
Treating children for worms yields long-term benefits, says new study - elsewhen
https://news.berkeley.edu/2020/08/03/treating-children-for-worms-yields-long-term-benefits-says-new-study/
======
nabla9
Parasite 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...](https://royalsocietypublishing.org/doi/abs/10.1098/rspb.2010.0973)

~~~
SomeoneFromCA
From 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
It 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
I 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.

~~~
learnstats2
The problem with saying it, is even if you mean IQ is academically the average
result on a particular test design, people understand it in common English to
mean something more like 'value as a member of society'.

~~~
SomeoneFromCA
Science should not be concerned with the interpretation of its discoveries.

~~~
AlotOfReading
Interpretation is an inseparable part of science. Take the issue of race for
example. People since the 30s have repeatedly pointed out that there's no
consistent biological basis for race. The concept is just flat out not
biologically rooted. Yet scientists kept using it because it was convenient
and they came from a worldview where race was very much a reality. Thus
studies were (and continue to be) done on the basis of biological racial
categories.

~~~
SomeoneFromCA
Not sure about races, but one can certainly tell the difference between
ethnicities; I can tell apart a Russian and an Armenian for example, with more
than 75% success rate. Therefore there certainly is difference between people
in different geographic areas. If people have differences in their outer
appearances, there might be differences (not very large, obviously) in the way
their neural systems work;denying that, IMO is a very ideological position.

~~~
AlotOfReading
It's the consensus of the vast majority of relevant professionals that "humans
cannot be divided into biologically distinct categories", i.e. races. That
quote comes from the ASHG [1], but another relevant field is anthropology
where again, the largest professional organization (the AAAS) says the same
thing [2]. The AAPA concurs [3]. If you think these associations might be a
little biased, someone published a national survey of anthropologists a couple
years ago confirming these views [4].

Some technical caveats: So yes, on some level you can approximately group sets
of people into things roughly matching modern broad racial categories on the
basis of genetics. This isn't because of anything real (i.e. there's nothing
all members of a group share that doesn't exist "outside" them), but simply
because you can broadly categorize any large set of things, regardless of
whether those categories are actualized. Race as a social construct (e.g.
identifying someone as "black" or "caucasian") is absolutely, undeniably a
thing. It's simply not reflecting an underlying biological reality. There are
also people in the community who argue that even if racial categories aren't
biologically actualized, they're still useful (or that the definition I gave
previously doesn't apply), but that's a much more complicated matter for which
entire libraries' worth of debate exist.

[1]
[https://www.cell.com/ajhg/fulltext/S0002-9297(18)30363-X](https://www.cell.com/ajhg/fulltext/S0002-9297\(18\)30363-X)
[2]
[https://www.americananthro.org/ConnectWithAAA/Content.aspx?I...](https://www.americananthro.org/ConnectWithAAA/Content.aspx?ItemNumber=2583)
[3] [https://physanth.org/about/position-statements/aapa-
statemen...](https://physanth.org/about/position-statements/aapa-statement-
race-and-racism-2019/) [4]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299519/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299519/)

------
setgree
At 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-h...](https://statmodeling.stat.columbia.edu/2015/08/18/macartan-
humphreys-on-the-worm-wars/)

~~~
jessaustin
Presumably 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.

~~~
triceratops
How do you spend so little? My dog's monthly heartworm medicine alone costs
$5/dose.

~~~
Shog9
Dog 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
I’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
Please 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
please 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.

~~~
wizzwizz4
The “offended” would be “sometimes, I dismiss” – there's no way to re-word
that to be less offensive (even though it isn't _particularly_ offensive, I
wouldn't think) without omitting it entirely.

------
thesz
Deworming 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
When 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.

------
valuearb
If 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-
so...](https://www.pbs.org/wgbh/nova/article/how-a-worm-gave-the-south-a-bad-
name/)

~~~
anonAndOn
>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-
low...](https://www.theguardian.com/us-news/2017/sep/05/hookworm-lowndes-
county-alabama-water-waste-treatment-poverty)

~~~
giardini
anonAndOn 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-
hea...](https://www.nhs.uk/news/heart-and-lungs/are-worms-key-to-health/)

------
supernova87a
I 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-...](https://www.nytimes.com/2020/07/10/business/social-programs-
profit.html)

~~~
Viliam1234
Some educational programs have excellent results in short term, but the effect
disappears in long term. For example, do some extra activities with kids
during the first grade, and they will have measurably better outcomes in the
second grade, but will be indistinguishable from their peers by the fifth
grade.

~~~
Waterluvian
Education is a ball being rolled up a hill. It’s not a bucket being filled
with water.

Super oversimplified but I’ve found it tells the general story: you can’t just
come back to it later and expect to find the same progress. Constant
nurturing, whether from yourself or a caregiver or an education system, is
what has an impact. And I believe this is true for almost any age.

------
civilian
Hasn'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
Givewell 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...](https://blog.givewell.org/2016/12/06/why-i-mostly-believe-in-worms/)

~~~
civilian
mea culpa! That's fascinating, thanks for the link.

------
jdc
There is a charity doing this I learned about through GiveWell.

[https://www.evidenceaction.org/dewormtheworld-2/](https://www.evidenceaction.org/dewormtheworld-2/)

------
yourkin
Does 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/)

------
ferros
How common are worms in western societies?

~~~
pieceofcakedude
Extremely... 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.

~~~
DelightOne
Can you just take meds for every worm there is or how do you know what kind of
worms to test for?

------
rihegher
And probably side effects as asthma and allergy

[https://www.nhs.uk/news/heart-and-lungs/are-worms-key-to-
hea...](https://www.nhs.uk/news/heart-and-lungs/are-worms-key-to-health/)

~~~
ce4
Old K5 article on hayfever/asthma self medication using hookworms:

[https://web.archive.org/web/20080108063512/kuro5hin.org/stor...](https://web.archive.org/web/20080108063512/kuro5hin.org/story/2006/4/30/91945/8971)

------
hutzlibu
It 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
Is 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.

------
peter_retief
The 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.

~~~
doukdouk
In 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-
econom...](http://emiguel.econ.berkeley.edu/research/twenty-year-economic-
impacts-of-deworming)

~~~
peter_retief
There 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
All 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
My problem is how do you run a randomized trial with something as common as a
deworming pill that is handed out in clinics by nurses and can be bought over
the counter? I am just curious.

~~~
doukdouk
I don't see how that would be a problem: even if it was common, handing out
pill to one group but not the other would still lead to one group being more
"dewormed" than the other, all others things being equal.

Anyway, in this case, I do not believe deworming was as common as you assume:

> Baseline parasitological surveys indicated that helminth infection rates
> were over 90%, and over a third had a moderate-heavy infection according to
> a modified WHO infection criteria (Miguel and Kremer 2004)

> Drug take-up rates were high, at approximately 75% in the treatment group,
> and under 5% in the control group (Miguel and Kremer 2004).

5% of the population taking the drug when >90% should means the drug is not
"common".

~~~
peter_retief
In South Africa it has always been the default to deworm all children. In
schools, clinics. [https://www.sanews.gov.za/south-africa/government-
launches-d...](https://www.sanews.gov.za/south-africa/government-launches-
deworming-programme-learners)

~~~
doukdouk
This trial was done in Kenya, not South Africa.

~~~
peter_retief
I know that, I was relating my own experience of African healthcare since I
live in South Africa. Kenya is not that different I imagine.

------
markdown
I 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
There 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
Ivermectin is known to have a negative impact on biodiversity:
[https://www.sciencedirect.com/science/article/abs/pii/S00489...](https://www.sciencedirect.com/science/article/abs/pii/S0048969717330498)

~~~
bigphishy
Consider the fact that it obliterates any and all invertebrate it encounters,
of course that is going to lower lower biodiversity.

------
dacodanelson
Must 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?

~~~
doukdouk
My 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.

