Helminth therapy, also known as helminthic therapy, is an experimental therapy in which people intentionally infect themselves with live helminth parasites. As helminths can alter a person’s immune response, some people believe that helminthic therapy may, one day, help doctors treat some autoimmune and allergic diseases.
I've never seen and article about 'therapeutic worms' that didn't include some discussion about the risks of worms, and indeed the article you linked to listed ten possible complications. There's almost always some comment about how we treat worms for good reasons, but maybe that comes at a cost.
I've done a lot of literature review and there is no evidence hookworms enter the brain (TFA is about roundworms). Necator is associated with cognitive issues especially in the American South, but that's due to dozens or even hundreds of worms, not the 10-20 typically used for helminth therapy.
"Some people" including both the founder (pg) and the main moderator (dang) of HN (and me too, though my opinion doesn't matter much outside the bounds of this comment).
The thinking I've seen explained before - and personally agree with - is that it's better for people to be able to disagree with a downvote than to have shallow "I disagree" replies.
Although every time it gets discussed there are people on both sides of whether it's good or bad for downvoting to disagree to be encouraged, eg recently here: https://news.ycombinator.com/item?id=37251926
I'd say: if you disagree, and the reason for disagreeing hasn't already been commented by someone else, then leave a downvote for OP, and upvote for replier. If you disagree, and someone else hasn't explained why, then reply. If you disagree, but are too lazy to explain why, that is very lame. If you disagree, but you can't well explain why, then perhaps you should do more thinking.
I mostly agree with what you've written, but I don't think this is completely reasonable:
> If you disagree, but are too lazy to explain why, that is very lame.
I'll agree that generally it would be better for the community to explain the disagreement if nobody else has done it already, but we're allowed to be lazy if we want (and if it isn't in a way that actively worsens the site), or to just be too busy and needing to move on rather than dive into writing a potentially long comment. And in either of those cases, you could choose to therefore not downvote since you're not going to comment, but surely giving the downvote is still contributing slightly in a helpful way by sending the "a person disagrees" signal to HN's comment sorting algo, so I think it's fine to do that as a lazy option even though not as good as taking the non-lazy route!
Well that makes it pretty clear why this site has pretty much evolved into another worthless echo chamber with people fistbumping around the popular opinion. Because that’s how you earn internet points.
Maybe try and stop caring about internet points - other than acting as a prompt to ask yourself "do these downvotes mean I should think more about what I said and consider whether it was a good thing to say", downvotes don't do anything bad to you and a high karma score doesn't do anything good.
I wish more people could view points/karma as simple a useful tool for the website, not a metric of personal achievement. Especially as it's such a shit metric for personal achievement - I've earned 124 points (so far) just for submitting this article, which took me 30 seconds and no skill at all. While I've written comments that I felt were useful, intelligent, and not quick to write that only got a single upvote because it was just helpful to one person. Who cares?
I'd also add that it doesn't make much sense to say "that makes it pretty clear why this site has pretty much evolved" about a policy that has been the same since the site launched 15+ years ago.
And also that the HN Guidelines even explicitly say "Please don't post comments saying that HN is turning into Reddit. It's a semi-noob illusion, as old as the hills." with each of the words in the second sentence linking to old comments making the same claims dating back as far as 2009." (though personally I do think it's getting worse... but I've no idea if that's real or just from the angle I'm looking at it from.)
But of course you're free to leave if you don't like the site any more, or you could email the mods and lobby them to change the guidelines in some way, or you could try setting a good example to others by only posting substantial and interesting comments etc. Plenty of options :)
Unrelated question: Do you have to have a certain amount of "points" on an HN account to be able to see the downvoting button, or something? I've only ever seen the up-arrow and assumed that either my account received some kind of "black mark" or that it hasn't met some arbitrary threshold.
I was on the fence about that when submitting, but decided to stick with "use the original title" as the simpler option. But I would be fine if dang wanted to edit that out (or not).
If you're not joking, you're quoting a rule from a different website... which even if it were a rule on this website, I still wouldn't consider the quote in this title to be breaking.
"Oh my God" does not actually refer to any religion or deity. In common English parlance it is exclusively used to convey shock or disbelief—as seen in this article.
> researchers are exploring whether a preexisting medical condition that caused her to be immunocompromised could have led to the larvae taking hold.
I really wish this bit of the article was better written! Are they finding out whether she was immunocompromised? Or are they investigating the role a known pre-existing immunocompromising condition may have played in the infection?
I was reading the article the whole time waiting for a compromised immune system to be mentioned, and the one time that they did mention it, it was ambiguous!
I think the Guardian article mixes this up slightly. In the linked journal article they describe how when she initially presented with her symptoms she was treated with prednisolone, causing the immunosupression.
edit: and they note in the conclusion that the immunosuppression may be what allowed the migration to the brain
The paper linked to in the article doesn't go into detail on that, but does say "Six months after surgery (3 months after ceasing dexamethasone) [...] Neuropsychiatric symptoms had improved but persisted"
I've heard other cases like this in Asia, where some people ate raw snake meat (ie sushi style), which was considered delicacies, and one man ended up with parasite in his lungs and was on TV news. Another case was in US where a boy ate pork that was not fully cooked and ended up with parasite in his brain. Since then, I'm very careful to make sure all pork are fully cooked (especially at barbeque).
It is very safe, but that doesn’t mean the risk is zero. The fact that stories like that have become major news stories kind of illustrates how unusual it is these days.
Yeeeeah there's plenty of stories about raw meat like that unfortunately.
We had (have?) a scare too; at christmas our company did a fancy gala dinner party, and the starter was a fish tartare of sorts. A few days later my GF had diarrhea, turns out there's a parasite in that type of fish that causes it days later.
> We had (have?) a scare too; at christmas our company did a fancy gala dinner party, and the starter was a fish tartare of sorts. A few days later my GF had diarrhea, turns out there's a parasite in that type of fish that causes it days later.
It's safe to assume all fish are a parasite risk (for instance due to nematode worms or cod worms) - with the notable exception of tuna, and most farmed salmon. However! In the US, all non-tuna fish is required to be frozen to -4F for at least 7 days or -31F for 15 hours to kill parasites. [1]
You can make sushi - or tartare - out of any US frozen fish.
If you caught parasites it would have either been fresh fish, which (except for tuna) is never ok to use according to the FDA - or the cold chain was improperly maintained. In either case it could even be worth a report to local health authorities. However tartare or ceviche or any other kind of raw fish preparation in the US is safe if it's made from tuna or (properly) frozen fish.
Is there a reason why tuna is specifically called out as an exception?
I would imagine that tuna, being near the top of the food chain, would accumulate an awful lot of things in their bodies, not just mercury as commonly feared.
Weird eh? My understanding is tuna don't get parasites as often. I read about it here. [1]
> Exempted from the FDA's freezing requirements are, as Herron mentions, large species of tuna—deemed safe based on the frequency with which they are eaten in raw form and the infrequency of related, documented parasitic infection—as well as aquacultured fish, like salmon, given verification that the feed it's raised on is parasite-free.
> To meet FDA guidelines, every other type of fish must be frozen to those temperatures, even if the table does not indicate that it carries a parasite risk, because it "may have a parasite hazard that has not been identified if these fish are not customarily consumed raw or undercooked."
Based on this, it sounds more like tuna is the only fish we know is mostly parasite-free, not the only fish that is mostly parasite-free. Perhaps most fish is actually parasite-free, but since we don't have enough evidence of that, the FDA is not going to allow selling it unfrozen.
There's a lot more to worry about with the cleanliness of vegetables than whole pieces of meat (ground beef is a different story.) Of course, the worry with vegetables comes indirectly from animals (as feces) and because they tend to be prepared at lower temperatures than meat and eaten raw more often.
The main parasite from raw pork was trichinosis, but that's not really a thing anymore in the US. Not since the FDA mandated that you can't feed as much literal raw meat garbage to pigs in the 70s. [edit: Swine Health Protection Act, 1980]
You can still get hepatitis E, among other things, from raw pork though so you know, be careful.
Some high-end restaurants are serving raw pork now though [1], but personally, I wouldn't - and I'm an adventurous eater.
> Based on analysis of U.S. foodborne disease outbreaks, pork may be responsible for between 8 and 13 percent of roughly 1 million foodborne human salmonellosis cases each year. [1]
I'm down with the Bible on this one. No pork for me.
I cooked a pork chop when I was very young and came back to find many worms trying to escape as it cooked. This is the default for pork and is considered mitigated by certain drugs that must be given to the pigs.
And yes, large worms have been pulled from people's brains in the US--resulting from pork. They appeared to have displaced or feasted on brain matter.
> They believe the patient was probably infected with the parasite directly from touching the native grass or after eating the greens.
After reading this, it got me wondering how parasites actually get into the human body if not directly ingested, as that seems fairly straightforward. That led me to this interesting snippet[0]:
> Parasites usually enter the body through the
- Mouth
- Skin
> Parasites that enter through the mouth are swallowed and can remain in the intestine or burrow through the intestinal wall and invade other organs. Often parasites enter the mouth through fecal-oral transmission.
> Some parasites can enter directly through the skin. Others are transmitted by insect bites.
> Rarely, parasites are spread through blood transfusions, in transplanted organs, through injections with a needle previously used by an infected person, or from a pregnant woman to her fetus.
Now, my remaining questions: how and why does a parasite navigate the body? For example, how did the parasite in this article likely begin in her digestive system and end up in the brain? Do they swim aggressively (yuck)? If so, does their destination matter to them?
This reminded me of a Dr House episode where the patient somehow ingested tape worm eggs, which managed to make their way into the brain, thigh muscle etc... through blood, then hatch there.
Looks like it is referred to as Neurocysticercosis [0].
The parasite does not necessarily chose where it might end up, so it is up to luck.
The victim probably ingest a bunch of eggs, which will find their way into different parts of the body, with different level of survivability.
The brain does look like a cosy place to survive.
Not an expert, but it definitely does. They can be incredibly specific in how they do things. I got a bad case of swimmer's itch after kayaking and it turns out it's from a parasite's larva. In a bird, it would go in through the feet, get into the circulatory system, mate inside the circulatory system, get their eggs into the bird's gut and let them be pooped out where they then need to do another process in a snail. In a human, they just get stuck in your skin and cause an immune reaction.
This brings up a follow-up question: how do the parasites know where to go? For example, the parasite in this article has never been observed in a human before -- yet it knew how to navigate a human's body well enough to get to the brain. That's some pretty impressive adaptive navigational instinct.
They'll be responding to things like temperature, ph level, etc. since they don't have a map to follow, and over many many generations the ones that follow the environmental clues that lead them to the best places for them to go will be the ones that reproduce the most, hence "learning" (sort of) where to go through evolution.
Therefore when they find themselves in a new animal, like a human, they're not in a "shit I'm lost!" situation, they'll just act based on the same stimuli as normal, wherever that takes them.
It probably doesn't know, and just got stuck in the brain by chance. It's not even clear that the brain is actually the optimal location for it to survive and/or reproduce, since the sample size is so small.
Stuff like this makes me wonder if I should deworm once a year just to be safe. In the U.S., the recommendation is that "healthy individuals do not need to deworm".
- More than 300,000 people living in the United States are infected with Trypanosoma cruzi, the parasite that causes Chagas disease
- At least 14 percent of the U.S. population has been exposed to Toxocara, the parasite that causes toxocariasis
- 60 million U.S. citizens are infected with Toxoplasma Gondii
- The Trichomonas parasite is extremely common, affecting 3.7 million people in the United States
A healthy individual is far more likely to be asymptomatic if they do have a parasite infection. That makes me question the recommendation for healthy individuals to avoid deworming.
Usually the recommendation to not undergo unnecessary medical action is because the action itself can be not great for you. Killing parasites can be difficult because, unlike most bacteria and viruses, parasites are eukaryotic (same as us). This means drugs designed to target parasites may also be likely to target our cells to some degree.
Most of the time treatment is fine, but in some people the side effects can be quite severe. This is the root of the recommendation to not do so unless you know you have a reason to.
Other countries recommend routine deworming. So it must be a fairly close call.
And honestly I am very pro-science but the “do no harm” bias in medicine makes me fundamentally question a lot of the recommendations. If it was just slightly better to deworm, do you think they’d recommend it? And then face accusations after any side effects (even if it was statistically the right call to do).
Not trolling, but in certain cities the amount of human waste in the streets suggests the answer could be far from zero. These unsanitary conditions seem to me to be an additional risk factor that probably wasn't taken into account when the risk factors for 'wealthy countries' were being calculated.
IDK whether this is significant to the original question (de-worm or not) because I'm not qualified to speculate, but I think it certainly suggests that at least for some cities, the evidence should be re-evaluated with realistic sanitation conditions in mind.
> And honestly I am very pro-science but the “do no harm” bias in medicine makes me fundamentally question a lot of the recommendations.
It's really not that - people have a fundamental desire to take action to mitigate tail risk even when that action poses more actual risk. You have to look at risk-reward tradeoff across the population. Treating the entire population for a disease very few of them have will almost certainly yield more (and potentially more harmful) realized side-effects than the actual primary effects being caused by the disease itself. Especially when patients aren't seeking treatment, so are most likely asymptomatic.
Ditto testing low-risk populations for all sorts of conditions they mostly don't have. Even a test that is 99% accurate in a high-incidence population is going to be utterly ineffective when applied to the general population. Bayes theorem tells us this. The side effects up to and including death of investigating or treating these false positives adds up to a real net-negative situation.
If it was even an eency weency bit better to treat in the US I would say they would overwhelmingly do so because they'd be sued into the ground otherwise.
tl;dr: especially when it comes to treatments, action is not always better than inaction. Generally, the US medical system tends towards action.
The WSJ article is behind a paywall so I can't double check this, but you can have a 99% accurate test with a 20% misdiagnosis rate. The difference is that 99% is per-person, and 20% is per-positive-result. A rare condition will have more false-positives relative to true-positives than the test accuracy would indicate.
It's a bit easier to understand if you think of the extreme case: if the disease is completely eliminated than all positives are false-positives.
The point is that a test that has a guarantee like "out of 100 people who test positive, only one will turn out to be negative" (99% specificity) can have an arbitrarily high false-positive rate when applied to the whole population: if a condition affects 1 in 10k individuals, then out of 10k individuals that take that test, 100 will be positive, but only 1 will be a true positive. The rarer the condition, the more specificity you need in your test to have a low false positive rate.
Firstly, not all worms are created equal. The most common worms in NA and Western Europe (like pinworm) just aren’t that serious.
Second, absent actual testing, the risk/reward of deworming is very much a function of the likelihood that you actually have one or more of these worms. That probability is too low in, say, the US to give routing deworming positive expected value. It’s telling that even routine testing isn’t worth the time/cost.
Thirdly, it’s not like… _exactly_ clear that all of these parasites are a problem in the first place. Many of them are frequently asymptomatic with negligible long term consequences. There are even those who believe that the near eradication of hookworm and its minor gut immunosuppressive effect in the developed world is the explanation for much higher rates of inflammatory bowel disease. I that one, but the general idea is that a lot of these worms just don’t actually cause much harm.
And lastly, deworming medications aren’t exactly a joke. They can have serious risks associated with them. Overall it just doesn’t make any sense to routinely deworm in the developed world.
it actually has nothing to do with individual patient health. The reason why 'we' don't recommend it is because we want to spend money and resources on others. Its about cost. providing the cheapest treatment for everyone so that you 'maximize coverage'.
Probably safer to get a cheap CT scan done in Mexico if you are worried about parasites inside your skull than to take dewormers. That said, Ivermectin is a very safe medication that you can try with minimal side effects.
You're probably right - however I've recently found a number of papers indicating a heightened risk of parasitic infection post cdiff which I had earlier this year.
Getting on an airplane, flying to a foreign country, getting a dose of radiation, then flying back is significantly more risky than your risk of having adverse parasitic infections in a developed country. This is a good example of how logic can completely break down in the face of a little bit of medical knowledge about obscure edge case stories.
But it is a) a nice vacation and b) saver for ypur health (assuming you take a MRT, but then CTs are very low radiation now). All in all better than taking medication without proper indication to do so.
You’re getting a dose of radiation for the airplane flight anyway might as well pitch an umbrella and a lounger on the beach in Mazatlán while you’re at it
And worms aren’t all bad. Your body’s immune system likely welcomes its presence. Our th1-th2 balance is supposed to have evolved with an assumption of helminth infections happening over the course of your life, so having a worm or two is likely a good thing. Supposedly. Don’t go around barefoot in feces to get hook worms. Not anymore than trying to deworm once a week destroying kidneys I suppose.
>And worms aren’t all bad. Your body’s immune system likely welcomes its presence. Our th1-th2 balance is supposed to have evolved with an assumption of helminth infections happening over the course of your life, so having a worm or two is likely a good thing. Supposedly
What is the point of making a claim and then walking it back?
I did years of allergy shots (environmental), it helped a middling amount. When it came to dog and cat allergy, I could have gone for several more years of inconvenient shots. Instead, I got a self-applied treatment of Necator americanus that I found through the helminth therapy wiki. I found a marked improvement in my pet allergies, which is great since I live with a cat and two dogs now.
It's not a cure but a marked reduction in symptoms. I used to have to take fexofenadine basically daily. Now I only need it under extreme conditions.
I'm sure the worms have long since died off and I may need to re-up.
There is no single “deworming” medicine, and the treatments to cover actual infections of some of those come with significant side effects and risks. Even treating an (unlikely) real acute infection can cause a cascade of inflammatory responses that can kill a person if not monitored by medical professionals.
The idea of deworming in healthy individuals in developed countries is the domain of alternative medicine, where people tend to use questionable supplements or under dosed pharmaceuticals for peace of mind.
However, even antibiotics aren’t as safe as some of these people think. One of my acquaintances died following complications of antibiotics that he purchased over the internet and self-administered. It was a rare outcome of using the antibiotic, but statistically it was several orders of magnitude more likely to cause problems than the condition he thought he was self-treating.
It’s the ingrained thought that one can preemptively control outside forces on one’s health. That because there’s more than 1, the statistic must mean, me too.
My recommendation is if you feel like you want piece of mind, to talk to your doctor about it. If your doctor recommends a treatment, follow it. Don’t just buy deworming medication because you fear you might have worms.
> My recommendation is if you feel like you want piece of mind, to talk to your doctor about it. If your doctor recommends a treatment, follow it.
I don't know anything about worms, but I'm very certain that I could choose a doctor that would recommend treatment or one that would not, depending on what I've already decided I want.
Most advice is given in the spirit of good faith, that you are not actually trying to hurt yourself.
Further, if you do pick your doctor based on the fact that they will give you the treatment you want, at least someone other than you knows that you are taking medications with potentially bad side effects.
> Further, if you do pick your doctor based on the fact that they will give you the treatment you want…
Isn’t this how the opioid epidemic started? Going to doctors that would prescribe you OxyContin because you hurt your finger? Or back? Or knee? Or ego?
If you want pain meds, I'm sure it's easy at any of those "pain management clinics" I see advertised.
If you call a few doctors and ask "Does your practice handle worms? I'm worried I might have worms," you'll have at least some of them say "absolutely, all the time, come right in".
If they want a happy customer and they know your expectations and they know the risk of dewormer is low, then they'll probably go along with it to make you a recurring ~~customer~~ patient.
You might not even know you've accidentally guided the doctor in that direction.
This might be true, but I’ve determined personally that they’re absolutely disgusting. I honestly might take action against them if they were known to be good for my health
It’s pretty hard! Or at least killing them is easy, not getting infected again immediately isn’t so easy.
Drugs are effective against the worms, but not the eggs. So you have to deworm once, wait for the eggs to hatch, then deworm again 2 weeks later.
The eggs are small enough to blow around in the wind. And will be all over the bedding and kids clothes if they’re infected (and probably their school environment). So the chances of reinfection, and family wide infection are high.
> The idea of deworming in healthy individuals in developed countries is the domain of alternative medicine
It used to be the domain of every farm kid in flyover country. Deworming was a once-a-month thing because you're working with animals, animal poop, and generally around things that might have parasites in them.
I'd imagine you don't want to use anything that would kill a parasitic worm in your brain for the same reason heartworm treatment is so dangerous. Dead parasites have to go somewhere.
Intestinal parasites aren't as big of a concern as far as the danger of treating yourself at home. You do want to know what you're dealing with and the appropriate handling of the parasite though.
My mom says she took ivermectin frequently as a child, and we’re in the disparagingly named named “flyover country.”
Looking at Wikipedia it seems she was taking it after it was approved for animals, but before it was for humans. I don’t know if she’s mistaken it for another medication or if that’s just what was done then. I know when a friend of mine thought he had worms she suggested he take the dog form of it, and this was well before all of the recent press, so I’m inclined to think it’s the latter.
I did not mean the term "flyover country" disparagingly. I used it because it accurately reflects how the coastal peoples think of the silent majority.
That is going to wreck your microbiome and if you aren't taking full dosages to kill everything each time you massively increase the already elevated risk of antibiotic resistance. Don't do this and if you're doing this definitely don't just take "some" - always finish the FULL antibiotic dose. But remember that you're massively weakening a system that you need to stay healthy each time
As a person who lives in an area known to have Lyme, and as an avid hiker, it is not hard to do tick checks periodically. Ticks don't embed immediately, and generally there is a window of several hours up to about half a day where you can remove a tick safely with little to no danger of infection. Even then, not all ticks carry Lyme, and not all Lyme infected ticks will pass on the disease.
If you do find an embedded tick, monitor the site after removing and disinfecting. Talk to a doctor. Getting treated for Lyme the moment symptoms become apparent (the characteristic bullseye) is going to be much better for your health (and everyone elses) than preemptively guzzling Amoxicillin every year.
Honestly Lyme disease is blown way out of proportion. It’s not all that hard to check for ticks to avoid it, and the course of the disease with treatment really just isn’t particularly serious for most who get it. There’s even growing skepticism around the presence of some of the reported sequelae.
The big things if you are in a Lyme disease area are to check for ticks and just go to the doctor if you either have the rash or symptoms.
Regularly taking antibiotics is awful for your gut health, somewhat risky from an antibiotic resistance perspective, definitely risky from a C Diff perspective, and probably wouldn’t even help very much since you do need to take them somewhat promptly after infection.
As someone living in an area with lots of Lyme disease and tick borne encephalitis I recommend everyone in the same boat to get a vaccine for TBE. It's not expensive and it can save your life. At least with Lyme, if you notice it you can get pretty good treatment. There is no specific treatment for TBE. You're either lucky or you end up disabled for life or dead.
Also, there are over the counter blood tests for Lyme. I buy one at least once a year just in case.
Finally, let me comment on the practice of "tick testing". Many people (including myself) want to send their ticks for testing to various labs that claim "24h results" and modern methods. Unfortunately such testing is a bit pointless, because most ticks in endemic areas are infected and still one can get lots of infected ticks and be fine if they are removed quickly.
As the article says on deworming, it’s not so simple: “Some medications for example could trigger inflammation as the larvae died off. An inflammation can be harmful to organs such as the brain, so they also needed to administer medications to counteract any dangerous side-effects.”
If you’ve got kids in a daycare, then there’s a good chance your family may end up with pinworms at some point, which can stick around for months due to their lifecycles. If you get it though, you’ll know.
That got me to google pinworms and related symptoms.
Firstly, gross.
Secondly, I'm surprised I've never heard about it before as we raised two kids through daycares, then pre-schools, and elementary school seemingly without ever getting it and not ever even hearing about it.
That is pretty sketchy data. However, deworming once a year might be an overkill. What is the health cost of deworming to individual? What is the cost to the environment?
possibly? a dead worm will start decaying. a rotting worm in your brain could easily lead to a sepsis state in one of the organs least able to deal with it.
As someone who grew up in mud and all kinds of filth while playing in a (stereo)typical Indian city, I have to say this makes sense. We kids were just left to play by themselves for hours at a time while we made merry in the dirtiest streets. Nobody was “clean”. There were open drains everywhere and let’s just say that a ball going into those drains never stopped an exciting game of gully cricket.
rybosworld says >"In the U.S., the recommendation is that "healthy individuals do not need to deworm"."<
You quote something but provide no source. I believe the quote is at least not wise and probably is incorrect. People should periodically be checked for parasites. Otherwise they may be writing posts to YC under the influence of a worm!8-)
Butt seriously, many individuals in the USA have worms. When I was a child in the southwest USA we were tested at least once a year for parasites including worms. That was decades ago. Yet today the topsoil is the same, the plants and animals are the same and the parasites remain. Children still put their hands into dirt, eat dirt and sand, and touch everything. Gardeners are just as bad. I had worms as a child and I likely catch them now and again. I take care of it.
Some people "deworm" themselves in their work: e.g., ivermectin products are often applied to animals' skin. That ivermectin clears many parasites from the cowboy as well as from the cow.
Alright, now I'm emailing my doctor to inquire about an annual regimen of Ivermectin!
Most of my contact with soil / decomposing matter is just by turning my compost pile and casually farming black soldier fly larvae. Even though I wear two layers of gloves and a respirator when working around this it just seems like a good idea.
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[ 4.6 ms ] story [ 224 ms ] threadThey rarely talk about what happens when the worms go their own way, as living things often do.
Helminth therapy, also known as helminthic therapy, is an experimental therapy in which people intentionally infect themselves with live helminth parasites. As helminths can alter a person’s immune response, some people believe that helminthic therapy may, one day, help doctors treat some autoimmune and allergic diseases.
The thinking I've seen explained before - and personally agree with - is that it's better for people to be able to disagree with a downvote than to have shallow "I disagree" replies.
edit: pg @ https://news.ycombinator.com/item?id=117171
Although every time it gets discussed there are people on both sides of whether it's good or bad for downvoting to disagree to be encouraged, eg recently here: https://news.ycombinator.com/item?id=37251926
> If you disagree, but are too lazy to explain why, that is very lame.
I'll agree that generally it would be better for the community to explain the disagreement if nobody else has done it already, but we're allowed to be lazy if we want (and if it isn't in a way that actively worsens the site), or to just be too busy and needing to move on rather than dive into writing a potentially long comment. And in either of those cases, you could choose to therefore not downvote since you're not going to comment, but surely giving the downvote is still contributing slightly in a helpful way by sending the "a person disagrees" signal to HN's comment sorting algo, so I think it's fine to do that as a lazy option even though not as good as taking the non-lazy route!
Oh well, it was nice while it lasted.
I wish more people could view points/karma as simple a useful tool for the website, not a metric of personal achievement. Especially as it's such a shit metric for personal achievement - I've earned 124 points (so far) just for submitting this article, which took me 30 seconds and no skill at all. While I've written comments that I felt were useful, intelligent, and not quick to write that only got a single upvote because it was just helpful to one person. Who cares?
I'd also add that it doesn't make much sense to say "that makes it pretty clear why this site has pretty much evolved" about a policy that has been the same since the site launched 15+ years ago.
And also that the HN Guidelines even explicitly say "Please don't post comments saying that HN is turning into Reddit. It's a semi-noob illusion, as old as the hills." with each of the words in the second sentence linking to old comments making the same claims dating back as far as 2009." (though personally I do think it's getting worse... but I've no idea if that's real or just from the angle I'm looking at it from.)
But of course you're free to leave if you don't like the site any more, or you could email the mods and lobby them to change the guidelines in some way, or you could try setting a good example to others by only posting substantial and interesting comments etc. Plenty of options :)
> Hacker News does not allow users to downvote content until they have accumulated 501 "karma" points.
[1]: https://en.wikipedia.org/wiki/Hacker_News
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https://www.9news.com.au/national/news-melbourne-tullamarine...
No kidding!
I really wish this bit of the article was better written! Are they finding out whether she was immunocompromised? Or are they investigating the role a known pre-existing immunocompromising condition may have played in the infection?
I was reading the article the whole time waiting for a compromised immune system to be mentioned, and the one time that they did mention it, it was ambiguous!
edit: and they note in the conclusion that the immunosuppression may be what allowed the migration to the brain
https://wwwnc.cdc.gov/eid/article/29/9/23-0351_article
https://wwwnc.cdc.gov/eid/article/29/9/23-0351_article
It's from raw/undercooked pork and beef.
Do you have a source? It is my understanding that pork in the US is very safe since the late 2000's (or maybe even earlier).
https://news.sky.com/story/man-18-dies-from-tapeworm-larvae-...
We had (have?) a scare too; at christmas our company did a fancy gala dinner party, and the starter was a fish tartare of sorts. A few days later my GF had diarrhea, turns out there's a parasite in that type of fish that causes it days later.
It's safe to assume all fish are a parasite risk (for instance due to nematode worms or cod worms) - with the notable exception of tuna, and most farmed salmon. However! In the US, all non-tuna fish is required to be frozen to -4F for at least 7 days or -31F for 15 hours to kill parasites. [1]
You can make sushi - or tartare - out of any US frozen fish.
If you caught parasites it would have either been fresh fish, which (except for tuna) is never ok to use according to the FDA - or the cold chain was improperly maintained. In either case it could even be worth a report to local health authorities. However tartare or ceviche or any other kind of raw fish preparation in the US is safe if it's made from tuna or (properly) frozen fish.
[1] https://www.fda.gov/files/food/published/Fish-and-Fishery-Pr...
I would imagine that tuna, being near the top of the food chain, would accumulate an awful lot of things in their bodies, not just mercury as commonly feared.
> Exempted from the FDA's freezing requirements are, as Herron mentions, large species of tuna—deemed safe based on the frequency with which they are eaten in raw form and the infrequency of related, documented parasitic infection—as well as aquacultured fish, like salmon, given verification that the feed it's raised on is parasite-free.
> To meet FDA guidelines, every other type of fish must be frozen to those temperatures, even if the table does not indicate that it carries a parasite risk, because it "may have a parasite hazard that has not been identified if these fish are not customarily consumed raw or undercooked."
[1] https://www.seriouseats.com/how-to-prepare-raw-fish-at-home-...
You can still get hepatitis E, among other things, from raw pork though so you know, be careful.
Some high-end restaurants are serving raw pork now though [1], but personally, I wouldn't - and I'm an adventurous eater.
[1] https://www.seriouseats.com/case-for-raw-rare-pink-pork-food...
Or at least, that's most likely how I got e.coli back in 2016 or so. Undercooked pork from a pork roast at a wedding.
> Based on analysis of U.S. foodborne disease outbreaks, pork may be responsible for between 8 and 13 percent of roughly 1 million foodborne human salmonellosis cases each year. [1]
[1] https://www.fsis.usda.gov/news-events/publications/pork-salm...
Perhaps the curing and smoking might somewhat reduce whatever risk remains today?
I cooked a pork chop when I was very young and came back to find many worms trying to escape as it cooked. This is the default for pork and is considered mitigated by certain drugs that must be given to the pigs.
And yes, large worms have been pulled from people's brains in the US--resulting from pork. They appeared to have displaced or feasted on brain matter.
I don't need pork.
After reading this, it got me wondering how parasites actually get into the human body if not directly ingested, as that seems fairly straightforward. That led me to this interesting snippet[0]:
> Parasites usually enter the body through the
- Mouth
- Skin
> Parasites that enter through the mouth are swallowed and can remain in the intestine or burrow through the intestinal wall and invade other organs. Often parasites enter the mouth through fecal-oral transmission.
> Some parasites can enter directly through the skin. Others are transmitted by insect bites.
> Rarely, parasites are spread through blood transfusions, in transplanted organs, through injections with a needle previously used by an infected person, or from a pregnant woman to her fetus.
Now, my remaining questions: how and why does a parasite navigate the body? For example, how did the parasite in this article likely begin in her digestive system and end up in the brain? Do they swim aggressively (yuck)? If so, does their destination matter to them?
[0] https://www.merckmanuals.com/home/infections/parasitic-infec...
Looks like it is referred to as Neurocysticercosis [0].
The parasite does not necessarily chose where it might end up, so it is up to luck. The victim probably ingest a bunch of eggs, which will find their way into different parts of the body, with different level of survivability. The brain does look like a cosy place to survive.
[0] https://www.who.int/news-room/facts-in-pictures/detail/neuro...
Probably a good way to find more: https://house.fandom.com/wiki/List_of_medical_diagnoses
Not an expert, but it definitely does. They can be incredibly specific in how they do things. I got a bad case of swimmer's itch after kayaking and it turns out it's from a parasite's larva. In a bird, it would go in through the feet, get into the circulatory system, mate inside the circulatory system, get their eggs into the bird's gut and let them be pooped out where they then need to do another process in a snail. In a human, they just get stuck in your skin and cause an immune reaction.
Therefore when they find themselves in a new animal, like a human, they're not in a "shit I'm lost!" situation, they'll just act based on the same stimuli as normal, wherever that takes them.
So, in other words, parasites can enter the body through just about any tissue.
But then I see stats from the CDC on infection rates. https://www.cdc.gov/media/releases/2014/p0508-npi.html
- More than 300,000 people living in the United States are infected with Trypanosoma cruzi, the parasite that causes Chagas disease
- At least 14 percent of the U.S. population has been exposed to Toxocara, the parasite that causes toxocariasis
- 60 million U.S. citizens are infected with Toxoplasma Gondii
- The Trichomonas parasite is extremely common, affecting 3.7 million people in the United States
A healthy individual is far more likely to be asymptomatic if they do have a parasite infection. That makes me question the recommendation for healthy individuals to avoid deworming.
Most of the time treatment is fine, but in some people the side effects can be quite severe. This is the root of the recommendation to not do so unless you know you have a reason to.
And honestly I am very pro-science but the “do no harm” bias in medicine makes me fundamentally question a lot of the recommendations. If it was just slightly better to deworm, do you think they’d recommend it? And then face accusations after any side effects (even if it was statistically the right call to do).
IDK whether this is significant to the original question (de-worm or not) because I'm not qualified to speculate, but I think it certainly suggests that at least for some cities, the evidence should be re-evaluated with realistic sanitation conditions in mind.
It's really not that - people have a fundamental desire to take action to mitigate tail risk even when that action poses more actual risk. You have to look at risk-reward tradeoff across the population. Treating the entire population for a disease very few of them have will almost certainly yield more (and potentially more harmful) realized side-effects than the actual primary effects being caused by the disease itself. Especially when patients aren't seeking treatment, so are most likely asymptomatic.
Ditto testing low-risk populations for all sorts of conditions they mostly don't have. Even a test that is 99% accurate in a high-incidence population is going to be utterly ineffective when applied to the general population. Bayes theorem tells us this. The side effects up to and including death of investigating or treating these false positives adds up to a real net-negative situation.
If it was even an eency weency bit better to treat in the US I would say they would overwhelmingly do so because they'd be sued into the ground otherwise.
tl;dr: especially when it comes to treatments, action is not always better than inaction. Generally, the US medical system tends towards action.
I read that sentence a few times. 99% accurate seems quite high. WSJ recently opined about the 1-in-5 cancer misdiagnosis rate.
https://www.wsj.com/articles/are-you-sure-you-have-cancer-di...
"Are You Sure You Have Cancer?"
It's a bit easier to understand if you think of the extreme case: if the disease is completely eliminated than all positives are false-positives.
Second, absent actual testing, the risk/reward of deworming is very much a function of the likelihood that you actually have one or more of these worms. That probability is too low in, say, the US to give routing deworming positive expected value. It’s telling that even routine testing isn’t worth the time/cost.
Thirdly, it’s not like… _exactly_ clear that all of these parasites are a problem in the first place. Many of them are frequently asymptomatic with negligible long term consequences. There are even those who believe that the near eradication of hookworm and its minor gut immunosuppressive effect in the developed world is the explanation for much higher rates of inflammatory bowel disease. I that one, but the general idea is that a lot of these worms just don’t actually cause much harm.
And lastly, deworming medications aren’t exactly a joke. They can have serious risks associated with them. Overall it just doesn’t make any sense to routinely deworm in the developed world.
And worms aren’t all bad. Your body’s immune system likely welcomes its presence. Our th1-th2 balance is supposed to have evolved with an assumption of helminth infections happening over the course of your life, so having a worm or two is likely a good thing. Supposedly. Don’t go around barefoot in feces to get hook worms. Not anymore than trying to deworm once a week destroying kidneys I suppose.
What is the point of making a claim and then walking it back?
You say that, but I've heard at least one story where someone did exactly that (and claimed that it cured their allergies and asthma): https://www.thisamericanlife.org/404/enemy-camp-2010/act-thr...
I'll personally stick to allergy shots, though.
It's not a cure but a marked reduction in symptoms. I used to have to take fexofenadine basically daily. Now I only need it under extreme conditions.
I'm sure the worms have long since died off and I may need to re-up.
The idea of deworming in healthy individuals in developed countries is the domain of alternative medicine, where people tend to use questionable supplements or under dosed pharmaceuticals for peace of mind.
However, even antibiotics aren’t as safe as some of these people think. One of my acquaintances died following complications of antibiotics that he purchased over the internet and self-administered. It was a rare outcome of using the antibiotic, but statistically it was several orders of magnitude more likely to cause problems than the condition he thought he was self-treating.
My recommendation is if you feel like you want piece of mind, to talk to your doctor about it. If your doctor recommends a treatment, follow it. Don’t just buy deworming medication because you fear you might have worms.
I don't know anything about worms, but I'm very certain that I could choose a doctor that would recommend treatment or one that would not, depending on what I've already decided I want.
Further, if you do pick your doctor based on the fact that they will give you the treatment you want, at least someone other than you knows that you are taking medications with potentially bad side effects.
Isn’t this how the opioid epidemic started? Going to doctors that would prescribe you OxyContin because you hurt your finger? Or back? Or knee? Or ego?
If you want pain meds, I'm sure it's easy at any of those "pain management clinics" I see advertised.
If you call a few doctors and ask "Does your practice handle worms? I'm worried I might have worms," you'll have at least some of them say "absolutely, all the time, come right in".
If they want a happy customer and they know your expectations and they know the risk of dewormer is low, then they'll probably go along with it to make you a recurring ~~customer~~ patient.
You might not even know you've accidentally guided the doctor in that direction.
30% of Danes have pinworm. Developed countries aren’t immune from parasites. Especially such parasites.
Drugs are effective against the worms, but not the eggs. So you have to deworm once, wait for the eggs to hatch, then deworm again 2 weeks later.
The eggs are small enough to blow around in the wind. And will be all over the bedding and kids clothes if they’re infected (and probably their school environment). So the chances of reinfection, and family wide infection are high.
It used to be the domain of every farm kid in flyover country. Deworming was a once-a-month thing because you're working with animals, animal poop, and generally around things that might have parasites in them.
Intestinal parasites aren't as big of a concern as far as the danger of treating yourself at home. You do want to know what you're dealing with and the appropriate handling of the parasite though.
Looking at Wikipedia it seems she was taking it after it was approved for animals, but before it was for humans. I don’t know if she’s mistaken it for another medication or if that’s just what was done then. I know when a friend of mine thought he had worms she suggested he take the dog form of it, and this was well before all of the recent press, so I’m inclined to think it’s the latter.
We really should come up with something in reverse. "The arrogant coasts," perhaps ;)
If you do find an embedded tick, monitor the site after removing and disinfecting. Talk to a doctor. Getting treated for Lyme the moment symptoms become apparent (the characteristic bullseye) is going to be much better for your health (and everyone elses) than preemptively guzzling Amoxicillin every year.
The big things if you are in a Lyme disease area are to check for ticks and just go to the doctor if you either have the rash or symptoms.
Regularly taking antibiotics is awful for your gut health, somewhat risky from an antibiotic resistance perspective, definitely risky from a C Diff perspective, and probably wouldn’t even help very much since you do need to take them somewhat promptly after infection.
Also, there are over the counter blood tests for Lyme. I buy one at least once a year just in case.
Finally, let me comment on the practice of "tick testing". Many people (including myself) want to send their ticks for testing to various labs that claim "24h results" and modern methods. Unfortunately such testing is a bit pointless, because most ticks in endemic areas are infected and still one can get lots of infected ticks and be fine if they are removed quickly.
Firstly, gross.
Secondly, I'm surprised I've never heard about it before as we raised two kids through daycares, then pre-schools, and elementary school seemingly without ever getting it and not ever even hearing about it.
https://focus.science.ubc.ca/worms-ae3a1579c58c
Humanity evolved with parasites. Like gut bacteria, excessive focus on hygeine may be more harmful than helpful.
And, this was most of India not just us.
US 2023 pop >> 340M .. so about 1 in 4 people you randomly interact with are allied beings.
You quote something but provide no source. I believe the quote is at least not wise and probably is incorrect. People should periodically be checked for parasites. Otherwise they may be writing posts to YC under the influence of a worm!8-)
Butt seriously, many individuals in the USA have worms. When I was a child in the southwest USA we were tested at least once a year for parasites including worms. That was decades ago. Yet today the topsoil is the same, the plants and animals are the same and the parasites remain. Children still put their hands into dirt, eat dirt and sand, and touch everything. Gardeners are just as bad. I had worms as a child and I likely catch them now and again. I take care of it.
Some people "deworm" themselves in their work: e.g., ivermectin products are often applied to animals' skin. That ivermectin clears many parasites from the cowboy as well as from the cow.
Most of my contact with soil / decomposing matter is just by turning my compost pile and casually farming black soldier fly larvae. Even though I wear two layers of gloves and a respirator when working around this it just seems like a good idea.
Cook your meat and seafood folks!
If you are eating undercooked/raw meat or fish and stuff, if you're eating at restaurants, etc... there's no reason not to.
It blows my mind people don't disinfect, not just wash, produce in the US.
Next time someone says "touch grass", I'll remember this, and say "No thanks, I don't want brain worms."