Your Friendly Neighborhood Hookworms

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0:37Be smart. Get WISE. Download the WISE app today. Terms and conditions apply. Hey, I'm Latif Nasser. Hi, I'm Molly Webster, and this is Radiolab. And what are we doing today, Molly? Okay, well, Latif, remember back in 2009, before you and I both worked at the show, there was an episode called Parasites. Oh my God, love that episode. It is really one of my favorites. And in that episode, we talk about this tiny, maybe creepy little worm called a hookworm. That's right. You remember it. Yeah, I mean, it hooked into my brain. The hookworm hooked into your brain? It's the story of that one guy, and then there's the final scene where he's walking through the— Oh, wait.

1:21Okay, wait, wait, wait. You don't actually have to say it. Don't say what the final scene is, is because what we're going to do here is I'm going to play the hookworms chunk of that episode. Oh, okay. And then I have an update, a 20-year-later hookworm and human medical update. VH1 behind the music, where is the hookworm now? Yes. Where is the hookworm and where is the human? Okay, great. This whole episode, it introduced this idea that this thing that we think is like the biggest, scariest, grossest pest of all time. Maybe they're not as gross as you think. And now, 20 years later, people are saying, maybe they're really not as gross as you think.

2:08Love it. And there's just like all this cool new research about hookworms in the human body. and specifically one very important type of disease, autoimmune disorders. Ooh, that, as you know, is one I'm particularly interested in. But, well, yeah, I'm sold. I would like to hear more. Okay, great. So I'm going to play the original hookworm segment just so we all know what's going on. And then we'll jump into an update in about 20 minutes. Okay, great. Wait, you're listening. Okay. All right. Okay. All right. You're listening to Radiolab. From WNYC.

2:52Rewind. Hello, I'm Jad Abumrah. And I'm Robert Krillrich. This is Radiolab. Our topic today... Parasites. Parasites. Now, we've met them, they're nice, and we've met them, and they're not so nice. I don't know that we've met any nice ones, really. Oh, we haven't? I thought that... Oh, the blood flukes. They're pretty nice. Yeah, they were nice. So now the question is, let's just talk about scale. I mean, for the most part, they're irritating and little, and they seem kind of invisible and sort of offstage. But when you back off a little bit and consider them, you know, in the effects that they have on the world.

3:27They're actually these powerful sculptors of monumental narrative. In other words, these are little guys telling very big stories. In fact, here's an example. Recently, I went to visit a guy named Dixon Despamier from Columbia University. He's a parasitologist and, well, he does a bunch of different things. We ended up talking about, well, he told me this crazy story. Okay. Molly, jumping in here really quick, this next part of the story, which has to do with Rockefeller, think of it like those stories that has been told so many times. It starts to become like a tall tale. It's a living myth. So the facts are a little blurry, but the idea is right.

4:13Here we go. The story I love telling the most is How We Eradicated Hookworm. The story begins in 1908. John D. Rockefeller, Sr. Really rich guy is sitting in his New York office, and he's thinking, How can I make more money selling something to the South? Yeah, I've got all this money, got all these resources. I just need a new market. In terms of new markets, the South was pretty much untapped. If only those damn Southerners. Just get off their butts and get going. Problem was, they weren't. They weren't getting off their butts. The farms were not operational. The economic engine was turned off.

4:49The economy was in the toilet, and so John D. Rockefeller wanted to know why. Why aren't they producing more? Yep. What's happened to their economic engine? So he thought... I know. I'll form a commission. Yeah. So he sent out a bunch of economists and sociologists and people like that on the original Rockefeller commission. They did everything a commission could possibly do to try to find out why these southern gentlemen were not rising to the occasion. And they came back with the following conclusion. Well, we don't exactly know what's wrong, but we think that these people are sick from something because they don't behave like we do.

5:25What does that mean? They are slow. Not mentally. They're slow physically. They're pale. I'll give you an example. Remember the movie Deliverance? Sure. Okay. Remember that little guy that played the banjo? I remember the other scene that we all remember. We're not going to talk about that. No, we're not. No, we're not. If you can recall what that little banjo player looked like. A little wiry-looking guy, but he looked old. Sickly pale. Yeah, sickly pale and yet an adult. Well, wait a second. That is not a description of all Southerners. No. It's a description of one teeny corner in a... No, but what the commission did say about a lot of these Southern people that they encountered is that a lot of them, they just don't look right.

6:07They look weak. They look wan. They look kind of wan. Wan. Wan. They look wan. Pale, lethargic. That's interesting. Wan. or Juan? Juan. So the thought was that maybe these Southerners had some kind of laziness disease. This is really what a lot of folks thought. But one member on the committee suggested to Rockefeller, you know what, perhaps these people are anemic. Anemic. They're anemic, do you say? Yeah, they're anemic. It sounds like a medical problem then. Maybe they're not lazy after all. Maybe they're anemic, and maybe they're just weak. Next thing you know, Rockefeller puts together another commission to find out what the basis for the anemia was.

6:43And not only did they find anemia, but they found a correlation of the anemia with soil types. That's bizarre. Sandy Lomi soils, anemia. Hard-packed clay soils, no anemia. Sandy Lomi soils, good farmland. Hard-packed clay soils, not such good farmland. So all the rich farmers were anemic and all the poor farmers were doing okay. And this seemed to be a clue. The incidence of anemia was linked somehow to the soil. Maybe. Bum, bum, bum. Yes. Something was in the soil. That's correct. So somehow they hit upon this idea of looking for hookworm. The hookworm. The hookworm. So they thought, all right, let's run some tests.

7:28And when they did, big time, they discovered hookworm big time. So the anemia is due to hookworm. Now the question became, how are these Southerners getting the hookworm and giving it to one another? And a pretty good place to start to look for an answer was their feces. Because if these hookrooms are in you, they're going to come out of you when you go to the bathroom. So they asked these Southerners, when you guys defecate, where do you do it? Most of them said something like this. I defecate over there. See that tree over there? That's where I defecate. So I defecate over there, but I live over here.

8:05Okay, so then the investigators asked the next question. When you go to that tree and do it, do you wear any shoes? Most of them said, no. Barefoot, just like everybody else. Because it's comfortable. So clearly these worms are in the feces that are landing near the tree. They are somehow getting into people's feet the next time they come to use the tree. But no one intentionally steps in their own, you know, no one does that. Which meant... Oh my goodness, oh my goodness, it can crawl. Right, so let's find out how far it can crawl. So what they did, these researchers, is they built a sandbox.

8:44And then they took some hookworm-infested stool. And put it right in the middle. Then every day, we'll sample from the stool sample out in the sand in all directions and find larvae and find out how far they can travel. How's that sound? So now we have larvae in the stool, and they begin to crawl away from the stool, seeking a victim. On day one, they crawled an entire foot in all directions. But they weren't at two feet. On day two, my God, they're at two feet. At day three, they're at three feet. I can't believe this. They're crawling a long way. Day four, they crawl to four feet. What about day five?

9:26I'm allowed to ask that. And what about day five? Five feet? No. No. Four feet. That's it.

9:41So how in the world could you deal with this problem when these worms can crawl four feet? It doesn't matter where you defecate. They're going to crawl away from that. And within a four-foot radius of that stool sample, you're going to get hookworm. Unless you do something radical that's never been done before. They devised a scheme for burying the stool sample into the ground six feet deep. Because if the worms can only make it four feet, well, then that's two feet past the point where they die. We call that the outhouse.

10:23And in fact, Rockefeller got his wish. The South did rise again. That sounds too easy to me, though. You're telling me that an understanding of hookworm, which created the outhouse, removed the, quote, southern laziness disease, and they did rise? It did. And you bring that all back to the hookworm? I do. Really? No, I bring it back to sanitation. Now, to be fair, you can find plenty of other reasons why the South rose again. Air conditioning and highways and universities and stuff like that. So the hookworm had some help. But what is clear is that when we as a country began to distance ourselves from our own excrement, to put it bluntly, when we stopped walking around in our own s**t, there were all of these unintended consequences.

11:04Salmonella disappeared. Eostolidica disappeared. Shigella disappeared. Cholera disappeared, Giardia disappeared, Cryptosporidium, anything that's associated with parasites in feces disappeared. Every time we built outhouses, and people used them religiously, guess what? Their kids could stay in school longer. They could learn more. They gotta head faster.

11:49Dixon Desvamier is a professor of public health in environmental health sciences and microbiology at Columbia University. Can they make longer titles at that university? He literally wrote the book on parasites. The book is called Parasitic Diseases. You know it very well. It's soon to be a major motion picture. but now in its fourth edition. In its fourth edition. And while we're on the subject of hookworms and the glorious campaign to deworm America, because this has been a very carefully crafted and intentionally fair program, you have heard the case against hookworms. Now let's turn the coin and say something nice about hookworms.

12:28And to begin that discussion, let's go to our reporter, Patrick Walters. Okay. So Pat, are you there? Yeah, I'm here, Robert. So tell us a little bit about this fellow. What's his name exactly? His name is Jasper Lawrence. That's right, Jasper Lawrence. So where is he from? He actually grew up in England. He grew up in this little farm in the southwest corner of England. And it's important to know, I think, before hearing any part of his story, that Jasper has had allergies for pretty much his whole life. On really bad days, my eyes would swell up so much from pollen or airborne allergens that they would feel like they were swelling shut.

13:02but I could feel my eyes squeaking in my sockets. It was an enormously uncomfortable feeling. But it was nothing debilitating. They were just allergies. So, you know, he's just like most other people have allergies, just learn to deal with it. You know, you live with it. But what changed for me in my late 20s, early 30s was my asthma. And at that time I was living in Santa Cruz. I was relatively recently married. We had three cats that had been grandfathered in with the relationship. and I started a landscaping business. I really didn't want to work for someone else. Like someone with allergies, starting a landscaping business.

13:36That seems kind of unexpected. Stupid is actually the word for it. And within six months or a year... He starts to notice... This really weird barking cough. Was there anything particular that brought this on? No, it was just sitting and breathing. Cats certainly didn't help. Right. And during that period, my asthma got much worse very, very quickly. By the time it was 1996, 1997, I was seeing specialists having skin allergen tests and cycling through emergency inhalers, trying Singular and all these other drugs that were coming on the market. I was being hospitalized at least a couple of times a year.

14:19I mean, I looked terrible. I had dark eyes and pale, waxy skin. I had that allergic look. It was a really bad time. and he decides in the summer of 2004 to take a vacation. You made this visit to England. Yeah. I took my two daughters back to see my aunt, who had raised me. Very early in the visit, I was sitting at her kitchen table, and she asked me if I'd seen a BBC documentary about parasites and their connection with things like asthma and allergies and multiple sclerosis. And of course I hadn't, but I went upstairs and got on the Internet after lunch. and I stayed on the internet until perhaps two in the morning.

15:02I didn't stop. And he's reading and reading. The work of all these researchers. One study after the next. In Japan, epidemiological studies in Africa, animal models of multiple sclerosis. This enormous weight of evidence. That in the developing world, people don't really have asthma or allergies. And what he discovers is that behind all of this, to his shock, is hookworms. Hookworm? Yeah, hookworms. Yeah, I learned that asthma was 50 % less likely in someone who had a hookworm infection. So this sort of just, like, hits you. Oh, yeah. What did you think when you read that? Oh, I immediately was determined to obtain hookworm.

15:48Immediately. I couldn't wait. So hookworms are these very tiny worms the size of a little hare. But if you take a microscope and you zoom way in, they have this big circular mouth brimming full of pointy teeth. Very scary to look at. They have these toothy mouths so that they can burrow up through your feet, ride through your blood, and eventually end up down in your gut and start chewing on the inside of your intestines. This guy wants hookworms in his intestines? Absolutely. And so you just Google it? Yeah, hookworms for sale. I mean, you know, someone's got to be selling them. But, uh... Not nothing.

16:32I contacted every laboratory supply company in the world and parasitology research centers, and they all said the same thing. No. Various flavors of no. And so I came to the conclusion that I was going to have to go to the tropics. So, fast forward a little. Jasper is in Cameroon along the coast. Quite literally and figuratively the armpit of Africa. He's 200 miles north of the equator. It's extremely hot. He finds a guy to drive him around. And so he and his driver would go to a village. He'd get out of the car. Walk up to these villagers and ask them if they could see the latrine. Just an open area of ground, usually with bushes so people can have a little bit of privacy.

17:15And I would go over to the area, remove my shoes, and start walking. The first time I did that, I almost couldn't do it. It must have been 110 degrees that day, 100 % humidity. And the stench and the noise from the insects, it was so repulsive and so disgusting.

17:50How many villages, latrines, do you think you visited? Between 30 and 40. Jasper spent two weeks there walking around in village latrines, and then you flew home. I got back from Africa in early February, so I was looking at allergy season coming up. And the day I realized that I no longer had allergies, it was such a good day. I got into my car, and I started driving, and I had the window down. You know, I felt the breeze blowing across my face. In the past, what that meant was that very quickly my eyes would be itching uncontrollably, snot and phlegm was going to be pouring out of every orifice in my face, and it didn't happen.

18:36It didn't happen. I just started screaming in the car. I was so, so happy.

18:50And I haven't had an asthma attack since I went to Africa. I no longer have allergies.

19:03The vast majority of the benefit that I've experienced has come from hookworm. What is the hookworm doing? Do you know? Well, so the immune system that we learned about in elementary school is all about, like, these attack cells that go after foreign invaders and destroy them. And that's a big important part of the immune system. But if the immune system were allowed to attack and destroy things unchecked, it could kill you. And there are lots of diseases where the primary symptoms are caused by the immune system attacking the body that it's really designed to protect. Allergies and asthma are just two of these.

19:35Some of the more serious ones are like type 1 diabetes, multiple sclerosis, Crohn's disease, in which the immune system actually starts attacking the inside of the intestines. There are like 80 of these diseases. 80 of them. And so what scientists have found in lots and lots of mouse studies, and in some human studies to this point too, is that once the hookworms get inside the gut and the immune system actually starts attacking somehow, hookworms actually stimulate these cells, which just quiet things down and tell the attack cells to stop attacking. So these are like lullaby cells? Exactly. What lots and lots of scientists think, Joel Weinstock, Tufts Medical Center, and dozens of others, is that over thousands and thousands of years, hookworms almost developed in tandem with the human immune system.

20:33Co-evolution. Parasites living within your body, your immune system changes. So you got to a point where the hookworms could survive safely. The worm gets a home, there's food coming down the food pipe, and in return... The human immune system gains some kind of positive regulatory advantage.

20:56So that if you had this glitch where your immune system started attacking your own body, the presence of the hookworms would keep things... Controlled. That's the gift. You do something for the worm, the worm does something for you. So then by that logic, what we in the West, in the richer countries, have done stupidly is we have cleaned ourselves up too much and we don't have enough wormies in us. Yeah, this is called. They call it the hygiene hypothesis. The hygiene hypothesis. That we're not dirty enough. Too clean. We function like rainforests. We're ecosystems. And we've entirely eliminated a class of organism that co-evolved with us and our genetic predecessors for millions of years.

21:39Now, I don't want to leave the impression that hygiene is bad for you. People can't go back to living in filth, kids playing in sewage by the riverbank. But in improving our hygiene, we are also excluding organisms that may be important for making us well. So then what does Jasper do about all this? He decides to start a business selling hookworm to people. What? You can call him up and he will literally FedEx a dose of hookworms to your door. how sorry to break in for a second pat hi jad where does he get the hookworm from this is weird jasper gets the hookworm from himself could you describe how you go about getting hookworm from uh your stool into uh one of your patients well it's a very easy organism to work with it it just it gets up and it walks out of it so it doesn't take an enormous amount of work to separate it from the feces.

22:38And then having done that, I repeatedly wash them in solutions of antibiotics to make sure that anything that could live on them is killed. People contact us, we'll have them complete a questionnaire, submit a recent blood test, then we'll ship them a dose and all the materials and equipment and the instructions necessary to infect themselves. To me, is this a safe thing to do? Jasper, Jasper has done tons and tons of research but he's not a doctor. The treatment is not approved by the FDA. I wonder, is there any serious sort of double-blind study trying to figure out whether some safe delivery of hookworm might make sense?

23:13Yes, so one of the guys who was sort of a pioneer in this hookworm research is David Pritchard. I'm Professor David Pritchard. Immunologist and parasitologist. At the University of Nottingham where I study parasites and the wound healing properties of maggots. So we've now got two safety trials under our belts, but we've yet to conduct the trials to show the therapeutic benefit results from infection with worms. So Pritchard infected himself pretty much just to make sure that it was safe. What we did was 10 of us in the lab took worms at different doses. We were either given 10, 25, 50 or 100 worms.

23:51And then we had to report on the symptoms. And on the back of that study, we determined that 10 worms were tolerated. But Pritchard, when he did this proof of safety study, actually gave himself 50 hookworms. Oh. Which put him out of commission for a while. Well, I felt pretty bad. I mean, pain in the gut, really. You know, you could feel them because they are biting on your tissues. I mean, if you have too many hookworms, they can cause things like diarrhea. And the most serious side effect, and the side effect that makes them sort of a public health enemy is that they can give you anemia. So if you have too many, you lose quite a bit of blood to these parasites?

24:29Well, you know, if you take too many hookworm, which you're not going to if you come to us, the worst thing you're going to get is anemia. But it's not like you wake up one morning and you're drained of blood. Very slow to develop and it's very easy to deal with. Jasper's kind of just gone for it. You know, it's a very sort of like cowboy move. To the scientific community, I think they believe that I'm premature. It's not FDA approved. In offering this to the public. You don't know what it is. You don't know its purity. it's not safe. I've talked to several clients who had really severe allergies and asthma.

24:59They say they've just achieved these great results. Jasper also says he's seen success with a few multiple sclerosis patients and several Crohn's disease patients too. How many people do you think that you have infected? It's about 85 right now. How is business? Business is adequate, but I honestly don't know why I don't wake up in the morning with my front garden 20 deep, with people with ulcerative colitis, Crohn's disease, allergies. I just don't know why I'm not completely buried. The way he sees it, people are scared. Well, they're the people who are coming from a point of view of what they learned in kindergarten about clean drinking water and sewers.