From: km@cs.pitt.edu (Ken Mitchum)
Newsgroups: sci.med
Subject: Re: CFIDS and Lyme
Date: 8 Sep 92 12:53:40 GMT
Reply-To: km@cs.pitt.edu (Ken Mitchum)
Organization: Univ. of Pittsburgh Computer Science

In article <1992Sep4.180631.21788@lamont.ldgo.columbia.edu> odp@ldgo.columbia.edu (carl brenner) writes:

>	Now there's this disease called Lyme that has *extremely* similar
>symptoms, and which is almost impossible to diagnose definitively (except
>perhaps through culture, which is very difficult if you don't have an EM rash
>to work with). We all know that seronegative Lyme exists, but determining the
>number of people who actually have it is also very difficult. 

>This business of one having a definite etiology is
>completely bogus if you can't make the diagnosis with any accuracy. No matter
>what you may like to think, your differentiation between the two is based on
>a diagnostic house of cards. It may make you feel righteous to pretend that
>there's a verifiable difference between the two, but there isn't. All we have
>(for now) are these pointless antibody tests to make this differentiation. 

The similarity of symptoms may be meaningless. When students start out
medical school, they typically try to view diseases in terms of 
symptoms. They soon discover that all the diseases have all the
same symtpoms. It is not at all unusual for a second year medical
student to decide he or she has some rare disease based on the symptoms
they read about.

This is like the guy at the party who singles me
out and says "Hey doc, my left arm hurts - what causes that?".
Many very different disease cause the same symptoms, and since
some symtpoms are more related to each other than to disease
processes per se, the same symptoms tend to occur together,
such as fatigue and shortness of breath. The fact that such
diverse things as pneumonia, collagen-vascular diseases, and
heart failure can both symptoms makes the combination less than
helpful.

The fact that people with Lyme disease get fatigued and have other
symptoms usually referred to as "constitutional" in common with
CFS may or may not be meaningful - the symptoms alone do no tell
you without some hint as to at least the nature of the disease
(infectious, inflammatory, etc). I do find it interesting that
people with self-diagnosed CFS are a bit selective in their
search for diseases with similar symptoms, and are more apt to
choose an interesting infectious disease such as Lyme than,
say, depression, which also  has many symptoms in common with CFS.

>	It's not really clear what point you're making with these statements.
>Are you saying that anyone who treats a suspected Lyme patient that has a
>negative serological antibody test is a quack? (I don't want to put words
>in your mouth, please correct me if this is not your belief.) I would disagree.

Nope. In fact, a recent Annals of Internal Medicine has an article
based on decision-analysis of Lyme disease which gives guidelines
as to the treatment of Lyme disease without positive evidence.
We are talking about the "Lyme doctors", those whose patients
curiously have Lyme disease in an incredibly high incidence (like
100%) and who treat them forever with sucessive courses of
antibiotics.


>	But every time we point out that things are not as cut and dried as
>you would like, you raise the issue of these unnamed "quacks" who have nothing
>to do with the issues we're discussing. Stick to the issues at hand, please, and
>knock it off with the McCarthyite smears.

There is no similarity at all between the labelling of the "Lyme doctors"
as quacks and what Joseph McCarthy did. To be analagous, I would have
to pick out a group of doctors I didn't like, and state something like
"I personally know, and have evidence of, the fact that all of these
individuals secretly are 'Lyme doctors', and make their living treating
non-existent disease." What I did state was that doctors who do make
their living treating such non-existent disease are quacks, and you
agreed with me. That is not McCarthyism.

>	There's nothing "mainstream" about ignoring reality. There's a difference
>between "skepticism" and "denial." There's also a difference between "science"
>and "dogma." You use "mainstream" as if we're into homeopathy or talking about
>space aliens or something. Another pathetic smear tactic.

How long have you been reading this newsgroup? "Mainstream doctor" is
a derogatory term: admitting to being a mainstream doctor is an
admission of guilt. Nothing more.

 -km