Misinformed Medical Providers Lead to Misinformed Public

At GALDA, we don't like to bash medical providers but there is so much potentially harmful, misleading information in the article, Monitor Board of Contributors: Know your biting bugs (and how to protect from them)! published online this week by the Concord Monitor, we feel compelled to warn the public.  It's quite troubling that the article, full of inaccuracies, was written by a pediatrician and president of Concord Pediatrics.

The article is linked here:  http://www.concordmonitor.com/home/12852697-95/monitor-board-of-contributors-know-your-biting-bugs-and-how-to-protect-from-them

In the piece, Dr. Patricia Edwards advises readers not to worry about wood ticks or dog ticks claiming these are "only annoying."  It's hard to imagine that this physician has never heard of the potentially fatal Spotted Fever Rickettsiosis and the other serious diseases spread by different tick species (including the "dog ticks" she mentions).  Isn't she aware that tick-borne disease science is constantly evolving and that an alarming number of pathogens have been discovered in ticks in recent decades? In fact, even Borrelia burgdorferi (Bb) - the organism that causes Lyme disease – has been documented in other tick species including dog ticks and lone star ticks.  Research shows that the transmission of Lyme disease appears to depend upon the host, meaning we cannot rule out transmission to humans by other tick species.  People should never be advised to be dismissive about a tick bite due to the type of tick removed. 

Next, Dr. Edwards should know, Ixodes scapularis ("deer ticks") do not get big enough to see "within hours."   Typically, engorgement happens rather gradually as they feed over several days.

  -courtesy Bugguide.net

The doctor also writes that a tick must be attached for at least 36 hours to transmit Lyme disease (LD). Though this is often touted by many, it's not necessarily true, as demonstrated in studies published long ago.  Some studies suggested that ticks may sometimes transmit LD in less than 12 hours.  In addition, some tick-borne diseases, such as Rocky Mountain Spotted Fever (RMSF), are known to be transmitted in only a few hours.  RMSF and other tick-borne infections may prove quickly fatal. 

Readers must be advised to seek immediate medical attention should symptoms develop following any tick bite, no matter how long the tick may have been attached.  Medical providers must remember these other diseases may be transmitted more quickly and by various species of ticks.  Early diagnosis and treatment can mean the difference between life and death.

Dr. Edwards advises removing a tick with your fingers.  NEVER, EVER do this. (Proper tick removal instructions appear at the bottom of this article.)

Ticks may have infectious secretions that shouldn't be touched with bare hands.   In fact, Borrelia burgdorferi has been documented in tick saliva and, more recently, in tick excrement. See article linked here:

http://www.ncbi.nlm.nih.gov/pubmed/22651382

Dr. Edwards mentioned prophylactic treatment after a tick bite, but be careful.  A one or two dose Doxycycline regimen is often recommended by the IDSA as a "prophylactic treatment" to prevent Lyme disease, however, this treatment has not been proven to be effective and is highly controversial.  This may prevent a rash from forming, but may not stop the actual infection.  Plus, a recent CDC study proved that trying to prevent Lyme disease by taking 1-2 Doxycycline doses is a really bad idea.  Here's the link:

http://www.ncbi.nlm.nih.gov/pubmed/22421585

(As an aside, another serious concern about the 1-2 dose Doxycycline regimen is that taking too little of an antibiotic during the early stages of infection may stop antibodies from forming against the Lyme bacteria, thereby causing a person to test negative by antibody test, even if they are still infected.  This may create a diagnostic nightmare!  This phenomenon has been documented in early syphilis as well as in early Borreliosis cases.)

Finally, Dr. Edwards writes that "prolonged treatment with antibiotics is not indicated and can often be dangerous.”  She fails to mention that one clinical trial clearly showed patients improved when they were treated with longer courses of antibiotics.  She doesn't share that there is no study that has ever proved that a few weeks of antibiotics cures Lyme disease.  She doesn't note that many infectious diseases (including Tuberculosis and Lyme's spirochetal cousin Syphilis) often require longer courses of antibiotic treatment nor that acne patients are treated with Doxycycline for months to years, with few problems.  

The article doesn't compare the true risks: the danger of longer antibiotic therapy vs. the danger of allowing a serious infectious disease to destroy a human body, a human life.  Dr. Edwards fails to disclose that scientists and medical providers are at odds about the treatment of Lyme disease and that thousands of Lyme patients (and their physicians) report that they have greatly improved with much longer courses of antibiotics instead of the short courses currently recommended by the IDSA.  (The three "longer treatment" clinical trials, by the way, did not examine treatment that lasted very long.  Some patients report it takes many months to even years before they really get better.  New clinical trials need to examine more lengthy treatment in Lyme disease, especially since it's accepted that other diseases may require such treatment.) 

Again, the science is emerging. Treatment is a very controversial subject. This, at least, should have been highlighted by the writer.

 *****

In the past several decades, many new pathogens have been identified in ticks, animals and humans. Scientifically and medically as a whole, we probably don't know half of what we need to know about ticks and the organisms they carry. But, even though tick-borne disease science is evolving, medical providers must diligently keep up with all of the latest information.  Authoritative doctors risk harming their patients and the public if they are so grossly misinformed.

GALDA implores medical professionals:  Because so many people are exposed to tick bites regularly and we're learning these arachnids can carry some really nasty bugs, we urge you to educate yourself on an ongoing  basis about ticks and the diseases they carry.  It's important to read all of the science, not just that cherry-picked by IDSA and CDC.  (It's surprising to see the amount of contradicting published literature available that is routinely ignored.)  Don't just visit your old "standby" websites, but sites like the International Lyme and Associated Diseases Society, as well (www.ILADS.org).  And investigate for yourself, here's a link to several great Lyme disease medical literature bibliographies to help you get started. 

http://www.lymeinfo.net/lymefiles.html

But please, for the sake of your patients, learn all that you can.  Your patients need and deserve a super-educated YOU.

*****

Proper tick removal:  DO NOT TOUCH TICKS WITH BARE FINGERS.  And, try not to leave the head in.  Both before and after their use, sterilize fine-nosed tweezers to remove an attached tick.  Grasp the tick with the tweezers as close to the skin as possible.  Then, pull straight out.  Avoid touching the tick’s body, especially avoid crushing it during removal.  Never twist, turn, burn or apply substances to the tick - these things may cause the tick to regurgitate its stomach contents (Lyme bacteria, etc.) into your skin.  Watch for any signs and symptoms following any tick bite and seek immediate medical care should symptoms develop. 

For more information, visit Georgia Lyme Disease Association's Prevention web page: 

http://georgialymedisease.org/prevention