Re: Toxemia Pregnancy Caused By Microscopic Parasite

Here is the whole article:

February 8, 1983
THE DOCTOR'S WORLD
By LAWRENCE K. ALTMAN, M.D.
ACARDINAL rule of medicine is to greet startling new research findings with a healthy dose of skepticism and not to accept their validity until confirmed by other scientists.

Take the case of two articles in the Jan. 1 issue of the American Journal of Obstetrics and Gynecology, in which researchers in Chicago reported discovery of a microorganism they believe causes toxemia of pregnancy, a disease that may cause the deaths of up to five million pregnant women and fetuses throughout the world each year. They named the organism, apparently a tiny worm, Hydatoxi lualba.

Despite its publication in a respectable medical journal, news of the report startled many doctors and raised serious questions in the minds of some scientists, especially those specializing in parasitology. There had been little evidence in the past linking toxemia to any environmental condition that might favor the transmission of a parasite. The new organism would add toxemia to legionnaire's disease and a growing list of other conditions newly attributed to organisms medicine had somehow failed to find before. And parasitologists who read the articles severely criticized technical aspects of the studies themselves.

Toxemia of pregnancy appears mysteriously, usually during the last three months, and affects about five percent of expectant mothers. Its symptoms include high blood pressure, swelling from accumulation of body fluids, and abnormal amounts of protein in the urine. Severely affected women can experience coma, seizures and permanent brain damage. Discovery of an infectious cause for the disease could have critically important implications for public health as well as for prevention and treatment.

At its best, the story represents the vigorous, often impassioned gives and takes of a scientific community that believes public reports of new medical advances should come only after being reported in a scientific journal. This one conformed to that rigid policy, yet left many serious questions in the minds of many scientists.

After the discovery was reported in the obstetrical journal, a public relations firm issued a news release for Loyola University Medical Center that drew wide public attention.

The entire story will take at least several months to sort out while scientists elsewhere spend their time and taxpayer funds to do the experiments to confirm or deny the reported findings, which came from research done over the last eight years at three universities.

The researchers were Dr. Silvio Aladjem, chairman of the Department of Obstetrics and Gynecology at Loyola Stritch School of Medicine in Chicago; Judith Lueck, a graduate student in physiology at Loyola; Dr. John I. Brewer, an obstetrician at Northwestern University, and Marilyn Novotny, a biologist at Northeastern Illinois University. None are parasitologists. Their work was funded by the National Cancer Institute, the American Cancer Society, the Dean's Fund of Loyola and other sources.

In separate interviews with several parasitologists who read the reports, the most favorable appraisal heard was skepticism as to the results.

Their questions also touched on a seldom-discussed problem in medicine - the procedures by which editors choose independent referees to review the merits of manuscripts submitted to scientific journals.

The researchers reported discovering ''worm-like forms'' in length up to 1.5 millimeters - one-twentieth of an inch - in the blood or tissues of 41 women with a precancerous condition called trophoblastic disease or a cancer called choriocarcinoma; in 35 women with toxemia; and in the umbilical cords of infants delivered of mothers with the condition. It was also found in the blood of 14 of 15 staff personnel and the husbands of four patients. The researchers said it had characteristics of a helminth, a class of parasitical worms that includes hookworms and tapeworms.

In experiments on pregnant beagles, the researchers said, inoculation with the microorganism produced toxemia. The researchers published 21 pictures of various forms of the organism. Most of the parasitologists interviewed said they were astonished at what they saw. To the parasitologists they did not look like organisms at all. They seemed to be fibers or other extraneous bodies. Dr. Marietta Voge, a parasitologist at the University of California at Los Angeles, said ''there is no evidence of living or once-living material in any picture.''

Dr. Paul Beaver of Tulane University in New Orleans, who is widely regarded as the dean of parasitology, said he saw virtually no possibility ''that those things that are illustrated can have any significance whatever with toxemia of pregnancy.''

Objects as long as those described in the articles should be large enough to be seen with the naked eye, according to the parasitologists, who said they were further astonished that the researchers had been unable to isolate them from blood.

Moreover, both Dr. Beaver and Dr. Irving G. Kagan, a parasitologist at the Centers for Disease Control in Atlanta, said nothing as large as the organisms described in the journal articles could circulate in the blood. ''It couldn't pass through the largest capillaries,'' Dr. Kagan said.

The Illinois researchers reported that the new organism cannot be identified with standard chemical stains that bind with RNA and DNA, the genetic fabric of living things. By that definition, the organism does not contain significant amounts of protein, which, the scientists interviewed said, took it out of the realm of parasitology.

''I don't know what it is,'' Dr. Kagan said. ''They may have something very important, but if so it is not a parasite.'' However, he cautioned that there were cases in parasitology in which experts' first impressions proved wrong.

Dr. Brewer said he was aware of the criticisms but that he had shown the specimens ''to at least 10 parasitologists around the country and all have believed it is a real thing, not an artifact.'' They had urged his team to publish so that other groups could try to reproduce the findings, Dr. Brewer said. He added that two independent doctors in different cities in this country had notified the research team that they have identified the organism by using the techniques described in their articles.

However, Dr. Brewer declined to name any of these parasitologists ''because I don't care to.'' Dr. Voge said ''Dr. Brewer should name the parasitologists'' who, in turn, should publicly provide the scientific reasons for the opinions they gave Dr. Brewer. Further, Dr. Voge contended, Dr. Brewer's team should submit its specimens to an expert committee for independent evaluation.

A standard practice among parasitologists is to send specimens to each other through the mails. Candidates for classification as new helminths are usually sent to a reference center at the Agriculture Department in Beltsville, Md.

When asked if he would send such specimens to parasitologists at the Centers for Disease Control and the National Institutes of Health, Dr. Brewer said that in the past he had personally delivered specimens to other researchers but that because he now had so many requests his team would not send microscope slides to any other researcher. He said the team would welcome other scientists to his laboratory to examine the specimens there. Scientists at the Centers for Disease Control said they were considering such a visit.

Several of the parasitologists interviewed expressed concern about the fact that Dr. Brewer is both a co-author of the two papers and editor in chief of the American Journal of Obstetrics and Gynecology. Published in St. Louis, it is the official journal of eight obstetrical and gynecological societies.

In keeping with its standard policy, the journal sent both articles to independent reviewers, whose names Dr. Brewer declined to disclose. It is standard practice for journals to keep confidential the names of its reviewers to protect them from criticism, although reviewers sometimes waive that confidentiality.

In sending manuscripts for review, it is customary for medical journal editors to select specialists in the field of research involved. However, Dr. Brewer said that none of the reviewers was a parasitologist.

Asked if that was not an unusual step, Dr. Brewer said that the unnamed parasitologists who had examined the specimens ''didn't know what it was'' but had said ''it was a real thing, not an artifact.''

Asked about the criticisms, Dr. Brewer said he did not ''blame anyone for doubting'' the findings and that his team was ''wide open for criticism. I don't mind it a bit. That is what research is.''