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"I can't say there is no such thing as chronic Lyme," Feder said. "But the hard science says chronic Lyme does not exist." ********** In the contentious debate, there are some small signs of compromise.
Feder, for instance, acknowledges that in some cases he has prescribed antibiotics to patients - who had been infected with Lyme in the past - for longer than current guidelines suggest. *************************************
Lyme Disease Diagnosis Challenged Some See No Evidence Illness Can Be Chronic; Others Disagree
By WILLIAM HATHAWAY | Courant Staff Writer October 4, 2007
Every week, Dr. Henry M. Feder Jr. gets at least a couple of calls from pediatricians who have patients with achy joints, fatigue and other symptoms they can't explain. The parents of the children often insist the problem is Lyme disease.
But Feder, who works at the Connecticut Children's Medical Center in Hartford, says in virtually all those cases there is no evidence of infection by the tick-borne bacteria. He is forced to tell desperate parents that long-term treatment with antibiotics will do their child no good.
Today, the New England Journal of Medicine is publishing a review authored by Feder and six other Lyme disease experts who argue that there is no scientific evidence for the existence of chronic Lyme disease, a diagnosis used by some doctors to justify months or even years of treatments with antibiotics.
Though it contains no new scientific information, the publication of a scientific review in a prestigious medical journal is a strong rebuke to the "Lyme-literate" doctors who, the authors suggest, regularly treat patients for a condition they do not have.
"I can't say there is no such thing as chronic Lyme," Feder said. "But the hard science says chronic Lyme does not exist."
Advocates in the long-term Lyme camp criticized the study, saying that the publication of the review in such a prestigious medical journal will lead to the inability of thousands of people to get treatment for potentially debilitating symptoms such as fatigue, joint pain, cognitive difficulties and other neurological ailments.
"It's a disaster for people with chronic Lyme disease," said Dr. Raphael Stricker, president of the International Lyme And Associated Diseases Society. "Since it appeared in the New England Journal of Medicine, everyone will take it as dogma, and nobody will want to pay for treatment."
The authors of the study are also critical of lawmakers who attempt to mandate insurance coverage for long-term antibiotic treatment for Lyme, as well as Connecticut Attorney General Richard Blumenthal, who launched an antitrust investigation over the recent approval of treatment guidelines that recommend against extended courses of antibiotics.
However, organizations representing Lyme patients say the review in the journal ignores valid scientific evidence of long-term infection by the Lyme bacterium and that it was written by some of the same people under investigation by Blumenthal.
"It is just the same old people saying the same old thing," said Pat Smith, president of the Lyme Disease Association. "They just choose to select one set of research and ignore other research."
Feder and patient advocates like Stricker and Smith agree on one thing - thousands of people show up at doctors' offices suffering from mysterious joint pain, fatigue, mental confusion or disabling neurological conditions.
However, they don't agree on how many of these patients actually suffer from Lyme disease. Feder and the mainstream medical community hold that the vast majority of Lyme cases are easily treated with short courses of antibiotics if the disease is identified quickly.
But Stricker and Smith say existing diagnostic tests miss many Lyme cases and that thousands of people end up suffering needlessly when extended courses of antibiotics can eliminate or at least neutralize the stealthy Lyme bacterium, B. burgdorferi.
But the review argues that a great majority of people with those symptoms do not have Lyme. The idea that Lyme bacteria somehow elude detection and antibiotic therapy, it says, is unsupported by existing studies.
"Ninety percent of those patients who walk in my door don't have Lyme," Feder said.
No rigorous study has found that patients who had been clearly infected with Lyme benefit from long-term courses of antibiotics more than they would from a placebo. Also, many subjects experienced adverse side effects from antibiotic treatment.
"And worse, doctors tend to miss real underlying conditions," when making a diagnosis of chronic Lyme, Feder said.
Feder acknowledges that he and other doctors sometimes simply don't know what is making patients so sick. And those patients are particularly susceptible to doctors who claim they have a name for their ailments and cure for their symptoms, he said.
"I have to tell them that I can't help you by giving you more [intravenous antibiotics], Feder said. "As a doctor, that really hurts me. If I don't give it to them, I am a bad guy."
But advocates for Lyme patients say that is exactly what doctors like Feder are doing - hurting patients by not treating them.
"Doctors will tell them they do not know what is wrong with them," Smith said. "They are punishing patients by taking away the only treatment that is working for them."
In the contentious debate, there are some small signs of compromise.
Feder, for instance, acknowledges that in some cases he has prescribed antibiotics to patients - who had been infected with Lyme in the past - for longer than current guidelines suggest.
And Smith says her group is willing to discuss the possibilities that some other factor than Lyme may be causing some illness.
"I challenge them [to sit down and discuss their findings] with physicians and researchers who have different viewpoints," Smith said. "We better find out what is happening with these patients."
Smith and other patient advocates are irked that some of the authors on the study are individuals being looked at as part of Blumenthal's antitrust investigation.
For instance, the senior author of the NEJM review is Dr. Gary Wormser of New York Medical College. Wormser also helped write Lyme treatment guidelines for the Infectious Disease Society of America, which recommended against the long-term use of antibiotics for the treatment of Lyme.
The financial interests of Wormser and a few other authors of the IDSA guidelines led Blumenthal to launch an antitrust investigation into whether they may have had a conflict of interest in writing the recommendations and ignored evidence that could have justified the use of antibiotics for more than 30 days.
Blumenthal Wednesday called the inquiry "increasingly active and progressing well" but did not say when he expected it to end.
The doctors have denied that commercial interest influenced written guidelines, and some have criticized Blumenthal for interjecting himself on the wrong side of a scientific debate.
-------------------- There is no wealth but life. -John Ruskin
All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer Posts: 5639 | From Aptos CA USA | Registered: Apr 2005
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