Cure Unknown: Inside the Lyme Epidemic

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9780312378134: Cure Unknown: Inside the Lyme Epidemic
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When Pamela Weintraub, a science journalist, learned that her oldest son tested positive for Lyme disease, she thought she had found an answer to the symptoms that had been plaguing her family for years―but her nightmare had just begun. Almost everything about Lyme disease turned out to be deeply controversial, from the microbe causing the infection, to the length and type of treatment and the kind of practitioner needed.

On one side of the fight, the scientists who first studied Lyme describe a disease transmitted by a deer tick that is hard to catch but easy to cure no matter how advanced the case. On the other side, rebel doctors insist that Lyme and a soup of "co-infections" cause a complicated spectrum of illness often dramatically different – and far more difficult to treat – than the original researchers claim. Instead of just swollen knees and a rash, patients can experience exhaustion, disabling pain, and a "Lyme fog" that leaves them dazed and confused. As patients struggle for answers, once-treatable infections become chronic.

In this nuanced picture of the intense controversy and crippling uncertainty surrounding Lyme disease, Pamela Weintraub sheds light on one of the angriest medical disputes raging today. The most comprehensive book ever written about the past, present and future of Lyme disease, Cure Unknown exposes the ticking clock of a raging epidemic and the vulnerability we all share.

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About the Author:

Pamela Weintraub is a senior editor at Discover magazine. Previously editor in chief of OMNI and consulting editor at Psychology Today, she has covered science and biomedicine for national media for more than twenty-five years. She lives in Brooklyn, NY.

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Introduction   Navigating by Lymelight   Starting in the early 1990s, after we moved from a city apartment to a wooded property in Westchester County, New York, our family began to get sick. At first the illness was subtle: The vague headaches, joint pains, and bone-weariness seemed par for the course in our busy suburban lives. But as years passed, the symptoms intensified and multiplied, burgeoning into gross signs of disease.   My knees became so swollen that I descended the steps of my house while sitting. Swallowing my food, I choked. My arms and legs buzzed—gently at first, but then so palpably I felt like I was wired to a power grid. A relentless migraine became so intense I spent hours each day in a darkened room, in bed.   My husband, Mark, an avid tennis player with great coordination, began stumbling and bumping into walls. Formerly affable, he began exploding at offenses as slight as someone spilling water on the floor. He was an award-winning journalist with a love of literature and a vocabulary so vast he was our stand-in for the dictionary. But slowly he began struggling with memory and groping for words. Finally, ground to a halt, he left his job as editor in chief of the newsletter Bottom Line Health one day after realizing that he’d spent hours trying to read a single, simple paragraph.   Our youngest son, David, began to sleep—first so long that he could not do his homework or see his friends; eventually, so much (fifteen or more hours a day) that he could not get to class. Violating the strict attendance policy at his prep school, he was asked to leave.   Hardest hit was Jason, our oldest, who suffered fatigue and shooting pains starting at age nine, the summer we took up residence in our fairytale house in the woods. The doctors called these “growing pains” normal, but by age sixteen Jason was essentially disabled. He couldn’t think, walk, or tolerate sound and light. His joints ached all day long. On medical leave from high school, he spent his days in the tub in our darkened main-floor bathroom, drifting in and out of consciousness while hot water and steam eased his pain. As his condition worsened, as all sorts of lab tests came back negative, a raft of specialists at New York City’s top teaching hospitals suggested diagnoses from migraine aura (the dizzying buzz of a migraine) to fifth disease (a swelling of the joints caused by infection with parvovirus). Each diagnosis elicited a treatment, but none of them worked.   “What about Lyme disease?” I asked.   “There are too many symptoms here and he’s way too sick for Lyme disease,” responded the pediatrician, who declined to even test for it.   But by 2000, with answers still eluding us, the pediatrician drew fourteen vials of blood, testing for hormone imbalance, mineral deficiency, anemia, and a host of infections, including Lyme. A week later he contacted us, baffled. Just one test, a Western blot for antibodies against Lyme disease, had come back not just positive, but off-the-charts reactive. Jason was quickly reported to the Centers for Disease Control and Prevention (CDC) as an unequivocal case of Lyme disease. When the head of infectious disease at Northern Westchester Hospital put his imprimatur on the diagnosis, we had an explanation for Jason’s illness and an inkling as to what might be wrong with the rest of us, at last. Our nightmare had just begun. As with the quest for diagnosis, almost everything about Lyme disease turned out to be controversial. From the length and type of treatment to the definition of the disease to the kind of practitioner we should seek to the microbe causing the infection (or whether it was an infection at all), Lyme was a hotbed of contention. It was the divisiveness surrounding the disease that had caused our pediatrician and the specialists we’d consulted to hold back diagnosis as Jason and the rest of us became increasingly ill.   For patients with early-stage Lyme disease the illness tended to be mild, and a month of antibiotic treatment usually offered a cure. But for those who slipped through the cracks of early diagnosis, for people like us, infection could smolder and progress, causing a disabling, degenerative disease that confounded doctors and thrust patients into the netherworld of unexplained, untreatable ills. Despite the effectiveness of early treatment, withholding therapy had become increasingly common as a battle royal over Lyme’s essence spilled from medical centers and clinics into the communities where people got sick. The same doctors who routinely doused acne and ear infections with years of antibiotic often would not prescribe even ten days of such treatment for Lyme unless proof of infection was absolute. Meanwhile, the few doctors willing to treat the sickest patients with longer-term or higher-dose antibiotics could be called up for trial by medical boards, putting their practices and licenses at risk.   The war over Lyme had raged for twenty-five years when it swept us up in its madness. On one side of the fight were university scientists who first studied Lyme disease, initially writing it up in medical journals as an infection of the joints. The disease they described was caused by the spirochete Borrelia burgdorferi and transmitted to people by the bite of a deer tick. It was hard to catch and easy to cure no matter how advanced the case when first diagnosed. Late disease was rare, these academics said, because Lyme was recognized easily through a bull’s-eye rash and a simple, accurate blood test. Rarely was their version of the disease seen outside the Northeast, parts of California, and a swath of the Midwest.   To the horror of these scientists, the circumscribed disease of their studies had been hijacked by “quack suburban doctors” who saw Lyme everywhere, from Florida to Texas to Michigan, invoking so many signs and symptoms that they included every complaint under the sun. These heretical doctors, the scientists charged, were dispensing antibiotics like water, all the while raking in money from patients too deluded to realize they didn’t have Lyme disease at all. The patients had other things, the scientists said: sometimes mental disorders, but also chronic fatigue syndrome and .bromyalgia, illnesses with no known cause or cure.   On the other side of the fight, far from the ivory tower, the rebel doctors and their desperately sick patients insisted that Lyme and a soup of coinfections caused a spectrum of illness dramatically different from the one the scientists described. Knees didn’t always swell and the rash (rarely a bull’s-eye) often wasn’t seen. Instead the patients were mostly exhausted, in chronic pain, and dazed and confused. The mental condition they called “Lyme fog” robbed them of short-term memory, stunted their speech, and crippled their concentration. Brain infection could inflict a host of frank psychiatric problems from bipolar disorder and depression to panic and obsessive-compulsive disorder (OCD), they said, and Lyme could trigger autism or be confused with amyotrophic lateral sclerosis, known as Lou Gehrig’s disease, or ALS. Because their illness differed profoundly from the disease described in textbooks, because it often eluded blood tests, the patients went undiagnosed and untreated for years. As they struggled for answers, oncetreatable infections became chronic, inexorably disseminating, and causing disabling conditions that could never be cured. If treatment was to work at all, the heretic Lyme doctors said, it required high-dose antibiotics, often in combination or delivered intravenously, sometimes for months or years.   The patients, for their part, tried to comprehend why the academics dismissed their cases as false. The scientists were promoting an impossibly narrow version of Lyme disease to protect their early work and secure a windfall from Lyme-specific patents, some patients believed. A flow chart entitled “The Wall of Money” began circulating around support groups, connecting some of the researchers with U.S. patents and federal or industry grants. Other patients complained that university physicians consulted for managed care, making hundreds of dollars an hour dismissing Lyme diagnoses and advising rejection of their claims. The academics advanced their agendas, the patients charged, by reporting the doctors who treated them to disciplinary boards.   As medical tribunals swept through the Lymelands, primary care physicians became ever more cautious about treating or even diagnosing Lyme disease for fear of becoming targets themselves. Stepping into the breach, a few doctors—Ed Masters of Missouri, Charles Ray Jones of Connecticut, Ken Liegner and Joe Burrascano of New York—went to the mattresses for the patients, but with the Lyme war so brutal, thousands of cases were missed.   Lyme or not Lyme? Diagnoses could get mixed up. Dueling brain tumor stories make the point. A young woman from Australia went hiking in California. From that trip on her health declined. She eventually experienced such pain, disorientation, and inflammation that doctors thought she might die. She returned to the U.S. for treatment, and neurologists in Manhattan diagnosed a brain tumor. They actually operated, but when they opened her up, there was no tumor. It turned out the young woman had Lyme disease. She was treated with antibiotics and cured. A young man from New Jersey was diagnosed with Lyme disease and treated with antibiotics for months without impact. Finally he was sent to a local medical center, and further testing was done. Doctors discovered a brain tumor and operated to re...

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