I devour infectious disease books however the latest one has given me a bit of indigestion. I recently read Lyme: The First Epidemic of Climate Change by investigative reporter Mary Beth Pfeiffer. I came across this book after seeing it mentioned favorably in the premiere scientific journal, Nature. I don’t share their enthusiasm for the book.
For those who follow infectious disease news, the controversies and mythologies surrounding Lyme Disease are nothing new despite the fact that they seem to multiply, become more complex, and become more insoluble day-by-day.
Pfeiffer’s book is written from the viewpoint of someone who gives a lot of credence to alternative therapies for nebulous conditions that may or may not be related to Lyme infection. The best aspects of Pfeiffer’s book are its chronicling of the increasing geographic range of the Ixodes scapularis deer tick responsible for Lyme Disease transmission and explicitly linking it to suburban reforestation plans that put people into much greater contact with ticks.
She also deserves credit for cataloging the other important infections that can be spread by the deer tick such as Powassan virus, babesiosis, ehrlichiosis, and anaplasmosis — all of which are important for doctors to consider when evaluating someone with a potential tick-borne illness.
However there are several areas with which I strongly disagree with the book. Not surprisingly, much of my disagreement deals with her disparagement of the Infectious Diseases Society of America (IDSA) and major academic Lyme Disease researchers which she basically describes as a involved in a vast conspiracy to hide the truth about Lyme. This ire is focused almost entirely on the contentious subject of “chronic Lyme Disease” — an impossible to define concept that centers on the belief that ongoing damage-causing Lyme infection continues after sufficient antibiotic therapy and merits further antibiotics, hyperbaric oxygen, or other therapies.
In this brief review, it is impossible to rebut everything she asserts (with backing from certain physicians) but I would just point out that almost every patient I have seen who has this constellation of symptoms has no objective evidence of immune system response (i.e. C-reactive protein levels are completely normal) indicating that, even if remnants of the Lyme bacteria are present, there is no inflammation associated with and hence it does not make biological sense to attribute symptoms to something that the immune system itself is not attributing symptoms to. Furthermore, antibiotic therapy — which Pfeifer discounts the danger of — is not warranted.
One of my other problems with the book is how Pfeiffer conflates different diseases spread by ticks which could be confusing to the non-medical reader. While it is definitely the case that multiple infections with tick-borne pathogens can occur in the same person, it is not the usual case and lumping them all into the “Lyme” problem makes matters worse. For example, Borrelia miyamotoi does not cause Lyme Disease — it causes a distinct clinical syndrome — as does Babesia microti. The reader is left with dread feeling that every tick bite will unleash a Pandora’s Box of pathogens upon them and that of all infectious disease threats, this is the most pressing (while she discounts the arguably largest threat of antibiotic resistance fueled by antibiotic overuse).
I also have a lot of objections to what she writes about standard testing, its limitations, and the clinical diagnosis of Lyme by its characteristic rash.
I fear this book will make the field even more contentious and give patients, who desperately want answers for their symptoms, to continue down the wrong lane lined with those will not offer any evidence-based, scientific answers or therapies.