Approximately 2 million people in the United States are living with limb loss, and this figure is expected to double by 2050. Lower-limb amputation accounts for the vast majority of all amputations, and diabetes—specifically, diabetic foot ulcers (DFUs)—is the leading cause of nontraumatic...
By Ron Sherman MD, MSC, DTM&H and Lynn Wang, BA
William Shakespeare wrote: "That which we call a rose, by any other name, would smell as sweet" (Romeo and Juliet, Act 2, Scene 2). William Baer reportedly said the same thing when asked why he used the name "maggot therapy" to describe the use of fly larvae (maggots) to treat osteomyelitis and soft tissue wounds.
Recently, I was asked by a group at Walter Reed to comment on their selection of an acronym for maggot therapy. I will share my thoughts here because many people have similar concerns, and because—after spending nearly two hours considering this issue—I simply had little time left to research anything else for this month's blog entry.
The most common terms for maggot therapy are: "maggot therapy," "larva (or larval) therapy," "maggot debridement therapy," and "larval debridement therapy." The relative frequency of these terms varies, depending on the context and geographic distribution of the population being surveyed (i.e., scientific literature, internet use, survey of medical personnel). The corresponding acronyms are: MT, LT, MDT and LDT, respectively. "MDT" is now the most common acronym. Several years ago, use of the acronym MDT was confined to North America, with LT or LDT more common in Europe; but MDT is now also most common in Asia and the South Pacific, parts of Africa and the Middle East – all areas with rapidly expanding programs in biosurgery.
The first question I was asked was (and I am paraphrasing, here as elsewhere): Wouldn't "larva therapy" be a better term than maggot therapy, since the proper scientific word for a maggot is larva? Yes, the scientific term is larva, but the term "larva" is not specific; it includes the immature forms not only of flies but also of all other holometabolous (undergoing "complete metamorphosis") insects, as well as the immature stages of many other invertebrates. While the term "maggot" is not scientific, it is much more precise, being reserved only for fly larvae (and maybe one or two people I used to know).
I jumped in with the next question, myself: What is the goal in choosing a name? In 1990, when we started our maggot therapy program at the University of California and the VA Medical Center in Long Beach, California, we gave careful thought to selecting an appropriate acronym. We coined the phrase "maggot debridement therapy” (which gave us the acronym: "MDT") because it met our goals: to avoid repeating the word "maggot" every time we spoke about the treatment, without hiding the fact that maggots were exactly what we were referring to. For us, MDT had a better sound and rhythm than "MT." Besides, 23 years ago we believed maggot therapy was only useful for debridement. (These days, I use the term "maggot therapy" instead of "maggot debridement" when I refer to the treatment of non-necrotic wounds.)
If you look at the origin of the term "larva therapy" both in William Baer's time and in the present day, it is often used not with the intent of optimizing communication or being scientifically accurate, but rather with the intent to obfuscate – to hide the fact that the treatment involves maggots, or at least to avoid the use of the "M-word."
I realize that procedural names can frighten patients. When I was training in Medicine, a new imaging technology was developing: NMR. But the term "NUCLEAR magnetic resonance" scared some patients, so the acronym was eventually changed to "MRI." If the goal is to hide the fact that maggots are being used, then "LT" or "LDT" make sense. But if the goal is to communicate more precisely what the treatment is, then I believe acronyms derived from "maggot therapy" are the better choice. Besides, the secret meaning of “larval therapy” can not be kept hidden for long: by any other name, the sweet smell will still escape.
I have always believed in "calling it as I see it." I believe patients are most likely to get past something if you put it out in the open and let them see it, speak it, and move beyond it. Most people are not able to move beyond something that they keep inside themselves, because it follows them everywhere. If you wish to see people getting over the thought of maggots, then you must demonstrate, by example, that "maggot" is not a dirty word.
So...what term or acronym do you use? More importantly: Why?
About The Author
Ron Sherman MD, MSC, DTM&H has led a long career at the forefront of biotherapy, pioneering the development of medicinal maggots for over 25 years. He is now retired from his faculty position at the University of California, but continues to volunteer as Director and Board Chair of the BTER Foundation, and as Laboratory Director of Monarch Labs.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.