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Questionable Diagnosis and Treatment
Edward McSweegan, Ph.D.
Lyme disease is the most common tick-transmitted disease in
the United States. It is most often contracted during warm-weather
months. In 1999, the U.S.
Centers for Disease Control and Prevention (CDC) recorded
16,273 cases . The infection is caused by Borrelia burgdorferi,
a spiral-shaped bacterium (spirochete) named after Willy Burgdorfer,
Ph.D., a public health researcher who identified it in 1982. The
spirochete enters the skin at the site of a tick bite. After incubating
for anywhere from a few days up to a month, it migrates through
the skin and can spread to lymph nodes or disseminate through
the bloodstream to organs or distant skin sites.
|Ixodes scapularis is the most common tick vector in the
northeastern and miswestern U.S. The picture shows (from left
to right) the nymph, adult male, and adult female. The spot on
the thumb shows the relative size of the nymph.
Lyme disease typically begins with a skin rash called erythema
migrans (EM), often accompanied by flu-like symptoms of fever,
malaise, fatigue, and muscle and joint pains. The characteristic
skin lesion where the bite occurs is a flat or raised red area
that expands, often with clearing at the center, to a diameter
of up to 20 inches. However, it does not always occur, which can
make the diagnosis more difficult, especially when the patient
is not aware of having been bitten by a tick. Other early signs
can include small skin lesions, facial nerve paralysis, lymphocytic
meningitis, and heart-rhythm disturbances. Early cases are usually
cured by three weeks of orally administered treatment with a common
antibiotic (amoxicillin or doxycycline). However, if untreated
or inadequately treated, neurologic, cardiac, or joint abnormalities
may follow. Worldwide, Lyme disease has probably been directly
responsible for fewer than two dozen deaths .
The disease is named after the town of Old Lyme, Connecticut,
where researchers recognized its nature in 1975. In Europe, associations
between tick bites and several skin diseases had been known for
decades, but it was not understood that various conditions were
part of a single illness. Since its nature was clarified, Lyme
disease has emerged as a significant source of public controversy
. Some people claim to be persistently infected with B.
burgdorferi and suffering from debilitating symptoms as a
result. Many infectious agents can cause chronic infections or
can be difficult to eradicate with standard antibiotic treatments.
Unfortunately, it is frequently difficult to diagnose such infections
and, in the case of Lyme disease, it is especially difficult to
know what percentage of cases persist in the form of chronic infections.
Other possibilities for persistent symptoms include: autoimmune-like
reactions in which the body attacks its own organs and tissues,
physically damaged or scarred organs and tissues from an earlier
infection, or another tick-borne infection such as babesiosis
Of course, symptoms occurring long after the onset of Lyme
disease can also be coincidental. A recently published long-term
study of 212 Connecticut residents suspected of having Lyme disease
found that their incidence of pain, fatigue, and difficulty with
daily activities was similar to those 212 age-matched controls
without Lyme disease . As noted in an accompanying editorial:
After a median follow-up of 51 months, patients with a diagnosis
of Lyme disease that met the national surveillance case definition
developed by the Centers for Disease Control and Prevention (CDC)
had the same profile of symptoms and the same quality-of-life
indicators as age-matched controls without Lyme disease. Thus,
recognition and treatment of clear-cut Lyme disease resulted
in a return to baseline with no measurable sequelae. On the other
hand, patients who were reported to have Lyme disease but who
did not meet the CDC's case definition of Lyme disease had increased
symptoms and worsening quality-of-life indicators. The implication
is that many of these individuals really did not have Lyme disease
and therefore did not respond to the treatment .
Limitations of Laboratory Tests
The diagnosis of Lyme disease should be based primarily on an
evaluation of the patient's symptoms and the probability of exposure
to the Lyme spirochete. Laboratory evaluation is appropriate for
patients who have the arthritic, neurologic, or cardiac symptoms
associated with Lyme disease, but it is not warranted in patients
who have nonspecific symptoms, such as those of chronic fatigue
syndrome or fibromyalgia . As aptly summarized by Matthew J.
Rusk, MD, and Stephen J. Gluckman, MD, of the University of Pennsylvania:
A true-positive test result consists of a positive enzyme-linked
immunosorbant assay [ELISA] or immunofluorescent assay [ILA]
followed by a positive Western blot. However, positive results
do not prove that [the] patient has Lyme disease and have little
predictive value in the absence of characteristic symptoms .
The FDA agrees with the above two paragraphs and has outlined
a two-step algorithm for laboratory testing . In a 1997 FDA
Public Health Advisory, it advised physicians that:
The results of commonly marketed assays for detecting antibody
to Borrelia burgdorferi (anti Bb) . . . may be easily misinterpreted.
. . .
Although package inserts for some commercial assays describe
their intended use "to aid in the diagnosis of Lyme disease,"
this statement does not fully reflect current knowledge . . .
and many such assays yield potentially misleading results. .
Assays for anti-Bb frequently yield false-positive results
because of cross-reactive antibodies associated with autoimmune
diseases or from infection with other spirochetes, rickettsia,
ehrlichia, or other bacteria such as Helicobacter pylori .
One laboratory offered a one-step Lyme Antigen Urine Test [LUAT],
data for which were presented at Lyme advocacy meetings and published
in the journal of a Lyme advocacy group. However, LUAT systems
return a high rate of false-positive results and have been discredited
In February 1999, the FDA approved the
B. burgdorferi Antibody Detection Assay, an "in-office"
test that provides results within an hour. The results are similar
in accuracy to those of the ELISA test and must be confirmed with
a Western blot test done by a laboratory. In May 2001, the FDA
approved another ELISA test called
Produced by Immunetics, Inc., of Cambridge, Massachusetts, it
is the first diagnostic tool to use a synthetic product called
C6, a hybrid marker based on components derived from the surface
of B. Burgdorferi. The C6 test is sensitive only to antibodies
generated during an active infection. Both tests should facilitate
accurate diagnosis and reduce the number of chronic or problematic
cases through early antibiotic treatment.
Some practitioners are inappropropriately diagnosing Lyme disease
in many of the patients who consult them and are administering
one or more of the inappropriate treatments described below.
Malariotherapy and ICHT
Malaria is a parasitic disease that typically involves bouts of
fever reaching 40°C to 41°C (104°F to 106°F).
Before the antibiotic era, patients in the late stages of syphilis
were sometimes given malaria with the hope that the fever would
kill the spirochetes responsible for the syphilis. The practice
was never subjected to controlled studies and was abandoned decades
ago when antibiotics became widely available. In recent years,
many Lyme patients have allowed themselves to be injected with
blood containing a malaria parasite, Plasmodium vivax .
Persons seeking such treatments usually had to travel to Mexico.
However, in one case, a Texas resident acquired P. vivax-contaminated
blood from an unknown source, injected himself, then treated himself
with the antimalarial drug chloroquine . There is no evidence
that malaria infection cures Lyme disease (or any other disease
for that matter). Moreover, patients who receive malaria-containing
blood face significant risks of serious illness or death caused
by the malaria itself, a transfusion reaction, or an infection
by other pathogens that might be in the blood. All things considered,
malariotherapy is far more dangerous than Lyme disease.
Another form of fever therapy administered to patients alleged
to have chronic Lyme disease is "intracellular
hyperthermia therapy (ICHT)," in which a substance such
as 2,4-dinitrophenol (DNP) is administered. According to a
The net result of ICHT uncoupler therapy causes the mitochondria
to be converted from efficient "powerhouses" of energy
production to "chemical furnaces", heating cells from
the "inside-out." The Lyme spirochetes are subjected
to such an amount of heat over a prescribed time that they cannot
survive. In essence, ICHT maybe considered a form of therapeutic
is a metabolic poison that can result in severe weight loss and
even death .
Hyperbaric Oxygen Therapy (HBOT)
High-pressure (hyperbaric) oxygen is legitimately used to treat
deep sea divers suffering from decompression sickness ("the
bends") and smoke inhalation, and to help treat several other
conditions . There are 300 hyperbaric facilities in the United
States. Some of these facilities have been used to treat AIDS,
chronic fatigue syndrome, and Lyme disease. The Lyme patients
subjecting themselves to long hours in these small chambers apparently
hope that high-pressure oxygen will enhance oxygen-dependent immune
mechanisms and kill spirochetes lurking beyond the reach of antibiotics.
Is HBOT effective against Lyme disease? At far as I know, it has
not been subjected to clinical testing for that purpose. One Lyme
patient who reported on the Internet said, "After 30 hours
of therapy [at $4,000] in 90-minute doses I had no positive results
for chronic Lyme treatment." Another online patient wrote,
"The director of the clinic is refusing to refund . . . me.
This money was for some of the dives I was scheduled to take,
but was unable to because I was sick." At best, HBOT is an
experimental treatment for Lyme disease. At worst, it is a big
waste of time and money.
silver and silver salt preparations have been touted as cures
for AIDS, chronic fatigue, herpes, TB, syphilis, lupus, malaria,
plague, acne, impetigo, and many other diseases. Lyme disease
is just the latest target. A 1996 Federal Register notice declared
that the "FDA is not aware of any substantial scientific
evidence that supports the use of . . . colloidal silver ingredients
or silver salts for these disease conditions." The same notice
stated that "human consumption of silver may result in argyria
-- a permanent ashen-gray or blue discoloration of the skin, conjunctiva,
and internal organs" . Despite these warnings, some Web
sites devoted to Lyme disease or colloidal silver products display
reports of laboratory experiments in which colloidal silver killed
spirochetes. One is a
from Dr. Burgdorfer, written on National Institutes of Health
(NIH) stationary. The letter merely reports on a pilot study using
colloidal silver to kill spirochetes in a test tube and states
that additional laboratory and human studies are underway. Many
silver and Lyme advocates have used the letter to suggest that
colloidal silver has been proven effective against Lyme disease.
However, no study has shown that colloidal silver is safe or effective
for treating people with Lyme disease (or anything else).
Overuse of Intravenous Antibiotics
Many Lyme disease activists and patients assert that Lyme disease
is a difficult-to-treat, chronic infection that requires long-term
consumption of broad-spectrum antibiotics. (See
beliefs about Lyme disease.) Although medical practice and
clinical trials suggest otherwise , many Lyme patients undergo
long-term intravenous antibiotic treatment. For appropriate intravenous
antibiotic treatment, the American
College of Physicians recommends 21-28 days and various
guidelines call for 10-30 days for the commonly used drugs.
Much longer usage has been reported among patients who have Lyme
disease as well as patients who have been inappropriately diagnosed
Outpatient intravenous therapy is a multi-billion-a-year business.
It remains largely unregulated and can cost patients thousands
of dollars per week. Price-gouging, drug markups, kickbacks, and
self-referral of patients by physicians with financial ties to
infusion companies have occurred. In 1995, for example, Caremark,
Inc., pled guilty to mail fraud charges for entering into illegal
contracts with physicians by paying them to refer Medicaid patients
to use Caremark's infusion products. The settlement provided for
approximately $44.5 million in civil penalties and restitution
from Caremark . In Michigan, prosecutors charged a physician
and Caremark employees with scheming to overbill Blue Cross/Blue
Shield for drugs and equipment for patients with Lyme disease
The intravenous antibiotic therapy administered to Lyme patients
sometimes has disastrous results. During the early 1990s, the
CDC described 25 cases of antibiotic-associated biliary complications
among persons with suspected disseminated Lyme disease . All
patients had received intravenous ceftriaxone (Rocephin) for an
average of 28 days for suspected Lyme disease. (Ceftriaxone can
form precipitates in the presence of bile salts. The resulting
"sludge" can block the bile duct.) Twelve patients subsequently
developed gallstones. Fourteen underwent cholecystectomy to correct
bile blockage. Twenty-two developed catheter-associated bloodstream
infections. Yet most of the patients lacked documented evidence
of disseminated Lyme disease or even antibodies to B. burgdorferi. In 2000, physicians reported the death of a 30-year-old woman
who died from an infected intravenous set-up that had been left
in place for more than two years. She was being treated for "chronic
Lyme disease" that was unsubstantiated .
The risks and costs associated with such treatments were analyzed
in a 1993 report whose authors concluded that most patients with
a positive Lyme antibody titer whose only symptoms are fatigue
or nonspecific muscle pains, the risks and costs of intravenous
antibiotic therapy exceed the benefits .
In an Internet newsgroup post, a woman described being on intravenous
Rocephin for 4 weeks, developing gallstones, and switching to
another antibiotic regimen for three weeks. She also mentioned
a sudden high fever, anemia, low white cell count, systemic pain,
heart rhythm disturbance, and neurologic symptoms. Such descriptions
are common among devout Lyme patients and provide an unsettling
view into the desperate and dangerous measures some people will
take to treat suspected Lyme disease. The woman ended her account
by writing she had switched her medication to ciprofloxacin. This
drug is potent but should not be used unnecessarily. Its adverse
reactions include acute psychosis and other neuropsychiatric reactions
Another patient said he was treated at a Mexican clinic where
the doctor admitted that he and his staff knew little about Lyme
disease. The patient wrote, "I started on IV Rocephin (two
grams a day), and later added oral azithromycin. My symptoms did
improved, but I soon hit a treatment plateau. We then tried IV
doxycycline, but this made me sick to my stomach." He goes
on to describe a long list of other drugs (IV Claforan, Cefobid/Unisyn,
Premaxin, a second round of Cefobid/Uisyn, and IV Zithromax),
followed by bouts of "severe diarrhea" and phlebitis.
Three months and some $25,000 later, DMSO was added to another
infusion of Zithromax.
A number of these so-called "Lyme-Literate Medical Doctors
(LLMD) have been investigated by their state bord for their extensive
use of powerful intravenous antibiotics and other unconventional
Such practices are likely to draw even greater scrutiny with
the recent publication of the results of two clinical trials on
chronic Lyme disease. The investigators noted "in these two
trials, treatment with intravenous and oral antibiotics for 90
days did not improve symptoms more than placebo." 
Many patients who believe they have chronic Lyme disease are
willing to endure considerable discomfort in their effort to get
rid of their symptoms. This behavior is fostered by the misguided
belief that antibiotic therapies are not working unless they make
the patient feel worse. These patients typically refer to this
condition as "herxing," a colloquial term for the Jarisch-Herxheimer
(J-H) reaction. This reaction is an acute response thought to
be caused by a sudden release of allergy-causing or toxic substances
when certain organisms (most notably the spirochete that causes
syphilis) are attacked with antibiotics.
About 10% of patients treated for early Lyme disease experience
a J-H reaction involving chills, fever, muscle pains, rapid heartbeat,
and slight lowering of blood pressure during the first 24 hours
of antibiotic therapy. These usually last for several hours, and
require little more than aspirin and bed rest. Yet many Lyme newsgroup
participants write about a "herx" beginning days or
weeks after the start of antibiotic therapy, and "herxing"
for weeks at a time -- often in a cyclic fashion." Herxing"
events have even been likened to an "exorcism"
that is "a necessary evil to be endured." Some of these
patients are likely to be suffering from the side effects of their
inappropriately prescribed antibiotics. It is also safe to assume
that the mistaken belief that Lyme treatment involves temporary
worsening will lead some people to neglect other illnesses. Neurological
symptoms, blurred vision, gastrointestinal upset, vomiting, and
palpitations, for example, should be reported to a physician,
not posted on the Internet with a request for comments.
Fear, ignorance and Internet rumors have also created an environment
for expanding the mythology of Lyme's protean properties far beyond
scientific fact or medical observation. For example, a recent
spat of Internet postings has suggested that Lyme can be acquired
through sexual contact.
"I think that Lyme is also a STD [sexual-transmitted disease],"
said one newsgroup poster. Another wrote, "I've talked to
many couples who claim they transmitted to each other through
sexual contact. I believe I gave it to my wife."
At least one "Lyme specialist" appears to be telling
patients that Lyme is sexually transmitted and therefore their
family members should be tested. One person reported to Quackwatch
that a family member had been tested and told that the test was
positive and that a 4-5 month course of antibiotics was necessary.
There is no basis for such advice. The infection is acquired
from the bite of an infected tick. People are "dead end"
hosts and do not spread Lyme infections to others.
The topic of pregnancy and Lyme is also rife with rumor and
unnecessary fear. During a quarter of a century of research and
surveillance, there have been no documented cases of mother-child
transmission and no cases of fetal injury associated with a Lyme
infection. Recent attempts to demonstrate venereal, transplacental
and contact transmission of Lyme spirochetes in hamsters have
also failed . In contrast, a case of perinatal transmission
of human granulocytic ehrlichiosis (HGE) was reported in the New
England Journal of Medicine . Like B. burgdorferi, HGE is
transmitted by the Ixodes tick, and simultaneous infections with
both have been reported.
The fact that Lyme disease is usually curable has not discouraged
the formation of over a hundred support groups and nonprofit foundations,
some with financial backing from intravenous services hoping to
promote further long-term antibiotic therapies . These groups
and their ardent followers have used the Internet and other media
to barrage politicians and the general public with misinformation,
dire personal stories, rumors, and exaggerated claims about thousands
of people being maimed, killed and bankrupted each year by Lyme
disease. The core message is that Lyme is a deadly chronic disease
that requires long-term antibiotic therapy paid for by insurance
companies. Despite its alleged frequency, NIH-funded clinical
trials in Boston and Bethesda were hampered by a lack of patients
who met science-based criteria for chronic Lyme disease. A third
trial underway at Columbia
University has had to modify its patient entry criteria in
order to find enough patients to carry out the study.
Support groups and individual patients have created many Web sites
that contain unsubstantiated assertions, inaccurate medical information,
and personal testimonies for the dubious treatments described
above. Indeed, the Internet has provided a powerful mechanism
for organizing patients and presenting poorly documented information
to the public and the press.
Internet newsgroups have posted wild criticisms of physicians
and researchers who disagree with their claims and concerns. Research
reports that run counter to the claims of Lyme activists are denounced
and their authors accused of incompetence and financial conflicts
of interest. Magazines and news organizations whose stories on
Lyme disease are not sufficiently hysterical are barraged with
e-mail complaints and urged to contact certain organizations for
"the truth." Protests have been organized to denounce
Yale University's research meetings and Lyme clinic because, according
to the protesters, Yale "ridicules people with Lyme disease,
presents misleading information, minimizes the severity of the
illness, endorses inadequate, outdated treatment protocols, excludes
opposing viewpoints, and ignores conflicts of interest."
Researchers have been harassed, threatened, and stalked .
A petition circulated on the Web called for changes in the way
the disease is routinely treated and the way insurance companies
cover those treatments. Less radical groups have had their meetings
invaded and disrupted by militant Lyme protesters.
Some Lyme organizations have tried to raise funds for their own
research on hyperbaric oxygen treatments, pregnancy-related Lyme,
and a clinical trial of chronic Lyme patients. Others have organized
"scientific" meetings that include anecdotal reports
by physicians friendly to their cause, and one group has launched
a journal that reflects its leaders' beliefs.
Disease Buyers Club markets vitamin and nutrient supplements
(e.g., flax seed oil, evening primrose oil, coenzyme Q10, garlic,
B-complex) to Lyme patients. Its web site states that these nutrients
are not a cure but "provide daily support for the body's
natural metabolic activities." The club offers "a 10
percent discount off Pro Health's already low, every day catalog
prices." and states that "10 percent of each sale will
go to Lyme disease research and advocacy projects." However,
the initial proceeds went to the Lyme
Alliance, of Concord, Michigan, an advocacy group that filed
brief supporting a court
appeal by a Joseph Natole, Jr., M.D., whose state medical
board had sanctioned him for inappropriately managing patients
with actual or suspected Lyme disease. According to a report on
the Alliance's Web site: the court ruled against the doctor; his
license was suspended for three months; he was fined $50,000;
and he was subsequently indicted on federal charges of overbilling
insurance companies. The Alliance later circulated a
stating that, "Lyme disease can and does exist as a chronic
illness with persisting infection, and that the disease is greatly
underdiagnosed and undertreated." The petition demanded that,
"Physicians who are on the front lines of Lyme disease patient
care not be harassed, persecuted or made to fear for their medical
practices because they do not adhere to the conservative "short
term" care for Lyme disease."
A Lyme Vaccine
After a decade of research and pressure from patient advocates
and Congress , the FDA licensed the first vaccine for Lyme
borreliosis on December 21, 1998. The vaccine, called Lymerix,
was derived from a recombinant version of the OspA lipoprotein
of B. burgdorferi. Lymerix was intended for "at-risk"
individuals between the ages of 15 and 70 years. Given in three
separate injections and an annual booster, the vaccine appeared
to be effective in preventing infections.
Yet, after years of pre-license clinical trials and three years
of commercial sales, the manufacturer, GlaxoSmithKline, pulled
the vaccine off the market on February 26, 2002. Glaxo cited poor
sales and a projected market this year of less than 10,000 people
 as the basis for their decision to end production and distribution
of Lymerix. The suddenly demise of Lymerix may give other vaccine
manufacturers pause in considering the development of future vaccines
against infections that readily respond to common antibiotic therapies,
have little associated morbidity, and almost no associated mortality.
Ironically, many of the original advocates for a vaccine turned
against Lymerix as soon as it hit the market. Citing its less
than perfect efficacy and anecdotal evidence of vaccine-induced
arthritis and other injuries, they crowded FDA hearings with tales
of personal injury, flooded the Internet with anti-vaccine tautologies,
and jointed lawsuits seeking compensation from Glaxo and Pasteur
Mérieux Connaught, the maker of a second, but never licensed
Despite the lawsuits and the web site tales of personal anguish,
repeated studies have failed to find any evidence of specific
adverse events associated with Lymerix. Neal Halsey, who helped
monitor the first vaccine trial, said, an "active, aggressive
search for patients who developed arthritis" after vaccination
found no evidence of increased arthritis risk . A CDC study
published in the February 2002 issue of Vaccine also failed
to detect any "unexpected or unusual patterns" of adverse
reactions to vaccination . Reports of adverse reactions to
Lymerix, and other vaccines, can be searched for on the
Adverse Event Reporting System (VAERS) Web site.
As another tick season approaches, it is interesting to note the
results of a recent survey of parental attitudes toward Lymerix
. The survey authors found that respondents in Nassau County,
New York indicated they would "definitely" (23%) or
be 'likely" to (65%) request Lymerix for their children.
The positive response to Lymerix may be due to the fact that most
survey respondents got their information about Lyme disease and
the vaccine from a friend or an advertisement (49% and 44%, respectively).
The Internet was not identified as a source of information. Yet,
the survey found that most respondents were "surprisingly
misinformed" about Lyme infections. For example, they considered
Lyme infections to be a chronic, difficult-to-treat disease. "Chronic
Lyme disease" is a term favored by support groups and patient
advocates, but has no basis in medical fact or practice .
The endless public repetition of this misleading mantra may have
influenced parental opinions in favor of vaccination as a prevention
to a chronic infection that does not exist. That option ceased
to exist on February 26, 2002.
Despite the Internet noise, fundraising letters from activists,
and high-ticket lawsuits, it is not difficult to find accurate
information about Lyme disease. Most state health departments
provide free brochures or direct online information. Good sources
The Bottom Line
- Lyme disease, when diagnosed early, is readily treatable
with oral antibiotics.
- Positive antibody tests, by themselves, do not provide sufficient
basis for diagnosing Lyme disease. The diagnosis should be based
on the overall picture, including history and physical findings
- Negative antibody testing after the first few weeks strongly
suggests that the patient does not have Lyme disease .
- Many patients with chronic nonspecific symptoms (such as
headaches, fatigue, achiness, mental confusion, or sleep disturbances)
mistakenly believe that they have Lyme disease.
- Intravenous antibiotic therapy, when given appropriately,
should not last more than a month. It should not be given unless
oral antibiotic therapy has failed and persistent active infection
has been demonstrated by culture, biopsy, or other bacteriologic
- Malariotherapy, intracellular hyperthermia therapy, hyperbaric
oxygen therapy, colloidal silver, dietary supplements, and herbs
are not appropriate measures for treating Lyme disease. Doctors
who recommend them should be avoided.
Disease Cases Reported to CDC by State Health Departments, 1990-1999.
CDC Web site, Update, June 22, 2001.
- Barbour AG. Lyme Disease: The Cause, the Cure, the Controversy.
Baltimore: Johns Hopkins University Press, 1996.
- Aronowitz R. Making Sense of Illness: Studies in Twentieth
Century Medical Thought. New York: Cambridge University Press,
- Seltzer EG and others.
outcomes of persons with Lyme disease. JAMA 283:609-615,
- Gardner P. Long-term outcomes of persons with Lyme disease
(editorial). JAMA 283:658-659, 2000.
- Sigal LH and Hassett AL.
of societal and geographical environments to "chronic Lyme
disease": The psychopathogenesis and aporology of a new
"Medically Unexplained Symptoms" Syndrome. Environmental
Health Perspectives 110:607-611, 2002.
- Rusk MH, Gluckman SJ. Serologic testing for Lyme disease.
When -- and when not -- to order, and how to interpret results.
Consultant 38:966-972, 1998.
- FDA Public Health Advisory:
for antibodies to Borrelia burgdorferi; limitations, use, and
interpretation for supporting a clinical diagnosis of Lyme disease.
July 7, 1997.
- Klempner MS and others. Intralaboratory reliability
of serologic and urine testing for Lyme disease. American
Journal of Medicine 110:217-219, 2001.
malaria associated with malariotherapy of Lyme disease. MMWR
Self-induced malaria associated with malariotherapy for Lyme
Disease -- Texas. MMWR 40:665-666, 1991.
- Caprette DR.
of metabolic poisons to study mitochondria function. June
- Environmental Techtonics Corporation:
- Federal Register 61:53685-53688, 1996. To access the full
text, search the
Register for "colloidal silver."
- Klempner MS. Two controlled trials of antibiotic treatment
in patients with persistent symptoms and a history of Lyme disease. New
England Journal of Medicine, June 12, 2001 (early
- Steere AC and others.
overdiagnosis of Lyme disease. JAMA 269:1812-1816, 1993.
- Reid MC and others.
consequences of overdiagnosis and overtreatment of Lyme disease:
An observational study. Annals of Internal Medicine 128:354-362,
- Fix AD, Strickland GT, Grant J.
bites and Lyme disease in an endemic setting: problematic use
of serologic testing and prophylactic antibiotic therapy.
JAMA 279:206-210, 1998.
General Montgomery stops Medicaid fraud and returns $2.3 million
to state. Press Release, June 19, 1995, Attorney General
- Kelly F. Lyme disease alleged to be false diagnosis. Ann
Arbor News, June 19, 1998.
- Ettestad PJ and others.
complications in the treatment of uncomplicated Lyme disease.
Journal of Infectious Disease 171:356-361, 1995.
- Patel R and others.
from inappropriate therapy for Lyme disease. Clinical
Infectious Disease 31:1107-1109, 2000.
- Lightfoot RW Jr and others.
parenteral antibiotic treatment of patients with fibromyalgia
and fatigue and a positive serologic result for Lyme disease.
A cost-effectiveness analysis. Annals of Internal Medicine
- Mulhall JP, Bergmann LS.
acute psychosis. Urology 46:102-103, 1995.
- Woodrum JE, Oliver JH Jr.
of venereal, transplacental, and contact transmission of the
Lyme disease spirochete, Borrelia burgdorferi, in Syrian hamsters.
Journal of Parisitology 85:426-430, 1999.
- Horowitz HW and others.
transmission of the agent of human granulocytic ehrlichiosis.
New England Journal of Medicine 339: 375-378, 1998.
- Weiss R. Lyme Disease Foundation's influence at NIH gets
under scientist's skin. The Washington Post, April 21 1997, p
- Grann D. Stalking Dr. Steere over Lyme disease. New
York Times Magazine, June 17, 2001.
- Robinson, MB. Senators Urge Haste on Lyme Vaccines. Bergen
Record, Sunday, Dec 7, 1997.
- Associated Press. Lyme Vaccine Pulled Off Market. Feb 26,
- Associated Press. Lyme vaccine test crippled him, man, 73,
charges. Norwalk Hour (Connecticut). Sept. 14, 1995, pp. 6.
- The Lyme Vaccine Controversy, Consumer Reports (online) November
- Lathrop, SL, et al. Adverse event reports following vaccination
for Lyme disease: December 1998-July 2000. Vaccine 20:1603-1608,
- Barone, Sr, SS Bohrer, and WA Erhardt. Parental Knowledge
of and Attitudes Toward LYMErix (Recombinant OspA Lyme Vaccine).
Clinical Pediatrics 41:33-36, 2002.
- Sigal, LH. Misconceptions about Lyme Disease: Confusions
Hiding behind Ill-Chosen Terminology. Annals of Internal Medicine
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Medicine 12(5):51-58, 1995.
- Cunha BA. Overdiagnosing and overtreating Lyme disease. Emergency
Medicine, August, 1994, pp 30-36.
Index to Fad Diagnoses
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This article was revised on September
- Dr. McSweegan is a microbiologist who lives and works in
Maryland, but has spent many summers in Old Lyme, Connecticut.
Between 1993 and 1995, he managed a federal Lyme disease research
program. This article has been reviewed by Judith N. Barrett,
M.D., Luther Rhodes III, M.D., Marvin Rosenthal, M.D., and the
late John H. Renner, M.D.