British billionaire's family stricken

General or non-medical topics with information and discussion related to Lyme disease and other tick-borne diseases.
duncan
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Re: British billionaire's family stricken

Post by duncan » Fri 18 Dec 2015 12:46

Henry: You failed to answer my question. Moreover, my question is not diagnostic; I am asking if you are stating that no one can be seronegative with Lyme unless they have an EM.

As to which alphabet wants to lay claim to the 2T is not the issue: The issue is the purported universal accuracy of the 2T vs real world results. However, it would be interesting to know who was involved in the evolution of the 2T that eventually was promulgated by the CDC and stamped by the FDA. Trace back to check the cast of characters who levied influence, from Dearborn and even earlier. I'd wager there'd be a few names we'd recognize.

Also, did you do as I suggested? Check early C6 studies to see how they justified the need for the C6?

Henry
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Re: British billionaire's family stricken

Post by Henry » Fri 18 Dec 2015 15:19

Duncan: I was referring only to the criteria for enrollment to the seronegative arm of the Klempner study. I could speculate on other possibilities, but won't.

The alphabet you mention wasn't an issue to you, but it was to Lorima to whom my remarks were directed.

I may check the early C6 studies if I have time..............However, they were covered in the recent review by Schriefer. They show (Table 3) that C6 is more sensitive than 2T testing during early infection with EM; however, C6 and 2T testing are equally sensitive and specific during late disease (stage 3). In 2001, C6 was approved by the FDA to replace the conventional ELISA as the first-tier test -- because of its greater specificity, obviously due to the use of a specific peptide as a ligand in the assay. That decision came as a result of extensive comparative studies over the past few years. The trend now seems to be the eventual replacement of non-quantitative Western blots with quantitative ELISAs using define ligands, many of which are now being tested and look to be most promising. The establishment (by the CDC) of a reference reagent repository should accelerate these efforts and enable one to compare the results obtained with new vs old tests using the same panel of reference specimens. All that is discussed in the last part of the review article.

duncan
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Re: British billionaire's family stricken

Post by duncan » Fri 18 Dec 2015 15:44

Eh. I am not asking about your article.

Go read the actual studies. 1999 Journal of Clinical Biology. Journal of Clinical Biology again in 2002. There are others as well. The C6 at one point seems to actually have been touted as being more accurate for late stage diagnosis than the 2T. How can that be? The C6 excellence for late stage cases is also one of the reasons it was recommended for use in Lymerix-vaccinated people. It would appear that you may be misunderstanding some important basics here, but who knows unless you invest some time reading.

BTW, did you know that back in 1999 62% of so-called PTLDS patients in a study registered as positive for infection based on the C6?

Things began to change after 2005. The Steere et al paper in 2008, for example. Anyway, you may wish to hone up on your diagnostics' history.

One last question: If the 2T is so invariably accurate, why are some advising clinicians to take its results with a grain of salt depending on geographic location - like, say, North Carolina?

Lorima
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Re: British billionaire's family stricken

Post by Lorima » Fri 18 Dec 2015 16:03

Henry wrote: "Lorima: A close examination of the IDSA guidelines reveals that they do not address the issue of diagnosis."

Oh my dear Henry.
What on earth can you be thinking?
The whole point of the guidelines is to instruct physicians on diagnosis and treatment of these diseases.

You are making things up again. And stating them with such spurious certainty! You are supporting my view that there is no use discussing science with you, since you can't even remember what the IDSA guidelines say.

The IDSA guidelines' very first paragraph says the following, in italics for emphasis:
"Clinical findings are sufficient for the diagnosis of erythema migrans, but clinical findings alone are not sufficient for diagnosis of extracutaneous manifestations of Lyme disease or for diagnosis of HGA or babesiosis. Diagnostic testing performed in laboratories with excellent quality-control procedures is required for confirmation of extracutaneous Lyme disease, HGA, and babesiosis."

Please refresh your memory where necessary, and make a commitment to tell the truth, at least about simple, easily verifiable, verbal matters.
Here is the link:
http://m.cid.oxfordjournals.org/content/43/9/1089.full

I'll say more about your other inaccuracies in a follow-up comment, to avoid the TL;DR problem.
"I have to understand the world, you see."
Richard Feynman

Henry
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Re: British billionaire's family stricken

Post by Henry » Fri 18 Dec 2015 17:09

Lorima: You are wrong and that is not a fair assessment, to say the least. Aside from making general statements on diagnosis, the IDSA guidelines deal mainly with treatment. They do not get into any details with respect to diagnosis , e.g., the algorithim for 2T testing , the criteria for interpreting Western blots , sensitivity, specificity -- any thing like that. You have to go to the CDC and FDA website for specific details and information like that. Since the IDSA guidelines deal mainly with treatment, they start with the assumption that one is dealing with patients who have been correctly diagnosed -- as the remarks in the first paragraph state. However, they don't get into diagnosis any further than that general statement.

Duncan: I'm reading.....................

duncan
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Re: British billionaire's family stricken

Post by duncan » Fri 18 Dec 2015 17:29

Henry, while you are reading, you may wish to take another look at the IDSA Guidelines, which do in fact offer insights into diagnostics. For example: "Background and Diagnosis of Early Neurologic Lyme Disease".

Henry
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Re: British billionaire's family stricken

Post by Henry » Fri 18 Dec 2015 17:53

Duncan: Once again, another general statement with regard to clinical findings. Obviously, the IDSA guidelines can not be considered -- or intended-- to be a primary reference on the diagnosis of Lyme disease. They defer to the CDC in that regard.

duncan
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Re: British billionaire's family stricken

Post by duncan » Fri 18 Dec 2015 18:07

And yet they do offer diagnostic insights; for instance, the possibility of using an IA metric with a CSF exam.

I thought you said "they don't get into diagnosis..."

Sorry, don't mean to nit-pick, but it was you who lectured earlier about the need for accuracy.

Henry
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Re: British billionaire's family stricken

Post by Henry » Fri 18 Dec 2015 18:26

Duncan: Let me put it this way. Even though it does contain some useful information on diagnosis, do you consider the IDSA guidelines to be a complete and definitive source of information on the diagnosis of Lyme disease? Much of the information they provide on diagnosis is general. Certainly much more detail can be found in other publications dedicated specifically to diagnosis, notably, the CDC and FDA websites.

duncan
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Joined: Wed 5 Sep 2012 18:48

Re: British billionaire's family stricken

Post by duncan » Fri 18 Dec 2015 18:39

I guess one of my points here is this: In medicine, there should be no circumstances where researchers are allowed - or even encouraged - to round off. (I suppose I need to clarify that this observation is both literal and metaphorical.) The admonition is especially pertinent to Borrelia and other TBDs, if only because of the sheer number of infected. Every mistake made is compounded when it is ignored and new mistakes forged because of that turning a blind eye to earlier errors. Possible case in point: TBD diagnostics.

But at least we agree that accuracy is important.

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