Over at The Examining Room of Dr. Charles, the good doc brings up another instance of quackery from an unexpected source: Dr. Henry Heimlich, originator of the Heimlich maneuver for choking. While that procedure has clearly saved many lives, Dr. Heimlich doesn't stop there--he advocates using his maneuver for drowning victims and asthmatics, neither of which have been scientifically proven (and indeed, major medical associations have spoken out against them). Dr. Charles also reveals that Heimlich also carries out other questionable research, including deliberately infecting HIV+ individuals with malaria, which he touts and a cheap and effective cure for AIDS. More after the jump....
Now, at first glance, deliberately giving someone malaria--a deadly disease in its own right--in order to cure another deadly disease sounds preposterous. And I certainly agree that it is, but let me back up a minute to explain how (I assume) Heimlich arrived at this idea (or at least, without pretending to know his mind, let me give a bit of historical background).
To start with, it certainly isn't absurd to try and use one infectious agent to fight against another. Antibiotics, of course, originated with the observation that a chemical produced by a mold was killing bacteria--microbial biowarfare. These organisms have been co-evolving for eons, and in some cases, have become pros at exploiting one anothers' weaknesses--and humans have, in turn, exploited these microbes for use in our own medicines. In addition to classic antibiotics, I've also written previously on another type of microbe-on-microbe warfare, using bacteriophage--viruses that infect bacteria--to kill their bacterial hosts. I also mentioned in that post the use of a bacterium, Legionella pneumophila, to kill *its* host, an amoebae called naegleria. So, while it may (in principle) sound crazy to infect someone with one microbe in order to halt their infection with another, there is historical precedent.
Second, more precedent. Malaria itself has been used in the past as a treatment for another infectious disease--syphilis. It was thought that the fevers malaria infection caused were high enough to kill the spirochete that causes syphilis. In the early 1900s, it was already known that quinine could treat malaria, but the mercury-based treatments used for syphilis at the time frequently caused as much harm to the patient as the bacterium did. So they could infect the syphilis patient with malaria, allow them to become ill and develop a high fever, and then treat the malaria with quinine--and ideally the patient would be cured of both infections. (Sound far-fetched? It won the Nobel prize for medicine in 1927).
Third, fevers are indeed thought to be an evolutionary adaptation to defend us against infectious disease. Many microbes can replicate only in a limited temperature range--too high or too low, and the microbes don't replicate quickly enough, allowing the body's defenses to overwhelm them. This response is conserved throughout many areas of the animal kingdom. Studies have shown that even in ectothermic animals such as lizards, those who behaviorally "give themselves a fever" by sunning and other mechanisms that result in a body temperature increase fared better when experimentally infected with bacteria than did their brethren who weren't allowed to employ such mechanisms. So fever indeed does seem like a good thing when it comes to ridding ourselves of unwanted microbial invaders.
To summarize then, we have a treatment that 1) is a variation on inter-microbial warfare that's been ongoing for probably billions of years, that 2) we've previously harnessed to supply us with life-saving chemicals such as antibiotics, that 3) has already been awarded one Nobel prize, and that 4) produces a physiological response that is generally regarded as an ancient defense against microbial pathogens. Maybe Heimlich's actually on to something with this malaria-AIDS-treatment-thing?
Unfortunately, the problem--well, one of them, anyway--is that syphilis and AIDS are very different diseases. It should be obvious, but perhaps it's not to Heimlich--just because something works against one microbe, it doesn't mean it will be effective against the next. HIV and Treponema pallidum, the bacterium that causes syphilis, aren't alike in many ways except that they both cause human disease. And unlike syphilis, HIV doesn't directly attack our heart, or our circulatory system--it damages the very system we rely on to defend ourselves against a host of pathogens. Additionally, it's already been noted in the biomedical literature just how deadly a malaria co-infection can be to an HIV+ individual (summed up, for example, in this recent review--including being at an increased risk of treatment failure. So even if the malaria treatment did work, the possibility remains that the malaria, then, couldn't be eradicated from the patient. And finally, though malarial treatment of syphilis was used for many years and thought at the time to be fairly successful, it should be noted that there were no formal clinical trials to confirm this success--so how good it really was in practice remains uncertain.
If a poor outcome due to infection of HIV+ patients with malaria is likely, how then could these studies be carried out? Well, the answer is: sneakily. (More on this in an upcoming post--my blood is still boiling and you'll see why later). As Dr. Charles dug up, however, the New York Times wrote about this in 2003, and to put it mildly, many people were not pleased that these studies were carried out in this day and age:
The University of California at Los Angeles is investigating whether two of its researchers aided experiments in China in which H.I.V. patients were deliberately injected with malaria in an effort to kill the AIDS virus.
The China research was done from 1993 to 1996 at the request of Dr. Henry J. Heimlich, now 83, the inventor of the Heimlich maneuver, which can save people who are choking.
Dr. Heimlich, who has courted controversy in several fields of medicine, argues that inducing high malarial fevers can stimulate the immune system to fight AIDS, Lyme disease and cancer. In the early 1990's, he held fund-raising parties in Hollywood, raising tens of thousands of dollars from movie stars and agents to pursue a malaria AIDS cure.
The Centers for Disease Control and Prevention opposes malarial therapy, and some medical experts have harshly criticized him for experimenting on humans in China when it was unthinkable that such a trial would have been approved in the United States.
I don't know whether other such studies are ongoing or not. It's noted here that the Heimlich Institute pulled some of their own webpages supporting or discussing malariotherapy, and invitations to speak at events have been rescinded. However, I find it hard to believe that this idea will go away, Heimlich-sponsored or not. The CDC put out a warning about this type of research back in 1993; almost a decade and a half later, here we sit, incredulous that these studies were allowed to take place. Meanwhile, I'm sure a group of people, somewhere out there, are saying how Heimlich is just being "censored" by "big pharma" because his AIDS "cure" isn't something that they can patent and make themselves a bazillion dollars.
I didn't google for that group. I just don't want to know.
Am I missing something? If high temperature is the key, why not just place the AIDS patients in a hot room and avoid the risk of a malaria infection? Does fever have an additional role?
Also, is there any evidence that Heimlich's approach worked?
Perhaps the children with malaria who appear to be "protected" from AIDS death, are protected because they are false positive for HIV.
1) False-positive HIV serological tests in acute malaria patients in Ethiopia. Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. B12068)Kassa D, Petros B, Mesele T, Tilahun T, Mekonnen T, Meless H, Wolday D EHNRI, Addis Ababa, Ethiopia
2) Biggar RJ et al. ELISA HTLV retrovirus antibody reactivity associated with malaria and immune complexes in healthy Africans. Lancet. 1985 Sep 7; 2(8454): 520-3.
3) Volsky DJ et al. Antibodies to HTLV-III/LAV in Venezuelan patients with acute malarial infections. N Engl J Med. 1986 Mar 6; 314(10): 647-8.
This is the kind of scientific nonsense that makes me bang my head against the wall. There are enough problems trying to treat HIV in Africa (like health ministers who don't believe it's a real virus, or a complete lack of healthcare infrastructure) without adding on this sort of shoddy research that the Heimlich Institute is coughing up (ba-dum-ching).
And we wonder why the health literacy rate in the U.S. is so low....
I think i read somewhere that an early treatment for malaria was to put the patient in a cold room. I doubt it was proven with clinical trials, but i think the idea was to combat the fever. There were no cold rooms in Florida, and it was expensive to haul ice from the North. So it led to air conditioning and refrigeration, which, when properly used, can lead to increased health.
ABC's Health Report, and NPR's Health and Technology are cheap ways to get a broad idea of what's what in health. They're also available as podcasts, to fit your busy schedule.
George- because we're warm blooded animals, our body temperatures are controlled. Putting someone in a hot room doesn't increase their body temperature, it just makes them sweat a lot. Fever is a natural, body controlled process that we only know how to induce by making people sick.
Of course, when people are sick you want to keep them warm, so they don't waste valuable energy producing the heat themselves. And medications can reduce fever- something you really don't want to do.
The only time you should reduce a fever is in very young children when the fever is high enough to cause brain damage.
Studies show that reducing the temperature for any sickness prolongs its duration and increases death rate. This is because white blood cells- our bodies' defense system- work best at higher temperatures.
And apparently this goes across phyla- lizards, for instance, seek out heat when they are sick. Artificially keeping their body temperature at normal led to increased death rates. Keeping them at hotter temperatures reduced mortality to almost 0%.
How well do we know the effects of temp on HIV replication in humans? Some papers but not many.
Microbiologica. 1990 Jan;13(1):21-6. Enhancement of HIV-1 marker detection in cell cultures treated with mild heat-shock. Furlini G, et al.
They report more HIV protein in cells infected in culture AND heat treated but no effect of heat on virus in cells infected in vivo.
But then there's
Res. Virol. 1994 May-Aug;145(3-4):163-70. Effect of an elevated temperature on the replication of HIV1 in a monocytic cell line. Schweitzer-Thumann C, Kirn A, Aubertin AM.
This paper sees NEGATIVE effect of heat on virus from latently infected U1s.
Arch Virol. 1996;141(3-4):439-47. Heat shock induces HIV-1 replication in chronically infected promyelocyte cell line OM10.1. Hashimoto K et al.
These see a POSITIVE on virus from another infected cell line.
I couldn't find any papers more recent. Are these results contradictory? Does anyone know this subject? Seems like not enough is known about it. Fascinating though.
Fascinating stuff. Thank you Tara and Renee for the information. White cells work best at high body temperatures; I'll have to look a bit closer at that.
My god. If there wasn't full and complete informed consent for this, he should have his degree (and scrotum) revoked.
(Sound far-fetched? It won the Nobel prize for medicine in 1927)
So? They awarded the 1949 Nobel to Egas Moniz for the prefrontal leukotomy - more commonly known as the lobotomy.
The Nobel isn't quite what it's cracked up to be.
And in 1926, it was given to Johannes Fibiger for a theory of tumorigenesis which was absolutely, flatly wrong. He claimed that tumors could be formed by a parasite he had discovered in mice and rats.
If you want to induce a fever, clearly you have to produce a homeopathic solution of an NSAID like aspirin.
Of course, the headaches that come along as a side affect would be pretty bad.
Oh, I'm not saying the Nobel means it actually worked or that it should be considered today. I'm just saying that, once upon a time, it was a fairly well-known practice.
Well, then: so what? Leeches and trepanation were once well-known practices as well - it doesn't make them any less far-fetched or useless.
True. But with malaria for syphilis, well-respected people of the time actually thought it worked--enough so that they awarded it their highest prize. Whether it actually worked for neurosyphilis or not remains in doubt, but again, it was at least a well-known and accepted practice. Just trying to give the context here, to show why someone like Heimlich might think malaria to cure AIDS would be a good idea, or why he'd even consider it at all.
Look up heat shock proteins and immunity/HIV. There's plenty of information out there.
Try this: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&DbFrom=pubmed&Cmd=Li…
I'm not sure how well malaria therapy for syphilis worked, but it at least gives you some idea how desperate people were to treat neurosyphilis in the preantibiotic era. The infections were done mostly with vivax malaria, which will make you sick as a dog but won't kill you. It remained in use up to the 1940s.
It's also a goldmine of data for people who want to study the progress of induced malaria infections in untreated patients.
On HIV and malaria, from my past entanglement in the field there didn't seem to be much interaction, eg compared to the effect of HIV on tuberculosis. As both falciparum malaria and HIV are highly prevalent in sub-Saharan Africa, you would think that if there was a preventative effect it would have been noticed by now.
"George- because we're warm blooded animals, our body temperatures are controlled. Putting someone in a hot room doesn't increase their body temperature, it just makes them sweat a lot."
Until their cooling system breaks down and they get heat stroke. A cure that would be worse than the disease.
"Leeches and trepanation were once well-known practices as well - it doesn't make them any less far-fetched or useless."
Hang on, leeches aren't useless! In fact, leeches are used in reconstructive microsurgery - link
And trepanning is still used to treat epidural and subdural hematomas.
Don't be so quick to dismiss as "far-fetched"!
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The idea of fever induced heat treatment is not crazy, but the orgasm has to be sensitive in the 99F to 103F degree range. I suspect that some researcher somewhere would have noticed that before now.
The antiviral treatments given these days only slow the progression. A stopgap more than a solution.
Since HIV seems to seek out the CCR5 protein in CD4+ T cells that are prevelant in the gut, it would seem to me that a form of benign Escherichia coli (E. coli) could be genetically engineered to produce the CCR5 protein at an attractive level to HIV and further to eat/absorb the HIV that attack it. If the E. coli was otherwise normal and benign, it could be taken orally, and shelf life of E. coli should be good based on how long infective E. coli seem to live outside a host.