Thomas Goetz (Host/Narrator) (4:42)
Drug story is sponsored by GoodRx. Every prescription has a story, and for many patients, affordability is a defining chapter. Goodrx makes it easier to find lower prices on prescriptions from GLP1s to flu meds, so cost isn't a barrier to care. Trusted by nearly 30 million Americans and over 1 million healthcare professionals each year, Goodrx offers savings at more than 70,000 pharmacies nationwide, helping people start and stay on the therapies that keep them healthy. To start saving, go to goodrx.com drugstore that's goodrx.com drugstory GoodRx is not insurance. Welcome back to Drugstore. We tell each episode in three parts. The diagnosis, the prescription and side effects. This is part one, the diagnosis, where we explore the disease behind the drug, or in this case, the diseases. Because ivermectin is proven to work on many diseases, diseases with one thing in common. They are caused not by a bacteria or a virus, but by an animal. A parasite. Oftentimes, it's a type of worm called a helminth. Now, technically speaking, a parasite is an organism that lives inside or on another creature and feeds off of it. A tick is a parasite. So are lice, as is the tongue eating louse. That's this little crustacean. It's a relative of a shrimp that swims into A fish's gills, winds its way into the mouth and then eats the fish's tongue. Yeah, and get this, it then takes the place of that tongue. It lives there in the mouth, helping the fish eat, just as a tongue would, but taking a nibble of food every now and again. That, my friends, is a parasite. There are thousands, maybe millions of parasites on earth. Yeah, it just makes your skin crawl. In fact, there's actually a condition called delusional infestation, also called delusional parasitosis, where people are convinced that they have parasites. You might feel a bit of this right now, feeling like something is crawling on your skin, under your socks, maybe under your shirt. It's a little itchy. And no, a parasitic cleanse is not the answer. There is no evidence that those cleanses work. If you really think you have parasites, go see a doctor. Do not DIY this. Anyway, parasites have been worming their way into the human body for as long as there have been humans, even before. Just as fish and birds and dogs and horses all get parasitic infections, so do we. Many of these parasitic diseases started in the trough since about 1492, basically. Over the past 600 years of conquest and migration and slavery, parasitic diseases have spread around the world. Parasites are everywhere. Here's a factoid. The U.S. centers for Disease Control and Prevention is based in Atlanta, Georgia, because 75 years ago, parasitic diseases were common in the Deep South. It was mostly malaria, but also hookworm. In fact, let's start our tale there in the southern United States with a story about hookworms circa 1900. Charles Stiles was born in New York and educated in the zoological sciences at the finest institutions in Europe. Stiles was particularly interested in parasites and livestock, like trichinosis in swine and tapeworm in cattle. At the time, the study of parasites, this is called parasitology. This was a brand new field of medicine. Parasites, it was discovered, caused diseases like giardia and malaria. And compared to bacteria, parasites were easier to find, sometimes even visible to the naked eye without a microscope. But that did not make them any easier to deal with. So around 1900, Charles Stiles took a job as the chief zoologist for, for the U.S. public Health Service. And when he heard about health problems in the American south. Anemia, stunted growth, he had a hunch that parasites were involved. So Stiles began to research. Well, there's really no other way to say this. He went on a study of human shit across the South. He took stool samples from everyone willing to let him. And soon he had definitively identified hookworms as a cause of widespread malaise. Based on his poop studies, he estimated that around 40% of Southerners, whites and blacks, almost always poor, they carried hookworms. He called these parasites necator americanus, which translates as American murderer. This was a misnomer, actually. People rarely die of hookworm infections, but hookworms did make daily life much, much worse. At the time, this was the first years of the 20th century. To be poor in the south meant almost no sanitation. No running water, no toilets, often no outhouses. People pooped well wherever, in the woods, behind bushes. And most poor people went without shoes, children especially. It was just easier that way. Shoes cost money. These were ideal conditions for the hookworm to prosper. Let's start in the dirt. Hookworm larvae live in the soil and burrow through to reach their target, human feet, where they quickly slip into the pores of bare skin. This might cause a rash. It was called ground itch. But the worm is in the larvae, which are super tiny, scarcely visible to the human eye. They then wriggle their way into blood vessels and enter the bloodstream. And now the ride is on. The larvae flow to the heart and they are pumped out into the lungs. This usually causes a cough, which is just what the hookworm needs, because with every cough, the hookworm is forced out of the lungs, into the mouth and then, gulp, swallowed. And now the worm is home free in the small intestine. The worm latches onto the intestinal wall. There it feeds on blood and grows to just half an inch long at most. From there, the adult worm produces more larvae, which are expelled with a stool into the dirt past the bush, where the worms wait for other feet to pass by. And so the cycle continues. But let's hook back, sorry, to the adult worms, back in the intestines. As they fester, sucking the blood out of their host. Hookworms cause anemia, that is a severe and chronic iron deficiency caused by blood loss. Symptoms of anemia are weakness and extreme fatigue. The English language is full of words to describe this. Indolence, sloth, lethargy, lassitude, laziness. In 1902, at the Pan American Sanitary Congress in Washington, D.C. charles Stiles announced his discovery. And he noted that there might be a connection between this hookworm, the American killer, and the characteristic state of southern lassitude. And that became front page news. The headline in the New York sun screamed germ of laziness. Found at the time, this stereotype of a lazy southerner, especially white southerners. It was commonplace as the north expanded in a frenzy of industrialization, the south was still overwhelmingly rural. Poor white Southerners were scorned as unmotivated and slow. And the stereotype lined up neatly with racial slurs about lazy black people. And that has been an even more enduring smear. So Charles Stiles had found his cause. But what about the cure? Once the germ for laziness headlines faded, no one seemed that interested in following up on Stiles work to do anything about the hookworms. It may have affected 40% of the population, sure, but hookworm was mostly an affliction of the very poor and often blacks. Remember, this was the Jim Crow era South, not a time of great progress. So this was just not a priority for the fledgling U.S. public Health Service or the growing nation. So Stiles started stumping and lecturing about what he thought should be done. He said, my hobby may be summarized in the two words clean up. In our filthy American habits of daily life, I see the cause of more preventable sickness and preventable death than I do in any other one factor. Eventually, in 1908, Stiles hooked up. Sorry. With advisors to John D. Rockefeller, the founder of the Standard Oil Company and the richest person in the United States at the time. Rockefeller was interested in putting his wealth towards philanthropy, and Stiles work fit the bill. Soon there was a Rockefeller Sanitary Commission dedicated to eradicating hookworm in the southern United States. This would later become the Rockefeller Foundation. Stiles and the Rockefeller team identified three strategies to fight hookworm. First, infected people were to be treated with thymol. This was a naturally occurring chemical used as a disinfectant and Epsom salt to kill and purge the worms. This involved a lot of vomiting and diarrhea, but it usually worked to rid a body of worms within 24 hours. Second, they went on an outhouse building campaign. One estimate at the time held that 35% of white households and 75% of black households had no privies. That would have to change. The goal was to build an outhouse for every home with a pit at least four feet deep. Third, shoes. Now, this was a big cultural change. Children in the south rarely wore shoes, especially in the summer. But shoes keep the worms out. The hookworm campaign quickly took off. State governments got engaged with Rockefeller money. Many southern states established sanitary commissions and better state departments of health. Soon there was talk of an expanded national public health service, one that could build on the success of the hookworm campaign and advance sanitation and healthcare across the land. The Rockefeller Coalition framed this as a movement for the conservation of country life. But they were really demanding that people change how they lived, where they lived, what they wore, how they ate. Change was the only way to keep disease at bay. And many people did not like all that change. Enter the National League of Medical Freedom. This opposition group condemned scientific medicine, arguing that people should be free to pursue whatever form of treatment they believed best, and that the federal government should steer clear of endorsing certain kinds of medicine as more worthy than others. The League was funded by homeopaths, osteopaths, and others in the alternative medicine business. At first, it worked. The League and a successor group, the American Medical Liberty League. They managed to delay approval of what was called the medical octopus, a stronger national health organization. But by the time of the New Deal and more effective drugs and treatments in the 1930s, the opposition faded, though it did not disappear. That idea of defending medical freedoms against mainstream medicine, does that sound familiar? That idea would not die. It has not died. So now back to hookworm. That was eliminated in the southern U.S. more or less, by the 1950s, though it's not entirely gone from the south, and it still appears in dogs and cats and horses nationwide. And hookworm is still sadly common around the world. Which takes us to another worm. Let's follow our drug story to Africa to meet another parasitic disease, river blindness. In the villages of sub Saharan Africa, in countries like Ghana, Nigeria, and Cameroon, people depend on rivers because that is where the food is, where the water is, that's where the work is.
