Prof: Chronic Lyme Disease A Lemon

Findings Cause Treatment Controversy

By: Andrew Peters

Posted: 11/27/07

A UConn Health Center professor recently created controversy voicing his conclusion that the condition known as Chronic Lyme disease has no scientific basis and medication should not be prescribed to treat it.

Dr. Henry Feder's argument upset chronic Lyme patient advocates, who believe the disease is legitimate.

Feder's Oct. 4 article in the New England Journal of Medicine, "A Critical Appraisal of 'Chronic Lyme Disease,'" argued that chronic Lyme disease is an unfounded explanation for a variety of other symptoms that aren't caused by the Lyme bacteria.

"Chronic Lyme disease, which is equated with chronic B. burgdorferi infection, is a misnomer, and the use of prolonged, dangerous, and expensive antibiotic treatments for it is not warranted," reads the report, which was authored by Feder and five other members of the Ad Hoc International Lyme Disease Group.

Feder's article advised against prolonged antibiotic treatment for chronic Lyme patients, angering those who contest that those treatments can still help. In response to the article, a group of about 25 protesters gathered outside the Health Center, proclaiming "Lyme kills!" and calling for him to be fired.

Lyme disease, named after the Connecticut town where it was common in the 1970s, is caused by the bacteria Borrelia burgdorferi and transmitted through tick bites - usually when the tick is attached for over a day, Feder said.

A large red skin rash commonly develops between three to 10 days after infection, which may be accompanied by fever, fatigue, or joint or muscle pain - but nearly all cases can be resolved quickly with antibiotics. However, for between 5 to 10 percent of people who develop the additional symptoms, the joint and muscle pains persist, Feder said.

The mysterious lingering symptoms have long been a source of debate. Feder contests that the Lyme bacteria is eliminated by the first bout of antibiotics, and there is no use in additional antibiotic treatments. But supporters of the chronic Lyme disease theory aren't so sure - and were upset by Feder's recommendation that antibiotics shouldn't be used to treat the symptoms.

"There's not enough data for Feder to come to such a strong conclusion that there are no benefits of treatment; we can't be sure that Lyme disease is eradicated [by the initial antibiotics]," said Dr. Daniel Cameron, president of the International Lyme and Associated Diseases Society (ILADS). "That's a frustration. ILADS is arguing that physicians who went to medical school should be able to use personal judgment when treating Lyme patients."

But Feder refuted the notion that lingering symptoms mean the Lyme bacteria is still present.

'[Continuing to show symptoms] does not mean you're still infected," Feder said. "That's part of this controversy."

Although it can be difficult to pinpoint the causes of the chronic Lyme symptoms, Feder is fairly certain of one thing: it's not actually Lyme.

"Persistent Lyme infection unresponsive to antibiotics has not been scientifically demonstrated using hard science," Feder said.

"Chronic Lyme disease is the latest in a series of syndromes that have been postulated in an attempt to attribute medically unexplained symptoms to particular infections," his article reads.

But doctors like Cameron say that not enough is known about Lyme disease to draw such strong conclusions about treatment.

"Controversy always happens when there's very little data," Cameron said. "For now, we need to let the doctors use their own judgment. I don't think it's going to be nearly as simple as Dr. Feder and his colleagues are projecting.

"I don't understand why they had to make such a strong statement without including any of the ILADS numbers and potentially denying a patient treatment that may help them."

But continuing antibiotic treatment if there's no Lyme bacteria present can be dangerous, Feder said. Those who believe they are suffering from chronic Lyme disease often spend months and years obtaining risky treatment for an illness they don't have.

Feder said some treatments for chronic Lyme - such as intravenous antibiotics - can do much more harm than good.

"IV antibiotics can cause clots or severe infections," Feder said. "The risks are real; the costs are tremendous."

Regardless of the risks, Feder doesn't think his report will sway chronic Lyme advocates.

"People who believe are not going to change - it's almost like a religion," Feder said. "I can't say they're wrong, but I can say science is not on their side."

"There is a counterculture of physicians who seem to blame every unknown ill on Lyme disease," Feder said. "A lot of things get blamed on Lyme that are not Lyme's fault."

He estimated there are thousands of patients in Connecticut alone who believe they have the illness - probably dozens at UConn alone.

"Maybe [chronic Lyme patients] are stressed, depressed, have chronic fatigue or chronic migraines," Feder suggested instead. "But they don't like some of those answers."

"Many patients with intermittent or selflimited symptoms may feel better over time as a result of the natural course of their condition, and controlled trials indicate that nearly 40 percent of patients with post-Lyme disease symptoms have a positive response to placebo," according to the article.

But it would take much more conclusive research to convince doctors like Cameron that antibiotics can't help.

"I always welcome discussion of benefits and drawbacks of treatment," Cameron said. "What I don't like is when strong recommendations are made without discussing limitations of the data."

Contact Andrew Peters at

Andrew.Peters@UConn.edu.