From: odp@ldgo.columbia.edu (carl brenner)
Subject: Re: Yet another Lyme question
Organization: Lamont-Doherty Geological Observatory
Date: Sat, 26 Sep 1992 16:57:17 GMT

In article <1863@hsdndev.UUCP>, rind@binoc.bih.harvard.edu (David Rind) writes:
> In article <1992Sep22.185713.23895@lamont.ldgo.columbia.edu>
>  odp@ldgo.columbia.edu (carl brenner) writes:
> >In article <1847@hsdndev.UUCP>, rind@binoc.bih.harvard.edu (David Rind) writes
> >> Please cite the studies you are referring to.  I know of no evidence
> >> of a 50% relapse rate for 2 week treatment of early Lyme disease, and
> >> I would strongly suspect a detection bias in a retrospective study
> 
> >Luft BJ, Steinman CR, Neimark HC, et al. Invasion of the central nervous
> >	system by Borrelia burgdorferi in acute disseminated infection.
> >	JAMA 1992;267:1364-1367.
> >Steere AC, Hutchinson GJ, Rahn DW, et. al. Treatment of the early 
> >	manifestations of Lyme disease. Ann Intern Med 1983;99:22-27.
> 
> Neither of these papers discusses relapse rates.  
> 
> The second paper did find the development of what the authors called 
> "minor late symptoms" in significantly less than half the patients that 
> they studied (judging from the abstract -- I haven't pulled the actual
> paper).

	I almost get the feeling you didn't even read my post. I used a *direct*
*quote* from the first paper that said that low doses of tetracyclines and 
penicillin were associated with an "inordinately" high failure rate. It's not
like I made it up out of whole cloth. After that sentence, they had a footnote
that referenced the second paper, which, frankly, neither of us has read (though
this won't stop us from squabbling over it :-)). I think it's safe to assume
that if we actually read the thing, we'd find what they're referring to.
	As for your quote from the abstract, I would simply ask: "minor" to whom?
(The answer, of course, is "to the physician.") This is one of the gripes that
many Lyme patients have about much of the Lyme literature. The researchers will
frequently acknowledge the patients' persisent complaints, but dismiss them as
"vague" and attribute them to fibromyalgia or chronic fatigue syndrome. Whatever
is wrong with these patients, it's pretty devastating. In my county alone, the
number of people who can't work due to their Lyme disease is over 100. I don't
think they believe they're "cured." 
	

>The first study looked at disseminated Lyme disease.  Apart from that,
>it's a good idea to be cautious about people finding things via
>PCR -- it's just too sensitive.  There are all sorts of things we'd
>like to use PCR to detect, but so far the specificity in most of them
>isn't very good.


	It was a CONTROLLED study, David!! *None* of the 16 controls had positive
PCR assays. I agree that PCR is not perfect, but when one group is 8/12 and the
other is 0/16, I think it's pretty convincing. Why, when confronted with
evidence like this, do you choose to look for an explanation that denies the
obvious? I really have a hard time understanding this. 


> >	The cure rates for Lyme are much much lower than generally
> >acknowledged and it's time for everyone to come to terms with this.
> 
> Again, you need to watch out for detection and selection biases.
> People who work with severe cases of any disease always have the
> sense that the overall natural history of the disease is much worse
> than it really is.

	Yes, this is true, and I admit I have to be careful about this. Please
understand, I do believe that early Lyme is quite curable when treated
aggressively enough. (No, I am not endorsing IV therapy for early Lyme, just
a more prolonged treatment course.) However, I believe that the cure rates
for "late" Lyme are very poor. Whether this is do to persistent infection,
immune problems, tissue damage, or some combination of these things isn't clear,
but I believe the emerging evidence on intracellularity of the spirochete is
very interesting.

> >P.S. How come I'm the only one citing references in this Lyme discussion?
> >All of the resident net.skeptics are long on sarcasm and nastiness and
> >red herrings (like "Lyme quacks") and awfully short on facts.
> 
> What exactly seemed sarcastic in either my initial post or this one?
> Is asking for references inappropriate when someone quotes a study?

	I wasn't referring to you, and did not find anything wrong at all
with your request for documentation. On the contrary, I'm pleased that you
made an effort to follow up on my citations (even if you do persist in
disagreeing with me ! :-)).
	I was really directing my comments at Gordon, but I would just as soon
not pursue this line. I don't want to get bogged down in another flame war.

> -- 
> David Rind
> rind@binoc.bih.harvard.edu


Carl Brenner