Visiting physician sheds new light on Lyme disease | Hacker News Reader

Visiting physician sheds new light on Lyme disease

mvtimes.com

51 pointskungfudoi8 comments

It would be exciting...except the red flag for me: http://www.ncbi.nlm.nih.gov/pubmed/?term=Zubcevik%2C+Nevena%...

A hotshot Harvard Medical School infectious disease physician should at least have a more prominent publication record. If there is evidence that actually backs this up, great. Publish it under peer review.

There is a shady industry in chronic antibiotics for "chronic lyme" which is a collection of vague symptoms, which fly in the face of antibiotic therapy, and for which the "recommended" testing rejects the official CDC testing and can only be provided by cash-only "proprietary" laboratories. The physicians who do this, all conveniently happen to be cash only...

This could be one case where using a preprint server like the http://biorxiv.org/ would be key. Getting positive peer reviews when peers are opposed in principle is hard: no amount of data will convince them.

That said, she stated to be new to the field. She should have a publication record from work in her prior field of research.

The problem with chronic lyme - the data for it is extremely weak, in the form of single case reports or small case series that have been poorly written. And getting in pubmed is not the problem - nowadays, you can cough onto a poster at a conference and it will show up. Furthermore, infectious disease docs are easy to convince if you have good data - it is one of the more experimentally accessible fields in medical science. When the spirochete for Lyme was isolated and cultured, and the initial antibiotic treatments proven, the field was quick to accept it.

That plus we see a steady stream of patients mistreated and told they have "chronic lyme" that end up in the hospital due to antibiotic complications, or because the "lyme doctor" told them to stop their other medications, gives a lot of us pause regarding anything mentioning "chronic lyme".

It's not that ridiculous. She has only been an attending physician for 2 years, having graduated from Physical Medicine and Rehabilitation residency in 2014.

However, she is not an infectious disease physician by training, which is important to keep in mind, depending on how you look at things. PM&R does work with spinal cord and traumatic cerebral injury, which is why she argues that chronic lyme is similar. However, PM&R is not typically the specialty running point on antimicrobial therapy planning.

Still - most people who are going into a field of research (and who have a mentor on top of things) should have at least a poster at a major convention of the society of their field, a case report, or something, by the end of residency. A completely blank pubmed record is not unusual, but unsettling for someone making these kinds of claims.

There are certain bacteria that are known to require many years of antibiotics to resolve:

1.) tuberculosis

2.) Leprosy (Mycobacterium leprae)

For both of these it is normal to take antibiotics for many, many years.

Also, less seriously, ordinary acne is often treated with antibiotics for years. My sister took antibiotics for 5 years to deal with her acne.

It is possible that there is a tick borne bacteria that also falls into this category. Some of the stories of long-term Lyme would suggest this.

The 2 days of antibiotics for "prophylactic" protection makes sense only if the goal is to create antibiotic-resistant bacteria. 2 days of a relatively weak antibiotics is pure anti-science. She makes a good point here:

"She also said the two-day course of doxycycline, often prescribed for people who find a tick embedded on their body, has little or no prophylactic value."

Wow! Only two days? I've been diagnosed and treated for Lyme's twice. Both times it was ten days of doxycycline.

Important:

“Sudden-onset dementia should really be a red flag for Lyme [disease], especially in people with compromised immune systems,” she said.

“Everyone over 50 has a compromised immune system.”

Dr. Zubcevik said that doctors and parents should know that Lyme presents differently in children than it does in adults. “71 percent of the time, headache is the most common symptom in children,” she said. “Mood disturbance, fatigue, and irritability are also frequent symptoms in children. If they are acting out in school all of a sudden, get them tested.”

“The bull’s-eye rash only happens 20 percent of the time,” she said. “It can often look like a spider bite or a bruise. If you get a bull’s-eye it’s like winning the lottery. Borrelia miyamotoi, which we have a lot in Massachusetts, will not test positive on either test. That’s a huge problem, so the CDC is moving toward a different kind of test.”

Crazy:

"Dr. Zubcevik said there are videos that show a white blood cell pursuing a spirochete, which evades capture by drilling into tissue."

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