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The Lyme Times V 24 No 2

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The Lyme Times V 24 No 2 FEATURE - My History of Lyme Ivory Tower Coverups Impede Progress Toward Cure Frontline physicians knew about persistence and how to treat it 20 years ago By Joseph J. Burrascano, Jr., MD new. By the early 1930s, we had the basic Lyme Disease is not a new illness. It has framework for Lyme (acute and chronic been recognized in one form or another skin lesions), plus constitutional, neu- for over a hundred years. In unraveling rologic and arthritic symptoms associated its history, one can see many instances with a tick bite. Why was this crucial of missed opportunities, unrecognized history ignored by American researchers patterns and outright mistakes by scientists, in the 1970s? physicians and government officials. Lyme before Connecticut Over time, a divide has developed In 1965, Dr. Sidney Robbin, semi-retired between the frontline Lyme-treating phy- internist in Montauk, NY, described ex- sicians and scientists and physicians at panding circular rashes that responded In 1982, Willi Burgdorfer, Ph.D., seen here major university and government insti- to penicillin treatment. He also described inoculating ticks, discovered the spirochete that tutions throughout the U.S. a peculiar monoarthritis that he named causes Lyme disease in ticks from Shelter Island, How did this come to be? What are the “Montauk Knee.” NY . The spirochete was later named Borrelia consequences? Could any of the troubles In 1970, Dr. Rudolph Scrimenti, a Wis- burgdorferi in his honor. Photo: NIAID/RML we now face in the Lyme Wars have been consin dermatologist, published the first prevented? report of ECM rash in the U.S. Like Dr. portant work spanning the prior 90 years What follows is a brief history of Lyme Robbin’s observations, Scrimenti reported as seen through my eyes. It includes as yet was ignored. Somebody is not reading the that the rash responds to penicillin. literature! Big mistake! unpublished and largely unknown but im- What did we learn? That, as in many ill- portant facts and stories that need to be nesses, it is the front line physician who Along comes Willi told. So read and enjoy! makes and reports important observations. In 1982, Dr. Willi Burgdorfer, NIH en- In the beginning... Lyme, Connecticut tomologist and specialist in relapsing fever Borrelia, examined ticks from Shelter Skin rashes now associated with Lyme In 1975, after many calls from local res- were recognized and described as long ago Island, NY, and published his finding of a idents led by artist Polly Murray, the CDC spirochete as the causative agent of Lyme. as the late 1800s. sent Dr. Allen Steere, a Yale rheumatologist • 1883 - Dr. Alfred Buchwald described Instead of assigning the study of this and epidemiologist, to Connecticut to study new entity to the infectious disease branch a skin lesion he names acrodermatitis a cluster of unusual rashes and painful of the NIH, however, immunologists and chronica atrophicans (ACA). swollen joints, especially in children. rheumatologists were given the job, thus • 1909 - Arvid Afzelius described an Dr. Scrimenti, hearing of the findings in expanding ring-like skin rash, later setting the stage for the current divide per- Connecticut, called Steere and his contacts petuated by this same group who still insist named Erythema Chronicum Migrans at Yale and related his experiences with the on the immune-based theory of persistent (ECM); in 1990. Dermatologist Bernard ECM rash and the use of penicillin. It is symptoms in the chronic Lyme patient. Berger, MD, recognizing that the rash unclear whether Yale paid much attention Another big mistake! is not chronic, renamed it Erythema to these observations. What did we learn? 1983 - Based on Migrans (EM). In 1977, Dr. Steere published a study of regimens used for syphilis, antibiotic trials • 1934 - The appearance of ECM or ACA 51 cases describing a new clinical entity and began with mixed and generally poor was associated with benign cutaneous calls it “Lyme Arthritis.” He recommended results. lymphocytomas. treatment with aspirin and steroids; con- • 1985 - In Southampton, NY, Dr. Bernard The tick connection was made over sidering it self-limited, he saw no benefit ninety years ago! Berger, a dermatologist, and pathologist from treatment with antibiotics. After all, Dr. Alan MacDonald biopsied the • 1921 - Arvid Afzelius connected the he was a rheumatologist and not an in- disease with joint problems, which he periphery of the EM rash, cultured fectious disease specialist. This newly de- spirochetes from the skin, and did speculates are somehow related to the scribed entity, Lyme arthritis, seemed to be bite of a tick. antibiotic sensitivity studies. associated with the bite of an Ixodes tick. • Discovered that amoxicillin is superior to • In 1922 the disease was found to be Dr. Steere suspectsed a virus. associated with neurological problems penicillin, and that erythromycin worked What did we learn? That from the very great in vitro, but was nearly useless in and in 1930 with psychiatric problems. beginning, the CDC and academic “Ivory • 1934 - arthritic symptoms are reported real people. The first of many treatment Towers” ignore important observations surprises began! in association with the disease. from front line physicians. This delays the What did we learn? That Lyme is not use of antibiotics for nearly a decade. Im- 8 The Lyme Times.
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