Comment on What science needs

Mon, 03 Dec 2012 03:53:24 GMT

Lyme is a curious case, because most of the findings that researchers act unaware of are findings they are aware of but choose to ignore. There is a small group of doctors, most prominently Gary Wormser, who are determined to prove that chronic Lyme does not exist, despite a great deal of evidence to the contrary. To continue defending his position, Wormser has been reduced to claiming (6 years ago, in the IDSA recommendations, which govern most Lyme treatment in the US) that if you do a Western blot and an ELISA test, and either one of them comes back negative, that should override a positive result from PCR (which pretty much never gives false positives unless you really screwed up the primer design) or even visible detection of spirochetes via microscopy (on the grounds that Borrelia can't be visibly distinguished from the microbes for leptospirosis or syphilis, even though all three have similar recommended treatments). Wormser and his gang dismiss all histological studies of the effects of antibiotics on Borrelia, every one of which has shown that antibiotics reduce the number of spirochetes, but don't eradicate them. They claim that the dosage and pharmacodynamics were not compared correctly, and so their theories should be taken as stronger proof than experiments in animals. They also use the "no-man" principle above: One of their papers "proves" that patients don't have Lyme by taking a group of patients, applying 5 different tests, and concluding that they don't have Lyme if any one of the tests is negative, without any consideration of the false negative rates.

Changing the clinical guidelines to include additional antibiotics, on the grounds that they kill cysts, would mean admitting that some patients in the past might not have been cured of Lyme by antibiotic treatment without those additional drugs. That would invalidate many of the papers published on Lyme by the members of the committee that wrote the guidelines.

Lyme is, I think, the only disease in the world where patients routinely are diagnosed to have the disease by undisputed clinical evidence, get treatment, come back to their doctors and say "But I still have the symptoms!", and are told that it's all in their head because a paper proves that they've been cured. A key problem is that the accepted clinical tests are presence of the bulls-eye rash (which happens only on infection in most cases) and a positive blood serum assay (but the spirochetes live inside cells and may not trigger a blood immune response after dispersion). The only evidence most patients have that they're still sick is that they still feel sick. Wormser et al. spend their time coming up with ways to discredit any clinical tests that have any chance of diagnosing late-stage Lyme.

Completely coincidentally, admitting that chronic Lyme exists, and, worse yet, coming up with an accepted way of diagnosing it, could instantly create a pool of hundreds of thousands of Americans covered by insurance policies that would then be obligated to pay indefinitely for treatment that costs up to $1000/month for oral amoxicillin, and perhaps $10,000/month for the more-effective intravenous drugs.

Wormser's most recent paper argues that if a patient has a negative Lyme ELISA test on blood serum, then positive tests for Lyme based on immunological assays of synovial fluid, and also positive PCR tests, should be ignored, because all patients in a prior study of patients with Lyme who had positive blood serum tests had positive blood serum tests. Yes, you read that right.

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