As the authors so rightly pose we need International and Transcontinental perspectives which also include patients in the process. For too long the IDSA small cohort who wrote the IDSA Lyme disease guidelines have held too much control and power Worldwide, using their narrowly held beliefs to dictate policies to our Health Authorities. There is now far too much scientific evidence that shows their restrictive view to be no longer valid for many people with Lyme Disease complex.
Evolving Perspectives on Lyme Borreliosis in Canada
J.L.H. Sperling, M.J. Middelveen, D. Klein, and F.A.H. Sperling
Link to the full paper here
With cases now documented in every province, Lyme borreliosis (LB) is emerging as a serious public health risk in Canada. Controversy over the contribution of LB to the burden of chronic disease is maintained by difficulty in
capturing accurate Canadian statistics, especially early clinical cases of LB.
The use of dogs as sentinel species demonstrates that potential contact with Borrelia burgdorferi spirochetes, as detected by C6 peptide, extends across the country. Dissemination of infected ticks by migratory birds and rapid establishment of significant levels of infection have been well described.
Canadian public health response has focused on identification of established populations of the tick vectors, Ixodes scapularis and I. pacificus, on the assumption that these are the only important vectors of the disease across Canada. Strains of B. burgdorferi circulating in Canada and the full range of their reservoir species and coinfections remain to be explored. Ongoing surveys and historical records demonstrate that Borrelia-positive Ixodes species are regularly present in regions of Canada that have previously been considered to be outside of the ranges of these species in recent modeling efforts.
We present data demonstrating that human cases of LB are found across the nation.
Consequently, physician education and better early diagnoses are needed to prevent long term sequelae. An international perspective will be paramount for developing improved Canadian guidelines that recognize the complexity and diversity of Lyme borreliosis.
An International and transcontinental perspective on LB is needed to better understand the complexity of this disease as it currently exists in Canada.
With diagnostic options narrowly focused on those appropriate to the eastern USA, Canadian patients have been restricted in their access to health care.
Development of better testing and emphasis on patient outcomes is needed, including more opportunity for adaptive approaches and more comprehensive documentation of outcomes.
Such conditions allow better clinical diagnoses and treatments that take into account the diversity of Borrelia genotypes as well as their coinfections and regionally variable ecological circumstances.
These improvements are particularly important in the context of government funded healthcare where avoidance of chronic illness is more consciously tied to broader economic as well as societal benefits.
Difficult-to-diagnose diseases are not only a challenge to our current paradigms for medical research and administration.
Much is at stake in resolving such problems, since successful public healthcare is considered by many Canadians to be a defining characteristic of the Canadian state .
Consequently, Lyme patients who abandon the Canadian medical system are a sign of a fundamental incompatibility between their perceived needs and what the current Canadian system provides, and in doing so they are part of the thin edge of a wedge that may alter this system in fundamental ways.
Successful resolution of these conflicts will depend on action by both patients and physicians, ideally via cooperation rather than conflict. But for hundreds and perhaps thousands of Canadians the means matter less than the desired endpoint,which is timely treatment and effective care for people who suffer from the debilitating conditions that characterize Lyme borreliosis.
Pub med here
Pub med here