This year, 2010, will be a spectacular year for the BTER Foundation, and for Biotherapy in general. Several events coming up, including the 8th International Conference on Biotherapy (ICB-2010).

Information will soon be posted on this and other websites concerning ICB-2010. For now, SAVE THE DATE: October 7-10, 2010; Los Angeles, CA. This will be the first time that the International Conference on Biotherapy will be held in North America. Hope to see you all there. Visit the Conference Website for current information: www.BTERFoundation.org/icb/icb2010.htm. Or contact the BTER Foundation (conference@BTERFoundation.org) if you want to work on the program.

I can't believe it's been over a year since my last entry! Plenty has transpired, but I have had (I have made) no time to write about it. I will try to do better.

The biggest news right now is that the BTER Foundation has a new web design. This has been a project in the planning for nearly a year, because the vast number of resources grew beyond the ability of the earlier site structure to organize and retrieve them. Take a look at the new www.BTERFoundation.org. Leave a message as to how well the site serves you, or how it could be improved.

Better yet, leave a note as to how YOU can help the website grow, or how YOU can help the BTER Foundation help others.

Also, you can read about some of the other developments this past year in Biotherapy in the BTER Foundation newsletters.

The following newsletter was sent out by the BTER Foundation: www.bterfoundation.org/tbl/TBL_V4N5.htm This is the introduction:

"The BTER Foundation has just issued the following press release, which also can be found at: www.bterfoundation.org/indexfiles/BTER%20Foundation_PR_0811.pdf

"As you can see below, we are very pleased to announce that the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) took our concerns about maggot therapy coding seriously, and issued coding recommendations that should support your requests for insurance reimbursement.

"We are grateful for their efforts to work together in this way to improve patient services and clinician compensation. Their action demonstrates their support for all of us that use or receive biotherapy.

"Thank you all who wrote letters for us to take to the CMS Public Hearing in Baltimore, back in April, 2008. The words of Margaret Mead (which appear at the bottom of most of our newsletters), ring true, again: 'Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.'"

The BeTER LeTTER newsletter archives, with all earlier issues, can be found at: www.bterfoundation.org/indexfiles/letter.htm

Maggots Finally Get Some Respect

At the risk of appearing conceited, let me devote today’s report to two instances where biotherapy was awarded some respect by the society in general, and the medical community in particular.

Maggot therapy began its current revival in the United States in the early 1990’s. In the United Kingdom, this occurred about 5 years later. There are many proponents of maggot therapy in the UK, and many people who deserve credit for creating the laboratories and clinics where it all started. Since those early days, Mary Jones devoted her time to spreading the word, and the skills, through her efforts teaching other health care providers to treat patients with maggot dressings. Earlier this year, her Maggot Therapy work was formally recognized by the Queen of England. Mary Jones was awarded an MBE in the Queen's New Year Honors for her services to nursing. Read more about it at: http://news.bbc.co.uk/1/hi/wales/7163148.stm

This past June, the Director of the BioTherapeutics, Education & Research (BTER) Foundation, Ronald Sherman (yes, that’s me), was recognized by the editors of Medical Device and Diagnostics Industry as one of the “100 Notable People” in the medical device industry for 2008. This tribute was published in the June, 2008 issue of the trade journal.

Among Dr. Sherman’s contributions listed in this cover story are his clinical trials of medicinal maggots for wound-healing, and his success in securing FDA marketing clearance for those maggots --- the first live animal to achieve such a status in FDA history.

Ronald Sherman began his interest in maggot therapy as an Entomology undergraduate, and wrote his first paper with Plastic Surgeon Ed Pechter while in medical school (published 1983). By 1989 he had the opportunity to design and conduct his first prospective clinical trials of maggot therapy. With funding by the Paralyzed Veterans of America (PVA), California PVA, and the Andrus Foundation (American Association of Retired Persons), he spent the next 5 years evaluating the safety and efficacy of the flies that he captured in Southern California. Sherman modernized methods for disinfecting them and applying them to wounds. He has supplied nearly 1,000 therapists in the United States with medicinal maggots for use in their patients, and he has assisted others worldwide in setting up their own maggot-rearing laboratories (today more than 25 laboratories supply medicinal maggots to patients in 35 countries). In 2003, the Food and Drug Administration (FDA) began regulating medicinal maggots. In January, 2004, Sherman’s Medical Maggots became the first living organism to receive marketing clearance by the FDA as a prescription medical device. found a safe and effective strain, which has been maintained with genetic purity until this day.

These two commendations are a landmark in biotherapy history, for they indicate that maggot therapy and those who promote it are now welcome back into the mainstream. Indeed, at least in Britain, they are even welcome in high society. Congratulations to Mary Jones and Ron Sherman. Congratulations to British and American Society, for making it back to the future of medicine.

Patients and their families weigh in about maggot therapy and reimbursement

What do patients and their families have to say about maggot therapy and reimbursement? Read for yourself -

During 2006 my mother developed a serious pressure wound at a skilled nursing home. The best conventional care . . . was woefully deficient in debridement of the necrotic tissue to promote healing. My mother’s primary care physician gave a prescription order for the MDT therapy. I then paid Monarch Labs and . . . practitioner nurse to administer about six dressings, for a total of about $1,200. The MDT treatments were vastly more effective than the Panafill ointment used by the home care nurse program. The head home care nurse observed the MDT treatment program and became so convinced of its efficacy that she tried to implement it into her own program with much resistance from management. When I applied for reimbursement our HPO was SCAN backed by Medicare. I provided all the data requested by SCAN and nothing came of it. Lots of red tape with no reimbursement due to no code for MDT. MDT was the only effective debridement method.

Mr. D. (son), California

Letter from Massachusetts, requesting HCPCS code for medicinal maggots

Another letter to CMS, requesting reimbursement coding for maggot therapy and medicinal maggots -

Medicaid HCPCS Coordinator
Centers for Medicare & Medicaid Services
Mail Stop S2-01-16
7500 Security Boulevard
Baltimore, MD 21244-1850

Dear Medicaid HCPCS Coordinator:

I am a Registered Nurse who has worked in wound care facilities for 10 years. I have tried to obtain maggot therapy for many of my patients who failed IV antibiotics and conventional debridements, but because there is no assigned HCPCS code for this product and therefore no reimbursement available, this therapy has been unobtainable for clients who would benefit from treatment.

This lack of availability has led to higher cost for inpatient surgical debridements and greater length of stay in hospitals.

I feel that maggot therapy would be a lower cost choice and should be available for use and reimbursement to these clients who need this particular therapy.

Thank you for your consideration in this matter.

Nurse F, Massachusetts

In an addendum, she added:

I have tried to obtain maggot therapy for many of my patients who failed IV antibiotics and conventional debridements, but because there is no assigned HCPCS code for this product . . . this therapy has been unobtainable . . . . because we could not be reimbursed for them, it was stopped . . . . This . . . has led to higher cost for inpatient surgical debridements and greater length of stay in hospitals.

Letter to CMS from Michigan

We received many letters to present to CMS, explaining why reimbursement coding for maggot therapy is so important. I will post a few over the next several days. They speak for themselves, for the authors, and for the biotherapy community at large.

Dear Sirs:

While I can not be physically present at your meeting, I would like to comment via this email on Medicare coverage of medical maggot therapy. I treat diabetic ulcers on a daily basis in my podiatric medical practice. It is heartbreaking to see the loss of limbs and lifestyle changes my patients must undergo. Personally I have treated some of the worst of these patients with medical maggots and gotten very gratifying results. Unfortunately, this therapy is not covered by their insurance and the patient must bear this financial burden. The people that find themselves in this position are usually the least able to afford it. This means they are denied a treatment that could potentially save their limb. I have seen both sides of this: the saved limb by maggots and the lost limb because the patient could not afford the maggots. It is imperative that Medicare develop a code for medical maggot therapy.

Sincerely,
Dr. D, Michigan