Monday, November 01, 2010
Lyme teken
From Reuters Health Information
Few Doctors Believe in "Chronic" Lyme Disease
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By Frederik Joelving
NEW YORK (Reuters Health) Oct 25 - Despite lots of media attention, "chronic" Lyme disease is not a widely accepted diagnosis -- even in Connecticut, where the tick-borne Borrelia burgdorferi infection was first discovered.
That's according to a new statewide survey, reported September 1st in the Journal of Pediatrics, that found just 2% of doctors in Connecticut said they had diagnosed and treated the controversial chronic version of the disease. And half the respondents said they don't believe the condition exists.
"Chronic Lyme disease" refers to disease that persists after appropriate treatment - not to recurrent or persistent arthritis that can last for years in untreated patients (often called "late Lyme disease").
"Chronic Lyme disease is used in North America and increasingly in Europe as a diagnosis for patients with persistent pain, neurocognitive symptoms, fatigue, or all of these symptoms, with or without clinical or serologic evidence of previous early or late Lyme disease," according to a 2007 review article in the New England Journal of Medicine. The lead author of that review, Dr. Henry Feder of the University of Connecticut Health Center in Farmington, is one of the two researchers who conducted the current survey.
If you are online a lot, "you think every doctor in Connecticut believes in chronic Lyme," said Dr. Feder.
"What the poll shows is that's not true," he added.
Most medical groups agree that Lyme disease should be treated with oral antibiotics only for a few weeks (usually doxycycline). But some doctors and patient groups argue that longer courses, lasting months or even years, may be necessary if symptoms linger. Some of these clinicians say chronic Lyme disease may be incurable.
Two years ago, the controversy over the existence of chronic Lyme disease entered the courts. The Infectious Diseases Society of America (IDSA) barred physicians who advocate longer treatment courses from a guidelines panel, and Connecticut's attorney general sued the IDSA.
While the IDSA guidelines were upheld by an independent review panel last April, that didn't end the debate.
"There is a very small number of doctors who are very active on the Internet as well as politically and have a different point of view than the evidence dictates," said Dr. Feder, who is a member of the IDSA but was not involved in establishing the guidelines.
According to the National Institute of Allergy and Infectious Diseases, rigorous clinical studies have shown that prolonged antibiotic treatment is of little benefit to patients who have no signs of infection, but still suffer from fatigue and headaches.
According to the Centers for Disease Control and Prevention, about 38,000 confirmed or probable cases of Lyme disease occurred in the U.S. in 2008, mainly in Wisconsin, Minnesota and the Northeast where the ticks that carry it are widespread. In Connecticut, the rate translated to about 78 cases per 100,000 residents.
Dr. Feder and Dr. Michael Johnson sent their survey to a random sample of 33% of primary care doctors in Connecticut and received answers from roughly 40%. The two authors report that half of the 285 respondents didn't believe in the existence of chronic Lyme disease. Slightly fewer said they were undecided but had not diagnosed or treated any patients with chronic Lyme disease.
Dr. Daniel Cameron, an outspoken opponent of the IDSA guidelines and past-president of the International Lyme and Associated Diseases Society, which was formed by advocates for chronic Lyme disease, could not be reached for comment.
Lyme expert Dr. Raymond Dattwyler, of New York Medical College in Valhalla, said he wasn't surprised by the poll results.
"Chronic Lyme disease is just not accepted by the vast majority of physicians," he told Reuters Health. "The majority of people who get the diagnosis of chronic Lyme disease have either depression, fibromyalgia or another chronic illness."
"If you look at the symptoms that they report to be associated with chronic Lyme," he added, "population studies have shown those are very common complaints among the general population."
"The tragedy is that sometimes really serious, treatable diseases are ignored."
J Pediatr. Posted September 1, 2010. Abstract
Few Doctors Believe in "Chronic" Lyme Disease
Other Health Care Provider Rating: 0 stars ( 0 Votes )
Rate This Article:
0 stars
* Print This Print This
* Email This Email this
processing....
Information from Industry
OA knee and hand—Can you provide effective pain relief with a topical option?
Learn about a topical treatment for OA knee and hand pain.
Review efficacy data
By Frederik Joelving
NEW YORK (Reuters Health) Oct 25 - Despite lots of media attention, "chronic" Lyme disease is not a widely accepted diagnosis -- even in Connecticut, where the tick-borne Borrelia burgdorferi infection was first discovered.
That's according to a new statewide survey, reported September 1st in the Journal of Pediatrics, that found just 2% of doctors in Connecticut said they had diagnosed and treated the controversial chronic version of the disease. And half the respondents said they don't believe the condition exists.
"Chronic Lyme disease" refers to disease that persists after appropriate treatment - not to recurrent or persistent arthritis that can last for years in untreated patients (often called "late Lyme disease").
"Chronic Lyme disease is used in North America and increasingly in Europe as a diagnosis for patients with persistent pain, neurocognitive symptoms, fatigue, or all of these symptoms, with or without clinical or serologic evidence of previous early or late Lyme disease," according to a 2007 review article in the New England Journal of Medicine. The lead author of that review, Dr. Henry Feder of the University of Connecticut Health Center in Farmington, is one of the two researchers who conducted the current survey.
If you are online a lot, "you think every doctor in Connecticut believes in chronic Lyme," said Dr. Feder.
"What the poll shows is that's not true," he added.
Most medical groups agree that Lyme disease should be treated with oral antibiotics only for a few weeks (usually doxycycline). But some doctors and patient groups argue that longer courses, lasting months or even years, may be necessary if symptoms linger. Some of these clinicians say chronic Lyme disease may be incurable.
Two years ago, the controversy over the existence of chronic Lyme disease entered the courts. The Infectious Diseases Society of America (IDSA) barred physicians who advocate longer treatment courses from a guidelines panel, and Connecticut's attorney general sued the IDSA.
While the IDSA guidelines were upheld by an independent review panel last April, that didn't end the debate.
"There is a very small number of doctors who are very active on the Internet as well as politically and have a different point of view than the evidence dictates," said Dr. Feder, who is a member of the IDSA but was not involved in establishing the guidelines.
According to the National Institute of Allergy and Infectious Diseases, rigorous clinical studies have shown that prolonged antibiotic treatment is of little benefit to patients who have no signs of infection, but still suffer from fatigue and headaches.
According to the Centers for Disease Control and Prevention, about 38,000 confirmed or probable cases of Lyme disease occurred in the U.S. in 2008, mainly in Wisconsin, Minnesota and the Northeast where the ticks that carry it are widespread. In Connecticut, the rate translated to about 78 cases per 100,000 residents.
Dr. Feder and Dr. Michael Johnson sent their survey to a random sample of 33% of primary care doctors in Connecticut and received answers from roughly 40%. The two authors report that half of the 285 respondents didn't believe in the existence of chronic Lyme disease. Slightly fewer said they were undecided but had not diagnosed or treated any patients with chronic Lyme disease.
Dr. Daniel Cameron, an outspoken opponent of the IDSA guidelines and past-president of the International Lyme and Associated Diseases Society, which was formed by advocates for chronic Lyme disease, could not be reached for comment.
Lyme expert Dr. Raymond Dattwyler, of New York Medical College in Valhalla, said he wasn't surprised by the poll results.
"Chronic Lyme disease is just not accepted by the vast majority of physicians," he told Reuters Health. "The majority of people who get the diagnosis of chronic Lyme disease have either depression, fibromyalgia or another chronic illness."
"If you look at the symptoms that they report to be associated with chronic Lyme," he added, "population studies have shown those are very common complaints among the general population."
"The tragedy is that sometimes really serious, treatable diseases are ignored."
J Pediatr. Posted September 1, 2010. Abstract
# posted by roodbont @ 2:12 AM 
