As many know by now, there are two distinct and different treatments for Lyme disease. One treatment plan voiced by the CDC, the Infectious Disease Society of America (IDSA) and every Emergency Room around the country is that there is no Chronic Lyme Disease (CDL) and that one or two, 10 to 30 day courses of antibiotics will definitively kill the Lyme disease. However, if not caught early, systemic damage can take years to fade away.
The second method of treatment voiced by MD’s that call themselves Lyme Specialists or Lyme Literate MD’s (LLMD’s) advocates that there is Chronic Lyme Disease (CLD) and that it is best treated with long term antibiotics.
How does this happen? How can there be two distinct methods of treatment in a scientific profession with the most educated, literate medical specialists on the planet? How did this situation come about and how can scientific and historical analysis help to understand this troubling situation?
The first scientific precept to understand in this situation is that anyone can be fooled and that the easiest person to fool you, is you. MD’s, Judges, PhD’s in physics and even Neils DeGrasse Tyson are susceptible to the prejudices and biases of the human species. This is the fundamental basis for the existence of science: a methodology for understanding the natural world that is not anecdotal, that is not your personal story or your individual perception.
The second historical connection to be made is that throughout the entire history of medicine, this kind of dissention around the proper treatment for the same physical ailment is the norm, not the exception. Over the last 3000 years, healers have been on their own or in small groups, using only their clinical practice, personal experience and desire to alleviate pain and suffering to help them decide the best course of treatment. For thousands of years, medical treatment was hampered by completely inadequate theory (Four Humors and Spontaneous Generation), Stone Age tools (basically a knife) and personal experience/ guesswork. Modern medicine began around the 1870’s with the introduction of the Germ Theory of Disease, the consolidation of scientific methodology (experimentation) in universities throughout the world, statistical analysis of treatment results and significantly faster communication technology (telegraph, 1838; telephone, 1878; radio, 1901) enabling the sharing and comparing of scientific results.
The definition of modern medicine is that clinical treatment protocols must follow research, rigorous experimentation and statistical outcome analysis of a clinical trial period. If this scientific process is ignored and only clinical experience is used to evaluate and treat patients, then that physician is practicing “medieval” medicine. How do you tell a renowned physician with 30 years of clinical healing experience, that the results he sees with his own eyes can be tainted and corrupted by his very desire to make patients well? How do you tell a leader in the field of medicine that her 30 years of personal experience amounts to anecdotal medical stories…unless she is following experimentally based protocols? It’s a hard sell.
When Lyme disease first started showing up in the early 1970’s, MD’s were on their own as far as treatment protocols. Give antibiotics for a short time or for a long time were the two main avenues of treatment. Over the next 40 years, treatment results began to accumulate and well-controlled experiments were carried out producing scientific protocols. The main result of the scientific experimentation was that one or two courses of antibiotics kills Lyme disease and that symptoms and systemic damage caused by the disease can take years to fade away – whether or not long term antibiotics are given. In other words, there is no such thing as Chronic Lyme Disease and long term antibiotic therapy does not improve the lingering symptoms.
The best history of this unfortunate situation is published in the Lancet here: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2811%2970034-2/abstract.
New England Journal of Medicine further describes the lack of protocols and controls on LLMD’s: http://www.nejm.org/doi/full/10.1056/NEJMra072023:
“The diagnosis of chronic Lyme disease and its treatment differ substantively from the diagnosis and treatment of recognized infectious diseases. The diagnosis is often based solely on clinical judgment rather than on well-defined clinical criteria and validated laboratory studies, and it is often made regardless of whether patients have been in areas where Lyme disease is endemic…”
“How should clinicians handle the referral of symptomatic patients who are purported to have chronic Lyme disease? The scientific evidence against the concept of chronic Lyme disease should be discussed and the patient should be advised about the risks of unnecessary antibiotic therapy. The patient should be thoroughly evaluated for medical conditions that could explain the symptoms. If a diagnosis for which there is a specific treatment cannot be made, the goal should be to provide emotional support and management of pain, fatigue, or other symptoms as required. Explaining that there is no medication, such as an antibiotic, to cure the condition is one of the most difficult aspects of caring for such patients. Nevertheless, failure to do so in clear and empathetic language leaves the patient susceptible to those who would offer unproven and potentially dangerous therapies.”
The LLMDs who chose long term antibiotic therapy were encouraged by their patients’ desire to please, vocal patient advocacy/support groups, laboratory companies that promoted expensive testing and even movie producers (“Under Our Skin”) who had an investment in producing certain results. All of this corrupted, unblinded, emotional and anecdotal experience is filtered out by the scientific process to produce correct medical protocols. When this tainted evidence is not filtered out by laboratory experimentation, then even the best doctors in the world can fool themselves into practicing “medieval” medicine.
Time will eventually filter out medicine practiced on the exclusive basis of clinical treatment. More scientific studies will accumulate and it will become harder and harder for LLMD’s to justify the harmful effects of long term antibiotic therapy.
By Victor Dominocielo, M.A., 6/26/14
Victor Dominocielo, M.A., a California-credentialed teacher for 36 years, is the Human Biology and Health teacher at a local middle school. He earned his Master of Arts degree in Education from UCSB. The opinions expressed are his own.