Almost a decade has passed since maggots averted the amputation of Pam Mitchell's left foot, and the Akron resident still sounds tremendously grateful. In her case, maggot therapy accomplished something that modern medicine—specifically, three courses of antibiotics—was unable to do: Defeat a dangerous and persistent bone infection and heal the deep, open wounds that had developed on both of her feet.
Foot ulcers are a common complication of diabetes, which Mitchell, now in her 50s, has had since the age of 10. In the hospital where she was being treated, "they told me I had to have my foot amputated, that it would never heal," she says. "It's been healed for 9 years. I barely have a scar."
Diabetes isn't the only condition in which maggots (aka fly larvae) can be therapeutic. The FDA has approved the larvae for the following indications: "For [cleaning] non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic or post surgical wounds." The maggots munch away dead or infected tissue, leaving behind only healthy flesh.
I've written about Mitchell and the science of maggot therapy before. (She, too, has written about her experience, most notably in her book, Maggots, Miracles and Me.) This month, we got back in touch, and I asked her how someone in need of maggot therapy could go about getting it today. I also spoke with Ronald Sherman, an Irvine, Calif.-based doctor who for years has been studying and publishing research on maggot therapy. Here's what I learned from them:
1. You need a prescription. To obtain hygienic maggots, one first needs a doctor's prescription. The maggots can then be ordered from a company that breeds medical-grade maggots, such as Monarch Labs of Irvine, Calif., where Sherman is the laboratory director.
2. Doctors don't have much of an incentive to try using maggots. Doctors can make good money treating infected wounds with antibiotics or by surgery—and the work isn't too unpleasant. That's not the case with maggots, which have to be applied fresh to the wound, wrapped in a dressing so they don't wriggle away, and replaced every couple of days. "There isn't any money to be made on maggot therapy," Mitchell says. "They cost under $100, and how much can a doctor charge for putting them on and taking them off?"
3. On the other hand, the low cost can work in patients' favor. Some insurance plans reportedly reimburse for maggot therapy. And even if yours doesn't, and you end up paying $100 or so out of pocket...well, that's a lot cheaper than a wheelchair.
4. Once you have a prescription, you don't actually need a doctor to apply the maggots. "Anybody can do it," says Mitchell. "I've [known] patients who do it themselves."
5. Not all doctors will write a prescription. Mitchell had a tough time convincing her providers to give the therapy a try. She recalls them telling her that they'd heard of maggot therapy but that they felt it wouldn't work in her case. "Some doctors are ignorant," she says. "And some are arrogant."
6. There's no up-to-date directory of doctors who will prescribe maggots. Sherman, who previously worked for University of California, Irvine, used to maintain a list on the UC, Irvine website of doctors who had prescribed or ordered medical maggots. But he said it's very out of date and asked me not to publicize it. "Some of [the doctors] were sort of embarrassed" to be on the list, he says. Others were inundated with requests. "Some of them asked to be removed when they kept getting phone calls, more than they could handle," he says.
7. A new public list is in the works. Sherman, who has retired from UC, Irvine, says he is working on a new list. He plans to make it available on the website of the BioTherapeutics Education and Research Foundation, a nonprofit that promotes the medical use of maggots, leeches, bees, and other living organisms. He and Mitchell are both on the board of directors of the BTER Foundation.
8. For now, seek out the "maggot lady." That's what Mitchell calls herself. "I have a list of doctors who've ever ordered [maggots] in the country, which doesn't mean they're still doing it," she says. She doesn't have permission to publish the names on the list, but she says she frequently helps put patients who are seeking maggot therapy directly in touch with doctors who are willing to consider prescribing it. She permitted me to post her E-mail address, which is pamsmaggotinfo [at] aol.com.
How does her list compare to the active prescribers Sherman knows of? "Pam has their names and 20 times more," Sherman says.