Lyme neuroborreliosis as described in 1999

[Spanky]

"RitaA":

The title of this thread clearly indicates that I was posting an article about how Lyme neuroborreliosis was viewed and described in 1999.

Yeah, thanks, got that.

And I was responding to this statement:

RitaA: It contains a lot of detailed information about the differences between early and late neuroborreliosis.

...and pointing out that the most recent set of treatment guidelines point out that that "difference" is more one based on tradition than "a pathophysiological basis for this distinction".

Now...why anyone would object to, or quarrel with, my pointing that out is, frankly, sort of mystifying... I mean, that is the statement...it is clear... and it would appear to simply acknowledge that the distinctions between early and late may be somewhat blurred. And it appears to be geared toward protecting the patient in that circumstance.

And in general terms, as I said, there seems to be a practice of trying to play "gotcha" by digging through old abstracts and trying to find contradictions...when the 'contradiction' is simply due to more and better information being available today. A clearer and better persepective.

Also..."some people", here, seem to be obsessing on trying to play some peculiar word games with definitions, semantics...and I am, gain, trying to point out the simple futility of that...(not that I have any hope of it doing any good, whatsoever)

[RitaA]

...and pointing out that the most recent set of treatment guidelines point out that that "difference" is more one based on tradition than "a pathophysiological basis for this distinction".

Now...why anyone would object to, or quarrel with, my pointing that out is, frankly, sort of mystifying... I mean, that is the statement...it is clear... and it would appear to simply acknowledge that the distinctions between early and late may be somewhat blurred. And it appears to be geared toward protecting the patient in that circumstance.

Spanky,

You make a good point about the distinctions between early and late Lyme disease becoming more blurry as new case studies and the results of research are published. I also agree that this is intended to protect the patient by encouraging medical professionals to remember (or learn) that Lyme disease may present in any number of ways -- not always following textbook descriptions.

And in general terms, as I said, there seems to be a practice of trying to play "gotcha" by digging through old abstracts and trying to find contradictions...when the 'contradiction' is simply due to more and better information being available today. A clearer and better persepective.

I must admit that I find some of the older articles very educational and of historical interest. One thing I've noticed is that some authors do a better job of recapping related published articles and former research than others. This is likely based on the asssumption that anyone interested in learning more will do a bit of fact finding themselves, and this makes perfect sense to me.

Once in a while I'll just happen upon something that hasn't previously been posted here on LNE, and that's what happened with the article that prompted this thread. I'd like to think I'm contributing to the already impressive collection of published articles on this site.

Also..."some people", here, seem to be obsessing on trying to play some peculiar word games with definitions, sematics...and I am, gain, trying to point out the simple futility of that...(not that I have any hope of it doing any good, whatsoever)

Yes, well good luck with that "mission impossible"!

[Spanky]

"RitaA":

You make a good point about the distinctions between early and late Lyme disease becoming more blurry as new case studies and the results of research are published.

Perhaps. But my point is really intended to be limited to the specific passage that involves early/late neurologic Lyme disease only.

But I also wanted to bring that section up, as it may provide the answer to Duncan's question as to why the word "usually" was used. And I am not trying to suggest that the traditional stage classification has no relevance, whatever...and I certainly don't think that is what the IDSA is saying, either.

"Spanky":

Also..."some people", here, seem to be obsessing on trying to play some peculiar word games with definitions, semantics...and I am, again, trying to point out the simple futility of that...(not that I have any hope of it doing any good, whatsoever)

Yes, well good luck with that "mission impossible"!

Seems to me, that looking at the Guidlelines, you do see that, to some extent, the text is organized by stage.

But if you look at specific recommendations, those, for instance, where ivs are recommended, or repeat courses...what you get seems to be recommendations very much aligned with the degree of patient involvement.

[duncan]

Spanky, sorry, didn't mean for you to think I had left a question out there. My observation about researchers like Wormser employing vague terms like "usually" was merely that, an observation. The tendency can be problematic, and even dangerous - but it certainly isn't restricted to Wormser. Just so happens his name is one of those panelists you referred to. Panelists who in the late neuro section of the IDSA guidelines refer to a study with clinical cure rates of 70%, and wrote in summation the dosage in question was "...effective in resolving illness in the majority of patients with late Lyme disease." My problem is the somewhat cavalier manner that the panel wields the word "majority." The use IS accurate, but that 30% left outside of the box is somewhat abandoned it seems to me, left to fend for themselves. While I am an advocate of democracy, its limits are readily apparent in research circles. If there are 1000 late stage NB sufferers out there, and this particular study cited in the guidelines is accurate, and one doctor treats those 1000, he/she might think 999 will be cured(afterall, that is a majority), when in fact one third will be turned back into the streets very ill. "Majority". "Usually". Words like that in seminal writings can be misinterpreted is the point I was making, even when the supporting percentage is provided. Like a fish tale over time...

[Spanky]

"duncan":

Spanky, sorry, didn't mean for you to think I had left a question out there. My observation about researchers like Wormser employing vague terms like "usually" was merely that, an observation.

Okay. Then I would say that the section I quoted may explain your "observation", then.

The tendency can be problematic, and even dangerous - but it certainly isn't restricted to Wormser.
Just so happens his name is one of those panelists you referred to. Panelists who in the late neuro section of the IDSA guidelines refer to a study with clinical cure rates of 70%, and wrote in summation the dosage in question was "...effective in resolving illness in the majority of patients with late Lyme disease." My problem is the somewhat cavalier manner that the panel wields the word "majority." The use IS accurate, but that 30% left outside of the box is somewhat abandoned it seems to me, left to fend for themselves.

Well, as you, yourself noted, the use of the word "majority" is accurate. When there is inherent ambiguity or imprecision, I think that the language chosen probably needs to reflect that.

And writing guidelines for a situation where there are so many variables, I would assume, could well be a daunting task. I think that their choice of words is somewhat hard to quibble with when they are trying to convey the sense that the word chosen actually implies.

While I am an advocate of democracy, its limits are readily apparent in research circles. If there are 1000 late stage NB sufferers out there, and this particular study cited in the guidelines is accurate, and one doctor treats those 1000, he/she might think 999 will be cured(afterall, that is a majority), when in fact one third will be turned back into the streets very ill. "Majority". "Usually". Words like that in seminal writings can be misinterpreted is the point I was making, even when the supporting percentage is provided. Like a fish tale over time...

Yes, what the critics of the Guidelines often focus on is really a question of degree, of emphasis...and whether or not the chosen language suits their perception of the matter at hand.

And in addition, there is a tendency for the detractors to fault the IDSA for mistakes made by practitioners in diagnosis and treatment, as if the language chosen by the IDSA could somehow prevent that from happening.

What I have also noticed, is that online laypersons seem to feel that they are competent to read, comprehend and analyze technical documents written for a professional audience and place them in proper perspective.

Doubtful, at best.

[duncan]

Exactly! The pervasive use of Latin always throws those pesky impertinent "online laypersons." They need to know their place.

[Spanky]

"duncan":

Exactly! The pervasive use of Latin always throws those pesky impertinent "online laypersons." They need to know their place.

Well...

...they simply need to know what it is that they don't know.

You'd be surprised how many people don't know this.