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[at-l] Lyme Disease Article in NYTimes



Orange Bug wrote:
> Read this article folks.......

Here it is.  It's not much longer than some of the recent TP/WF posts
and yes I know I violated the copyright. Gina Kolata almost sounds like
a trail name, dontcha think?

June 13, 2001

Lyme Disease Is Hard to Catch and Easy to Halt, Study
Finds

By GINA KOLATA

Lyme disease is very difficult to catch, even from a deer tick in a
Lyme-infested area, and can
easily be stopped in its tracks with two capsules of an antibiotic, a
new study shows.

And two other studies conclude that prolonged and intensive treatment
with antibiotics, a course of
care advocated by a small group of doctors, does nothing for people with
symptoms often attributed
to chronic Lyme disease. These findings are in keeping with the
assertions of researchers who say that
in most cases, such symptoms have nothing at all to do with the
disorder.

The three studies, scheduled to be published on July 12 in The New
England Journal of Medicine,
were released yesterday because the journal's editors thought they were
so important, with the onset
of summer and the accompanying fear of Lyme disease.

"This is reassuring information for people who make decisions based on
evidence," said Dr. Jeffrey
M. Drazen, the journal's editor in chief. 

Researchers, both those associated with the studies and others who were
not, said they hoped the
findings would ease what they called inflated public fear of Lyme
disease, which is widely perceived
as a grave illness that is easy to catch. A total of 16,019 cases were
reported to the Centers for
Disease Control and Prevention in 1999; 92 percent of those cases were
in nine states, most of which
are in the Northeast, including New York and Connecticut.

Dr. Leonard H. Sigal, a Lyme disease expert at the University of
Medicine and Dentistry of New
Jersey-Robert Wood Johnson Medical Center in New Brunswick, who was not
associated with the
studies, said the message from them was that "Lyme disease, although a
problem, is not nearly as big
a problem as most people think."

"The bigger epidemic," Dr. Sigal said, "is Lyme anxiety."

The study to see whether a single dose of the antibiotic doxycycline
could prevent Lyme disease was
directed by Dr. Robert B. Nadelman, a professor of medicine at New York
Medical College and
attending physician at the Westchester Medical Center, both in Valhalla,
N.Y. 

Dr. Nadelman said many doctors, in hopes of heading off Lyme disease
infection, had been giving
10-to-21- day courses of the antibiotic to people who had found deer
ticks on their bodies. "They
would be treating people as if they actually had the disease," he said.

He and his colleagues wondered whether one dose would be enough. They
recruited 482 people in
Westchester County, N.Y., where the incidence of Lyme disease is among
the highest in the world.
All had found deer ticks on them. (The insects were identified by
entomologists.)

Half got a single dose of doxycycline, taken in the form of two
capsules, and the others got two
dummy capsules. The investigators found that the drug did prevent Lyme
disease: just one person, 0.4
percent of those who took it, came down with the illness. But even among
those who took the
placebo, the chances of getting the disease was just 3 percent. 

Dr. Eugene Shapiro of Yale University School of Medicine, who wrote an
accompanying editorial,
noted that the antibiotic often caused nausea, vomiting and abdominal
pain and that among those who
took it, there would have been very little chance of getting Lyme
disease in any case. People who are
bitten can watch the site where the tick fed, Dr. Shapiro said, and if
they develop a rash within a few
weeks, they can take a full course of antibiotics. 

"Give that person 10 to 21 days of antibiotics," he said, "and they will
be fine." 

Dr. Sigal agreed. He added that deer ticks crawl around the body for
hours before settling down to
feed, and during that time are easily washed off with a washcloth. And,
he said, "even if you get the
disease, it is easily treatable and it is curable." 

But Dr. Jesse L. Goodman, a Lyme disease expert at the University of
Minnesota, said some people
were so horrified by the possibility of getting Lyme disease that even a
3 percent risk was too much.
"As a physician, I could respect that," Dr. Goodman said, adding that he
would offer those people
doxycycline. 

Lyme disease researchers emphasized, however, that previous studies had
shown that most people
with the infection get better on their own, without antibiotics. And
while a small percentage develop
serious symptoms, like arthritis or heart disorders, even the vast
majority of these get better, the
researchers said.

Dr. Raymond Dattwyler, director of the Lyme Disease Center at the State
University of New York at
Stony Brook, said the typical Lyme disease patient has a rash but no
other symptoms, takes an
antibiotic and is cured.

The two other studies released yesterday, financed by the National
Institutes of Health, addressed the
question of how to treat people who had Lyme disease and later developed
symptoms like fatigue,
aches and pains, and memory loss. Both were conducted by Dr. Mark S.
Klempner of Boston
University School of Medicine and his colleagues.

One study enrolled patients who had antibodies to the Lyme disease
microorganism, Borrelia
burgdorferi, an indicator that they had been infected. The other
enrolled patients who no longer had
antibodies but had had a documented case of Lyme disease. Half the
patients in both studies received
an intravenous antibiotic, ceftriaxone, for a month, followed by oral
doxycycline for 60 days; the
others received placebos.

The studies were meant to enroll 260 patients, but they ended early,
after enrolling just 129 patients,
because an independent committee overseeing them said it had become
clear that the antibiotics were
no more effective than the placebos. 

Dr. Shapiro said he was not surprised. Although a small group of doctors
and patients insist that
symptoms like fatigue and memory loss after a bout with Lyme disease are
due to chronic infection
with the disease organism, those symptoms are very common among the
general public, leading Dr.
Shapiro and others to believe there is some other cause.

"Whatever is going on with these patients," he said, "if it is
unresponsive to antibiotics, it is unlikely that
it is untreated Lyme disease." 

In contrast, antibiotics have been shown to work extraordinarily well
when, for instance, the Lyme
organism has demonstrably infected the brain, Dr. Dattwyler said. 

But some who have treated hundreds of patients with long-term
antibiotics, like Dr. Sam L. Donta of
Boston University Medical Center, were not convinced. The antibiotics in
the studies were not given
for a long enough time, Dr. Donta said, and he would have chosen
different ones. Perhaps all that the
studies show, he said, is "that this particular treatment doesn't work." 

Dr. Brian Fallon, an associate professor of psychiatry at Columbia
University, is directing another
study of chronic Lyme disease that focuses on patients who have problems
with fatigue, their memory
and their ability to think. In his study, also supported by the National
Institutes of Health, the patients
receive intravenous antibiotics for 10 weeks, or a placebo. 

Dr. Fallon said he saw many such patients in his private practice and
would continue to refer them to
colleagues for long-term treatment with intravenous antibiotics. 

Dr. Sigal said, however, that in addition to the expense of long-term
intravenous antibiotics  and
some patients end up taking them for years  the drugs are dangerous.
Some patients have died of
infections caused by the catheters in their bodies, and others have
experienced side effects from the
drugs, including destruction of bone marrow, requiring a bone marrow
transplant.

"These are not benign drugs  they're all poisons," Dr. Sigal said. When
they are needed to fight an
infection, their risks, of course, are outweighed by their benefits. But
when there are no benefits, he
added, the risks are naturally unacceptable.