
Battle to wipe out debilitating Guinea worm parasite hits 10 year delay - sohkamyung
https://www.nature.com/articles/d41586-019-02921-w
======
aristophenes
15 or so years ago I was in a remote African town and a local business had a
picture of Gerald Ford up. Perplexed I asked why. The United States, I presume
while Ford was president, had sent aid to build a bridge, some irrigation
canals, and eradicated what he described as a worm that you pull out of your
skin by wrapping it around a pencil and turning, an inch an hour. I guess it
would have been this worm or something similar.

Not a big deal for us, I'm sure hardly anyone outside the area heard of it.
But for the locals it changed their lives, the food they could eat, the
quality of life they could live. I'd say that I wish we did more stuff like
this instead of the geopolitical games, but on another trip I found out that
the majority of the Kenyan governments entire budget is foreign aid. Didn't
_seem_ to be doing much. But I knew some people from the USA who existed on
donations that ran a free school for children, with meals out of a slum. They
were poor in the US, but doing so much good. While the official NGO staff
drove around in $50,000 SUVs to do surveys.

Doing good is hard. Throwing money at something is not enough. It takes
thoughtful, wise people and hard work. But there have been so many people
pulled out of really bad conditions over the last few generations. Many many
unsung heros.

~~~
casefields
We do. Bush and aids: [https://www.history.com/news/what-was-a-george-w-bushs-
great...](https://www.history.com/news/what-was-a-george-w-bushs-greatest-
achievement)

------
refurb
_reduced the number of new infections from 3.5 million per year in 1986 to
just 28 in 2018_

Jesus! They need to stop being so hard on themselves. That remarkable
progress!

~~~
jessriedel
Yea, I sort of wonder how important it is to actually eradicate it. Like, how
much would it cost to achieve eradication (given the new knowledge of dog
transmission) vs. maintaining the current extraordinarily low infection rate
indefinitely? Is the latter (on-going) cost cheaper than the interest on the
former (one-time) cost? I'm sure this econ analysis has been done, but
articles like these rarely mention it.

~~~
tialaramex
Eradication of Guinea Worm means no more Guinea Worm. Zero ongoing cost for
all subsequent time.

This is actually more substantive than for Smallpox because Smallpox is
deliberately stored in a lab in case it is interesting (supposedly for
defensive research, in practice for weaponisation) and so invariably every
decade or four it'll leak. Guinea Worm isn't suitable for that, when they
eradicate it that's the end of the parasite forever.

This is an infinite benefit. So to model that without getting nonsense out you
have to use a discounting model where you arbitrarily consider infinite future
value to not be worth more than, say, 10 billion dollars, and there's your
answer. But that's a paper exercise, why bother? You could choose values that
say a trillion dollars or $9.99.

~~~
vidarh
> This is an infinite benefit. So to model that without getting nonsense out
> you have to use a discounting model where you arbitrarily consider infinite
> future value to not be worth more than, say, 10 billion dollars, and there's
> your answer. But that's a paper exercise, why bother? You could choose
> values that say a trillion dollars or $9.99.

It's really not that arbitrary. There are many ways of valuing this, sure.
Here's a fairly straightforward one:

Say it costs you A per year to maintain current levels, and the yearly cost of
capital to eradicate is X amount of capital * y% yearly cost per year (e.g. if
you borrow X at y% interest, or if you have X but sacrifice y% returns by
spending the money instead of investing it), and the lowest viable cost to
save at least as many lives as the infection currently claims is B, then it's
a question of whether A+B or X*y% is lower. Whichever is lower will allow you
to divert more funds to other targets, and so save more lives (or do something
else). Of course there are risks here, in that any of the variables can
change, so if they're close it may be worth it to eradicate simply to
eliminate the risks that the alternatives get more expensive going forwards.

But this is not a very hard thing to model. The reason we don't do that more
often is that often there are many other factors involved, such as politics
and emotions and who fights hardest to get funded.

~~~
gibba999
... only it doesn't work.

Those models work very well on a short-term timescale. We have major upheavals
every few hundred years. At that point, the fiat money in the bank account
disappears. Once eradicated, the worm doesn't come back.

~~~
sbierwagen
You seem distracted by the use of the word “dollars”. No need to be so
literal, they’re just using them as an abstract unit of value. It can be
replaced with milligrams of gold or Satoshis without loss of meaning.

~~~
gibba999
It can. And that gold sits around until the Germanic tribes invade Rome and
take it all. Major upheavals affect all systems.

------
pvaldes
An interesting experience from this history is showing how parasites jump in
zero seconds to a handful of other species when its main host is unavoidable.

We were repeatedly guaranteed for years than Guinea worms were exclusive from
humans. Thus wiping it would not affect any other species, and could be
protected only if some humans would agree to suffer the parasite in their
bodies, that is a gross price. Now we know that this was incorrect. Plain
false, and nobody see it.

The species is linked with other mammals, could be saved from extinction and
is not different to a hundred thousand species of other parasites in the
planet.

To decide to wipe an animal just because is ugly and unsentient is a deeply
wrong path and a pandora box. Treating the drinking water would suffice to
prevent most cases in human patients.

A similar problem could easily happen if we mess with mosquitoes without a
full, extensive, complete, knowledge of what we are doing and asuming the
consequences of it.

~~~
mantap
I find this incomprehensible. It's a disease. What does it matter if it is
bacteria, eukaryote or virus? Medicine involves killing things that interfere
with us and hopefully eradicating them completely.

The whole "mosquito extinction" fears are really overblown. Nobody is
proposing to eradicate all species of mosquito - only the ones that carry
malaria. And the normal system of eradication (removing standing water) is
much _more_ invasive than the proposed method of genetic engineering.

~~~
pvaldes
Not, is not a disease, is an animal.

An animal that can cause a non lethal and treatable disease in part of its
life cicle, and is linked with copepods, frogs and fishes, dogs, baboons and
humans.

There is a simple solution in two steps to avoid being infected with guinea
worms:

1) _don 't drink copepods_. Provide african people living in the same
distribution area as this animal with a modern system of water purification;
or teach them to boil the water before drink it, so they will not eat alive
water fleas that carry the larvae. Simply filter the water trough a cloth
before drinking would be enough to protect you from this parasite (but will
not protect against other problems so boiled water technique is much more
safe). If not, use chemicals to treat drinking water.

and 2) people _infected by the parasite should avoid to bath in drinking water
or put their wounded feet in drinking water_.

Life cycle stopped and end of the problem in the same year with the magic of
parasitology

Why we sould not run to extinct entire species?

We don't know where hides the next cure for cancer, the next cool matherial
for engineery or the next modern generations of painkillers. Parasites had
helped in the past with some of our problems and could hold the key to a
treasure of solutions to our present and future problems.

Even if not, to randomly remove pieces of a machine could lead to unexpected
consequences. This animal is the result of million years of evolution and when
is gone, is gone forever. If we find in the future that some of those
consequences are undesirable, the machine is beyond repair.

~~~
snagglegaggle
It's as easy as those two steps, but in most of Africa those two steps are not
easy. Read the article: for the people in Africa affected by the worm the
disease is so debilitating they are unable to grow food or continue their
education. This parasite ruins lives.

>Why we sould not run to extinct entire species? We don't know where hides the
next cure for cancer,

This is like trying to argue against abortion because any given baby could be
the next Einstein. Sure, but any given baby could also be the next Hitler...
and both statements aren't even wrong
([https://en.wikipedia.org/wiki/Not_even_wrong](https://en.wikipedia.org/wiki/Not_even_wrong)).

Whatever ill effects of the guinea worm's extinction can be overcome. If they
can't, we were all probably going to die anyway.

~~~
pvaldes
I'm reasonably sure that we will not find a tiny hitler inside the packets of
6 guinea worms, but if is really there, we could choose just not follow it

The "not even wrong" argument is incorrectly applied here. We are not talking
of filosophy, this is biology so the idea that parasites can be useful is
perfectly falsifiable. We can just do more research and find if something in
this animal is useful (nothing prevent us to do this because, well... is not
extinct).

We have many examples of parasites doing useful things before and the "99%" of
species are still really poorly known, so that wouldn't be an impossible
scenery.

Here is another humble and useless roundworm that fortunately nobody decided
to extinct before 1960's:

[https://en.wikipedia.org/wiki/Caenorhabditis_elegans](https://en.wikipedia.org/wiki/Caenorhabditis_elegans)

From living in mudville streets to became a space survivor and genetic
rockstar. Not bad

[http://news.bbc.co.uk/2/hi/science/nature/2992123.stm](http://news.bbc.co.uk/2/hi/science/nature/2992123.stm)

~~~
snagglegaggle
Look: Your ideas are misguided and dangerous. Read the article to see the
effects of the guinea worm. The parasite ruins lives.

The "not even wrong" was applied appropriately as the statement "there is some
good to be had from keeping the guinea worm" is potentially true but
_practically_ unverifiable and is part of an argument whose goalposts can be
moved easily and indefinitely, and are already so far away as to be
unassailable.

There is some value to biodiversity and its study and there are likely
parasites that are beneath our radar but that this _specific one_ can be
isolated and studied and has recorded negative effects on humanity is enough
to destroy it.

>I'm reasonably sure that we will not find a tiny hitler inside the packets of
6 guinea worms, but if is really there, we could choose just not follow it

Maybe studying the DNA of the guinea worm leads researchers to a breakthrough
in targeting retroviruses at vulnerable human subpopulations and genocide is
committed because we didn't exterminate it!

See? You don't know that won't happen!

~~~
pvaldes
> Your ideas are misguided and dangerous.

Torches and pitchforks at this hour of the nigth? ok I'll start running.

Well... Or maybe yours are wrong. At least you grant that biodiversity has
"some" value. If we start wipping species just by caprice, there will be
easier to extinguish the next. Is a slippery slope, and we will shoot
ourselves in the face at some point with some serious and totally unexpected
cascade of consequences. It has happened before. It happens _all the time_.

> the parasite ruins lives

For a year or less. Is a nuissance, for sure, but people can fully recover
from it to enjoy the rest of their lives. Can be easily avoided with just a
bucket and a piece of cloth and there is not any reason to let the people with
the parasite walk for the water when a bucket is enough to alleviate their
feet.

Poliomyelitis ruin lifes, this... hem, not normally.

~~~
snagglegaggle
Alright, we've gone full circle. You're just repeating how super simple it is
to avoid infection (it's not, otherwise no one would have guinea worm and it'd
already be extinct!) and minimizing the impact this has on people's lives
without actually addressing anything I've brought up.

~~~
pvaldes
Wouldn't be my intention to minimize the impact it has currently over the
lifes of 30 people each year in the entire planet, but you must admit that
among 7700000000 humans (0.0000000039 % of humanity affected by Guinea worm)
is not a high number.

With zero people dead by this animal in the last years, does not feel like its
extinction would be an urgent problem to adress.

If we wipe it, what would prevent somebody tomorrow to ask for the extinction
of the much more dangerous sharks?, or tigers, polar bears, scary spiders, and
dogs of course (dogs kill lots of people each year, maybe we should wipe
them), or pretty much anything alive that could cause allergies to some
people, or that could be seen by somebody as disgusting or ugly.

Economic resources are limited and we have worse problems that are not being
adressed.

------
pvaldes
As a counterpoint, it must be said that more than half of the life beings in
the planet are parasites of other species. Wiping all of them would be a
disaster for biodiversity conservation and a direct danger for humans.

First, would make the populations of all agricultural plagues explode,
populations of rats would increase also even more (but rodents would be much
safer for humans). That would lead to choose between famine or free buffet of
pesticides for all of us: breakfast, lunch and dinner. Second would have a
profound impact on the development of our inmune system leading to people
suffering a cascade of nasty autoinmune diseases.

Parasites can have other benefits. Some clean the body of the host storing its
heavy metals; other enter in open wounds and then feed on bacteria, releasing
painkillers and substances that arre known to accelerate the healing of
wounds. This avoid innecessary mutilations. The fine microsurgery made by some
flies has been still not achieved by modern medicine and has saved lots of
human lifes in the past wars.

The reason for the disparition of many cases of guinea worm is wiping entire
freshwater ecosystems

~~~
dawg-
I thought the official definition of a parasite was an organism that benefits
itself at the expense of the host? If the host gains from the relationship it
would be called something else entirely. In that case, I think your statement
that half of life on the planet are parasites is not really accurate...

~~~
pvaldes
The real number is unknown, because parasites are shared often among different
hosts, but could be much higher in fact.

Each species of free living animal known have at least one parasite, hosting
20 different species is not uncommon. Humans have several thousands just in
the Platyhelminths group. Each plant known have at least two or three
parasitic fungus. All known viruses except virulent bacteriophages are
parasites, and is expected that most unknown viruses will be parasites also
(we only had studied a small percentage of the extant viruses and there are
serious estimates that calculate over 100 millions). Many bacterias also are
parasites. Lots of fungus are parasites of animals also. And parasites have
its own parasites.

