Town declares science wrong, science not impressed

A "fan" on twitter sent me the crushing news that all I believed about the science of Lyme disease is wrong. Unlike many fans, he cited a source, a well-known New England publication. The New England Journal of Medicine? Nope. The Darien (CT) Times.

According to the headline, "surveys refute national Lyme disease findings." So they must at least be quoting a science publication. Right?

Actually, they are quoting the famous work of one Kent Haydock, chairman of the Deer Management Committee. How did he accomplish this astonishing first act in what will no doubt be a stunning scientific career?

He showed the agitprop Lyme advocacy film Under Our Skin to 41 local families and then asked them if they had signs of Lyme disease and if it was ruining their lives. Not surprisingly, the answers to both questions were "yes" a remarkably high percentage of the time.

Once I stopped laughing at the credulity of the reporter, I sat amazed, staring at the screen---amazed not just that a paper could print such a thing without even a winking smiley, but shocked that the paper thinks so little of Connecticut's readers. That anyone thinks that a cheap propaganda piece by the "deer committee" is anything resembling evidence shows a big gap in our system of science education. In the discussion of Lyme disease, this article not only adds nothing, it "endumbens" the dialog. For shame.

(I can't wait to get a copy of Sheril and Chris's new book!)

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That leads to the pending legislative bill currently in front of the state Senate that would ensure doctors will not face retaliation for diagnosing and treating a chronic Lyme case with long-term antibiotics.

The bill was passed in the state House of Representatives 137-0.

âChronic Lyme disease remains unrecognized by the Infectious Disease Society of America, because they say, they have no published data on it,â Haydock said. âThe film presents heart-rending evidence of chronic Lymeâs impact on suffering families, and shows how some physicians have been censured for providing long-term treatment.â

"Heart-rending evidence". Mmmm hmmm. Not statistically incontrovertable evidence, but heart-rending evidence.

and right next to it is this google ad . . .

By Pareidolius (not verified) on 07 Jun 2009 #permalink

The blockquote should have extended down to the quote from Haydock.

By Pareidolius (not verified) on 07 Jun 2009 #permalink

That's funny, I read your article and once I stopped laughing at the credulity of your reporting, I sat amazed staring at the screen--amazed not just at that a website could post such a thing without even a winking smiley, but shocked that the website thinks so little of it's readers. That anyone thinks this is a cheap propaganda peice by the "deer committee" and isn't showing evidence shows a big gap in our system of science education. In the discussion of Lyme Disease your article not only adds nothing, it "endumbens" the dialog. For shame.

Science: systematic knowledge of the physical or material world gained through observation and experimentation.

By Fight to be Right (not verified) on 07 Jun 2009 #permalink

This may be a stupid question, but who the hell is the Deer Committee and why do they give a shit? They are not the public health officials, and hunting licenses are regulated at the state level, not the town level. That is, even if a bunch of prodnoses and busybodies wish that their town had more hunters and fewer walking venison, the money from hunting licenses and the number of hunting licenses issued is in no way directly routed to their town. If the rationale is that they have too darn many deer and they want to organize a cull, they can do that without legislative assistance.

Although you know what I've found really helps keep the ticks at bay in New England? Turkeys. Seriously, they eat ticks like mad. Maybe CT should give the turkey hunters a rest for a few years.

They should have read about Stalin and Lysenko . . .
The politburo has deecreed that Mendelian DNA is the bunk and Lysenko was right!

We know you're frightened of the scientific facts:

Kathleen honey, your website is just a few tinfoil hats short of, so I don't think anybody here is going to take you you too seriously.

By Pareidolius (not verified) on 07 Jun 2009 #permalink

I was sick with Chronic Lyme Disease for 6 years until I completed a treatment involving 4 grams of Ceftriaxone 4 days a week for 3 months. I proved science wrong ;-)

Your article is so outrageously arrogant and inaccurate, You Sir, are the joke, and I am not laughing at the credulity of your reporting. I find it interesting you describe yourself as "one who likes to communicate joy to others.", while making such snide and demeaning comments in your "post." I suffer from Chronic Lyme Disease and Bartonella, something you probably never heard of, even as an MD, because it is a lesser known co-infection and because clearly your investigative skills are so sadly inadequate. Nor do you care, apparently.
Under Our Skin is right on target. I found it interesting you forgot to mention that legislation in Ct. has recently passed to protect Dr.'s from having their licenses suspended for prescribing long term antibiotics. Clearly you have not done your research with an openmind....and it shows. Mocking a film that is so accurate for so many of us who suffer from this disease, is hurtful, demeaning and sad. Clearly, you are not aware of how deadly this epidemic is, nor will you,until you unfortunately have a loved one who has been touched by this disease. I wouldn't wish that on the Devil himself, never the less an uneducated, arrogant and illiterate Lyme M.D. as yourself.

LOL Fight to be Right, and it is a scientific fact Palmd is afraid of science that doesn't support his quackery.


your website is just a few tinfoil hats short of

LOL. That made my morning.

By the bug guy (not verified) on 08 Jun 2009 #permalink

"A practicing internist" says it all. When you are a real MD you will learn that acquiring expertise is a lifelong exercise, and that ignorance and arrogance can keep you from finding the truth you seek, if, indeed, you are seeking the truth.

Yup, PalMD, just keep practicing and one day you'll get it right! Then you'll see how all these things you thought were wrong (reiki, chiropractic, CLD) are really The Truth!

By Dave Ruddell (not verified) on 08 Jun 2009 #permalink

the dissemination of knowledge on lyme disease is so critical that any study suggesting the need for increased awareness or treatment or whatever at least raises a question in the minds of MDs and those who have unrecognized lyme disease. just this weekend my neighbor told me she had a tick bite (we live in an endemic area)but she wasn't worried as the rash did not look like a bulls eye. i am too tired to even explain that many do not get a rash whatsoever and that she should go get doxy antibiotic ASAP just-in-case because no one who hasn't had the experience can understand how bad undiagnosed lyme can be. 30 to 45 days of immediate antibioitc treatment can prevent so much suffering...but combating the ignorance of the MDs and the media is just too much. In the end, you just realize you can only heal yourself. PalMD, whose pal are you anyway?

By denise cordes (not verified) on 08 Jun 2009 #permalink

Noticeably absent from the dissenting comments: any credible evidence from scientific studies to support their opinions.

By Harriet Hall (not verified) on 08 Jun 2009 #permalink

As always, Harriet. As always.

@13: Your insult betrays either ignorance or sloppy reading. Use Google to look up the word "internist." Hint: it is not the same as "intern."

To everyone else who casually assumes that PalMD has no idea what he is talking about, check out his blog history before you make a fool of yourself. Yes, he knows about the CT legislation. Yes, he's familiar with ILADS. Open-minded, educated people can, in fact, reach different conclusions from you after analyzing the same data. The interesting question is why do the data not convince this physician?

@14: PAL never denied the existence of Lyme Disease or effectiveness of immediate antibiotic treatment. In fact, he reiterated these points many times in the past, including the fact that in many cases rash does not appear. He does have a problem with continuous claims that long-term antibiotic therapy has any effect on the alleged chronic lyme disease years after the original diagnosis.

When so many accusatory, ad hominem, dismissive comments flood a blog or an article discussion, it is often a sign of a network. The chronic Lyme network resembles the chronic fatigue (CFS), multiple chemical sensitiovity (MCS), anti-vaccination, Morgellon's networks; usually of alienated and resentful people who believe they have found answers to their conversion, somatization-type reaction in phantom illnesses.
The illnesses come and go, but the symptoms and accusations remain the same over decades and now a century or more.
Their error is known as error of causality (ad hoc, ergo...) thinking. The most common logical human error.
The accusing commenters here will not be swayed by evidence or by anything less than a thorough revision of personal belief systems. They would all flunk basic courses in biology and medicine and basic psychology if their answers to questions were based on their beliefs;
not because medicine and biology are wrong or because of a political-economic conspiracy or of stupidity or rigid elitist thinking. It's because science and medicine tell it like it is. Resistant minds have too much at stake to yield belief. It's political.
Commenters: One can start with a basic psychology text (or upper division 101) and the book, "From Paralysis to Fatigue" (by Shorter - a professor of history.) Then American Nervousness and other histories of somatization.
The problem is you.

By Wallace Sampson (not verified) on 08 Jun 2009 #permalink

Thanks for the insight...well I like this gal [promotional woo site] because she doesn't get into the political side of Lyme Disease.

By Jill Jackson Barrows (not verified) on 08 Jun 2009 #permalink

@21: I didn't realize Lyme Disease had a political side to it.

As a fellow internist (a facuty member at an academic institution, not a doctor in training or "intern") just thought I'd throw in my 1) support for PalMD, 2) my shared incredulity that this unscientific survey is being reported as science (what was the n, standard error, sample of the survey, methods of statistical analysis, was this a pilot study?), 3) a link to the ISDA recommended guidelines for Lyme disease (Borrellia burgdorferi) treatment:

Best regards,

PharmGirl, MD

By PharmGirl MD (not verified) on 08 Jun 2009 #permalink

Thanks, PharmGirl!

I am amazed that anyone could not have their interest in chronic lyme disease by the cases of suffering patients that were in Under Our Skin. Just maybe there is more to learn about Lyme! When you close your mind to learning you are no longer efficient or leading the discovery of cures and no longer helping all who need you. I had a rash in 1991 and was tested by the usual Lyme test (in fact, I have had 4 or 5 of that same test over the years 1991 to 2007)and received the results as negative (all the tests). We KNOW the test is only useful and true 50% of the time. SO WHY USE IT? Over the years going to the doctors saying something is terribly wrong--my life is altered and I cannot use my new degree that I worked hard to acquire (age 44 to 52-went back to college). I have been receiving help as a Fibromyalgia/Chronic Fatigue patient but nothing was working. I am getting so bad I had to use a wheelchair at a recent museum trip. What are we supposed to do? Why can't we see a change? I was given the Western Block test in July 2007 and received the positive diagnose for Lyme by the end of August. Now, I am on treatment, but because of the stubborness of doctors and the existing protocol for Lyme so stuck in the mud that patients are sunk and in despair, I am most likely not going to be healed. The damage is so bad my neuropathy is taking over. The pain and exhaustion is horrible and has altered my life to much less than I ever thought possible. I planned to use my degree to help at risk students and to always "make a difference" but instead I am really not well enough to keep up at home. I do one outside thing one day and am down for two afterwards. I am thankfully on treatment but it takes catching the Lyme bacterium that has been dormant when it comes out and activates and I fear there is no real way to reverse the damage but at least I have treatment to keep it from progressing. I hope. HELP us. Learn all you can. I just don't see how you can argue with the nuclear microscope video of the bacterium hiding in a thick mucous. WHY? I don't understand with the hundreds of patients who have been helped with their chronic LYME. Your article is horrible and leads us down the dangerous path of no treatment and no way to discover all we can about the Lyme bacterium. PLEASE look at the Under Our Skin movie again scientifically! I can see it is irrefutable and MUST be entered into data in order to stop this epidemic. PLEASE!

By Arlene Nason (not verified) on 08 Jun 2009 #permalink


First off let me say I am sorry that you are suffering so badly. I hope you get better.

Secondly, if you wish to get people to hear your message may I suggest you learn to use paragraphs.

Lastly, if there is one thing I have leaned from Mark Crislip's podcasts it is this: The plural of anecdote is anecdotes; not data.

Anecdotes (or better yet case studies) can suggest hypotheses but these need to be tested scientifically. So far no-one has done this published the papers that would convince PalMD, Pharmgirl MD and others. Until they do I fail to see what you want them to do.

Damn it! I knew I was reading the wrong New England publication! I am going to call my library in the morning and ask them to subscribe to The Darien Times! Although, if you'll remember correctly, I sometimes think that other New England publication is crap too...

Still, this is a breakthrough for me!!!I have been embroiled in this debate over a particular topic for the last year and have not been able to gain any headway. I think that what I need to do it just to start showing pictures of my stuff to folks and see if they believe it. If I can get enough people to buy it, BOOM, I win.

There is so much wrong here. The science advocates have already addressed most of it though, and PalMD has already written posts debunking most of the shouting here already. But I'm bothered by this:

I suffer from Chronic Lyme Disease and Bartonella, something you probably never heard of, even as an MD, because it is a lesser known co-infection and because clearly your investigative skills are so sadly inadequate.

I'm a mere third year med student, and I'm still very aware of Bartonella.
Are you saying you have Cat Scratch disase, endocarditis, angiomatosis, or trench fever?
Are you suffering bartonella sepsis (if so, good job blog posting from the ICU!)

Because that's the major illnesses various bartonella species I know about cause. Or are you saying you have not 1, but 2 diseases that science doesn't think exist?

Wow, it's a "who's who" of science-based medicine in this thread. Just a couple more and we'll have the whole set.

Palmd hasn't debunked anything, and we will soon debunk him! You dr's that listen to IDSA, should listen to just for a min. There are publishinsgs if you cared enough to look. Unfortunetly you probably won't untill you are touched by this disease wich may be soon.

After you get sick and finish your First round of antibiotic, you will feel better and thank God you got your health back and that the antibiotics had helped you. Then suddelnly a few months later you are sick again, feeling the same way you did before but oddly the symptoms seem a bit more intense.

After your Second round of antibiotic you feel better again. Thanking God once more and moving on blaming yourself for maybe not taking your antibiotics correctly, after all the dr's say you are cured because they treated you correctly, even refusing to test again.

O.K. you thinks to yourself, it must be all in your head. You begin to educate yourself on this disease because you know your not crazy. You find alot of information confirming your worst fear. You now know you are still infected but won't be able to get the help you need.

It has been three years of ups and downs. trying to live healthy, work, raise a faimily and suddenly your body literally shuts down, you can't get out of bed, it hurts from head to toe and you can't think straight. Obviously something is very wrong.

You know what is wrong and you know what you need. You know you are not crazy and you feel like you did three years ago when you first got sick but only worse. You know the antibiotics made you better for a little while, maybe I didn't get enough for long enough.

I was lucky to find a doctor that was going through the same thing. He did testing to cover his but, and thankfully knew who should do the testing. Yep, sure enough, a beyond cdc required positive. I knew I wasn't crazy!!

Back on antibiotic treatments, antibiotic therapy, and I soon can get out of bed, walk, and think a little better. Slowly but surely I am getting better. I will continue treatments for a long time. The IDSA is wrong, thank God for ILADS, they saved my life.

For those of you that are suffering, don't listen to these dr's, listen to yourself. You are not crazy and just because they like to remain ignorant doesn't make us crazy. There are more of "us" than "them" and soon the "them" will become "us". I only hope they will admit it before it kills them.

I like your blog, Pal. Your comments section is wackier than mine. I want to come play over here with "these dr's."

"There are more of "us" than "them" and soon the "them" will become "us". I only hope they will admit it before it kills them."

US vs. THEM, the staple of crankery.

I was a solo family medicine practitioner in CT (right next to Lyme, actually) for 8 years. Despite my location at ground zero, and the reputation of the area for having a heaping helping of "Borreliosis neurosis", I was always pleasantly surprised at how laid back most people were about this. I often gave people the option of taking a single 200mg dose of doxy for treatment of a tick bite with no other symptoms - and many declined, preferring to wait and see.
The chronic Lyme issue came up only a hand full of times in 8 years. I had one woman who repeatedly got rashes on her legs and called it "Lyme disease". Happily, the venous stasis and recurrent cellulitis that she actually had was ammenable to doxycycline.
I did see several cases of neuro-Lyme presenting as dementia which partially reversed after a few weeks of IV treatment, and many cases of Lyme arthritis, erythema migrans, and a few heart blocks. The vast, vast majority were treated appropriately, got better, and never had another problem (unless they got bit again).

By Dr. Steve (not verified) on 09 Jun 2009 #permalink

Wow. More random threats and vitriol from the crazies. Why do they always fall back on "I hope you get it and die" threats when faced with their own dishonesty?

Rhetorical question...

By LanceR, JSG (not verified) on 09 Jun 2009 #permalink

Here is a crazy question:

You have three ant hills, one very small, one a bit bigger, and one being big.

You have 3 cans of ant killer, apply one can to each hill.

The very small hill of ants are destroyed, never to rebuild again.

The one a bit bigger is partially destroyed, but in time will grow back to size.

The one that was big, wasn't affected much at all and continued growing at a fast pace.

Since the small hill was totally destroyed by one can, 2 cans will destroy the one a bit bigger.

How many cans will you need to destroy the big one and keep it from rebuilding again? Three or more? or a lifetime battle?

Your parable eludes me

I'll probabaly call an exterminator.

I took Step 1 of my medical boards a little while ago. One question was to provide the most likely diagnosis for a patient whose description read like the diagnostic criteria for CLD. I went with the (I hope) correct answer of "somatization disorder", although Lyme disease was an option.

By Xerxes1729 (not verified) on 09 Jun 2009 #permalink


Your parable of ant hills is incorrect treatment for insects.
Similarly, your suggestion of treatment for lyme disease is equally incorrect.

Additionally, there is a reason we're all so reluctant to listen to your idea that continous stream of antibiotics will help.
It's called antibiotic resistance. Giving a patient a continous stream of antibiotics leads to resistant bugs. That's how we get things like MRSA, and VRE. I suggest you google those terms to expand your google PhD

The Chronic Lyme nuts are breeding more antibiotic-resistant microbes. They will die of MRSA sepsis before they will ever admit they're wrong. Problem is, they'll take out entire hospital wards of grandparents and preemies in the process.

It's not bad enough that they're crazy -- they're dangerous, too!!!

/btw, even community college nursing students taking Microbio 1 know what Bartonella is.

By Rogue Epidemiologist (not verified) on 09 Jun 2009 #permalink

I suggest you google those terms to expand your google PhD

Don't talk shit about the PhD, dude. He is clearly studying for the Google MD.

Why are these dr comments all sarcastic and insulting?

Re #35's ant problem

I say take off and nuke the entire site from orbit.

It's the only way to be sure.

Kent Haydock is an earnest 80-year-old-citizen concerned enough about deer overpopulation to do something about it. There have been a number of fatalities in his town this year due to deer-car collisions. Lyme disease and destruction of nearby forest are two other unfortunate side effect of our ecology out of balance. Kudos to him for doing something about a problem that his local government has been ill equipped to handle.

For another take on the state of Lyme disease research, check out the interview I just posted by Willy Burgdorfer, Ph.D., M.D., and Scientist Emeritus at the National Institutes of Health (NIH). Dr. Burgdorfer is the discoverer and namesake of the spirochete (a type of bacterium) that causes Lyme disease, called Borrelia burgdorferi. He has received numerous awards, including the Robert Koch Gold Medal, the IDSA Bristol Award, the Schaudinn-Hoffman Plaque, and the Walter Reed Medal.

"Lyme discoverer Willy Burgdorfer breaks silence on heated controversy"

Sarcasim and insults only bring this debate to a lower level; and is not impressive in any way. Where are your science based evidence against CLD. There is not a test for cure, so where is the evidence that it does not exist?

How can it be dissmissed because we need to research more. It may not be able to be seen in the blood always, but that doesnt mean it is not in tissue, able to reproduce and move around entering the blood again. Maybe that is why symptoms come and go.

There is evidence of a flare of symptoms as well during antibiotic treatments, a "die off" period also known as "Herxing" Jerich Herxhiemer reaction. A very physical reactin including high fever. Would that happen if there wasn't anything dieing off?

Today's sientific evidence doesn't prove people are crazy, so go and learn something and keep your sarcasm and insults to yourself.

It may not be able to be seen in the blood always, but that doesnt mean it is not in tissue, able to reproduce and move around entering the blood again.

I can haz evidence, plz? kthxbai

What possible mechanism could account for this? Did you read this in the prestigious SDGIMIAB journal?

When ignorance is trumpeted over science, and the argument from incredulity is given precedence, sarcasm is the only viable response. When you learn *how* diseases work, you may be able to understand *why* we dismiss this chimeric "Chronic Lyme Disease".

By LanceR, JSG (not verified) on 10 Jun 2009 #permalink

The scientist that discovered the bacteria said hit hides in tissue, I believe him more than you, you still haven't proven it doesn't exist.

"... you still haven't proven it doesn't exist."

Nor have you proven that a dragon isn't living in my closet. I hope everyone believes me rather than you.

The scientist that discovered the bacteria said hit hides in tissue

I don't believe he said what you think he said.

And the Invisible Pink Unicorn (pbuh) gambit never really works.

By LanceR, JSG (not verified) on 10 Jun 2009 #permalink


By MonkeyPox (not verified) on 10 Jun 2009 #permalink

Jo Anne, the Jerich Herxhiemer reaction would occur even from gut bacteria being killed by the antibiotics. Since there are more bacterial cells in a person than human cells, a Jerich Herxhiemer reaction is not unexpected even if no disease organisms are present.

My suspicion is that it is the immune system stimulation from the Jerich Herxhiemer reaction that is "therapeutic" when antibiotics are given for what is called chronic lyme. It is the NO from the iNOS expressed in response to the Jerich Herxhiemer reaction.

I explain that in my post on Morgellons, which I think is essentially the same as what is called CLD.

A common bacterial infection replicates every 20 minutes that is 3 times an hour or 72 times a day and the medical establishment regularly treats that infection with a 10 day course of antibiotics. That is a total of 720 bacterial replication cycles.

The Lyme Spirochete replicates once every 24 hours. In many cases the medical provider does not know how long the patient has had the condition. If the Lyme has been undiagnosed or misdiagnosed for a year or two, then the symptoms are frequently misdiagnosed as ALS or MS.

It is completely logical for practitioners to treat a long term Lyme infection for the same 720 replication cycles. Treating a patient for 30 days or even 60 days would be like treating a bacterial infection for half of a day or maybe a full day. It is not enough.

720 replication cycles would be over two years of antibiotics

By treatlyme (not verified) on 11 Jun 2009 #permalink

Thank you for more impressive, informative comments, I wasn't coming back again. I have CLD or whatever name you want to give it. (cld,fibro,cfs,als,ms,/'itis,'osis,syndrome, etc.) There are alot of people experiencing the same horrible thing, all with history of Lyme bacterial infection. How can it be they are all crazy?

We can't just say they are crazy, more research is needed. We need to prove it is something. I would be more than glad to donate any part of my body that won't kill me. When I die, I hope that they learn something.

I want to listen and learn everything on this controversy, do you have links to your comments?

Ooh... that's gonna make 'em mad, daedalus. "Hallucinatory"? Such inflammatory language! [/sarcasm]

By LanceR, JSG (not verified) on 11 Jun 2009 #permalink

And why would we define treatment algorithims based on "replication cycles"? Generally empiric studies are considered the appropriate way to determine antibiotic dosing guidelines. Please provide citations from peer reviewed journals, not from newspapers with your answer.

An example:

Dearest goddess, please forgive my humble error.
The google MD is a far less recognized degree, I was afraid they wouldn't get the joke.

Would that happen if there wasn't anything dieing off?

Yes. It's called drug fever.

And, while I'm being pedantic, it's dying not dieing. Don't worry, I make that mistake myself all the time. Not the drug fever mistake, or the misunderstanding science mistake, just the spelling error.

I think âhallucinatoryâ is the more correct term. When someone has âphantom limb painâ, it isnât called âdelusional limb painâ, even though everyone knows that there is no limb to feel pain and even though the patient canât be reasoned out of his/her belief that they feel pain. To my understanding, the term delusion is never applied to phantom limb pain. The only instances of âdelusional limb painâ appearing in Google are from comments I have made using the term.

Acute low ATP causes hallucinations. Alcohol withdrawal does, cocaine abuse does, hypoglycemia does. Why are hallucinations of creepy-crawly things in your skin unexpected? Look for the final common pathways and you will likely find the physiology that is affected by these conditions. I think the final common pathway is low NO.

I have no desire to make anyone mad, and I don't think that anyone of good will does.

Actually I found it quite interesting, He not only said what he believes, but explained it without being sarcastic or insulting. I am interested in learning more about it and how it may be a factor in my suffering.

From my experience on psych, it's a hallucination if they have a sensory experience without a sensory stimulus.
We call it a delusion if a patient has a fixed, false belief. As that applies to delusional perceptions, the patient has a fixed, false belief misinterpting an existing stimulus incorrectly.

On psych when we had a lecture that touched on delusional parasitosis, they emphasized that patients with delusional parasitosis were misinterpreting normal sensations (like their clothes touching their skin, or wind/fan drafts) as parasites crawling on their skin etc.

I don't have a paper in frontof me or anything, but we discussed setting off their delusion by inducing stimuli. The same does not apply to patients hallucinating, if you touch them, they don't suddenly start feeling bugs.

It's kind of a crappy designation, and sometimes it feels pretty arbitrary, but to the best of my knowledge, that's the convention.

I think a lot of doctor's skepticism about chronic Lyme infection comes from placebo-controlled trials where people with persistent symptoms after Lyme infection were randomised to IV antibiotics or placebo and there was no difference in outcome. Like this one:
Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease.Klempner MS, Hu LT, Evans J, Schmid CH, Johnson GM, Trevino RP, Norton D, Levy L, Wall D, McCall J, Kosinski M, Weinstein A.
New England Medical Center and Tufts University School of Medicine, Boston, MA, USA.

BACKGROUND: It is controversial whether prolonged antibiotic treatment is effective for patients in whom symptoms persist after the recommended antibiotic treatment for acute Lyme disease. METHODS: We conducted two randomized trials: one in 78 patients who were seropositive for IgG antibodies to Borrelia burgdorferi at the time of enrollment and the other in 51 patients who were seronegative. The patients received either intravenous ceftriaxone, 2 g daily for 30 days, followed by oral doxycycline, 200 mg daily for 60 days, or matching intravenous and oral placebos. Each patient had well-documented, previously treated Lyme disease but had persistent musculoskeletal pain, neurocognitive symptoms, or dysesthesia, often associated with fatigue. The primary outcome measures were improvement on the physical- and mental-health-component summary scales of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36)--a scale measuring the health-related quality of life--on day 180 of the study. RESULTS: After a planned interim analysis, the data and safety monitoring board recommended that the studies be discontinued because data from the first 107 patients indicated that it was highly unlikely that a significant difference in treatment efficacy between the groups would be observed with the planned full enrollment of 260 patients. Base-line assessments documented severe impairment in the patients' health-related quality of life. In intention-to-treat analyses, there were no significant differences in the outcomes with prolonged antibiotic treatment as compared with placebo. Among the seropositive patients who were treated with antibiotics, there was improvement in the score on the physical-component summary scale of the SF-36, the mental-component summary scale, or both in 37 percent, no change in 29 percent, and worsening in 34 percent; among seropositive patients receiving placebo, there was improvement in 40 percent, no change in 26 percent, and worsening in 34 percent (P=0.96 for the comparison between treatment groups). The results were similar for the seronegative patients. CONCLUSIONS: There is considerable impairment of health-related quality of life among patients with persistent symptoms despite previous antibiotic treatment for acute Lyme disease. However, in these two trials, treatment with intravenous and oral antibiotics for 90 days did not improve symptoms more than placebo.

By Dr. Steve (not verified) on 12 Jun 2009 #permalink

Borrelia species have several other characteristics that make them a challenging pathogen. They can reside and grow intracellularly (inside the cells); out of reach of the hostâs immune system. By rotating their filaments, the spirochetes are able to move throughout the body in a corkscrew fashion; invading tissue, penetrating cells, replicating, and destroying the host cells they infect. The spirochetes hide their flagella, which are normally antigenic, from the host immune defenses. As Borrelia emerge from host cells they can wrap themselves with the membrane of the host cell, thus concealing themselves from the hosts immune system.

Borreliaâs ability to grow slowly and avoid attack by the hostâs immune system makes it a difficult pathogen to destroy. Not only can borrelia evade the host immune system, but often will suppress it as well.

Itâs also important to remember that borellia can go dormant in the body for lengthy periods of time. Then it can return to cause disease at any time.

Info from a real scientist/MD..

My favorite part, Jo Anne, is his link to the Marshall Protocol.

What a fucking criminal.

By MonkeyPox (not verified) on 12 Jun 2009 #permalink

Why? Have you met him, are you ill?

A veterinarian? That's who you cite? A vet??? SRSLY?

Daedalus2u may be wrong... delusional is the better term.

This is called "false experts". Don't like the science? Find a vet *snicker* or other unqualified person that agrees with you. It is a form of lying.

By LanceR, JSG (not verified) on 12 Jun 2009 #permalink

He is sick with disease and the bacteria is in animals as well. I knew and believed what he is saying before I read his article. I live and feel it everyday, antibiotics got me out of bed and walking after 28yrs from being bit and feeling fine. I definetly would not be better if I only had antibiotics for 4-6 weeks.

"Medicine is learned by the bedside and not in the class room. Let not your conception of manifestations of disease come from work heard in the lecture room or read from the book: see and then research, compare and control. But see first."
- Sir William Osler, MD
The Father of Modern Medicine

This is called "false experts". Don't like the science? Find a vet *snicker* or other unqualified person that agrees with you. It is a form of lying.

When I say "You are wrong, here is why, and oh BTW, you're an idiot", that is not an ad hominem attack. Ad hominem is saying "You're an idiot, therefore you're wrong".

Let's keep our fallacies straight, shall we? "False experts" is a very common fallacy in these sorts of discussions. So is crying "that's ad hominem! You called me an idiot! I win!!"

By LanceR, JSG (not verified) on 14 Jun 2009 #permalink

Jo Anne, That is a very interesting paper. My interpretation is not that the presence of the bacteria is causing the disorders, but rather that what is causing the disorders is also causing those intracellular infections to persist.

The normal way that cells rid themselves of unwanted intracellular guests (i.e. everything not synthesized by the cell itself is via autophagy).

If you ramp up autophagy and increase the turnover of cellular contents, everything that the cell needs, it can make de novo so long as the nuclear and mitochondrial DNA remains intact.

The turnover of cellular contents requires ATP to operate the proton pumps that acidify the lysosome and drive the pH gradient that drives transport into the lysosome and that activates the lytic enzymes that degrade everything.

A high ATP level in cells facilitates that. The ATP level is regulated by NO, high NO means high ATP. During sepsis, the NO level becomes very high, so does the ATP level.

Multiple bouts of fever was used to treat intracellular infections such as neurosyphilis. In many cases clinical resolution of the neurological symptoms was not accompanied by complete clearance of the infection.

Low NO inhibits autophagy by lowering ATP levels, and also by causing the oxidation of the ATP powered proton pump. I think that low NO is the final common pathway between the brain fog of disorders characterized by neuroinflammation that what is called CLD. The presence of an infection is unnecessary for the neurological symptoms, neuroinflammation all by itself will do it.

The Lyme vaccine was abandoned because of problems with autoimmunity. Autoimmunity does cause neuroinflammation in rheumatic fever which causes neurological symptoms such as Sydenhamâs chorea. Other infections can cause neurological symptoms through autoimmunity. Toxoplasmosis is reported to. If those symptoms are mediated through autoimmunity, the continued presence of the organism is not necessary.

"Medicine is learned by the bedside and not in the class room. Let not your conception of manifestations of disease come from work heard in the lecture room or read from the book: see and then research, compare and control. But see first."

Ah yes, the patient rebuking the physicians with Sir Osler. So classic that it must be in a movie somewhere.

This is what we did. We saw first. We researched, we compared, we controlled. But we saw first.

Just because the answer isn't what you wanted it to be doesn't mean that you get to criticize us with Osler. He didn't say "research until you get the answer your patient asked for!"

Let me give you another scenario. One from my own training.

We had a patient with a long history of migraines who, once or twice a month, has what she calls a "complex migraine" which paralyzes here on one side of her body.
She consistently says that the only thing that improves her paralysis is IV narcotics, in high doses, every 4-6 hours, for 3-5 days. Then the paralysis resolves on its own.
When you see the patient, even though she says she can't move, her muscles have tone, and there is no physical finding, or test result that leans toward her having any sort of a paralysis. Now medicine says there is no organic cause of this syndrome.

Does the fact that she "gets better" with IV narcotics mean that IV narcotics are a cure for this mysterious paralysis she has? Or does it mean that there is a psychlogical issue that is "responding" to IV narcotics for other reasons.

Now I'm not claiming you're getting high off of antibiotics. I'm claiming that your responding to antibiotics isn't necessarily evidence that you have a bacterial infection.

Besides the possible straight psychological aspect, antibiotics aren't the "magic bullets" we portray them as, they have other physiologic effects. Penicillins and macrolides, for example, (and under some specific circumstances) also have some anti-inflammatory properties.

There is still more to "see".

There is still more to "see".

See, that right there is the problem. You (and people like you) keep telling us that there is something to see. We ask you to show us this wonderful/horrible/mystical thing, and you show us a big pile of nothing.

Believer (B): "It's dragon poop! Isn't it wonderful??"

Skeptic (S): "Um... no. That's just a dirt clod."

B: "No! It's dragon poop! A dragon pooped it!"

S: *poking it with a stick* "No... that's just dirt. With some leaves mixed in... and a worm. Lumbricus rubellus apparently. No dragons."

B: "A worm! See! It must be a baby dragon!!"

S: "No. Just a common earthworm. Just common dirt. And it appears that someone dug it up with a small shovel and put it here."

B: "No! It's dragon poop! Why are you so closed-minded?!?"

S: "As a matter of fact, there's a small garden shovel right there in your pocket. With dirt still on the handle. And your hands are dirty. You dug this clump of dirt up and put it here, didn't you?"

B: *increasingly hysterical* "No!! I told you, it's dragon poop! I saw the dragon myself! Why don't you believe me! Look!!! It's right behind you!!!"

S: *turns to look* "No, that's a squirrel. And a rather small, bedraggled specimen at that. Looks like a dog's been chasing it. Now, back to this dirt..."

B: "No! You just hate me! You're mean! You see the dragon, but you just don't want to admit it! You're working for the anti-dragon company!"

S: *shaking head sadly* "Okay... I have to go, um, over there now. Bye."

B: "Why won't anyone BELIEVE me?!?!?!"

You claim there is more to see, but we've *SEEN* dirt. And you never offer anything else.

By LanceR, JSG (not verified) on 17 Jun 2009 #permalink