Re: Lyme disease: time for a new approach?
The authors of this Editorial (BMJ2015;351:h6520 doi:10.1136/bmj.h6520) make a call for a scientifically supported debate on Lyme disease, taking into account unsolved questions regarding its pathogenesis, its diagnosis, its clinical course. They point to the need of a solid research agenda and a broad minded multidisciplinary approach that dares to put "beliefs about a disease" in question. Their call looks completely legitimate to me, except for the fact that their working definition of Lyme disease seems to include "unresolved systemic symptoms in patients with or without serological evidence of the disease". I believe it is not scientifically sound practice to start with accepting the hypothesis that patients with unexplained symptoms suffer from Lyme disease. Rather, they are in need of a thorough and indeed open minded clinical assessment focused on the so far truly unresolved character of their symptoms. In fact, this kind of approach is not new for those who practice clinical medicine based on scientific evidence. To me, the main question in the ongoing debate on Lyme disease, is therefore whether doctors are still allowed to tell a patient: "I don't know."
Competing interests: No competing interests