Sawbones: A Marital Tour of Misguided Medicine - The Parasite Delusion

Episode Date: May 25, 2021

Last week, we talked about if eating papaya seeds could rid your body of parasites (spoiler: it can’t). But being concerned about having parasites is not new. We continue the conversation by looking into the phenomenon of Ekbom’s syndrome, or delusional parasitosis, a difficult disorder to both manage and treat.Music: "Medicines" by The Taxpayers

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, what's wrong with you? It's books! One, two, one, two, three, four!

Hello everybody and welcome to Saabon's Marital Tour of Miscite of Medicine. I'm your co-host, Justin McElroy. And I'm Sydney McElroy. Right. Right? Yeah. Feeling good. Happy?

Feeling good. Feeling Friday. Got that sun outside. Yeah, this warm weather is. Yes. Energizing. Got my day, got my sea. That's coffee. I'm growing plants outside again.

Yeah, you said they're starting to perk up a little bit. I know, I was so worried. I was so worried my herbs were not responding well at the beginning of the season. And I thought there was the frost where I didn't get them in. Oh. And they got snowed on.

Oh, I thought they were done for. But they're growing again. So all is what, they just had to chill for I don't know. If you think you would be I don't know anything about that. You might be thinking oh man I love to hear sin into a gardening podcast and that'd be so relaxing. Let me simulate the experience for you They're never gonna grow. It's never growing. It's never gonna grow. I enjoyed this so much last last year It's never growing. They're all dead. I'm a failure every day. And then eventually they perk up. They're growing really well.

And I'm very happy. It's much more relaxing episode. Firenice. Firenice. Firenice. That's life with me. What are we talking about this week, Sid? Justin, kind of building off of last week's episode,

where we talked about the TikTok trend of eating papaya seeds to rid yourself of parasites that most likely aren't there. And also, it's probably ineffective. We mentioned that there is this sort of kind of, I don't want to say it's a common belief, but it is definitely something that you find out there in the internet of a fear that you have parasites and a lot of people who are willing to build off that fear by selling you products related to that or whatever or just or just knowledge like a lot of it isn't even here's some pills. It's just join our community and we'll tell you some weird stuff you can eat at home. Yeah. A lot of it built on the idea that like Dr. Sly and there's conspiracy and all that kind of stuff.

Sure. And we mentioned briefly delusional parasitosis, which is the fixed belief that you were infested with some sort of parasite worm bug something, but it is not actually physically there. Which is like weirdly, I don't know, maybe I'm a layman, so I might have a skewed perspective of this because I'm just drawing on the experience of hearing you talk about your studies. But it seems like all the delusions one could have in the entire world, it seems like strangely common. You know what I mean?

Like it's a strength, it's like specifically like this is one that pops up a lot, which is considering it's a delusion, it's weird, right? Like you wouldn't think that it would just be like, there'd be a common theme. It is, it is really interesting because you can see, and I should say, I have a little bit more experience with this than probably your average family doctor, just because I did extra training in my career in tropical medicine and global health, and I've taken some extra courses in parasitology and that kind of thing. So when you do that sort of

medicine, sometimes these patients who have this condition can find you. And I was found by multiple people who were hoping that with my credentials and expertise, I might be able to find the parasite that they were convinced that they had. So I have cared for people with this and I can attest to how whatever your feelings are about if there is a parasite or not. It is a very difficult disorder for the person who has it. It's very challenging to treat if you're trying to help someone with it. It can really take over someone's life. It can't imagine that sense of always being invaded, always being something going on in your body against your will. It must be very troubling.

And it can be part of this, can be one feature of other psychiatric diagnoses. You know, you have an underlying psychiatric condition. And part of that is this delusion, along with maybe some other delusions or hallucinations or things like that. But what I really want to focus on is what is also known as ECBOMS syndrome, which is just the isolated delusion that you are infested with parasites, just that, that fixed. And by delusion, I mean a fixed belief that is not factual. So it is not something that we could just talk you out of.

It is very firmly implanted in your brain. This is something that is true. So it is named for the Swedish neurologist Carl Axel Ekbaum, who actually he is best known, which this is where you may have heard of, Dr. Ekbaum. Where I, a cop. We're just a... A William. ...may have heard of him.

No, but he's best known for his description of restless leg syndrome. Okay. You've heard of that? Sure, yeah, yeah, yeah. That Ekbaum also is credited with being the primary physician to describe that condition and kind of the underlying, like what it is. In fact, sometimes Rastas Leg Syndrome is called Willis Ekbom Syndrome, although I've never heard anybody say that.

Okay. So I love that comment. Yeah, but it can be known as a... Somebody says that's a way. Somebody who wonder why you've just related. Right. You might hear it call this. You won't.

Well, it's actually important to why it really does matter. I promise. I mean, kind of tangentially it explains something matter to Willis. Remember Willis is a writer's that can't. It's interesting that I was reading about this. There aren't a lot of, I guess, eponyms, specifically in psychiatry. And so it's weird that this guy gets to, and Bob got a couple of them. Not that Russell Sagan syndrome is a psychiatric disorder. It's neurologic.

But anyway, the point is, he got a couple eponyms. However, he did not call it ECBOM syndrome. He was not that kind of guy. He called it Dermata-Zoen-Won, Dermata-Zoen-Won, which literally translates to skin animal delusion or delusional parasitosis would be the English that we would take from that. He didn't name it after himself. That came later. In this disorder, people are laboring under this fixed delusion that they have been infested with something. He dubbed what he would call the pathonomonic feature. Pathonomonic means like the hallmark of something. If you see this, it is almost always indicative of this disorder, right?

This symptom or sign. He said the path in a monot feature is the quote, matchbox sign. You mean, he guesses what the matchbox sign would be? The sign that why would he call it? What is it? Ignites it that strikes up against it and sets it aflame. He called the matchbox sign is when a patient brings you something to investigate, to look at closer.

And back then, it would usually be carried in something like a matchbox because they're usually tiny like flex of things, particles, pieces. That name has changed over time because not a lot of people bring me matchboxes anymore. Is it a ziplock bag sign or a Tupperware sign? I'm sure both of those brands are super, to be a ziplock. But the idea is that it was very common for sufferers of this condition to collect bits of things

from their body, put them in something like a matchbox and bring them to the doctor so that they could look at them under the microscope and see what this was that they had been infested with. Because so these patients all experienced a sensation of formication. Formication. Formication. Formication. That is the sensation that like bugs are crawling under your skin.

And so it can be like an itching, a crawling, that whole sensation. You may have experienced it. Most of us have for some reason it's something. And because they were experiencing that sensation, the patients would often damage their own skin through scratching, picking, trying to remove the insects. So a lot of these patients would present

with the sensation of bugs crawling, the fixed belief that they had some sort of parasite, and then also a lot of skin wounds from self injury, basically trying to remove the parasites. After his initial case series, and I'm going to get into some of the things that he wrote about in his first publication, which he published in 1938, and everybody sort of became aware of this. That is when it got the name, Ekbaum Syndrome. But because Restless Leg Syndrome was also connected to Ekbaum, there was a lot of confusion. That is why that matters.

So eventually they dropped Ekbaum Syndrome for delusional paracetosis and just thought a delusional paracetosis. In ECBOM's work, he talks about previous case reports of this phenomenon. So there had been prior to 1938, scattered writings from different doctors here and there about like, hey, I had a patient, they had this thing. Here's what I did, that kind of thing. But it had not been sort of united cohesively under one condition described. And that's what you do, like, especially back then,

when we were still trying to understand all these different diagnoses, you would need some sort of, like, paper, like landmark paper that would take the time to collect all of the available information about that condition and united under one sort of theory. Does that make sense? And that's what he's doing in this case series that he published.

The thought had been up to that point in these isolated cases that it was a psychiatric condition, that there was nothing actually happening physically in the patient's skin. It was, you know, something with the brain. One doctor claimed to have treated it successfully with just psych, yeah, like psychoanalysis. Like he talked the patient out of it.

A couple other doctors had claimed that opium fixed it. As it does for sex. Ekbaum decided that he was going to, he worked first in a neurology clinic and then later in a psychiatric hospital. And so he saw patients with this and he decided to kind of form his own opinion based on cases he was personally caring for. In all of the cases he talks about in the paper, which I read, it's available online if

you're interested to read his original work. In each case, there are some things that are all in common. Okay. Everybody thinks that somehow a bug got to them and invaded them. A bug, a worm, a parasite, something. It either came from another person. There was one case of like they had borders in their house and someone had stayed in their house that they thought was sick and then they found something in the sheets later and they thought, okay, that's how it got in me. They had to sleep in like an unclean apartment.

There was one that they thought their apartment was very damp and that that was why they got it. Or they held some object that turned out to be infested. Sometimes people would say they were outside and brushed against something, felt the immediate singing sensation and bam, there you go. Everybody had sort of like a very fixed story as to when and how. Traumatic usually are just sort of benign. Usually just benign every day kind of happened.

And then they obviously believed that they had been invaded at that point. It would start with that sort of sensation and then build into the finding of the parasite, finding of the bugs. So first you have the sensation and then you start finding them either. You're seeing worms,, finding of the bugs. So first you have the sensation, and then you start finding them either. You're seeing worms, you're seeing small bugs. Sometimes they would be described as like little white globular kind of things.

Sometimes they were black or brown or crusty. Sometimes like literally big round worms. I saw come out of me, whether it be in my stool or I cough them up or vomited them up or I dug them out of my skin, all of these things. Many patients insisted this was a brand new organism, science didn't know about it, doctors didn't know about it, that's why they were having so much trouble. Getting somebody to figure it out is because they had discovered something that no one

ever had before. That was pretty common. All of them had some sort of itching or discomfort, right? We have a bunch of fine tools back then for looking for this kind of stuff too. So it makes more sense that something could escape our perception. And it was in, you know, we're still sort of constantly making these discoveries at this point. Sure. So it fit with that.

And then they had all taken measures to remove these parasites somehow, either by one patient burned her skin with matches to kill them and remove them. Others would just scratch with their fingers or like a kitchen spoon, some sort of object, apply caustic substances to their skin, like a lot of them would bleach or something like that to try to kill them. They all suffered from wounds related to their treatments.

And all were completely, completely convinced of this. There was no talking the patients that he saw out of this delusion. Now what's interesting is unlike his predecessors who felt that this was purely a psychiatric condition, he sort of was of the, the opinion that while it is not a parasite, he did not feel in any way. He never was able to find any sort of parasite on them through any of his, you know, he would look under a microscope at all the things they would bring in and nothing was ever a parasite. But he did feel that there was some sort of sensation that they were truly experiencing, that that whatever it is, itching, crawling, burning sensation was absolutely real, and they were misinterpreting it.

So not completely neurological or psychiatric? Yes, not completely psychiatric. Now, he did say though that what is interesting, what he said is, you know, if you did have like itching that you couldn't control, most people probably would not believe it to be an infestation of a parasite, or if they did think they had a parasite, if they went to the doctor, the doctor checked them out

and did these tests and all this and then said no, it's not a parasite, he felt that most patients would say, okay, I accept that as the truth. So there is something different about these patients who are convinced, despite medical that as the truth. So there is something different about these patients who are convinced despite medical evidence to the contrary, right? Like that is different. They're willing to hold on to that belief despite all of this to the contrary.

But he says at the end of his paper, you know, treatment is still kind of a mystery. He found that opium was not routinely helpful. He tried things like bromide and phenobarbital, which he didn't feel helped much. One patient said the opium, by the way, made the bugs calmer, so the sensations were less because it chilled them out, but they were still there. Topical, like itch relief creams, basically, to start with somewhat helpful, like for the symptoms to patients, but it didn't do anything for the belief that they had a parasite. One patient was helped by moving to a new apartment because they felt like it was not infested. So that helped them a great deal. And over the years, since this description, the disease, despite ECBOMS sort of assertion that, like, I do think there is something maybe that we

don't know about in their skin that's causing itching or in their brain or in their nerves or something that's causing itching under along with the psychiatric component. It was largely seen as a psychiatric condition. There are other causes for the sensation of itching, but basically this fixed belief is psychiatric in nature. There are some cases that we would eventually discover were associated with like amphetamine use. This is a common side effect of people who use methamphetamines, especially if you're

abusing methamphetamine type of side. So does something you see depicted in pop culture a lot? Like somebody who is afflicted like that, like scratching themselves and you're trying to claw at themselves. Well, and it is that sensation. So they experience that sensation and so they can scratch or pick up their skin because of that sensation, trying to relieve it, and they may develop a belief as well that they

have some sort of parasite in their skin. And I have seen that too. Although it is not necessarily as fixed because in a lot of those patients, if they stop using methamphetamines Eventually that will go away. The sensation goes away. The belief goes away So it's sort of a different thing. I want to talk about though in 2002 when a new wrinkle is introduced to this whole idea. I'm ready I could use the break because I have become extremely achieved by listening to you

That is a side effect, but before we do that, let's go to the billing department. Let's go. The medicines, the medicines that I've skilled at my card before the mouth. Somewhere between science and superstition, There is a podcast. No! No! Look, your daughter doesn't say she's a demon. She says she's the devil himself. That thing is not my daughter. And I want you to tell me there's a show where the hosts don't just report on French science

spirituality, but take part themselves. Well, there is, and it's Oo Ross and Carrie on Maximum Fun. This year, we actually became certified exorcists. So yes, Carrie and I can help your daughter. Or we can just talk about it on the show. Ono Ross and Carrie on MaximumFun.org. Now, Sid, you said you discovered a new wrinkle in this, in this particular mystery. on maximumfun.org. Now, you said you discovered a new wrinkle in this, in this particular mystery.

Well, I didn't discover a new wrinkle. Well, something else happened. OK. In 2002, this, I mean, because this, like, at this point, this is something that we know happens. We know, as I'll get into, is incredibly difficult for the patient who's experiencing it and is a very challenging disorder to try and help someone treat or cure or overcome. In 2002, a woman named Mary

lethal became convinced that her young son had a new, unknown, undescribed medical condition. He had some sores around his mouth, and she found what she thought was some sort of multi-colored, thread-like object in them, hair-like thread-like, something like that. And she took him to the doctor, the doctor couldn't find anything in particular wrong. So she took him two more doctors. He saw lots of doctors, specialists, dermatologists, infectious disease specialists. And basically, she became convinced that there was some sort of of condition that involved these hair-like particles, causing sores in the skin of her son and then her theory was probably other people that was new to science, had never been found before.

And the doctors were either just not listening or involved in some sort of conspiracy as to why they weren't recognized. This is a good start. All bad stuff starts this way. She examined the fibers herself under a microscope, like a toy microscope. They had the house and she felt like these are new to science. These are something that nobody's ever seen before. The doctors that her son was seen eventually would diagnose

Munchausen's by proxy believing that there was no actual, or at least this was not the medical condition that her son was experiencing and that she was seeing symptoms that weren't there, believing in things or creating things, something was happening in order for this, but there was not a medical condition. The primary problem was a psychiatric condition

on the part of her. She of course disagreed with this. She decided that if the doctors wouldn't listen to her, she was going to have to sort of build a community to agree with her and to fight for this cause. So first, you have to name it, right? You've discovered a new disease. You feel that it is up to you to bring it to public awareness.

So she called it MoreGalens. Have you heard of MoreGalens? No, never. I heard of MoreGalens originally from someone I saw who was convinced they had it. And that introduced me to the world of the internet where it exists and the papers, if you can use that word, that have been published about it. The word more gallons, the name for the condition, the root of that is really interesting where

this comes from. Where did she find this name? Why? It is a reference to a document called a letter to a friend upon occasion of the death of his intimate friend. It was written in 1656, it's a really long time ago, by Sir Thomas Brown, who was a philosopher and a physician. And he's writing a letter to his friend because his friend's friend just died of tuberculosis, right? And he sends him this very lengthy, you can read it, it's all available.

He sends him this very lengthy letter where he sort of, first of all, he's describing the death by tuberculosis. And it's been sort of debated, is he actually describing the death of the young man or is he just describing like what we know so far, what tuberculosis is like, kind of from the perspective of a physician. Either way, he talks about that case

and then he sort of muses about different medical conditions and kind of where we are in that knowledge, and then just like generally about the human condition, it becomes this sort of expansive, thoughtful, you know, letter where he's really just sort of talking about life and humanity. And he gives advice towards the end about living a good life

and making the most of your life and that kind of thing. So it's this long, expansive, thoughtful, personal document that he didn't publish at the time, by the way. It would be found and published after his death later. So it wasn't really even something that he was trying to like get the word out about, get the word out about. But in this letter, he talks about an odd condition that is isolated to this one French province

where children, and I mean, it's literally two sentences. Children develop hairs on their backs and then they get convulsions and coughs and he named it more gallons. It's, I mean, literally, you can find it. It's like two sentences. And based on that, she named this condition more gallons, thinking that this may be connected in some way.

Sure, perfect. As you may already guess, nobody believes this is connected to whatever Sir Thomas Brown was writing about in 1656. There is no, I mean, not even proponents of more, people who believe that more gallons is an actual parasitic disease, they don't believe that it is the same thing, whatever the heck Thomas Brown was talking about.

But that is where this name comes from. That is why it is called more gallons. That is the strange history of the name. She formed a foundation for this, to raise awareness, to raise money, to get research into this condition. A lot of internet groups spun off from this. As soon as this was sort of put out there, a lot of people found her and said, I have it

too, or my child hazard or my friend hazard or my neighbor hazard. Obviously, now isolated to children, lots of different, you know, all over the globe, lots of different, you know, all over the globe, lots of different ages found this and joined her in her quest to get more research done. Enough lobbying was done that Congress asked the CDC to form a team and investigate. This real thing. More gallons. And they did. They did.

They put together a large multidisciplinary team to take samples from these patients, analyze them, take their histories, take their stories, and try to figure out, is this really a medical condition that for whatever reason doctors have decided to ignore and neglect conspire against? Or is this maybe not, and it's actually a collection of different symptoms, disorders, whatever,

that maybe are difficult to diagnose or for whatever reason people haven't figured out yet, and then we're just sort of collecting under this, like a basket, that we're just tossing them all in, even though they have nothing to do with each other. The report was published in 2012, and basically it found no evidence of any sort of new organisms, any sort of parasitic

and infestation infection, anything like that. Big zone show. Nothing. They analyzed fibers from over a hundred different patients and most of them were just cotton, like from clothes and things like that. It's the things you would imagine would leave fibers on your skin. And that study put it into it. That's why everybody deleted their Facebook groups and moved on with their lives. No, that's not the end of the story. I will say that the, I think the foundation is not in operation.

Currently, there was that movie that came out within the last. Remember, we almost watched it under under their skin, under our skin. Oh, yeah. It's a documentary that talks about this. Anyway, there is still an active community that believes in this, even though the report from the CDC was pretty definitive, that this is not, more gallons is not a unique parasitic infection, but another specific form of delusional parasitosis, especially the differentiating factor between like more gallons and the general term delusional parasitosis,

people who have more gallons believe that these fibers are inanimate objects that are in them somehow. I mean, in terms of like where people think they come from, you get wildly different explanations. For some people, it is aliens. For some people, it is some sort of parasite. It could be a conspiracy theories like the government, chemicals, 5G radiation. I mean, all those kinds of things. It was 5G, that's why I live it popped up in 2002. I'm gonna go ahead and put the 5G thing to bed right now.

I'm bringing the headlines. It does look like aliens are a thing that's happening right now. So maybe the aliens. I've heard people say things like nanoparticles that are implanted from insects that the government have deployed drones. You get lots of from the very mundane, I think that there is a worm in my skin to much larger conspiracy theory base.

It really depends on who you're talking. You get a wide array of explanations from the patients themselves. But that's the fun of make pretend there's no bad, there don't have to be any boundaries allowed because the only limit is your imagination. But I think, I think that this is one of those times where you really have to remember where the damage has been done, not by these people who, I think a lot of them unfortunately have an undiagnosed, untreated psychiatric condition in the sense that they have delusional parasitosis, and instead of seeking care from a psychiatrist because of the

delusion, they're not going to go to a psychiatrist or somebody who can help them with behavioral health. They're going to go to a dermatologist or an infectious disease specialist or a parasitologist or somebody like that. And then unfortunately, what they'll eventually find is one of these charlatans who will feed into that delusion and claim that they also believe it, whether they do or not, maybe they do, maybe they don't, but we'll sell them things and give them things and have them come back for appointments and pay them to treat them for something. I mean, that is unfortunately, it's the same thing we've talked about with chronic Lyme disease, which is not an actual condition.

There is post- Lyme disease treatment syndrome, but there is not a chronic form of Lyme disease. But there are these quote unquote Lyme literate physicians who will endorse that as real, even though it's not, and will treat you with antibiotics for years, even though that is completely not evidence-based and will not help you in any way and may harm you, you'll find the same thing with more gallons and other delusional parasitosis type flavors of it, so to speak. But people who suffer from this, it's very similar to these early cases from ECBOM. They believe that this organism is new. They believe that nobody is going to be able to tell them about it because it's new. How can you address how you keep a therapeutic relationship

with a patient like this where you cannot grant them the thing that you would need as a basis of trust, which would be, this is real, we're working on it together. Like, how do you treat someone while not acknowledging or not validating what they think is their chief complaint? The, the, okay, so the recommendations on how to treat this, I have found in my practice, are not very successful. I don't,. I don't know. I used to think it was just me, maybe I'm very bad at this, but I had other physicians that I worked with who had way more years of experience in this area and had as little successes I did. So maybe it's just that difficult. Or maybe I'm bad at it, I don't know. But the recommendations are that you,

I mean, you can't agree like that is not, that is not the way for something like this to agree that there is a parasite there that you know factually isn't. And I mean, don't get me wrong. I always take the time to, first of all, there are lots of other things that can cause the sensation of bugs crawling in your skin formication or itching. So investigate all of those things.

There are a lot of lab tests and diagnostic studies that you may need to do. In addition to a very detailed history and physical examination, I did take the time to look at things under the microscope. I don't think there's anything wrong with that. I will take the time. You took the time to put this in a tub where I'm bringing it to me. I will look at it for you because then I am able to confidently walk in the room and say, this is a piece of cotton. That is all about it. Or this is a scab. This is just a scab that you've picked off of you. It is not a bug. And I can feel very confident

saying those things. There are some recommendations that you should, you could treat with some sort of anti-paracidic. I never did that because did that because I feel like that that violates informed consent. I don't believe you have a parasite, so why am I giving you a drug that I don't think you need. I have a lot of problems with that. It's like magic feathers here, Tori. Yes, so that is not something that I feel comfortable with. I do think that treatments for the skin and the itching are totally fine because

you are experiencing those sensations. So like, here's some medicines for the itching. Treat the wounds, make sure there's no infections. There were often skin infections on top of that. So treat those, talk about proper wound care, talk about the importance of, you know, if you're having these sensations, you still like digging at your skin and scratching your skin or putting bleach on your skin, please stop these things and talking about those dangers. So like helping to stop the self-harm behaviors in that way, that was an area I focused a lot on. And then the other thing that they recommend is to just continue to insist, you know, I really think an anti-psychotic medication would help you with these symptoms. And hopefully eventually patients will agree to take one.

And there have been case reports that suggest that if a patient will start routinely taking one of those medications that address psychosis, including like delusions and hallucinations, that there is success there in some patients. I haven't found like widespread numbers that everybody gets better, but like there is some success there. And then I think it's a multidisciplinary approach. You

need a doctor that you know and trust to work with. If you need to work in conjunction with like a psychiatrist or a psychologist, a counselor, somebody like that, and the dermatologist who they first go to or for me as the family doctor, they first go to or the infectious disease, especially as they first go to. Working together in sort of a multi-disciplinary team could be really helpful because then you're not just because the hardest thing is a lot of these patients just get passed on from person to person like no it's not that leave like you know the your germ condition is that you're picking at your skin, stop it, go home. You have to engage with this is difficult, this is going to require a lot more help. I need to gain your trust that I

am trying to help you. And maybe the help doesn't look like you think it should look, but I promise you if we work together, we can, we can together come up with a plan without ever like, I mean, I would never endorse just going along with the delusion. I think that's wrong. I mean, you're lying. You know, I'm saying so accusatory. I was suggesting that. No, but it's tough. It's a tough, it's incredibly tough. And every time I think like, it's so tough to treat, it is exponentially harder for the person who's suffering from it. And so that's why I like, and of course, I should should mention it has been tied over time to chronic Lyme and tick-borne illness. There are a lot of doctors, or not a lot of doctors. There are people

in this area. Some of them are doctors. Some of them are just advocates who insist it's all connected. It's all connected. And I have a chart. Look over here at my court board. It's all connected. And these are the people that make me mad. Not the patients. The patients are suffering. Nobody would choose this. Nobody would choose to believe they're infected with a parasite that no one can see or treat or cure. And they're constantly damaging their own skin

and an attempt to remove it. Nobody would ever choose that, right? Right. I get mad at the people who see that suffering and see the opportunity to make a buck or to make a name for themselves. Those are the people I get mad at. Not the patients, the patients are suffering.

Yes. And maybe, you know, I think that there is at least this to be said, there is no parasite here. There is no more gallons organism. There is no magical hair-like thing that's causing this. There is no thread worm thing that's causing this. There's none of these worms that people think that none of that is true in these cases. No.

But they might be itchy. Maybe ECBOM was right. Maybe they are itchy. And maybe we just need to work a little harder to figure that piece of it out too. Obviously, there is a psychiatric component for many of these patients. But there's also people who are itchy. Some people, guys, some people are itchy. Do you know why the, do you know why the itch sensation exists?

Why do we feel itchy? Isn't it? You really did skin cells? It's to tell us if there's a bug on us. Oh, yeah. It makes sense. That's a better answer than mine. So you're we evolved to recognize that when we get that sensation, formication or itch or whatever, when we get that sensation, our our animal brain says bug, bug, get it. So isn't it normal that people would have that sensation and think, bug, get it? Now, obviously, there's a problem when despite all evidence, you continue.

Trust me, bug. Particularly if bug. But, like, that all fits. So, it's hard. It's hard, but you can't just write people off because they're difficult. You just got to work harder and work with them. But you can still throw as many verbal, not literal, but verbal rocks as you want at the people who will take advantage of those who are suffering and desperate and feel tossed aside.

You know who I never felt tossed aside? Our listeners. Oh, me too. We're so supportive of us during the maximum fun drive and we so appreciate them. And we really appreciate you for listening. That's awful because we're both of you. I think we're gonna take next week off, but we'll be back with you in two weeks after that.

And I'm excited about it for one. Oh, thanks to the taxpayers for these, they're some medicine as the intro and outro of our program. And thanks to you for listening.ino, we're appreciate it. Thank you. Until next time, my name is Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole in your head. Alright!

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