Embedded Files
Alan Barbour
@alanbarbour
Professor, Microbiology & Molecular Genetics
School of Medicine
Director, Pacific-Southwest Regional Center of Excellence for Biodefense and Emerging Infections
Alan Barbour
Biology of arthropod-borne diseases; control and prevention of vector-borne infections and vectors; Lyme borreliosis and relapsing fevervaccines;, infectious diseases; emerging diseases; population biology
Up-to-date, full bibliography is available at my website (http://spiro.mmg.uci.edu/bibliography.html).
American Society for Clinical Investigation
American Academy of Microbiology
Fellow, Infectious Diseases Society of America
Address University of California
3012 Hewitt
Mail Code: 4028
Irvine, CA 92697
Phone:
(949) 824-5626
Fax:
(949) 824-5490
Email:
URLs
Laboratory and personal website
Barbour Lab
Departments of Microbiology & Molecular Genetics and Medicine
University of California Irvine
Irvine, CA 92697-4028
Lab phone: +1.949.824.3737 Fax: 824.5490
Alan G. Barbour
Microbiology & Molecular Genetics, Medicine, and Ecology & Evolutionary Biology
University of California Irvine
Irvine, CA 92697-4028
Voice: +1.949.824.5626
E-mail: abarbour@uci.edu
Research interests: Biology of arthropod-borne diseases; control and prevention of vector-borne infections and vectors; Lyme borreliosis and relapsing fever.
Director, Pacific-Southwest Regional Center of Excellence for Biodefense and Emerging Infectious Diseases.
Chair-elect/Secretary, UC Irvine Academic Senate, 2009-2010
Alan G. Barbour
1993- 2107
NIH Grants- $122 Million
Patents- 23
With all that money coming in and multiple sources of potential income from patents, test kits, vaccines and vaccine trials, Barbour continues to claim he has no "interests" to declare, no competing interests, or conflicts of interest, or he just won't say. For example...
"There are no patents, products in development or marketed products to declare." Source
"The author has declared that no competing interests exist." Source
"No potential conflicts of interest." Source
"The authors declare that they have no competing interests." Source
"The authors declare that they have no competing interests." Source
"The authors of this letter declare that they have no competing interests." Source
"The authors declare that there are no conflicts of interest." Source
"The author has declared that no competing interests exist." Source
No Claims Statement- This work was supported by grants (AI-088079 to D.F. and P.J.K. and AI-100236 to A.G.B.) from the National Institute of Allergy and Infectious Diseases, National Institutes of Health. Source
No Claims Statement- The research was supported by National Institutes of Health grant AI-065359 Source
No Claims Statement- The project described was supported by the Preventive Health Services Block Grant from the Centers for Disease Control and Prevention. Laboratory work at University of California Irvine was supported by the National Institutes of Health grant AI-065359. Source
No Claims Statement- This work was supported by grants (AI088079 to D.F. and P.J.K. and AI100236 to A.G.B.) from the National Institute of Allergy and Infectious Diseases, National Institutes of Health. Source
No Claims Statement- This work was supported by Public Health Service grants AI-24424 and AI-100236 from the National Institute of Allergy and Infectious Diseases. Source
Connected To The IDSA 2006 Guideline Authors- Alan Barbour is also on the Board of Directors of the American Lyme Disease Foundation.
Alan Barbour Quote- "Many consider Lyme disease to be a nuisance that involves a trip to the physician's office every year or two and a few weeks of antibiotics." Alan G. Barbour, MD, Lyme Disease, The Cause, The Cure, The Controversy, page 243. Source
Alan Barbour Quote-“Lyme disease is primarily a disorder of suburban, educated middle- and upper-class people. Lyme disease can be as disabling as syphilis, but there usually is not a stigma to having Borrelia burgdorferi infection.” Alan Barbour, MD. Journal of the American Medical Association, January 21, 1998. Source
Alan Barbour Quote- “Currently, there are many sources of information about Lyme disease, much of which is in disagreement with the experts' advice. These sources include the Internet, books on Lyme disease written by laypersons, and pamphlets, newsletters, and call-in help lines of patient advocacy groups.” Alan Barbour, MD. Journal of the American Medical Association, January 21, 1998. Source
Alan Barbour Quote- "Studies have shown that an infected tick normally cannot begin transmitting the spirochete until it has been attached to its host about 36-48 hours..." Source
Alan Barbour Quote- "The EM rash, which may occur in up to 90% of the reported cases..." Source
Alan Barbour Quote- "The clear distinction of the LD [Lyme Disease] and the RF [relapsing fever] groups of microbes based on numerous highly reliable markers... should aid in the improved diagnosis as well as treatment of these two diseases, which is hindered by the conflation of a common name for agents causing two different types of diseases." Source [It should also help with more grant research funding and more vaccine funding for Barbour.]
NIH Grants
Total In NIH Grants- Over $122 MILLION
LONG, ANTHONY DOUGLAS et al.
UNIVERSITY OF CALIFORNIA-IRVINE
2017
NIAID
NIAID
$154,500
LONG, ANTHONY DOUGLAS et al.
UNIVERSITY OF CALIFORNIA-IRVINE
2016
NIAID
NIAID
$270,375
BORRELIA MIYAMOTOI INFECTION IN MICE AND HUMANS
BOCKENSTEDT, LINDA K et al.
YALE UNIVERSITY
2015
NIAID
NIAID
$670,392
INFORMATIVE IMMUNODIAGNOSTICS FOR LYME DISEASE
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2013
NIAID
NIAID
$192,448
6084
INFECTION AND IMMUNITY IN RESERVOIR HOSTS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2013
NIAID
$131,294
6089
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2013
NIAID
$1,603,094
7344
IDENTIFICATION OF SIGNATURE GASES FOR THE DIAGNOSIS OF INFECTIOUS DISEASES
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2013
NIAID
$431,288
PACIFIC SOUTHWEST RCE FOR BIODEFENSE & EMERGING INFECTIOUS DISEASES RESEARCH
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2013
NIAID
NIAID
$8,653,168
INFORMATIVE IMMUNODIAGNOSTICS FOR LYME DISEASE
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2012
NIAID
NIAID
$230,188
PACIFIC SOUTHWEST RCE FOR BIODEFENSE & EMERGING INFECTIOUS DISEASES RESEARCH
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2012
NIAID
NIAID
$11,075
6084
INFECTION AND IMMUNITY IN RESERVOIR HOSTS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2012
NIAID
$224,275
6089
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2012
NIAID
$1,381,767
7344
IDENTIFICATION OF SIGNATURE GASES FOR THE DIAGNOSIS OF INFECTIOUS DISEASES
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2012
NIAID
$303,864
PACIFIC SOUTHWEST RCE FOR BIODEFENSE & EMERGING INFECTIOUS DISEASES RESEARCH
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2012
NIAID
NIAID
$9,206,084
6084
INFECTION AND IMMUNITY IN RESERVOIR HOSTS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2011
NIAID
$170,569
6089
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2011
NIAID
$779,728
PACIFIC SOUTHWEST RCE FOR BIODEFENSE & EMERGING INFECTIOUS DISEASES RESEARCH
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2011
NIAID
NIAID
$8,985,358
PACIFIC SOUTHWEST RCE FOR BIODEFENSE & EMERGING INFECTIOUS DISEASES RESEARCH
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2010
NIAID
NIAID
$146,092
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2010
NIAID
NIAID
$344,719
6084
INFECTION AND IMMUNITY IN RESERVOIR HOSTS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2010
NIAID
$159,440
6089
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2010
NIAID
$562,705
PACIFIC SOUTHWEST RCE FOR BIODEFENSE & EMERGING INFECTIOUS DISEASES RESEARCH
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2010
NIAID
NIAID
$8,627,554
6084
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2009
NIAID
$162,208
6089
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2009
NIAID
$711,951
PACIFIC SOUTHWEST RCE FOR BIODEFENSE & EMERGING INFECTIOUS DISEASES RESEARCH
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2009
NIAID
NIAID
$9,625,099
PACIFIC SOUTHWEST RCE FOR BIODEFENSE & EMERGING INFECTIOUS DISEASES RESEARCH
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2009
NIAID
NIAID
$3,853,630
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2009
NIAID
NIAID
$349,653
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2008
NIAID
NIAID
$350,963
9008
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2008
NIAID
$1,621,895
PACIFIC-SOUTHWEST CTR FOR BIODEFENSE & EMERG INFECT DIS*
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA-IRVINE
2008
NIAID
NIAID
$10,078,421
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2007
NIAID
NIAID
$358,965
9008
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2007
NIAID
$1,573,950
PACIFIC-SOUTHWEST CTR FOR BIODEFENSE & EMERG INFECT DIS*
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2007
NIAID
NIAID
$9,805,034
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2006
NIAID
NIAID
$370,808
9008
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2006
NIAID
$1,334,149
PACIFIC-SOUTHWEST CTR FOR BIODEFENSE & EMERG INFECT DIS*
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2006
NIAID
NIAID
$9,796,830
8309
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2005
NIAID
$934,739
9008
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2005
NIAID
$1,683,840
PACIFIC-SOUTHWEST CTR FOR BIODEFENSE & EMERG INFECT DIS*
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2005
NIAID
NIAID
$9,980,000
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2005
NIAID
NIAID
$351,183
BIOLOGY AND CONTROL OF LYME DISEASE BORRELIA
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2004
NIAID
NIAID
$291,879
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2004
NIAID
NIAID
$351,906
BIOLOGY AND CONTROL OF LYME DISEASE BORRELIA
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2003
NIAID
NIAID
$291,879
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2003
NIAID
NIAID
$352,608
BIOLOGY AND CONTROL OF LYME DISEASE BORRELIA
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2002
NIAID
NIAID
$291,879
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2002
NIAID
NIAID
$353,289
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2001
NIAID
NIAID
$348,223
BIOLOGY AND CONTROL OF LYME DISEASE BORRELIA
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2001
NIAID
NIAID
$291,879
BIOLOGY AND CONTROL OF LYME DISEASE BORRELIA
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2000
NIAID
NIAID
$304,479
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
2000
NIAID
NIAID
$339,003
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
1999
NIAID
NIAID
$326,031
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
1998
NIAID
NIAID
$313,556
INTERFACE OF BORRELIA SURFACE PROTEINS AND ANTIBODIES
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
1998
NIAID
NIAID
$274,422
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
1997
NIAID
NIAID
$301,563
INTERFACE OF BORRELIA SURFACE PROTEINS AND ANTIBODIES
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
1997
NIAID
NIAID
$263,869
GORDON CONFERENCE--BIOLOGY OF THE SPIROCHETES
BARBOUR, ALAN G.
GORDON RESEARCH CONFERENCES
1996
NIAID
NIAID
$2,000
NIAMS
$2,000
NIDCR
$2,000
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF TEXAS HLTH SCI CTR SAN ANT
1996
NIAID
NIAID
$42,084
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
1996
NIAID
NIAID
$247,498
INTERFACE OF BORRELIA SURFACE PROTEINS AND ANTIBODIES
BARBOUR, ALAN G.
UNIVERSITY OF CALIFORNIA IRVINE
1996
NIAID
NIAID
$253,721
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF TEXAS HLTH SCI CTR SAN ANT
1995
NIAID
NIAID
$268,054
INTERFACE OF BORRELIA SURFACE PROTEINS AND ANTIBODIES
BARBOUR, ALAN G.
UNIVERSITY OF TEXAS HLTH SCI CTR SAN ANT
1995
NIAID
NIAID
$235,988
INTERFACE OF BORRELIA SURFACE PROTEINS AND ANTIBODIES
BARBOUR, ALAN G.
UNIVERSITY OF TEXAS HLTH SCI CTR SAN ANT
1994
NIAID
NIAID
$180,481
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF TEXAS HLTH SCI CTR SAN ANT
1994
NIAID
NIAID
$257,746
GENETIC AND PATHOGENICITY OF BORRELIA BURGDORFERI
BARBOUR, ALAN G.
UNIVERSITY OF TEXAS HLTH SCI CTR SAN ANT
1994
NIAID
NIAID
$183,884
MOLECULAR BASIS OF BORRELIA PATHOGENESIS
BARBOUR, ALAN G.
UNIVERSITY OF TEXAS HLTH SCI CTR SAN ANT
1993
NIAID
NIAID
$257,742
GENETIC AND PATHOGENICITY OF BORRELIA BURGDORFERI
BARBOUR, ALAN G.
UNIVERSITY OF TEXAS HLTH SCI CTR SAN ANT
1993
NIAID
NIAID
$183,350
Source- https://projectreporter.nih.gov/reporter_SearchResults.cfm?icde=34980872
Additional Funding By Various Private Organizations
Total Amounts Of Grants- Unknown
Example of Grantor- Bay Area Lyme Foundation
Patents- 23
Show/Hide Search CriteriaThere were 23 connections of patents to projects matching your search criteria.
Click on the column header to sort the results
Core NIH Project NumberPatent NumberPatent TitlePatent Owner Primary Agency
U54AI065359
8597941
Bioreactor for quantification of headspace VOC content from cultures
UNIVERSITY OF CALIFORNIA SYS OFFICE/PRES
U54AI065359
9637748
Conjugative plasmids and methods of use thereof
UNIVERSITY OF WISCONSIN-MADISON
R01AI024424
6617441
Diagnostic test for borrelia infection
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
R37AI024424
6617441
Diagnostic test for borrelia infection
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
R01AI024424
5932220
Diagnostic tests for a new spirochete, Borrelia lonestari sp. nov.
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
R37AI024424
5932220
Diagnostic tests for a new spirochete, Borrelia lonestari sp. nov.
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
R37AI024424
5436000
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
R01AI024424
6077515
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
R37AI024424
6077515
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
R01AI024424
5436000
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
R01AI024424
5585102
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
R37AI024424
5585102
UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
U54AI065359
8093064
Method for using magnetic particles in droplet microfluidics
UNIVERSITY OF CALIFORNIA LOS ANGELES
U54AI065359
9279808
Method of detecting and identifying circulating antigens in human biological samples
UNIVERSITY OF NEVADA RENO
U54AI065359
8962237
Method of detecting and identifying circulating antigens in human biological samples
UNIVERSITY OF NEVADA RENO
U54AI065359
9310365
Method of diagnosing and treating melioidosis
UNIVERSITY OF NEVADA RENO
U54AI065359
8753831
Methods for detection of botulinum neurotoxin
BECKMAN RESEARCH INSTITUTE/CITY OF HOPE
U54AI065359
8067192
Methods for detection of botulinum neurotoxin
BECKMAN RESEARCH INSTITUTE/CITY OF HOPE
U54AI065359
8435759
Plasmid-encoded neurotoxin genes in Clostridium botulinum serotype A subtypes
UNIVERSITY OF WISCONSIN-MADISON
U54AI065359
9453057
Plasmid-encoded neurotoxin genes in Clostridium botulinum serotype A subtypes
UNIVERSITY OF WISCONSIN-MADISON
U54AI065359
8263104
NORTHWESTERN UNIVERSITY
U54AI065359
9498521
Purification, characterization, and use of Clostridium botulinum neurotoxin BoNT/A3
UNIVERSITY OF WISCONSIN-MADISON
U54AI065359
8440204
Subtype of Closteridium botulinum neurotoxin type A and uses thereof
UNIVERSITY OF WISCONSIN-MADISON
Source- https://projectreporter.nih.gov/reporter_PatResults.cfm?icde=34980872
PubMed Search Results
Terms- Barbour, Borrelia, Vaccine
36 Abstracts
1989- 2015
Cook V, Barbour AG.
Ticks Tick Borne Dis. 2015 Jul;6(5):549-58. doi: 10.1016/j.ttbdis.2015.04.009. Epub 2015 Apr 28.
PMID:
26005106
Select item 246957752.
Diversity of antibody responses to Borrelia burgdorferi in experimentally infected beagle dogs.
Baum E, Grosenbaugh DA, Barbour AG.
Clin Vaccine Immunol. 2014 Jun;21(6):838-46. doi: 10.1128/CVI.00018-14. Epub 2014 Apr 2.
PMID:
24695775
Select item 238263013.
Baum E, Randall AZ, Zeller M, Barbour AG.
PLoS One. 2013 Jun 24;8(6):e67445. doi: 10.1371/journal.pone.0067445. Print 2013.
PMID:
23826301
Select item 187707914.
Detection of borreliacidal antibodies by flow cytometry.
Callister SM, Jobe DA, Schell RF.
Curr Protoc Cytom. 2004 Nov;Chapter 11:Unit 11.5. doi: 10.1002/0471142956.cy1105s26.
PMID:
18770791
Select item 165843335.
Ornstein K, Barbour AG.
Vector Borne Zoonotic Dis. 2006 Spring;6(1):103-12.
PMID:
16584333
Select item 156080696.
Tsao JI, Wootton JT, Bunikis J, Luna MG, Fish D, Barbour AG.
Proc Natl Acad Sci U S A. 2004 Dec 28;101(52):18159-64. Epub 2004 Dec 17.
PMID:
15608069
Select item 129198557.
Sen E, Schell RF.
Microbes Infect. 2003 Aug;5(10):869-78.
PMID:
12919855
Select item 126531378.
Tsao J, Barbour AG, Luke CJ, Fikrig E, Fish D.
Vector Borne Zoonotic Dis. 2001 Spring;1(1):65-74.
PMID:
12653137
Select item 126154429.
Pal S, Luke CJ, Barbour AG, Peterson EM, de la Maza LM.
Vaccine. 2003 Mar 28;21(13-14):1455-65.
PMID:
12615442
Select item 1206901610.
Ornstein K, Berglund J, Bergström S, Norrby R, Barbour AG.
Scand J Infect Dis. 2002;34(5):341-6.
PMID:
12069016
Select item 1198230411.
Laboratory testing for suspected Lyme disease.
Bunikis J, Barbour AG.
Med Clin North Am. 2002 Mar;86(2):311-40. Review.
PMID:
11982304
Select item 1130912112.
Bunikis J, Mirian H, Bunikiene E, Barbour AG.
Mol Microbiol. 2001 Apr;40(2):387-96.
PMID:
11309121
Select item 1099837413.
Antigenic variation in vector-borne pathogens.
Barbour AG, Restrepo BI.
Emerg Infect Dis. 2000 Sep-Oct;6(5):449-57. Review.
PMID:
10998374
Select item 1072053214.
Luke CJ, Marshall MA, Zahradnik JM, Bybel M, Menefee BE, Barbour AG.
J Infect Dis. 2000 Mar;181(3):1062-8.
PMID:
10720532
Select item 1067942315.
Borrelia pathogenesis research in the post-genomic and post-vaccine era.
Nordstrand A, Barbour AG, Bergström S.
Curr Opin Microbiol. 2000 Feb;3(1):86-92. Review.
PMID:
10679423
Select item 1041172216.
Sohaskey CD, ZĂĽckert WR, Barbour AG.
Mol Microbiol. 1999 Jul;33(1):41-51.
PMID:
10411722
Select item 1033849417.
Bunikis J, Barbour AG.
Infect Immun. 1999 Jun;67(6):2874-83.
PMID:
10338494
Select item 1006769718.
Edelman R, Palmer K, Russ KG, Secrest HP, Becker JA, Bodison SA, Perry JG, Sills AR, Barbour AG, Luke CJ, Hanson MS, Stover CK, Burlein JE, Bansal GP, Connor EM, Koenig S.
Vaccine. 1999 Feb 26;17(7-8):904-14.
PMID:
10067697
Select item 935293719.
Analysis of promoters in Borrelia burgdorferi by use of a transiently expressed reporter gene.
Sohaskey CD, Arnold C, Barbour AG.
J Bacteriol. 1997 Nov;179(21):6837-42.
PMID:
9352937
Select item 917847620.
Luke CJ, Huebner RC, Kasmiersky V, Barbour AG.
Vaccine. 1997 Apr-May;15(6-7):739-46.
PMID:
9178476
Select item 898520121.
An OspA-based DNA vaccine protects mice against infection with Borreliaburgdorferi.
Luke CJ, Carner K, Liang X, Barbour AG.
J Infect Dis. 1997 Jan;175(1):91-7.
PMID:
8985201
Select item 897340222.
Unusual strain of Borrelia burgdorferi isolated from Ixodes dentatus in central Georgia.
Oliver JH Jr, Chandler FW Jr, James AM, Huey LO, Vogel GN, Sanders FH Jr.
J Parasitol. 1996 Dec;82(6):936-40.
PMID:
8973402
Select item 899335823.
Sadziene A, Thompson PA, Barbour AG.
Ann N Y Acad Sci. 1996 Oct 25;797:140-50. No abstract available.
PMID:
8993358
Select item 862707124.
Sadziene A, Thompson PA, Barbour AG.
J Infect Dis. 1996 May;173(5):1184-93.
PMID:
8627071
Select item 874012225.
Experimental immunization against Lyme borreliosis with recombinant Osp proteins: an overview.
Sadziene A, Barbour AG.
Infection. 1996 Mar-Apr;24(2):195-202. Review.
PMID:
8740122
Select item 789042426.
Borrelia burgdorferi mutant lacking Osp: biological and immunological characterization.
Sadziene A, Thomas DD, Barbour AG.
Infect Immun. 1995 Apr;63(4):1573-80.
PMID:
7890424
Select item 789039427.
McGrath BC, Dunn JJ, Gorgone G, Guttman D, Dykhuizen D, Luft BJ.
Infect Immun. 1995 Apr;63(4):1356-61. Erratum in: Infect Immun 1995 Jun;63(6):2390.
PMID:
7890394
Select item 761066428.
Sadziene A, Barbour AG.
Wien Med Wochenschr. 1995;145(7-8):162-5. Review. German.
PMID:
7610664
Select item 831537829.
Stover CK, Bansal GP, Hanson MS, Burlein JE, Palaszynski SR, Young JF, Koenig S, Young DB, Sadziene A, Barbour AG.
J Exp Med. 1993 Jul 1;178(1):197-209.
PMID:
8315378
Select item 850300630.
The biological and social phenomenon of Lyme disease.
Barbour AG, Fish D.
Science. 1993 Jun 11;260(5114):1610-6. Review.
PMID:
8503006
Select item 841806831.
Role of attached lipid in immunogenicity of Borrelia burgdorferi OspA.
Erdile LF, Brandt MA, Warakomski DJ, Westrack GJ, Sadziene A, Barbour AG, Mays JP.
Infect Immun. 1993 Jan;61(1):81-90.
PMID:
8418068
Select item 147551932.
Antigenic variation and strain heterogeneity in Borrelia spp.
Wilske B, Barbour AG, Bergström S, Burman N, Restrepo BI, Rosa PA, Schwan T, Soutschek E, Wallich R.
Res Microbiol. 1992 Jul-Aug;143(6):583-96. Review.
PMID:
1475519
Select item 155474133.
France LL, Kieleczawa J, Dunn JJ, Hind G, Sutherland JC.
Biochim Biophys Acta. 1992 Mar 27;1120(1):59-68.
PMID:
1554741
Select item 205613334.
Sadziene A, Thomas DD, Bundoc VG, Holt SC, Barbour AG.
J Clin Invest. 1991 Jul;88(1):82-92.
PMID:
2056133
Select item 213623735.
Dunn JJ, Lade BN, Barbour AG.
Protein Expr Purif. 1990 Nov;1(2):159-68.
PMID:
2136237
Select item 276138836.
Bergström S, Bundoc VG, Barbour AG.
Mol Microbiol. 1989 Apr;3(4):479-86.
PMID:
2761388
Most Recent NIH Grantor- 2017
NIH - National Institutes of Health
John Salzman
Assistant Extramural Inventions Policy Officer / IT Policy Analyst
NIH Division of Extramural Inventions & Technology Resources (DEITR)
Office of Policy for Extramural Research Administration (OPERA)
Office of Extramural Research (OER), National Institutes of Health
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Examples Of Patents
Diagnostic test for borrelia infection
[Also For Future Use In Vaccines]
United States Patent
6,617,441
Barbour , et al.
September 9, 2003
Vaccines for Protection Against B. lonestari sp. nov. Infection
The present inventors contemplate vaccines for use in both active and passive immunization embodiments. Immunogenic compositions, proposed to be suitable for use as a vaccine, may be prepared most readily directly from immunogenic B. lonestari sp. nov.-specific surface antigens, such as Vmp or Osp lipoprotein.
Source
United States Patent
5,585,102
Barbour , et al.
December 17, 1996
**Please see images for: ( Certificate of Correction ) **
Flagella-less borrelia
Abstract
This invention relates to flagella-less strains of Borrelia to novel methods for use of the microorganisms as vaccines and in diagnostic assays. Although a preferred embodiment of the invention is directed to Borrelia burgdorferi, the present invention encompasses flagella-less strains of other microorganisms belonging to the genus Borrelia. Accordingly, with the aid of the disclosure, flagella-less mutants of other Borrelia species, e.g., B. coriacei, which causes epidemic bovine abortion, B. anserina, which causes avian spirochetosis, and B. recurrentis and other Borrelia species causative of relapsing fever, such as Borrelia hermsii, Borrelia turicatae, Borrelia duttoni, Borrelia persica, and Borrelia hispanica, can be prepared and used in accordance with the present invention and are within the scope of the invention. Therefore, a preferred embodiment comprises a composition of matter comprising a substantially pure preparation of a strain of a flagella-less microorganism belonging to the genus Borrelia.
This text discusses the current state of knowledge about Lyme disease, including its more controversial aspects. Four case studies are used to illustrate the ... More
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This text discusses the current state of knowledge about Lyme disease, including its more controversial aspects. Four case studies are used to illustrate the varying course of the disease in different individuals and under different circumstances. A fifth patient is used as a model for people who, despite the absence of a clear medical diagnosis, remain convinced that Lyme disease explains their symptoms. The text explains how Lyme disease is spread, who is at risk, and describes the symptoms and consequences - from the rash following a tick bite to serious complications, such as infection of the nervous system, joints and heart. Diagnostic tests for the disease are described, and the test results explained. There is also a comparison made between Lyme disease and conditions often mistaken for it, such as fibromyalgia and chronic fatigue syndrome. In addition, the text outlines what individuals can do to avoid getting Lyme disease, as well as what the community as a whole can do to reduce the number of Lyme-carrying ticks.
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Mixed Blessings Vaccine
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Home > Feature Stories > Health & Medicine > ProfileAlan Barbour, M.D.
Professor, microbiology and genetics
Mixed blessing
Despite his ambivalence about how it's being marketed, the co-creator of the Lyme disease vaccine sees exciting possibilities in the unique way it works(08.29.2002)
Earlier generations understood that nature is not always benign. The farmhouse stood isolated, the surrounding plowed fields holding back the forest. At well-kept homes in the deep South, the bare, dirt yards were neatly swept and inspected often for animal — especially snake — tracks.
If we still felt that arm's-length wariness toward nature, Lyme disease probably would not now be one of the top 10 infectious diseases, believes the scientist who holds the patent on the world's first Lyme disease vaccine. When UCI's Alan Barbour, who holds professorships in the School of Medicine and the School of Biological Sciences, draws a diagram of the route of transmission of the disease, as he did in his 1996 book Lyme Disease: The Cause, the Cure, the Controversy, he places humans into their most fundamental framework, as animal preyed upon by other animals.
Unlike most infectious diseases, Lyme is a problem for the rich. It tends to turn up in wooded suburbs that are full of deer, mice and people. The disease is transmitted by ticks that pick up the bacteria from the bloodstream of field mice and then pass it on to deer and humans.
Named for the upscale Connecticut suburb in which it was first diagnosed in 1975, Lyme disease had been brought forcefully to the medical community's attention by mothers worried about their children's aching, swollen joints. The disease has become a center of controversy among people who believe Lyme's effects on the heart and nervous and immune systems are underestimated by the medical profession. In his book, Barbour speculates that Lyme may be the brucellosis of the nineties, a disease that for a while was thought responsible for an array of stubborn symptoms. One of Lyme's discoverers has called the disease "a magnet for people who just don't feel well."
On the other hand, the numbers of people infected have placed Lyme disease in the upper ranks of infectious diseases — less than AIDS but probably more than syphilis or tuberculosis. Over the past few years, approximately 10,000 Americans per year have been diagnosed with Lyme disease, but this is a cautious count and Barbour guesses the true number of annual infections may be nearer 50,000. Antibiotic treatment exists but stirs its own controversies.
Lyme disease remains concentrated along the Atlantic seaboard from Virginia to Maine, and in the prosperous upper midwestern states of Wisconsin and Minnesota. At lower risk is the West Coast, from about Santa Barbara to British Columbia.
In 1997, 172 cases — 100 percent more than in the previous year — were reported throughout California, and in 1998, a first case was reported in Los Angeles County.
The vaccine that Barbour's discoveries helped create went on the market in early 1999. Reaction and gratitude have been immediate. In Minnesota, a Lyme disease hot spot, a newspaper columnist wrote that a statue of Barbour should be erected at the state capitol, right next to that of Leif Ericson.
Barbour himself has mixed feelings about his creation of the vaccine, both pride and worry. "What I'd hope to see is that it will be beneficial for people who really need it," he said. "I'd hate to see it being used under circumstances where it was primarily because of marketing that someone ended up taking it."
Advertisements for the vaccine have appeared in national magazines and on television. In common with many other physicians, Barbour is troubled by the advertising of prescription medicines directly to an unwary public. All medicines have side-effects, he points out. Could the vaccine trigger arthritis in people who already have a genetic predisposition? He sees the possibility. Other researchers have wondered whether the vaccine might simply suppress the bull's-eye rash and deprive victims of that valuable warning sign. Even the U.S. Food and Drug Administration committee that approved the vaccine in December 1998 issued a number of warnings against its misuse.
Marketed under the trade name LYMErix by Philadelphia pharmaceutical giant SmithKline Beecham Biologicals, the vaccine is designed to be given as three shots over a year's time, but not to anyone younger than 17 (young people actually are more at risk, but clinical trials on them haven't been completed). FDA clearance to sell a second Lyme vaccine also has been sought by a French pharmaceutical company, Pasteur Merieux Connaught. Either company, or both, will pay royalties to the patent-holders, Barbour and the Swedish colleague in whose lab the Lyme-causing bacteria was DNA-sequenced.
Though he's ambivalent about the uses of the vaccine, Barbour is very proud of the research that produced it. At a time when some bacteria have grown resistant to antibiotics and new treatments must be found, he sees exciting possibilities in the way this vaccine works. Unlike any previous vaccine, this one kills the infectious bacteria not in the human bloodstream but in the body of the tick itself. A vaccinated human, in effect, cures the tick.
The basic discoveries on which the vaccine is based were made long ago. In 1981, while studying deer ticks at the National Institutes of Health Rocky Mountain Laboratories in Montana, Barbour and a fellow researcher isolated within the tick gut the bacterium responsible for causing Lyme disease. Because the other researcher, Willy Burgdorfer, first found the organism, it bears his name: Borrelia burgdorferi.
Barbour's great initial contribution was the discovery of a culture medium in which B. burgdorferi would grow and multiply. Once it could be reproduced, it could be studied. Barbour went on to clone the bacteria, identify a biologically vulnerable protein on its surface, and eventually work on development of the new vaccine.
He identified, too, a possible tactical advantage against ticks: they're slow. A tick takes a day to attach its sucking mouth and another day before the bacteria it carries begin passing via the tick's saliva into the victim's bloodstream. On the surface of the bacteria, as it was found inside ticks, was a particular protein, termed OspA, that remained virtually identical wherever in America ticks were found. As soon as it met human blood, OspA immediately began turning into another protein, OspC, in a wide variety of strains, each with different DNA. OspA remained constant inside the tick because ticks — like other invertebrates — have no immune system; with no immune attack, the bacteria had no reason to develop defenses.
Barbour describes what happens when a Lyme-infected tick meets a vaccinated human. The tick, he says, is "almost like a little drill, a roto-rooter. It carves out a place for itself and begins to feed. After a while, it begins secreting saliva to make it easier, so that's when the infection starts. It comes in with the saliva. But by that time, it's no longer making OspA, it's making OspC, so the vaccine doesn't work once that happens. In an immunized person, the person has the antibody to OspA in their blood, and that goes into the tick at the same time as the rest of the blood, killing the bacteria. So that's unlike any other vaccine, and in terms of the potential, that indicates it may be possible to make a vaccine against malaria in the same way."
Malaria, rheumatoid arthritis, multiple sclerosis, ulcers, heart disease — all do have or are suspected of having a bacterial trigger. All have been mentioned by Barbour as possible beneficiaries of this new approach. But the work will be done by others; Barbour plans to continue his research on ticks, with the work partly financed by his patent royalties. Ticks carry many diseases — Rocky Mountain Spotted Fever, relapsing fever, Colorado tick fever, ehrlichiosis, tularemia, among others — and Barbour intends to remain focused here.
Should field mice be vaccinated, he wonders, the way rabies vaccine is distributed to wild animals in the South, by strewing vaccine-laden food through suburbs? Could a vaccine be created which would make ticks fall off faster, or make them itch so that people would notice them quickly? Could ticks be eradicated? Should they be?
"I don't think anybody is going to stand up and say 'we need ticks,'" he said. "There isn't a big constituency for ticks. They may have some role in the big scheme of things, but to be able to reduce the number of ticks — that's what would really be the most effective way to prevent Lyme disease."
For more information on Lyme disease, visit the American Lyme Disease Foundation web site: www.aldf.com, or the Centers for Disease Control and Prevention:www.cdc.gov/ncidod/diseases/lyme/lymeinfo.htm
— Merrily Helgeson
http://archive.today.uci.edu/Features/profile_detail.asp?key=79
Alan Barbour- Quotes
"Lyme disease is rarely fatal: only a few deaths are attributable to the disease in the entire world" Alan Barbour, MD, in Lyme Disease, The Cause, The Cure, The Controversy, page 34
"[Lyme disease] is curable and stigma-free" Alan Barbour, MD, ibid., page 192
"Lyme disease bacteria remain in the skin for two or more days until spreading to the other parts of the body. Until the microorganisms spread, there is no need for an antibiotic that is distributed throughout the body" Alan Barbour, MD, Lyme Disease, The Cause, The Cure, The Controversy, page 225
"Like Lyme disease, CFS and fibromyalgia are diagnosed using strict criteria that have been agreed upon by physicians and other experts. . . . Diagnoses of CFS, fibromyalgia and chronic Lyme disease undoubtedly are being made in cases that do not fully meet the strict criteria" Alan Barbour, MD, Lyme Disease, The Cause, The Cure, The Controversy, pages 202-203
"Many consider Lyme disease to be a nuisance that involves a trip to the physician's office every year or two and a few weeks of antibiotics" Alan G. Barbour, MD, Lyme Disease, The Cause, The Cure, The Controversy, page 243
". . . a topical antibiotic to prevent Lyme disease after a tick bite is desirable" Alan Barbour, MD, Lyme Disease, The Cause, The Cure, The Controversy, page 244
"An antibiotic ointment might prevent infection from other bacteria but would likely have little effect on B. burgdorferi" Alan Barbour, MD, ibid., page 222
"For many people who become infected with Lyme disease spirochetes, this immune response that limits the erythema rash is sufficient to cure them of the infection. The spirochetes have either been completely eliminated from the body or so limited in their spread that they no longer can cause harm" Alan Barbour, MD, ibid., page 8
"Eventually, antibodies, perhaps aided by lymphocytes, attach to spirochetes in the blood and remove them from the circulation. However, by the time that occurs, some spirochetes have left the blood and entered distant organs. They are able to do this because they can attach themselves to the sides of blood vessels and then penetrate the cells that line veins and arteries. Once they reach the other side of the blood vessels, spirochetes can reside and move in the liquid between cells" Alan Barbour, MD, ibid., page 9
A B. burgdorferi organism may spend some of its life inside cells. After all, for these bacteria to leave the blood and go into tissues, they must pass through cells that line the blood vessels. . . . these intracellular spirochetes can escape the effects of the antibiotics that do not penetrate into cells well. When an antibiotic of that class is stopped, so the argument goes, the live bacteria inside the cells could reseed the rest of the body" Alan Barbour, ibid., pages 125-126
"The fact that the N.I.H. plans to spend about $4 million on this study [the long-term use of antibiotics to treat Lyme disease] means less money for more useful projects" Alan Barbour, MD, in The New York Times OP-ED of July 5, 1997
“Lyme disease is primarily a disorder of suburban, educated middle- and upper-class people. Lyme disease can be as disabling as syphilis, but there usually is not a stigma to having Borrelia burgdorferi infection.” Alan Barbour, MD. Journal of the American Medical Association, January 21, 1998
“Currently, there are many sources of information about Lyme disease, much of which is in disagreement with the experts' advice. These sources include the Internet, books on Lyme disease written by laypersons, and pamphlets, newsletters, and call-in help lines of patient advocacy groups." Alan Barbour, MD. Journal of the American Medical Association, January 21, 1998
NEW YORK STATE ASSEMBLY STANDING COMMITTEE ON HEALTH
NEW YORK STATE ASSEMBLY STANDING COMMITTEE ON HEALTH
PUBLIC HEARING: CHRONIC LYME DISEASE AND
LONG-TERM ANTIBIOTIC TREATMENT
November 27, 2001
1 ALAN BARBOUR, M.D.; Sworn
2 MR. GOTTFRIED: Okay. Thank you.
3 Please, begin.
4 DR. BARBOUR: All right. I have no
5 idea what has gone on previously during the day, but
6 I thought I would mainly leave most of my time to
7 answering questions; and I would read a couple things
8 that I've written in the past, that are in the public
9 record and available for the public to see.
10 One is a short couple of sentences from
11 an op. ed. piece I wrote for the New_York_Times on
___ ____ _____
12 July 5th, 1997. And there I wrote:
13 "Many scientists who study Lyme disease
14 find themselves uncomfortably in conflict with
15 advocacy groups that might otherwise be their
16 benefactors. The controversy is not only about
17 priorities for research, but also about how to define
18 the disease and how best to treat it."
19 I basically feel that this is the same
20 situation now, in 2001, as what occurred in 1997.
21 The other -- a little longer piece is
22 from a book I wrote called Lyme_Disease:__The_Cause,_
____ ________ ___ ______
23 The_Cure,_The_Controversy, by Johns Hopkins Press,
___ _____ ___ ___________
24 published in 1996, and this is from page 190. And
25 it's after I describe a hypothetical case of someone
270
1 who might have had Lyme disease and might not have
2 been given the diagnosis of chronic Lyme disease.
3 And her name was Evelyn. This is, again, a
4 hypothetical situation. And the subtitle for this
5 paragraph is, quote, "Is Lyme disease equivalent to a
6 Borrellia burgdorferi infection?"
7 "Before reconsidering Evelyn's
8 diagnosis, let's back up to the point when her
9 physicians concluded that she did not have Lyme
10 disease. As should be clear by now, since your
11 conclusion is controversial, some of these
12 differences of opinion over the diagnosis and
13 management lie in the fact that some people
14 distinguish between 'Lyme disease' and Borrellia
15 burgdorferi infection. Separated in many people
16 minds are, on the one hand, a clinical syndrome Lyme
17 disease which might be defined on the basis of
18 symptoms in a way that is valid and useful to patient
19 care, and on the other hand, an infection by a
20 particular microorganism, Borrellia burgdorferi. The
21 acknowledged difficulty in detecting the
22 microorganism widens the gulf between the concept of
23 Lyme disease and a spirochete infection. In a
24 situation such as this, that is, where the diagnostic
25 line between infection and no infection is fuzzy, it
271
1 is tempting to make a diagnosis on the basis of a
2 constellation of symptoms alone, rather than a more
3 comprehensive view incorporating not only symptoms,
4 but also laboratory data and the likelihood of
5 becoming infected. Attributing a troubling,
6 disabling and chronic disease to a potentially
7 treatable infection is appealing for both physician
8 and patient.
9 "Nevertheless, diagnosis on these
10 grounds may be hasty. To invoke one type of
11 bacterium to account for all cases of what falls
12 under the broader diagnostic umbrella of Lyme disease
13 is akin to saying that all or most forms of arthritis
14 of the knee are due to Borrellia burgdorferi. There
15 are many kinds of arthritis, only one of which is
16 Lyme arthritis. A common form of arthritis,
17 rheumatoid arthritis, may be initiated by one or more
18 infectious agents, but this has not been proven.
19 Even the suspicion that an infection is the causative
20 agent has not yet led to a widely-accepted treatment
21 or means of prevention.
22 Those physicians who have a more
23 restricted definition of chronic Lyme disease appear
24 to be on the firmest scientific ground to judge from
25 the medical literature and textbooks, but that is not
272
1 to say that the observations of those arguing for a
2 more broadly defined chronic Lyme disease are
3 invalid. It has been suggested by some that certain
4 patients do benefit from extended courses of therapy
5 and only approach normal health while being treated
6 with antibiotics, then these reports warrant serious
7 consideration. As has been discussed" - elsewhere in
8 the book - "this positive outcome with antibiotics
9 may be the consequence of a placebo effect either of
10 the medication itself or the physician's optimism and
11 encouragement. Alternatively, non-specific effects
12 of antibiotics may play a role in producing the
13 patient's sense of greater well-being. Perhaps,
14 through the poorly understood effects,
15 anti-inflammatory effects, or another bacterium.
16 Nevertheless, until a group of patients meeting the
17 broader definition of Lyme disease are treated
18 blindly and randomly in a controlled trial, it may be
19 shorted-sighted to reject on hand some of these
20 reports of inexplicable benefits from antibiotics."
21 Now, that's by -- where I stop.
22 I would just add that since I wrote the
23 book there has been the NIH study. And Dr. Klempner
24 is the principal investigator, and I'm sure you have
25 that information before you and it probably been
273
1 discussed.
2 I think the other information that may
3 be relevant here is the results of the study of the
4 Persian Gulf -- people with -- who have been said to
5 have Persian Gulf syndrome. And there's a large
6 Veterans Administration study - I think it's still
7 going on, I'm not sure if that's completed or not -
8 of treating these individuals with antibiotics,
9 mainly a form of tetracycline. And I think if --
10 this may be relevant in the sense that if a benefit
11 is shown of antibiotics in this situation, it might
12 indicate, you know, an effect of antibiotics that
13 hadn't been anticipated in terms of treating people
14 with these fairly non-specific symptoms.
15 I'm open to questions.
16 MR. GOTTFRIED: Thank you, Doctor. I
17 have a couple of questions.
18 You were making the distinction between
19 Lyme disease and infection with the specific
20 bacterium that we've all been talking about --
21 DR. BARBOUR: Yes.
22 MR. GOTTFRIED: -- which I won't try to
23 pronounce. Is your point that the collection of
24 symptoms that we call -- that are associated with
25 Lyme disease may be caused by bacteria other than
274
1 that or may be somehow non-bacterial or what?
2 DR. BARBOUR: Well, I think here we
3 come back to the question of how you define Lyme
4 disease just on the basis of symptoms. For
5 epidemiologic purposes, for county cases, it's -- I
6 think everybody would agree it's best to be very
7 precise so you don't mix apples and oranges. But for
8 an individual patient, then I think most physicians
9 and health care professionals would be, you know, a
10 little broader in their definition.
11 So, I think if -- but even if we accept
12 that limitation, I think Lyme disease can be -- has
13 been defined. I've seen it defined this way on Web
14 sites and literature that's so broad that, you know,
15 it could include other -- it certainly could include
16 other causes for that person's symptoms. And these
17 may be other bacteria; they may be a combination of
18 problems, as has been suggested for the Persian Gulf
19 syndrome, as a combination of various factors coming
20 together to produce symptoms of fatigue, muscle aches
21 and things like that. So, yes, to answer your
22 question, if it's defined broadly enough, then --
23 yeah, then I think there could be another
24 explanations. I think the idea that erythema
25 migrans, the skin rash which was once thought to be
275
1 characteristic of Lyme disease, I think there's -- in
2 my mind, I think there is evidence that it can be
3 caused by other bacterium. They're related to
4 Borrellia burgdorferi, but they're another species.
5 MR. GOTTFRIED: Okay. On the question
6 of appropriate treatment, we had at least one witness
7 earlier in the day, the medical director of one of
8 our major managed care companies, saying that they
9 reject long-term antibiotic treatment unless
10 essentially ordered to pay for it by our external
11 review system. Because they only believe in paying
12 for treatment or providing treatment that comes out
13 of evidence-based medicine, and that long-term
14 antibiotic treatment is not backed up by
15 evidence-based medicine, suggesting -- although I
16 guess we -- well, implying that there was an
17 evidence-based judgment against long-term antibiotic
18 treatment.
19 Do I understand your testimony to be
20 that there is not at this point an evidence-based
21 medicine judgment as to what the appropriate
22 treatment is?
23 DR. BARBOUR: My understanding of the
24 data is that if someone has had Borrellia burgdorferi
25 infection and this decision -- this conclusion has
276
1 been reached after considering the clinical history,
2 the epidemiology, the laboratory tests, such was done
3 in the study in Boston - an NI-sponsored the study -
4 my understanding of the data, of that data and other
5 data, is that there's no additional benefit of
6 prolonged treatment for those individuals.
7 But my point is, I think there isn't
8 enough evidence-based medicine with regard to
9 individuals who may never have had Lyme disease to
10 begin with, but have a constellation of symptoms
11 that, you know, in some cases have led to a diagnosis
12 of Lyme disease by a health care professional and
13 have ended up being treated. I don't think -- from
14 what I understand, there has not been an adequate
15 study of those individuals to see if, really, in
16 fact, they're being benefited by antibiotics. This
17 was done -- has been done in the case of the VA study
18 with the Persian Gulf -- the people with Persian Gulf
19 syndrome, and they're testing that. It's very
20 well-defined in terms of, you know, their symptoms in
21 individuals and what they were at risk for, but they
22 are doing that study.
23 As far as I know, there hasn't been
24 another study that would be at all comparable to
25 that, with individuals who really don't even -- might
277
1 not even be considered to have Lyme disease to begin
2 with by, you know, the strict definition of the NI
3 study.
4 MR. GOTTFRIED: Okay. Other questions?
5 DR. MILLER: Yes.
6 I'm Joel Miller. I'm on the Health
7 Committee. And I have a quote that you had made. It
8 said -- and this was on -- well, this is what you
9 have said:
10 "I think we need to go back to an
11 organism-based definition of the infection. And when
12 it comes to treating disease, we need a more
13 empirical approach to conditions that don't fit in
14 that diagnostic box. Also, as with most scientific
15 quests, there is still a lot to learn, but at least
16 there are these organisms identified. It remains for
17 research as to understand what happens when someone
18 is infected with more than one of them at a time."
19 Now, it's been the testimony today that
20 there is a great deal to learn: That, in fact, we
21 haven't been able to rule out the infection of these
22 organisms; that the one common theme is that the
23 diagnostic tests are more a failure than a help,
24 they're more a confusion than an assistance; and that
25 to base treatment on waiting for these laboratory
278
1 tests to come back, it may, in fact, put the patient
2 at great risk. There was also testimony today about
3 the study that you're citing, in Boston, which talked
4 about the long-term treatment of antibiotics. And
5 basically the testimony was, it was neither long-term
6 nor the appropriate treatment with the appropriate
7 antibiotic.
8 And so the question is: Wouldn't you
9 like to stand on your comment that there's a great
10 deal to learn, and we have to learn more about how
11 these organisms function, than to say that there is
12 no basis to treat the organisms unless you can have a
13 laboratory test show you that they're there and that
14 this is probably not an organism-based disease?
15 DR. BARBOUR: Well, that's a lot to
16 comment on. I think I know where that quote came
17 from. It was fairly recently. It was on a Web
18 publication, if I'm correct. And that had to do with
19 mixed infections, which I think is another issue.
20 DR. MILLER: But we have more than one
21 microorganism here. Sometimes --
22 DR. BARBOUR: Right. I'm an infectious
23 disease physician, and we're used to finding out
24 what's the cause of diseases; that's how we operate.
25 Other physicians are in the position of acting and
279
1 treating people for diseases in which they have no
2 idea what the cause is -- and maybe in the future we
3 will know. I think in most cases of Lyme disease
4 that I'm familiar with, either directly or hearing
5 about or reading about, going to meetings, the
6 individuals have, you know, through a combination of
7 talking to them, the patient history, physical, some
8 laboratory tests, including the ELISA and/or Western
9 blot, I think that you can come to a pretty good
10 conclusion about whether they have that infection or
11 not.
12 I think the -- what is, in my mind, the
13 problem and why, you know, we're all struggling with
14 this and -- you know, for a long, long time, for
15 several years now -- is coming to some agreement
16 about -- what about the individuals who really don't
17 fall into that more classical presentation? I think
18 no one would argue about how to manage the people if
19 they do have the positive blood test, they do have
20 the classic skin rash and live in an area that has a
21 lot of Lyme disease. It's the people who don't fall
22 in that category that everybody has difficulty with.
23 And my point is, why not study those individuals and
24 do a study of whether antibiotics help or not? I
25 agree that the study in Boston, it was well done in
280
1 term of how it was set up and defined. And they had
2 to -- obviously, by their criteria had to stop at
3 some point. I would hope that they or someone else
4 is planning to do a study that would, you know, look
5 at longer oral treatments and -- with people who may
6 not have had Lyme disease to begin with by the
7 classic definition.
8 DR. MILLER: Did I hear you to say that
9 that study was well done?
10 DR. BARBOUR: Well, I think it was well
11 done in the sense of how it was defined, yeah. I
12 mean, they were --.
13 DR. MILLER: Yeah, they defined --.
14 DR. BARBOUR: I'm not in a position --
15 I don't have it in front of me or reviewed it
16 intensely last night to know, but --.
17 DR. MILLER: But if you use six weeks
18 as a definition of long term, but use low doses of
19 potentially the inappropriate antibiotic to determine
20 whether long-term treatment by antibiotics was
21 adequate -- we had one study presented today that
22 took two years for resolution, checking on clear
23 symptoms of infection.
24 Empirically speaking, though, if
25 someone comes and has symptoms, and you treat them
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1 with antibiotics and they continue to get better, in
2 spite of the fact that they haven't found your
3 particular bacteria yet, would you say that continued
4 treatment with antibiotic, as long as they were
5 getting better, made sense?
6 DR. BARBOUR: Well, I would think it
7 would make sense if there was a controlled trial to
8 show that it had a benefit, yeah.
9 DR. MILLER: In other words, if they're
10 really not getting better because of the antibiotics,
11 or even if they're getting better with the
12 antibiotics, we should immediately find someone with
13 the same symptoms and not give them the antibiotic to
14 see if they get equally better over the same long
15 period of time?
16 DR. BARBOUR: I'm sorry, I didn't hear
17 that.
18 DR. MILLER: Well, we have someone who
19 goes into a physician's office, the physician
20 diagnoses them based on their skill as a physician,
21 says, "I think you have Lyme." They begin a regimen
22 of antibiotic treatment, the patient continues to get
23 better. And you're saying, well, we really don't
24 know if the patient is getting because of the
25 antibiotic; we should immediately find someone with
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1 the same symptoms and not treat them, and see if they
2 get equally better? How else do you do a
3 double-blind study, or how else -- do you have some
4 other way of doing the study, unless you do that? I
5 mean, is that what you're suggesting, that it's not
6 enough that the person is getting better? I mean, we
7 can prove they're getting better. You're doubting
8 whether they're getting better because of the
9 antibiotic. So, the only way we can make a
10 determination here is to find someone with the same
11 symptoms and not give them the antibiotic and see if
12 they get well also; is that what you're saying?
13 DR. BARBOUR: Well, I think that's
14 maybe an overly simple way of saying it, and I
15 think --.
16 DR. MILLER: It's pretty direct, I
17 thought. It was about as simple as I could make it.
18 DR. BARBOUR: I don't think you just
19 one person versus another. It would have to be a
20 large study --
21 DR. MILLER: So, you can't treat --?
22 DR. BARBOUR: -- which there was a
23 question whether antibiotics help or not. Some
24 people walk into an office, who have an bacterial
25 infection, and we treat them for as long as
283
1 necessary.
2 DR. MILLER: There you go. That's
3 exactly what we would like to see. I mean, frankly,
4 if someone walks into your office and they have what
5 you perceive to be infection, you can't tell them to
6 wait in the waiting room until you have ten other
7 people, so you can have a group. I mean, each
8 physician, don't you believe, has to treat the
9 patients as they come in, with the symptoms that they
10 have, with the treatment that they have on hand.
11 I mean, it's interesting that, you
12 know, we have to look for this bacteria. I wonder --
13 was his name Lister, who couldn't quite tell whether
14 the bacteria were causing illness, but he thought if
15 we eliminated bacteria in general maybe people would
16 survive in a hospitals instead of dying? I mean,
17 sometimes you have to make this leap.
18 But clearly we're in the middle of a
19 major controversy and disaster. We have 10,000
20 people in New York State that have - quote, unquote -
21 chronic Lyme disease, which in your opening remarks
22 you suggested was not the same as the spirochetal
23 disease, which is an infection but something else,
24 yet they get better with antibiotics, and you're
25 suggesting it's not valid because we don't have a
284
1 double-blind study. And then you alluded to a study
2 in Boston, which the only -- I mean, the overwhelming
3 comments about it was that it was totally flawed. I
4 mean, if that study was totally flawed, we shouldn't
5 refer to it at all. I mean, I remember a time in the
6 paper where they talked about someone discovered cold
7 hydrogen fusion. That lasted a week, until someone
8 said no one else could produce it.
9 But, I mean, frankly, at this point we
10 have physicians treating sick patients, and what
11 you're suggesting is, in spite of the fact they're
12 getting better with antibiotics, this may not be an
13 infection and we should wait to do another study. I
14 mean, what would you like us to wait for?
15 DR. BARBOUR: Well, I don't know what
16 the testimony has been before, you know, I spoke.
17 But I am very convinced that if this is going to
18 be -- that sort of opinion was widespread, that all
19 it took is -- someone gets better with antibiotics,
20 we really don't know if there is an infection or not,
21 and we're just going to continue it for symptoms that
22 I consider to be non-specific and could have another
23 cause, not -- when I'm speaking about infection and
24 we continue antibiotics for something like a fever, a
25 documented fever, a documented elevated white
285
1 count -- the documented recovery of the tuberculosis
2 bacteria from the sputum, from the bone -- you know,
3 we have evidence that the infections continued. We
4 have evidence from controlled studies that if someone
5 stops antibiotics after four weeks, that they have a
6 ten percent chance of relapsing, and so we use it for
7 six to eight week. There are studies that indicate
8 this.
9 And I am very sure that in the case
10 that -- you know, such that you're describing,
11 except, you know, for the occasional one which, you
12 know, no one else knows what to do, then I think the
13 physician has the justification for going ahead and
14 treating. But for most cases, we can't operate in
15 medicine that way. We have to have some sort of
16 evidence that this is doing some good. I mean, I
17 think we gave up bleeding people a long time,
18 leeches, even though that was the accepted treatment
19 for a number of diseases, because, you know, we found
20 out that that really wasn't doing any good for most
21 people. So, I think if the idea of treating - you
22 mentioned 10,000 people - for long period of times, I
23 think we need better evidence that this is going to
24 do them some good.
25 DR. MILLER: I appreciate what you're
286
1 saying. We just have a number of problems, and that
2 is the relative total abandonment of these 10,000
3 people by other specialists in the health field. So,
4 it's not as if they're being asked to come to an
5 office where someone is treating them successfully
6 for anything else, and so that's a problem. The
7 other problem is that, yes, sometimes we can find the
8 bacterium. Unfortunately, it's at autopsy, which
9 doesn't have the patient or their family at this
10 particular time. And that's been the problem.
11 Sometimes it's three years, sometimes it's five
12 years. In one case, it was 13 years later that they
13 finally found the spirochetes or -- you know, the DNA
14 evidence that the spirochetes were there.
15 And so, you know, the problem that we
16 have right now is that there is enough peripheral
17 evidence to show that there is a good possibility
18 that the bacteria are present, just that our current
19 techniques are not fully capable of identifying them
20 at this particular point. And that's something we
21 have to consider. If it's our diagnostic skills that
22 are failing us, but not our ability to treat, don't
23 you think we should go ahead with the treatment if,
24 in fact, it shows improvement in 80 percent of the
25 patients that come in for treatment and the other 20
287
1 percent are not really being hurt? Because, again,
2 no other physician is willing to treat them for
3 anything.
4 So, you know, under a circumstance like
5 that, wouldn't you agree that it might not be a bad
6 idea to continue the antibiotic treatment as long as
7 80 percent of the people are getting better, the
8 other 20 percent aren't being hurt, that no other
9 physicians are rushing forward to treat them? And
10 that many times, many years later, in fact, we
11 finally do get a positive test for these. You know,
12 you sort of try to do the best you can and treat the
13 patients best way you can. Doesn't it seem that that
14 would be an appropriate best way?
15 DR. BARBOUR: Well, I think my earlier
16 remarks tried to emphasize that I have -- I'm open to
17 the idea that, you know, antibiotics help here, I
18 really am.
19 But what bothers me is, why does it
20 have to be a Borrellia burgdorferi infection? You
21 know, California doesn't have very many cases of Lyme
22 disease - there's some - but there are a lot of
23 individuals here in California who have a very
24 similar illness as what folks in New York are
25 suffering from. I don't think that most of them have
288
1 Lyme disease; they may have something else. They may
2 get better with antibiotics, but if Lyme disease --
3 my point is, if you're trying to define Lyme disease
4 just on the basis of these symptoms and not take into
5 account negative laboratory results, then why
6 couldn't it be some other bacterial infection? In
7 the '50s, brucellosis was considered to cause exactly
8 the same symptoms, and there was -- chronic
9 brucellosis was the cause of this. Chronic fatigue
10 syndrome was considered for a long time to be caused
11 by the Epstein-Barr virus. There are other
12 infections that might be doing this.
13 And what bothers me is, you know, the
14 failure of imagination to consider other things. And
15 if antibiotics are helping, then why not do a study,
16 you know, to determine if they're really working or
17 not? I've suggested this to individuals with the
18 Lyme Disease Foundation, I've suggestion it to
19 individuals at NIH, and at meetings, to people at
20 CDC. Why not find out if this works or not? You
21 know, the study in Boston was some information. I
22 agree it wasn't complete, but I disagree that it was
23 completely flawed. I don't agree with that at all,
24 that statement. So, I'm very -- I'm trying to
25 encourage people to do an adequate study of this.
289
1 Does it help or not?
2 I urge you to contact the people at the
3 VA. Dr. Sam Donta, who I'm sure some of you are
4 familiar with, is the lead investigator of that
5 study. Perhaps he has some data on whether
6 tetracycline helps these folks who have very similar
7 symptoms as what some of the folks with chronic Lyme
8 have.
9 DR. MILLER: I'm not going to dwell on
10 this much longer.
11 MS. MAYERSOHN: I just want to ask --.
12 DR. MILLER: I just want to say that we
13 do have two different spirochetes that have been
14 identified as the possible cause of problems, along
15 with other bacterium as well, that have to be treated
16 in addition to spirochete. So, this is an infection
17 that we lumped together, and it could be caused by
18 more than one entity. But the key factor is that all
19 of them respond to antibiotics and that you need the
20 antibiotics.
21 I'm going to stop at this point. I
22 thank you for your testimony. But Nettie Mayersohn,
23 who is my boss, is going to say something.
24 MS. MAYERSOHN: No, I'm just wondering
25 why the study comes even into what we're trying to do
290
1 today, which is to allow doctors and patients to
2 decide on the course of treatment without
3 interference by any outside group. So, you can do as
4 many studies as you like, no one cares. And we all
5 support the study, but let the treatment go on the
6 way it's suppose to go on, with a decision being made
7 by the doctor and the doctor's patient.
8 By the way, Doctor, I wanted to ask
9 you: Do you treat many cases of Lyme disease in the
10 course of a year?
11 DR. BARBOUR: No, I don't. No. Well,
12 let me say something about -- I don't have problem
13 if, you know, a physician and a patient, an informed
14 patient, you know, undergo -- the patient undergoes
15 prolonged treatment with antibiotics in the case
16 where somebody doesn't have a better explanation. I
17 stress that I hope that a thorough diagnostic workup
18 had been done to rule out other possibilities. But
19 if it's an adult and they're willing to pay for it,
20 or someone is willing to pay for it, then I -- you
21 know, that's up to them. But I do have a problem --
22 I've seen children being treated for long periods of
23 time with multiple antibiotics, and I'm not sure
24 that's in all cases justified. And so that -- and
25 I've seen people with complications --
291
1 MS. MAYERSOHN: Those children --.
2 DR. BARBOUR: -- from antibiotics for
3 the longest period of time.
4 MS. MAYERSOHN: Those children have
5 parents, Doctor.
6 DR. BARBOUR: And I think that people
7 need to be informed about those possibilities.
8 MS. O'CONNELL: Doctor, this Maureen
9 O'Connell. I'm a member of the committee as well.
10 And I'm just going to tell you that, you know, we're
11 going to end our comments with you very shortly, and
12 I thank you for your testimony. But we just had a
13 youngster in here who -- when you talk about a
14 thorough diagnostic workup, she had seen 17
15 specialists before someone would even venture to make
16 a diagnosis of this young lady. And by that time she
17 was practically -- and ten months -- wherein she was
18 practically completely and totally incapacitated to
19 the point that she could not lift up her head. And
20 of those 17 consults that she had, no one initiated
21 any treatment or made any definitive diagnosis, and
22 other -- all tests were inconclusive.
23 So, we're facing a dilemma here. And
24 physicians who are treating, who are on the front
25 lines, are facing a dilemma, and patients are
292
1 suffering. So, until such time as we have more
2 definitive tools, we need to do something for these
3 patients. And I don't think you would disagree with
4 that. This just is a process that may take more time
5 to do some very good studies, but in the interim we
6 do have a problem that needs to be addressed.
7 DR. BARBOUR: Well, maybe I don't
8 understand what the problem is. Why can't a
9 physician with an informed patient treat them with
10 antibiotics if -- I mean, who is preventing that?
11 MR. GOTTFRIED: Well, Doctor, this is
12 Assemblyman Gottfried. Part of the issue here is
13 that you -- well, what's preventing it is, A,
14 insurance companies that refuse to pay. And for many
15 people, if the insurance company can't pay for the
16 treatment, that effectively keeps it from them. And,
17 secondly, our State Health Department has been
18 bringing a significant number of physician discipline
19 cases at physicians who were providing this long-term
20 antibiotic treatment. And part of our inquiry is to
21 determine whether that form of treatment and the
22 chronic Lyme diagnosis is in the reasonable ballpark
23 of professional judgment, and if so, would that lead
24 you to believe that these physician discipline cases
25 are inappropriate? And so while the Legislature is
293
1 not in the business of making medical judgments,
2 there are public policy consequences or public policy
3 related reasons why this kind of issue would be of
4 interest to us.
5 DR. BARBOUR: Yeah, I understand. I
6 obviously can't make a comment on individual cases.
7 There may be other factors involved than just simply
8 the length of antibiotic treatment. It's a difficult
9 problem, I agree. I think the data that's out there
10 suggests that -- you know, the published data in
11 peer-reviewed papers suggests or indicates, strongly
12 indicates, that prolonged therapy is not going to do
13 much good. So, that's why I stress again, why not do
14 a controlled study to help settle this issue?
15 MR. GOTTFRIED: Well, let me just
16 ask --.
17 DR. BARBOUR: Until you have that
18 evidence-based medicine, then one can understand why
19 the insurance companies would be a little reluctant
20 to pay for something that may not work.
21 MR. GOTTFRIED: Doctor, when you say
22 studies document that the long-term treatment is not
23 effective, we've heard -- I mean, we're aware of the
24 Klempner study that was published in the New England
25 Journal this spring. Are there others that come to
294
1 that conclusion, that you could point us to?
2 DR. BARBOUR: Well, let me turn it
3 around. I think that, as far as I know, is the only
4 one that addresses that question. Let me turn around
5 with it, though. There are other studies -- and I
6 don't have them in front of me and I couldn't quote
7 them -- but my recollection is that there are other
8 studies indicating that relatively short periods of
9 treatment, for instance, up to a month, are effective
10 in the majority, if not large majority, if not all
11 patients. So, there is that data available.
12 MR. GOTTFRIED: Okay.
13 DR. BARBOUR: You know, again, we're
14 not -- that's individuals that have very well-defined
15 cases of Lyme disease. I don't think that's what
16 either one of us are talking about here. I think
17 we're talking about people, as you said - or someone
18 said - that may have, you know, a negative test,
19 laboratory test, standard test, or who don't get
20 better with antibiotics after a month or so.
21 MS. MAYERSOHN: They're not the issue.
22 DR. BARBOUR: That's what we're dealing
23 with, and that's what there is very little data on.
24 MR. GOTTFRIED: Okay. Okay. I
25 appreciate your being available to us and your
295
1 testimony, and I know we had to -- we had you lined
2 up for earlier in the day, and I appreciate your
3 willingness to be available at this point. And I
4 want to thank you for your testimony.
5 DR. BARBOUR: Okay. Well, good luck in
6 what you're trying to do. I think it's a tough job.
7 MR. GOTTFRIED: Well, thank you.
8 DR. BARBOUR: Bye.
9 MR. GOTTFRIED: Okay. Which reminds me
10 of a passage in Confucius which says that it is
11 difficult to be a ruler, but being a subject isn't
12 easy either. Okay. One of his disciples asked
13 whether there was one expression that could save the
14 empire, and that was his answer.
15 Okay. Our next witness is Pam
16 Weintraub, a reporter with HMS_Beagle and former
___ ______
17 editor of Omni magazine. And just, again, let me
____
18 know -- and this comment is not particularly aimed at
19 you, but if both the witnesses and the legislators
20 are efficient and expeditious, we can all get home.
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