Media

The following CBS11 report suggests that a “dramatic new breakthrough” in the field of Morgellons was revealed at the recent Morgellons conference:

http://cbs11tv.com/health/Morgellons.Disease.Morgellons.2.689110.html

There may be a dramatic new breakthrough for hundreds of Texans who suffer from a mysterious disease. CBS 11 News was the only station at a medical conference that uncovered new research in the fight to prove Morgellons Disease is real.
[…]
In 2007, Dr. Stricker and experts in agrobacterium studied skin samples from seven Morgellons patients and found the DNA from the bacteria in all seven samples. Now the question is, how are people getting the bacteria in their bodies.

Firstly, this is not new, it’s over a year old. These findings were reported in January, 2007 – over a year ago.

Secondly, and more importantly, there is a very easy explanation as to how the bacteria got in their bodies: catheters. It’s very simple, and hinges upon three facts:

1. The most common cause of agrobacterium infection is from intravenous catheters.
2. Dr. Stricker uses intravenous catheters to treat his Morgellons and late-stage Lyme patients.
3. Dr. Stricker supplied the samples used to test for agrobacterium

It seems then that these agrobacterium infections may not be a part of Morgellons, but are more likely a result of Dr. Strickers’ treatment methods.

(EDIT: See Dr Smith’s response, in the comments section).

UPDATE:

Dr Smith says:

In these patients, agrobacterium was NOT cultured from the patients’ body. The DNA was detected by PCR testing in Dr. Vitaly Citovsky’s lab at StonyBrook. The samples submitted were skin biopsy specimens done on out-patients in the course of routine offiice visits. The patients were not acutely ill at the time and none had an in-dwelling catheter at the time. It is my understanding that 7 of 7 patients with Morgellons tested positive for agrobacterium and 0 of control patients were positive.

Let’s assume that is accurate, and see what other reasons there could be for this group of patients to have Agrobacterium in their skin samples.

First let’s ask what the difference is between the “Morgellons” patients and the control patients. From the Morgellons case definition:

3. Skin lesions, both (a) spontaneously appearing and (b) self-generated, often with pain or intense itching. The former (a) may initially appear as “hive-like”, or as “pimple-like” with or without a white center. The latter (b) appear as linear or “picking” excoriations.

“Self-generated” here means that the patient generates their own lesions by scratching and picking. The medical term for this is Neurotic Excoriations. There is a remarkable similarity between the lesions of patients with Neurotic Excoriations, and many (but not all) patients who claim to have Morgellons.

The control subjects were healthy individuals (lab workers), who did NOT have Neurotic Excoriations.

Hence another possible explanation for this study is that people with Neurotic Excoriations are greatly more susceptible to Agrobacterium infection (especially in the skin), than the general population. This seems very reasonable, as for the lesions to be “self-generated”, it would take constant repeditive scratching for many months. Fingernails get dirt under them. Dirt harbors agrobacterium. The scratching transfers agrobacterium to the skin.

Correlation does not imply causation. The presence of agrobacterium in a group of seven, while being absent in a control group, is statistically significant enough to warrant investigation. The presence of agrobacterium is likely indicative of some factor that the seven patients shared. I’ve given two possible shared factors here: 1) They were all patients of Dr. Stricker, and 2) They scratch their skin far more than is healthy. It is not hard to come up with other commonalities, such as the unusual use of certain medications prescribed by Stricker, or even the equipment and envirionment used to collect the samples.

This post is a response to claims of a “dramatic new breakthrough”, and I simply hope to point out that this is no such thing, but simply a statistically interesting observation that currently indicates absolutly nothing, but perhaps warrants further study.

Indeed it may well turn out that Agrobacterium IS a common infection in patients with Neurotic Excoriations, and this may be a previously undiscovered common complication, which doctors can then treat. Meaning it could actually be a useful breakthrough, but not directly to do with the assertion that Morgellons is a distinct disease.

Three interesting articles on Morgellons in the Journal of the American Academy of Dermatology this month, the first two are free:

Morgellons disease: A rapport-enhancing term for delusions of parasitosis, Murase, Wu and Koo.
http://www.eblue.org/article/PIIS0190962206012175/fulltext

Morgellons Disease? Waddell and Burke
http://www.eblue.org/article/PIIS0190962206012217/fulltext

And one you’d have to pay for:

The Challenge of Morgellons disease, Koblenzer
http://www.eblue.org/article/PIIS0190962206012187/fulltext

Here’s an excerpt of the Koblenzer article:

Today, the informed dermatologist may be anywhere from doctor number five to number ten or more in this patient’s search for relief, and the patient will, in the interim, have raised both heaven and hell in a frantic attempt to solve the problem that has literally taken over his or her life. Today, the internet further complicates an already difficult situation, as we see in the two letters in this Journal, as our patients share every facet of their condition, every theory as to cause, and every attempt at relief, however far-fetched, with their fellow sufferers.

This sharing, and a tremendous amount of suffering, have given rise to the formation of “The Morgellons Research Foundation,” an organization devoted to “researching an emerging infectious disease,” with a medical board that boasts five MDs and an RN. Interestingly, none are dermatologists. An internet search for “bugs in the skin” will bring one to the Foundation’s Web site, and as Murase et al point out, the information therein may be very misleading to someone who suffers from delusions of parasitosis. One reads of cellulose fibers, fibers with “autofluorescence,” fuzz balls, specks, granules, strongyloides stercoralis, cryptococcus neoformans, “alternative cellular energy pigments,” and various types of bacteria for which potent antibiotics are prescribed, in the ever broadening spectrum of possible “pathogens.” In no case does one read of positive confirmatory tests, though many tests are undertaken. As Murase et al note, one also reads of numerous associated medical and psychiatric disorders that are attributed to, rather than co-existent with, or causative of the distressing symptoms. Frustration is extreme and suicidality is not unknown.

Clearly, as more and more of our patients discover this site, there will be an ever greater waste of valuable time and resources on fruitless research into fibers, fluffs, irrelevant bacteria, and innocuous worms and insects. It behooves us, therefore, as dermatologists, not only to be aware of this phenomenon, but also each to develop an effective way to work with these patients, and so enable the patients to be able to accept one of the medications that we know to be effective. This is a challenge indeed—so often the patient, feeling “brushed off” or not understood, simply does not follow through either with medication or with psychiatric referral.

If one is to succeed in helping these patients, it is important that one acknowledge to the patient that what the patient describes is exactly what that patient is experiencing. One can then empathize, as did Murase et al, with the patient’s pain and discomfort, their anger and frustration with dismissive doctors, and the devastating changes wrought by the condition in the patient’s life, and so develop a therapeutic relationship. With regard to causation, Morgellons disease may be an acceptable appellation, but it may also be that the touted “mysteries” of this disease only prove stimulus for further research by the patient. So, perhaps without going too far into the difference between a disease with a definite cause and a syndrome that may have different ones, it may be reasonable for us to refer to the symptom complex in question as “Morgellans syndrome” rather than disease 

Of note: all these doctors are saying they are considering using the term “Morgellons” to refer to conditions involving DOP when talking to people who suffer from  DOP and who also think they have Morgellons.  They are doing this since it eases communication with the patient.

Those who cannot remember the past are condemned to repeat it
– George Santayana, The Life of Reason

Have you seen it before? Or have you seen the same problem in a slightly different form?
– G. Pólya, How to Solve It.

Is Morgellons a real disease? Are over 5000 people affected by a common causative agent that causes fibers to appear in the skin, along with itching, lesions and symptoms that match those of Chronic Fatigue Syndrome or Fibromyalgia?

That seems like a difficult problem to answer. If you can’t immediately answer it, then take the advice of Polya, and ask “have you seen the same problem in a slightly different form?”.

And yes, we have. Right in the question actually, we have Chronic Fatigue Syndrome, and Fibromyalgia. Two syndromes with a long list of symptoms, nothing detectably wrong with the patient, and contested causation. Is Morgellons simply CFS with itching and scratching?

But let’s take Polya’s advice and then add in some Santayana. Has the same problem arisen in the past? It sounds like we would need to look at the history of medicine. Have there been cases where thousands of people though they had a specific novel illness, but that illness turned out to be nothing new?

First let me pause for a second to say, again, that I think people are really sick. They have real symptoms, they may have a variety of problems, they need treatments. What is under debate here is if people all have the same illness, and if “Morgellons” is a new disease.

Back to the past. Morgellons is a complex subject, but the prevailing theory is that there is a degree of psychosomatic illnesses mixed in with real illnesses, and greatly compounded by mass hysteria, fed mostly by the media coverage during 2006.

To understand how this might be the case, we need to look at similar events in history. There are a lot of them, and I cannot do justice to them all, but others have done the work for me, so I shall give you pointers, if you are interested.

http://home.hamptonroads.com/stories/story.cfm?story=110940&ran=130308

“People don’t need the Internet as long as they’ve got the media,” said Edward Shorter, a professor of psychiatry and the history of medicine at the University of Toronto. Once the media reports come out about a new possible disease, even if it’s not real, some people see it, “and they say, ‘That’s what I’ve got. That’s my disease,'” Shorter said.

According to Shorter, mass hysteria has taken many forms:

— UTERUS AILMENT: The word hysteria is derived from Greek, meaning “wandering of the uterus.” In the 19th century, many people thought a malfunctioning uterus led to any number of symptoms, including pain, paralysis or amnesia. Sigmund Freud and other early psychologists considered these symptoms psychological.

— TEETH: At the beginning of the 20th century, there was a vogue for pulling out all of one’s teeth, “on the grounds that you could be suffering from autointoxication, from infected root canals.”

— COLON: Around the time of the first World War, there was a trend of removing much of the large colon “on the grounds that your feces were leaking out of your colon and poisoning the rest of your body.”

http://www.stayfreemagazine.org/archives/21/edward_shorter.html

In the early 1800s, for example, doctors talked about “spinal irritation,” believing that when a certain point along the spine was pressed or hurt, it created peripheral pains and other motor (muscular) system problems. Consequently, doctors increasingly began seeing patients whose problems conveniently fitted the diagnosis. These patients–usually women–complained of temporary blindness, paralysis, and other ills. Some couldn’t walk, others couldn’t move their arms, many remained paralyzed for months in bed. Doctors would come across patients so catatonic that it was impossible to tell whether they were alive. Unable to detect pulses or respiration, doctors found that the only sure sign of death was when the body emitted a “cadaverous smell.”

Some of these patients no doubt had undiagnosed organic diseases. But Shorter convincingly argues that the majority of cases were psychosomatic.

It’s a funny thing: by the early 1900s, these symptoms had virtually disappeared. Medicine had started to shift away from the spine to the brain. Also, the social position of women improved. Whereas Victorian era mores had rendered women immobile–unable to have careers or lives of their own–psychogenic paralyses were, Shorter contends, “a metaphorical way for women to convey their dysphoria.” Once women won greater freedom, these kinds of symptoms became obsolete.

Psychosomatic symptoms didn’t disappear, however — they simply changed with the times. In case after case, from somnabulism to neurasthenia to “Yuppie flu,” we see how medical and cultural trends alternately reinforce and erode particular psychosomatic symptoms. Shorter argues that this is because patients don’t want to be seen as crazy and they therefore unconsciously or semiconsciously exhibit the “right” symptoms.

Hystories, by Elaine Showalter, Columbia University Press, is a good book on the subject:

Mass Hysteria has been around for centuries. In Extraordinary Popular delusions and the Madness of Crowds (1841), Charles Mackay, a London journalist, described what he called “moral epidemics,” including tulipomania and witchcraft. One hundred fifty years later, Mackay’s book still has relevance. As Simon Wessely, a senior lecturer in pyschological medicine at Kings College School of Medicine in London, explains, “All that has changed is the precise nature for false explanation. In previous times mass hysteria would be blamed on demons, spiritism and diabolic possessions. Nowadays we are oppressed by equally invisible gases, viruses and toxins“

A quote within the above mentioned Extraordinary Popular delusions and the Madness of Crowds is of twisted relevance. Back in the late 1700s, the use of microscopes was causing problems:

Oh that I had remained in that happy state of ignorance wherein you first found me! Yet will I confess that, as my knowledge increased, so did my pleasure, until I beheld the last wonders of the microscope; from that moment I have been tormented by doubt and perplexed by mystery: my mind, overwhelmed by chaotic confusion, knows not where to rest, nor how to extricate itself from such a maze. I am miserable, and must continue to be so, until I enter on another stage of existence.

Does that remind you of anyone?

Morgellons is nothing new. Similar diseases, plagues and demonic possessions have sprung up and spread through the populace since the start of human history. If it follows the path of history, Morgellons will fade away (like Epstein-Barr flavored CFS), and be replaced by something new. You can’t stop it, but we can at least be aware that these things happen, and we can try to mitigate their ill effects by providing some perspective.