CDC publishes Morgellon's Study

Skin lesions and fibers on patients with unexplained
dermopathy. (from  Pearson et al. PLoS ONE)

Yesterday the Centers for Disease Control officially released their long-awaited study of people suffering from a condition that has come to be called Morgellons.  Preferring to use the term "unexplained dermopathy," researchers provided no scientific support for the condition, leaving open the possibility that many such cases may be psychological in origin.

While the conclusions of study may be shocking to members of the media, public health experts and entomologists who regularly see people with non-existent bug problems are not surprised. A smaller study published last May found no connection between similar unexplained dermopathies and skin parasites.  And professional entomologists who regularly interact with the public are very familiar with samples of supposed biting insects and far-ranging descriptions pests that fit no profiles of real insects or mites. As I discussed in a post last year, some of these samples come from people with a special kind of delusion called delusory parasitosis, while others come from people experiencing allergic reactions, drug side effects, or other medical conditions. All of these can produce sensations closely resemble tiny bites or creeping sensations on the skin like a plague of bugs.

In recent years, some people with these unexplained skin conditions have sought an alternative explanation for skin lesions and the accompanying itching sensations.  The name Morgellons is a lay term supposedly originating from an obscure 1690 reference in a medical monograph referring to a similar condition of the time called "the morgellons." Though the condition is poorly defined, it usually involves seeing unidentified fibers associated with the skin, and many feel it is related to some as-yet-undescribed parasite.

The findings of this week's study in the online journal PLoS ONE, include:

• Approximately 50% of patients who underwent clinical examinations had fibers in or on skin lesions (open or crusted sores). However, when the fibers and other particles collected from participants were photographed and analyzed, they were found to be either hairs, cellulose, or polyester.  There was no evidence that the fibers preceded the lesions, caused the lesions, or occurred in normal skin.
• Evidence of prior drug use (i.e., from amphetamines, barbituates, benzodiazepines, cannabinoids, cocaine, opiates or propoxyphen) was found in 50% of clinical participants.  Drug use could account for some cases of unexplained dermopathy--formication (the sensation of tiny bugs, like ants, crawling on the skin) is a well-known side effect of drug use withdrawal.
• Over 75% of case patients reported some exposures to solvents through hobby activities. The  prevalence of such exposures among the healthy adult population in the U.S. is unknown and not enough data on type and duration of solvent exposure was collected to draw conclusions.
• The rate of functional impairment and disability found in case-patients was higher than the general population and similar to that detected among people with serious mental illness.

Prevalence of cases with Morgellons-like symptoms was low in the California study group, approximately 3.65 cases per 100,000 people (or one in 27,000 people).  While being the largest, most comprehensive study of  unexplained dermopathy to date, the study had limitations.  It lacked a control group and was mainly descriptive in nature.  Nevertheless the researchers say that they could find no unifying of definitive cause of the condition among people reporting Morgellon-like symptoms. The authors were unable to confidently say whether unexplained dermopathy represents a new medical condition or is another manifestation of delusory parasitosis; however a peer review panel concluded that in the absence of a single, well-described, published case with fibers emerging from intact skin, "it will be difficult to justify the resources needed to start a new study."

Ultimately this study will not end the debate over unexplained dermopathies, like Morgellons. People who believe they suffer from the condition will point to the inability of the researchers to definitively say that "there is no such thing." Dermatologists, physicians and mental health experts will point to the lack of evidence for the condition, the innocuous origin of the "fibers" seen in Morgellons cases, lack of any parasites in skin biopsies and data that suggests a correlation of the condition with psychosomatic illness and drug interactions.

The study concludes with the recommendation that, given there is still no definitive explanation for unexplained dermopathy, sufferers may benefit from standard medical therapies or those recommended for treatment of delusory infestations.  For sufferers of the latter I find the recommendations of Misha Heller and colleages especially humane and sensible. In their letter published in the Archives of Dermatology, they note that the most important step toward successful treatment of delusional patients is developing a strong doctor-patient relationship of trust.  Without adequate rapport, they say, patients are unlikely to comply with prescriptions for anti-psychotic medications, which can make all the difference in the life of someone suffering from delusory parasitosis.

All of this can be baffling to pest management professionals. After all, we're not doctors, nor are we trained to diagnose medical or mental health conditions in patients. Nevertheless, this is an issue that affects nearly all of us at some time over our careers.  When you encounter a customer who claims to have Morgellons, or who points to tiny pests that can not be seen, it's important to stick to what you know.

• Don't allow yourself to be persuaded to apply unnecessary insecticides to control insects that cannot be detected or do not exist. 
• Advise your customer to seek medical assistance for bite-like symptoms (Keep in mind, however, that many doctors are not well informed about pests or even delusory parasitosis. If you know a local MD or dermatologist who is informed about this condition, refer them). 
• Inspect the home, making use of sticky cards and pitfall traps, to ensure it is free of bed bugs, biting mites, and other biting insects. Remember, providing a customer assurance that their home is pest free can be as great a service as pest control itself.

Structural Pest Control Service Winter Update

Whether companies who provide canine bed bug and termite
sniffing services should be licensed or require certification
was a topic of discussion at the January Advisory Committee
meeting.

The Structural Pest Control Advisory Committee met today after a (literally) stormy day in Austin--and I don't mean politics.  Yesterday brought some wet relief to parched central and north Texas, as well as rare winter tornadoes in several communities.

Today's committee meeting was mostly uneventful in terms of actions; however some interesting topics were introduced that should lead to follow-up discussions in later meetings.  The meeting started off with a moment of silence for Bill Stepan, our committee member who passed away in November. David Kostroun then led the committee through responses to the Self-Assessment Questionnaire that we were asked to fill at the end of the year.

Priorities for the Committee
One of the priorities for the coming year that some respondents mentioned was better communication with the public about pest control issues and how to help the public find answers to questions about pest control, the reliability of pest control businesses, and pesticides.  Tommy Kezar noted that the TDA website formerly allowed visitors to view regulatory actions to see what companies had been recently cited or fined for violations.  This page is no longer view-able on the agency's new home page. In fact, apart from information on how to file a structural pest control complaint, there is relatively little useful pest control-related information for consumers on the new consumer protection site.  Given that the site is new, I trust that this will change.  One feature I always found useful was the ability to check a company's license information to assure myself that it was operating with a valid license.  I hope this feature is restored.

Kezar also noted a couple of cases that he has seen where license renewals have been held up because of problems with background checks. Department staff were, allegedly, not very helpful in responding to efforts by licensees to discover the particulars about why a background check failed.  Chief Administrator Kostroun promised to look into procedures for responding to such requests for information.

Performance Data for SPCS
Stephen Pahl, Administrator for the Consumer Protection Division of TDA (the new division that houses structural pest control) gave a brief presentation on data that the agency is required to report to the LBB (Legislative Budget Board). The data includes statistics on numbers of new business and individual licenses issued, complaints resolved and inspections conducted each quarter.  Some of the more interesting numbers for the Sep-Dec Quarter included:

• 275 SPC business inspections were conducted in the fall of 2011 (slightly exceeded target goals).
• 45 complaints were resolved that resulted in a formal enforcement action (more than double the target goal).
• The 43 non-commercial establishment inspections (hotels, restaurants, local governments, etc.) was about a third of the target for the quarter; however staff attribute this to the priority they have placed on conducting school IPM inspections and some difficulties with new schedule-optimization software. 
• 139 schools were inspected, representing nearly 70% of the schools scheduled for inspection in the year.  I understood that the rate of quarterly school inspections will likely taper off this year as software improvements are made to rebalance the scheduling of commercial and non-commercial establishments over the next few months.
• Although quarterly data on school compliance rates for FY 2012 were not available, last year 52.4% of Texas schools were found to be in (complete) compliance during inspections. This metric, however, gives little insight in to the type or significance of non-compliance issues found by inspectors.
• Complaint case sufficiency rate is the percent of cases sent to Austin from local SPCS inspectors that ultimately are approved for enforcement action.  A high sufficiency rate indicates that inspectors are not submitting many frivolous or unenforceable cases.  This year's sufficiency rate was 92%.

School IPM Coordinator CEUs

Michael Kelly noted that the Department will be prioritizing the effort to publish formal rules for the new school IPM Coordinator CEU requirement imposed by Sunset committee action two years ago. To refresh your memory, as of January 1, 2011 School IPM Coordinators are required to obtain 6 CEU hours on pest control, pesticide and IPM-related topics every three years.  We are now 13 months into the three year period, and rules for how this system will work have not yet been published.  Kelly handed out the draft rule which specifies that only one of the six hours must be in laws and regulations specific to IPM programs in schools (I have stated in the past that I think this is inadequate, but won't go into that today).  What is still missing from the rules, however, is a mechanism for approval of the school IPM laws and regs CEU, and specific instructions for when CEUs will be due.  It was suggested that there may need to be a new CEU category for School IPM rules and regulations. The committee agreed that coordinators who were certified prior to Jan 2011 should be required to complete their six hours by Dec 2013.  Newer coordinators should be required to get their 6 hours within three years of taking their initial 6 hour orientation course (which they must take within six months of appointment as IPMC). Presumably the Department will be publishing new rules for public review within the next quarter.

Should Bed Bug Dogs be Licensed?

One of the most interesting discussions was a review of some information collected by Leslie Smith on bed bug dog certification, and discussion about whether dog handlers should be licensed.  While no one is actually proposing that dogs be licensed, handlers and companies who provide dog-sniffing services appear to be another matter.  The committee asked if Kelly would come up with some proposals on possible licensing options so that the issue could be discussed more rigorously, and recommendations formalized by the committee at the next advisory committee meeting.

Agency Legal Staff

Deputy General Counsel for Enforcement, David Gipson, reported that the SPCS has been without an official attorney for several months. It has been difficult, he said, to find qualified lawyers willing to work for the salary offered by TDA. As a result, legal work for SPCS has been divided among three TDA legal staff. According to Gipson, this has the added advantage of minimizing the impact on SPCS programs when an attorney leaves for any reason.

The next committee meeting is tentatively scheduled for April 26. The SPCS is receiving applications for positions on the advisory committee, especially the two open seats for industry and a consumer position. If interested, you should contact Michael Kelly.

Some competition

After all the political discussion this week in the media about "vulture capitalism" I'm reminded that battles in the pest control industry can become just as heated as any political campaign.  According to an article this week in Pest Management Professional, after 21 months of legal battles between BASF and rival manufacturers, it looks as if at least one company has won the right to sell generic fipronil.

Control Solutions is currently selling a granular and SC formulated version of fipronil that will compete with Bayer Top Choice and BASF Termidor.  The current label for Taurus G (granular fipronil) lists only fire ants as a target pest, although additional pests may be added in the future.  Like Termidor, the Taurus SC label includes instructions for perimeter pests and termite control.  For termites it allows for an "Exterior Perimeter - Localized Interior" treatment, a form of treatment pioneered by BASF. According to Control Solutions, both products are now available through most distributors (Univar is not yet selling the Control Solutions' fipronil, pending additional negotiations) in Texas.

I don't usually post about battles between chemical manufacturers over market share; but as I pointed out in an earlier post, this is a big deal for the pest control industry. Patent expiration always leads to price reductions for the industry, and this one will be no exception. And when it comes to a leading termiticide, we're talking lots of money.

For its part, BASF has worked hard to protect its patents and develop new uses and formulations to stay ahead of the competition.  Termidor DRY is one example of a unique BASF formulation, as is a new formulation that will require less trenching and less water for perimeter treatments.

I won't weigh in on whether it's a good idea to go with a less expensive, off-brand insecticide; however I will make a generic observation about generics. Everyone should know that despite having the same active ingredient, generic products are never identical to the original.  For example, the way an active ingredient is formulated will vary from manufacturer to manufacturer.  Formulations include solvents, adjuvants and stabilizers to make the technical ingredient easier to mix, store and use. If you choose to switch to a generic product in your business, be sure to make sure it's giving you the same performance you expect from the original. As with any new product, it's important to decide what works best for you and your business. After all, wise decisions are all that stand between you and the "vulture capitalists".

Verdict in Utah deaths

Follow the label directions.  How many times have I heard this, and how many times have I said this in CEU courses for pesticide applicators? Unfortunately, the most important lessons are sometimes the ones we get so used to that we forget to heed.

I don't know if that was the reason a Utah fumigator placed Phostoxin pellets in a rodent burrow too close to a home.  Or whether it was disbelief that the pesticides that we work so closely with on a daily basis would really sicken (or in this case, kill) a customer.  Whatever the reason, failing to observe the directions on a pesticide label led to the deaths of two beautiful Utah children, and there was no excuse.

I think all of us who work with pesticides owe it to ourselves, our employees and our customers to read the reports about the final disposition of the Utah pest control operator originally charged with negligent homicide in the death of the two children.
Exterminator Given Probation-Fox 13 Salt Lake City
Parents Speak Out - Salt Lake City Tribune

The lesson of thalidomide

According to an article appearing today in the New England Journal of Medicine, the end of 2011 marked the fiftieth anniversary of the withdrawal of the controversial drug, thalidomide, from most worldwide markets. For anyone interested in the role of federal regulation of consumer/professional products, the thalidomide story is one well worth remembering.

In 1961 the same debates about intrusive federal regulations were raging that we hear today.  One debate at the time was whether a federal agency, the Federal Drug Administration, should have the authority to set standards for whether a drug should be registered based on health and safety standards set by the government.  Physicians, the argument ran, should be the final arbiters about whether a drug should be available.  About this time, a rookie medical review officer in the FDA made the decision to deny registration to a drug with the trade name Kevadon, based on the scanty human safety data available at the time.  As a result, Americans were largely spared the large number of thalidomide babies that were being born to women in Europe and other developed countries. By the time doctors raised the alarm, over 10,000 were born withsevere limb-reduction defects, in some cases with hands or feet emerging directly from their torsos.

The story got me thinking about the value of regulatory standards and the role of government as a, supposedly, unbiased gatekeeper for drugs or pesticides or allowable pollutants.  Although we don't always agree with the governing authorities, I, for one, am grateful that someone is looking out for my welfare through science-based standards.  And let's hope we never have to relearn the lesson of thalidomide.

Universities teach their students about bed bugs

Thanks to Don Baumgartner, EPA Pesticides Section (Region 5, Chicago), for compiling this list of web sites related to bed bug control in college student housing. If you are already servicing, or are considering servicing,  university dorms for bed bug control, some of these links might prove useful.

The University of Florida has possibly the most detailed set of specifications/recommendations for treating student housing.  This publication by Wayne Walker and colleagues is definitely worth checking out at http://edis.ifas.ufl.edu/in880

Other related Univ guides to bed bugs are:

• University of Indiana http://www.ehs.indiana.edu/BedBugs/preventionquickfacts.shtml
• University of Pennsylvania http://www.business-services.upenn.edu/housing/assets/pdf/pestcontrol/bedbug_facts.pdf
• Stanford: https://www.stanford.edu/dept/rde/cgi-bin/drupal/housing/living/what-you-should-know-about-bed-bugs
• University of Florida guide for housing staff: http://ipm.ifas.ufl.edu/pdf/Bedbug_Guide_for_staff.pdf
• From bedbug.com: http://www.bedbug.com/Page-Bedbug-tips-when-residing-in-a-dormitory_192.aspx
• From Rick Cooper at Bed Bug Central: http://www.bedbugcentral.com/bed_Bugs_college.cfm
• From About Insects: http://insects.about.com/od/insectssociety/qt/How-To-Keep-Bed-Bugs-From-Coming-Home-With-Your-College-Student.htm
• Video interview of Rick Cooper about sending your child to bed bug colleges: http://www.youtube.com/watch?v=IG0fZbZWfF8&feature=related

A word to the wise. It might not be a good idea to share these links with a nervous parent sending their child off to college for the first time.