Re: CDC funds Lyme disease research
From: A_Weisman (a_weisman_at_yahoo.com)
Date: 06/29/04
- Next message: A_Weisman: "Re: A Story About Lyme Disease"
- Previous message: A_Weisman: "Re: lyme disease documentary"
- In reply to: A_Weisman: "Re: CDC funds Lyme disease research"
- Messages sorted by: [ date ] [ thread ]
Date: 29 Jun 2004 12:15:02 -0700
>From: Tbdbullseye (tbdbullseye@aol.com)
>Subject: Re: CDC funds Lyme disease research
View this article only
Newsgroups: sci.med.diseases.lyme
Date: 2004-06-29 07:28:20 PST
>Here is some Fish info which was cited\ by A_Weisman, and which I
find
>offensive and dangerous:
<<Nadelman, R.B., Nowakowski, J., Fish, D., Falco, R., Freeman, K.,
>McKenna, D., et. al. Single dose doxycycline prophylaxis after Ixodes
>scapularis tick bites: a randomized double-blinded placebo-controlled
>study. New England Journal of Medicine 345:79-84, 2001.>>
Ann-Oh, I understand your concerns about this article and study. I
share many of the concerns.
My point was that Durland Fish himself made a series of public
statements indicating HIS concern about the study and the results:
==========================================================================
Search Result 5
From: Art Doherty (doherty@utech.net)
Subject: Antibiotic Treatment of Tick Bites Prevents Only 20 Percent
of Lyme Disease Cases, Says Yale Researcher, Yale News Release, 14 Jun
01
View: Complete Thread (2 articles)
Original Format
Newsgroups: sci.med.diseases.lyme
Date: 2001-06-15 07:50:35 PST
YALE News Release
CONTACT: Karen N. Peart 203-432-1326 #404
For Immediate Release: June 14, 2001
Antibiotic Treatment of Tick Bites Prevents Only 20 Percent of Lyme
Disease Cases, Says Yale Researcher
New Haven, Conn. -- Even if every patient who noticed they had a tick
bite received prompt antibiotic treatment and if it were 100 percent
effective in preventing Lyme disease, it would only prevent 20 percent
of the total Lyme disease cases, Yale researcher Durland Fish said.
Fish, an author on the New England Journal of Medicine's (NEJM) newly
released article on the antibiotic doxycycline's preventative effect
on
Lyme disease, said the study was based only on patients who had seen
and
removed a deer tick. "Most patients contracting Lyme disease never see
the tick that caused infection," Fish said. "The nymphal stage of the
deer tick is about the size of a poppy seed and even though it takes
three to four days for it to feed before removing itself, most people
will not notice it. This is because the tick also secretes an
anesthetic
while it is feeding, as well as infectious bacteria."
One published study showed that only about 20 percent of patients with
Lyme disease recalled a tick bite. "This is an amazing, but true, fact
of tick biology," said Fish, associate professor in the Department of
Epidemiology and Public Health at Yale School of Medicine. "The key
difference in this issue is between tick bites that are recognized by
the patients and those which are not. Most are not."
Unrecognized tick bites in humans cannot be studied, but animal
studies
done by Fish, show that more than 80 percent of infected ticks will
cause Lyme disease in mice after 72 hours of feeding, the maximum
feeding time for nymphs. This rate, coupled with a 25 percent natural
rate of infection of deer ticks in the Northeast, yields a 20 percent
chance of infection from a nymphal deer tick, proving that Lyme
disease
is easy to catch.
"People who live in Lyme disease areas should take the risk of tick
bites seriously and do all they can to prevent them, keeping in mind
the
20 percent chance of infection if they miss a tick, instead of the 3
percent chance if they find one," Fish said. "Bites from deer ticks
are
extremely common in the Northeast."
One Centers for Disease Control study co-authored by Fish estimates
that
one in five Westchester Country residents are bitten by deer ticks
each
year, an annual average of 179,000 tick bites.
The NEJM study also reported that over 18 percent of the tick-bite
patients received a second tick bite within the 90-day study period
and
over 6 percent of the patients had multiple ticks attached when they
were initially observed. "With such a high frequency of contact
between
ticks and people, prevention methods other than treating tick-bites
with
antibiotics are badly needed," Fish said.
# # #
Questions, comments, suggestions? Send them to mailto:opa@yale.edu.
Antibiotic Treatment of Tick Bites Prevents Only 20 Percent of Lyme
Disease Cases, Says Yale Researcher, Yale News Release, 14 Jun 01
http://www.yale.edu/opa/newsr/01-06-14-02.all.html
=======================================================================
Noted Lyme Conservative Dr. Durland Fish Speaks Out!
http://www.angelfire.com/punk/lymedisease/SCfish.html
Noted Lyme Conservative Dr. Durland Fish Speaks Out!
EDITORIAL COMMENT: The East Coast did not realize the story got so
much coverage here, too.
BW0528 JUN 13,2001
Lyme Disease Risk in Northeast Is Real, Says Expert
Business Editors & Health/Medical Writers BIOWIRE2K
LARCHMONT, N.Y.--(BW HealthWire)--June 13, 2001--"The June 13 New York
Times article stating that Lyme disease is very difficult to catch,
even from a deer tick in a Lyme-infested area, is misleading and a
potentially dangerous message to the public," said Durland Fish,
Ph.D., an associate professor in the Department of Epidemiology and
Public Health at Yale School of Medicine.
Dr. Fish is editor in chief of the peer-reviewed journal Vector Borne
and Zoonotic Diseases, published by Mary Ann Liebert, Inc., and a
co-author of one of two original articles(a) to be published with a
review article and an editorial on Lyme disease in The New England
Journal of Medicine, on which the Times story was based.
"The study on tick bite treatment to prevent Lyme disease was based
only on patients who had seen and removed a deer tick," explains Dr.
Fish. "The vast majority of patients who contract Lyme disease never
see the tick that infected them. The nymphal stage of the deer tick is
about the size of a poppy seed, and even though it takes three to four
days for it to feed before removing itself, most people will not
notice it because it is so small and because the tick also secretes an
anesthetic while feeding, as well as infectious bacteria. One
published study showed that only about 20 percent of patients with
Lyme disease recalled noticing a tick bite. Most tick bites are not
recognized by patients."
Unrecognized tick bites of humans cannot of course be studied,
explained Dr. Fish. He pointed out that animal studies he himself has
done show that more than 80 percent of infected ticks will cause Lyme
disease in mice after 72 hours of feeding, the maximum feeding time
for nymphs.
This rate, coupled with a 25 percent natural rate of infection for
deer ticks in the Northeast, yields a 20 percent chance of infection
from a nymphal deer tick, proving that Lyme disease is easy to catch
-- and sharply contrasting with the 3 percent chance quoted in the
Times article, Dr. Fish emphasizes.
"People who live in Lyme disease areas should take the risk of tick
bites seriously and do all they can to prevent them, keeping in mind
the 20 percent chance of infection if they miss a tick, rather than
the 3 percent chance if they find one," cautioned Dr. Fish.
Bites from deer ticks are extremely common in the Northeast. A Centers
for Disease Control study co-authored by Dr. Fish estimated that one
in five Westchester County residents are bitten by deer ticks every
year, an average of 179,000 tick bites annually for the area. The
Nadelman study* also reported that more than 18 percent of the tick
bite patients examined received a second tick bite within the 90-day
study period, and more than 6 percent of patients had multiple ticks
attached when initially observed.
"Such a high frequency of contact between ticks and people indicates
that prevention methods other than treating tick-bites with
antibiotics are badly needed," commented Dr. Fish.
Vector Borne and Zoonotic Diseases publishes original research papers
on an increasingly widespread group of infectious diseases that pose
serious threats to public health in the U.S. and worldwide, including
bartonellosis, dengue, Ebola, ehrlichiosis, hantavirus, Lyme disease,
malaria, and West Nile virus, examining geography, seasonality, and
other risk factors that influence diagnosis, management, and
prevention of these unique diseases.
Mary Ann Liebert, Inc., is a privately held, fully integrated media
company known for establishing authoritative peer-reviewed journals in
new and promising areas of science and biomedical research. Its
biotechnology trade magazine, Genetic Engineering News (GEN), was the
first in its field and is today the industry's most widely read
publication worldwide. A complete list of the firm's 60 publications,
books, and newsletters is available at www.liebertpub.com.
(a) "Prophylaxis with Single-Dose Doxycycline for the Prevention of
Lyme Disease after an Ixodes scapularis Tick Bite," by Robert B.
Nadelman, M.D., Durland Fish, Ph.D., et al. The full text of the
article is available at www.nejm.org.
CONTACT: Mary Ann Liebert, Inc., Larchmont Paula Masi, 914/834-3100,
ext. 615 Fax 914/834-1388 pmasi@liebertpub.com www.liebertpub.com Lyme
Disease Risk in Northeast Is Real, Says Expert, BWire, 13 Jun 01
http://ny-web1.businesswire.com/cgi-bin/f_headline.cgi?day1/211640528&ticker=
or Lyme Disease Risk in Northeast Is Real, Says Expert, excite.com, 13
Jun 01 http://news.excite.com/printstory/news/bw/010613/ny-mary-ann-liebert
-----
========================================================================
I also think it is important for you to consider Fish's role in the
study. He is a Ph.d NOT an md and the treatment recommendations almost
certainly didn't come from him. That wasn't the expertise he added to
the study.
Also: the discovery of a new borellia by Fish may turn out to be quite
significant as I mentioned.
And though Greatcod thinks that this study won't help, his criticims
thus far are very general. This study could contribute to preventive
measures and to a better understanding of the illness.
Not every research accomplishment or study is aimed at developing a
better test. And while greatcod calls for more education of doctors,
he fails to recognize that the problem is that doctors are being
"educated" in a way that he doesn't like or agree with but a way that
IS consistent with the prevailing mainstream view of Lyme.
For the record, I don't agree with those views. BUT I do recognize
that the majority of doctors agree with them and the "llmd" view is
not well documented and is a small minority view.
When Lymeland calls for "more education" we need to realize that what
we're asking for if granted will result in the dissemination of
information that we don't agree with especially if funded by the
government CDC NIH and public health.
What greatcod and Lymies really mean isn't more "education." It is
that they want doctors to be forced to agree with the llmds. But the
llmds are so few in number, their views aren't well documented and
they don't have the credentials or affiliations to be persuasive. For
the record, I think the llmd view is more right than wrong and more
right than the "mainstream" view. Of course there is a great deal of
differences amongst and between "llmds" in their approaches and too
many of the llmds are on the fringes of medical practice in many ways.
So what greatcod wants to happen, isn't going to happen in the way he
wants. So I say he should be careful in asking for it.
And I was trying to point out how strange it seems to ask for
something like "more research" and then complain when it happens. And
to cry "bias" without being able to show that research proposals that
you agree with were submitted and not funded, is absurd.
The GAO investigation showed absolutely no evidence of what Lyme
patients said would be discovered. It might have been an inadequate
investigation but Lyme patients and advocates haven't showed us how it
was. Disagreeing with it but not being able to show where it missed
something significant isn't very persuasive.
Also the cry for a good test misses much of what the controversy is
about. Even if there is a good test that proves infection, the
mainstream view is that a few weeks of antibiotics and almost never IV
is needed and that more treatment hasn't been shown to help. Even if
there was a good test to prove ongoing infection following initial
infection, they still don't believe in more treatment.
>How many people had the single dose of doxycycline "discovered" and
advocated
>by Fish and his cohorts when they presented with tick-bite and/or
erethema
>migrans rash, and today are suffering severely and are convinced that
it can't
>be Lyme disease because this wonderful Fish discovery allowed them to
cure Lyme
>disease immediately?
Good points and I agree. But I don't agree that Fish advocated this. I
think the study was based on limited circumstances (known tickbite and
rash and treatment given within three days which almost never happens
in real life) and it provides no rationale for such treatment in any
other circumstance beyond what was involved in the study. The study
had other problems too.
And many doctors have misused the study and believe that even in
infection that hasn't been discovered promptly that two doses of doxy
are enough now.
Very dangerous.
In fact inadequate treatment could cause real problems including
aborting the antibody response and creating resistant infection. This
would make later diagnosis and treatment more difficult.
But I just don't think the treatment recommendations from the study
came for Fish. And I did see him come out publicly and caution people
not to draw too much from the study and to avoid misuse of the
information.
>How many of them will never be properly diagnosed and treated for
Lyme? How
>many will live painful lives and die painful deaths? Do you know?
No I don't and these are valid concerns.
>How many doctors and researchers, Public health officials, county and
state
>health departments will pooh-pooh any further need to think about
educating
>doctors, treating patients, once Fish has used our money to create a
map
I don't think the creation of the map will cause or exacerbate this
type of problem which already exists.
I would hope it would be used to help target preventive measures at
high risk areas.
Physicians shouldn't misuse the information. For example, residence in
a high risk area isn't the only exposure. Many travel to, recreate in,
vacation in, work in areas where they don't reside.
The information from the study may have other uses I mentioned in my
earlier post.
>which may be only CDC results, based on extremely inaccurate and
strict
>epidemiologic info
I don't know the details about whether the study involves only
epidemiologic date or tick surveys but you may have a valid criticism
here.
>and based on under-diagnosis and under-reporting by physicians who
don't give a
>flying fig, don't want to waste the time doing the paper work, and
are never
>encouraged to report,
The fact that mandatory reports aren't made is a problem. But I don't
think it is fair to say that doctors and labs who are required to
report, don't do so.
I would guess that some of the llmds don't report for fear of bringing
scrutiny to their practices since many take the low profile approach?
So it may be that llmds contribute to this problem too. "Mainstream"
doctors may underdiagnose. But "llmds" may in fact overdiagnose and
use dubious grounds to base their diagnosis. Such as the Bowen test.
>let alone are ever under any enforcement by anyone state or national
to report
>cases of any infections,
Well this could cut both ways, like against the llmds.
>or will be based on info supplied by States who have no money and no
interest
>to do the field work required to find out the real picture of Lyme
disease in
>their area
I don't know. could be a valid criticism.
>and finally that said map has to be the final word since the CDC
funded it?
Well who's to blame for that?
>The CDC map given on their site as to risk of Lyme disease shows Ohio
almost
>bare of risk and Indiana with lots of risk, even though there have
been over 80
>cases reported in Ohio in each of the last 5 years and only about 20
- 21 cases
>reported from Indiana over each of the last 5 years.
I believe the CDC map is outdated. And there are real problems with
their epidemiologic approaches I agree.
Are llmds or ILADS and LDF and LDA funding studies of their own and
providing data that contradicts this?
> AND, the CDC allows the press to report their surveillance numbers as gospel
>and final figures, while hiding in fine print on their material that
the
>disease is under-diagnosed and under-reported and that the actual
numbers could
>be 6 to 10 times the reported numbers.
I disagree with how you've stated this. The press reports what the
press reports the CDC doesn't control the press. If you mean the CDC
should provide more accurate information or give caveats such as the
23,000 cases are only 10% or less of actual cases that would meet CDC
SURVEILLANCE guidelines and those guidelines result in underreporting
of the actual incidence of disease since many actual cases won't meet
the strict criteria, and that CDC should give a more realistic
estimate of the actual incidence of Lyme disease, I agree
wholeheartedly. And CDC should employ better epidemiological
approaches to get to the actual incidence of Lyme, create categories
of "probable" and "possible" cases along with "definite" and "Cdc
surveillance criteria qualified definite cases" I agree.
>They even have this disclaimer:
>http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5231a7.htm
>"Lyme disease surveillance case definition: State and local public
health
>officials rely on health-care providers, laboratories, and other
public health
>personnel to report the occurrence of notifiable diseases to state
and local
>health departments. Without such data, trends cannot be accurately
monitored,
>unusual occurrences of diseases might not be detected, and the
effectiveness of
>intervention activities cannot be easily evaluated. In the United
States,
>requirements for reporting diseases are mandated by state laws or
regulations,
>and the list of reportable diseases in each state differs."
And the press should use that information. CDC should make it clearer
but part of the problem is lazy and stupid reporters too. And Lyme
advocates not getting this information out clearly, putting out papers
about the actual incidence of disease.
I've seen Karen Forschner and Pat Smith and many others quoted citing
the CDC case figures without providing their own explanations dozens
and dozens of times.
So in part this is a failure of Lyme patient advocacy compouding poor
work by the CDC.
>Sorry, I am not convinced Fish or the CDC are good investments for
our
>hard-earned taxes.
>Ann - OH
I'm not convinced it isn't. I agree with and have expanded on some of
the points you make. But there is more to the story.
And greatcod's complaints just don't mean too much to me. Yes there
are other research goals to be pursued but that doesn't make these
goals bad. And he misses much of the point and the implications of
what he thinks he wants.
Thanks ann, I invariably appreciate your comments and information.
- Next message: A_Weisman: "Re: A Story About Lyme Disease"
- Previous message: A_Weisman: "Re: lyme disease documentary"
- In reply to: A_Weisman: "Re: CDC funds Lyme disease research"
- Messages sorted by: [ date ] [ thread ]
Relevant Pages
|
