LYMEPOLICYWONK: Newly Discovered Tick Pathogen, Borrelia miyamotoi, May Increase Safety Risks for Patients in NIH Tick Feeding Study

An important study by Dr. Stephen Barthold and Dr. Ben Luft was recently published. The title sounds a bit bleak, but don’t let the title fool you: “Ineffectiveness of Tigecycline against Persistent Borrelia burgdorferi”. This study is about how the little guy (Borrelia burgdorferi) always wins and survives despite antibiotic treatment—here tigecycline. To my mind, the findings on persistence are much more important than the finding that tigecycline doesn’t do the job. When one antibiotic doesn’t work, you try another, and if that one doesn’t work, well, you try another or you kick it up a notch and start trying combination antibiotics, like they do with tuberculosis. You don’t fold up the tent and go home because active infection requires antibiotic treatment. And, you won’t ever find out which antibiotic or combinations of antibiotic work, until you try them. So, roll up your sleeves, we have some work to do here.

Pam Weintraub asks an important question over at Aeon discussion board: Why do doctors keep fighting about Lyme disease? Dr. Elizabeth Maloney kicked off with opening thoughts, Pam Weintraub joined in, Dr. Sheila Statlender and Dr. Lee as well as many patient voices have created a lively debate. Is you haven’t contributed yet, I encourage you to do so.

Have you ever heard the saying “what goes around, comes around”? How about “you scratch my back, I’ll scratch yours”. The revolving door between government and industry is cause for concern. The revolving door between the CDC and the vaccine industry is even greater cause for concern. The most recent revolving door has Dr. Julie Gerberding, the first woman to head the Centers for Disease Control and Prevention, being named president of Merck’s vaccine division. Do you think she knows a thing or two about vaccines and how to get them through the process? Do you think she has connections? Dr. Gerberding comes from an infectious disease background.

A terrific article by Jerome Groopman, “Health Care: Who Knows Best”, appeared in the New York Times about the healthcare bills. Groopman’s article discusses how healthcare should be implemented in terms of guidelines and notes that there are two choices. The first is through mandates. The second is through “nudging” consumers in the right direction, but leaving the final choice to the consumer. (This approach is advocated by the author of the book Nudge, who is an advisor to Obama.) If this sounds like the Lyme debate, you are catching the drift. As we know, the distinction between mandatory guidelines that do not permit physicians and patients to make choices and guidelines that permit individuals to make their own choices, even if they are unpopular, can determine whether a patient has the opportunity to get well. The question boils down to this: Do the experts know best or do some decisions simply belong to the patient and the treating physician?

Ever wonder what is going on with surveillance numbers? How come some states go up, up, up and others go down? If you look at Lyme surveillance in the US from 1990 to 2007 and just consider did cases go up or down, it can get pretty interesting. I don't know what to think when cases go down. Did all the ticks move out of dodge? Did the doctors quit diagnosing? Did people finally get the message and stay in doors with a book? Did the disease definition change? Is there a new department of health head? Did staffing go down? Did certain areas of the US just fall off the books because they were told there was no Lyme south of the Mason Dixie? I don't have answers. This is a list of those states that zigged when others were zagging. Tell me your thoughts.