Putting Wild Maggots on Your Head Is Not “Maggot Therapy,” but It Does Suggest Pre-Existing Pathology (2007)

Sir: I was surprised and disappointed to see Dr. Emsen’s poorly documented and inappropriately titled report of myiasis in the April 15, 2007, issue of this fine Journal.1 The misleading title, “Fatal Side Effect of Maggot Treatment on Wound Healing” does not accurately reflect the two fundamental facts about the case: (1) what was reported was not “maggot therapy” but rather an uncontrolled maggot infestation (“myiasis”); and (2) no evidence was presented to support the contention that the maggots caused the reported pathology. What Dr. Emsen actually described was self-inflicted myiasis with wild, nontherapeutic fly larvae (maggots). These were not medicinal maggots, and what the patient did, without medical supervision, contradicts the current principles and practice of maggot therapy. The term maggot therapy should be applied only to the medical use of specific, medical-grade larvae (maggots tested for safety and effectiveness and rendered germ-free). Maggot therapy is defined as a “controlled, therapeutic myiasis.”2,3 In the United States, the Food and Drug Administration regulates medicinal maggots as prescription-only medical devices, given that many of the wounds treated with maggot debridement therapy are quite serious and require close medical attention. In most other countries, maggot debridement therapy is performed or regulated similarly. After confusing self-inflicted myiasis with maggot debridement therapy, the author then suggests that the maggots were responsible for the patient’s demise. While invasive myiasis can be deadly, no identification was provided to demonstrate that these maggots were an invasive species. It has previously been shown that most cases of wound-associated myiasis (although generally not self-induced) are benign.4 We know the patient must have had a wound, but no other history was presented. We are only told that when the maggots were removed, the wound extended through the cranium and into the brain. It is then implied that the single batch of larvae, placed on the wound 7 days earlier, must have been responsible for this destruction. After the maggots were removed and the patient had spent a week in the hospital, the patient became septic and died. We are asked to believe that this, too, was a result of the maggot infestation. I would contend that someone desperate enough to put maggots on his or her scalp wound is suffering from either a serious and long-standing wound or cognitive impairment. The reported patient likely suffered from both. He likely had a long-standing tumor or other invasive wound that had extended through his skull and into his brain by the time he applied maggots to his head. To claim that the maggots were responsible for all of this pathology, along with the sepsis a week after they were removed, without presenting any information about the wound before infestation or the maggots themselves, is irresponsible at best and misleading at worst. Let us call this report what it really is: a terrible outcome in someone who attempted inappropriate treatment of his own wound with unidentified, nonmedicinal maggots. Let us title our communications more honestly and responsibly, since many readers will look no further to glean their “take-home message.” DISCLOSURES The BioTherapeutics, Education, and Research Foundation supports patient care, therapist education, and research in maggot therapy, leech therapy, phage therapy, and other modalities that use live organisms to treat disease. The author is a cofounder and laboratory director of Monarch Laboratories, which produces medical-grade maggots in North America. Ronald Sherman, M.D., M.Sc., D.T.M.&H. University of California, Irvine BioTherapeutics, Education and Research Foundation Irvine, Calif.