IDSA: Did They Change the Blade in Occam's Razor?

by Dawn Irons

In the 14th century there was a principle that was established by an English logician and Franciscan friar William of Ockham. This principle purported that, "All things being equal, the simplest solution is the best." This principle became known as Occam's Razor.

The medical establishment has used this principle in training generations of physicians. The principle has also been expressed with many analogies. Who hasn't heard a doctor tell their patient, "In medical school we were taught that when you hear hoof beats we should assume it is a horse and not a zebra." [Be sure to read Dr. Virginia Sherr's article entitled In Defense of the Zebra in this issue of PHA.]

The principle has been shared throughout the ages. The most elementary form of defining Occam's Razor is probably the old adage, "If it looks like a duck, waddles like a duck, and quacks like a duck…it is probably a duck!"

In short, Occam's Razor is the logical conclusion that simplest solution is the best answer.

Logical Simplicity vs. Complex Contortions

The Infectious Disease Society of America (IDSA), one of the largest medical societies in the United States that boasts of 8,000 members, has recently been under investigation for anti-trust violations by the Attorney General of Connecticut, Richard Blumenthal. 

What are "anti-trust violations" you ask? I am so glad you asked! If we are to apply Occam's Razor to this issue, it boils down to "follow the money". Remember the Parker Brothers board game Monopoly? He who has the most property and money at the end of the game wins. The Attorney General's investigation proved major conflicts of interests (financial interests) of the writers of the IDSA's 2006 Lyme treatment guidelines. Not only did the guidelines tell physicians nation wide what the IDSA believed was the best way to treat Lyme disease, they went so far as to say that other modes of treatment (traditional or alternative) were not to be recommended. They did not suggest the use of any supplements…not even vitamin C. They did everything in their power to steer treatment options to only one possible choice. Their choice. 

With the publication of these Lyme guidelines by the 8,000 strong IDSA, other previously published guidelines for the diagnosis and treatment of Lyme disease by the International Lyme and Associated Diseases Society (ILADS), whose membership ranges about 300-400 members (who are actually treating-- hands-on-- Lyme disease patients on a daily basis) was completely overshadowed by this Goliath organization.

These two organizations have polar opposite opinions of how Lyme disease should be diagnosed and treated:

IDSA (the Goliath in this showdown) published guidelines that stated that Lyme disease was easily diagnosed and easily cured with 28 days of antibiotics. They stated that if symptoms persisted then there was likely some other problem going on-but the Lyme disease would have been "cured".

ILADS (the underdog in this showdown) had a simple solution that the Occam's Razor principle exemplified beautifully. They believed that if after 28 days of antibiotics the patient still had symptoms of Lyme disease, then they would treat until the symptoms subsided because clearly they were still dealing with Lyme.

Now I am not a brain surgeon or a rocket scientist, but in my layman's opinion the simplest solution would be that the 28 days of treatment was inadequate to cure the disease and that more treatment would be warranted. I think it takes some fancy gymnastics (or a limber contortionist) to jump to the conclusion that after 28 of days of antibiotics, with persisting symptoms, that the disease has morphed into some other disease entirely, but the person is now "cured" of Lyme disease. Where is the LOGIC in that?

Investigating Modes of Lyme Disease Transmission

The IDSA vs. ILADS debate will continue for years. Unfortunately the patients are the ones that suffer as collateral damage when the doctors cannot agree.

There is much medical controversy over the possible modes of transmitting Lyme disease. IDSA pretty well sticks with the theory that is only transmitted by the bite of a deer tick. ILADS considers various modes of transmissions and wishes to study this issue further.

Lyme disease is a spirochetal bacterium, much like another spirochete, Treponema pallidum which causes Syphilis. Syphilis, we know, is a sexually transmitted disease. So it stands to reason that research into this possibility might be a benefit to the public health.

Sexual Transmission

The medical community is once again at complete odds over the issue of sexual transmission of Lyme disease. IDSA doctors stick to their guns and say that Lyme is only transmitted by the bite of a deer tick. ILADS believes they have seen enough trends and anecdotal cases that would warrant a closer look with some serious researchers (those without conflicts of interest.)

The two schools of thought rarely find common ground in their approach to the illness. Edward McSweegan, Ph.D., the former program officer for Lyme disease at the National Institute of Health's (NIH) National Institute of Allergy and Infectious Diseases was released from his duties after he spoke out on the internet about what he felt was the NIH putting forth unscientific and incorrect information about Lyme disease. McSweegan further criticized the Lyme Disease Foundation (LDF) as putting forth "wacko" theories about the disease.

McSweegan went on to publish a website called "Quackwatch". This site was dedicated to his ideas that the NIH, LDF, and much of the information on the internet concerning Lyme disease was pure quackery. 

Quoting form his website, www.quackwatch .org, McSweegan adamantly says, "At least a few LLMDs (Lyme Literate Medical Doctors) appear to be telling patients that Lyme is sexually transmitted and therefore their family members should be tested. One person reported to Quackwatch that a family member had been tested and told that the test was positive and that a 4-5 month course of antibiotics was necessary." 

"There is no basis for such advice or beliefs. Lyme infections are acquired from the bite of an infected tick. People are "dead end" hosts and do not spread Lyme infections to others." This is a fact of which he is absolutely certain.

Unfortunately for McSweegan, the scientific evidence does not seem to support his theory. In fact, the research that has been done regarding sexual transmission of Lyme disease has had significant findings and suggests that further research be done.

In April of 2001, Dr. Gregory Bach presented his research which was titled Recovery of Lyme Spirochetes by PCR in Semen Samples of Previously Diagnosed Lyme Disease Patients to the International Scientific Conference on Lyme Disease. His study showed that initially there was a 40% infection rate among male partners of females who were diagnosed with Lyme and of male Lyme patients by the Western Blot and PCR blood testing methods. As the study progressed there were 100% positive results of semen and vaginal samples of Lyme titers and PCR blood testing in the sexual partners of Lyme infected patients.

Dr. Ron Kennedy of Santa Rosa, California says, "Sexual transmission of Lyme disease has been anecdotally reported and the Lyme spirochetes have been found in semen and breast milk. Transmission by these routes, although seemingly likely, has not been proven." He further suggested that more research needed to be done.

With all the controversy surrounding the sexual transmission of Lyme disease, and the public health implications that encompasses, one has to ask why there is not more vigorous research being done on this bacterium which is the fastest growing infectious disease in the country.

Congenital Transmission

McSweegan denies that congenital transmission of Lyme disease exists. His website boldly states, "The topic of pregnancy and Lyme is also rife with rumor and unnecessary fear. A recent review of case reports and other research found no specific patterns of fetal malformation or adverse events in pregnancy. In addition, the authors noted that ‘larger epidemiological and serological series have consistently failed to demonstrate an increased risk to pregnant women who develop Lyme disease if they receive appropriate antimicrobial therapy.’ Attempts to demonstrate venereal, transplacental and contact transmission of Lyme spirochetes in hamsters also have failed."

I suppose that is good news for the hamsters, but not so much for the humans. In 1985, researchers published the first proof of maternal-fetal transmission of Borrelia burgdorferi (Bb): A baby died shortly after birth and Bb spirochetes were found in the infant's spleen, kidney, and bone marrow. (Schlesinger P, Duray P, Burke B, Steere A, Stillman A. Maternal-fetal transmission of the Lyme disease spirochete Borrelia burgdorferi. Annals of Internal Med. 1985:(Vol 103) 67-68.) To date miscarriages, still birth, neonatal death and congenital Lyme disease have all been described in the medical literature.

There have been several studies that have shown that gestational Lyme disease parallels the diversity of prenatal syphilis. (Gestational Lyme Borreliosis: Implications for the Fetus, A.B. Mac Donald, Southampton Hospital, NY.)

Autopsies and clinical studies have associated gestational Lyme disease with various medical problems including fetal death, hydrocephalus, cardiovascular anomalies, neonatal respiratory distress, hyperbilirubinemia, intraunterine growth retardation, cortical blindness, SIDS and maternal toxemia of pregnancy. (Gestational Lyme Borreliosis: Implications for the Fetus, A.B. Mac Donald, Southampton Hospital, NY.)

Another study out of the departments of Obstetrics and Gynecology at the University of Trieste School of Medicine showed Lyme Borreliosis positive blood tests were associated with spontaneous miscarriages.

Blood Transmission

The Centers for Disease Control and Prevention (CDC) have reported at least 21 cases of Babesia microti and WA-1 Babesia parasites having been transmitted by transfusion from asymptomatic infected donors. Babesia is one of the many co-infections that are often accompanied with a Lyme diagnosis.

This raises the question of how safe the national blood supply is and what safe-guards are in place to prevent infected blood getting into the supply.
A review of the top blood banks showed some concerning trends where blood and organ donation are concerned in terms of Lyme disease and Babesia. Some banks had standards that prevented blood to be donated. Other banks had a policy of waiting 6 months. And still other banks had a policy that as long as you were symptom free they would take your blood…regardless of whether you had ever received treatment for the disease.

The Red Cross will accept blood from a Lyme disease patient so long as they are symptom free and have completed a course of antibiotics. (This raises the issue of the controversy: does 28 days of antibiotics "cure" Lyme? If symptoms persist the IDSA says it is a new disease entirely. Then what disease has it become? Is it safe to donate with this new "yet unnamed" disease?)

The UCSF Blood Center has a permanent deferral for anyone who has ever been diagnosed with Lyme disease or Babesia. They will never again accept blood from these people.

The New York Blood Center will accept Lyme patients blood if they are symptom free and are through with treatment. If you have symptoms they will defer you for 6 months. At that time they will accept your blood again even if you have not received treatment for the disease.

There are studies that show that both Lyme borrelia and Babesia microti and WA-1 parasites remain viable under blood bank conditions. To see the lack of consensus on what protocols are in place concerning blood and organ donation… this should be sounding sirens on the highest hill, the legislative Capitol Hill! This is an issue of public safety.

Back to Occam's Razor

If it is really a medical principle that the simplest solution is the best answer, it is time we start demanding answers. There is enough evidence that at least warrants some serious research into these issues.

While the medical controversy rages on, pride and ego set aside, who is going to connect the dots of the information that has significant findings but needs further research?

This we know:

Borrelia burgdorferi (Bb) spirochetes have been shown to be in the bodily fluids of breast milk, semen and vaginal fluids. 

Bb spirochetes have been proven to survive blood bank conditions along with Babesia microti and WA-1 parasites.

Bb spirochetes have been found in the autopsies of congenitally infected Lyme infants throughout multi systemic organs.

Bb spirochetes have been found in the autopsies of fully treated Lyme patients who had the maximum recommended course of antibiotics (clearly it was not "cured.")

So if Occam's Razor is applied to the Lyme disease controversy, the only logical conclusion would be that there is a desperate need for more research. These issues are not settled issues, and for them to be treated as such should be considered criminally negligent. 

This disease is a close relative to another spirochete that is sexually transmitted. Can you imagine if no one had ever demanded that blood testing for AIDS be mandated? These diseases are not dissimilar. 

For the IDSA to hold doggedly to their beliefs concerning Lyme disease, even though they chose to settle out of court to avoid malpractice claims, makes one wonder that, if Occam's Razor is still a medical principle, has IDSA changed the blades/rules? 

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