To the Editor:
I am responding to the article, “Divide deepens over treatment of persistent Lyme disease symptoms,” by reporter Barry Stringfellow published in the June 2 issue of The MV Times. The study upon which the story was based was of limited value, the study design compromised by the absence of a true placebo group, with resultant conclusions wanting for more information.
All patients received two weeks of IV treatment prior to randomization into two treatment groups and a third placebo group. The statement made that not first treating the placebo group would be unethical is unsustainable, as all enrolled patients had had symptoms for more than two years, and most had been treated in the past. The conclusions, therefore, that the antibiotic treatments were ineffective cannot be definitely stated, as all groups had some improvement.
The design using 12 weeks as being long-term treatment is not based on any factual information. There is currently no test to determine if the infection is or is not present in a given individual, thus limiting the conclusion that 12 weeks of those treatments constituted ineffective long-term antibiotic treatment. The limited observed improvement over this time period is not surprising, as most practitioners caring for these patients find that when symptoms are present for two or more years, a number of months are likely required to achieve meaningful improvement, and in many cases apparent cure.
As to the cause of the ongoing symptoms, it does not seem much of a stretch to presume that infection is still present, and there is increasing information that this is the case. There is no credible alternative explanation, and there appear to be specific, safe, and effective antibiotic regimens to resolve the infection. There is also exciting new information that sheds light on the bacterium’s ability to persist and tolerate antibiotics, and on the persistence of certain chemical markers in people with persisting symptoms.
There is certainly a need for better understanding of the underlying process, as well as for a definitive test for the disease. The Institute of Medicine reviewed the available information a few years ago with similar conclusions. So has the Massachusetts Special Commission to Conduct an Investigation and Study of the Incidence and Impacts of Lyme Disease, in 2013.
Sam T. Donta, M.D., professor of medicine (ret.)
Fellow, Infectious Disease Society of America
Consultant, infectious diseases, Falmouth Hospital
