Friday, February 27, 2015

Lyme disease: a review of its epidemiology, evaluation, and treatment.

This is a letter to the Executive Director of Psychosomatics Journal by Lyme disease patient advocate and activist Carl Tuttle, from HudsonNH. There are some very important points he makes here, such as how very quickly a tick can infect a human, how many patients do not see a skin rash after a tick bite, and whether infection persists after antibiotic therapy. At the end of this post you'll find 19 external links to articles, studies, case reports and letters to editors, as well as a list of legislators working on Lyme bills to help patients reclaim their health and Lyme-Literate doctors to protect their private practices and continue to serve the Lyme community 


Psychosomatics. 2014 Sep-Oct; 55(5):421-9. doi: 10.1016/j.psym.2014.02.006. Epub 2014 Apr 19.

Gerstenblith TA, Stern TA.

Consultation Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Avery D. Weisman Psychiatry Consultation Service, Massachusetts General Hospital, Boston, MA. Electronic address:

Feb 25, 2015

The Journal of Consultation and Liaison Psychiatry
James Vrac, Executive Director
Editor-in-Chief: Theodore A. Stern, MD, FAPM,

Dear Executive Director Vrac,

I would like to call attention to the article published in Psychosomatics coauthored by Psychosomatics Editor-in-Chief: Theodore A. Stern, MD, FAPM.

It is difficult to accept that this article was approved through a "peer-review process" as there appears to be a bias viewpoint of Lyme disease with a great deal of missing and or misleading information.

For example,

Misleading information:

#1 "The transmission of the spirochete requires that the tick be attached to the new host for24–48 hours."

Stricker et al describes three cases in which transmission of Borrelia burgdorferi, appears to have occurred in less than 24 hours.[1] Dr. Willy Burgdorfer (discoverer of the Borrelia burgdorferi spirochete) was quoted during a conference at Bard College in 1999 stating that about 5-10% of ticks that are carrying Lyme disease have a systemic infection and have the disease in their saliva and can transmit it as soon as they bite. He said, "There is no safety window."

#2 "….erythema migrans rash occurs in more than 80% of individuals with Lyme disease"

The State of Maine Department of Health and Human Services has documented on average 48.25% incidence of rash-related Lyme over the last 4 years (See page 3 of each official report.)  [2] [3] [4] [5]  Dr. Gensheimer served as an Epidemic Intelligence Service Officer with the national Centers for Disease Control and Prevention prior to her assuming her current position in Maine. The 80% number is pure disinformation propagated by the CDC.

#3 "Selecting which individuals are appropriate for serologic testing is important, as testing helps support or refute the clinical diagnosis, but it can neither establish nor exclude the diagnosis of Lyme disease."  "Current serologic testing assays are unable to distinguish between active and inactive infection."
So in summary there is no laboratory test to gauge treatment failure or success. The current two-tier FDA approved testing method insures that persistent infection will never be identified. Per the U.S. Food and Drug Administration website [6] there appears to be seven pages of patient complaints regarding faulty/misleading Lyme disease antibody testing and subsequent misdiagnosis. Lyme disease antibody tests landed a sixteen year old Massachusetts boy in a psychiatric ward.[7]  The misdiagnosis resulted from faulty/misleading two tier serology as this boy's Western blot did not meet the five out of ten band IgG criteria for positive results. The physician responsible for the misdiagnosis is regarded as an "expert" in Lyme disease. In addition, this case shows that the "one-size-fits-all" IDSA treatment guideline was a complete failure.

Incidentally, China's criteria for a positive Western blot diagnosis of Lyme disease were established with only one IgG band and one single IgM band.[8]

#4 "Serologic testing is more reliable in later-stage disease." "It is rare to have CSF antibodies without serologic ones, so the absence of serologic antibodies indicates that Lyme disease is not present."

Seronegativity in Lyme borreliosis; 103 Peer-Reviewed Studies  [9]
"If false results are to be feared, it is the false negative result which holds the greatest peril for the patient."

#5 "…there is no evidence that B. burgdorferi infection persists in humans after a course of antibiotic therapy"
Persistent Lyme infection; 273 Peer-Reviewed Studies [10]
"In 1991 the Lyme disease organism, Borrelia burgdorferi, was grown from the cerebrospinal fluid of my patient Vicki Logan at the Centers for Disease Control in Fort Collins, Colorado despite prior treatment with intravenous antibiotics.  Her case made the front page of the New York Times Science Times in August of 1993." -Kenneth Liegner, MD [11]

Vicki Logan/Poughkeepsie Journal article challenging CDC treatment guidelines [13]
#6 "Multiple patient advocacy groups that have encouraged patients (many of whom had negative results on serologic testing) to think that they have chronic infections have flourished"
Misinterpretation of laboratory results is the main reason why the medical community is dismissive of patients with Lyme disease and their symptoms. Faulty diagnostic tests create confusion, causing physicians to miss the small period in which they can give successful short-term treatment. As a result, many patients have late-stage Lyme disease. Since we only test for antibodies against the infection and not the bacteria itself, we have no way to rule out active, continuing infection.
If the Infectious Diseases Society of America and the Centers for Disease Control and Prevention are correct with their single-treatment approach for all stages of Lyme disease and two-tier method of testing, why do we have so much legislation involving Lyme disease? [14]

#7 "Some have even encouraged legislative efforts to subvert evidence-based recommendations and demand long-term antibiotic treatment owing to persistent infection."

Texas Senator Chris Harris says he was severely affected by the disease, but "got a lucky break." His doctor, constrained by a disciplinary board that limited antibiotic use for tick-borne illness to 1 month or less, arranged for 17 physicians to take turns writing prescriptions for Sen. Harris's treatment. "As a Lyme disease survivor," says Sen Harris, "I know how important the correct treatment can be. This bill is a vital step forward in properly treating those who have this disease." [15]
Here are some additional studies to consider: (Missing from the Gerstenblith and Stern article)

Congenital Transmission of Lyme: 28 Peer-Reviewed Studies [16]
Case report of persistent Lyme disease from Pulaski County, Virginia [17]
Chronic Borrelia burgdorferi infection: a case report [18]

As the reader reviews the article by Gerstenblith and Stern one might begin to question if it was written as a playbook on how to avoid legal accountability for misdiagnosis and perhaps should have been titled "Willful Ignorance for Beginners" In the tragic case of the Lyme patient who committed suicide, prescribing steroids to a patient with infection further suppressing the immune system, certainly led to the demise of this patient. 

In conclusion:

We have been dealing with an antibiotic resistant superbug cleverly concealed to promote vaccine development. A preventive vaccine for Lyme disease would not satisfy the FDA if a chronic persistent infection and seronegative disease exist.[19]  Post-treatment Lyme disease syndrome is simply a fabricated medical condition disguising treatment failure.

We need to ask the question, "Why are the peer-reviewed studies, case reports and information I provided missing from the Gerstenblith and Stern article and what was the incentive for promoting the existing dogma? Was there influence (bias) by a colleague at Mass General Hospital inappropriately influencing this article?

Respectfully submitted,

Carl Tuttle,
Hudson, NH


[1] Clinical evidence for rapid transmission of Lyme disease following a tickbite

[2] Report to Maine Legislature Lyme Disease February 2009

[8] A Study of the Technique of Western Blot for Diagnosis of Lyme Disease caused by Borrelia afzelii in China

[9] Seronegativity in Lyme borreliosis: 103 Peer-Reviewed Studies
[10] Persistent Lyme infection: 273 Peer-Reviewed Studies

[14] Letter to the Editor, The Lancet Infectious Diseases Published May 2012
[15] Texas legislature passes Lyme bill recognizing long-term antibiotic treatment as option for persistent disease

[16] Congenital Transmission of Lyme: 28 Peer-Reviewed Studies
[17] Case report of persistent Lyme disease from Pulaski County, Virginia
[18] Granulomatous hepatitis associated with chronic Borrelia burgdorferi infection: a case report

[19] Petition: Calling for a Congressional investigation of the CDC, IDSA and ALDF   

Cc: to Elsevier's senior management team

Ron Mobed, Chief Executive Officer
Adriaan Roosen, Executive Vice President, Operations
Mark Seeley,  Senior Vice President and General Counsel
Youngsuk "YS" Chi, Chairman


Sen. Richard Blumenthal
Sen. Terry Gipson
Sen. Kemp Hannon
Sen. John Bonacic

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