The CDC estimates that there will be approximately 30,000 new cases of Lyme Disease in the U.S. this year, making it our commonest tick-borne illness. Since its characterization in 1975, the infection has caused hundreds of thousands of acute illnesses, which are typically short in duration but can be debilitating for several days up to a few weeks, with fever, a typical skin rash, headache and joint pain and sometimes swelling. Rarely, meningitis can occur, but even then severe sequelae rarely complicate the situation.
Treatment consists of a combination of several antibiotics given orally over the course of 3-4 weeks; but appropriate treatment depends upon accurate diagnosis. The symptoms are common to numerous other conditions: infections, immune-mediated disorders (including lupus and arthritis), and psychological dysfunctions. The typical skin rash an expanding target-shaped lesion on the extremities called erythema chronicum migrans is most helpful in securing the diagnosis, as is the seasonal incidence (summertime) and the presence of an engorged tick. When the constellation of these suggestive findings is present, a confirmatory blood test is often positive evidence of the ailment.
Unfortunately, due to the vagueness of the symptoms and the commonly-missed or absent skin rash, a definitive diagnosis is often lacking, and treatment is given prophylactically. This approach has led to a thriving but evidence-free cottage industry of administering prolonged treatment for a condition that does not exist: Chronic Lyme Disease (CLD). A substantial number of physicians have devoted themselves to acquiring a superficial knowledge of the transmission and treatment options for actual Lyme Disease, and have used that as a jumping-off point to enticing (or welcoming) patients with the flimsiest link to actual infection with the bacterium known to cause Lyme, to enter long-term (often intravenous) antibiotic treatment to suppress CLD activity. The active CLD doctor-patient grapevine in endemic areas (now seen across the nation) generate many such referrals. And since many of these sufferers and sufferers they are, just not from CLD will react to any treatment via the placebo effect, these unethical doctors will benefit from a substantial cure rate, while pocketing thousands of dollars in direct payments as well as insurance reimbursements for the professional care, the intravenous medications, and the oversight of physician-extenders (Nurse Practitioners and Physician Assistants) at the patients homes.
This sad situation is explained in an article written by the pseudonymous Dr. Russell Saunders, who describes himself as a pediatrician in New England. The rationale for hiding behind that name is amply justified in his article, which describes at some length not only the time course and methods of CLD quackery, but also the intensity of the vitriol of both patients and doctors involved the attacks leveled on him when he dared to contest the prevailing mythology of CLD:
What is for certain is that Lyme disease activists are a passionate bunch. Some time ago, I wrote a blog post in which I had the temerity to question the validity of chronic Lyme diagnoses. For doing so, I was likened in comments to Josef Mengele, a comparison that warmed the cockles of my gay, half-Jewish heart.
He also notes the example of the nonsensical conspiracy theories leveled against the Infectious Disease Society of America, when they issued new treatment guidelines for Lyme Disease and failed to acknowledge the existence of CLD, much less endorse any treatment for it. (The quack-busting site "Quackwatch" also has an incisive skewering of this behavior.
ACSH s Dr. Gil Ross had this to say: I was in on the ground floor, so to speak, as a rheumatology fellow, when Lyme Disease was first described in 1975. Thereafter, as a practitioner on Long Island, I became familiar with the rapidly-growing business of chronic Lyme Disease experts and their quack treatments. It s bad enough injecting helpless people with needless antibiotics and charging big bucks for it, but the thought of how it might contribute to microbial resistance renders it even more unethical. Still, the patients believing they are benefitting makes this group of businessmen-doctors very hard to bring down.