Subject: Comments on DHS Report: Investigation of suspected Lyme disease in Malibu, Los Angeles County Date: Thu, 24 Feb 2000 12:37:41 -0800 From: Art Doherty To: LymeBarb@aol.com, pcm@pacific.net, CFritz@dhs.ca.gov, Dvugia@dhs.ca.gov 24 February 2000 Comments on the recently released report by the California Department of Health Services, January 18, 2000, subject: Investigation of suspected Lyme disease in Malibu, Los Angeles County Summary: "Clinical data on participants did not objectively support a diagnosis of Lyme disease in any of the participants." The report itself refutes this statement in the "Results - Clinical information" section where many symptoms of Lyme disease are noted for the Malibu patients. What are the DHS/CDC "objective" symptoms needed to support a clinical diagnosis of Lyme disease? If by "objective clinical data" you mean positive serology, does the fact that seronegative Lyme disease is not unusual under various conditions have any impact on this conclusion? See: Seronegative or False Negative Lyme disease - An Annotated Bibliography http://www.geocities.com/HotSprings/Oasis/6455/seronegative-special.html "The results of this study do not indicate that residents of the Malibu area are at significantly increased risk of tick-transmitted infectious disease, including Lyme disease". This is a typical bureaucratic statement of little or no consequence - it can't be proven wrong in the future! What does "significantly" mean? "Increased" over what? Is there ANY increased risk of Lyme disease in the Malibu area? What IS the risk for Lyme disease in the Malibu area? Does the fact that the U.S. Army found a HIGH risk of contracting Lyme disease at Vandenberg Air Force base (north of Malibu) and a MODERATE risk (which would be a HIGH risk using today's U.S. Army standards) at Camp Pendleton near San Diego (south of Malibu) have any bearing on the risk of Lyme disease in Malibu? See: U.S. Army Lyme Disease Risk Assessment, Camp Pendleton, 1992 http://www.utech.net/users/10766/003.txt U.S. Army Lyme Disease Risk Assessment, Vandenberg Air Force Base, 1995 http://www.utech.net/users/10766/005.txt ----- Results - Exposure/environmental questionnaire: "One patient reported camping or hiking in naturally wooded area in the 12 months preceding onset of LD illness." So what! This is a typical method of minimizing the Lyme disease threat. As if the only type of activity where one could be bitten by a Lyme disease infected tick is camping or hiking. I got my tick bite - leading to my rash, leading to my Lyme disease symptoms, leading to my positive test, leading to my antibiotics treatment, leading to my probable cure - in my back yard, trimming trees. Not camping! Not hiking! ----- Discussion: "Based on clinical information available in their medical records, most of the patients did not have consistent objective symptoms typically associated with LD. The most common clinical presentation was of non-specific long-term myalgia and arthralgias; frank arthritis was rare and when present was usually attributable to another cause (i.e., rheumatoid arthritis)." "Did not have consistent objective symptoms typically associated with LD"! What do you know about the symptoms of Lyme disease? All patient symptoms mentioned in this report are symptoms of Lyme disease. Your discussion implies that the presence of "frank arthritis" is required for a diagnosis of Lyme disease. That's simply wrong. See: Symptoms of Lyme Disease http://www.geocities.com/HotSprings/Oasis/6455/lyme-links.html#symptoms Also, did you know that Lyme disease was discovered in 1975 when a large number of children who had been misdiagnosed with "juvenile rheumatoid arthritis" were found to have a bacterial infection later called Lyme disease. And, did you know that Lyme disease was "rediscovered" in Santa Ynez, California in 1995, twenty years later, when a number of children who had been misdisagnosed with "juvenile rheumatoid arthritis" actually had Lyme disease. ----- Recommendations: While the present study revealed little evidence to support the hypothesis that residents of the Malibu area are at elevated risk for Lyme disease, ..." "Elevated risk"? Is that like "significantly increased risk" as used in the summary. See comments above for the summary. "Even in a clinically compatible illness, physicians should not automatically regard a "positive" serologic result as confirmation of the diagnosis and need for treatment." This is a preposterous statement! This could be interpreted to mean that even if a patient has had a tick bite, and a rash, and Lyme disease symptoms, and a positive test (notice the DHS/CDC says "positive", meaning they do not have any faith in positive Lyme disease test results!), the doctor should not be too quick to prescribe antibiotics! Give me a break! What is a "clinically compatible illness"? "Serologic and other tests for LD and other tick-borne diseases should be requested only when these diseases are suspected based on clinical symptomatology and not as part of a routine "tick panel"". Do you really mean to say, as it appears, that, if a patient has been bitten by a tick and later has some symptoms that might be associated with a tick-borne disease, that that patient should not be tested for a tick-borne disease? What's a "tick panel"? The term "tick panel" is usually used by veterinarians when talking about testing dogs. Hey, if they can do it for dogs, why not people? Oh, but the insurance is different! And, state bureaucrats must protect the medical/insurance industry. What about the people! Would you say the same things about testing or treatment if it was you, your wife, or your son or daughter who had been bitten by a tick? ----- ----- For more information on Lyme disease in California, see: Lyme disease in California http://www.geocities.com/HotSprings/Spa/6772/california-index.html For more information on Lyme disease Lots Of Links On Lyme Disease http://www.geocities.com/HotSprings/Oasis/6455/lyme-links.html ----- Art Doherty Lompoc, California doherty@utech.net