Maggot Therapy Rediscovered A Literature Review
Maggots as Medicinal Devices
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Maggot Therapy or Maggot Debridement Therapy (MDT) is once again being used by doctors around the world. The ancient method of treating wounds is resurfacing amidst technological advancements and it looks promising. People are being exposed to yet another wonder of the natural world that has been discovered, lost and rediscovered. However, there are questions that need to be answered in order for people to fully understand and, eventually, accept the therapeutic benefits of maggot therapy.
This kind of therapy is normally being used to treat non-healing wounds. Maggot therapy is not the first treatment being administered to patients with non-healing wounds. It is usually the case that other debridement methods such as surgery are the first options. This implies that maggot therapy is seen a last resort. It can be the case that once maggot therapy is considered, the wounds could have already caused irreversible damages.
One of the diseases that can result to non-healing wounds is diabetes. In the United States alone, around 14.6 million people have been diagnosed with diabetes in 2005, while it has been estimated that 6.2 million are also suffering from diabetes but have not been diagnosed yet (NDIC, 2005). This means that 7 percent of the population of the United States has the potential of developing non-healing wounds.
As such, the need for alternatives is greater than ever. With more and more people being exposed to the risks of various diseases now plaguing mankind, people have the right to accessible medications and treatments. It is the obligation of the medical community to present viable options to the public. It must be taken into consideration that each and every kind of treatment has its own advantages and disadvantages. An open mind must be kept.
Every action has its own set of objectives. Objectives set the direction that needs to be taken. They also give focus. If there are no objectives, chaos might reign and there is a chance that the actions done will not result to anything of benefit. This is the same with all researches. Studies arise from problems. However, there are many questions that need answers. This makes it easy for a study to go on and answer questions that are not related to the actual issue that it wants to resolve. Therefore, it is of utmost importance for this study to identify the key questions that it wants to address. This will ensure that the research will be able to give something of relevance.
This particular study will attempt to determine if maggot therapy is making a comeback in the field of medicine. The term making a comeback is defined, for the purposes of this study, as gaining acceptance among medical professionals and patients alike. The level of acceptance will be determined through the data contained in the literatures to be reviewed.
In addition, acceptance is not limited to the actual number of maggot therapy patients. It will also cover the cases where maggot therapy is being considered even if it the last resort. As such, diseases where maggot therapy is an option will be included or considered in the review of related literature. One such disease is non-healing wound due to diabetes.
Another aspect of maggot therapy that will be discussed in the study is the possible and actual benefits that patients can get from undergoing such treatment. However, both the strengths and weaknesses of the therapy must delved into in order to give the study a breath of fairness thus decreasing, if not totally eliminating, any cloud of doubt that would affect the credibility of the study. Doing so will allow the study to determine if there is a need to advocate or promote maggot therapy. This will also determine if the level of acceptance being received by maggot therapy is being affected by its reputation.
The review of related literature is very important in emphasizing the need to conduct the study. This is the case since the review will determine if there are actually research gaps that need to be filled. If it is to be determined that the questions presented in this section has not been answered yet, then it can be justified that there is indeed a need to further the study on maggot therapy.
Based on the discussion above, it becomes apparent that the three variables involved in the study are benefits of maggot therapy, level of acceptance and actual number of maggot therapies being conducted. The study will be determining if the perceived affects of maggot therapy is affecting the way both medical professionals and patients see it as a form of acceptable therapy. The perception of the professionals and patients are important in determining the acceptability because acceptability in itself is a form perception. In turn, the actual number of maggot therapies being performed is a key indicator that maggot therapy is indeed gaining acceptance within the medical community as well as among the patients.
The population studied was composed of diabetic patients with non-healing wounds. Diabetic patients with chronic wounds usually have less treatment options like surgery since their condition is very delicate. This means that they need all of the available options in order to address their needs.
There are readily available data regarding diabetes such as the percentage of the population infected by it. In this particular study, the population are actually the population used in the researches to be reviewed later on.
In order to better make the case of this study, five articles will be reviewed. It is the intent of this section of the paper to present the data that are already known in terms of maggot therapy. The five articles to be discussed were chosen because they answer some of the questions regarding the therapy.
Maggots have been used to treat wounds since the ancient times. Its use is not limited to certain areas. Rather, it is scattered throughout the known world. From the Mayans of South America to the aborigines of Australia, records have been discovered showing that maggots were deemed as safe and effective medical devices. During wars, maggots were also used to treat wounded soldiers. They haven been known to decrease mortality among soldiers.
However, changes occurred. Due to continuous research and development in the field of medicine, more options became available to people. With the discovery of penicillin, maggot therapy was slowly pushed to the sidelines. It was further overshadowed by technological advancements that allowed doctors to treatment patients relatively easier and faster. The notoriety of the sources of maggots also contributed to the decline of maggot therapy utilization.
According to Jones and Thomas (2000), the common greenbottle fly species, Lucilia sericata, are good for maggot therapy because they produce proteolytic enzymes that breaks down only dead tissues and this species of fly do not have the tendency to burrow into healthy tissues. This limits the breakdown of the tissues making it harmless to healthy ones.
Citing Robinson and Norwood (1993), Messer and McClellan (1935) and Pavillard and Wright (1957), Jones and Thomas further argued that maggots have the ability to kill and/or prevent bacteria in wounds by ingesting and digesting them, increasing the pH level of the wound to around 8 to 8.5 and secreting antimicrobial chemicals that combat infection.
The arguments presented by Jones and Thomas claims that maggot therapy is very beneficial to the patients especially in case where granulation of tissues must be stimulated. In the paper, empirical evidences are overwhelming, making it a credible source of information.
However, there are still those who claim that using maggots to stimulate granulation or treat wounds is disgusting. Bob Carlson revealed in his Biotechnology Healthcare article in February 2006, that there is an increasing demand for maggots in the medical community. Despite this, there is still, what he called, the “YUCK Factor”. Dr. Ronald Sherman, a co-author on a study on the utilization of maggot therapy in 1983, stated that the wounds are disgusting and not the maggots (Carlson, 2006).
He added that those who say that maggot therapy is disgusting are usually those who don’t have to go through life with chronic, foul-smelling and draining wounds. Taking the statement made by Dr. Sherman, it may be surmised that the perception of people, in general, about maggot therapy can be the result of misinformation or lack of it altogether.
This also implies that the perception of those who are not familiar with the process of maggot therapy is generally negative. On the other hand, people who agreed to undergo the treatment could have done so because they see it in a positive light. However, it can also be the case that they did it because they are already out of options.
Diabetic patients with diabetic wounds may say differently from those who side with the “YUCK Factor”. In a study published in the Journal of the American Podiatric Medical Association, Armstrong et al. were able to show that maggot therapy is both efficient and cost-effective. In there study, they found that out of their 60 nonambulatory patients with neuroischemic diabetic foot wounds included in the research, 45 percent experienced wound healing in 6 months. They also concluded that maggot therapy can reduce the number of amputation cases in relation to diabetic patients.
According to Ruiz, Suarez, Orantes, Mares and Cherit (2005), the utilization of maggot therapy is increasing in Mexico that they are actually having a maggot shortage. They imply that the success of maggot therapy in Mexico can be partly attributed to the fact that the patients were given an alternative to amputation, which was common among people with wounds.
The numbers presented Ruiz, Suarez, Orantes, Mares and Cherit show that maggot therapy should not be seen as a last resort. Given the level of efficiency and cost-effectiveness of the treatment, the patients must be immediately made aware of all the options available to them so that they could see the path towards their recovery. As stated earlier, if maggot therapy is to be left on the sidelines, there is a chance that it might be too late.
The conventional methods currently being used by medical professionals to treat wounds are not being strip away of their merit. However, it is the case that some conventional methods, like surgery, highly depend on the ability of humans to differentiate between infected and healthy tissues and this is very difficult to do.
There are also antibiotics. Yet, there wounds that do not respond to them and thus, making time for the infection to spread. These arguments were made by Martin and Pitetti (2007). In making these arguments, they referred to the works of Dr. Sherman.
Based on the literature presented above, it can be said that maggot therapy is now being seen as beneficial. However, these benefits are all coming from the point of view of the medical professionals. Even though, case studies were presented in some of the literature, the points of view of the patients were not explored. Since the patients are the ones who directly benefit from the treatment, they should also be asked if they perceived the treatment as a success or not.
In addition, the relationship between perception and acceptance was also not discussed. In relation to this study, this is the weakness being shared by all the literatures reviewed. This suggests that the research gap is the determination if there is a relationship between the level of acceptance and its effect of the actual number of maggot therapies being conducted. Some of the questions that need to be answered are the following:
Do patients, in general, have a negative or positive perception towards maggot therapy?
What are the factors that lead to the patients agreeing to undergo maggot therapy?
What are the factors that contribute to the perception of the patients towards maggot therapy?
Does perception affect the acceptance of maggot therapy?
Does acceptance directly affect the actual number of maggot therapies being conducted?
It must be noted that only the perception of the patients are is being asked. This line of questioning deviates from the objectives set above, which is to determine the perception and level of acceptance of both medical professionals and patients. However, this is justifiable since the literature review revealed that maggot therapy has gained a significant level of acceptance among medical professionals as reflected by the number of maggot therapy advocates.
Even though the trend suggests that more and more medical professionals are turning to maggot therapy to treat wounds, the literatures reviewed still declared maggot therapy as a non-conventional form of treatment.
If maggot therapy is truly deemed as efficient in treating wounds then it should not be regarded as merely an alternative. The seemingly contradicting ideas in the studies reviewed suggest that there is still something lacking. It may be the case that the research on the relationship between perception and acceptance can shed some light on the grey areas.
The case supporting maggot therapy has already been made. Numerous studies are already out professing its benefits. More and more medical professionals are now offering their patients with the chance to forego amputation by allowing maggots to stimulate healthy granulation of their wounds. As such, the number of patients who has experienced the wonder of natural wound treatment is also increasing. Yet, there are still some questions left unanswered such as categorizing maggot therapy as merely and alternative treatment despite its already proven efficiency.
In conclusion, there is still a need to conduct further research not on the benefits of maggot therapy but on the way people see the treatment as among one of the best options available to them. There is no doubt that experts were able to point out that maggot therapy has been revived. However, they were not able to make people, especially the general public that maggot therapy is not something out of a curio shop.
Since the way people perceive things affects the level of acceptance of a certain practice, it is important for the medical community to enlighten people on the matter at hand. Only when the medical community is aware of the objections can they better address them.
The medical community must not be complacent merely because there is an increase of maggot therapies being conducted. There are more people who may not have chronic wounds now but may develop them later on in their lives. If as many as possible are already made aware of the benefits of maggot therapy, there is a greater chance for them to be open to the idea once the need to conduct it arrives.
It is often said that prevention is better can cure. By opening the eyes of the general public to the potentials of maggot therapy, there is a chance for it to gain more acceptance not just in the medical community but also among the patients.
Armstrong, D. G., Salas, P., Short, B., Martin, B., Kimbriel, H., Nixon, B., et al. (2005). Maggot therapy in “lower-extremity hospice” wound care: fewer amputations and more antibiotic-free days. Journal of American Podiatric Medical Association. 95(3), pp. 254-7.
Carlson, B. (2006 February). Crawling through the millennia: maggots and leeches come full circle. Biotechnology Healthcare.
Jones, M. & Thomas, S. (2000). Larval Therapy. Nursing Standard.14(20), pp. 47-51.
Robinson, W. & Norwood, V.H. (1933). The role of surgical maggots in the disinfection of osteomyelitis and other infected wounds. Journal of Bone and Joint Surgery. 15, pp. 409-412.
Martin, D. & Pitetti, K. (2007). Proceedings from the 3rd Annual GRASP Symposium. Wichita, Kansas.
Messer, F.C. & McClellan, R.H. (1935). Surgical maggots: a study of their functions in wound healing. Journal of Laboratory and Clinical Medicine. 20, p. 1219.
National Institute of Diabetes and Digestive and Kidney Diseases. (2005). National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States, 2005. Bethesda, MD: U.S. Department of Health and Human Services, National Institute of Health.
Pavillard, E.R & Wright, E.A. (1957). An antibiotic form maggots. Nature. 180, pp. 916-917.
Ruiz, J., Suarez, A., Orantes, M., Mares, M., Cherit, J. (2005). Larval debridement therapy in Mexico. Wound Care Canada.3(1), pp. 42- 46.