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proof of antibiotic resistant lyme?
- Thread starter msf
- Start date
Oops, posted by mistake.
I just found this while searching for articles about the ELISPOT.
http://pathology.imperial.nhs.uk/in...ls,0&cntnt01productid=2709&cntnt01returnid=43
It seems that these kind of tests are now standard use in the NHS for TB - I wonder how long it will be before they are standard use for Lyme?
I just found this while searching for articles about the ELISPOT.
http://pathology.imperial.nhs.uk/in...ls,0&cntnt01productid=2709&cntnt01returnid=43
It seems that these kind of tests are now standard use in the NHS for TB - I wonder how long it will be before they are standard use for Lyme?
anciendaze
Senior Member
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Except in the sense that "every profession is a conspiracy against the laity", nothing about this situation is unique to Lyme Disease. Some time back I went looking for the reason tests for autoimmune problems were scaled back to find fewer cases. It turned out these tests were finding too many people with preclinical disease, for which doctors have no good treatments. This prompted a professional group to reevaluate criteria. The end result was that laboratory tests showing significant autoimmune activity prior to onset of clinical disease were adjusted in sensitivity until the threshold matched clinical judgment based on other signs. Objective tests were adjusted to match clinical opinion. This then worked its way into research criteria. An opportunity to discover what was going on in autoimmune disease at an early stage, when it might be possible to use less-drastic interventions, was thrown away to avoid overloading practicing doctors with information they did not want. This is perverse, unless you realize that the purpose of tests is to bolster the authority of physicians, not reveal errors in judgment.
Looking back at medical history I don't find any break in the tradition that began long ago of saying "this can't be wrong, we've been doing it for centuries." Such thinking allowed diseases like TB to persist without anyone important noticing that treatments were largely ineffective. The outcome was bad for patients, yet provided a steady income for doctors. Every kind of moral, psychological and constitutional failure was attributed to those damned patients, who had not been educated enough to know they were supposed to get better. Fresh air, healthy diet, exercise and positive thinking were long thought to be the answer despite the fact that nearly every sanatorium had its own graveyard. Resistance to the idea that TB was even a communicable disease persisted long after Koch had shown the role of mycobacterium tuberculosis. Koch did receive the Nobel Prize in 1905, 23 years after his research was published. Even then this was controversial. The idea that an immune response to tuberculin, which he also discovered, could be used as a test for TB infection was around from the beginning, (Arthur Conan Doyle, acting as a medical reporter, mentioned it in a dispatch about the discovery,) yet nothing was done about this until a much later date. Screening cattle for mycobacterium bovis, and Pasteurizing milk, could have reduced incidence of human TB, but this did not take place in regions as large as the UK until after a generation of Americans had demonstrated a substantial drop in incidence. There was also a TB vaccine, BCG, which is another story all by itself.
My point in all this history is that unless you produce a "wonder drug" which cures the problem without requiring any new thinking on the part of the doctor, the medical profession will predictably resist efforts to inform them of errors they are making in diagnosis and treatment until the current generation retires.
Looking back at medical history I don't find any break in the tradition that began long ago of saying "this can't be wrong, we've been doing it for centuries." Such thinking allowed diseases like TB to persist without anyone important noticing that treatments were largely ineffective. The outcome was bad for patients, yet provided a steady income for doctors. Every kind of moral, psychological and constitutional failure was attributed to those damned patients, who had not been educated enough to know they were supposed to get better. Fresh air, healthy diet, exercise and positive thinking were long thought to be the answer despite the fact that nearly every sanatorium had its own graveyard. Resistance to the idea that TB was even a communicable disease persisted long after Koch had shown the role of mycobacterium tuberculosis. Koch did receive the Nobel Prize in 1905, 23 years after his research was published. Even then this was controversial. The idea that an immune response to tuberculin, which he also discovered, could be used as a test for TB infection was around from the beginning, (Arthur Conan Doyle, acting as a medical reporter, mentioned it in a dispatch about the discovery,) yet nothing was done about this until a much later date. Screening cattle for mycobacterium bovis, and Pasteurizing milk, could have reduced incidence of human TB, but this did not take place in regions as large as the UK until after a generation of Americans had demonstrated a substantial drop in incidence. There was also a TB vaccine, BCG, which is another story all by itself.
My point in all this history is that unless you produce a "wonder drug" which cures the problem without requiring any new thinking on the part of the doctor, the medical profession will predictably resist efforts to inform them of errors they are making in diagnosis and treatment until the current generation retires.
Yeah, I guess a resistance to new ideas, even when they have all the evidence in their favour, is to be found in every profession.
RE: autoimmune disease, was that provoked by the Portuguese blood screening results, where they found that a significant portion of the population had auto-immune markers in their blood?
RE: autoimmune disease, was that provoked by the Portuguese blood screening results, where they found that a significant portion of the population had auto-immune markers in their blood?
Oh, and I wonder if anyone one has done a study of conservatism in science, and whether it increases with age? I think I already know what the result would be, but it would be interesting if this acknowledged as part of the scientific process. Of course, the opposite can also be a problem, i.e. young scientists defying convention in order to establish themselves.
Then there was that paper that someone posted on here a few weeks ago, the one where they found that the physician's impression of the success of a particular treatment varied depending on what condition they were told the patient had.
The problem is that some people use this as an excuse to condemn the whole scientific process, rather than seeing it as something that can be improved upon.
Then there was that paper that someone posted on here a few weeks ago, the one where they found that the physician's impression of the success of a particular treatment varied depending on what condition they were told the patient had.
The problem is that some people use this as an excuse to condemn the whole scientific process, rather than seeing it as something that can be improved upon.
anciendaze
Senior Member
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No, my comments about autoimmune disease were based on experience some years ago. I was bothered by the fact that these remain "of unknown etiology" after a great deal of research, and that nobody seems to have succeeded in tracing the course of preclinical disease. I was already well aware of the negative effects of current treatments on people I know.
We have long seen use of corticosteroids to broadly suppress immune response, or methotrexate to deplete a wide class of immune cells. More recent attempts have used monoclonal antibodies, like Rituximab to deplete CD20+ B cells, for example. This still falls far short of the specificity of immune response possible.
If the problem is similar to those where adoptive immunotherapy has succeeded in treating leukemia/lymphoma we still need to be considerably more specific to make treatments less harmful than the diseases. My own estimate is that we still have room to make treatment 100 times more specific, which would likely mean 100 times more effective, and 100 times less damaging. This would completely alter the prognosis for patients who develop these diseases.
Such treatment is likely to remain expensive for some time. This means that advances in treatment need to be paced by advances in prevention, which seems impossible with the current state of the art. If we can reduce the number of new cases, we might then have the money to treat them properly, even cure them. Current ignorance and institutional inertia, together with increasing incidence, predict future crises, and possible collapse of segments of the healthcare system.
Chronic infectious diseases, like Lyme disease, are part of what I would call the front end of potential long-term pathologies. Most directed research is aimed at the back end of the pathological process. It is virtually impossible to trace problems all the way back to initial causes after pathology has persisted for many years. The clinical picture of the disease has become extremely complicated by that time.
Lyme disease has connections with long-term problems in the nervous system, heart and joints. There are also indications it affects endocrine function. Persistent hidden infection may also serve as a trigger for autoimmune disease. If you take a look at the numbers of people suffering from neurological problems, heart problems or joint problems all of unknown etiology, you have to wonder if our inability to cross this one particular infectious disease off the list of contributing factors is crippling research which might benefit a large segment of the general public. It doesn't matter if the problem turns out to be due to some unrelated factor, we won't be able to determine those factors until we clear such confounding factors out of the way.
We have long seen use of corticosteroids to broadly suppress immune response, or methotrexate to deplete a wide class of immune cells. More recent attempts have used monoclonal antibodies, like Rituximab to deplete CD20+ B cells, for example. This still falls far short of the specificity of immune response possible.
If the problem is similar to those where adoptive immunotherapy has succeeded in treating leukemia/lymphoma we still need to be considerably more specific to make treatments less harmful than the diseases. My own estimate is that we still have room to make treatment 100 times more specific, which would likely mean 100 times more effective, and 100 times less damaging. This would completely alter the prognosis for patients who develop these diseases.
Such treatment is likely to remain expensive for some time. This means that advances in treatment need to be paced by advances in prevention, which seems impossible with the current state of the art. If we can reduce the number of new cases, we might then have the money to treat them properly, even cure them. Current ignorance and institutional inertia, together with increasing incidence, predict future crises, and possible collapse of segments of the healthcare system.
Chronic infectious diseases, like Lyme disease, are part of what I would call the front end of potential long-term pathologies. Most directed research is aimed at the back end of the pathological process. It is virtually impossible to trace problems all the way back to initial causes after pathology has persisted for many years. The clinical picture of the disease has become extremely complicated by that time.
Lyme disease has connections with long-term problems in the nervous system, heart and joints. There are also indications it affects endocrine function. Persistent hidden infection may also serve as a trigger for autoimmune disease. If you take a look at the numbers of people suffering from neurological problems, heart problems or joint problems all of unknown etiology, you have to wonder if our inability to cross this one particular infectious disease off the list of contributing factors is crippling research which might benefit a large segment of the general public. It doesn't matter if the problem turns out to be due to some unrelated factor, we won't be able to determine those factors until we clear such confounding factors out of the way.
I completely agree with your conclusion, and about the front end and the back end...I also think there needs to be some kind of leap forward in the understanding of what auto-immunity is, although I don't know enough about the subject to even suggest how you might go about determining which of the competing theories is true. It seems to me, though, that this confusion as to what 'auto-immunity' means has a knock-on effect on the research, particularly when it comes to determining the etiology of these diseases.
What I mean by this is that, if you define auto-immunity as the presence of auto-immune markers in a patient in which there are clinical signs of disease, and in the absence of an infectious process, then to determine whether something is an 'auto-immune' disease or not then you would first need to rule out whether there is an infective process at work in the patient.
Of course, this might not turn out to be the most useful definition of auto-immune disease, but whatever definition is used the research needs to be guided by it.
Of course, this might not turn out to be the most useful definition of auto-immune disease, but whatever definition is used the research needs to be guided by it.