On Lyme disease and woo

It was a first for this blog. I removed a comment in reference to my post on Lyme disease activism. I appreciate and learn from commenters who criticize me. By exposing weaknesses in my positions they help me refine my arguments. But I will remove comments containing personal attacks and gratuitous foul language. Such comments generate more heat than light. Besides, scientific discussions are corrupted when attached to strong emotions or someone’s agenda. At their best discussions of science are sterile and sometimes even seem boring.

The post in question, in essence, applauded the new IDSA guidelines and suggested that Lyme disease can be quack fodder. Why quack fodder? Diagnostic guidelines from the International Lyme and Associated Disease Society, recently cited by Dinosaur, allow a diagnosis of “chronic Lyme disease” in the absence of any abnormal physical or laboratory findings. And the symptoms on which the diagnosis can be made are vague, overlapping sufficiently with other diseases or even the normal population to be meaningless. So, you have statements like this: Available data suggest that objective evidence alone is inadequate to make treatment decisions, because a significant number of chronic Lyme disease cases may occur in symptomatic patients without objective features on examination or confirmatory laboratory testing. Well, in the absence of objective findings how do we know those patients have Lyme disease in the first place?

That’s just another way of saying the diagnosis of chronic Lyme disease is subjective, isn’t it? That’s why it’s potential quack fodder. Any patient with vague symptoms can be declared to have chronic Lyme disease and be subjected to all sorts of woo.

The Infectious Disease Society of America (IDSA) recognizes that there are some patients who “remain unwell” following completion of standard courses of antibiotic treatment for Lyme disease. I’m willing to reserve judgment about such patients, currently the subject of randomized controlled trials. I will not summarily dismiss the notion of chronic Lyme disease as long as it is under investigation. Unfortunately such patients, until the condition is better defined, are all too vulnerable to the purveyors of woo.