Bullying Borrelia

General or non-medical topics with information and discussion related to Lyme disease and other tick-borne diseases.
Post Reply
Lorima
Posts: 914
Joined: Mon 29 Oct 2007 20:47

Re: Bullying Borrelia

Post by Lorima » Thu 17 Jan 2013 16:17

Henry wrote:Lorima:  Steere's work focuses on arthritis because he is a rheumatologist by training and practically all of his grant support is from the NIAMD. Most -- if not all -- Lyme disease researchers know that the serology in patients with Lyme induced arthritis is strikingly different and not typical of that seen in patients with late Lyme disease or neuroborreliosis. This is most likely due to the rather strong inflammatory response in the arthritic joints of such patients. I think Steere has been quite careful in confining his views to that pathology.
I don't see that "Steere has been quite careful in confining his views to that pathology", at all. To the contrary, I think he has vigorously and successfully sought to extend his diagnostic scheme, which he formulated based on his arthritis patients, to the whole field of LD. I can document this in detail, but it is so well-known that I am surprised you would question it. What makes you think Steere has been careful in this way? 
"I have to understand the world, you see."
Richard Feynman

hv808ct
Posts: 256
Joined: Wed 30 Jul 2008 4:11

Re: Bullying Borrelia

Post by hv808ct » Fri 18 Jan 2013 18:07

by Lorima » Wed 16 Jan 2013 16:48
I think this is going to have to change in medicine, now that PubMed, PMC, and open access publishing are making it easy for intelligent lay people to assess the medical literature. It's not that all of it is bad; just that there seems to be frighteningly low standard of discernment between what the evidence offered actually shows, and what "expert opinion" claims it shows.
“Intelligent lay people.” Three words that assume so much about science and expertise and the accessibility and comprehension of both.

This is what scientists complain about when confronted online by people with ‘Google PhDs’ and ‘Master’s degrees in Wikipedia’. More precisely, this is what Kruger and Dunning discovered in their 1999 study of students’ perceptions of their own abilities, and published as: “Unskilled and Unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments.”

Just because something is accessible does not mean it is comprehensible or accurate. The Internet contains a huge amount of “information”. But much of that information is in the form of rumor, myth, fantasy, conspiracy theory, lie, propaganda, insult, misinformation, disinformation, factual error, deception, and omission; all of it placed online by amateurs, activists, pundits, kooks, propagandists, conspiracy nuts, vandals, kids, crooks, con artists, cranks, and Wikipedia contributors masquerading as credentialed experts. It’s a morass of digital white noise, parts of which can only be navigated by persons with some degree of prior knowledge about a particular subject.

The “intelligent lay person” does not necessarily possess that prior knowledge or hands-on expertise. I am an “intelligent lay person.” Yet, that status does not encourage or entitle me to question Wiles’1993 proof of Fermat’s last theorem, the manner in which the Higg’s boson was detected, the role of Linear A and Linear B in the development of early Greek writing, the advantages of surgical interventions vs. drug interventions in cardiac care, the placement of flow meters in commercial plumbing schemes, or what is causing that deep rattle in my car’s engine when it idles. I’m not entitled to offer opinions on any of the above because I lack specific knowledge and hands-on experience in all of those fields. And for some of the above…I’m just not smart enough. I know that I don’t know certain things. Many things, actually. I’m aware of my ignorance and not terribly arrogant about what I do know.

In contrast, Lorima apparently assumes that because PubMed journals are accessible they are comprehensible, and having accessed them he/she will understand them and then be entitled to comment authoritatively on their contents and implications. ( Much like the woman questioning her child’s doctor in this related piece about ignorance and arrogance.) I wish I had that confidence.

Not only does Lorima assume too much, but by implication, he/she also dismisses the relevance of grad school, medical school, and every kind of advanced technical training or apprenticeship. Why bother with the hard work of acquiring skills and hands-on experience when you can just sit back and scroll through the Internet’s often dubious offerings, picking and choosing what to believe and what to question based on prior beliefs.

I suspect that Lorima—like many other “intelligent lay people”—assumes he/she actually is entitled to an opinion about various complex scientific, medical or technical subjects. Politicians and preachers do it all the time. Sorry, you’re not. You’re not entitled to opinions about the Higg’s boson, Mars rovers, the epidemiology of tick-borne viruses in North America, climate change, primate evolution or anything else. That’s for real experts who took the time and effort to become experts. You don’t get to dispute facts unless you are capable of generating alternative interpretations or additional facts, and that requires going through all of the trouble of actually learning, studying, experimenting, collaborating, etc.

What you are entitled to is an opinion about the implications of those facts, including associated costs, social implications, various policy options, etc.

Sorry, but that’s the way it is. Now bring up Google and type in “1999 Kruger Dunning” and read their paper.

TicksSuck
Posts: 100
Joined: Thu 31 May 2012 20:25

Re: Bullying Borrelia

Post by TicksSuck » Fri 18 Jan 2013 18:39

I’m not entitled to offer opinions on any of the above because I lack specific knowledge and hands-on experience in all of those fields.
One is always entitled to offer one's opinion even while lacking specific knowledge. (You are doing just that here with your opinion on Lorima.) It's to the intelligent specialists to decide if they will let themselves be influenced by this opinion.

Just my opinion :ugeek:

Lorima
Posts: 914
Joined: Mon 29 Oct 2007 20:47

Re: Bullying Borrelia

Post by Lorima » Fri 18 Jan 2013 22:26

hv808ct,

:roll:

I was brought up to believe that one should not judge people's intelligence or knowledge primarily by their credentials. I have a lot of respect for the people here who may not have advanced degrees, but have proved their good will, diligence, intelligence, and competence by their contributions here. You, not so much.

However, since you and maybe other Lyme establishment members seem to think it's important... I have a PhD in molecular and cellular biology. (I've said that before in the forum, but it hardly seems necessary, or polite, to say it repeatedly, for the benefit of people like you who drop in occasionally.) When my lab has something really hot, I publish in Cell. But I've also published in J Exp Med, J Cell Biol, J Biol Chem, BBRC, PNAS, etc. I have several publications with over 1500 citations.

It's true that I've only been following the Lyme disease field for about 6 years now, after having to step in and find diagnosis and treatment for sick family members, who were supposedly getting "the best medical care in the world" at the Harvard hospitals. It only took me a couple of days of reading the literature, to figure out that the mainstream Lyme dogma was a house of cards. It turns out that living with people whose health is being ruined by neglected Lyme disease, provides one with a kind of "specific knowledge and hands-on experience" that the experts are lacking, and making no effort to acquire. I was shocked at the state of the field, as are most of its victims, and I wouldn't have thought it was possible if I hadn't seen it myself. But I can hardly shrug my shoulders and ignore it, now that I know. Medicine had better get its act together, in this age of PubMed Central, and patients being able to compare notes on the internet.

Now, maybe Henry, if he's still participating, will answer my question.

(And thanks, TicksSuck.) :)
Last edited by Lorima on Sat 19 Jan 2013 0:06, edited 3 times in total.
"I have to understand the world, you see."
Richard Feynman

Lorima
Posts: 914
Joined: Mon 29 Oct 2007 20:47

Re: Bullying Borrelia

Post by Lorima » Fri 18 Jan 2013 22:48

{Repeating my question}
Henry wrote:Lorima:  Steere's work focuses on arthritis because he is a rheumatologist by training and practically all of his grant support is from the NIAMD. Most -- if not all -- Lyme disease researchers know that the serology in patients with Lyme induced arthritis is strikingly different and not typical of that seen in patients with late Lyme disease or neuroborreliosis. This is most likely due to the rather strong inflammatory response in the arthritic joints of such patients. I think Steere has been quite careful in confining his views to that pathology.
I don't see that "Steere has been quite careful in confining his views to that pathology", at all. To the contrary, I think he has vigorously and successfully sought to extend his diagnostic scheme, which he formulated based on his arthritis patients, to the whole field of LD. I can document this in detail, but it is so well-known that I am surprised you would question it. What makes you think Steere has been careful in this way? 
"I have to understand the world, you see."
Richard Feynman

User avatar
inmacdonald
Posts: 976
Joined: Fri 13 Jan 2012 22:32

Re: Bullying Borrelia

Post by inmacdonald » Mon 21 Jan 2013 19:50

Is New Knowledge "bullying" or is denial of "new knowledge" the real bullying?

Borrelia miyamotoi infection is co-transmitted with Lyme Borreliosis in the Northeastern USA
and elsewhere in the word.
Were a physician to rely on 2 tier CDC testing for Lyme Borreliosis,
the actual true diagnosis of B.miyamotoi would fail to be realized.

How many patients with Miyamotoi Borreliosis have been MISSED by Dr Auwaeter and Dr. Michael Melia??
How many other LB co-infections have been missed by Drs Auwaeter and Dr Melia because they
relied on negative results in 2 tier serologic LB testing and therefore did not
advance to testing for Microti Babesiosis, Ehrlichiosis (granulocytic and monocytic), Anaplasmosis, Coxiella burneti, and WA1 strain Babesiosis .?

If bullying is in play, it is Not the 600 member ILADS membership but rather the
10,000 membership IDSA.
Recall that the German Borreliosis Society, an academic society of German physicians with
a membership diagnosing One Million New Cases of Lyme Borreliosis in the German State, [calendar year 2012]
Have posting their objections to the IDSA guidelines and delivered a white paper document
to the IDSA Central Offices in Washington DC.

To Read the "Transations of the American Clinical and Climatological Association"
"Bullying Borrelia : when the culture ..." ...........................................
one would never learn about the
huge opposition of Board Certified German Republic physicians to the IDSA guidelines
and the support of the GBS for the ILADS guidlelines.


So Where is th bullying in terms of numbers?
Where is the bulling in terms of testimony of IDSA member physicians
before medical licensure boards with the intent of revoking medical licensure of ILADS
physicians.?
Where is the bullying by IDSA and EIS graduate physicians in taking editorial
rejection of proffered manuscripts which include clinical and basic science findings
which are at variance with IDSA guidelines.? But taking action to block the presentation of
scientific and medical manuscripts, the IDSA has so far succeeded in their mission to
restrict the access of the medical profession to practice experience by licensed MD's
in care of Lyme borreliosis patients which oppose the IDSA guidelines.

If there is a marauding cadre of bully pulpit Lyme practitioners, let it be exposed to the clear light of day to the public by its member numbers, actions at state medical licensing boards,
and Editorial power in USA published medical journals which publish Lyme borreliosis manuscripts.

The bully is the large bodied type with the big stick.
Let us be clear about who is Goliath and who is David.


Respectfully,
Alan B. MacDonald MD
January 21,2013

PS; ? CLIMATOLOGICAL ASSOCIATION??
Not the Journal of the American Medical Association, nor the Lancet, Nor Nature Medicine,
not PLOS Medicine. Whither .."climatological" association??

tosho
Posts: 282
Joined: Sun 16 Dec 2007 0:54
Location: Poland

Re: Bullying Borrelia

Post by tosho » Tue 22 Jan 2013 21:21

inmacdonald wrote: Recall that the German Borreliosis Society, an academic society of German physicians with
a membership diagnosing One Million New Cases of Lyme Borreliosis in the German State, [calendar year 2012]
One million new cases in Germany in one year? This is a completely unreliable information.

Lorima
Posts: 914
Joined: Mon 29 Oct 2007 20:47

Re: Bullying Borrelia

Post by Lorima » Tue 22 Jan 2013 22:46

Tosho, are you sure? Why? 

I'm not sure one way or the other; it doesn't come from an "official" source, but the official sources are all wrong, when it comes to Lyme disease, so I have to use other means of judging. It doesn't seem unreasonable to me, if primary care doctors in Germany are treating more liberally than in other countries we know about.

Here's a link to the figure; the actual number of cases given is 743,000, (close enough to a million, for chatting purposes.) 
{Edited to add: this is the figure/map for 2008, which was the one I found on the web. Dr. MacDonald says the analogous figure/map for 2012 (sure it's not 2011? pretty early for 2012 to be available) has one million cases.)
{Edited again to add: Dr. M has provided a reference for the 1,000,000 figure, here:
http://www.lymeneteurope.org/forum/view ... 471#p34075
It comes from a group at the University of Leipzig, and is referenced to Dr. Kistemann of the University of Bonn; more details have been given in another one of my posts, here:
http://www.lymeneteurope.org/forum/view ... 471#p34094
The one million number, for doctor's office visits, seems to be true. It doesn't necessarily translate into one million new cases, however, as far as I can see. It also doesn't include cases for which a doctor was not consulted, or that were misdiagnosed as something else.}




http://magazin.bfbd.de/de/90.html?det=126&cd_fk=210 

This is from the DBG (Deutsche Borreliose-Gesellschaft=German Borreliosis Society) which I like. It uses the ILADS disease model, which matches what I see in my community. But I'm sure they're scorned by IDSA and EUCALB. 

The population of Germany is about 82 million. So 743,000 (see map info) would mean an incidence of 0.9% (see second map). 

If this is the number treated, which I would suspect is what you would get by counting codes for insurance payouts, that would be 1 out of 100 citizens treated, in a year. That doesn't seem crazy, to me, in a region with this kind of seropositivity (see PLOS One paper, below.) It's clear that they should get really serious about tick-bite prevention, as should we all.

The authors of the map (whom I can't determine, which I don't like) are using the diagnostic code for Lyme disease, A69.20. 

Here's a link to diagnostic codes: 

http://www.icd10data.com/ICD10CM/Codes/ ... 69-/A69.20 

A69.20 seems to be "Lyme disease, unspecified". 

Maybe this includes everyone who gets a few weeks of doxycycline, and in Germany, perhaps many doctors are not afraid to treat right away after an Ixodes tick bite, like that ID doctor in Pittsburgh, PA, US recommended. 
http://pittsburgh.cbslocal.com/2012/09/ ... e-disease/
Arguing against this, and for the idea that these numbers are for actual EM, is the mention of erythema migrans in the figure legend - but it looks to me as if the code A69.2 is "Lyme disease, unspecified," which means that those treated for tick bite alone would probably be coded this way. 

Looking at PubMed sources, here's one on seropositivity from an IDSA/EUCALB-respectable source (Fingerle is the name I recognize). 

http://www.plosone.org/article/info%3Ad ... ne.0041321 
PLoS One. 2012;7(8):e41321. doi: 10.1371/journal.pone.0041321. Epub 2012 Aug 15.
Seropositivity of Lyme borreliosis and associated risk factors: a population-based study in Children and Adolescents in Germany (KiGGS).
Dehnert M, Fingerle V, Klier C, Talaska T, Schlaud M, Krause G, Wilking H, Poggensee G.
Source
Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.
Abstract
BACKGROUND:
Lyme borreliosis (LB) caused by spirochetes of the Borrelia burgdorferi sensu lato complex is the most common tick-borne disease in the northern hemisphere. Data on the distribution and on risk factors in Germany are sketchy.
METHODOLOGY/PRINCIPAL FINDINGS:
Blood samples of a nationwide population-based cross-sectional study from 2003-2006 in children and adolescents aged 1 to 17 years in Germany (KiGGS) were analysed (n = 12,614) to assess the seroprevalence of anti-Borrelia antibodies. Data from standardized interviews were used to assess potential risk factors. First, sera were screened for anti-Borrelia antibodies by ELISA. The overall prevalence was 4.8% (95% confidence interval (CI) 4.3-5.4%). Positive and borderline ELISA test results were confirmed by a line blot revealing a combined prevalence of 4.0% (95% CI 3.6-4.5%). Seroprevalence of ELISA was significantly higher in males (odds ratio (OR) = 1.37; CI 1.15-1.63) and in the southern part of Germany (OR = 1.41; CI 1.09-1.83), but significantly lower in children and adolescents with migration background (OR = 0.33; CI 0.24-0.44). Study participants from households with cats had a higher chance of seropositivity (OR = 6.7; CI 5.6-8.0). In a multivariable model the odds of seropositivity increases by 11% for every year of age for boys and 6% for girls.
CONCLUSIONS/SIGNIFICANCE:
This survey is the first nationwide, representative seroprevalence survey of LB in children and young adolescents. The study shows that infections with Borrelia burgdorferi are endemic in all parts of Germany despite regional differences. Even at a young age children are exposed to tick bites including seropositivity. Encouraging a thorough check for ticks and promptly removal of ticks are the key public health strategies to reduce the risk of LB and other tick-borne diseases in children and adolescents. Further epidemiological studies are warranted to better understand the burden of disease related to LB.
PMID: 22905101 [PubMed - in process] PMCID: PMC3419690 Free PMC 

snip
In children aged 1 year and older the risk of seropositivity increased by 6–11% each year and at the age of 17 years, 7% of children and young adolescents have already experienced at least one tick bite with successful seroconversion. However, it has to be kept in mind that IgG antibodies can persist for over 10 years [30]. Therefore the true age of a child or young adolescent at the time of infection cannot be determined and the seroprevalences seen in the different ages reflect the cumulative incidence proportion. Children and young adults with migration background were less likely to be seropositive. One possible explanation for this finding could be less exposure to ticks due to different factors such as origin from non-endemic country or behavioural factors.

In our study, residence in rural areas and small towns was a risk factor for seropositivity. Residence in forested areas has been identified as risk factor for Lyme borreliosis in the USA and in Europe [31]–[33]. Our findings are in concordance with the results of population-based studies from the southern part of Germany revealing high incidences of Lyme borreliosis in rural areas of Baden-Württemberg and Bavaria [6], [12]. However, in our study we observed seroprevalence as high as 3.7% in metropolitan areas. Foci of borrelia-infected ticks have been demonstrated in urban parks and private gardens in Europe with infection rates up to 55% [34]–[38]. Furthermore, rodents such as the Norway rat (rattus norvegicus) and the black rat (rattus rattus) which can be a pest in metropolitan cities can act as reservoir host possibly enhancing the risk of Lyme borreliosis [39].

snip

Serological assays

The sera were tested at the National Reference Centre for Borrelia for the presence of anti-Borrelia IgG antibodies.

ELISA.

For screening an enzyme-linked immunosorbent assay (ELISA) (Enzygnost Lyme link VlsE/IgG, Siemens Healthcare Diagnostics GmbH, Eschborn, Germany) was used. This quantitative ELISA is based on a detergent extract from cultured B. afzelii (strain PKo) mixed with recombinant VlsE from B. burgdorferi s.s. (strain B31), B. afzelii (strain PKo), and B. bavariensis (strain PBi). The test was automatically processed on a BEP®III (Siemens Health Diagnostics GmbH, Eschborn, Germany) and interpreted as recommended by the manufacturer. Validation studies for this ELISA have been published [43], [44].

Line blot.

As a confirmatory assay a line blot was performed (Borrelia Europe plus TpN17 LINE, IgG, Virotech, Rüsselsheim, Germany). This test includes the purified antigens OspC, DbpA, and p83 (all from B. afzelii strain PKo) and the recombinant antigens VlsE (from B. burgdorferi s.s. strain B31 and B. garinii strain IP90), BmpA (PKo), DbpA (from B. garinii strain PBr, B. bavariensis strain PBi, and B. spielmanii). Antigens are bound separately to a nitrocellulose membrane either as single antigens or in case of VlsE and DbpA as a mix of the respective antigens. The test was performed and interpreted according to manufacturers recommendations.

Seropositivity

Results of ELISA and line blot were categorised as negative, borderline or positive. A subset of samples - determined by the availability of sera - with a positive or borderline ELISA test result, was subjected to line blot to confirm the test result. Results of ELISA as well as combined results of ELISA and immunoblot were considered. To combine results the following rules were applied: In case of both a positive ELISA and immunoblot test result, the sample was categorised as positive. In case of a borderline test results from both tests, the sample was categorised as negative. In case of discordant test results, the sample was categorised as negative, except in cases involving a borderline ELISA test result and a positive immunoblot result or vice versa; then the sample was categorised as positive. Samples with borderline or positive result in ELISA, that due to lack of sera, missed out on immunoblot results were categorised as missing. Samples with negative test results in ELISA, that were not further tested by immunoblot, were categorised to be negative.
Last edited by Lorima on Fri 25 Jan 2013 19:45, edited 2 times in total.
"I have to understand the world, you see."
Richard Feynman

User avatar
inmacdonald
Posts: 976
Joined: Fri 13 Jan 2012 22:32

Re: Bullying Borrelia

Post by inmacdonald » Wed 23 Jan 2013 14:37

Dear Tosho:

the ONE MILLION new Lyme borreliosis cases diagnosed in Germany
is correct for year 2012 alone.
It is based on mandatory public reports from German Health Insurance
companies based on PAID CLAIMs.
A map of case numbers for each of the regions of Germany is Posted
on the Net.
If you need to see the 2012 map, I will request it from my colleague
Dr Armin Schwartzbach , a physician member of the German Borreliosis
Society.
Best,
Alan

tosho
Posts: 282
Joined: Sun 16 Dec 2007 0:54
Location: Poland

Re: Bullying Borrelia

Post by tosho » Wed 23 Jan 2013 16:18

Sorry, I don't buy one million new cases in one year in Germany at all. TBDs are a serious medical problem, but please don't make such hysteria if you want to be treated seriously by others.

Post Reply