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A knife fight in Lyme Alley
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A knife fight in Lyme Alley

I'll spare you the earlier published articles going back and forth on this point, but will summarize to say that Kowalski and Agger did a study trying to prove that long term abx are useless in Lyme.  Then Stricker (my hero!) and Johnson rebutted Kowalski/Agger, pointing out among other things that K&A's analysis was faulty, because for example they sent questionnaires to 600+ Lyme patients and only got back `200, but claimed to have a huge cohort for the study, instead of just surmise and anecdote.  Then K&A published an attempted rebuttal to Stricker and Johnson:

Reply to Stricker and Johnson

    by Todd J. Kowalski and William A. Agger

+ Author Affiliations

    Section of Infectious Disease, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin

    Reprints or correspondence: Dr Todd J. Kowalski, Gundersen Lutheran Health System, Section of Infectious Disease, 1900 South Ave, C04-001, La Crosse, WI (***@****).

"To the Editor—We appreciate the attention paid to our article [1] by Stricker and Johnson [2] but disagree with their conclusions on statistical and scientific grounds. They suggest performing intention- to-treat statistical analysis on our cohort and counting those who did not return surveys as having experienced treatment failure [not exactly, but of course that's how K&A would play it]. This is neither a plausible nor appropriate analytic strategy.

"First, our definition of treatment failure was based on clinical data obtained from a review of medical records over an average follow-up period of 2.9 years. The survey had no effect on the determination of treatment failure, making their point irrelevant. [Of course the survey had no effect on treatment failure in the real world!]

,,, [skipping some stuff here]

"Stricker and Johnson also claim that treatment failure was defined too stringently [2]. We counter that nonspecific subjective complaints such as fatigue, musculoskeletal complaints, and insomnia are ubiquitous; of themselves, they cannot possibly be used to discern whether someone is suffering from Borrelia burgdorferi infection or countless other acute and chronic physical, emotional, and psychological maladies that manifest identically.

[[That statement, friends, is exactly how nonLLMDs see us:  we don't have a infection, we just have "countless other acute and chronic physical, emotional, and psychological maladies that manifest identically [to Lyme]."  What an idiot!]]

... "It is well recognized that some patients have various subjective complaints after treatment for Lyme disease [5–7]. In our experience as infectious disease clinicians, many (and perhaps most) patients with systemic infectious diseases complain of fatigue, musculoskeletal pain, and various body aches well after cure of their infection. However, such complaints are not an appropriate indication to continue or reinitiate therapy for an infection that is otherwise cured."

[[So, we're cured, we just think we're sick.  Morons.]]

...

"Stricker and Johnson's emphasis on the persistence of subjective complaints in our population does emphasize the key takehome point of our study: longer antibiotic courses did not decrease symptoms better than shorter courses in patients with early Lyme disease. Objective clinical failure, subjective complaints, and the objective functional status of patients (measured by the SF-36 health-assessment survey) were similar among patients regardless of the duration of antibiotic treatment. The conclusion is clear. When it comes to antibiotic treatment duration for early Lyme disease, longer is not better [1, 5, 6]. As physicians, we should recall one of our first oaths before prescribing prolonged or repeated courses of antibiotics for early Lyme disease: primum non nocere. ['First, do no harm']"

If I could swear on a website without getting bonged, I would!  AGGH!!!
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To me, the most telling damnation of Kowalski and Agger's thesis is that their definition of "short term antibiotic treatment" was doxycycline for 10 days, and their definition of "long term antibiotic threatment" was doxycycline for up to 8 weeks.

All these fools proved was that doxycycline alone, for only 8 weeks, is not enough to cure this inherently antibiotic resistant infection.

Dismissing, as irrelevant, the persistent presence after treatment of those very symptoms used to define and diagnose the condition in the first place it irrational and entirely contrary to the scientific method.
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I believe it was last year that a infectious disease doc at Gunderson posted two mocking, contemptuous comments about chronic Lyme patients on Facebook.  After a big outcry by Lyme patients, the comments were removed and the hospital issued an apology on his behalf.  I don't recall seeing an apology from him personally.

It goes to show you the prevailing opinion at that medical institution. I am not surprised they set out to prove the "chronic Lyme crowd" wrong.  I wouldn't be surprised if the whole study was biased from start to finish.  If they really wanted to prove they were right, they should have embarked on a study to try to prove themselves wrong.
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