Aug 19, 2010

Sculptors of Monumental Narrative

Dickson Despommier tells us the story of how the insatiable millionaire John D. Rockefeller turned an eye to the untapped market of the American South and ended up eradicating the hookworm (and, in the process, a number of other awful afflictions) with an ingenious contraption. Then Pat Walters introduces us to Jasper Lawrence, a modern-day entrepreneur whose passion for hookworms stems from lifelong battles with allergies and asthma. But unlike Rockefeller, Jasper sees this parasite as friend, not foe.

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Speaker 1:

... listener supported WNYC Studios.

 

Jad Abumrad:

Hello? I'm Jad Abumrad.

 

Robert Krulwich:

And I'm Robert Krulwich.

 

Jad Abumrad:

This Radiolab. Our topic today ...

 

Robert Krulwich:

Parasites.

 

Jad Abumrad:

... parasites.

 

Robert Krulwich:

Now we've met them. They're nice. And we've met them when they're not so nice.

 

Jad Abumrad:

I don't know that we've met any nice ones, really,

 

Robert Krulwich:

But we haven't? I thought that [crosstalk 00:00:23].

 

Jad Abumrad:

The blood flukes! They were pretty nice.

 

Robert Krulwich:

Yeah, there were the blood flukes. So and now the question is let's just talk about scale. For the most part, they're irritating and little and they seemed kind of ...

 

Jad Abumrad:

Invisible.

 

Robert Krulwich:

... invisible and sort of off stage.

 

Jad Abumrad:

Yeah.

 

Robert Krulwich:

But when you back off a little bit and consider them and the effects that they have on the world ...

 

Jad Abumrad:

... they are actually these powerful sculptors of monumental narrative.

 

Robert Krulwich:

In other words, these are little guys telling very big stories.

 

Jad Abumrad:

In fact, here's an example. Recently I went to visit a guy named Dickson Despommier [but 00:00:57] Columbia University. He's a parasitologist and, well, he does a bunch of different things. And we ended up talking about ... Well, he told me this crazy story.

 

Dickson:

The story I love telling the most is...

 

Jad Abumrad:

And before we start, I just want to say one thing. The following two stories contain moments that are a little bit gross. Just want to make sure you've been warned.

 

Dickson:

The story I love telling the most is how we eradicated hookworm.

 

Jad Abumrad:

The story begins in 1908.

 

Dickson:

John D. Rockefeller Sr.

 

Jad Abumrad:

Really rich guy is sitting in his New York office. And he's thinking ...

 

Dickson:

How can I make more money selling something to the South?

 

Jad Abumrad:

Yeah. I've got all this money. We've 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 Southerns ...

 

Dickson:

... would just get off their butts and get going.

 

Jad Abumrad:

The problem was they weren't. They weren't getting off their butts.

 

Dickson:

The farms were not operational. The economic engine was turned off.

 

Jad Abumrad:

The economy was in the toilet. And so John D. Rockefeller wanted to know why. Why aren't they producing more?

 

Dickson:

Yeah, what's happened to their economic engine?

 

Jad Abumrad:

So he thought...

 

Dickson:

I know all form of commission.

 

Jad Abumrad:

Yeah.

 

Dickson:

So we sat down 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.

 

Jad Abumrad:

What does that mean?

 

Dickson:

They are slow. Not mentally. They're slow physically. They're pale. I'll give you an example. You remember the movie Deliverance?

 

Jad Abumrad:

Sure.

 

Dickson:

Okay. Remember that little guy that played the banjo?

 

Jad Abumrad:

I remember the other scene that we all remember.

 

Dickson:

Yeah.

 

Jad Abumrad:

We're not going to talk about that?

 

Dickson:

No, we're not. But if you could recall what that little banjo player looked like. A little wiry looking guy, but he looked old.

 

Jad Abumrad:

Sickly, pale.

 

Dickson:

Yeah. Sickly pale and yet an adult.

 

Robert Krulwich:

Well, wait a second. That is not a description of all southerners. It is a description of one teeny corner in a [crosstalk 00:03:05].

 

Jad Abumrad:

No, but what the commission did say about a lot of the Southern people that they encountered is that a lot of them, they just don't look right. They looked weak. They looked wan. They looked kind of wan...

 

Robert Krulwich:

Wan. I think they were wan.

 

Jad Abumrad:

... Wan. Pale, lethargic.

 

Robert Krulwich:

It's interesting. Wayan or wan?

 

Jad Abumrad:

Wan.

 

Robert Krulwich:

[inaudible 00:03:19].

 

Jad Abumrad:

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."

 

Dickson:

Anemic? They're they're anemic, you say? Yeah, they're anemic. Sounds like a medical problem. Then maybe they're not lazy after all. Maybe they're anemic. And maybe they're just weak.

 

Jad Abumrad:

Next thing you know, Rockefeller puts together another commission, this one with doctors and he sends them ...

 

Dickson:

... back down to the South to find out what the basis for the anemia was. And not only did they find anemia, but they found a correlation of the anemia was soil types. That's bizarre. Sandy, loamy soils, anemia. Hard pack clay soils. No anemia. Sandy, loamy soils. Good farmland. Hard pack clay soils, not such good farmland. So all the rich farmers were anemic and all the poor farmers were doing okay.

 

Jad Abumrad:

And this seemed to be a clue. The incidence of anemia was linked somehow to the soil. Maybe something was in the soil.

 

Dickson:

That's correct. So somehow they hit upon this idea of looking for hookworm.

 

Jad Abumrad:

The hookworm.

 

Dickson:

The hookworm.

 

Jad Abumrad:

So they thought, "All right, let's run some tests."

 

Dickson:

And when they did, big time. They discovered hookworm, big time. So the anemia is due to hookworm.

 

Jad Abumrad:

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 hookworms 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 ...

 

Dickson:

I defecate over there, you see a tree over there. That's where I defecate. So I defecate over there, but I live over here.

 

Jad Abumrad:

Okay. 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..."

 

Dickson:

... Barefoot, just like everybody else because it's comfortable.

 

Jad Abumrad:

So clearly these worms are in the feces that are landing near the tree that 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 ...

 

Dickson:

Oh my goodness. It can crawl. Right? So let's find out how far it can crawl.

 

Jad Abumrad:

So what they did, these researchers, is they built a sandbox and then they took some hookworm-infested stool...

 

Dickson:

... and put it right in the middle. Then every day we will 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 crawl 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.

 

Jad Abumrad:

What about day five?

 

Dickson:

I'm allowed to ask that.

 

Jad Abumrad:

Okay.

 

Dickson:

And what about day five?

 

Jad Abumrad:

Five feet?

 

Dickson:

No.

 

Jad Abumrad:

No? Four feet?

 

Dickson:

That's it.

 

Jad Abumrad:

So after four feet, they're what, exhausted

 

Dickson:

One would assume. On day six, they were still at four feet and on day seven, they were dead. So 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.

 

Jad Abumrad:

Because if the worms can only make it four feet, well then that's two feet past the point where they die.

 

Dickson:

We call that the outhouse. So the outhouse was invented by exploring the lifecycle of hookworm. And, in fact, Rockefeller got his wish. The South did rise again.

 

Jad Abumrad:

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.

 

Dickson:

It did.

 

Jad Abumrad:

And you bring that all back to the hookworm?

 

Dickson:

I do.

 

Jad Abumrad:

Really?

 

Dickson:

No, I believe bring it back to sanitation.

 

Jad Abumrad:

Now, to be fair, you can find plenty of other reasons why the South rose again.

 

Dickson:

Air conditioning and highways and university and stuff like that.

 

Jad Abumrad:

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 on our own, there were all of these unintended consequences.

 

Dickson:

Salmonella disappeared. [inaudible 00:08:26] disappeared. Shigella disappeared, cholera disappeared. Giardia disappeared. Cryptosporidium. Anything that's associated with parasites in feces disappeared. Every time we built outhouses and people use them religiously, guess what? Their kids can stay in school longer. They could learn more. They got ahead faster. (silence)

 

Jad Abumrad:

Dickson Despommier is a professor of public health and environmental health sciences and microbiology at Columbia University.

 

Robert Krulwich:

Can they make longer titles at that university?

 

Jad Abumrad:

He literally wrote the book on parasites.

 

Robert Krulwich:

The book is called Parasitic Diseases. You know it very well. It's soon to be a major motion picture. Now in it's fourth edition.

 

Jad Abumrad:

In its fourth edition.

 

Robert Krulwich:

And while we're on the subject of hookworms and the glorious campaign to de-worm 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. And to begin that discussion, let's go to our reporter Patrick Walters.

 

Patrick:

Okay.

 

Robert Krulwich:

So Pat, are you there? Are you there?

 

Patrick:

Yeah, I'm here, Robert.

 

Robert Krulwich:

So tell us a little bit about this fellow, what's his name, exactly?

 

Patrick:

His name is Jasper Lawrence.

 

Jad Abumrad:

That's right, Jasper Lawrence.

 

Robert Krulwich:

So where is he from?

 

Patrick:

He actually grew up in England. He grew up in this little farm in the southwest corner of England. 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.

 

Jasper:

On really bad days. My eyes would swell up so much from pollen or airborne allergens that they would feel like there was swelling shut. I could feel my eyes squeaking in my sockets. It was an enormously uncomfortable feeling...

 

Patrick:

But it was nothing debilitating.

 

Jasper:

... They were just allergies.

 

Patrick:

So he's, like most other people who have allergies, you just learn to deal with it.

 

Jasper:

You know, you live with it.

 

Patrick:

But...

 

Jasper:

... What changed for me in my late twenties, early thirties 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 landscaping business. I really didn't want to work for someone else [crosstalk 00:10:52].

 

Patrick:

Think someone with allergies starting a landscaping business. That seems kind of unexpected.

 

Jasper:

Stupid is actually the word for it. And within six months or a year...

 

Jad Abumrad:

... he starts to notice ...

 

Jasper:

... this really weird barking cough.

 

Patrick:

Was there anything particular that brought this on?

 

Jasper:

No, it was just sitting and breathing. Cats certainly didn't help.

 

Patrick:

Right.

 

Jasper:

And during that period, my asthma got much worse very quickly. By the time it was 1996, 1997, I was seeing specialists having skin allergen tests and cycling through emergency inhalers, trying Cingular and all these other drugs that were coming on the market. I was being hospitalized at least a couple of times a year. I looked terrible. I had dark eyes and pale, waxy skin. I had that allergic look. It was a really bad time.

 

Patrick:

And he decides in that summer of 2004 to take a vacation.

 

Jad Abumrad:

He made this visit to England.

 

Jasper:

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, 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. I didn't stop.

 

Patrick:

And he's reading and reading ...

 

Jasper:

... the work of all these researchers.

 

Patrick:

One study after the next.

 

Jasper:

In Japan. Epidemiological studies in Africa. Animal models of multiple sclerosis.

 

Patrick:

This enormous weight ...

 

Jasper:

... of evidence ...

 

Patrick:

... 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.

 

Robert Krulwich:

Hookworm?

 

Patrick:

Yeah. Hookworms.

 

Jasper:

Yeah. I learned that asthma was 50% less likely in someone who had a hookworm infection.

 

Patrick:

So this sort of just like hits you.

 

Jasper:

Yeah.

 

Patrick:

What'd you think when you read that?

 

Jasper:

Oh, immediately was determined to obtain hookworm immediately. I couldn't wait.

 

Patrick:

So hookworms are these very tiny worms, the size of a little hair, but if you take a microscope and use the 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.

 

Robert Krulwich:

This guy wants hookworms in his intestines?

 

Patrick:

Absolutely. And so you had to just Google it.

 

Jasper:

Yeah. Hook hookworms for sale. You know, someone's got to be selling them.

 

Patrick:

But...

 

Jasper:

... not nothing. I 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.

 

Patrick:

So fast forward a little. Jasper is in Cameroon, along the coast ...

 

Jasper:

... quite literally, and figuratively, the armpit of Africa.

 

Patrick:

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 ...

 

Jasper:

... we'd get out of the car ...

 

Patrick:

... walk up to these villagers and ask them if they could see the latrine.

 

Jasper:

Just an open area of ground, usually with bushes, so people can have a little bit of privacy. And 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've been 110 degrees that day, a hundred percent humidity. And the stench and the noise from the insects. It was so repulsive and so disgusting. (silence)

 

Patrick:

How many villages, latrines do you think you visited?

 

Jasper:

Between 30 and 40.

 

Patrick:

Jasper spent two weeks there walking around in village latrines, and then he flew home.

 

Jasper:

Yeah. 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. 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. I just started screaming in the car. I was so happy. And I haven't had an asthma attack since I went to Africa. I no longer have allergies. The vast majority of the benefit that I've experienced has come from hookworm.

 

Robert Krulwich:

What is the hookworm doing? Do you know?

 

Patrick:

Well, so the immune system that we learned about in elementary school is all about 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. Some of the more serious ones are like type one 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.

 

Robert Krulwich:

80 of them?

 

Patrick:

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.

 

Robert Krulwich:

So these are like lullaby cells?

 

Patrick:

Exactly. What lots and lots of scientists think, Joel Weinstock...

 

Robert Krulwich:

... Joel Weinstock, Tufts Medical Center ...

 

Patrick:

... and dozens of others is that over ...

 

Robert Krulwich:

... thousands and thousands of years ...

 

Patrick:

... hookworms almost developed in tandem with the human immune system.

 

Robert Krulwich:

Co-evolution parasites living within your body. Your immune system changes.

 

Patrick:

If you got to a point where the hookworms could survive safely....

 

Robert Krulwich:

... the worm gets a home, there's food coming down the food pipe. And in return ...

 

Patrick:

... the human immune system gains some kind of ...

 

Robert Krulwich:

... some form of ...

 

Patrick:

... positive regulatory ...

 

Robert Krulwich:

... advantage.

 

Patrick:

So that if you had this glitch where your immune system started attacking your own body, the presence of the hookworms would keep things ...

 

Robert Krulwich:

... controlled. And 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 as we have cleaned ourselves up too much and we don't have enough worm using us.

 

Patrick:

Yeah. This is called...

 

Robert Krulwich:

They call it the hygiene hypothesis. The hygiene iPod, that we're not dirty enough.

 

Jad Abumrad:

Too clean.

 

Jasper:

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.

 

Robert Krulwich:

Now, 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 river bank. But in improving our hygiene are also excluding organisms that may be important for making us well. So then what is Jasper do about all this?

 

Patrick:

He decides to start a business, selling hookworm to people.

 

Robert Krulwich:

What?

 

Patrick:

You can call him up and he will literally FedEx a dose of hookworms to your door.

 

Robert Krulwich:

How?

 

Jad Abumrad:

Sorry to break in for a second, Pat?

 

Patrick:

Hi, Jad.

 

Jad Abumrad:

Where does he get the hookworm from?

 

Patrick:

This is weird. Jasper gets the hookworm from himself.

 

Jad Abumrad:

Could you describe how you go about getting hookworm from your stool into one of your patients?

 

Jasper:

Well, it's 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. And then having done that, I repeatedly washed 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.

 

Robert Krulwich:

Is this a safe thing to do?

 

Patrick:

Jasper has done tons and tons of research, but he's not a doctor. The treatment is not approved by the FDA in the [crosstalk 00:20:25].

 

Robert Krulwich:

That's why I wonder, is there any serious sort of double blind study trying to figure out whether some safe delivery of hookworm might make sense?

 

Patrick:

Yeah. So one of the guys who was sort of a pioneer in this hookworm research is David Pritchard.

 

David:

I'm professor David Pritchard.

 

Patrick:

Immunologist and parasitologist ...

 

David:

... at the University of Nottingham where I study parasites and the wound healing properties of maggots. So we've now got two safety trials and drive belts, but we've yet to conduct the trials to show that therapeutic benefit results from infection with worm.

 

Patrick:

So Pritchard infected himself pretty much just to make sure that it was safe.

 

David:

What we did was 10 of us in the lab took worms at different doses. We were either given 10, 25, 50 or a hundred worms. And then we had to report on the symptoms. Along the back of that study, we determined the 10 worms were tolerated.

 

Patrick:

But Pritchard, when he did this proof of safety study actually gave himself 50 hookworms, which put him out of commission for a while.

 

David:

Well, I felt pretty bad. Pain in the gut, really, you can feel them because they are biting on your tissues.

 

Patrick:

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.

 

David:

So if you have too many, you lose quite a bit of blood to these parasites.

 

Jasper:

Well, 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.

 

Patrick:

Jasper is kind of just gone for it. It's a very sort of like how boy move.

 

Jasper:

For the scientific community, I think they believe that I'm premature ...

 

Speaker 8:

It's not FDA approved...

 

Jasper:

.... in offering this to the public.

 

Speaker 8:

... You don't know what it is. You don't know it's purity. It's not safe.

 

Patrick:

But I've talked to several clients who had really severe allergies and asthma. They say they've just achieved these great results. And Jasper also says he's seen success with a few multiple sclerosis patients and several Crohn's Disease patients too. Like how many people do you think that you have infected?

 

Jasper:

It's about 85 right now.

 

Patrick:

How is business? Is it everything that?

 

Jasper:

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.

 

Patrick:

The way he sees it, people are scared.

 

Jasper:

Well, they are the people who are coming from a point of view of what they learned in kindergarten about clean drinking water and sewers. To them, worms and parasites are so repulsive that there's nothing good to be said about them. But I can make you better. It's simple. It's cheap. For God's sake, these organisms fall out my rear end every day, a half a million at a time. The raw material is human excrement for God's sake. All people have to do is open their minds. Are you really that scared of a little worm? (silence)

 

Robert Krulwich:

Thanks to reporter Pat Walters.

 

Jad Abumrad:

Thanks, Pat.

 

Robert Krulwich:

Add to a Jasper Lawrence.

 

Jad Abumrad:

And to the worms.

 

Robert Krulwich:

And to the hookworms. Thank you, hookworms.

 

Jad Abumrad:

Thank you, hookworms.

 

Robert Krulwich:

More information about hookworms on our website and that's the end of this section of Radiolab.

 

Jad Abumrad:

[crosstalk 00:23:51] see the address?

 

Robert Krulwich:

Yes.

 

Jad Abumrad:

Radiolab.org/hookworm. No, just.org. Radiolab will continue in a moment. (silence)

 

Speaker 9:

Message 2.

 

Speaker 9:

End of message.

 

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