Daniel Cameron, MD, MPH

Chronic Lyme disease: Doctors seek answers

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by

Dr. Daniel Cameron
in

Greenberg’s Letter to the Editor states, “The recently published article by Shapiro et al hoped to be topical in this age of ‘alternative facts’ but fell short, providing mainly biased viewpoints that prevent independent assessment of existing research in chronic Lyme disease. Presenting this conclusion as unquestionable is misleading.” [1]

Shapiro and colleagues began their article writing, “Recently, there has been considerable interest in the topic of fake news. For infectious diseases physicians, false and misleading information about the diagnosis and treatment of Lyme disease is not new. It is increasing in frequency and prominence, creating much confusion among primary care physicians and their patients.” [2]

The authors dismiss the need for retreatment with antibiotics, stating, “results of multiple clinical trials show that patients with well-documented Lyme disease who have residual nonspecific symptoms after treatment do not benefit from additional treatment, even with extended courses of IV antibiotics.” [2]

Greenberg’s letter expressed concern over the quality of data from the clinical trials cited by Shapiro and colleagues. Her concerns included the following:

• “Critical statistical reviews of American antibiotic retreatment studies by more than one research group concluded that these trials were underpowered, did not prove that retreatment was ineffective, and found support for a possible role of antibiotics in retreatment of chronic Lyme disease.”

• “Two trials demonstrated improvement in patients with severe significant symptoms at baseline.”

In turn, Shapiro responded to Greenberg’s letter, simply stating, “Most ─ if not all ─ of the issues raised by Greenberg in regards to our recent article have been addressed in detail in a previous publication in this journal.” [2]

Greenberg concludes, “The authors’ claim that definitive, rigorous, evidence based research exists regarding treatment of chronic Lyme disease is a disservice to fellow physicians and suffering patients alike. More and better-designed treatment studies in chronic Lyme disease are clearly needed.” [1]

 

References:

  1. Greenberg R. Chronic Lyme Disease: An Unresolved Controversy. Am J Med. 2017;130(9):e423.
  2. Shapiro ED, Baker PJ, Wormser GP. False and Misleading Information about Lyme Disease. Am J Med. 2017.

Comments

3 responses to “Chronic Lyme disease: Doctors seek answers”

  1. Calum Grant, PhD Avatar
    Calum Grant, PhD

    Patients like myself are getting fed up with what seem like semantic arguments: it is active Borreliosis, or is it something else. It’s obvious that something is going on; there is a medical condition that needs treating. By closing off the argument, Shapiro et al. are doing patients a great disservice. They show a remarkable lack of scientific curiosity in why such a large proportion of people with obvious tick bites and EM rashes either fail the 2-tier test or have lingering life-changing symptoms.

    A large chunk of patients are respond to antibiotics, but given the current scientific uncertainties, treatment should be based on clinical response. If we can give antibiotics for mild acne, why not give antibiotics to enable people like me to be able to work and live a normal life?

    Reply
  2. Rosalie Greenberg, MD Avatar
    Rosalie Greenberg, MD

    Thank you Dr. Cameron for sharing the letter that I wrote to the editor of the American Journal of Medicine regarding a poorly written biased article. I am grateful that my letter was published. The response of the authors is quite telling.
    Their Reply
    “Most—if not all—of the issues raised by Greenberg in
    regards to our recent article1 have been addressed in detail in
    a previous publication in this journal.2 Her concerns with
    respect to the work of Berende et al likewise have been
    addressed at length in a commentary by Melia and Auwaerter.

    Eugene D. Shapiro, MD
    Phillip J. Baker, PhD
    Gary P. Wormser, MD

    There is no question that the authors response was condescending, dismissive, and basically closed off any opportunity for any factual lively scientific discourse that one would expect from a group of scientists. To paraphrase- they said “You are wrong , we answered it already. Go look it up.”
    A phrase I heard recently comes to mind: “You are entitled to your own opinion, but not your own facts.

    Reply
  3. KarlaL Avatar
    KarlaL

    It is notable that authors of the disputed AJM journal article are the same people who have been targeting Julia Bruzzese, with disastrous results for her and her family. https://on-lyme.org/en/sufferers/lyme-stories/item/260-the-ultimate-lyme-test-julia-s-story

    The AJM article cites an American Lyme Disease Foundation paper (authored by Philip Baker), that was published in response to the award-winning Pei-sze Cheng I-Team investigative report on Julia. At the time the segment was airing, Dr. Baker sent copies of the ADLF paper (without permission) to her father’s personal email list of friends and family members.

    Both Dr. Gary Wormser and the American Lyme Disease Foundation paper made public claims that, Since Julia’s two-tier tests were negative, it is extremely unlikely that she could even have Lyme disease. Since that time, her family discovered that positive ELISA results were hidden from them by one of the hospitals that she was admitted to. After progressing in her treatment, Julia currently tests positive for Borrelia burgdorferi as well as four additional coinfections including Borrelia Miyamotoi, Tularemia, Bartonella, and Babesia.

    In spite of all of the documentation of infection with multiple tick-borne illnesses and demonstrated clear progress in her symptoms, Julia continues to receive insurance denials for her treatment. Extremely suspiciously, the most recent denial from the New York State, lifted phrases word for word from the ADLF paper. New York State has refused to reveal the name of her reviewer.

    I hope the family requests that New York States Attorney General Eric Schneiderman investigate many irregularities in Julia’s insurance denials.

    Equally unethically, representatives from the CDC have also attempted to interfere in Julia’s care. The attempted interference in the medical care of a young girl who is clearly fighting for her life by the authors of the AJM opinion piece and the CDC just gives more evidence that they are being blinded by their own dogma and will strike out at anyone who challenges them.

    Reply

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