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Treating children for worms yields long-term benefits, says new study
- dayofthedaleks 6y agoFor starters, it keeps them from wiping their asses on the carpet.
- dang 6y agoPlease don't do this here.
- setgree 6y agoAt an earlier stage, this work attracted a fair bit of methodological controversy, e.g. https://www.vox.com/2015/7/24/9031909/worm-wars-explained https://www.vox.com/2015/7/24/9031909/worm-wars-explained https://statmodeling.stat.columbia.edu/2015/08/18/macartan-humphreys-on-the-worm-wars/ https://statmodeling.stat.columbia.edu/2015/08/18/macartan-h...
- jessaustin 6y agoPresumably the 2019 Nobel Prize committee had seen that criticism? Frankly I'm appalled that intestinal worms still plague so many human beings. I happily spend about $50 a year to worm a herd of horses, a herd of cattle, and a dog. Surely as a species we can find the resources to buy these children some pills, at least until we cowboy up and eradicate these worms from our planet entirely.
- DaiPlusPlus 6y ago> Surely as a species we can find the resources to buy these children some pills We did: it's called universal healthcare - and many of our species' nation-states already use this system and have been seeing the overall positive results for about a century now - but some societies, for a variety of reasons, do not.
- jessaustin 6y agoOne supposes Kenya and other, poorer nations in Africa will appreciate this advice, and then they'll snap their fingers and all will be well...
- neves 6y agoI think the parent was talking about the USA.
- refurb 6y agoIt's actually relatively straightforward to get Medicaid coverage for children in the US. There is a specific program to cover them (and pregnant women). https://www.medicaid.gov/chip/index.html https://www.medicaid.gov/chip/index.html "The Children’s Health Insurance Program (CHIP) is a joint federal and state program that provides health coverage to uninsured children in families with incomes too high to qualify for Medicaid, but too low to afford private coverage."
- tialaramex 6y agoI appreciate that for many Americans this feels like it's enough, or at least almost enough, but it's nowhere close. Dozens (every US state and territory is handled separately) of separate systems in which you can fill out a bunch of paperwork to apply to have insurance for children is nowhere close to the zero friction "free at the point of use" goal of universal healthcare. Some countries with universal healthcare don't do a great job of achieving zero friction, but they're all way ahead of a disjointed paperwork process that only results in getting insurance that ought to have been free for everyone from the outset. And, one of the most obvious problems is: CHIP only covers children you can provide an SSN for. So maybe Steve, aged 4 is covered because you had him in San Antonio but his older sister Esther was born in Mexico and travelled over the border with you. She can't get CHIP because she doesn't have an SSN and powerful people want to make sure it stays that way.
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- aaron695 6y agoI image you also give your animals nutrient supplements. If, and that's a big if, as a species we can find the resources to buy these children some cheap pills then it's not necessarily worming tablets. But it's complex, people love the idea of de-worming kids. It sells well, and once you open up aid to communities then you can do a lot of other stuff. It's not the 50 cent pills it's the $1000s finding them and training someone to get to them, so tomato tomato who pays for that.
- jessaustin 6y agoI agree, international aid is problematic. Much better would be improving "gene drive" tech to the point that we wipe out helminths completely. That seems a few decades away, and in the meantime maybe lives can be improved via other methods.
- eaandkw 6y agoNot that I am in favor of parasitic worms or anything but I would be careful to assume that erraticating helminths or any species for that matter would only be beneficial. I don't know where they fall in the food chain. Maybe they are essential for some other species to thrive that we depend on.
- jessaustin 6y ago...any species... There are at least 300 species from multiple phyla that feed on humans. We might also consider those species that feed on our livestock, although such an action would have less ethical urgency. It isn't impossible that other species might eat them, but given their baroque life cycles it seems quite unlikely that any other species depends on them for survival. But sure, if people decide to start with tests on isolated tropical islands, I won't argue.
- taneq 6y agoCompared with the thousands of species that go extinct every year as a normal part of evolution, much less the tens or hundreds of thousands of species currently being wiped out by human activity, surely wiping out small group of species is not that big a price to pay for ridding humanity of a truly horrible affliction?
- setgree 6y agoI'm sure they did! Kremer is a really important figure in the history of economics, and the magnitude of the effects of his work on deworming are debatable. These things are perfectly compatible. I think the articles I posted might help readers form their own conclusions about the work, rather than deferring on account of Kremer's prestige and authority; per Feynman, "Science is the belief in the ignorance of experts." [0] Regarding the fact that it's appalling that so many people still deal with this problem -- I agree. As Gelman says (second link I posted in GP), the reason that magnitude of effects is important is opportunity costs: > The 800-pound gorilla in the room is opportunity cost, or cost-benefit analysis. As you say, who could be against de-worming kids? I’m reminded of Jeff Sachs’s argument that all of these sorts of interventions are worth doing, and that rather than trying so hard to rank the cost-effectiveness of different health and economic interventions, the rich countries should just kick in that 1% of GDP or whatever and do all of them. I’m not saying Sachs is necessarily right on this, I’m just saying that most of the discussion seems to be on traditional statistical grounds (Is there an effect? Is it statistically significant? Has it been proven beyond a reasonable doubt?) and the cost-benefit or opportunity cost calculations are implicit. [0] https://news.ycombinator.com/item?id=23816584 https://news.ycombinator.com/item?id=23816584
- triceratops 6y agoHow do you spend so little? My dog's monthly heartworm medicine alone costs $5/dose.
- Shog9 6y agoDog heartworm pills are a MASSIVE rip-off. The active ingredient - ivermectin - can be purchased without prescription at any farm supply shop in sufficient quantity to last several dogs' lifetimes with plenty to spare. The maintenance dosage is miniscule. Pet prescription meds are only slightly less of a scam than human prescription meds.
- rubyron 6y agoI’m a retired DVM. What you say is true, but I just want to caution anyone reading this that ivermectin is deadly for collies and many herding breeds. Rule of thumb is “white feet, do not treat.”
- krustyburger 6y agoPlease don’t be offended, but I find this absolutely fascinating. Abstractly I know veterinary science is at least as complex as anything involving humans. But somehow I tend to dismiss just how much variability a veterinarian is expected to be able to account for.
- fsckboy 6y agoplease don't be offended but if you find yourself saying "please, don't be offended", LPT, you can generally reword what you are about to say so it's simply a compliment instead of containing the negative messsage. You are impressed by how much variation a veterinarian must account for in a single species, and they handle multiple species.
- deleted 6y ago[deleted]
- erikerikson 6y agoPlease see [0]. Many people do find the money to buy those children pills. Pretty sure the study is tracking the consequences of that intervention. You could give a little as well to help make it even more broadly effective. So could the readers of this comment. In fact, please consider doing so. [0] https://www.givewell.org/charities/sci-foundation https://www.givewell.org/charities/sci-foundation
- supernova87a 6y agoI think it's worth mentioning that almost any public health, education, welfare program for children gives excellent returns on investment, compared to trying to apply that same money to people later in life (unemployment benefits, job retraining, etc). The amount you can positively change a child's life for the better means that reasonable expenditures on known problems should almost be a no-brainer. ( I'll see if I can dig up an article link about the difference in outcomes per $ spent, versus age of recipient.) Edit: here are multiple links within the article about the above: https://www.nytimes.com/2020/07/10/business/social-programs-profit.html https://www.nytimes.com/2020/07/10/business/social-programs-...
- barry-cotter 6y agoThis isn’t true in education. I can’t speak to other fields but early childhood interventions are not more effective than later ones in that field. We can’t be sure, statistically, but the opposite is more likely to be the case. https://offsettingbehaviour.blogspot.com/2018/04/the-heckman-curve-is-flat.html?m=1 https://offsettingbehaviour.blogspot.com/2018/04/the-heckman... https://www.nzae.org.nz/wp-content/uploads/2017/07/Rea_and_Burton.pdf https://www.nzae.org.nz/wp-content/uploads/2017/07/Rea_and_B... IS THE HECKMAN CURVE CONSISTENT WITH THE EMPIRICAL EVIDENCE ON PROGRAM RETURNS BY AGE? The Heckman Curve depicts the empirical evidence on rates of return to public investment in human capital as rapidly diminishing with age. Investment early in the life course is characterised as providing significantly higher rates of return compared to investments targeted at people who are older. In this paper we use the Washington State Institute for Public Policy estimates of program benefit cost ratios to assess whether the Heckman Curve is consistent with the latest evidence. The data does not support the claim that programs targeted earlier in the life course provide the largest returns, or that adult programs will have benefit cost ratios that are less than one. The paper concludes by discussing the various features of both human capital and interventions that might explain why the predictions of the Heckman Curve are not consistent with the evidence.
- harikb 6y agoIsn’t it unfair to compare the overzealous first-world parents who try to push education more at preschool level to those parents targeted by GP, providing a “decent lower school education” to the poor? I think education is also high ROI, but just like anything else in economics, you can only push it to a certain level after which one gets diminishing returns. For the purpose of the discussion here, we should spent more on education of younger kids.
- valuearb 6y agoIf this had only been known and treatable 200 years ago, who knows how U.S. history could have been changed. https://www.pbs.org/wgbh/nova/article/how-a-worm-gave-the-south-a-bad-name/ https://www.pbs.org/wgbh/nova/article/how-a-worm-gave-the-so...
- anonAndOn 6y ago>While the South eventually rid itself of hookworms The article is incorrect. Hookworm was never eradicated in the US. It was just confined to poor, black folks. [0] [0]https://www.theguardian.com/us-news/2017/sep/05/hookworm-lowndes-county-alabama-water-waste-treatment-poverty https://www.theguardian.com/us-news/2017/sep/05/hookworm-low...
- giardini 6y agoanonAndOn says:>"The article is incorrect. Hookworm was never eradicated in the US. It was just confined to poor, black folks... That is incorrect. Worms are endemic to the USA. See the CDC's posting "Parasites - Hookworm" at https://www.cdc.gov/parasites/hookworm/index.html https://www.cdc.gov/parasites/hookworm/index.html As a child I was treated regularly for worms, including but not limited to hookworms. Worms infest whites as well as blacks, Hispanics, and everyone else. Both rich and poor get worms. As the CDC posting states: "Hookworm infection is mainly acquired by walking barefoot on contaminated soil. One kind of hookworm can also be transmitted through the ingestion of larvae." And what kind of child doesn't walk barefoot in the mud or eat dirt? The answer possibly is sickly children! Some hypothesize that exposure to worms may be necessary for a child to develop a proper immune response: "Are Worms Key to Health?" https://www.nhs.uk/news/heart-and-lungs/are-worms-key-to-health/ https://www.nhs.uk/news/heart-and-lungs/are-worms-key-to-hea...
- ferros 6y agoHow common are worms in western societies?
- HarryHirsch 6y agoThey are not extinct: https://www.theguardian.com/us-news/2017/sep/05/hookworm-lowndes-county-alabama-water-waste-treatment-poverty https://www.theguardian.com/us-news/2017/sep/05/hookworm-low...
- projektfu 6y agoTaenia is not uncommon in places like France that have more "small farm" production and sublethal cooking methods. A small risk to take, I suppose. https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-017-2280-8 https://parasitesandvectors.biomedcentral.com/articles/10.11... Enterobius is quite common across the world. It's also considered to be minimally pathogenic, so it probably is only treated in symptomatic cases.
- SomeoneFromCA 6y agoEnterobius is actually airborne, and highly contagious. But adults usually do not have them.
- esaym 6y agoPinworms[0] are a lot more common than I think most people (doctors included) realize. Though the symptoms are not as bad (that we know of) [0]https://en.wikipedia.org/wiki/Pinworm_infection https://en.wikipedia.org/wiki/Pinworm_infection
- raxxorrax 6y agoDoesn't seem too dangerous... at least physically. Hope they don't make you want to smell cat urine.
- pieceofcakedude 6y agoExtremely... but unfortunately most Western doctors won't test for it, won't prescribe meds for it and are convinced that it's not possible in 1st world countries. In other words, utter quackery.
- nabla9 6y agoParasite load seems to affect negatively cognitive abilities. Decreased Parasite Load and Improved Cognitive Outcomes Caused by Deworming and Consumption of Multi-Micronutrient Fortified Biscuits in Rural Vietnamese Schoolchildren https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144834/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144834/ Parasite load explains 67% of the worldwide variation in intelligence: "Parasite prevalence and the worldwide distribution of cognitive ability" https://royalsocietypublishing.org/doi/abs/10.1098/rspb.2010.0973 https://royalsocietypublishing.org/doi/abs/10.1098/rspb.2010...
- sersnth 6y agoIn that first paper, it does not seem to indicate that there was a difference in the level of cognitive improvement in the albendazole + fortified biscuits group versus the placebo + fortified biscuits group.
- SomeoneFromCA 6y agoFrom the scond paper: "Templer & Arikawa (2006) also found that average IQ correlated significantly with average skin darkness (r = −0.92). The authors offered little explanation of why this trend exists, except that they believed skin colour was related to exposure to certain climates over evolutionary time." I doubt that scientists today would dare to make such statements, for the fear of being "cancelled".
- thdrdt 6y agoIt is very hard to create unbiased IQ tests. There will always be cultural differences and differences in opportunity. IQ tests should be taken with a grain of salt. It also depends on what you think is important. Smart people are not always wise people.
- SomeoneFromCA 6y agoI certainly agree with that. Nonetheless, being myself one of the "darker" skinned ethnicities, I see no offence in the statement that as a whole, darker nations seem to have lower IQ, there might be thousands of reasons for that; for some nations, colonial opressions, for some it might inherent biological reasons.
- civilian 6y agoHasn't GiveWell known this for awhile? More study is always good, of course! Evidence Action "Deworm the World Initiative" is one of GiveWell's top charities https://www.givewell.org/charities/top-charities https://www.givewell.org/charities/top-charities
- bluquark 6y agoGivewell decided to make this recommendation despite ongoing disputes in the literature. There was so much uncertainty about the long-term effects that at least as of 2016, they actually discounted the expected benefit by 100x. See https://blog.givewell.org/2016/12/06/why-i-mostly-believe-in-worms/ https://blog.givewell.org/2016/12/06/why-i-mostly-believe-in...
- civilian 6y agomea culpa! That's fascinating, thanks for the link.
- markdown 6y agoI thought we were supposed to be encouraging gut flora and fauna, and that deworming and antibiotics was causing all sorts of allergies and disorders. I mean, faecal transplants are a thing now. As a species, we spend trillions of dollars a year on armaments and the machinery of war, and can't even definitively answer simple questions about our own bodies. What a disappointment we are.
- bigphishy 6y agoThere is a drug called ivermectin that will kill all invertebrate without harming gut bacteria. I'm not sure what gave you the idea [ ... assumption] that treatment against invertebrate parasites automatically is detrimental to our gut biome. And I definitely don't follow your logic towards the end, but have a look at ivermectin it is a hell of a drug.
- adevx 6y agoIvermectin is known to have a negative impact on biodiversity: https://www.sciencedirect.com/science/article/abs/pii/S0048969717330498 https://www.sciencedirect.com/science/article/abs/pii/S00489...
- bigphishy 6y agoConsider the fact that it obliterates any and all invertebrate it encounters, of course that is going to lower lower biodiversity.
- adevx 6y agoI agree. Not only does it negatively affect human gut flora and fauna, but the deworming agents have a negative effect in nature especially on certain flies and beetles when administered to live stock. Instead of focusing on medication, I think there is a ton we can do by being more mindful about what we eat and how we prepare our food.
- deleted 6y ago[deleted]
- alexherry 6y agoQuickShortcutMaker Apk Free download for android phone . https://androidblue.com/quickshortcutmaker-apk/ https://androidblue.com/quickshortcutmaker-apk/
- jdc 6y agoThere is a charity doing this I learned about through GiveWell. https://www.evidenceaction.org/dewormtheworld-2/ https://www.evidenceaction.org/dewormtheworld-2/
- peter_retief 6y agoThe fact that many poor children have worms does not mean the worms cause the poor outcomes. Deworming is cheap and ubiquitous in primary care clinics in poor communities in Africa. Correlation does not imply causation.
- deleted 6y ago[deleted]
- doukdouk 6y agoIn this case, the deworming treatment was allocated randomly (see the paper [0]). Giving the deworming treatment to children make them less poor than those who did not get the treatment, and there should be no baseline differences on average between the two group of children since the allocation was random. Is going from "deworming children make less poor" to "the worms cause poor outcomes" such a stretch? [0] http://emiguel.econ.berkeley.edu/research/twenty-year-economic-impacts-of-deworming http://emiguel.econ.berkeley.edu/research/twenty-year-econom...
- peter_retief 6y agoThere are so many factors here, poor health can exacerbate worm infestations and healthy individuals with a good diet can live with parasites for many years with no adverse symptoms. Then there are the visits to clinics that give default deworming pills as part of any consultation. Is going from "deworming children make less poor" to "the worms cause poor outcomes" such a stretch? Sure, it is likely.
- doukdouk 6y agoAll those many factors equally affect both groups, that's the point of running a randomized trial. I am not sure how they are relevant to the claims that worms cause poor outcomes or that deworming children make them less poor adults. Could you please explain?
- peter_retief 6y ago
- rihegher 6y agoAnd probably side effects as asthma and allergy https://www.nhs.uk/news/heart-and-lungs/are-worms-key-to-health/ https://www.nhs.uk/news/heart-and-lungs/are-worms-key-to-hea...
- ce4 6y agoOld K5 article on hayfever/asthma self medication using hookworms: https://web.archive.org/web/20080108063512/kuro5hin.org/story/2006/4/30/91945/8971 https://web.archive.org/web/20080108063512/kuro5hin.org/stor...
- dacodanelson 6y agoMust be wonderful having the entire "third world" for researchers to test out their pet hypotheses, or at least to trial medications that might not otherwise be worth paying to have put through FDA scrutiny until you've dosed several thousands of innocent children. And who says colonialism is dead?
- MperorM 6y agoWhat exactly do you think is the alternative to giving deworming treatments?
- doukdouk 6y agoMy understanding is that this is not a clinical trial at all - the question is not whether the treatment works for health purposes, but whether this medicine, that was already tested for its medical effects, also has long lasting economic impact. Hence the FDA is completely irrelevant here.
- thesz 6y agoDeworming may also bring long term detriment [1]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1618732/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1618732/ Deworming increases response of immune system [2] and can lead to higher inflammation, more allergies and autoimmune diseases. [2] https://www.pnas.org/content/113/44/12526.full https://www.pnas.org/content/113/44/12526.full Right now I think we have to eat better.
- nashequilibrium 6y agoWhen I was a kid, I remember being dewormed about 3 times and I still remember the medicine, Vermox. The first time I freaked out because I saw the long worms come out And then some in my stool, but after that I was used to it. Now, as an adult I have crazy seasonal allergies, hopefully that wasn’t the cause.
- Shivetya 6y agoWell the issue raised here in the OP is mostly third world issues and it can be very difficult both in distance, language, as well as local government issues, in assisting people in need.
- hutzlibu 6y agoIt should not really surprise, that there are benefits from removing parasites. The only potential downside I see is, that the childa body does not learn to deal with them on its own.
- doukdouk 6y agoIs it really not a surprise? If someone told me that there was a magic, 50-cent-a-year pill that would increase my wage by 15% for the next 20 years, I would be skeptical.
- yourkin 6y agoDoes this coincide well with research on the symbiotic relationship between host and parasite? In general: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140032/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140032/ Novel treatment of Multiple Sclerosis with parasitic worms: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5666823/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5666823/
- andy753 6y agoGood to know