Lyme Disease Treatment Based on Faulty Logic
IDSA Ignored Important Research When Generating 2006 LD Guidelines
Aug 11, 2008
Though there are many papers that provide alternate views, one study: Two Controlled Trials of Antibiotic Treatment in Patients with Persistent Symptoms and a History of Lyme Disease, and others like it, form the basis of the Infectious Diseases Society of America's (IDSA) newest guidelines for Lyme disease treatment.
- Summary: Two antibiotics: 15 days of intravenous ceftriaxone and 28 days of oral doxycycline were given to patients with chronic LD. Control patients were given iv and oral placebos. Treatment and placebo patients reported statistically similar responses.
- Conclusion: Extended antibiotic use for chronic LD is ineffective.
Reasons Why This Study is Not Scientifically Valid:
- Although Dr Joseph Burrascano, a noted authority on diagnosing and treating Lyme disease, describes how different forms of Borrelia are sensitive to different antibiotics (LymeNet), only two antibiotics, ceftriaxone and doxycycline, were used in the study. Thus, the conclusion that extended antibiotic use is ineffective is only applicable to these two antibiotics.
- According to Dr Burrascano, neither antibiotic is effective against the spheroid or cystic forms of Borrelia that develop in patients who do not receive prompt treatment. His suggestion is that tetracycline or azythromycin would attack these forms.
- As spirochetes, Borrelia reproduce only about twice a month and the cystic forms reproduce even less often. It is likely many bacteria did not divide during the two week ceftriaxone treatment period and escaped its effect.
What Comprises Valid Research
Only controlled experiments can provide valid results. Studies sometimes discuss one or a few cases, and sometimes present the results of large-scale studies. Results based on large controlled studies are stronger than those based on fewer subjects. But answering one question brings forward new questions, and the results of studies on a few subjects often suggest new questions and hypotheses for testing and review.
Guidelines from the American Academy of Neurology
In 2007, the American Academy of Neurology (AAN) also published a guideline that conventional courses of antibiotics are effective for treating LD presenting neurological complications, but “there is no compelling evidence that prolonged treatment with antibiotics has any benefit in treating symptoms that persist following standard therapy ...”
The research demonstrating the lack of compelling evidence includes the same paper noted above.
The guideline continues: “It is clear from all available scientific studies that long-term use of antibiotics doesn't help to treat chronic symptoms that persist after treatment for Lyme disease ...” This statement is simply untrue. Several scientific studies that demonstrate otherwise and were available at the time these guidelines were generated were overlooked by the authors of the AAN guidelines – some of whom also authored the IDSA guidelines. Of approximately 13,000 papers on treatment of Lyme disease available at the time, the AAN group chose less than 600 to base their guidelines on.
New Tests and Treatment for Lyme Disease
A new test uses a synthetic chemical called C6, composed partially of Bb surface proteins, to identify antibodies produced against Bb. Another test, the Rapid Assay for Borrelia burgdorferi (RABb) uses fluorescent antibodies to bond to the DNA of all morphs of Borrelia. These tests are not accepted by the IDSA, AAN, and CDC. In 2008, the Journal of Medical Microbiology announced the development of a single dose form of long-acting doxycycline that is 100% effective in preventing primary symptoms of LD when provided immediately after a tick bite.
Whether these new tests and the new treatment are effective, they will not help the patient who has slipped past diagnosis and is already in secondary or tertiary stages of LD when treatment begins. It is this patient who is most desperately in need of assistance. And it is this patient who is being told by the IDSA: “Long-term use of antibiotics doesn't help to treat chronic symptoms that persist after [standard] treatment for Lyme disease.”
Why Research is Being Blocked
Our medical profession doesn't have the answers. But IDSA and AAN, among others, are trying to restrict further investigation into this disease. Dr Brian Fallon, director of the Lyme and Tick-borne Diseases Research Center at Columbia University, published a study in Neurology: "A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy," that demonstrated temporary improvement of Lyme disease symptoms with extended (ten weeks) antibiotic use. Dr John Halperin, Chairman of the IDSA study group and member of the AAN study group, wrote an article in the March 25, 2008 issue of Neurology entitled: "Prolonged Lyme disease treatment: enough is enough" in which he rejected the conclusion of Dr Fallon that more study is needed to find a treatment that provides a more lasting improvement.
The reasons seem to involve:
- Research, iv administration, and development of new antibiotics are extremely expensive.
- Many antibiotics are dangerous and sometimes lethal.
- LD patients appear to be healthy and sometimes present hypochondriacal symptom complexes, making physicians apathetic.
- Many physicians do not understand the IDSA protocol is based on scientifically invalid research.
- Physicians are themselves frustrated.
- Health insurance plans and HMOs exerting pressure on physicians to save them money.
Whatever the reasons, the costs of searching for a cure does not stack up against the value of a human life. When patients' entire lives become consumed by this disease, all they can hope for is days with minimal symptoms. Patients often cycle between focusing on hoping for a cure, being angry at the world, and languishing. This should not be necessary.
There is an urgent need to find cures for as many chronic sufferers as possible. Many have been cured or entered remission after being diagnosed with “chronic Lyme disease” and “post-Lyme disease syndrome.” A large proportion of people suffering the same situation can also be helped – but only if treatment is provided.
Source:
American Academy of Neurology (www.sciencedaily.com/releases/2007/05/070523163057)
