Journal ltr. to editor from Amer. Lyme Fdtn
Lipanj
Steere----wow is he afraid of the truth who wrote this obviously ltr.
to editor......I see Philip Baker - not a dr???? no MD or Dr. noted by
his name-----------
http://www.jci.org/articles/view/36641
Published in Volume 118, Issue 9 (September 2, 2008)
J Clin Invest. 2008;118(9):2990-2990. doi:10.1172/JCI36641.
Copyright (c) 2008, American Society for Clinical Investigation
Book Review
Beating Lyme: Understanding and treating this complex and often
misdiagnosed disease
Phillip J. Baker
American Lyme Disease Foundation Inc., Lyme, Connecticut, USA. E-mail:
exe...@aldf.com HMMM - AMER L. FDTN CONN.? IT IS NEW YORK - PUT
THERE TO BE CLOSER TO GET THE CLAWS INTO DR. B.
Published September 2, 2008
Constance A. Bean and Lesley Ann Fein. AMACOM Books. New York, New
York, USA. 2008. $15.95ISBN: 978-0-8144-0944-2 (paperback).286 pp.
In Beating Lyme, Constance Bean, health writer and former coordinator
of health education at MIT, and Leslie Ann Fein, medical director for
the Pennsylvania Lyme Disease Society, endeavor to provide insight and
information on the history, diagnosis, and treatment of this disease.
Unfortunately, in this reader's opinion, much of what is presented --
especially with respect to "chronic Lyme disease" as a persistent
infection -- is biased and not evidence based.
Despite the ability of conventional antibiotics to resolve early Lyme
disease, a small number of patients experience posttreatment symptoms
(e.g., fatigue, neurocognitive disorders, and musculoskeletal pain),
generally referred to as chronic Lyme disease. Some practitioners
believe these individuals have a persistent infection of Borrelia
burgdorferi (the causative agent of Lyme disease), requiring long-term
antibiotic treatment to cure. However, the NIH spent over $8 million
on 4 randomized, double-blind, placebo-controlled clinical trials on
the efficacy of prolonged antibiotic therapy for chronic Lyme disease
(1-4). These trials documented that patients presenting with symptoms
attributed to chronic Lyme disease had very real health impairments
but derived no significant benefit from prolonged antibiotic therapy
when compared with placebo, and they provided no evidence that chronic
Lyme disease is due to persistent infection by B. burgdorferi or a
coinfecting agent (1).
In Beating Lyme, the authors ignore the criteria of Koch's postulates
on the relationship between a disease and its causative organism;
there is no evidence that chronic Lyme disease is due to a persistent
infection, nor can it be defined as a distinct clinical entity and
distinguished from other conditions with similar symptoms, e.g.,
chronic fatigue syndrome and fibromyalgia. Under such conditions, how
can one justify any specific treatment, including antibiotic therapy?
Instead, the authors ask the reader to accept a clinical diagnosis
"that requires recognizing that a cluster of unexplained, apparently
unrelated symptoms [no less than 38 are listed] is characteristic of
Lyme disease" and that "the results of standard diagnostic tests are
generally negative." Since there are no published data from other
placebo-controlled clinical studies to refute the results of the NIH-
funded trials, it is time to abandon this unproven -- and potentially
harmful -- therapeutic approach and consider other therapeutic
possibilities.
What is needed is an integrated and multifaceted study of the nature
and cause(s) of the diverse symptoms associated with chronic Lyme
disease, chronic fatigue syndrome, and fibromyalgia; the latter two
also occur with varying degrees of severity and symptomatology. In
this context, the results of a small pilot clinical trial showed that
treatment with gabapentin, a drug commonly used to treat epilepsy and
neuropathic pain, alleviated the pain of chronic Lyme disease in 9 of
10 patients (5). Although this approach requires much more study, the
FDA recently approved the use of pregabalin (a related drug) for the
treatment of fibromyalgia. Other therapeutic possibilities are
suggested from the unanticipated beneficial effects (e.g.,
antiinflammatory properties) of some antibiotics that are unrelated to
their antimicrobial properties. For example, ceftriaxone, which is
often used to treat chronic Lyme disease, has profound neuroprotective
effects (6, 7). Although not yet documented in controlled trials, such
effects could ameliorate neurological symptoms, and some investigators
are even contemplating clinical trials to determine whether
ceftriaxone might be beneficial in treating patients with
neurodegenerative diseases such as MS or amyotrophic lateral
sclerosis. Perhaps these pharmacological effects, rather than
elimination of a presumed persistent infection, might account for the
short-lived benefits sometimes noted when antibiotics are used to
treat chronic Lyme disease. If so, perhaps drugs other than
antibiotics might be more suitable and effective for that purpose.
I agree with the authors that improved diagnosis and prompt antibiotic
therapy offer the best chance for success in curing early acute Lyme
disease and avoiding further complications. However, with respect to
chronic Lyme disease, it is time to discard the notion that it is due
to a persistent infection and begin to examine other possibilities.
Surely we owe at least that much to these patients.
References
Klempner, M.S., et al. 2001. Two controlled trials of antibiotic
treatment in patients with persistent symptoms and a history of Lyme
disease. N. Engl. J. Med. 345:85-92.
View this article via: CrossRef PubMed
Krupp, L.B., et al. 2003. Study and treatment of post Lyme disease
(STOP-LD): a randomized double masked clinical trial. Neurology.
60:1923-1930.
View this article via: PubMed
Fallon, B.A., et al. 2008. a randomized, placebo-controlled trial of
repeated IV antibiotic therapy for Lyme encephalopathy. Neurology.
70:992-1003.
View this article via: CrossRef PubMed
Kaplan, R.F., et al. 2003. Cognitive function in post-treatment Lyme
disease: do additional antibiotics help? Neurology. 60:1916-1922.
View this article via: PubMed
Weissenbacher, S., Ring, J., Hoffman, H. 2005. Gabapentin for the
symptomatic treatment of chronic neuropathic pain in patients with
late-stage Lyme borreliosis: a pilot study. Dermatology. 211:123-127.
View this article via: CrossRef PubMed
Rothstein, J.D., et al. 2005. β-Lactam antibiotics offer
neuroprotection by increasing glutamate transporter expression.
Nature. 433:73-77.
View this article via: CrossRef PubMed
Domercq, M., Matute, C. 2004. Neuroprotection by tetracyclines. Trends
Pharmacol. Sci. 25:609-612.
View this article via: CrossRef PubMed
This article Copyright (c) 2008, American Society for Clinical
Investigation
Copying, redistribution, and other usage policies
Mort Zuckerman
> Gee isn't the director and executor director of AMER. LYME FDTN Mr.
> Steere----wow is he afraid of the truth who wrote this obviously ltr.
> to editor......I see Philip Baker - not a dr???? no MD or Dr. noted by
> his name-----------
>
> http://www.jci.org/articles/view/36641
>
> Published in Volume 118, Issue 9 (September 2, 2008)
> J Clin Invest. 2008;118(9):2990-2990. doi:10.1172/JCI36641.
> Copyright (c) 2008, American Society for Clinical Investigation
> Book Review
> Beating Lyme: Understanding and treating this complex and often
> misdiagnosed disease
> Phillip J. Baker
>
> American Lyme Disease Foundation Inc., Lyme, Connecticut, USA. E-mail:
> neuroprotection by increasing glutamate transporter expression.
> Nature. 433:73-77.
> View this article via: CrossRef PubMed
> Domercq, M., Matute, C. 2004. Neuroprotection by tetracyclines. Trends
> Pharmacol. Sci. 25:609-612.
> View this article via: CrossRef PubMed
> This article Copyright (c) 2008, American Society for Clinical
> Investigation
> Copying, redistribution, and other usage policies
Lyme-and-LYMErix disease is tolerance to
fungal lipoproteins and the associated
1) activation of latent viruses, 2) tolerance to
mycoplasma, and 3) malignant and non-malignant
transformations resulting in the Great Imitators
and all kinds of cancers.
And Lyme, Connecticut, is where McSweegan
has his other house.
Kathleen
http://www.actionlyme.org