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Contradictory Information regarding Chronic Lyme Disease Treatments

The article under the section Treatment states: "Physicians who treat chronic Lyme disease have noted that combining a macrolide antibiotic such as clarithromycin (biaxin) with hydroxychloroquine (plaquenil) is especially effective in treatment of chronic Lyme disease."

However under the following subsection "Post-Lyme syndrome" and "chronic Lyme disease" the discussion says there has been only 4 trials to test the efficacy of long-term antibiotic treatments from those afflicted with "chronic Lyme disease". It goes on to state that none of these four trials provided evidence to support this treatment.

The information in these two sections is contradictory. Either there has been peer-reviewed and published articles that state that combining macrolide antibotics with other antibiotics is a viable treatment for "chronic Lyme disease", in which case that information needs to be given and referenced in the subsection "Post-Lyme syndrome, or there is no evidence for this treatment that has been published in a reputed science journal, in which case the statement regarding the efficacy in treating chronic Lyme disease needs to be removed. Silver (talk) 07:56, 30 September 2008 (UTC)

Thank you for noticing that. The study referenced to support the use of macrolides with Plaquenil in chronic Lyme disease is an uncontrolled study which used self-reported endpoints. Thus, it failed to account for both the natural history of "chronic" Lyme disease (which may include spontaneous improvement) as well as the placebo effect, which can be substantial in controlled studies in this setting. I think that highlighting this uncontrolled study from a low-impact publication is undue weight in the face of multiple large, randomized controlled trials which have found no benefit. I suppose one could regard the Med Sci Monitor paper as hypothesis-generating, at best, meaning that its observation is food for thought but would need to be replicated and confirmed in a more rigorously designed trial before affecting practice. MastCell ^Talk 17:19, 30 September 2008 (UTC)

I don't think this information is contradictory. The 4 studies you referenced, once of which studied late stage encephalopathy (not 'chronic lyme') all used either doxycycline or ceftriaxone. However, these are not macrolide antibiotics. The distinction is quite important, because the modes of action are very different among different antibiotic groups. There has never been a peer-reviewed study of macrolides in lyme, especially the utility in treating late stage or chronic versions of the disease. So there is no established conclusion as to whether or not long term macrolides offer benefit. As much as can be said in this arena is stated by the entry, that physicians have noted the utility of the treatment. I suppose a citation would be good here. But this is essentially a quote, not a scientific conclusion. —Preceding unsigned comment added by 74.195.228.205 (talk) 07:16, 5 July 2009 (UTC)

Is Macrolide therapy of chronic Lyme Disease (using hydroxychloroquine in tandem with macrolides) significant? Simesa (talk) 19:36, 5 July 2009 (UTC)

Official Ignorance = Wikipedia ignorance

The start of the article uses the terminology of putting quotation marks around the word chronic. This rankles for a start because it is an old biased practice, nowadays it is generally agreed and observed that Chronic Lyme Disease exists and thousands suffer from it. Indeed there are even NHS tests such as ELISA which can observe the presence of Borrelia in post-treatment patients.

Even the Wikipedia article goes on to say:
'Stage 3 – Late persistent infection
After several months, untreated or inadequately treated patients may go on to develop severe and chronic symptoms affecting many organs of the body including the brain, nerves, eyes, joints and heart. Myriad disabling symptoms can occur.

Chronic neurologic symptoms occur in up to 5% of untreated patients.[17] A polyneuropathy manifested primarily as shooting pains, numbness, and tingling in the hands or feet may develop. A neurologic syndrome called Lyme encephalopathy is associated with subtle cognitive problems such as difficulties with concentration and short term memory'

This is contradictory to tell us that "chronic" lyme is just an idea that some groups believe in but they have been disproven by studies, and then to go on and explain that persistent post-treatment Lyme is a definite part of the disease. I suffer from Lyme encephalopathy and of course I am biased but the article ignores or confuses these issues about Lyme:

First is there a chronic condition that persists for a long time after initial 3 week treatment?
The answer to that is yes and there are very few scholars who would be foolish enough to contradict it. It has been observed in this study in dogs: Appel MJG: 10th Annual International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders, National Institutes of Health, Bethesda, MD April 28-30, 1997.
Secondly is that chronic condition due to the Borrelia genus?
We don't know for sure, it is either L-form Borrelia, a co-infection, or systemic damage. But the dog study says that the Borrelia genus is able to reappear in spirochete form suggesting that it is this bacteria in L-form which is responsible.
Thirdly is long-term antibiotic treatment the best treatment for the chronic condition?
This is also unproven. The dog study and the human studies suggest that some improvement is seen but with the doses and treatment used the bacteria was able recover. Obviously this does not mean that Chronic Lyme does not exist as this biased Wikipedia article gives the impression. Long term antibiotic treatment is the ONLY treatment for chronic lyme, and just because it takes longer and requires higher doses than have been applied in limited trials does not mean that abx treatment is wrong or does not work. After all there are many many people who have been treated successfully. —Preceding unsigned comment added by Rwn110 (talk • contribs) 17:11, 5 January 2009 (UTC)

This article and other medical articles is from reliable sources, pls see WP:MEDRS. There is a fringe opposition and we say about it in article. But the article in based from medical consensus like from randomize control trials saying antibiotics are not working and are not worth the risk to people.

I think you may be confuse late-stage Lyme with chronic lyme?? Chronic lyme like LLDs talk about it is a condition where there is no evidence an infection was ever there, but htey treat it with antibiotics any way.

Theres lots of opinions and emotions about lyme and chronic lyme, thing is, Wikipedia has a position on medical subjects, it is the position of main-stream medical sources. RetroS1mone talk 04:58, 6 January 2009 (UTC)

One very serious problem with this article is the inclusion of the recent Fallon study of treating persistent lyme encephalopathy for ten weeks (no meaningful improvement) and grouping that study with the studies of chronic lyme. Fallon and his coworkers are studying very well defined late stage brain disease with strong supporting evidence that it is lyme. The patients were subjected to rigorous entry criteria. While his treatments didn't work, what he was studying was not the same thing as the mish-mash that Klempner and other authors Fallon is grouped with were studying. In fact, Steere himself studied a similar grouping of patients a decade ago. This is lyme encephalopathy, not 'chronic lyme'. Lyme encephalopathy is a serious and disabling brain disease caused by Bb invasion of the CNS. Is it chronic? Yes, it is. However, it is NOT the same thing as 'post-treatment lyme disease' or 'chronic lyme' as defined by the IDSA. It is chronic lyme encephalopathy. Patients with lyme encephalopathy have, typically, a history of exposure to Bb, objectively described neurologic, cognitive, and psychiatric syndromes, and usually (but not always) obvious and massive perfusion deficits on SPECT or PET of brain.

There is a dispute here which spills over into terminology. With most diseases, "chronic" and "late-stage" are semantically interchangeable. However, in Lyme disease, "chronic" Lyme disease has been used to refer to a group of symptoms which some groups of advocates controversially attribute to Lyme disease. Most major medical organizations that have looked at the issue have concluded that the entity called "chronic Lyme disease" has nothing to do with Borrelia. As to "scare quotes", see this recent article from the New England Journal of Medicine, and note its title. The term "late-stage Lyme disease" has been used by these mainstream medical organizations to describe a set of clearly defined long-term complications of Lyme disease, in contrast to the somewhat vague and questionably linked group of symptoms called "chronic Lyme disease". If our article fails to make this clear, then we should improve it. MastCell ^Talk 06:06, 6 January 2009 (UTC)

This dispute is about far more than terminology. Facts are systematically being interpreted very subjectivly here, to support the article's authors opinions. An example:

• True, the Fallon study did require patients to have memory impairment. But they also had severe other symptoms, like pain and chronic fatigue. Those clearly belong to the "chronic Lyme syndrom" (not a syndrom in my opinion). The results of the study have shown an improvement in all of those symptoms too. Therefore, we can not conclude that Fallon just examined 'lyme encephalopathy' and his results are not valid for other symptoms of chronic Lyme disease. It would theoretically be possible that patients who do not have 'lyme encephalopathy' but pain and fatigue do not improve. But this is not the case, as shown by Krupp:
• Krupp's study was just baldy interpretated by him and his colleagues: It clearly shows an improvement in fatigue and for this study, the only required symptom was fatigue!
• There are several other studies proving the improvement of chronic lyme symptoms by longterm antibiotic treatment: "Med Sci Monit 2003; 9(11):PI136-142. Prof. Dr. Sam Donta: Macrolide therapy of chronic Lyme Disease" and "Dr.med. Bernt-Dieter Huismans, Dr.med. Wolfgang Klemann Langzeitbehandlung mit Antiinfektiva bei persistierender Borreliose mit Borrelien-DNA-nachweis durch PCR. GRIN Verlag, 2008. ISBN 3640193849." for example.
• You are writing "This is lyme encephalopathy, not 'chronic lyme'. Lyme encephalopathy is a serious and disabling brain disease." Is this meant to suggest that the symptoms of chronic Lyme are less serious and disabling? What do you base this judgment uppon? As cited in several of the ILADS members' appearances at the IDSA review panel, chronic Lyme patients have a worse overall health than cancer patients.

We could go on like this, almost every statment in the article is not representig the current state of research. The bottom line is this: Just because big health institutions are ignoring scientific evidence, it is not an acceptable approach! You have to review all the facts and the facts are clearly favouring the guidelines of organisations like ILADS. -- String42 23:37, 8 October 2009 (UTC)

You are in the wrong place then. Wikipedia is intended to present the mainstream view of things, we aren't a site that is intended to promote or reveal "truth". That's just how it is. --Cameron Scott (talk) 10:54, 9 October 2009 (UTC)

Like I said: this is not an acceptable approach in my opinion. The truth in this case is not hard to find. It is in all media: the current major guidelines are not representing the whole story. That's what the article should reflect. It should in every single point reflect both sides: "some say 30 days, some say months of antibiotics". Instead it currently says: "30 days, all other statements are wrong". Wikipedia is also not meant to ignore half of the facts is it? In the guidelines it clearly says "statements are created by consensus, not by majority vote." There is surely no consensus regarding the evidence about the current article. —Preceding unsigned comment added by String42 (talk • contribs) 11:56, 11 October 2009 (UTC)

this is not an acceptable approach in my opinion. then you are out of luck I'm afraid, but that's what wikipedia does. We report what mainstream sources say about subjects and make some reference to minority views as reported in reliable sources. --Cameron Scott (talk) 11:59, 11 October 2009 (UTC)

First of all, this is not about "minority views" in general, but about a case where we have loads of scientific evidence being ignored by the article. There are plenty of other articles that review such scientific evidence even if it is not being reported by major sources. And of course Wikipedia is not meant to ignore such evidence by purpose. If someone has the time and knowledge to incorporate the results of scientific papers directly instead of relying on major sources reporting them it should be no question that he is encouraged to do so. In this case as everyone can see, it would be crucial since many major sources are not "up to date". —Preceding unsigned comment added by String42 (talk • contribs) 09:03, 13 October 2009 (UTC)

This wiki entry is an outrage not only due to its obvious disinformation, but for its sneering attitude towards anyone who disagrees with the current disinformation being spread. Putting chronic lyme disease in quotes is a disgrace. Can you imagine the cancer wiki entry having "chronic cancer" in quotes? It needs to be completely redone, as far too much weight has been given to the opinion of a small cadre of scientists with documented conflicts of interest, and the 3 or 4 poorly done, flawed studies they continually present to the public as proof of the non-existence of chronic lyme disease. There is so much disinformation in this entry it would be easier to start from scratch than try to amend this entry. —Preceding unsigned comment added by A riot (talk • contribs) 16:27, 3 October 2009 (UTC)

I completely agree regarding the miserable quality of the article: fact is, that most questions regarding lyme disease have not been answered definitely. For all positions, there exist studies which seem to be "proof". What the article does is to pick just one position and state that it's "truth" - this is obviously due to the inadequate professional knowledge of the authors. (otherwise we would have to assume they are spreading disinformation by purpose). I will just mention a few points here:

• In thousands of cases world wide, seronegative Lyme disease has been proven.(http://www.lymeinfo.net/medical/LDSeronegativity.pdf List of papers from 1900-2003 proving seronegative Lyme disease. Joanne Rubel 16. September 2003) Furthermore, in late stages of the disease, IgM levels are mostly missing, which will be regarded as negative result by CDC. It is therefore wrong to state that the CDC testing is considered reliable in late stages. Stricker and Johnson conclude in their paper, that the two tiered testing has a miserable overall sensitivity of 56%. (One could almost throw a coin instead)
• There are studies poving the effectivness of Hydroxychloroquin in the treatment of Lyme disease. (Donta S. Macrolide therapy of chronic Lyme Disease. Med Sci Monit,volume 9,issue 11, pages=136-142, 2003, PMID:14586290) It is furthermore unclear to me, how one can conclude from the failure of Ceftriaxon to improve symptoms, that all other antibiotics would fail too. In opposite, if you are familiar with the resistance strategies of Borrelia burgdorferi, you can quite certainly predict the failure of Ceftriaxon.
• The persistence of Borrelia burgdorferi in patients with chronic Lyme symptoms has been proven countless times.
• Many of the studies "proving" that longterm antibiotic treatment is ineffective were statistically flawed. On the otherside, the Fallon study proving an improvement in cognition, overall physical health, pain and chronic fatigue was not. The Krupp study, was just interpretated badly: it too has shown an improvement in fatigue through longterm treatment. Furthermore, some other studies have shown a benefit of longterm antibiotic treatment too.

For the latter two points and for further studies proving the above, please see the appearance of "Allison DeLong" and Steven Phillips at the IDSA hearing panel. In general I would like to ask the authors of the current version of this article, to carefully watch all of the ILADS members' appearances at the IDSA hearing panel: they have presented a tremendous amount of scientific evidence for the major controversial points in Lyme disease. You can watch the videos at http://webcast.you-niversity.com/idsaArchives/ -- String42 10:37, 8 October 2009 (UTC)

Note: This comment contains personal bias and unsupported personal ideas. and should be considered for moderation. —Preceding unsigned comment added by 206.248.90.28 (talk • contribs) 17:13, 14 July 2010 (UTC)

Ticks are not Insects

"While Lyme spirochetes have been found in insects other than ticks" implies that ticks are insects. Ticks are not insects. Please change that.

Rodrigomq (talk) 18:47, 8 May 2009 (UTC)Rodrigo Queiroz

If you see a minor error like this you ought to change it yourself and mark the edit as minor, I think. Fishmuffin (talk) 04:21, 16 August 2010 (UTC)

Diagnostic criteria / Prophylaxis from patient perspective

The Wiki was not the first place I turned for information on this subject, but in light of my experience seeing a MD after a recent tick bite with a questionable rash, it's the easiest place to mention some deficiencies in the state of online documentation here and elsewhere (such as/including the CDC). I grew up in and live in CT where Lyme is common, and was raised with the conception that one should rush to a MD for prophylactic antibiotics after any questionable bites. Upon actually seeing a MD within 3 days of a worrisome one, I discovered a few criteria not widely publicized anywhere: First, the EM rash is "flat," so [on an adult] a reaction that's raised/edemous and not clearly wide (>5cm) and flat is not indicative of EM; also any 'bullseye' clearing would have to be observed outside the central ~1cm area of bite trauma, since lightness directly at the bite is as likely to be from simple bruising/swelling. As far as the other diagnostic symptoms (fever/chills, myalgia, arthritis), I was informed that "you'd know," meaning they would be clearly in excess of any fatigue and soreness from a sleepless week spent doing yardwork. Finally, if neither the rash nor symptoms are clear, the ~36 hour rule applies even if the tick was removed roughly/in a manner that seemed likely to squeeze its contents into the bite; 'basically nobody gets Lyme from a tick on less than a day,' I was told. ... Had I been better-informed, particularly as to the nature of the rash, I would have known to wait and watch for clearer indications (such as un-raised EM appearing outside the edemous area) rather than wasting the time of the MD and myself. Clearly explaining what criteria are currently used should be orthogonal to any debate over whether they're appropriate. --69.177.176.250 (talk) 05:01, 3 June 2009 (UTC)

Section on transmission

I noticed the following statements in the section on transmission that I think need clarification.

1) "The majority of infections are caused by ticks in the nymph stage, since adult ticks are more easily detected and removed as a consequence of their relatively large size."

- This seems too conclusive to me in its sole attribution of tick size as the cause of nymphs being the main transmittors. Nymphs are active in May and June, which coincides with the greatest frequency of human outdoor activity. Adults are active in the fall and are more modestly active in April. Also, my understanding is that nymphs are most likely to feed on a person--larva are not yet infected because they have not had their first blood meal, and adults lay their eggs and die in April, which I presume might suggest that they are less likely to infect a human host (although this is pure speculation). Size also appears to be important, of course, but it is not the full story.

2) "It has also been heard that the original carrier of the disease is the white-footed deer mouse. Ticks are thought to receive it in early stages of life, when the tick feeds on mice."

- Aside from the awkward grammar and weasel words, I believe that it is actually well understood that mice are the primary host for the bacteria, and ticks typically (but not always) pick up the bacteria from mice at the larval stage. Again, a description of the tick life cycle, including when and how the bacteria is acquired, would help clarify this.

I just noticed that there is a separate wikipedia listing for tick microbiology that includes the life cycle; perhaps this could be included in condensed form in the main article, for clarity.

Thanks!

King of generalism (talk) 16:21, 19 June 2009 (UTC)

ELISA least sensitive of tests

In Guessing Game (6/4/09) ELISA is stated to be the least sensitive of the tests. The text is:

According to IGeneX, “Lyme bacteria are not always detectable in the whole blood, even in active disease. The bacteria like to hide…every patient responds differently to an infection and antibodies may only be present for a short time.” The most common Lyme test is called ELISA, which is mostly used among general practitioners not specializing in Lyme disease diagnosis and treatment. However, the ELISA test is considered to be the least sensitive, only detecting the patient’s IgM and IgG levels, which are the body’s reaction to the Lyme bacteria. Other Lyme tests are the Lyme IFA, which is good for detecting the disease while it is still new, or relatively infant within the body. The Lyme Dot Blot Assay test searches for bacteria present in urine and a Polymerase Chain Reaction test, which is a critically specific test, can detect the disease in nearly all stages of development. Another form of testing, which is the test that Morante had taken, was the Western Blot, which takes a literal picture of the antibodies within the blood that the body develops in reaction to the infection.

Simesa (talk) 12:13, 27 June 2009 (UTC)

Please take a look at our guidelines on appropriate encyclopedic sources. I don't believe that book qualifies by this site's criteria. Igenex is an interesting story, perhaps worthy of its own standalone article. In PMID 15626946, the Igenex website was specifically called out for providing inaccurate or misleading information about Lyme disease. You may also want to take a look a few threads up, at #Laboratory testing; basically, a number of reliable sources have raised significant concerns about Igenex. Whether those concerns are well-founded or not, I don't think this is the sort of source we should rely on to build an encyclopedia article. MastCell ^Talk 23:18, 27 June 2009 (UTC)

It would be helpful to have a journal's comparison of the tests - and Coulter says the standard tests are 51% accurate in detecting Lyme (see also WebMD). These articles for example, Laboratory tests and Tests flawed, have a very good discussion of ELISA but are by a patient-advocacy group. MSNBC here said in 2007 that a new test is needed but shallowly not why. Just today I saw this, which is clearly why people are steamed. I suppose that, as an established company, IGeneX's page Which tests to perform is technically a reliable source, but it says "The ELISA is a poor assay, with marginal sensitivity" and why. The CDC weighs in here (2005) and here, both of which say to diagnose based on symptoms! In short, it's pretty clear that ELISA is an inadequate diagnostic tool. Simesa (talk) 11:34, 28 June 2009 (UTC)

Please make a distinction between reliable and unreliable sources when posting; you're freely mixing the two, which is confusing at best and misleading at worst. Our guidelines can help. ELISA is an inadequate diagnostic tool when used in isolation. That's why no one in their right minds recommends using it in isolation; for instance, as you note, the CDC recommends that diagnoses be made clinically and laboratory testing used in an ancillary role. To be clear, material from the Igenex website is not appropriate as a source in this article; if you feel otherwise, we can of course solicit outside opinions, either from the Medicine WikiProject or the reliable sources noticeboard. MastCell ^Talk 03:41, 29 June 2009 (UTC)

I provided the results of a peer-reviewed journal, explanations by a lab that conducts all such tests, and an independent journalist's summary - for a test which (unlike the CDC) you agree should never be used by itself.

The CDC itself does not say that the ELISA test is more sensitive than any others, neither here nor in its 14-yar-old basis here nor in its 2005 MMWR here. The CDC oddly does say that diagnosis should be made based on symptoms, not tests.

The CDC's position has become so notorious that the Government Accounting Office has been asked to investigate (see here and here).

I have therefore removed the text "more sensitive" - it seems apparent that ELISA not only is less sensitive but should not be used at all, but hopefully that will come out of the investigations. Simesa (talk) 13:16, 29 June 2009 (UTC)

Again, please be more careful to use appropriate sources. I would also appreciate an attempt to address my concerns and work through this before trying to force the disputed material back into the article. You are using a primary source - a single journal article - to advance your viewpoint about Lyme testing. This inappropriate editorial synthesis; additionally, since your viewpoint contradicts that of experts in the field, you should not really be cherry-picking the primary literature to "rebut" published expert opinion in the field (see WP:MEDRS). Your edits violate Wikipedia's policies and guidelines, in my opinion, and I'd appreciate it if you would address these policies rather than throwing down a bunch of links to advocacy groups and websites.

The CDC website explicitly says: "The first step uses an ELISA or IFA test. These tests are designed to be very "sensitive". You're making a claim that is easily falsified with a single mouse click. That makes it hard to move forward. Could you explain your position? When the CDC explicitly describes the test as "very sensitive", why do you think it's OK to claim in the article that they claim the exact opposite? MastCell ^Talk 17:48, 29 June 2009 (UTC)

Saying that something "is designed to be very sensitive" and saying that it is is more sensitive than other tests can be two very different things - especially when the one study I was able to find explicitly contradicts the latter thesis (I wasn't cherry-picking as I was able to find only one published study - please feel free to cite other studies). If there are experts in the field who openly say that the ELISA test is either more sensitive or more diagnostically accurate than other tests, please feel free to cite their published opinions why as well.

Not one of the three links I cited in the article was from an advocacy group, but rather from sources I frankly have never had challenged in the past - a peer-reviewed journal as backed up by both industry experts and a news report from an independent publisher.

The truth is that all of these tests are terrible. The old ELISAs and WB's used single-strain Bb sonicate, and were not temperature shifted or otherwise modified to reflect what is now known about Bb protein expression once it enters the human body. See the research of DK adkins at the university of Oklahoma who identified numerous antibody responses, some quite strong, in a baboon model; many of these antibodies reflected immunoreactivity to heretofore unknown yet obviously important Bb antigens in mammalian infection. This is just one of MANY reasons why these tests are widely regarded as garbage, even behind the scenes in academia. As for the C6 test, emergin evidence seems to indicate that the vlsE protein is not expressed in CNS infection. It can be detected only 2/3 of the time in CSF samples from established early acute neuroborreliosis cases. It has been hypothesized that this inconsistent result is due to overwash into the CSF from the general immune system response to Bb made possible by the weakening of the blood brain barrier during infection. Additionally, studies of Bb protein expression in the primate CNS have failed to yield any meaningful evidence that the vlsE gene is expressed in the primate nervous system during Bb infection.

The old ELISA/WB model, which was never intended for diagnosis but rather to identify clear-cut cases for research and statistical purposes, is good for exactly that (maybe) and no more. Then again, it is possible that it is worthless even in these cases. There is a growing consensus among hard scientists that lyme science was horribly botched from the beginning. Eventually the ID docs will get off their asses and read the journals in between golf games and come to the same conclusions.

It's so far apparent to me that, in light of the lack of any cited sources to the contrary except the CDC's weasel-words, that the ELISA test should be reported here as being less diagnostically accurate than either the Western Blot or PCR tests. As I said, I'm completely open to seeing contradicting sources. Right now I'm willing to settle for not saying it's either more or less sensitive than other tests, but giving readers an incorrect impression on such a controversial topic is unthinkable. Simesa (talk) 19:38, 29 June 2009 (UTC)

See PMID 16338759, the same statement is made in PMID 17266710, but I don't think we need multiple sources. Tim Vickers (talk) 19:53, 29 June 2009 (UTC)

It is generally accepted that serological examination should follow the principles of a two-step approach 44, 46,62,63: 1) A serological screening assay, and 2) in the event of a positive or equivocal result a confirmatory assay. A sensitive ELISA is recommended, which - in case it is reactive - should be confirmed by the immunoblot.

I'm not sure I see what you're averring - your first source says "The best results are obtained from skin biopsies with culture or PCR (50%-70%) and synovial tissue or fluid (50%-70% with PCR)." and your second says "The best results are obtained from skin biopsies (50-70% with culture or PCR) and synovial tissue or fluid (50-70% with PCR)." Don't both of these statements support that ELISA is not the most sensitive test?

Also, the first source actually says "According to guidelines of the USA and Germany, serological diagnosis should follow..." which is just parroting the CDC. I think we should be quoting a primary source here, especially since we have a primary source that contradicts those guidelines. Simesa (talk) 20:10, 29 June 2009 (UTC)

Reading the Wilske review's discussion of this, it states:

Except in cases with the pathognomic clinical manifestation erythema migrans the diagnosis of Lyme borreliosis usually requires confirmation by means of a microbiological diagnostic assay. Antibody detection methods mainly are used for this purpose, whereas detection of the causative agent by culture isolation and nucleic acid techniques is confined to special situations. Since the present review is limited in space the reader who wants to go deeper into this field is referred to more comprehensive reviews

The article it recommends as a more comprehensive review (PMID 16020686 and full text) deals with the two types of assay in detail. I think this resolves the question nicely. Tim Vickers (talk) 20:51, 29 June 2009 (UTC)

Currently, the best use of PCR is for confirmation of the clinical diagnosis of suspected Lyme arthritis in patients who are IgG immunoblot positive. PCR should not be used as the sole laboratory modality to support a clinical diagnosis of extracutaneous LB. PCR positivity in seronegative patients suspected of having late manifestations of LB most likely represents a false-positive result. Because of difficulties in direct methods of detection, laboratory tests currently in use are mainly those detecting antibodies to B. burgdorferi sensu lato.

The PMIDs posted by Tim Vickers and MastCell are reliable sources (Long Island Press doesn't rise to the standard of WP:MEDRS). SandyGeorgia (Talk) 22:21, 29 June 2009 (UTC)

RfC on "Controversy and politics" section of "Lyme disease"

Does the "Controversy and politics" section of Lyme disease adequately follow wp:NPOV in reflecting the nature of the controversy? Simesa (talk) 12:00, 6 July 2009 (UTC)

Note - There was a "Lyme disease controversy" page at [1], but it was deleted as a POV fork per this deletion log. Simesa (talk) 18:52, 6 July 2009 (UTC)

I'm having difficulty believing that "viability" is a more biased term than "popularity" - I chose it specifically for its neutrality on whether "chronic Lyme disease" exists or not. I searched for reasonable replacements, but Thesaurus.com was not a help here. Simesa (talk) 09:50, 7 July 2009 (UTC)

I've rewritten that sentence, using the Nature Medicine article's summary of the mainstream and fringe views as a lead into introducing a better summary of the NEJM review. Tim Vickers (talk) 16:47, 7 July 2009 (UTC)

The rewrite looks fine to me. MastCell ^Talk 17:22, 7 July 2009 (UTC)

I've tweaked it a bit more, to define more clearly what is the mainstream view and what is the minority view, attributing each view to reliable sources, as required by WP;NPOV. Tim Vickers (talk)

Conferences

I'm not finding new conferences on Lyme - the last were an international conference, two competing U.S. conferences and the "4th International Conference on Rickettsiae and Rickettsial Diseases" all in 2005, the "Sixth UK Tick Borne Diseases Conference" (2007). The exception seems to be the "Climate Change Impact on Ticks and Tick-Borne Diseases" (February 2009 in Brussels, at which apparently no North Americans spoke). There apparently was a "5th International Conference on Rickettsiae and Rickettsial Diseases" in France in 2008 but I can find no summary of it on the internet. The new congressional bill would require HHS to sponsor such conferences. Simesa (talk) 15:06, 7 July 2009 (UTC)

I don't think listing conferences is at all important, I'd agree with you that we should omit this entirely. Tim Vickers (talk) 17:42, 7 July 2009 (UTC)

Steere 2009

A. Steere et al has published a new paper, Analysis of Borrelia burgdorferi genotypes in patients with lyme arthritis: High frequency of ribosomal RNA intergenic spacer type 1 strains in antibiotic-refractory arthritis (in Arthritis & Rheumatism, Volume 60 Issue 7 for July 2009, p 2174-2182, abstract here). This paper is also summarized here and here. The gist of it appears to be that "among the 17 patients who had been treated with antibiotics according to current guidelines, all 7 patients who were infected with RST1 strains had antibiotic-refractory arthritis, compared with 4 of 6 patients infected with RST2 strains and only 1 of 4 infected with RST3 strains."

The existence of the spirochete in the joint fluid may not have been confirmed, as the authors said "We hypothesize that RST1 strains are more virulent, leading to larger numbers of organisms in blood, and more inflammation in joints," (quote from here. However, the authors do cite the existence of antibiotic-refractory strains.

Now, this paper appears to support the possible existence of "chronic Lyme disease" in some people. How do you propose we put it into the article? Simesa (talk) 13:26, 8 July 2009 (UTC)

Hi Simesa, that's an interesting publication. I think two statements in this paper will help the interpretation of these results: in the introduction they state:

Lyme arthritis can persist for months or even several years despite 2-3 months of oral and/or IV antibiotic therapy, a condition that has been termed antibiotic-refractory Lyme arthritis ([1][4]). After such therapy, results of polymerase chain reaction (PCR) testing for B burgdorferi DNA in joint fluid are usually negative ([4]), which suggests that joint inflammation may persist after spirochetal eradication.

and in the results they state

However, in the 6 patients with antibiotic-refractory arthritis in whom joint fluid was obtained at least once during the postantibiotic period (5 of whom were infected with RST1 strains), PCR results were negative."

So this study is consistent with the autoimmune hypothesis of lyme-induced arthritis, where infection triggers an immune response that persists after eradication of the bacteria. As the authors note in their discussion:

Thus, a marked inflammatory response, such as that induced by RST1 strains, may set the stage for joint inflammation that persists after spirochetal killing.

We could cite this study to support the statement that some strains may carry a greater risk of triggering an autoimmune response, but this is a primary paper so I wouldn't give it too much weight. Tim Vickers (talk) 17:04, 8 July 2009 (UTC)

Tick Removal

Please add that a tick should be saved after removal for a period of one month for lab analysis. Also, that the date that the tick was removed should be noted. http://www.freep.com/article/20090628/FEATURES01/906280331/1025/FEATURES/Harvard+Medical+School+adviser Thanks, Rumjal --rumjal 17:38, 24 July 2009 (UTC) —Preceding unsigned comment added by Rumjal (talk • contribs)

Thank you for your suggestion. However, please note that Wikipedia is not a manual, and we can't write the article in a way that suggests we are giving medical advice. EyeSerene^talk 17:49, 24 July 2009 (UTC)

External links

I wondered if Wikipedia might wish to note other online encyclopedia articles in a separate section, below General? In this case, Online Encyclopedia Articles

http://en.citizendium.org/wiki/Lyme_disease

http://www.conservapedia.com/Lyme_disease And very good reply above! Thanks, Rumjal --rumjal 17:54, 24 July 2009 (UTC) —Preceding unsigned comment added by Rumjal (talk • contribs)

No thank you, neither link adds anything useful to this article. Tim Vickers (talk) 17:59, 24 July 2009 (UTC)

Conservapedia is a crackpot site and it does not have a history of accuracy or reliability on subjects related to science, medical matters so we would not use it. --Cameron Scott (talk) 18:01, 24 July 2009 (UTC)

Section on Ecology

The convoluted edit of the section on Ecology is presented here as a series of edits to this Talk page. This may help with editorial decisions wrt the present version.

---quote---

---

12 August 2009 - current revision

Urbanization and other anthropogenic factors can be implicated in the spread of Lyme disease to humans. In many areas, expansion of suburban neighborhoods has led to the gradual deforestation of surrounding wooded areas and increasing border contact between humans and tick-dense areas. Human expansion has also resulted in a gradual reduction of the predators that normally hunt deer as well as mice, chipmunks and other small rodents – the primary reservoirs for Lyme disease. As a consequence of increased human contact with host and vector, the likelihood of transmission has greatly increased. Researchers are also investigating possible links between global warming and the spread of vector-borne diseases including Lyme disease.

---end quote---

I didn't know how to repair this '...to Lyme residents...' matter. Removing it (as I did in the article) felt clumsy. 99.37.19.150 (talk) 15:11, 12 August 2009 (UTC)

Contradictory Information regarding Chronic Lyme Disease Treatments

Shame on Wikipedia. This is in no way a neutral article. They have posted information that is entirely biased toward the Infectious Disease Society of America who settled an anti-trust investigation brought by Attorney General Blumenthal. The IDSA was forced to replace the entire panel of members and in July of 2009 new hearings were held in regards to the Lyme guidelines. Information can be found about these flawed guidelines and the serious conflicts of interest the IDSA members had by viewing the Oscar nominated film (currently on the short list) Under Our Skin as well as reading the book Unknown Cure by Pamela Weintraub which includes all the references at the end of her book. These references and accurate research make the definition produced by Wikipedia entirely biased in favor of the IDSA. One of the conflicts found in the investigation is the following:

"IDSA sought to portray a second set of Lyme disease guidelines issued by the American Academy of Neurology (AAN) as independently corroborating its findings. In fact, IDSA knew that the two panels shared key members, including the respective panel chairmen and were working on both sets of guidelines a the same time -- a violation of IDSA's conflicts of interest policy." http://www.ct.gov/ag/cwp/view.asp?A=2795&Q=414284

Secondly, other facts now showing the fallibility of the IDSA guidelines in regards to many infectious diseases are presented at http://www.medscape.com/viewarticle/712341, entitled "Infectious Disease Treatment Guidelines Weakened By Paucity of Scientific Evidence," by Daniel M. Keller, PhD November 13, 2009 (Philadelphia, Pennsylvania)

The first paragraph states, "Two separate analyses presented here at the Infectious Diseases Society of America (IDSA) 47th Annual Meeting revealed that most of the society's treatment guidelines are based on expert opinion, nonrandomized trials, and case studies. Only about 15% of the guidelines are supported by randomized controlled trials (RCTs), considered the highest level of evidence." If evidence produced at their very own 47th annual meeting is not enough for Wikipedia to consider it's biased definition then I don't know what is.

We apparently cannot trust Wikipedia to be "neutral" as they state. Neutrality provides that all the facts be presented not biased information and opinions. A couple of lines stating that there is some disagreement is hardly non-biased. If you intend to produce accurate information for the public then you need to do your research. Wikipedia is participating in further harming those people who have been diagnosed with Lyme disease and those who are still seeking a diagnosis by producing inaccurate, biased information to the general public and calling it "neutral." —Preceding unsigned comment added by BorreliaB (talk • contribs)

Perhaps the problem has to do with different concepts of "neutrality". Wikipedia's working definition is found here. I would think that a truly neutral encyclopedia article would mention the Connecticut Attorney General's investigation - and we do. It would also mention the IDSA's response - we do. And then it would cover the resolution - at present, the IDSA guidelines are being reviewed by an independent panel, which was the compromise the two sides agreed upon. We note this.

To achieve balanced coverage worthy of a serious, respectable reference work, we depend on reliable sources. Medscape isn't a great source, since their editorial policy is unclear at best. Documentary films aren't great sources of medical information either - several award-winning documentaries have claimed that HIV doesn't cause AIDS, but that doesn't make it a fact. The positions of various expert bodies are quite clear, so our challenge is simply to present each in an appropriate context, so that we don't create false equivalence between a mainstream and a fringe position, nor do we unjustifiably marginalize a viewpoint. To your final point, there is indeed a wealth of inaccurate and misleading information on Lyme disease on the Internet (see, for example, this article on the topic). We therefore need to be all the more insistent on high-quality, reliable sources. MastCell ^Talk 01:54, 29 November 2009 (UTC)

The statement under the section in regards to the anti-trust investigation includes an opinion by Forbes which is therefore neither proven or neutral and should not be included in Wikipedia's definition. The word used in the article, "intimidation" is libel and the entire statement should be removed.

Along with that I would suggest the removal of the journalist's "suggestion" of IDSA conflicts of interest as that statement is unnecessary since it does not provide the evidence of the conflicts of interest by members of the IDSA panelists. Rather I would suggest that you input the information below:

A careful review of Reference No. 12, "A Critical Appraisal of 'Chronic Lyme'" listed at the bottom of the page for the Wikipedia Lyme Disease definition will give you the self admitted conflicts of interest from the authors themselves, many of which are involved in the controversy over Lyme Disease. The following admissions are made by the authors themselves:

"Dr. Feder reports receiving lecture fees from Merck and serving as an expert witness in medical-malpractice cases related to Lyme disease. Dr. Johnson reports holding patents on diagnostic antigens for Lyme disease. Dr. O'Connell reports serving as an expert witness related to Lyme disease issues in civil and criminal cases in England. Dr. Shapiro reports serving as an expert witness in medical-malpractice cases related to Lyme disease, reviewing claims of disability related to Lyme disease for Metropolitan Life Insurance Company, and receiving speaker's fees from Merck and Sanofi-Aventis. Dr. Steere reports receiving a research grant from Viramed and fees from Novartis. Dr. Wormser reports receiving research grants related to Lyme disease from Immunetics, Bio-Rad, and Biopeptides and education grants from Merck and AstraZeneca to New York Medical College for visiting lecturers for infectious-disease grand rounds, being part owner of Diaspex (a company that is now inactive with no products or services), owning equity in Abbott, serving as an expert witness in a medical-malpractice case, and being retained in other medical-malpractice cases involving Lyme disease. He may become a consultant to Biopeptides. No other potential conflict of interest relevant to this article was reported."

These above is a partial list of the conflicts of interest which were found by Connecticut Attorney Blumenthal during his investigation of the IDSA.

The article on Medscape, "IDSA Guidelines Weakened By Paucity of Scientific Evidence," is based on a presentation held at the IDSA's own 47th Annual Meeting entitled, "IDSA Guidelines: What Evidence Are They Based On?"

The video presentation and slides presented at the meeting provided facts that the IDSA did not use the best evidence when creating the most current guidelines and in fact did not rise to the expected standards for which guidelines should be based.

It therefore, makes the article listed in Reference 12, "A critical appraisal of chronic Lyme disease," questionable and the facts from this presentation should be listed directly under the information you list as "Post Lyme Syndrome." It provides an equal platform for readers of Wikipedia to base their opinions, thereby creating neutrality.

The itinerary for the video presentation is listed on the IDSA website at the following link:

[2]

Presentation Abstract

Session: 149-Community-Acquired Infections and Treatment Guidelines Sunday, Nov 01, 2009, 8:45 AM -10:45 AM Presentation: 1324 - IDSA Guidelines: What Evidence Are They Based On? Location: 105-AB Pres. Time: Sunday, Nov 01, 2009, 8:45 AM - 9:00 AM Category: N. Hospital-acquired and surgical infections, infection control, transplant infectious diseases and health outcomes including general public health and health services research Keywords: GUIDELINES; ID CONSULTATION; INFECTION Author(s): DONG H. LEE, MD, OLE VIELEMEYER, MD, PAOLA SOLARI, MD, MASHIUL CHOWDHURY, MD; Division of Infectious Diseases & HIV Medicine, Drexel University College of Medicine, Philadelphia, PA.

The actual video presentation from Dong H. Lee, MD can be viewed at [3].

Medscape's summary of Dr. Lee's presentation appears to accurately cover the issues brought to light in his Video presentation at the 47th Annual IDSA meeting.

time for divison into separate articles.

there should be a seprate -signs and symptoms of lyme disease- article,as well as a seprate -treatment of lyme disease-and a seprate -chronic lyme disease aticle.24.97.164.250 (talk) 17:05, 12 December 2009 (UTC)

Agreed. The subjects are quite different. The Chronic Lyme disease article, because it's a fringe subject, would allow the limited use of some unreliable sources to demonstrate alternative medicine beliefs on this subject. It would also, per WP:MEDRS and NPOV require the use of scientific and skeptical sources to demonstrate the mainstream opposition to this belief. -- Brangifer (talk) 18:23, 12 December 2009 (UTC)

I am not sure about the other splits (leaning against; WP:MOSMED may help), but I would really rather not split out the Chronic section. Wikipedia:Articles for deletion/Lyme disease controversy has some of the history of the treatment of this particular fringe subject; note: I commented there under my old username, Eldereft. I think the best solution is to include a brief summary of claims, but focus here on the effect the movement has had on Lyme disease research and society at large. The ILADS article could probably use expansion. - 2/0 (cont.) 22:27, 12 December 2009 (UTC)

Low quality image

Does anybody know an svg person on Wikipedia who can improve this image? Thanks. --Anna Frodesiak (talk) 09:16, 2 January 2010 (UTC)

Done Philg88 (talk) 02:24, 8 July 2010 (UTC)

12 yrs old,got lyme d -now 51 yrs old,,still have it -and it's getting worst -

hello -did u know,that if,u r young,u can,slow down,the process,of this illness -by sports,excercising - and,taking a nap -moving around helps -but,don't over,do it -your body,gets tired quick -dizzness -headack -fever -heart beat quick -stomach,hurts -feeling,low -these ,things happens -as u,get older -your body slows,down even more -some times,it's hard -i,have terorites attasks -tremmers -all over -it's worst now -the last 3,yrs -they come,often -the,burning,i feel,makes me cry,sometimes -in,my head -feet -legs -arms -hands -back -it's hard to sleep,sometimes -The doctors,don't understand,this -trimmers,all over -i,get tested for drugs, all the time -I'm,not a drug addite -i don't even drink liq -but,i get,tested,anyway -this is what the Pa,hospital,do to me,every time -i have 9 head injure's -assma -diabetes -it,runs in my family -my eye sight,is also affected by ,lyme d -the sp doc,says -i have a elec wheelchair -i use it when,i can -that's another problem -not,being,62 and over -when,my batteries die -thats it,for me -it's been 11 months,and i,still can't get batteries -so, i struggle,to walk -who, cares -when,your ,under 21 -u,have help -parents,org -after that -no one -then, when,u become,a sr -there's,help -i,was teaching myself cassino keyboard,guitar -and,now,my fingers hurt,so bad -tying hurts to -my eyes -burns -2 pr,of glassess,in 1 yr -2 pr,of reading glassess -i walk,on a tilt -51 -yrs old -some times,i feel,75 -blue moons, i feel 20 yrs old -i can't have flashing lites,close to me -or steady lite -music beats,can be a problem -to fast -i,will,have many tremmers -speach,quickens or slurs -i,can't go on rides -movements, some are hard -but, i am,doing the best,i could do -living alone -kids,grown ---Snakeyesthebandit (talk) 23:00, 19 February 2010 (UTC)Strike-through text
^{Superscript text}

What does this comment has to do with this discussion??

Life cycle

There may be an adequate alternative to the low quality life cycle image. I am not sure which are appropriate, but examples from gov sources include: [4] [5] Anna Frodesiak (talk) 19:02, 1 April 2010 (UTC)  Done Anna Frodesiak (talk) 10:19, 20 June 2010 (UTC)

Minnesota Action

The Minnesota Medical Practice Board now has a 5-year moratorium on persecuting doctors who treat lyme disease with long-term antibiotics. [6]

There's a rumor that the new IDSA lyme disease guidelines are coming out this month, but the IDSA website doesn't appear to have that stated. The revised guidelines were originally promised for the end of 2009. Simesa (talk) 15:08, 8 April 2010 (UTC)

That article makes it sound like the Board acquiesced to something it believed to be medically unsound, under political pressure from elected officials. Which is an interesting precedent. MastCell ^Talk 05:39, 9 April 2010 (UTC)

mmm - the surrounding spin has that tone, but the quote on the content of the resolution is, "It basically reads that in the interest of allowing time for science to resolve the issue, the Minnesota Board of Medical Practice (MBMP) voluntarily will take a five-year moratorium on the investigation, disciplining or issuance of corrective action based solely on long-term prescription or administration of antibiotic therapy for chronic Lyme disease. If during those five years, double-blind, peer-reviewed scientific studies have resolved the issues, the five-year moratorium will be nullified. At the end of five years, in the absence of such scientific studies, the board will reexamine the issue."

Sounds like the board is split on whether they believe IDSA or ILADS spin, so they decided to let the doctors decide for themselves, which is probably a good idea under the circumstances.

Please forgive any formatting or etiquette errors - I'm a newbie, and it's taking time to research and absorb the layers of policy, formatting, page history, etc. required to participate well.

Postpostmod (talk) 13:55, 14 April 2010 (UTC)

Welcome; your etiquette and formatting look great. On the subject at hand, I'm afraid I don't agree with your interpretation of the article cited by Simesa. It clearly indicates that the Board acquiesced to this moratorium under duress, not that it was at all convinced by anything ILADS had to say. The article describes the moratorium as a "bitter pill to swallow" for the Board, undertaken to "circumvent legislation".

The article further notes that "[Medical board] members fear the action erodes their authority to protect a patient’s health and safety and sets a dangerous precedent." The article further quotes the former Board president thus: "Legislating a standard of care based on who screams the loudest is an abdication of our responsibility." In all, it gives a clear impression that the Board undertook this moratorium under political pressure, and that it has grave concerns about the manner in which that pressure was applied. MastCell ^Talk 00:20, 15 April 2010 (UTC)

Thanks for responding. Text of MN Board of Medical Practice resolution is here. Postpostmod (talk) 12:23, 21 April 2010 (UTC)

Letter from CT Attorney General to IDSA regarding review panel’s voting violations

The letter appears at pages 3-6,here Postpostmod (talk) 12:23, 21 April 2010 (UTC)

Looks like this was taken into account, since each section of the guideline got an individual vote in the final report, which was what the AS requested in this letter. Tim Vickers (talk) 20:23, 22 April 2010 (UTC)

Connecticut review panel states that no change in guidelines required

See news story and IDSA press release here is a copy of the final report. Tim Vickers (talk) 16:52, 22 April 2010 (UTC)

Panel evenly split, 4-4, on diagnostic testing recommendations of 2006 guidelines

Hi Tim, nice to meet you. I appreciate your transparency, and that of WP:MED. It has sharpened my understanding of medical culture. I also am a Ph.D scientist, best known for work on cell adhesion molecules induced by inflammation. I live on the east coast.

Please see page 26 of the panel's report, under “Additional Review of Executive Summary Statement”.

The original statement, on page 1-2 of the guidelines, is:

“Clinical findings are sufficient for the diagnosis of erythema migrans, but clinical findings alone are not sufficient for diagnosis of extracutaneous manifestations of Lyme disease or for diagnosis of HGA or babesiosis. Diagnostic testing performed in laboratories with excellent quality-control procedures is required for confirmation of extracutaneous Lyme disease, HGA, and babesiosis.” [emphasis in original]

The panel was equally split, i.e. voted 4-4, regarding leaving this statement unchanged.Postpostmod (talk) 21:24, 25 April 2010 (UTC)

Chronic in lead

The paragraph in the lead summarizing the #Post-Lyme disease symptoms and "chronic" Lyme disease was recently removed for length concerns; the paragraph comprised about a third of the lead. This is a valid concern, but the lead section should also summarize the article. The chronic section currently takes up about one and one half vertical screens on my display, which I think is enough that there should be a sentence or two in the lead. I propose to add the following sentence to the end of the lead (following Occasionally ... autoimmunity):

Current scientific evidence does not support any connection between Borrelia and a group of medically unexplained symptoms controversially described as "chronic" Lyme disease.

With appropriate wikilinks and references, of course. Does this sound like a valid compromise? - 2/0 (cont.) 18:18, 24 July 2010 (UTC)

The length of the lead-in is fine. You are using that as an excuse to rationalize your own POV, which is not permissible in Wikipedia. 24.224.84.165 (talk) 12:28, 26 July 2010 (UTC)

I think you may have misunderstood what I am proposing - the current lead has no coverage of "chronic" Lyme disease, because what was until recently there was converted into a section at that diff link above (click on removed). I am proposing that we add a sentence to the lead noting that the controversy exists, but clearly stating that most relevant medical experts are on one side of it.

This leads to a related point - the section you have twice replaced is the one that was copied out of the lead that was summarizing the relevant section of the article. Per WP:LEAD it is perfectly appropriate to have that level of redundancy, but I am really not clear on why we should have two sections discussing the same aspect of the topic but no mention in the lead. Now - what material is covered at Lyme disease#Chronic Lyme disease controversy that is not covered better at Lyme disease#Post-Lyme disease symptoms and "chronic" Lyme disease? Corollary question: would there be any particular benefit in terms of making this a more complete and accurate encyclopedia article if we move this material into a section instead of a subsection? - 2/0 (cont.) 13:39, 26 July 2010 (UTC)

First of all, you are here to advocate a position. "I am proposing that we add a sentence to the lead noting that the controversy exists, but clearly stating that most relevant medical experts are on one side of it." Did you note that those same medical experts were criminally investigated? And did you know the investigation is still ongoing? And did you know that 9 out of 14 authors of the 'expert' guideline committee had conflicts of interests in the millions of dollars? Did you know they removed an author who disagreed with them? Yes, that's right -- that's criminal, and I noticed you didn't add any of those parts. You just parrot the IDSA's talking points, which is very convenient for your argument. Second of all, please stop edit warring Edit warring. You have already violated the 3RR; you need to allow other users to comment so that a consensus can be reached. —Preceding unsigned comment added by 24.224.84.165 (talk) 15:07, 26 July 2010 (UTC)

You seem to be vastly misinterpreting my position - I only want to follow Wikipedia:Neutral point of view and Wikipedia:Manual of Style (lead section) by including a brief mention of this aspect of the article in the lead section. At the moment, the "chronic" controversy is discussed twice in the body and not at all in the lead - this seems significantly sub-optimal. The IDSA material is discussed at the organization's article, as it should be. If you think the material is relevant enough to Lyme disease that it should be discussed here as well, please propose improved wording.

I would also really appreciate if you were to read policies more carefully before citing them. If you would like to continue this aspect of this discussion, may I venture that my talk page may be a more appropriate venue than the present page? - 2/0 (cont.) 08:08, 6 August 2010 (UTC)

[Following thread is copied from 2over0's user page at request of 2over0:]

== Proposing an edit ==

Hello, I'd like to change the last line of the Lyme disease intro to "A group of experts says that current scientific evidence...". What the evidence indicates is debatable, as is the process by which it has been translated into expert opinion. But there's no debating that "a group of experts says that...". I'm guessing you (and the WP:MED editors responsible for the article) haven't examined the published evidence, so it would be more accurate to indicate that the statement is based on authority only - which of course is entirely acceptable for Wikipedia purposes. Better yet would be to omit the statement entirely - it's begging one of the questions at the heart of the controversy. But you put it in there, and I'm sure you have some reason. Any problem with my proposed change? Postpostmod (talk) 15:24, 20 August 2010 (UTC)

• Please direct this discussion to Talk:Lyme disease#Chronic in lead. Please refrain from speculating on the motives and dedication of your fellow volunteers. Thank you, - 2/0 (cont.) 17:44, 20 August 2010 (UTC)

Say what?

I'm sorry you didn't like what I said, I meant it literally, not as a criticism. My honest interpretation of WP:MEDRS is that it's not standard to look at data, only reviews. That would mean not examining the published evidence, only summaries of conclusions, as is given in reviews. And I'm only suggesting the modification because I'm assuming you don't want to delete the statement entirely, since if you did you wouldn't have added it. In other words, you must have some reason, so it would be disrespectful of me to simply delete the statement, rather than suggest a way to keep it in and still be accurate.

Again, I'm very sorry if I inadvertently insulted you. I'm a scientist, living in a Lyme endemic area, just coming to grips with how WP:MED does its work.

Best wishes, Postpostmod (talk) 18:39, 20 August 2010 (UTC)

I don't think you're quite right about WP:MEDRS. We're certainly allowed to look at, and even cite, "primary" papers and data. What we're not allowed to do is to select and present that data in a way that advances our own interpretation over that of expert secondary sources (e.g. reviews, statements by major medical/scientific bodies, etc). The point is not to avoid the underlying data - the point is that we have to be careful not to (mis)use it to produce an editorial synthesis that conflicts with the synthesis of recognized, reputable experts and expert bodies. MastCell ^Talk 18:58, 20 August 2010 (UTC)

(edit conflict) I am not particularly attached to that statement one way or the other, hence waiting a month since proposing it, but I think that per WP:LEAD we should probably have some mention of the subject in the lead. Please feel free to delete the sentence with a clear rationale regarding why the article would be better without it (preferably posted at Talk:Lyme disease#Chronic in lead, though an edit summary could be enough if you are better at writing concisely than I am).

I think that WP:MEDRS is slightly more nuanced than that - we should prefer the reviews when they are better sources, but should not deprecate individual studies entirely. We as editors are required to refrain from adding our own interpretations to any source, though, which I think squares with your point on not looking at the data directly. Regards, - 2/0 (cont.) 19:07, 20 August 2010 (UTC)

How about, "The most prominent group of recognized, reputable experts, and expert bodies say that..."  ? (just kidding ;-)

For real, how about "The most prominent group of experts says that..."  ?

Best regards, Postpostmod (talk) 21:15, 20 August 2010 (UTC)

Thank you for copying this over - it really does help to hold discussions at a centralized discussion where all interested parties will be aware.

In general I like attribution, but I think we should steer clear of vague statements such as unnamed "experts", both as it is less informative to the reader and as it can lead to trouble down the line when new editors find new "experts". I think that the in-depth treatment of the literature at Lyme disease#Post-Lyme disease symptoms and "chronic" Lyme disease justifies the wording [c]urrent scientific evidence. A more conservative solution could be to cite the IDSA[7] and NIAID[8] directly, replacing the sentence with: IDSA and NIAID do not recommend long-term antibiotic care for "Post Lyme Disease Syndrome" or "Chronic Lyme Disease". The quotes are intended to indicate that these descriptors are not well-defined or widely accepted; if you can think of a better concise way to indicate this, I would support it. I would prefer to reserve discussion of the history leading up to the IDSA's Lyme Disease Review Panel for Infectious Diseases Society of America#Lyme disease treatment guidelines, which should be appropriately wikilinked. - 2/0 (cont.) 22:15, 20 August 2010 (UTC)

The attribution to specific people could be fixed simply by inserting the ref to the Wormser et al guidelines right after "experts", like this: "The most prominent group of experts says that..." But I think it would be better to delete it entirely from the lead - it's too complex an issue to summarize accurately in a sentence or two. So I did that. Also made couple of other small changes. Regards, Postpostmod (talk) 13:28, 21 August 2010 (UTC)

PS: Sorry, I didn't address the rest of your issues - I thought discussing the whole thing would get confusing, so am doing one thing at a time. Yay, it's the weekend! off to Ipswich for birdwatching. Wearing permethrin-impregnated clothing, of course. Best, Postpostmod (talk) 13:42, 21 August 2010 (UTC)

I can live with this solution - thank you. I disagree with some of your reasoning here (the whole article should not be framed in terms of a controversy with only a minor medical component), but I agree with the result. I am less clear on why you removed the example of arthritis here. The cited reference and associated papers seem to me to indicate that it is a decent example, whereas the current wording could be taken to mean the whole suite of symptoms persists, which is inaccurate.

Enjoy the birds! - 2/0 (cont.) 22:24, 21 August 2010 (UTC)

Thank you. I agree, the controversy is not the major point, so that's why it doesn't have to be in the lead if it causes too many problems. Although I bet we'll get complaints - c'est la WP.

Symptoms that have been considered relevant to "PLDS" include the arthritic and neurological ones mentioned with regard to the autoimmune hypothesis in the current ref#6 (Singh and Girschick 2004), and "fatigue, musculoskeletal pain, and neurocognitive difficulties" included in the meta-analysis which is current ref#5 (Cairns and Godwin, 2005). Specifically, studies most often cited are Klempner et al. PMID1140676 (current ref # 123 in the article), Krupp et al. PMID12821734 (ref#125), and Fallon et al. PMID17928580 (ref#127). Klempner refers to "persistent musculoskeletal pain, neurocognitive symptoms, or dysesthesia, often associated with fatigue", Krupp to "persistent severe fatigue" and "cognitive function (mental speed)", and Fallon to "mild to moderate cognitive impairment and marked levels of fatigue, pain, and impaired physical functioning". (I am quoting from the freely available abstracts on Pubmed.) For the purpose of the lead, I think it would be best just to say "symptoms".

The birds were great - highlight was hummingbirds. Best wishes, Postpostmod (talk) 14:39, 23 August 2010 (UTC)

The tick does not have to be on you for a full day in order to get Lyme Disease

The tick does not have to be on you for a full day in order to get Lyme Disease. I had a tick on me for less than 8 hours and contracted Lyme Disease. 96.32.29.215 (talk) 03:18, 28 July 2010 (UTC)

That's why the article says, " removal within 36 hours can reduce transmission rates to close to zero." It's still possible, just highly unlikely. — The Hand That Feeds You:^Bite 19:17, 24 August 2010 (UTC)