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Monday, August 12, 2013

Chronic Lyme disease is subject of controversy.

The “Room For Debate” section of the New York Times (8/11, Subscription Publication, 1.68M) website focused on Lyme disease, which it explains has caused “bitter disputes...over how to treat it and whether the illness can become chronic.” In the first selection (8/11, Subscription Publication, 1.68M), Richard I. Horowitz, author of the forthcoming “Why Can’t I Get Better?: Solving the Mystery of Lyme and Chronic Disease,” writes that “con-infections” by “two newly discovered pathogens transmitted by ticks” – Borrelia miyamotoi and Powassan encephalitis – “explain why some people with Lyme remain chronically ill even after treatment.” Horowitz points to “a rapidly expanding list of other bacteria, viruses and parasites that are transmitted by tick bites,” that “are often transmitted along with Lyme disease” and “while the Lyme is identified and treated, these other infections are not.”

        Monica E. Embers, assistant professor of bacteriology and parasitology at Tulane University Health Sciences Center, writes (8/11, Subscription Publication, 1.68M), “our research on primates has shown that the Lyme-causing bacteria can physically remain even after antibiotic treatment.” She explains that “tests vary in reliability depending on when blood samples are taken and by the type of antibodies being tested,” so that what is needed are “tests that can be used to diagnose patients at all stages of this disease” including those that will allow physicians to “distinguish patients with ongoing infection from patients who have been cured.”

        Brian Palmer, a reporter who covers science and environmental issues for Slate and The Washington Post, writes (8/11, Subscription Publication, 1.68M), that “whatever the source of these symptoms, antibiotics are not the cure.” That can be seen in “trial after trial after trial,” in which “placebos have proved just as effective at alleviating the symptoms of ‘chronic’ Lyme disease.” He notes that “the majority of chronic Lyme patients show no evidence of infection.”

        Eugene D. Shapiro, a physician and professor at the Yale School of Medicine, and Gary P. Wormser, a physician and chief of the division of infectious diseases and professor at New York Medical College, agree, writing at the New York Times (8/11, Subscription Publication, 1.68M) website that some physicians use the term “chronic Lyme disease” to describe “a variety of long-lasting symptoms such as fatigue, without any evidence of infection from the Lyme-causing bacteria, Borrelia burgdorferi.” They argue that treating such patients “for a Lyme-causing bacteria infection in the absence of diagnostic evidence can’t be justified,” noting that they “are unaware of any controlled trials that demonstrate the efficacy of antibiotics” in such cases and “find no rationale for why antibiotics would be beneficial.”

        Richard S. Ostfeld, of the Cary Institute of Ecosystem Studies and author of “Lyme Disease: The Ecology of a Complex System,” argues (8/11, Subscription Publication, 1.68M), for a focus on reducing the tick population. He says that effective measures have been identified “that are highly lethal to blacklegged ticks, but safe for wildlife, people and pets,” and that used in combination, may reduce tick populations sufficiently. Lyle R. Petersen, director of the division of vector-borne diseases at the Centers for Disease Control and Prevention, New York Times (8/11, Subscription Publication, 1.68M) piece, calls for “A Community Approach to Combatting Lyme Disease,” focused on “tick reduction.” He contends that isolated efforts are insufficient so that a variety of strategies that cover neighborhoods or entire communities are necessary.

        Author Amy Tan, co-founder of LymeAid 4 Kids, which pays for the diagnosis and treatment of uninsured children who have Lyme disease, describes (8/11, Subscription Publication, 1.68M) her experience with Lyme disease. She credits antibiotics for her recovery but says that if she stops taking them, “the symptoms march back,” calling for “a new standard for diagnosis, treatment and insurance coverage for Lyme disease.”

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