Dr. Harvey passed away in:
tinyurl.com/4xsgh3m
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Journal of the American Academy of Dermatology
Volume 56, Issue 4, Pages 705-706 (April 2007)
Letter to the editor
www.eblue.org/article/PIIS0190962207001958/fulltext
Morgellons disease
William T. Harvey, MD, MPH
To the Editor: The recent editorial by Dr Koblenzer,1 titled “The Challenge of Morgellons Disease,” appears with two referenced letters.2, 3 All authors imply that the term “Morgellons” and the related Morgellons Research Foundation are unwelcome imposters appearing on immutable turf. No author suggests awareness of either the Morgellons origin or the origin of delusions of parasitosis (DP) nor the assumptions and facts underpinning each.
The first approach we considered in responding to the editorial and letters was to address individual points raised by each. Repeated perusal suggested another more relevant approach. Each author provided abundant examples of an expansive medical system constrained by legal and fiscal (insurance) pressures that have resulted in the production of certified practitioners with little awareness of the necessary tools of critical thinking. The result of each is a hollow argument addressing a perceived issue without reference to the genesis, history, or information sources of either DP or Morgellons.
Serious students of the most basic sciences learn early that reality is the singular essence of each. “Truth” in this context is simply a semantic label given to current human understanding of that reality.4 Human truth never reaches reality, but as the Ancient Mariner, drifts forever, perhaps asymptotically approaching what is real. So it is with medical truth. Yesterday's texts are already trash, placing an enormous burden on each of us to look beyond our passed-on guidebooks, created as best they could be with the tools and knowledge available at the time.
Carl Sagan5 captured this essential professional obligation in an essay titled “The Burden of Skepticism.” He saw the essential task of every truth seeker to balance credulity and skepticism equally, impossible without the trait of intense humility in the presence of an unknowable universe. Within such a context, we as physicians must see disease names simply as labels and defined disease boundaries as crude guesses that continually evolve.
What then do we make of texts and distinguished tutors who tell us that all delusional people focused on dermal symptoms: (1) have created the physical signs they show us; and (2) their belief that parasites are responsible for their sickness is the product of a damaged mind? Those who try to freeze the present embrace skepticism of a new idea called Morgellons, but curiously, will cling fervently to a concept held as immutable fact, DP. The truth seeker will question both equally, and gather all that can be known about the assumptions and facts from which each were built. Most importantly, he or she will know the answer is, as always, in the patient and nowhere else.
All we had to do on encountering our first patient with DP was to examine the lesions with a child's portable microscope, query the patient about other signs and symptoms, then use current laboratory tests to characterize all distressing symptoms. Next was to examine others with the same signs, particularly babies, and scrutinize similar lesions unreachable by infant hands. Increasing numbers of similar patients (some not self-diagnosed) holding responsible professional positions successfully made it clear that DP lesions and psychosis were not linked by cause and effect.
As Koblenzer1 noted, inquiry into the history of Morgellons reveals that the term was adopted by a biologist-mother with affected children. When no physician could either name the illness or treat it, she found a placeholder title to aid communication while she sought to find answers. Thus, came the Morgellons Research Foundation,6 with 8263 registrant households.
To anyone willing to look and listen, all patients with Morgellons carry elevated laboratory proinflammatory markers, elevated insulin levels, and verifiable serologic evidence of 3 bacterial pathogens. They also show easily found physical markers such as peripheral neuropathy, delayed capillary refill, abnormal Romberg's sign, decreased body temperature, and tachycardia. Most importantly they will improve, and most recover on antibiotics directed at the above pathogens.
In the final analysis, everything we know is perception. What we perceive is still up to us, even as individual professionals. In the current climate of evidence-based medicine, more than ever, what we use as evidence and how we use it is paramount. In the hands of clear thinkers, reality will reveal itself.
References
1. Koblenzer CS. The challenge of Morgellons disease. J Am Acad Dermatol. 2006;55:920–922. Full Text | Full-Text PDF (73 KB) | CrossRef
2. Murase JE, Wu JJ, Koo J. Morgellons disease: a rapport-enhancing term for delusions of parasitosis. J Am Acad Dermatol. 2006;55:913–914. Full Text | Full-Text PDF (69 KB) | CrossRef
3. Waddell AG, Burke WA. Morgellons disease?. J Am Acad Dermatol. 2006;55:914–915. Full Text | Full-Text PDF (91 KB) | CrossRef
4. Ruchlis H. Clear thinking: a practical introduction. 1st ed.. Buffalo (NY): Promethius Books; 1990;.
5. Sagan C. The burden of skepticism. In: Frazier K editors. The hundredth monkey. Buffalo (NY): Promethius Books; 1991;p. 1–9.
6. Morgellons Research Foundation Web site. Available at: www.morgell
Read more: http://morgellonsgroup.proboards.com/thread/4024/nematode-research-dr-harvey#ixzz49b7ZOLPU
