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Get that maggot a medical license

Bleh. I know these are effective creatures in medicine, but the idea of leeches sucking and maggots chewing on you so you can heal is nausea-inducing. I skipped a picture on this one. A nice morning article here on the Blend – and no Sanjay Gupta for you!

Flesh-eating maggots and bloodsucking leeches, long thought of as the tools of bygone medicine, have experienced a quiet renaissance among high-tech surgeons, and for two days beginning Thursday a federal board of medical advisers will discuss how to regulate them.

Leeches, it turns out, are particularly good at draining excess blood from surgically reattached or transplanted appendages. As microsurgeons tackle feats like reattaching hands, scalps and even faces, leeches have become indispensable. And maggots clean festering wounds that fail to heal, as among diabetics, better than almost anything else, although their use in the United States has been slight, in part because of squeamishness.

But neither leeches nor maggots have ever been subject to thorough regulation by the Food and Drug Administration. So the medical advisers are being asked to create general guidelines about how they should be safely grown, transported and sold. Since 1976, the F.D.A. has required that makers of medical devices prove that their products are safe and effective. Those already on the market as of that year had to prove their worth; those invented later had to get approval before marketing.

There are unexplored corners of the nation’s medical market, however – no one knows how many, but they are certainly a vanishing few – in which doctors and manufacturers have been doing business since well before 1976 without much notice from the agency. The sale of maggots and leeches is one of those corners. In addressing it, officials first had to decide which part of the agency had oversight: its biological or device division.

“The primary mode of action for maggots is chewing,” said Mark Melkerson, acting director of the Division of General, Restorative and Neurological Devices. “For leeches, it’s the eating of blood. Those are mechanical processes.” Thus, the agency decided that maggots and leeches were devices, Mr. Melkerson said.

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Pam Spaulding

Pam Spaulding