Thursday, October 11, 2007
Chronic Lyme disease doesn't exist...?
This item suggests yet another example of mistaken causality in medicine, similar to AIDS, Mad-Cow, and a growing list ever since the days when the "slow virus" theory became popular over the older time-tested methods known as Koch's Postulates. If the same illogic applied to a murder investigation, you could be charged with a murder that happened today, because ten years ago you were observed visiting the dead person's house. Seems this conflict in medicine is the result of having thrown Wilhelm Reich's discoveries on bionous disintegration of cells onto the bonfires. I'm wondering how long it will take for these "dissenters in science" to be assaulted as "Lyme Deniers" and tarred as imbiciles and haters, followed by censorship of their words. J.D.
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http://www.newsday.com/news/health/ny-hslyme095407157oct09,0,2821438.story
Scientists say chronic Lyme disease doesn't exist
BY DELTHIA RICKS
October 9, 2007
In what is becoming one of the most heated debates in medicine, doctors, scientists and patients are lining up on two sides of a discourse about Lyme disease, an infectious condition whose incidence has risen sharply in recent years.
A prestigious group of physicians and scientists says there is no evidence that chronic Lyme disease exists, and that patients may be doing themselves more harm than good by undergoing prolonged antibiotic therapy.
The team wrote a report saying as much last week in the New England Journal of Medicine. Their analysis is of importance to New York, one of 10 states where Lyme is most often diagnosed.
Yet scores of people, told by their physicians that they have chronic Lyme disease, dismiss the report as biased and without merit.
Lyme disease is the most common of all vector-borne infections in the United States. Vectors include ticks, mosquitoes or fleas. In the case of Lyme disease, the vector is the Ixodes scapularis tick, or deer tick, which carries the bacterium Borrelia burgdorferi. Symptoms include fever, headache, fatigue and sometimes a skin rash. Left untreated, infection can spread to the joints, heart and nervous system.
Scientists at the Centers for Disease Control and Prevention estimate that 64,382 Lyme cases nationwide were reported between 2003 and 2005 and that 59,770 cases were reported in the 10 most affected states. Nearly 1,000 of those cases were reported on Long Island.
"This is very upsetting," said Eva Haughie of Manorville, adding that not only has she been bitten at least 45 times by ticks and their nymphs, or early-stage ticks, but that she has suffered with tick-borne infection since 1988.
However, a team of doctors who doubt "chronic Lyme" is genuine say using the term itself is a misnomer. Moreover, they say, prolonged use of antibiotics is expensive and dangerous.
The doctors cite drug resistance as one consequence and the destruction of the body's "good" bacteria as another.
Dr. Eugene Shapiro, lead author of the report and a professor of pediatrics and investigative medicine at Yale University, said more than 30 experts in infectious diseases participated in the research and support the conclusions. Co-authors include those from the CDC, Harvard Medical School and New York Medical College, home of Dr. Gary Wormser, who led a task force last year on development of new diagnostic and treatment guidelines.
Lyme disease is the most common of all vector-borne infections in the United States. Vectors include ticks, mosquitoes or fleas. In the case of Lyme disease, the vector is the Ixodes scapularis tick, or deer tick, which carries the bacterium Borrelia burgdorferi. Symptoms include fever, headache, fatigue and sometimes a skin rash. Left untreated, infection can spread to the joints, heart and nervous system.
Scientists at the Centers for Disease Control and Prevention estimate that 64,382 Lyme cases nationwide were reported between 2003 and 2005 and that 59,770 cases were reported in the 10 most affected states. Nearly 1,000 of those cases were reported on Long Island.
"This is very upsetting," said Eva Haughie of Manorville, adding that not only has she been bitten at least 45 times by ticks and their nymphs, or early-stage ticks, but that she has suffered with tick-borne infection since 1988.
However, a team of doctors who doubt "chronic Lyme" is genuine say using the term itself is a misnomer. Moreover, they say, prolonged use of antibiotics is expensive and dangerous.
The doctors cite drug resistance as one consequence and the destruction of the body's "good" bacteria as another.
Dr. Eugene Shapiro, lead author of the report and a professor of pediatrics and investigative medicine at Yale University, said more than 30 experts in infectious diseases participated in the research and support the conclusions. Co-authors include those from the CDC, Harvard Medical School and New York Medical College, home of Dr. Gary Wormser, who led a task force last year on development of new diagnostic and treatment guidelines.
Wormser told Newsday when the new guidelines were announced that 95 percent of Lyme disease cases are cured within 10 to 28 days with oral antibiotics. Long-term antibiotic therapy, he said, has not proven effective, and may be dangerous. The new research picked up the mantle from there.
"People who say they have chronic Lyme have symptoms, such as fatigue and aches and pains. The epidemiology is very similar to chronic fatigue syndrome and fibromylagia," Shapiro said yesterday. "It's also very similar to chronic Epstein-Barr infection, which people no longer believe in," he said of an infectious disorder that was commonly diagnosed in the 1980s.
Rather than calling the condition chronic Lyme disease, Shapiro and colleagues advocate referring to symptoms that persist for six or more months as post-Lyme disease syndrome.
Haughie wonders how doctors could be so callous.
She said tick-transmitted bacteria caused her to endure cognitive impairments similar to Alzheimer's disease and weakened her ability to walk and talk. Long-term antibiotic therapy, she said, helped her regain her strength and memory. She said doctors have prescribed antibiotics on-and-off since 1988.
Rosemary Markowsky, a patient in Manhattan, said she was apparently bitten in 1994 but it took more than a decade to get the correct diagnosis. "I was misdiagnosed for 12 years [and] now after 11 months of antibiotic therapy I am 90 percent better," she said.
Dr. Len Horowitz, an attending physician at Lenox Hill Hospital in Manhattan, said prolonged antibiotic therapy may be warranted for patients with advanced symptoms. "In the later stages, patients may even need intravenous [antibiotic] therapy because Lyme can progress from a simple infection to cardiac disease. The organism at this stage is more difficult to eradicate," he said.
In Wilton Conn., Dr. Steven Phillips, past president of the International Lyme and Associated Diseases Society, said he's dismayed that Shapiro's report appeared in such an influential journal. "It was biased and without merit," he said.
But even though Phillips said chronic Lyme disease is real, he acknowledged that no one knows how many patients are affected. "Everybody defines chronic Lyme differently," he said. "I define it as people who keep relapsing."
Finding a vaccine
1975 First cases of Lyme disease reported.
1981 Microbe identified.
1981 Microbe identified.
1988 Lyme Disease Foundation founded.
1989 The outer surface protein, OspA, found and cloned.
Early 1990s Antibodies to OspA found in many chronic Lyme disease patients.
1990-1992 Vaccinations with rOspA found to protect mice against Lyme disease infection.
1992-1995 Vaccinations with rOspA tested in other animals.
1995 Lyme vaccine found safe and effective in people with Lyme disease.
1995-1998 Vaccine found safe and effective in people without Lyme disease.
1998 FDA approves Lyme vaccine.
SOURCES: National Institutes of Health; Brown University
Early 1990s Antibodies to OspA found in many chronic Lyme disease patients.
1990-1992 Vaccinations with rOspA found to protect mice against Lyme disease infection.
1992-1995 Vaccinations with rOspA tested in other animals.
1995 Lyme vaccine found safe and effective in people with Lyme disease.
1995-1998 Vaccine found safe and effective in people without Lyme disease.
1998 FDA approves Lyme vaccine.
SOURCES: National Institutes of Health; Brown University
Related Item:Delivery
Report angers patients suffering with chronic Lyme
http://www.newsday.com/news/health/ny-hsside095407158oct09,0,209183.story
BY RIDGELY OCHS
October 9, 2007
Bob Levine doesn't understand why chronic Lyme disease has become such a divisive issue in the medical community.
"It's become a holy war," he said. "It is an issue of who's right and who's not, and the patients are stuck in the middle."
A review in the latest New England Journal of Medicine arguing that there is no evidence chronic Lyme exists and that the use of long-term antibiotics to treat it may be harmful frustrates the 50-year-old engineer from Port Jefferson.
Levine said he has been on and off antibiotics since 1998 to treat an array of symptoms, which he attributes to chronic Lyme disease. He said he has stopped using antibiotics "dozens" of times, only to have his symptoms - headaches, double vision, mental confusion, tingling, numbness and involuntary muscle twitching - return within six weeks and disappear again when he resumes the oral antibiotic Biaxin.
"It has ruined people's lives," Levine said of the disease. " ... All these people can't be head cases, including me."
Levine said he has been on and off antibiotics since 1998 to treat an array of symptoms, which he attributes to chronic Lyme disease. He said he has stopped using antibiotics "dozens" of times, only to have his symptoms - headaches, double vision, mental confusion, tingling, numbness and involuntary muscle twitching - return within six weeks and disappear again when he resumes the oral antibiotic Biaxin.
"It has ruined people's lives," Levine said of the disease. " ... All these people can't be head cases, including me."
Levine, who feels many of the researchers are arrogant, and others say they are perplexed by what they see as the narrowness of many doctors and researchers, who, because they don't understand the complexity of the long-term disease, dismiss it as nonexistent.
Colleen Nicholson of Bayville, a military spouse who is a patient advocate for military families who have been denied long-term antibiotics, said she believes many doctors ignore much of the research that has been done and have little hands-on contact with chronic Lyme sufferers.
"They are basically telling me my symptoms aren't caused by anything," said Nicholson, who, along with her two sons, is on long-term antibiotics. "They are self-proclaimed experts but they don't treat Lyme."
Levine said he worries that this latest review will put more pressure on doctors who treat patients like him - he would not reveal the name of his doctor. And he is concerned health insurers will begin to deny coverage. He estimated it would cost him $500 a month out of pocket for his antibiotics.
But regardless, he said, he will get the drugs. "I'll always find a way to get antibiotics," he said. "It's other people who don't have the resources I have pity for."
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