But right now, for many health and disease states
(1) we don't know if the altered microbiome is a cause or an effect or not related at all and
(2) even if there were a causal relationship between microbes and various health/disease states, there will also be enormous complexities relating to history and genes that will be very hard to sort out
(3) even if we knew a causal relationship this would not mean we would know how to change the trajectory (e.g., what microbes are there) in a useful way
Because there is so much iffy stuff out there relating to the microbiome and because some are starting to use studies of the microbiome to indirectly lend credence to their crap, I have decided to start giving out an "Overselling the microbiome award". I gave out the first one a few days ago: Overselling the microbiome award: Stephen Barrie on pre and probiotics at the Huffington Post
Interesting, Barrie posted a comment on the blog trying to defend his post, but I was not convinced. I think he did not understand my point about correlation vs. causation but am not sure.
Anyway, after I wrote the response to Barrie I looked around the web for others using the term microbiome in what seemed to be unsavory ways. And I found a really painful one. This is something called the "Marshall Protocol Knowledge Base." This so called knowledge base is a web site set up to promote, you guessed it, the Marshall Protocol. The Marshall Protocol is "a curative medical treatment for chronic inflammatory disease." In turn this protocol is based on the Marshall Pathogenesis which is "A description for how chronic inflammatory diseases originate and develop." It follows that this Marshall Pathogenesis "posits that chronic diseases (termed Th1 illnesses), are the result of infection by an intraphagocytic, metagenomic microbiota of chronic bacterial forms that are often referred to as the Th1 pathogens." I have read the last sentence dozens of times and I still do not know what it means. What is a metagenomic microbiota? I just do not know.
Anyway, I am sure everyone will be shocked to find out that the Marshall Protocol Knowledge Base, the Marshall Protocol and the Marshall Parthogenesis are being promoted by someone named, well, Marshall (Trevor Marshall) who seems to be the head of the Autoimmunity Research Foundation which is the place promoting the Marshall Ps (I swear, I will not call it the Marshall Plan, I will not, I will not).
Based upon what appears to be little if any actual published research, the Marshall Protocol promotes the treatment of all sorts of ailments with in essence long term
cocktail of multiple antibiotics at apparently low dosage and a long term attempt to alter Vitamin D levels by treating in part with very high doses of a drug called olmesartan. Among the ailments that this protocol is claimed to help are Crohn's, Type I diabetes, Multiple Sclerosis, Psoriasis, Rheumatoid Arthritis, Celiac Disease, and many many more. (I note they say "The Phase II clinical trial conducted from 2002-2008 by the Autoimmunity Research Foundation has demonstrated applicability of this antibacterial therapy to a wide range of chronic Th1 immune illnesses " and then cite a powerpoint presentation).
I could go on and on. But it seems clear to me that they are both making mistaken claims about what we know about the effect of microbes on health as well as making almost absurd claims about how one treatment system can cure a series of diseases by fixing ones microbial content. Note I am NOT saying microbes have no connection to these ailments - studies are supporting the microbial diversity in people with these ailments is different than in people w/o the ailments. Nor am I saying that Vitamin D is unimportant. In fact, it is becoming clear that Vitamin D is much MORE important than people realized. But importance alas, is different that saying we know exactly WTF is going on. And certainly the treatment outlined by the MP folks here is not as far as I can tell supported by any evidence of effectiveness not is it obvious how it connects to scientific knowledge about microbes and vitamin D.
Fortunately, others have taken on the MP folks here and have written about how it appears to be a scam of sorts, and a potentially dangerous one at that. See for example:
- The Marshall Protocol and other fairy tales
- The Marshall Protocol
- David Bradley: Slowburn treatment for chronic disease
- Sarcoidosis And The Marshall Protocol sCAM
I know, there are lots of medical scams out there. But this is the first one I have seen discussing metagenomics and the microbiome. And for that, I am giving the Marshall Protocol and the folks behind it, my second "Overselling the microbiome award".
UPDATE 7/18/2012 - some stories worth looking at
UPDATE 7/18/2012 - some stories worth looking at
- Phoenix news story about child nearly dying possibly in relation to MP
- County Attorney, Police Investigating Medical Protocol - KFYI
UPDATE November 2019.
- See Buyer Beware: “Miracle Cures” for Sarcoidosis - see last sentence below in particular.
- "Trevor Marshall came up with a treatment for chronic inflammatory diseases like sarcoidosis that consists of five seemingly simple steps. The first of these steps is to take a minimum of 40mg of olmesartan every 4-6 hours, which is a very high dosage. Olmesartan is not a drug that is commonly administered to treat sarcoidosis – in fact, it is used to treat high blood pressure, which is not one of the more prominent symptoms in sarcoidosis. Marshall protocol also requires limiting one’s Vitamin D intake, which means avoiding foods that are rich in Vitamin D as well as sun exposure. Vitamin D irregularity is common in sarcoidosis, but it is certainly not the root of the problem. However, Marshall Protocol bases its treatment on the belief that sarcoidosis is caused by an excess of Vitamin D paired with infection. We do not know what exactly causes sarcoidosis, but we do know that it is characterized by the formation of granulomas, not infection or Vitamin D irregularities. Focusing solely on these symptoms in treatment of sarcoidosis is missing the mark. Marshall Protocol is an expensive treatment, and there is no real evidence on its efficacy and we cannot be sure that it is harmless."
- And also see Disciplinary Action against Susan J. Shlifer, M.D.
- "USE OF HIGH RISK AND INEFFICACIOUS MARSHALL PROTOCOL 2.11 The "Marshall Protocol" implemented by Respondent in her treatment of patients is not supported by placebo controlled clinical trials or animal experiments. Developed by a non-physician, this protocol is contrary to the standard of care for treatment of anti-inflammatory and autoimmune diseases in the following aspects."