Moises Velasquez-Manoff

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The EconTalk podcast episode that Russ Roberts did with David Epstein, author of The Sports Gene, which I encouraged you to listen to last year, wound up tied for best show of 2013 in a listener vote. If you missed it and want to catch up, go here

In the latest program, Roberts interviews Moises Velasquez-Manoff, author of An Epidemic of Absence, which examines whether what’s purported to be a sharp spike in autoimmune diseases and allergies in America has been caused by our fervent efforts to cleanse ourselves of parasites and worms. The Food and Drug Administration is considering treatments in which these organisms would be purposely introduced into patients. The host and guest discuss an underground scene that isn’t waiting for FDA approval, in which medicalized hookworms and such are being injected into the sick who wish to gamble on this counter-intuitive medicine.

As a layman, it’s difficult to process any of this without thinking about the recent furor about immunizations in which junk science convinced some citizens that inoculations caused autism. And even more recently, the supposed advantage of breast feeding over bottle feeding, which has since been largely debunked, changed actual childcare policy in New York City. You have to wonder how much the increase in allergies and autoimmune diseases is the result of better statistical information about the incidences of these illnesses. And even if the rise is legitimate, there obviously could be a multitude of causes.

Listen to the podcast here. An excerpt about the so-called “worm therapy” underground:

Russ Roberts:

So, let’s talk about the hookworm underground and how it got started. Tell us what it is, this phenomenon of people injecting themselves deliberately with various types of parasites and why did anyone start to think that was a good idea?

Moises Velasquez-Manoff:

Yes. Well, back up. So, in the 1990s, people started thinking about some of the parasite questions I’ve been talking about. Mostly because they understood the immunology. And they understood that parasites suppress the immune system. And they began–and they noticed also some populations that were parasitized, these diseases were far less prevalent. So they began to think: Well, how about we deliberately introduce parasites as a way to cure some of these diseases? It’s an outrageous idea. But then a gastroenterologist named Joel Weinstock, who is now at Tufts U., developed a parasite, and medicalized it so it was in theory safe. The parasite is native to pigs. And the reason he chose this parasite is it cannot reproduce sexually in humans. So that you give it to the person and no one else gets it. That’s the idea. The context, the historical context, is: we spent lots of money in this country getting rid of parasites. The last thing you want to do is reintroduce them to the population, right?

Russ Roberts:

And you talk about how, when people would suggest these transmission mechanisms for allergies and autoimmune problems, the outrage that many in the medical profession, in the fields of science had to the idea that there was something beneficial about this scourge that we had eliminated.

Moises Velasquez-ManofF:

Yeah!

Russ Roberts:

It’s hard to–it’s difficult to accept. It’s emotionally unpleasant. But intellectually, it’s deeply disturbing. It’s like being told: Oh, we always were told to wash our hands, that that’s good for you. And doctors really should wash their hands. But it turns out maybe, sometimes, dirty hands are good for you. That’s horrifying.

Moises Velasquez-ManofF:

Right.

Russ Roberts:

As you say, it’s outrageous. So, what happened with this pig worm?

Moises Velasquez-ManofF:

So, he developed it–this is actually in testing right now for FDA (Federal Drug Administration) approval; and I should point out that some of the results–the early results were amazing. They were so impressive. It was like 3 dozen people and a 75% remission rate for Crohn’s Disease. It was unbelievable. And now it’s in testing. And some of the results have been very lackluster, so far. So we don’t really know if it works yet. But in any case, a bunch of underground people are reading this science. I mean, this is published in reputable journals. It makes sense to a certain kind of mindset that’s kind of ecologically and holistically oriented.

Russ Roberts:

And if you have a chronic disease, you’d love to try something different, if whatever you’ve been trying isn’t working reasonably. Right?

Moises Velasquez-ManofF:

Absolutely. I mean, I think actually at some point it’s a rational–it’s a very rational choice.”

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Cherokee reservation, North Carolina, 1939.

Did you grow up sort of poor? I did. Not on food stamps but close. Not in the projects but a couple of buildings away. It leaves a mark. The general theory of poverty has long been that if a poor person received a windfall of cash, it wouldn’t matter because the poverty resides within them. They would be back to square one and in need in no time. A study by Duke epidemiologist Jane Costello about casino money being dispensed to previously poor Cherokee Indians pushed back at that idea to an extent that surprised even the academic herself. From Moises Velasquez-Manoff’s New York Times op-ed, “What Happen When the Poor Receive a Stipend?“:

“When the casino opened, Professor Costello had already been following 1,420 rural children in the area, a quarter of whom were Cherokee, for four years. That gave her a solid baseline measure. Roughly one-fifth of the rural non-Indians in her study lived in poverty, compared with more than half of the Cherokee. By 2001, when casino profits amounted to $6,000 per person yearly, the number of Cherokee living below the poverty line had declined by half.

The poorest children tended to have the greatest risk of psychiatric disorders, including emotional and behavioral problems. But just four years after the supplements began, Professor Costello observed marked improvements among those who moved out of poverty. The frequency of behavioral problems declined by 40 percent, nearly reaching the risk of children who had never been poor. Already well-off Cherokee children, on the other hand, showed no improvement. The supplements seemed to benefit the poorest children most dramatically.

When Professor Costello published her first study, in 2003, the field of mental health remained on the fence over whether poverty caused psychiatric problems, or psychiatric problems led to poverty. So she was surprised by the results. Even she hadn’t expected the cash to make much difference. ‘The expectation is that social interventions have relatively small effects,’ she told me. ‘This one had quite large effects.’

She and her colleagues kept following the children. Minor crimes committed by Cherokee youth declined. On-time high school graduation rates improved. And by 2006, when the supplements had grown to about $9,000 yearly per member, Professor Costello could make another observation: The earlier the supplements arrived in a child’s life, the better that child’s mental health in early adulthood.”

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