Lyme wars

doi:10.1136/bmj.39363.530961.AD

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Alison Tonks, associate editor

BMJ, London WC1H 9JR

atonks{at}bmj.com

Patients with long term symptoms, lack of a scientific explanation, and insurance companies' reluctance to pay for treatment have created a perfect breeding ground for dissent, Alison Tonks reports

Lyme disease is a simple bacterial infection spread by ticks. There is a fairly characteristic rash, a well documented pattern of symptoms, and a safe effective treatment. But in the US, Lyme disease is at the centre of a long running and bitter controversy. It is no longer a disease but a legal and political battleground. At the core of the disagreement is the possibility that the Lyme bacterium could survive initial treatment, evade detection, and cause disabling symptoms for months or even years. A growing and vociferous patient lobby thinks it can. Mainstream medical opinion thinks it can't. Why does it matter? Because those who believe in chronic infection also believe in long term treatments, including repeated or prolonged courses of antibiotics that doctors are reluctant to prescribe and insurance companies are reluctant to pay for.

The trigger

The latest exchange of fire between the two sides was triggered by official treatment guidelines published by the Infectious Diseases Society of America.1 An update at the end of last year repeated that there was no evidence for existence of chronic infection, then listed 12 treatments that doctors ought not to give patients with Lyme disease. Long term antibiotics were on the list, alongside “hyperbaric oxygen, ozone, fever therapy, intravenous immunoglobulin, cholestyramine, intravenous hydrogen peroxide, [and] specific nutritional supplements.”1

Lyme advocacy organisations such as the Lyme Disease Association and the International Lyme and Associated Diseases Society dismiss the wackier treatment options such as fever therapy (hyperthermia), bee venom, and antioxidants, but both strongly support the option of long term or repeated courses of antibiotics for some patients.2 They argue that the …