Scientific Methods

[Ness78]

I am interested to know how doctors/scientists conduct studies for the effectiveness of long-term antibiotic use for chronic lyme?

How do they measure their data? Is it mostly anectodal evidence?  I have read some scientific literature that claims it is not effective, but so far the articles have not included what their measuring sticks are.
Has anyone come across their tesing methods?

I will also try to answer my own question, I am just wondering what others have come across.  

[JackieCalifornia]

Very well said, Ness.  I agree with your post entirely.  Thank you!

Take care --

[Ness78]

Hi Jackie,

That is a great article because it focusing  on moving forward and evolving the treatment for lyme to meet the developing understanding of biofilms and cell wall deficiencies.

I can understand people's frustration with IDSA almost holding back on the evolution with an out-dated model of treatment and understanding of the bacteria. That's just bad science. It's a 'the world is flat' mentality.  Science is organic and needs room to breath and grow to remain viable.  

It's unfortunate that as a result drug companies are not getting on board and developing more advanced antibiotics to target the cell wall deficiencies.

I am starting to get a feel for what is happening.  That is important as I move forward. I am also glad a took a good look at the 'IDSA camp' studies. My overall feeling is that their study is just to prove what they are saying is right, not to advance the understanding in the treatment of lyme. I hate to use sweeping statements like that because that is precisley what drives me nuts about some the articles I am reading....but it is just the overall sense that I got.


I'll sign off with a little blurb I found on one of the blogs written by a doctor frusterated with the clinical studies he has encountered on lyme:

"This post is a about "evidence based medicine." In my opinion, this is a sham, a fraud. Perhaps it works for HMO physicians who are required to see patients in 6 minutes: cookbook medicine. It is not a useful tool for thoughtful, curious physicians, intent on practicing their art to the best of their ability. Patients are all different as are all physicians. Diseases are nuanced and complex.

The practice of medicine is a mosaic of science, judgment, clinical experience and yes-intuition, a clinical nose, the product of years of practice."

I am cross eyed and lymed out for the day. Good night and thanks again.

[JackieCalifornia]

The article I cited above is 9 pages long, including 4 pages of footnotes, sources and a short appendix.  It's not based on questionnaires.  PubMed is just an abstract service.  You can also read the whole article and all its footnotes and sources online, for free, as well as others.  Took me about 30 seconds to locate it via google search.

I don't know where the point of view has arisen that those who take a more progressive view of Lyme treat only according to what they decided over breakfast on a whim, but I read that often.  It's a common objection to anything other than the IDSA/CDC point of view.  Ironically, from my point of view, it's the IDSA/CDC/mainstream docs who rely on incomplete and out of date information.

[Ness78]

Hi Jackie,

I guess I mean hard scientific objective evidence versus subjective questionairre evidence.  I am looking at the study by Klempner for example:

1.   Klempner, M. S., Hu, L., Evans, J., Schmid, C. H., Johnson,G. M., Trevino, R. P., Norton, D., Levy, L., Wall, D., Kosinski, M.,and Weinstein, A. (2001) Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. New Eng. J. Med. 345, 85–92

I have seen this study pop up a number of times and it seems to be one of the hallmark studies that speaks agains the use of long-term antibiotics.

I have found a good (apparently non-bias) analysis of the study suggesting that there are major holes in the study as far as evaluating patient symptoms before and after what they consider long term antibiotic use.  

Here is the website for the analyis of the Klempner study.

http://www(dot)personalconsult.com/articles/lymeklempnerstudy(dot)html

It lists the strengths and weaknesses of the study.  I like that it is a well-rounded analysis. As far as my measuring stick question goes, there is not a lot of objective scientific measuring.   It is subjective questionnaires

So far that is where I am at.  I can see there is a lot of controversy surrounding the Klempner Study.  I have also  found accusations against Klempner not handling the blood samples for the Western Blot correctly, (http://www.avonhistory (dot) org/bug/r14 (dot) htm) but going forth with the study anyways.

I guess I am inquiring into this because I like to know what goes on in the ivory tower before I consider it a valid source for an argument before or against anything.

This is probably old news for you, but I appreciate you being a good sounding board for a newbie. Thanks.

[JackieCalifornia]

If you go to ILADS [dot] org, there are posts and links about research and the kind of information I think you're looking for.

If you are into reading scientific papers, I'd suggest PubMed, which aggregates medical research papers online.  The site describes itself as:  "PubMed comprises more than 20 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites."

Here is the link that gets you to the home page {take all the spaces out and copy it into your browser}:

www. ncbi. nlm. nih. gov / pubmed

Then there is a search box and if you type Lyme into the box, you will have lots and lots to read from every point of view.  Here is the abstract (short summary) of a recent piece from Jan 2011, by Rafael Stricker, one of the leading docs in the aggressive treatment of Lyme:
================================================================
Infect Drug Resist. 2011;4:1-9. Epub 2011 Jan 7.
Lyme disease: the next decade.
Stricker RB, Johnson L.
Source

International Lyme and Associated Diseases Society, Bethesda, MD, USA.
Abstract

Although Lyme disease remains a controversial illness, recent events have created an unprecedented opportunity to make progress against this serious tick-borne infection. Evidence presented during the legally mandated review of the restrictive Lyme guidelines of the Infectious Diseases Society of America (IDSA) has confirmed the potential for persistent infection with the Lyme spirochete, Borrelia burgdorferi, as well as the complicating role of tick-borne coinfections such as Babesia, Anaplasma, Ehrlichia, and Bartonella species associated with failure of short-course antibiotic therapy. Furthermore, renewed interest in the role of cell wall-deficient (CWD) forms in chronic bacterial infection and progress in understanding the molecular mechanisms of biofilms has focused attention on these processes in chronic Lyme disease. Recognition of the importance of CWD forms and biofilms in persistent B. burgdorferi infection should stimulate pharmaceutical research into new antimicrobial agents that target these mechanisms of chronic infection with the Lyme spirochete. Concurrent clinical implementation of proteomic screening offers a chance to correct significant deficiencies in Lyme testing. Advances in these areas have the potential to revolutionize the diagnosis and treatment of Lyme disease in the coming decade.

PMID:
    21694904
    [PubMed - in process]
==============================================================
If you want to read the whole article, I'm sure you can find it and many many others.

This is not anecdotal evidence; these are scientific studies.