bad germs and not simply try to kill all of them.

E. coli in general is good for us; E. coli 0157:H7 is very bad for us. Parents need to use common sense: Let a kid play in the dirt, but don't let a kid play with a raw chicken in the dirt.

This is undoubtedly what Tony Basten, of Sydney's Centenary Institute, meant when he told the Sydney Morning Herald that children should be allowed to be outside "eating dirt ... playing with friends, picking their noses, and enjoying the sandpit," if only because "it's a good way to grow up."

Does all this mean that germs are our friends? Hah! Some friends. It's more complicated than that: Germs are family.
salon.com | May 4, 2000

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