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donderdag 22 maart 2012

Spontaneous remission is a myth

The chronic inflammatory diseases treated by the Marshall Protocol (MP) never go away on their own. It’s not that patients with Th1 disease can’t and won’t go through periods where they might feel better. Unfortunately, these periods are usually a sign that the immune system has become severely compromised.

Whether temporary “remission” is driven by immunosuppressive drugs like corticosteroids, a high intake of vitamin D, excessive sun exposure, or simply the accumulation of a bacterial load that is so high that the VDR is almost completely shut down by bacterial ligands – these periods are times when the Th1 pathogens are alive and well, spreading, and surely infecting other tissues. This unchecked infection leads to illnesses that will only be discovered later in life such as arthritis, heart disease, decreasing kidney function, diabetes, cancer and even the diseases of aging. But during the “remission period,” when the immune system is not capable of killing the pathogens, there is no corresponding inflammatory response that would be occurring if the body was mounting a defense against the infection. This causes the patient to feel a sense of temporary relief during immune suppression that is often mistaken for “wellness.”

Relapsing/remitting nature of infection

One of the important factors in why symptoms of illness relapses and remits is that infections relapse and remit. For example, Staphylococcus aureus is a major human pathogen which plays a role in deep tissue infections, osteomyelitis, and chronic lung infections. A key characteristic of these infections is that relapses can occur months or years after an apparent cure. These relapses, Dr. Bettina Löffler and her team from the Institut für Medizinische Mikrobiologie in Münster, Germany, believe are due to phenotype switching, a change in the bacterial behaviour. After infection and invasion of the patient's host cells, the bacteria form small colony variants (SCVs), tiny bacterial subpopulations that can evade the immune system as well as many antibiotics and grow slowly. 21268281

Microbes ability to easily switch between forms explains both their persistence and the variability in patients' symptom presentation from one time point to another.

Research with insufficient follow up

As it happens, members of the medical community who put credence in spontaneous remission tend to base their information on studies that are notoriously poor at following subjects for long periods of time – periods of time that would allow researchers to take note of the declines that occur after bacteria have spread and any temporary periods of palliation have subsided. These studies would have to last for at least 5-10 years, with endpoints assessing systemic illness. Such studies would surely find that disease symptoms persist even in those people who had once experienced temporary periods of relief.

There has somehow been a misconception that remission could last a lifetime. In reality, remission is accompanied by recurrence and relapses.

Trevor Marshall, PhD


Researchers at Jefferson Medical Center in Philadelphia found a 74% relapse rate in sarcoidosis patients with treatment-induced remission, while only 60% of patients identified as having a favorable prognosis actually sustained remission over 130 months.1

Many argue that the most accurate study of sarcoidosis to date is the 2003 NIH ACCESS study, which followed 215 sarcoidosis patients for two years - a period during which it is sometimes mistakenly thought that the disease can go into remission. The study found that measures of sarcoidosis severity remained unchanged over the two-year period, despite the fact that many patients were using corticosteroids and other drugs.

In fact, in the NIH ACCESS study there were no documented cases of spontaneous remission. Even in the positive-sounding “improved” category for clinical markers, the percentages described were at best “improved”, not “substantially better” and certainly not “cured.” An indication of lack of substantial improvement in the improved group is the fact that there were essentially no change in use of corticosteroid therapy during the two year period. The study also concluded that most patients with persistent sarcoidosis at two years were “unlikely to have resolution of the illness” and that “end-stage pulmonary sarcoidosis usually develops over one or two decades.”

In simple terms, the study found that not one patient recovered over a two year period, and that any patient to remain ill with sarcoidosis for two years is likely to die from the disease over the following ten to twenty years.

What is cure?

It has also been argued that there is a gap between how patients themselves and members of the medical community perceive success and improvement, as well as their concept of cure. The medical community has a tendency to be satisfied by results that show a patient has stabilized thanks to a particular medication, without taking into account systemic effects of disease, such as fatigue and pain, which are often excluded as endpoints.

A 2005 article on gene therapy described patients who had undergone treatment as “basically cured” – even though three had developed leukemia and one died.

The above example is a misuse of the word “cure.” For one thing, an actual cure results from a treatment that allows all participants to become well, no side effects or long-term harm included. Did the above study check in with its subjects a decade down the road in order to access their health years later? Probably not. But if they did, the subjects were probably symptomatic again, as gene therapy has not yet been adopted as an effective way to treat disease.

The public often isn’t satisfied with the medical community’s perception of a “cure,” which is why so many patients have left mainstream medicine – searching for solutions among doctors that practice alternative medicine or even among psychotherapists.

Unfortunately, for chronically ill patients, commercial culture and the media have combined to progressively define down what “better” means—so much so that assessing the significance of any new “breakthrough” becomes difficult, at best.

How is the Marshall Protocol different?

The MP is different. It is an attempt to address the underlying cause of Th1 disease – the bacteria causing symptoms in the first place. And unless these bacteria are targeted and killed, Th1 diseases do not go away. Indeed, if they went away on their own, why would there be hundreds of forums on the Internet where people with chronic disease discuss what it’s like to live a life full of relapses and pain?

Notes and comments
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1. Gottlieb JE, Israel HL, Steiner RM, Triolo J, Patrick H Outcome in sarcoidosis. The relationship of relapse to corticosteroid therapy. Chest. 1997;111:623-31.

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