Special issues

New sources of Immune suppression

Select medical situations

Hospitals and emergencies – for patients

Hospitalization exposes fragile patients to additional serious problems, such as antibiotic-resistant secondary infections, emboli, medication side effects or other serious adverse events. Compromised Marshall Protocol (MP) patients may not be able to combat these complications.

The following suggestions are meant to prevent the need for hospitalization and provide guidance for MP patients who find themselves hospitalized or in an emergency situation. MP patients should print out these suggestions, put the document in a folder for easy reference and take it with them to the ER or Urgent Care.

Note that the legal rights associated with medical care and hospitalization set forth in this article are applicable to patients in the United States and may not apply to patients in other countries.

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Working with a dentist

Main article: Working with a dentist

Dentists are one of the common medical specialists with whom Marshall Protocol (MP) patients will have to partner during the course of treatment. Like other parts of the body, teeth can easily be infected by bacteria. One of the benefits of visiting a dentist is that, unlike most other medical specialists, they have the tools to remove bacteria. Some patients find that they need to visit the dentist more frequently due to rapid tartar buildup.

Dentists treat dental symptoms, some of which are associated with periodontal disease. In an MP patient, sometimes a dental symptom, such as a tooth ache, is due to the immunopathological response, and a dental procedure can be delayed if not avoided.

For dental procedures requiring a local anesthetic, one without epinephrine (adrenaline) is essential.

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Working with an optometrist

Marshall Protocol patients who have sarcoidosis or symptoms of eye inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. should have an initial visit by an ophthalmologist (a medical doctor) to be sure that they do not have any conditions that need specific treatment.


Main article: Surgery

If the need for surgery or diagnostic procedure is not urgent, Marshall Protocol (MP) patients should request that it be postponed until more inflammation is resolved. MP patients who are to receive a local injected anesthetic, such as is given for dental procedures, should request that it not contain any epinephrine (also known as adrenaline). MP patients should also avoid having nitrous oxide used as a sedative.

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Select sources of infection

Smoking tobacco

Main article: Smoking tobacco

Smoking has been called “the single most preventable risk of disease” but the underlying disease process by which smoking is said to cause death and disease is not well-defined. However, there are several areas of study which point to the role of pathogens and modulation of the immune response in the diseases caused by smoking:

  • Pathogens have been detected in cigarettes.1)
  • Smoking has been shown to contribute to delayed apoptosis of immune cells as well as decrease production of antimicrobial peptides. Some evidence has emerged that smoking offers sick people symptomatic relief – through immunosuppression,2) an anti-inflammatory effect,3) or any number of other possible mechanisms.
  • Sick people are less likely to quit smoking, which may artificially inflate estimate of the harmful effect of tobacco. For example, schizophrenic patients, have reported that they smoked “primarily for sedative effects and control of negative symptoms of schizophrenia.”4) Symptomatic relief may also explain why people with mental illness are twice as likely to smoke than people without a mental illness.5)

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Main article: Tattoos

People are exposed daily to the intracellular microbiota that cause chronic inflammatory diseases. They exist in food, water, injectable medications, body fluids and have even been cultured from dry soil.

As with all injected substances, there is a small risk of introducing these pathogens during the process of tattooing.

Lupus vulgaris over a tattoo mark. Lupus vulgaris is caused by tuberculosis. While tuberculosis is widely accepted as an infectious disease, it is notable that chronic inflammatory diseases of “unknown” origin can also show cutaneous disease-specific lesions following a tattoo. This suggests a common, if not species-specific, pathology.

Researchers have documented that diseases such as lupus vulgaris (painful skin lesions caused by M. tuberculosis bacteria) can be induced by a tattoo procedure.6) Tuberculosis, of course, is unquestionably a bacterial illness.

But the literature also contains multiple reports of sarcoidosis patients – a disease of supposedly unknown origin – also developing skin lesions within tattoos. According to one researcher, this is “a well-recognized occurrence in patients with sarcoidosis.”7) Ali reviews dozens of cases in which granuloma have formed, more often than not, years after the application of a tattoo.8) More than one case report describes how a patient developed sarcoidal granulomas in only one pigment of a tattoo9) – which suggests that the needle corresponding to that pigment was infected.

There are a number of explanations for how a tattoo could cause this reaction, but the most logical one is that tattoo needles introduce new pathogens into the skin. For one, the fact that sarcoid granuloma appear years after the application of a tattoo corresponds nicely with the length of time it takes for bacteria to grow.

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Ticks, what to do when bitten

Vaccines and TB tests

Main article: Vaccines and TB tests

A number of recent reviews emphasize that vaccines are safe, but there have been several examples of vaccines that have been contaminated by pathogens. The slow-growing nature of chronic pathogens means there may be more cases of contamination than we realize.

Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP) patients should work with their doctors to examine the costs and benefits of taking any kind of injectable preparation which contains substances synthesized from organisms.

Flu vaccines may be important to prevent acute infections, the acquisition of which can substantially set back progress on the MP or be life-threatening. Influenza vaccination is associated with a 50% reduction in the incidence of sudden cardiac death, acute myocardial infarction (heart attack), and ischemic stroke. Both heart attack and stroke have their peak incidence in winter months, which correspond to the time of year when cases of influenza also peak.10)

Patients should follow their doctors' advice regarding the immunizations they feel are essential.

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Issues regarding eligibility for the Marshall Protocol


Children with a range of diseases and conditions can be treated with the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP). There are more than a dozen in the study cohort who are doing well, and others who are being treated by family physicians, not regularly reporting. Benicar is approved by the FDA for use in children and adolescents 6 to 16 years of age.

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Pregnancy and fertility

Both olmesartan (Benicar) and minocycline, the two mainstay medications of the MP, are contraindicated during pregnancy and while breastfeeding. When used in pregnancy during the second and third trimesters, drugs that act directly on the renin-angiotensin system can cause injury and even death to the developing fetus.

When pregnancy is detected in women on the MP, they must discontinue olmesartan (Benicar) as soon as possible. Also, minocycline hydrochloride, like other tetracycline-class antibiotics, can cause fetal harm when administered to a pregnant woman.

Women who are contemplating pregnancy should consult with their physicians about treating inflammatory disease first. Women with inflammatory disease who are already pregnant should do everything possible to keep the level of 1,25-DPrimary biologically active vitamin D hormone. Activates the vitamin D nuclear receptor. Produced by hydroxylation of 25-D. Also known as 1,25-dihydroxycholecalciferol, 1,25-hydroxyvitamin D and calcitirol. down. This means diligent avoidance of ingested vitamin D and exposure to sunlight/bright lights.

Pregnant women must not use the Marshall Protocol (MP). The MP may be begun only after delivery and when the baby has been weaned.

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Main article: Disability

Some Marshall Protocol (MP) patients may be unable to work due to the severity of their symptoms. Some of them may be eligible to receive disability income through government-sponsored programs or private insurance.

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Donation of blood, bone marrow, organs or other tissues

All blood banks may not have strict regulations against donations from people with so-called autoimmune diseases or Th1 inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue., but given the known bacterial etiology, MP patients are advised not to donate blood, bone marrow, organs or other tissues.

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Sapkota AR, Berger S, Vogel TM. Human pathogens abundant in the bacterial metagenome of cigarettes. Environ Health Perspect. 2010 Mar;118(3):351-6. doi: 10.1289/ehp.0901201. Epub 2009 Oct 22.
[PMID: 20064769] [PMCID: 2854762] [DOI: 10.1289/ehp.0901201]
Sopori ML, Kozak W. Immunomodulatory effects of cigarette smoke. J Neuroimmunol. 1998 Mar 15;83(1-2):148-56. doi: 10.1016/s0165-5728(97)00231-2.
[PMID: 9610683] [DOI: 10.1016/s0165-5728(97)00231-2]
Sopori M. Effects of cigarette smoke on the immune system. Nat Rev Immunol. 2002 May;2(5):372-7. doi: 10.1038/nri803.
[PMID: 12033743] [DOI: 10.1038/nri803]
4) , 5)
Forchuk C, Norman R, Malla A, Martin M, McLean T, Cheng S, Diaz K, McIntosh E, Rickwood A, Vos S, Gibney C. Schizophrenia and the motivation for smoking. Perspect Psychiatr Care. 2002 Apr-Jun;38(2):41-9. doi: 10.1111/j.1744-6163.2002.tb00656.x.
[PMID: 12132630] [DOI: 10.1111/j.1744-6163.2002.tb00656.x]
Ghorpade A. Lupus vulgaris over a tattoo mark--inoculation tuberculosis. J Eur Acad Dermatol Venereol. 2003 Sep;17(5):569-71. doi: 10.1046/j.1468-3083.2003.00787.x.
[PMID: 12941097] [DOI: 10.1046/j.1468-3083.2003.00787.x]
Antonovich DD, Callen JP. Development of sarcoidosis in cosmetic tattoos. Arch Dermatol. 2005 Jul;141(7):869-72. doi: 10.1001/archderm.141.7.869.
[PMID: 16027303] [DOI: 10.1001/archderm.141.7.869]
8) , 9)
Ali SM, Gilliam AC, Brodell RT. Sarcoidosis appearing in a tattoo. J Cutan Med Surg. 2008 Jan-Feb;12(1):43-8. doi: 10.2310/7750.2007.00040.
[PMID: 18258148] [DOI: 10.2310/7750.2007.00040]
Meyers DG. Myocardial infarction, stroke, and sudden cardiac death may be prevented by influenza vaccination. Curr Atheroscler Rep. 2003 Mar;5(2):146-9. doi: 10.1007/s11883-003-0087-x.
[PMID: 12573201] [DOI: 10.1007/s11883-003-0087-x]
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