the body politic / Germ Warfare by RUSTY UNGER (02/28/00: a long article from New York about the vehement and bitter controversy dividing the medical community about Lyme disease. First noticed in 1975 as a novel type of arthritis in Lyme, CT and determined to be caused by a tick-borne bacterium called borrelia, some maverick physicians want to alert their colleagues to their contention that the disease goes on in some cases to a persistent systemic form despite treatment. Of particular interest to me, as a psychiatrist, are reports that it may be behind certain puzzling cases of neurobehavioral symptoms. Most MDs scoff at these claims and discount case reports of patients whose deterioration has been reversed by aggressive recurrent treatment for the infectious process. “In one corner is a group of those predominantly university-based physicians who

develop drugs, receive research grants from federal health agencies, and often

advise insurance companies. They contend that Lyme is usually simple to

diagnose and easily curable with two to four weeks of oral antibiotics. Chronic

Lyme, they say, is extremely rare, not a disease but merely a group of

symptoms remaining after the initial infection is treated that usually disperse.

In the other corner stands a group of primary-care

doctors, those on the front lines who see Lyme

patients every day, and a number of other

scientists — all of whom maintain that the illness

is far more complicated. Late-term or lingering

cases of Lyme disease, they say, may require six

months or more of oral antibiotic therapy and

intense intravenous therapy — which some like to administer in a hyperbaric

chamber. They believe that the increased oxygen of the chamber helps kill the

tenacious spirochetes — known as Borrelia burgdorferi — deposited by the

blood-sucking deer tick. Burrowing rapidly into the tissues, joints, and central

nervous system, borrelia slightly resembles the syphilis spirochete in the way it

feeds, sleeps, and reproduces.” Detractors have accused the more aggressive Lyme doctors of overdiagnosing and overtreating. But recently they’ve gone further. Several of the “Lyme literate” (as they are known by their supporters) are under investigation or have already lost their licenses. Bad medical practice or merely the unpopularity of their approach and beliefs? A case study in how illness definition has political as well as scientific influences…