Monday, 7 December 2009


Well done Canlyme for the following response to AMMI

Press Release [published in the Canadian Health Reference Guide Nov. 25th, 2009] Copy To: Gwen Lovagi, Association of Medical Microbiology and Infectious Disease (AMMI) Canada From: Janet Sperling, Canadian Lyme Disease Foundation Re: CTV W5 Story – Lyme disease Debate (press release of 20 November 2009) It is encouraging to see that the AMMI is willing to keep the debate over Lyme disease open in a public forum like a press release. The Canadian Lyme Disease Foundation has been struggling for years to increase the transparency of the debate. Similarly, working with the investigative reporters of CTV’s W5 has been an opportunity to work with some of the best investigative journalists in Canada and we have welcomed their incisive input. We are in complete agreement that our ultimate goal is to protect and educate the public through the promotion of accurate diagnosis, prevention and treatment of human disease. We also agree with the statement that there is no need to alarm the public needlessly. Working with W5 allowed us to demonstrate that there is hope for the many Canadians who are struggling with Lyme disease. Among the three cases highlighted by the W5 documentary, one showed a full recovery and one showed a partial recovery, both of which responded well to antibiotics under medical supervision. These cases showed that there is hope and that education about Lyme disease is the key to recovery. The importance of such education was clear throughout the W5 documentary, as all the featured patients were faced with disbelief by their Canadian physicians that they were suffering from Lyme disease. Since the AMMI is in agreement that Lyme is much more treatable in its early stages, it is logically obvious that widespread education is essential to early diagnosis and treatment. For late stage Lyme disease, W5 documented that some Canadians have recovered from serious Lyme-like illnesses that responded positively only when treated by those educated in the complexities of Lyme disease. We do not believe that it is helpful for the AMMI to deflect attention away from antibiotic-treatable late stage Lyme disease by highlighting an old hypothesis that such illness is purely an induced autoimmune disorder. Not only has no useful treatment been developed on the basis of this hypothesis, but the weight of recent peer reviewed research has failed to support it. If the AMMI has reason to believe that we are wrong in this assessment of the autoimmune theory of late stage Lyme disease, then we would welcome a rebuttal supported by evidence.We are pleased to see that the AMMI has emphasized the importance of ‘epidemiologic findings about the likelihood of exposure to ticks’. However, it is important to remember that this logic may be mistaken to mean that people living outside of restricted areas should not have their Lyme symptoms taken seriously, which would allow them to progress to a stage that is more difficult to treat. Ground cover with oak leaves is only partially correlated with vector distributions, and dispersal of Ixodes ticks on birds migrating to areas distant from oak forests has been well documented. In the interests of accuracy, we note that the 2008 AMMI conference (1) referred to by the AMMI press release included only a single talk, not a symposium, on the epidemiology of Lyme disease. This plenary talk was presented by an American doctor. There was also a single poster presentation on Lyme disease at this conference. Interestingly, this poster demonstrated that Lyme disease was found in a dog in Alberta as well as in an Ixodes cookei tick removed from that dog. Thus the AMMI is aware that Borrelia burgdorferi (which is spelled with only one i, not two as in the press release) can be found in a putatively non-endemic areas of Canada and that tick vectors other than I. scapularis or even I. pacificus may be involved.We also wish to correct the AMMI press release statement that ‘One of the issues raised in the W5 story is the stated “fact” that 19,000 cases of LD have been seen in US Border States’. W5 did not say that, neither in the episode that was aired which gave the number as "closer to 15,000 a year" nor in the accompanying website text where it was given as 'nearly 13,000’ (2). We were surprised to see the AMMI suggesting possible over-reporting of Lyme disease in the United States. To our knowledge, this is the first such indication by a professional organization that US government Centers for Disease Control statistics on Lyme may have been tainted by interference 'engendered by a medical system that pays substantial dividends to both laboratories and physicians for the diagnosis and management of purported “chronic” LD'. In contrast, the CDC’s Morbidity and Mortality Weekly Report for May 7 2004 (3) states that 'Studies from the early 1990s suggested that LD cases were under reported by six to 12-fold in some areas where LD is endemic; the current degree of underreporting for national data is unknown'. In this light, we believe that it would have been more appropriate for the AMMI to claim biases in US CDC statistics in the presence of supporting evidence. Finally, we are glad to know that 'AMMI Canada doctors are at the forefront of antibiotic resistance issues and are confronting the over-use and misuse of antibiotics'. Antibiotic resistance is a serious problem in Canada and it is arguable that the largest component of this problem is due to the extensive use of antibiotics in animal feed at sub-therapeutic levels for economic gain (e.g. 4). We certainly support continued research into the responsible use of antimicrobials. We’re grateful that W5 journalists were willing to discuss the difficult situation that surrounds Lyme disease, particularly in the Canadian context. We look forward to continued discussion with AMMI Canada, whether in a public or private forum. 1) AMMI Canada Annual Conference 2008 Final Program last accessed 23 November 2009. 2) last accessed 23 November 2009, audio statement at 7:20 3) Morbidity and Mortality Weekly Report 53 (17): 365-369. last accessed 23 November 2009 4) CIPARS 2007 Farm Surveillance Preliminary Results last accessed 23 November 2009 TOP

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