"Moreover, factors such as the premorbid personality and a tendency to somatization may determine the length of convalescence and the response to postinfection fatigue and joint aches [71,72]." http://info.med.yale.edu/eph/vectorbio/fish/BarbourFish.pdf
"After a few weeks of infection, B. burgdorferi is rarely if ever present in the blood; in other involved tissues, such as joints or nerves, organisms are scarce [74]." http://info.med.yale.edu/eph/vectorbio/fish/BarbourFish.pdf
"When opportunities or resources to confirm the presence of an infection by specific laboratory tests are nonexistent or limited, antibiotics are often used empirically [77]. An inherent problem, though, for this empirical approach is the lack of a clear endpoint for treatment. Late Lyme disease is not likely to show a clear improvement within the time frame of the therapy, at least not for the standardly recommended period. Not surprisingly, there is controversy about whether the appropriate treatment duration for chronic Lyme disease is measured in weeks or months [5,68,78]. When antibiotics are given parenterally for weeks, the direct and indirect costs of administration of drugs are considerable for patients and thirdparty payers [79]. Studies of antibiotics for Lyme disease therapy have often been funded by pharmaceutical companies; the emphasis in these studies has been on antibiotics still under patent protection [80]."
http://info.med.yale.edu/eph/vectorbio/fish/BarbourFish.pdf
"Policy-makers are under pressure from some health professionals and lay persons who believe that the spectrum of B. burgdorferi disease is broader than the limits
accepted by most peer-reviewed medical journals."
"Alternative views of diagnostic criteria and treatment strategies have been presented primarily at regional meetings sponsored by patient advocacy groups and in newsletters devoted to Lyme disease. More recently, the influence of these points of view on the last international scientific meeting on Lyme disease was such that several additional abstracts, which had originally been rejected, were permitted presentation [82]."
"Despite these discouraging considerations, demand for preventive measures against Lyme disease has prompted efforts to develop a human vaccine for the disease [95]. One justification for this effort is the accumulated evidence over the last decade that the morbidity from B. burgdorferi infection in highly endemic areas is considerable; in some areas, 10% of the population has been infected [96]. Some patients with Lyme disease involving the joints or nervous system do not improve substantially even after parenteral antibiotic therapy [69-71,97]. Although doubts remain about many diagnoses of chronic Lyme disease, the specter of a large
number of persons with unrelieved disabilities prompts further consideration of a B. burgdorferi vaccine for high-risk populations, such as outdoor workers and residents of endemic areas."
"A novel approach to reduce the risk of Lyme disease through insecticides includes a self-delivery system for mice [108]. Cotton, treated with permethrin insecticide and provided in paper tubes, is used for nesting material by the white-footed mouse. The application system is designed to render mice tick-free during the entire enzootic transmission season and, thus, prevent immature I. scapularis from either transmitting or acquiring B. burgdorferi. Although this technique was effective in one study in Massachusetts, it did not reduce risk measurably in three field tests in
Connecticut and New York [109]. The diversity of reservoir-competent host species that help to maintain endemic foci of Lyme disease may limit the usefulness of any method that targets a single reservoir species."
"Personal protection measures are the most frequent recommendation provided by public health agencies to reduce the risk of Lyme disease [3]. These measures include the wearing of light- colored clothing, taping the tops of socks over trouser cuffs, and the use of insect repellents on clothing and exposed skin. Such recommendations are easy to make because they place responsibility for prevention on the individual. However, personal protection measures may
actually have limited effectiveness in suburban areas with high tick density. Clearly, public health agencies will have to take a more active role in prevention than providing simple cautions if their efforts are to reduce the incidence of B. burgdorferi infection."
"The history of Lyme disease also shows that a newly recognized disease may be defined as much by individuals and groups outside of academic and governmental institutions as by those within them. Consequently, a mix of opinion has formed about what Lyme disease is and how it should be managed."
http://info.med.yale.edu/eph/vectorbio/fish/BarbourFish.pdf
Quotes- Durland Fish
"This guy ..." Fish begins. "He cheated. He fabricated an article in the New England Journal of Medicine. He provided false results. The paper had to be retracted. He was banned from [National Institutes of Health] funding for a period of time. The guy used to be the director of some penile enlargement clinic out on the West Coast. I mean, this guy ... There's some problems with him."
He proceeds down the list, name by name: "Totally bogus." "He killed one of his patients." "They tried to shut him down." Words like "crackpot," "wacko," "buffoon" and "fraud" pepper his discourse. A little later, he stops to ponder a question. "I don't know," he says after a moment's thought. "I don't know why they hate me so much."
He had a degree in biology and wanted to do graduate work on mammals. But with the draft looming, he opted instead for an occupational deferment. "I went to work for the state health department, totally bored out of my mind inspecting restaurants. A terrible job, and I wasn't very good at it," Fish said. ... "I'm not a very good cop. ... I used to coach them on how to get by - how to cheat."
"I'm damned annoyed," he told Science. "These lay pressure groups are interfering with research."
Besides, he says, it's the doctors treating chronic Lyme cases for months and years who have a financial interest in their position. "If anyone has ... conflicts it's this group [ILADS]. I mean, they're making millions on this scam," he said. "This cast of characters here has some gall to challenge the Infectious Disease Society of America."
"I'm not an M.D. I don't have the training to be making recommendations on therapy or even to some extent diagnosis," he said. "But I understand science, and what's good science and what's bad science." "This is a matter of good science vs. junk science."
Now Fish is fighting a subpoena from state Attorney General Richard Blumenthal, who says Fish and 13 other experts may have improperly excluded scientific evidence of chronic Lyme when they issued guidelines last year for treating the disease.
Source- State Joins Dispute Over Lyme- Scientists Battle Over Treatment. By MICHAEL REGAN | (Hartford, CT) Courant Staff Writer, August 24, 2007
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