Doctors hotly debate treatment of Lyme disease

0 Comments | Oakland Tribune, Nov 20, 2006 | by Suzanne Bohan

The guidelines outraged Lyme disease specialists and prompted the attorney general of Connecticut last week to launch an official investigation into the association's guideline- development process.

Dr. Gary Wormser, one of the guideline authors and chief of infectious diseases at the New York Medical College, said long-term exposure to antibiotics poses serious health risks and isn't supported by scientific evidence for the treatment of Lyme disease. He doesn't believe that Lyme disease becomes chronic -- one course of antibiotics should clear out any borrelia. If symptoms remain, they may be caused by another disease, he added.

Stricker and others counter that the microbe can, in essence, hide out and evade detection.

"It's probably one of the most complex micro-organisms that's ever been described," he said.

"There's this disconnect between the science, which shows this very complex organism, and the clinical approach, which says you can treat it with antibiotics for four weeks and it's cured," Stricker said.

Infectious disease specialists like Wormser, he added, "have staked out a position, and they don't want to admit they're wrong."

Wormser countered that "infectious disease docs, like all physicians, want to do the best for their patients. The best available evidence indicates that the potential risk of long-term antibiotics outweighs any benefit."

Wormser said many patients come to him after having been treated for chronic Lyme disease, when they've in fact had other conditions, such as cancer or hepatitis.

Dr. Paul Mead, an epidemiologist with the CDC, added that studies have shown that people treated for Lyme disease had other conditions. He cited the example of a boy diagnosed with Lyme disease when he in fact had leukemia.

"That kid with leukemia has been cited about 5 million times," responded Stricker. "The reality is most of these patients come to me after every other known disease has been ruled out." About three- quarters of his patients recover after going off antibiotics, he said.

While the rancorous debate, often called "the Lyme War" rages, patients desperate for effective treatment get caught in the middle.

When asked what the medical community is doing to bridge the chasm between physicians regarding the diagnosis and treatment of Lyme disease, Stricker had little to point to, other than a proposal languishing in Congress to create a National Lyme Disease Advisory Council.

"I agree this is very undesirable," emphasized Wormser. He said the Infectious Diseases Society of America has expanded its Web site to better explain Lyme disease and that "other ways to address this very issue are under consideration."

Both Wormser and Mead recognized the relief that many people experience after finally receiving a Lyme disease diagnosis -- and hence a chance to recover from their mysterious and crippling ailments -- but emphasized their concern that the patients may not be getting the right therapy.

"What I tell people is that I recognize that they're suffering," said Mead. "And many are in horrible ways," he added. "But the best thing is to keep an open mind. Getting the wrong answer isn't going to cure you."