The B e TER L e TTER
April, 2020
Volume 16, Issue 2
Director's Letter

We are truly living in challenging times. I hope you and your family get through this epidemic unscathed; but I know this will not be the case for many of you. Too many of you.
If you are a health care provider – thank you for your service and your sacrifice. If you are not a health care provider, thank you for the sacrifices you are making, too, by protecting yourself and your family through social distancing and frequent hand-washing. You may even be helping out by making masks, delivering food and supplies, or a whole host of other actions that we have witnessed in communities throughout the world.
As if things weren’t bad enough just having a novel virus in our midst – one spread by both aerosols and droplet/contact – we must also contend with drastically limited services for all other health conditions, due to shortages in supplies, shortages of personnel, and the obvious safety concerns of having healthy and ill patients mixing in our healthcare facilities. As a result, one of the many consequences of the current Coronavirus epidemic is the closure of our clinics and unavailability of medical assistance for many non-Coronavirus related problems. 
Readers of this newsletter will know that medicinal animals can help, now more than ever, by extending the reach and services of our limited doctors, nurses, physical therapists, and other health care providers. As a case in point, let’s consider the ways that medicinal maggots can help the over-taxed healthcare system and protect patients, while attending to their wounds.

  1. Maggot therapy can reduce patient exposure risks by decreasing the need for clinic visits (maggot therapy can be applied and/or removed at home, even by non-therapists). 
  2. Maggot therapy can reduce the time burden on health care professionals, by providing surgical quality debridement without a surgeon (even without a health care professional, if necessary).
  3. Maggot therapy can decrease the amount of time it takes to achieve a clean (“debrided”) wound by at least 50%,* thereby further decreasing the need for clinic or hospital visits.
  4. Maggot therapy can decrease not only the human costs, but also the financial costs of wound care. 
It may seem like a strange time to be discussing financial costs, but financial costs actually prevent millions of people from seeking and/or accessing care, even during the best of times. Now that millions are furloughed or losing their jobs – and consequently losing their income +/- medical insurance - their access to affordable care. Unfortunately, “routine” illnesses do not stop their progression the way we all suddenly put our lives on hold for COVID-19.
How can the BTER Foundation help? The BioTherapeutics, Education & Research (BTER) Foundation regularly provides personal assistance and group courses in biotherapy. All of our in-person courses are currently on hold; but we will be rescheduling them as webinars. For the time being, if you have any questions about biotherapy, you can reach our therapists for assistance via e-mail ( ) or phone (949-246-1156). 
Thanks to our generous donors, we will be able to subsidize the cost of therapy for more of those patients who need it but cannot afford it. Applications for such “Patient-Assistance Grants” can be found on our website, .
What can you do? As I already noted at the beginning of this newsletter, you are probably already doing plenty, just by doing what you normally do. If you know someone – therapist or patient – who may benefit from maggot therapy or any other medicinal animal, let them know about our willingness and availability to help.
And one more thing: go wash your hands again. Because we care, and so do you.
R Sherman (signature)
* In the U.S., complete debridement appears to be achieved with maggot therapy, usually in just a single two-day course of treatment. Published studies that have evaluated debridement times more vigorously include the following:
         1.  Davies CE, Woolfrey G, Hogg N, Dyer J, Cooper A, Waldron J, Bulbulia R, Whyman MR, Poskitt KR. Maggots as a wound debridement agent for chronic venous leg ulcers under graduated compression bandages: A randomised controlled trial. Phlebology. 2015;30:693-9.
         2.  Dumville JC, Worthy G, Bland JM, Cullum N, Dowson C, Iglesias C, Mitchell JL, Nelson EA, Soares MO, Torgerson DJ; VenUS II team. Larval therapy for leg ulcers (VenUS II): randomised controlled trial. BMJ. 2009;338:b773.
         3.  Markevich YO, McLeod-Roberts J, Mousley M, and Melloy E. Maggot therapy for diabetic neuropathic foot wounds: a randomized study. In Proceedings of the 36th Annual Meeting of the European Association for the Study of Diabetes, Jerusalem, Israel, 2000.
         4.  Marineau ML, Herrington MT, Swenor KM, Eron LJ. Maggot debridement therapy in the treatment of complex diabetic wounds. Hawaii Med J. 2011;70:121-4.
         5.  Mudge E, Price P, Walkley N, Harding KG. A randomized controlled trial of larval therapy for the debridement of leg ulcers: results of a multicenter, randomized, controlled, open, observer blind, parallel group study. Wound Repair Regen. 2014;22:43-51.
         6.  Sherman RA. Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy. Diabetes Care. 2003 Feb;26(2):446-51. PMID: 12547878
         7.  Sherman RA. Maggot versus conservative debridement therapy for the treatment of pressure ulcers. Wound Repair Regen. 2002 Jul-Aug;10(4):208-14. PMID: 12191002
         8.  Sherman RA, Wyle F, Vulpe M. Maggot therapy for treating pressure ulcers in spinal cord injury patients. J Spinal Cord Med. 1995 Apr;18(2):71-4. PMID: 7640976
         9.  Wayman J, Nirojogi V, Walker A, Sowinski A, Walker MA. The cost effectiveness of larval therapy in venous ulcers. J Tissue Viability. 2000;10(3):91-4. Erratum in: J Tissue Viability 2001 Jan;11(1):51. PMID: 11299572
Biotherapy Community Workshops

All of our previously scheduled workshops and conferences are moving to on-line platforms. We will post updated information as soon as we have it.

Publication Credits

THE B e TER L e TTER is published by: 
BioTherapeutics, Education & Research (BTER) Foundation
36 Urey Court, Irvine, CA 92617
Phone: 949-246-1156 / Fax: 949-679-3001 

Ronald A. Sherman

Assistant Editors:
Brooke Medina

Contributing Writers:
Dr. Sagiv Ben-Yakir, Dr. Jose Contreras-Ruiz, Sheri Rosen,
Dr. Pascal Steenvoorde, Dr. Tarek Tantawi,
Your name could be here! 

Foundation Consultants:
Eve Iversen, Dr. Alana Jolley, Amy Mendez, Joanne Preston,
Dr. Aletha Tippett

Foundation Board:
Ronald A Sherman (Chair); Sagiv Ben-Yakir;
Chris Kleronomos; Samuel G Kohn (Treasurer); Sheri Rosen.

Past Board Members:
Donna Beales; Sharon Mendez; Pamela Mitchell; Randall Sullivan

Administrative Assistant:  
Brooke Medina