Dr. Stricker is president of the International Lyme & Associated Diseases Society (ILADS)/, and a member of the ILADS Working Group, which published ”Evidence-based guidelines for the management of Lyme disease” in 2004. Those guidelines consider chronic Lyme Disease a growing epidemic - and prolonged antiobiotic therapy a reasonable treatment for chronic infections. This article, first published July 31, 2006 in the
Hartford Courant, is reproduced with kind permission of the author.
A small group of scientists is turning the world of Lyme disease on its head. They deny the existence of chronic Lyme disease.
They insist there is no "credible scientific evidence" for persistent infection after a short course of antibiotic treatment because the corkscrew-shaped bacteria that causes Lyme disease, Borrelia burgdorferi, cannot survive this treatment. Fearing "over-diagnosis," they publish guidelines endorsing an insensitive testing program that misses half the patients with the tick-borne illness.
Fearing "over-treatment," they recommend antibiotic therapy barely adequate for acute infection and wholly inadequate for chronic Lyme disease.
Soon they will publish the latest version of an already restrictive set of guidelines that will further pressure the Centers for Disease Control and Prevention and academic institutions to ignore chronic Lyme disease. The guidelines will encourage insurance companies to embrace up-front cost savings inherent in shorter treatment and deny payment for longer treatment, even if the Lyme patient is still sick but showing signs of improvement.
Although the Lyme denialists claim support from mainstream medical groups, the reality is that the handful of them have managed to dictate policy to larger health care organizations through a closed process that rejects dissenting views. Unaware of this one-sided process, the rest of the medical industry blindly follows their lead while patients suffer.
Lyme disease is the most common tick-borne illness in the world. Named after the town where it was discovered in 1975, the disease is transmitted by the bite of an infected tick. Research has demonstrated that the Lyme bacteria is one of the most invasive and elusive pathogens known to man. After causing a telltale "bulls-eye" rash, the bacteria screws its way into multiple organs and tissues to produce often-debilitating muscle, joint, nerve, brain and heart ailments.
Although New England remains the epicenter of the disease, with up to 20 percent of new cases reported in Connecticut alone, Lyme disease and associated infections are popping up in new locations around the globe. Where you live doesn't accurately reflect your risk of catching Lyme disease because people travel on planes, trains and automobiles, while ticks travel on deer, birds and household pets. As a result, the risk of acquiring the disease is increasing unpredictably.
We know treatment is effective when instituted early, but fewer than half the people with Lyme disease even remember getting a tick bite or seeing a rash. The resulting infection may spread and become chronic before the victim has a chance to seek treatment.
Research over the past two decades suggests the key to eliminating chronic Lyme disease is prolonged antibiotic therapy. Lyme-treating physicians recognize this fact and studies support it.
The Lyme denialists refuse to accept this point of view.
Imagine if "AIDS denialists" had won out in the early 1990s. Doctors would have refused to prescribe antiviral medications and insurance companies would have refused to pay for them. How many millions of patients would have gone undiagnosed and untreated?
Sound scary? Welcome to the world of Lyme disease run by Lyme denialists.
Today many Lyme patients are going undiagnosed and untreated because of the Lyme denialist agenda. Although Lyme disease is usually not fatal, the disability associated with a chronic case is equivalent to congestive heart failure.
Health care providers, government agencies and Lyme patients must confront the Lyme denialists and fight for better recognition and treatment of Lyme disease.
Raphael B. Stricker, MD, is a hematologist and immunologist specializing in tickborne diseases. He is medical director of Union Square Medical Associates in San Francisco.
See also:Dr. Striker's recent article "Counterpoint: Long-Term Antibiotic Therapy Improves Persistent Symptoms Associated With Lyme Disease," Clinical Infectious Diseases, July 15, 2007.
"Lyme Disease & Chronic Fatigue Syndrome - A Patient-Researcher's Perspective"