Chronic Lyme: Real or imaginary?

lyme_brain.png One of the more surprising observations made while filming Lyme sufferers for UNDER OUR SKIN, was that almost all had been misdiagnosed as having “hypochondriasis,” or, “it’s all in your head” syndrome before receiving a Lyme diagnosis. The SPECT scan above shows the brain of a Lyme patient before and after treatment with IV antibiotics. The healthy orange areas of the brain are receiving adequate blood flow. The black and blue areas are starved for oxygen due to inflammation caused by the Lyme bacteria. (Photo courtesy of Dr. Robert C. Bransfield, MD, and Psychiatric Times.) A person with that much of their brain out of commission may exhibit any number of neurological symptoms, including depression, rages, seizures, and even hallucinations. Though it’s fairly obvious that this brain is impaired, SPECT scans are not mentioned as a diagnostic tool in the latest Infectious Disease Society of America (IDSA) Lyme disease guidelines, despite a number of promising studies out of Columbia University. Instead, the IDSA Lyme guidelines endorse an indirect antibody testing protocol that misses well over half the truly ill patients, and attributes ongoing Lyme disease symptoms to the “aches and pains of daily living.” At the 2008 American College of Rheumatology (ACR) Scientific Meeting, the IDSA Lyme Guidelines foot soldiers were out in force, armed with more “evidence” that chronic Lyme disease is an imaginary disease. Among the presenters was Leonard Sigal, M.D., R&D Director of Immunology at Bristol-Myer Squibb, and a contributor to both the 2000 and 2006 IDSA Lyme Guidelines. Calling ongoing Lyme symptoms, “Post Lyme Disease Syndrome” or PLDS, Sigal’s poster presentation said:

“After adequate antibiotic treatment, very rarely do patients continue to manifest objective evidence of ongoing infection, yet it has been estimated that over one third of Lyme disease patients report chronic physical, cognitive, and psychiatric symptoms or PLDS. There is no evidence that PLDS patients have ongoing infection with B. burgdorferi.” “Close to 45% of patients with Lyme disease will manifest the chronic symptoms characteristic of PLDS.” “Further, psychological factors such as depression and maladaptive belief systems could be significant risk factors for PLDS”

The problem with this study is the potential for bias. Isn’t it possible that these patients are suffering from treatment failure due to inadequate doses of antibiotics? Is Dr. Sigal really qualified to diagnosis these patients with a “maladaptive belief system,” when he is not a psychiatrist—he’s a rheumatologist? And what about his affiliation with Bristol-Myer Squibbs? Though Sigal’s studies are cited 5 times in the 2006 IDSA Lyme guidelines, and he’s listed as a reviewer, nowhere is it mentioned that:

“…there is growing scientific evidence that chronic Lyme disease does exist, and that this clinical condition is related to persistent infection with B. burgdorferi as shown by microbiological and molecular studies. Persistent infection occurs in animal models and humans because the Lyme spirochete is able to evade both the host immune response and short-course antibiotic therapy to establish chronic infection in protected tissue sites, much like TB. This chronic infection leads to persistent musculoskeletal, neurologic and cardiac symptoms that are the hallmark of chronic Lyme disease. By contrast, the leading theory for persistent symptoms owing to 'post-Lyme syndrome', namely an autoimmune response triggered by the eradicated spirochetal infection, has not been supported by scientific evidence.”
    --Sigal’s employer, Bristol-Myers Squibb (BMS), sells two blockbuster drugs, , which treats rheumatoid arthritis and potentially Lupus, and " article in the New York Times.) Because these types of conflicts muddy the evidence-based medicine waters, we applaud from the new IDSA Lyme Guidelines writing committee. Based on our research in the film, we tend to support this take on chronic Lyme disease, by : For more on Chronic Lyme, see the video clip, "," on the UNDER OUR SKIN site.