Quotes below are from Shapiro's published scientfic articles. Below the first section are quotes from additional articles.
From the Article- False and Misleading Information About Lyme Disease
QUOTE- "It is highly implausible that either patients with chronic Lyme disease or patients who had Lyme disease and have posttreatment symptoms, who are seronegative, who have no objective findings, and who have already been treated extensively with antibiotics would have cultivable B. burgdorferi in their blood. Nevertheless, fake research has been used to support this notion."
QUOTE- "False and misleading information about Lyme disease is not restricted to fake diagnoses, fake diagnostic tests, or fake laboratory research."
QUOTE- "Unfortunately, the news media sensationalizes controversial aspects of patients’ stories that they consider “newsworthy” under the guise of increasing “Lyme aware- ness.”18 Media-sponsored public discussions often use a format based on “false equivalency” in which emotional arguments and unproven opinions are given the same weight as the results of rigorous, evidence-based scientific research; obviously, it is incumbent upon all participants in such discussions to provide sufficient evidence to support the statements and claims they make."
False and Misleading Information about Lyme Disease.
Shapiro ED, Baker PJ, Wormser GP. Am J Med. 2017 Feb 16. pii: S0002-9343(17)30138-9. doi: 10.1016/j.amjmed.2017.01.030.
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https://www.amjmed.com/article/S0002-9343(17)30138-9/pdf
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QUOTE- "There continues to be no evidence that viable B. burgdorferi persist in humans after conventional treatment with antimicrobials."
Repeat or persistent Lyme disease: persistence, recrudescence or reinfection with Borrelia Burgdorferi?
Shapiro ED.
F1000Prime Rep. 2015 Jan 5;7:11. doi: 10.12703/P7-11. Review.
Link Here
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311275/
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QUOTE- "Recent studies have provided additional evidence that viable B. burgdorferi do not persist after conventional treatment with antimicrobials, indicating that ongoing symptoms in patients who received conventional treatment for Lyme disease should not be attributed to persistent active infection."
Update on persistent symptoms associated with Lyme disease.
Oliveira CR, Shapiro ED.
Curr Opin Pediatr. 2015 Feb;27(1):100-4. doi: 10.1097/MOP.0000000000000167. Review.
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QUOTE- "Misinformation about chronic Lyme disease on the Internet and in popular media has led to publicity and anxiety about Lyme disease that is out of proportion to the actual morbidity that it causes. I would reassure her that the outcomes of treatment are excellent and that congenital Lyme disease has never been documented. I would advise her to beware of misinformation on the Internet.
There is no evidence that chronic Lyme disease exists. On the basis of strong evidence from research, patients treated for Lyme disease who have persistent, nonspecific symptoms (eg, arthralgia and fatigue) do not have persistent infection…"
Borrelia burgdorferi (Lyme disease).
Shapiro ED.
Pediatr Rev. 2014 Dec;35(12):500-9. doi: 10.1542/pir.35-12-500. Review.
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QUOTE- "In most of these patients, nonspecific symptoms resolve over time without additional antimicrobial treatment."
Lyme disease.
Shapiro ED.
N Engl J Med. 2014 Aug 14;371(7):684. doi: 10.1056/NEJMc1407264.
Link Here
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QUOTE- "However, because there is no convincing evidence to indicate post-treatment symptoms are due to a persistent infection or that antimicrobial treatment is of benefit, approaches that do not involve extended antibiotic therapy should be pursued actively."
The reply. Klempner MS, Baker PJ, Shapiro ED, Marques A, Dattwyler RJ, Halperin JJ, Wormser GP. Am J Med. 2014 Feb;127(2):e11-2. doi: 10.1016/j.amjmed.2013.09.029.
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QUOTE- "We have carefully considered the points raised by these groups, along with our own critical review of the treatment trials. On the basis of this analysis, the conclusion that there is a meaningful clinical benefit to be gained from retreatment of such patients with parenteral antibiotic therapy cannot be justified."
Treatment trials for post-Lyme disease symptoms revisited. Klempner MS, Baker PJ, Shapiro ED, Marques A, Dattwyler RJ, Halperin JJ, Wormser GP. Am J Med. 2013 Aug;126(8):665-9. doi: 10.1016/j.amjmed.2013.02.014. Review.
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QUOTE- "Consequently, it is impossible to conclude that the findings have validity in judging the efficacy of doxycycline or ceftriaxone for the treatment of Borrelia burgdorferi in this animal model." Critical analysis of treatment trials of rhesus macaques infected with Borrelia burgdorferi reveals important flaws in experimental design. Wormser GP, Baker PJ, O'Connell S, Pachner AR, Schwartz I, ShapiroED. Vector Borne Zoonotic Dis. 2012 Jul;12(7):535-8. doi: 10.1089/vbz.2012.1012. Review.
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QUOTE- "Indeed, in the United States the majority of patients being treated with indefinite courses of antibiotic therapy for ‘chronic Lyme disease’ have no valid evidence of ever having had B. burgdorferi sensu stricto infection. Lyme disease activists in the United States often take issue with the term ‘post-Lyme disease syndrome,’ since they believe it conveys the message that there is no active infection to explain persistent symptoms."
Lyme borreliosis: the challenge of accuracy. Klempner MS, Halperin JJ, Baker PJ, Shapiro ED, O'Connell S, Fingerle V, Wormser GP. Neth J Med. 2012 Jan;70(1):3-5.
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QUOTE- "Advocacy for Lyme disease has become an increasingly important part of an antiscience movement that denies both the viral cause of AIDS and the benefits of vaccines and that supports unproven (sometimes dangerous) alternative medical treatments.
Some activists portray Lyme disease, a geographically limited tick-borne infection, as a disease that is insidious, ubiquitous, difficult to diagnose, and almost incurable; they also propose that the disease causes mainly non-specific symptoms that can be treated only with long-term antibiotics and other unorthodox and unvalidated treatments.
Similar to other antiscience groups, these advocates have created a pseudoscientific and alternative selection of practitioners, research, and publications and have coordinated public protests, accused opponents of both corruption and conspiracy, and spurred legislative efforts to subvert evidence-based medicine and peer-reviewed science. The relations and actions of some activists, medical practitioners, and commercial bodies involved in Lyme disease advocacy pose a threat to public health."
Antiscience and ethical concerns associated with advocacy of Lymedisease. Auwaerter PG, Bakken JS, Dattwyler RJ, Dumler JS, Halperin JJ, McSweegan E, Nadelman RB, O'Connell S, Shapiro ED, Sood SK, Steere AC, Weinstein A, Wormser GP. Lancet Infect Dis. 2011 Sep;11(9):713-9. doi: 10.1016/S1473-3099(11)70034-2.
QUOTE- "The most common reason for a lack of response to appropriate antimicrobial therapy for Lyme disease is misdiagnosis (i.e., the patient actually does not have Lyme disease).
For those unusual patients who have persistent symptoms more than six months after the completion of antimicrobial therapy, an attempt should be made to determine if these symptoms are the result of a post-infectious phenomena or of another illness.
These findings support earlier recommendations that such patients are best treated symptomatically rather than with prolonged courses of antibiotic therapy…
Consequently, routine use of antimicrobial agents to prevent Lyme disease in persons who are bitten by a deer tick, even in highly endemic areas, is not generally recommended because the overall risk of Lyme disease is low (1-3%), only doxycycline (which is not recommended for children < 8 years of age) has been shown to be effective and treatment for Lyme disease, if it does develop, is very effective." Lyme disease. Murray TS, Shapiro ED. Clin Lab Med. 2010 Mar;30(1):311-28. doi: 10.1016/j.cll.2010.01.003. Review.
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QUOTE- "Although there is still widespread misunderstanding of and misinformation about the disease among the lay public, its clinical manifestations as well as how to diagnose and to treat it are now well understood. In the vast majority of cases simple treatment with a relatively short course of orally administered antimicrobials results in long-term cure with no adverse sequelae." Lyme disease. Shapiro ED. Adv Exp Med Biol. 2008;609:185-95. doi: 10.1007/978-0-387-73960-1_14. Review.
"We conclude that the report by Yrjänäinen et al. [1], although provocative, provides insufficient data to justify the conclusion that anti-TNF-α is able to rescue B. burgdorferi from the bactericidal effects of ceftriaxone. Because the degree of efficacy of ceftriaxone in their study is so similar to that reported in a previous murine study of its efficacy that did not use anti-TNF-α [2], the data do not prove that anti-TNF-α actually played any role in their findings."
Anti-tumor necrosis factor-alpha activation of Borrelia burgdorferi spirochetes in antibiotic-treated murine Lyme borreliosis: an unproven conclusion. Wormser GP, Barthold SW, Shapiro ED, Dattwyler RJ, Bakken JS, Steere AC, Bockenstedt LK, Radolf JD. J Infect Dis. 2007 Dec 15;196(12):1865-6; author reply 1866-7. doi: 10.1086/523826.
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"The focus of this review, however, is not the objective manifestations of late Lyme disease but rather the imprecisely defined condition referred to as “chronic Lyme disease.” This term is used by a small number of practitioners (often self-designated as “Lyme-literate physicians”) to describe patients whom they believe have persistent B. burgdorferiinfection, a condition they suggest requires long-term antibiotic treatment and may even be incurable.5 Although chronic Lyme disease clearly encompasses post–Lyme disease syndrome, it also includes a broad array of illnesses or symptom complexes for which there is no reproducible or convincing scientific evidence of any relationship to B. burgdorferi infection.
One is the unproven and very improbable assumption that chronic B. burgdorferi infection can occur in the absence of antibodies against B. burgdorferi in serum.
When physicians who diagnose chronic Lyme disease obtain laboratory tests to provide support for their diagnoses, they often rely heavily on “Lyme specialty laboratories.” Such laboratories may perform unvalidated in-house tests that are not regulated by the Food and Drug Administration, or they may perform standard serologic tests interpreted with the use of criteria that are not evidence-based.
Antibiotic therapy in these patients is not warranted.
Although some clinicians would offer patients with category 3 disease an empirical trial of 2 to 4 weeks of an oral antibiotic, such patients should be told that the diagnosis is uncertain and that a benefit from treatment is unlikely.
Although anecdotal evidence and findings from uncontrolled studies have been used to provide support for long-term treatment of chronic Lyme disease, a response to treatment alone is neither a reliable indicator that the diagnosis is accurate nor proof of an antimicrobial effect of treatment.
The central question is not whether a few spirochetes might persist after antibiotic treatment, but whether clinical disease can be attributed to their presence.
It is highly unlikely that post–Lyme disease syndrome is a consequence of occult infection of the central nervous system.
Additional evidence against the hypothesis that chronic symptoms are due to persistent infection is the fact that antibodies against B. burgdorferi in many of these patients are undetectable, which is inconsistent with the well-established immunogenicity of the spirochete's lipoproteins.
If a diagnosis for which there is a specific treatment cannot be made, the goal should be to provide emotional support and management of pain, fatigue, or other symptoms as required. Explaining that there is no medication, such as an antibiotic, to cure the condition is one of the most difficult aspects of caring for such patients. Nevertheless, failure to do so in clear and empathetic language leaves the patient susceptible to those who would offer unproven and potentially dangerous therapies.
Physicians and laypeople who believe in the existence of chronic Lyme disease have formed societies, created charitable foundations, started numerous support groups (even in locations in which B. burgdorferi infection is not endemic), and developed their own management guidelines.
The attorney general of Connecticut has begun an unprecedented antitrust investigation of the Infectious Diseases Society of America, which issued treatment guidelines for Lyme disease that do not support open-ended antibiotic treatment regimens.2 In some states, legislation has been proposed to require insurance companies to pay for prolonged intravenous therapy to treat chronic Lyme disease.
The media frequently disregard complex scientific data in favor of testimonials about patients suffering from purported chronic Lyme disease and may even question the competence of clinicians who are reluctant to diagnose chronic Lyme disease. All these factors have contributed to a great deal of public confusion with little appreciation of the serious harm caused to many patients who have received a misdiagnosis and have been inappropriately treated.
Chronic Lyme disease is the latest in a series of syndromes that have been postulated in an attempt to attribute medically unexplained symptoms to particular infections.
Chronic Lyme disease, which is equated with chronic B. burgdorferi infection, is a misnomer, and the use of prolonged, dangerous, and expensive antibiotic treatments for it is not warranted.
Dr. Feder reports receiving lecture fees from Merck and serving as an expert witness in medical-malpractice cases related to Lyme disease. Dr. Johnson reports holding patents on diagnostic antigens for Lyme disease. Dr. O'Connell reports serving as an expert witness related to Lyme disease issues in civil and criminal cases in England.
Dr. Shapiro reports serving as an expert witness in medical-malpractice cases related to Lyme disease, reviewing claims of disability related to Lyme disease for Metropolitan Life Insurance Company, and receiving speaker's fees from Merck and Sanofi-Aventis.
Dr. Steere reports receiving a research grant from Viramed and fees from Novartis.
Dr. Wormser reports receiving research grants related to Lyme disease from Immunetics, Bio-Rad, and Biopeptides and education grants from Merck and AstraZeneca to New York Medical College for visiting lecturers for infectious-disease grand rounds, being part owner of Diaspex (a company that is now inactive with no products or services), owning equity in Abbott, serving as an expert witness in a medical-malpractice case, and being retained in other medical-malpractice cases involving Lyme disease. He may become a consultant to Biopeptides. No other potential conflict of interest relevant to this article was reported." A critical appraisal of "chronic Lyme disease". Feder HM Jr, Johnson BJ, O'Connell S, Shapiro ED, Steere AC, Wormser GP; Ad Hoc International Lyme Disease Group., Agger WA, Artsob H, Auwaerter P, Dumler JS, Bakken JS, Bockenstedt LK, Green J, Dattwyler RJ, Munoz J, Nadelman RB, Schwartz I, Draper T, McSweegan E, Halperin JJ, Klempner MS, Krause PJ, Mead P, Morshed M, Porwancher R, Radolf JD, Smith RP Jr, Sood S, Weinstein A, Wong SJ, Zemel L. N Engl J Med. 2007 Oct 4;357(14):1422-30. Review. No abstract available. Erratum in: N Engl J Med. 2008 Mar 6;358(10):1084. Agger, WA [added]; Artsob, H [added]; Auwaerter, P [added]; Dumler, JS [added]; Bakken, JS [added]; Bockenstedt, LK [added]; Green, J [added]; Dattwyler, RJ [added]; Munoz, J [added]; Nadelman, RB [added]; Schwartz, I [added]; Draper, T [added]; McSweegan, E [added]; Halperin, JJ [added]; Klempner, MS [added]; Krause, PJ [added]; Mead, P[added]; Morshed, M [added]; Porwancher, R [added]; Radolf, JD [added]; Smith RP Jr [added]; Sood, S [added]; Weinstein, A [added]; Wong, SJ [added]; Zemel, L [added].
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"In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post–Lyme syndrome.
A separate entity, defined differently by different authors, often referred to as “post-Lyme syndrome,” occurs in patients who have had Lyme disease, but, after treatment that would normally be expected to be effective, have continued to have residual chronic symptoms, including one or more of the following: musculoskeletal pain (without frank arthritis; fibromyalgia-like), fatigue, and “neuropsychiatric” symptoms.
The latter typically consist of perceived memory or cognitive difficulty, irritability, sleep disturbance, depression, headache, limb or other paresthesias—all in the absence of clinical or laboratory evidence of focal or inflammatory central or peripheral nervous system involvement.5–7 Thus, this entity is often included in discussions of neuroborreliosis, even though there is no evidence of CNS infection in such individuals.
As discussed above, patients who have received accepted antibiotic regimens for various forms of Lyme disease sometimes have residual chronic symptoms, referred to variably as post-Lyme syndrome (PLS), post-Lyme disease syndrome, post-treatment chronic Lyme disease (PTCLD), or even chronic Lyme disease. There has been controversy as to whether PLS is a form of active infection in which the organism is difficult or impossible to eradicate from various “privileged” sites vs a postinfectious or noninfectious type of chronic fatigue syndrome, in which there is no ongoing infection.
Anecdotally, some experience a subjective improvement while on antibiotics, with symptoms recurring rapidly following medication discontinuation, suggesting a placebo effect.
In summary, published antibiotic treatment trials of PLS provide compelling Class I evidence that PLS is not due to active Borrelia infection and is not responsive to further antibiotic therapy, particularly with respect to overall health-related quality of life and cognitive and depressive symptoms.
Prolonged courses of antibiotics do not improve the outcome of post-Lyme syndrome, are potentially associated with adverse events, and are therefore not recommended." Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, Krupp L, Gronseth G, Bever CT Jr; Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007 Jul 3;69(1):91-102. Erratum in: Neurology. 2008 Apr 1;70(14):1223.
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QUOTE- "Many of his statements are factually incorrect or misinterpretations of the literature."
Single-dose prophylaxis against Lyme disease. Wormser GP, Dattwyler RJ, Shapiro ED, Dumler JS, O'Connell S, Radolf JD, Nadelman RB. Lancet Infect Dis. 2007 Jun;7(6):371-3.
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QUOTE- "Furthermore, post-Lyme disease symptoms are occurring on a high background rate of indistinguishable symptoms in the general population.
The findings of this meta-analysis are uninformative and misleading, since the studies upon which it was based have substantive limitations including retrospective study design, lack of timely antimicrobial therapy (or in some instances no treatment at all), use of antimicrobial regimens no longer recommended, lack of 2-stage conditional serologic testing to establish the original diagnosis of Lyme disease, a distorted case mix with an over representation of patients with extracutaneous manifestations, failure to consider pre-Lyme disease traumatic psychologic experiences, and the likely inclusion of an unknown number of non-Lyme disease patients whose original complaints were exclusively subjective in nature and consisted of chronic arthralgias, fatigue, or cognitive difficulties.
Indeed, the majority of patients who carry the diagnosis of ‘chronic Lyme disease’ have no evidence of ever having been infected with Borrelia burgdorferi.
In many studies of ‘chronic’ Lyme disease a form of ‘protopathic bias’ can be a major problem. Such bias can occur when persons are diagnosed with ‘chronic Lyme disease’ because they have the outcomes of interest (e.g. chronic pain, fatigue). In addition, it is likely that there is reporting or recall bias in patients who are labeled as having Lyme disease. Thus, a person diagnosed with Lyme disease would be more likely to recall and/or to report subsequent symptoms such as arthralgia, myalgia or fatigue than would another person with the same symptoms who was never diagnosed as having Lyme disease.
Certainly, this is biologically implausible given the lack of antibiotic resistance in this genus, the lack of documentation of this event in either humans or animals (including highly immunocompromised animals), lack of correlation of subjective symptoms with seropositivity or signs of inflammation, lack of precedent for such a phenomenon in other spirochetal infections, and the resolution (or stabilization) of all objective manifestations in treated patients.
It is possible that ‘chronic Lyme disease’ is a functional somatic syndrome, especially since both the epidemiology and the phenomenology of ‘chronic Lyme disease’ are very similar to those of a number of other functional somatic syndromes such as hypersensitivity to candida, Gulf War syndrome, chronic fatigue syndrome and sick building syndrome. Physiologic explanations, whether they should exist for persistent symptoms, have not been elucidated."
Response to meta-analysis of Lyme borreliosis symptoms. Shapiro ED, Dattwyler R, Nadelman RB, Wormser GP. Int J Epidemiol. 2005 Dec;34(6):1437-9; author reply 1440-3.
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QUOTE- "The neuropsychologic and health outcomes of children with facial nerve palsy attributable to Lyme disease 7 to 161 months earlier are comparable to those who did not have Lyme disease."
Long-term neuropsychologic and health outcomes of children with facial nerve palsy attributable to Lyme disease. Vázquez M, Sparrow SS, Shapiro ED. Pediatrics. 2003 Aug;112(2):e93-7.
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QUOTE- "Consequently, misdiagnosis is frequent and is the most common cause of failure of treatment. The prognosis for most persons with Lyme disease is excellent."
Lyme disease. Shapiro ED, Gerber MA. Clin Infect Dis. 2000 Aug;31(2):533-42. Review.
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QUOTE- "In this cohort, although many patients reported increases in symptoms and/or increased difficulties with typical daily activities between 1 and 11 years after diagnosis of Lyme disease, the frequencies of these reports were similar to the frequencies of such reports among age-matched controls without Lyme disease.
The results of this investigation suggest that the prognosis for children with Lymearthritis who are treated with appropriate antimicrobial therapy is excellent."
Lyme arthritis in children: clinical epidemiology and long-term outcomes. Gerber MA, Zemel LS, Shapiro ED. Pediatrics. 1998 Oct;102(4 Pt 1):905-8.
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QUOTE- "Children with only non-specific symptoms such as headache, arthralgia or fatigue commonly are misdiagnosed as having Lyme disease. Although such non-specific symptoms often accompany more specific signs and symptoms (e.g., erythema migrans, arthritis) in children with Lymedisease, very rarely are non-specific symptoms the sole manifestation of Lyme disease."
Lyme disease in children. Shapiro ED, Seltzer EG. Semin Neurol. 1997 Mar;17(1):39-44. Review.
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"The prognosis is excellent for those with early Lyme disease who are treated promptly with conventional courses of antimicrobial agents." Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group. Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL. N Engl J Med. 1996 Oct 24;335(17):1270-4.
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QUOTE- "Virtually all children will respond well to treatment for any stage of Lyme disease. Misdiagnosis is the most common reason for treatment failure." Lyme disease in children. Shapiro ED. Am J Med. 1995 Apr 24;98(4A):69S-73S. Review.
Last Updated- May 2019
Lucy Barnes
AfterTheBite@gmail.com