There are few issues in our society which are more disturbing now than the present failure of “mainstream medicine” to appropriately address the needs of patients suffering from the effects of the most, and increasingly more, serious epidemic of vector-born tick bite related disease in the United States.
Directly due to some of the significant scientific limitations of present medical practice, the treatment of tick-borne disease has now become the single most controversial illness in modern medical history. Unfortunately, this controversy has now spilled over to invoke demeaning vitriol, ugly politics, and attempted character assassination. Treating physicians are being subject to treatment consistent with a modern resurgence of the Spanish inquisition while other physicians have, in the process, become ‘enemies of the people’ whose safety has, sometimes, been held at risk.
The editor of this web site is a neurosurgeon medical director of a multi-specialty clinic, which has included the treatment of patients disabled by the sequela of tick-borne disease. I, and my colleagues, have observed, over the years, many disabled patients coming to our clinic from around the country who have been previously given hopeless diagnoses, such as multiple sclerosis, and have been told that there was no possible treatment. We have observed that many of these patients, following antibiotic treatment, have made remarkable recoveries and we have considered this to be the very best example of unbiased “peer review.”
As I have become more interested and involved in the issue of tick-borne disease, my eyes have been progressively opened to this ongoing American tragedy. As a long-term resident of Minnesota who remembers well the experience of emerging from Pogami swamp in Ely MN during an Outward Bound exercise covered with leeches (aka African Queen), I was relieved with the knowledge that leeches only rarely transmitted any disease harmful to humans.
The question then is why ticks, on the other hand, have such filthy mouths with their saliva rife with spirochetes, ricketssia, gram negative bacteria, and parasites? Does this situation reflect a normal process of evolution or does this reflect the creation of “Frankensteinian” bio-warfare weapons scientists working in secret facilities creating “designer” arachnids?
Even though the DNA of the Borrelia burgdorfi (Bb) spirochete was found in the body of the 5,000 year old frozen alpine man Otzi, it remains an interesting historic fact how Bd came to be associated with the city of Lyme Connecticut and thus became the poster child for all tick-borne disease.
Bb’s reputation as “public enemy #1” is however well deserved. This organism is the most genomically (genes, plasmids, etc.) complex bacterium known to science and it is this complexity which allows Bd to continuously morph both physically and physiologically into its environment allowing it to continue to survive despite the adversity of drugs and the body’s immune system. Identifying Bb is difficult enough but this process is further confused by less than reliable laboratory testing and the existence of other Borrelias, including Borrelia miyamotoi which is also endemic in the U.S. and presents with symptoms similar to Bb in patients who have tested negative for Bb but who have had favorable responses to antibiotic treatment.
To add to the confusion, there are at least eight different species of Bartonella known to infect humans. In addition to infecting body tissues such as joints and the nervous system as does Bb, Bartonella has a particular affinity for becoming intracellular making it even less susceptible to antibiotic treatment.
It is unfortunate that the routinely used tests to determine Lyme disease are essentially non-specific and unreliable. Our clinic has been fortunate in having been able to identify a Bd culture test offered by Advanced Laboratory Services of Sharon Hill, Pennsylvania which has proven to be an important means of assisting us in making the determination as to who to treat with multiple antibiotics over significant periods of time.
When all of these “wild cards”, including the presence of other “dirty mouth” companion organisms, it should be not very surprising that treating tick-borne disease with antibiotics smacks of the same “shotgun treatment” liabilities shared by our present management of psychogenic disease, cancer, and a number of other infirmities.
What is the physician’s alternative? I was taught as a medical student that my responsibility was to always try to make the best diagnosis for my patient. If there was a 90% likelihood of an untreatable condition being present, it was my task to focus on the other 10% to come up with a treatable condition. Many patients diagnosed with untreatable neurologic problems have subsequently turned out to have treatable conditions. As a neurosurgeon, I have seen many MRI scans of the brain and spinal cord containing lesions which were considered “diagnostic” for demylinating disease such as multiple sclerosis. I now know that similar lesions can result from tick-borne disease.
Because epidemiologists have not always found live Bb organisms in chronic tick-borne disease cases, some have represented to the medical community that the treatment of chronic Lyme disease can “not be supported by the medical literature” and that there is no such thing as “chronic Lyme disease.” The fall out from this has led to the harassment and sometimes prosecution (with loss of medical license) of concerned physicians attempting to do what they believe to be in the best interest of their patients. This modern era inquisition has, sadly, created a climate of fear in the medical community resulting in many physicians being unwilling to even see cases of tick-borne disease.
The population of ticks and the incidence of tick-borne disease has dramatically increased in the U.S. It has been estimated that 90% of patients who continue to have disability secondary to tick-borne disease have not yet been identified in our population. In August 2013 the Centers for Disease Control (CDC) announced that they had revised their estimate regarding the prevalence of Lyme disease in the United States by 10 times. Clearly, the untreated cases become chronic and when they are finally diagnosed, they are typically often seriously impaired as well as costly to treat. Long-term antibiotic therapy is expensive and not without risk. The practice of medicine and surgery is always associated with some degree of risk. Good medical practice should always balance this risk against the potential benefit of treatment.
Some medical opinion leaders have stated that if there isn’t scientific evidence to support treating chronic Lyme disease, then these patients shouldn’t be treated with antibiotics because they must be afflicted with only functional disorders. As a neurosurgeon who has always had to make a decision as to a patent’s credibility prior to operating on them, I believe that I have become quite good at this process of evaluation. If medicine is really about “making sick people better” then even the totally functional patient should be treated with respect so that they can then be directed to appropriate care.
Today’s health care “buzz word” has become “evidenced-based medicine”; not “good evidence-based medicine.” This editor is aware of poor, flawed, and even faked scientific and clinical studies as well as good studies whose results have been misinterpreted. Although the present treatment of tick-borne disease has sadly pitted disabled patients against physicians, as well as physicians against physicians, there is good reason to believe that within a reasonable period of time (8+ years) that this controversy will finally be relegated to an episode that all will be pleased to forget.
Not only is our present testing for organisms non-specific it must be pointed out that our present treatment are also non-specific; and certainly not innocuous. With the coming of the new discipline of nanoscience this is, however, likely to change for the better.
NANODIAGNOSTICS- includes the development of nanodevices utilizing materials such as graphene (as thin as one atom) which will finally offer the possibility of being able to accurately identify single proteins.
NANOANTIBIOTICS- nanoantibiotics and nanopolymers will offer the possibility of directly targeting and destroying specific bacteria as well as infected cells. Nano technology will allow for small volumes of nanoantibionics to be much more highly effective thus avoiding the liability of creating resistant bacterial strains.
MICRO-DELIVERY SYSTEMS- the present means of delivering parenteral antibiotics requires central lines and ports. With the advent of small fluid volumes subcutaneous reservoirs can be connected to small implanted devices in the intra-osseous space. Few clinicians presently recognize that the intra-osseous space (bone marrow) is a direct connection to the body’s venous system. Small intra-osseous implants placed in the pelvic ileum are presently under development and are capable of continuously delivering nanoantibiotics (or other drugs) into the body at a constant rate over a period of weeks or months .
In addition to the fast developing field of notnano science there is every reason to believe that with better definition of each individuals genomic makeup that even more selective therapies will become possible in the future.
There is no place in our world for medical “witch hunts.” Those with opposing views need to re-establish not only a professional respect for their colleagues, but also for their patients.
Charles V. Burton, M.D., F.A.C.S.