Bull’s Eye
Unraveling the Medical Mystery of Lyme Disease
Jonathan A. Edlow,
M.D.
Yale University Press 2003
Reviewed by Doug
Fearn for ILADS
The author is a 1978
graduate of the University of Maryland medical school and is currently the
vice-chairman of emergency medicine at Beth Israel Deaconess Medical Center
and assistant professor of medicine at Harvard Medical School. He is a frequent
lecturer on Lyme disease (where he lectures is not specified).
The book is written
for the layman and starts with the usual history: Afzelius, Garin, Bujadoux,
Hellerstrom, Lennhoff, Bannwarth, Steere, Malawista, Polly Murray, Burgdorfer,
etc. ILADS members will find nothing new here. In fact, there’s nothing
new anywhere, except perhaps a glimpse into how most of the medical community
views Lyme disease.
He credits many doctors
with providing interviews; not one is an ILADS member, although a couple
of our members are referenced. Interestingly, Edlow complains of a reluctance
on the part of some of his previous sources to speak to him after 2000.
Although not mentioned specifically, it’s pretty easy to determine
that Alan Steere is one who refused to talk with him during the last couple
of years even though there seems to have been a lot of communication between
them ten years ago. Edlow started the book project in 1993 but put it aside
for several years before finishing it up just after the Ninth International
Conference on Lyme Borreliosis and Other Tick-Borne Diseases in August 2002.
There are photographs of fourteen Lyme disease luminaries, but Steere is
notably absent although he is quoted on many pages.
The increased incidence
of LD is attributed solely to the increase in the deer population. Ehrlichiosis
and Babesiosis are covered as additional tick-borne co-infections, but Bartonella
is only briefly mentioned as a bacterium found in ticks (but its ability
to infect humans is unknown). Under-reporting of tick-borne diseases is
acknowledged.
Laboratory testing
is covered in a couple of chapters, with lengthy explanations of sensitivity
and specificity and how they relate to test accuracy. Several tables detail
how a test with 95% sensitivity and 95% specificity can still lead to a
high percentage (up to a third) false positives. The ELISA test is faulted
for its high false positives. Someone with a better understanding of statistics
than I have would have to decipher this section and see if it is accurate.
The Western Blot test
is given a marginally higher grade than the ELISA. The author seems ambivalent
about the Dearborn two-tiered test procedure. PCR is discussed only as a
tool for evaluating museum and historical medical specimens.
The LYMErix vaccine
story seems reasonably accurate, although the fact that the vaccine is no
longer marketed is only mentioned in the epilogue.
A lot of ink is used
to support the “less-is-more” antibiotic treatment position, with
acknowledgment of “alternative” treatments. Dr. Joseph Burrascano
is placed in this alternative camp, almost as a cult figure, covered in
a few sentences. The author then devotes almost an entire chapter to Henry
Heimlich’s malaria treatment (although not with much enthusiasm for
the idea).
“Conventional”
doctors like Steere are presented as the experts on the disease, and are
acknowledged as being paid by insurance companies for their advice on the
presence of Borrelia infection.
In an epilogue, the
Ninth International Conference is characterized as a bizarre event with
a rabble of “alternative” proponents prevented from expressing
their views.
Absent is any mention
of L-forms, cyst-forms, and their potential to explain a lot of the puzzle.
I think the ten-year
writing time has taken a toll on this book. Old information is mixed with
new, and several chapters seem to just run out of steam and stop without
any real conclusion.
Someone outside the
Lyme community would take away the impression that there are a bunch of
level-headed, careful researchers who characterize the disease as hard to
catch and easy to cure, and a larger group of “alternatives” who
see LD in every patient and believe that endless antibiotics are the answer.
The author speculates that both camps are probably only partially correct,
and uses scientific (Copernicus) and medical (peptic ulcer) history to support
the notion. (Of course, in those two examples, the “rebels” were
ultimately proven to be correct.)
The promise of the
sub-title, “Unraveling the Medical Mystery of Lyme Disease,” is
not fulfilled; Lyme disease is still a mystery despite this book.
I believe Edlow is
trying to be objective and present both sides of the issue, but his failure
to have a point of view ultimately makes the book unsatisfying.
— D.W. Fearn
http://www.dwfearn.com
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