CALDA

Letters

Most people would not be overly concerned about the "mild and self-limiting subjective symptoms" mentioned by Feder et al. However most people would not tolerate a quality of life comparable to that of congestive heart failure, observed in chronic Lyme patients by both Klempner and Fallon, if reasonably safe treatment options were available.

Fallon and others have documented improvement in people treated with antibiotics. , Treatment involves some risk. So does not treating. The question is, who decides?

It's all very well for armchair generals to pontificate from their ivory towers, but they are not the ones who have to live in debilitated bodies. Patients do. It’s difficult, but cancer patients often have to make this kind of choice involving treatments that are even more dangerous than antibiotics.

It is inhumane to ask severely sick people to forego treatment while waiting for more effective treatments to be developed. Physicians should observe the principle of patient autonomy in discussing treatment alternatives with their patients. In the end, it should be the patient’s choice.

H. Feder et al. A Critical Appraisal of "Chronic Lyme Disease." N Engl J Med 2007: 357:1422-1430. Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001;345:85-92.

Fallon, BA et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2007 Oct 10; [Epub ahead of print]

Oksi J, M Marjamaki, J Nikoskelainen, and M Viljanen. Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. Ann Med. 1999; 31(3): 225-32.

Krupp LB, Hyman LG, Grimson R, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology 2003;60:1923-1930.