Lyme Wars - Part 1

http://www.bmj.com/cgi/eletters/335/7626/910#179199

William T. Harvey, MD,
Clinician/Research Coordinator
Rocky Mountain Chronic Diseases Specialists

8 December 2007

One notes with interest...and dismay... the number of responses to the “Lyme Wars” topic thirty years after Steere published the Lyme hypothesis[1, 2]. There should be little residual conflict given that the birth of critical thinking began centuries ago with the Renaissance via many European and UK thinkers, including physician William Harvey (reference intended). The arguments now appearing as BMJ “Lyme Wars” letters surprisingly ignore the insight shift of Harvey’s Padua University schoolmate, Nicolaus Copernicus. Although the essence of De motu cordis was that truth lay in the reality at hand, a century earlier Copernicus first made an even more fundamental point, that co-variants do not prove cause-and-effect. Unexpectedly, both concepts are ignored so frequently in the Lyme Wars thread that collectively they illustrate what has happened to recent scientific thinking and immediately clarify how such arguments can occur. Truth seems to lie in the simplest concepts, as Einstein had hoped. Here, brought to a grade school level is the concept that has invalidated most Borreliosis research over the past three decades: The finding of Borrelia in a chronically ill human does not prove Borrelia generated the illness. No one has ever elucidated the mechanism by which Borrelia exerts its claimed pathophysiology.

When Willie Burgdorfer first encountered Borrelia (burgdorferi sensu lato) in acutely ill New England patients, the correlation was initially made. Subsequently, it was verified numerous times in endemic areas of the planet. Ultimately, the numbers reached mathematically validity and in time revealed a zoonosis cycle bridged by at least one arthropod vector. This correlation came from Epidemiology devoid of a pathologic mechanism, but was strong enough to make the case for an acute illness. This method, as weak as it was, gave rise to the present US CDC case criteria for Lyme disease as an acute, readily treatable illness with predictable (but not well understood) signs and symptoms. What then is the dilemma where acute Lyme disease and chronic Lyme disease are juxtaposed in a mortal face-off? Enter semantics.

This dilemma did not occur in a vacuum. Outside the boundary of a relatively limited acute zoonosis, there must exist yet another illness; an illness so serious and pervasive that many astute clinicians and a few scientists would go to any means to give credibility to that illness. An NLM search taking only seconds will indeed uncover a veritable ocean of persistently ill humans with these similar characteristics: Their illness is chronic, multi-systemic, unpredictably varied, possibly life shortening, unsolved and appropriately kept outside the taxonomy of proven illnesses. The number of assigned labels is extraordinarily large, however, and vastly more inclusive than chronic Lyme disease is thought to be. If such an illness exists it necessarily would engender extreme clinical passion. And given no support by traditional science, labels would be found in large numbers, with similar descriptors, and would emerge as historical counterparts. This phenomenon has indeed occurred. Awareness began to appear between 1970-1980. New semantic identifiers such as Chronic Fatigue Syndrome, Fibromyalgia syndrome...and since the mid- 1980s, chronic Lyme disease…are only three.[3-13] If we follow the theme of similar intermittent laboratory abnormalities, basic abnormal physical findings and fundamental chronic symptoms, at least two-dozen other groups such as Bannwarth’s syndrome, Ekbom syndrome, Asperger’s syndrome and others emerge.[14-23]

A short foray into the universe of illness labels above reveals similar “wars” underway since 1980: Chronic Fatigue Syndrome (CFS) VS chronic Fibromyalgia syndrome (Fibromyalgia); CFS VS chronic Lyme disease (Lyme); Lyme and CFS VS Gulf War Syndrome (GWS) are among the obvious. Clinicians fortunate enough to encounter this larger chronically ill group outside of New England (where vector prevalence of Borrelia is high) were not tempted by Borrelia as a generator of chronic illness.[24-29] Rather, their semantic choices emerged from such random events as participation in recent wars, or travel to high-humidity regions where fungi are rampant.

In summary, Lyme Wars if followed to its root, is a failure of our medical education system to insist on teaching scientific method, and beginning that with the foundation of all truth: language (semantics). Something did likely occur in the world of human disease some 30 years ago as these “wars” attest to. “It” could be attributed to the population explosion, global warming, excess computer use, or even larger numbers of vaccines. But, I choose to wait until science shows us the mechanism rather than join the twenty first century’s trust in celebrity (trust papers from the most notable journals…or be pulled into the current “matrix” of popular mindset) rather than face the factual illness only where it exists: the patient. Even medical wars are cognitive constructs, generated by the human mind. If we are ever to get the term “evidence based medicine” correct, this is our wake up call. The “evidence” as Harvey showed us in the sixteenth century is in the ill (or deceased) human, not textual material often outdated before it reaches print. (812 words)

References

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