Dear Dr. Shippen – Let me be of assistance. I was on every combination of Lyme appropriate Antibiotics for over TEN YEARS. I had a catheter in my chest getting another series of Antibiotics for over FOUR YEARS. The saga of Lyme disease we all know is clearly an area of contentiousness. However, what I know with certitude is the treatment for most of these heretofore seemingly imponderable chronic conditions in light of emerging breakthroughs in genomics and molecular biology are outdated clinical approaches.
The only thing “dangerous” to me was staying on the dead end Lyme treatment options I was on. Thank God I was open and willing to try and LEARN a far superior approach. Thank God for the internet that has completely change the paradigm. Will more physicians get out of their orthodoxy and catch up to us patients?
PBS/NJN News shot a story about Lyme and the current testing and treatment right in my home. I was on the Front Page of Sunday “The Star Ledger” (the largest paper in the state), in addition to other major media appearances. I know the issue and every treatment option VERY WELL I assure you. Nothing I tried moved my clinical condition and serology even close to the what the MP so dramatically did!
My results are NOT anecdotal. There are websites (MarshallProtocol.com; CureMyTh1.com, and others) with powerful positive (in many cases miraculous) testimony from patients from all over the world. I ask respectfully that you and others please begin to listen – REALLY LISTEN and learn from highly informed patients.
To all in this discussion, I would add the following observations, not withstanding that some members have had some positive experiences with the MP, either under treatment or through significant experience in prescribing it, such as Greg Baney, who I respect in his efforts and search for answers. What those of us that question the elements of the MP object to is the combined elements of the MP without adequate scientific support.
Some facts about the Marshall Protocol (MP):
1. The MP has never been passed by a human experimental committee usually required before human trials are undertaken for new treatments (I have requested this information from several devotees and from Marshall himself and received no confirmation to date), nor has it undergone any controlled studies where various aspects of the protocol could be evaluated. Some patients may have benefitted, but for what reasons in the treatment – antibiotics? ARB effects? Vitamin D restriction? In any case, the treatment may take YEARS to see benefits and may require long periods of adverse (Herxheimer/immune dysregulation) reactions. Many patients cannot get through this initial phase or may never get through it. There is NO data on success/failure rates of those started on this unproven protocol. I have no doubt that some patients have been benefitted from treatment with the MP. My question would be how would they have done with antibiotics alone and would they have done better with additional vitamin D?
2. The MP has several aspects that have potential benefits and potential side effects:
a. Antibiotics used in low doses cyclically or chronically (possibly beneficial as has been demonstrated by Brown and others – possibly negative effects of dysbiosis and antibiotic resistance. The use of various antibiotics such as tetracyclines and plaquenil have been used effectively for year to induce remission in various autoimmune diseases for many years. Is this the major benefit from individuals treated with the MP? I have used this treatment for years with beneficial results that occur much more quickly than those reported by Marshall’s devotees. I have concluded that this aspect is the basis for the major benefits seen in most patients. Many post-lyme patients have seen clear benefits from cyclic, diverse antibiotics in various different “protocols.”
b. ARB with some documented anti-inflammatory effects (PPARgamma) – off label, untested at levels recommended – possibly may reduce inflammatory symptoms through several mechanisms, but potential adverse side effects at the recommended doses (as have been reported by some patients). Other ARBs, promoted by Richie Shoemaker, M. D. have better anti-inflammatory effects.
c. ARBs have not been demonstrated to have specific “activating” or “blocking” effects on VDR. An early publication, Marshall calls it a VDR blocker; another, Marshall calls it a VDR activator. There is NO specific evidence that it has specific VDR activities despite theoretical “modeling” published by Marshall showing potential ARB linkage to VDR structure with NO data on effects.
d. Restriction of all sources of vitamin D including sunlight exposure to the point of inducing overt well established severe deficiency of circulating levels of 25(OH)D3 – there are NO benefits ever demonstrated from this practice and clear adverse effects from sustained deficiency by all vitamin D experts published to date. There is no one other than Marshall’s group that have espoused this unproven theory. There are reports of exacerbation of symptoms in cases of Sarcoidosis with increases in vitamin D when increased 1,25D3 AND hypercalcemia are present. Interestingly, I know of NO patients that have been reported in published data of MP patients that demonstrate hypercalcemia, the hallmark of vitamin D toxicity. Many chronic infections have been shown to inhibit VDR activities that might reduce antimicrobial peptides (AMPs) that help the body fight off various infections. But vitamin D supplementation has been shown to increase AMP production, so why reduce it? Sunlight therapy has been reported for centuries to have specific healing benefits in patients with various chronic diseases, including TB, psoriasis, arthritis and autoimmune diseases and this treatment is available in the Dead Sea in Israel at the present time. This part of the MP doesn’t make common sense and my be detrimental as all studies of vitamin D deficiency have demonstrated. I have reviewed the bibliographies of many of the articles by Marshall and some of his devotees. The only source of published studies that would “support” the MP are articles written by devotees or Marshall himself in a circular bibliography fashion.
e. The discussion of various “steroid” endocrine receptor interactions with vitamin D as a “steroid” is endocrine nonsense. Most hormones have the ability to activate or interact with similar receptors, but the actual hormones have the most effective activities with their specific receptors. To suggest that vitamin D may in some way interfere with other “steroid” receptors is an unproven theory in search of data to support the theory. Most hormones require adequate other supportive hormones for best effects. Correcting demonstrated deficiencies of various hormones, in my experience, has beneficial effects in treatment of all patients (with the possible exception of hormone dependent cancers) and I know Dr. Blaney, who prescribes the MP supports endocrine evaluation and treatment.
Until the MP is subjected to controlled studies, it remains an unproven, (potentially dangerous?) approach to treatment of chronic diseases. Antibiotics may benefit some individuals with various chronic diseases, but the other aspects of the MP require validation before it should be promoted/supported on mmi.
Eugene Shippen, M. D. Private Practice, Shillington, PA
On Jun 20, 2011, at 2:58 PM, Harold Smith wrote:
Veny Musum and Dr. Bransfield.There are not any assumptionns but simply analytical summary of what the referenced web site details: anecdotal means one case, self reported means there is not an independent evaluator, chronic over years is evidence in the web site, and many treatments are utilized is evidenced in the web site and remitting relapsing is stated in parenthesis as my own experience of what the predominant number of chronic illness patients face. Having read extensively about hormones and vitamin D, studied and practiced very practical medicine for over 45 years, having read extensively about the Marshall Protocol, attended Dr. Marshall presentations in which the presentation built extensively and quite illuminating on the work of others in chronic stealth infections while terminating when the audience awaited details of the evidence supporting the MP theories, and the even more in depth critical reviews of its flaws, published about Vitamin D, treated extensively Vitamin D deficient chronic illness patients, etc. , I appreciate your offer to educate me. Please do so with studies outside the cited authors of the Marshall Protocol. From my point of view, go to CALDA web site and read the recent published LymeTimes article by Eugene Shippen MD and Harold Smith MD on Vitamin D in the 2010 publications. If you cannot access the article, I will regular mail you a copy. Although we are the authors, the references are to a multitude of other scientifically based physicians- not ourselves. I cannot find any studies on inducing vitamin D deficiency disease levels or hormone supplementation interfering with nuclear receptors in the immune system that support the confidence expressed in the “latest on the Marshall Protocol” beyond these authors. Scientific questions were presented to the MP and never answered. . There are components of the “latest” that are dangerous to patients- especiallly when an illness renders them desperate and more willing to gamble.. But I look forward to your contribution. When using MMI please include the details submitted in signature to enter MMI membership. I have included Dr. Shippen who may want to comment because I find the “latest” to have statements about hormone supplementation and hormone vitamin D that are generalizations and advice contradictedin the site’s referenced explanations about hormone supplementing This is very old ground for us and he may or may not find reasons to continue what has been a non dialogue before. Harold Smith MD private medical practice Bloomsburg PA
Dr. Smith – You are making a whole series of assumptions about both myself, the MP and the hard science it is grounded in. Are you interested in gaining a more complete understanding?
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