Eugene Weekly : Viewpoint : 1.28.10

Lyme Disease Rare
Controversy, misinformation abound
By Sarah Hendrickson, M.D

In a guest Viewpoint Jan. 7, a massage therapist from Corvallis wrote about Lyme disease, a not uncommon tick-borne infection in southern Oregon. Unfortunately, her column repeated misinformation and inaccuracies that are common on the web though unsupported by reproducible research evidence.  She claimed that “the health department says it doesn’t exist here.” Not my Lane County Public Health Department! We have reported four diagnosed cases since 2006 that were probably infected in Lane County. Lyme disease can be serious. However, it is well-studied and very treatable.

Lyme disease is caused by the bacteria Borrelia and is transmitted to humans by the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue and a characteristic circular skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart and the nervous system. Lyme disease should only be diagnosed by positive clinical examination findings and confirmed reports from legitimate laboratories.

Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include wearing clothes, using insect repellent and removing ticks promptly. Very few ticks are likely to be infected: only 3.5 percent of ticks from Jackson and Josephine Counties tested positive for Borrelia infection. 

Some groups argue that “chronic Lyme disease” is responsible for a range of medically unexplained symptoms including “terrible PMS, gastrointestinal upset, mood disturbances, hormonal symptoms, infections that don’t go away, and more.” Many, including the writer, believe that long term antibiotic treatment is required.  

But of four randomized controlled trials of long-term antibiotic treatments, two found no benefit, and two found inconsistent benefits with a lot of side effects and risks from the treatments. Medical expert groups, including the Infectious Diseases Society of America and the American Academy of Neurology, find that scientific evidence does not support a role for Borrelia nor ongoing antibiotic treatment in such cases. Other alternative therapies have been suggested, such as the use of hyperbaric oxygen therapy, anti-fungal medications, bee venom, “fever therapy,” intravenous hydrogen peroxide and the injection of toxic bismuth compounds. None of these treatments have been tested in controlled clinical trials and some have killed patients.

The FDA has issued warnings about such treatments, as well as cautioning that some less-reputable commercial labs are selling tests for Lyme disease in urine and blood that are flawed, non-standard and cannot be validated.

However, the controversy and the misinformation continue. Some alternative medicine doctors, patient advocacy groups and politicians continue to argue that the disease is significantly under-diagnosed with current testing, and that long-term treatments are beneficial. This issue has led to legal action over treatment guidelines, and harassment and death threats made against physicians who will not acknowledge “chronic” Lyme disease as a legitimate diagnosis. Even Oprah has been involved.

Your chances of suffering serious effects from a confirmed Borrelia infection are extremely low. There is a very high frequency of background complaints of a vague sort present in an otherwise “healthy” population. If you are concerned about non-specific symptoms that your doctor cannot diagnose, try regular exercise, morning exposure to sunlight, sleep well, stay away from nasty “substances” and focus on healthier parts of your life. 

Dr. Sarah Hendrickson of Eugene is a family medicine physician, and she serves as the (part-time) Lane County public health officer.