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| {{Distinguish|Neuroborreliosis}} | |||
| {{Infobox alternative medical diagnosis | |||
| |name = Chronic Lyme disease | |||
| |synonyms = Post-treatment Lyme disease syndrome<ref>{{cite book|last1=Bope|first1=Edward T.|last2=Kellerman|first2=Rick D.|title=Conn's Current Therapy 2017 E-Book|date=2016|publisher=Elsevier Health Sciences|isbn=9780323443357|page=553|url=https://books.google.ca/books?id=UitFDQAAQBAJ&lpg=PT3&dq=Conn%27s%202017&pg=PT588|language=en}}</ref> | |||
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| '''Chronic Lyme disease''' is a generally unrecognised diagnosis that encompasses "a broad array of illnesses or symptom complexes for which there is no reproducible or convincing scientific evidence of any relationship to ''B. burgdorferi'' infection."<ref name="nejm-feder"/> There is no clinical evidence that "chronic" Lyme disease is caused by a persistent infection.<ref>{{cite journal|last1=Baker|first1=P. J.|title=Chronic Lyme disease: in defense of the scientific enterprise|journal=The FASEB Journal|date=14 July 2010|volume=24|issue=11|pages=4175–4177|doi=10.1096/fj.10-167247|pmid=20631327}}</ref> It is distinct from post-treatment Lyme disease syndrome, a set of lingering symptoms which may persist after successful treatment of infection with Lyme spirochetes. The symptoms of "chronic Lyme" are generic and non-specific "symptoms of life".<ref name="SMB-Hall">{{Cite web |url=https://sciencebasedmedicine.org/does-everybody-have-chronic-lyme-disease-does-anyone/ |title=Does Everybody Have Chronic Lyme Disease? Does Anyone? |last=Hall |first=Harriet |authorlink=Harriet Hall |website=]}}</ref> | |||
| A number of ] are promoted for "chronic Lyme disease",<ref name="Quackwatch-Tests">{{Cite web |url=https://www.quackwatch.org/01QuackeryRelatedTopics/lyme.html |title=Lyme Disease: Questionable Diagnosis and Treatment |last=McSweegan |first=Edward |website=]}}</ref> of which possibly the most controversial and harmful is long-term ] therapy, particularly intravenous antibiotics.<ref name="Forbes-LTA">{{Cite magazine |last=Salzberg |first=Steven |author-link=Steven Salzberg |date=2016-04-04 |title=Long-Term Antibiotic Use For Lyme Disease Doesn't Work, Study Finds |url=http://www.forbes.com/sites/stevensalzberg/2016/04/04/long-term-antibiotic-use-for-lyme-disease-doesnt-work-study-finds/#78bd5c3e28b1 |magazine=Forbes}}</ref> Most medical authorities advise against long-term antibiotic treatment for ], though they agree that some patients do experience lingering symptoms.<ref name="idsa guideline"/><ref name="pmid17522387"/><ref name="nih-cld"/> Following disciplinary proceedings by State medical licensing boards in the United States, a subculture of "Lyme literate" physicians has successfully lobbied for specific legal protections, exempting them from the ] and ] treatment guidelines. This "troubling" political interference in medical care<ref name="Mason">{{Cite book |title=Policy & Politics in Nursing and Health Care |vauthors=Mason DJ, Leavitt JK, Chaffee MW |publisher=Elsevier Health Sciences |year=2014 |isbn=0323316069 |pages=310–311}}</ref><ref name="The-Scientist">{{Cite magazine |last=Warner |first=Susan |date=2007-02-07 |title=State official subpoenas infectious disease group |url=http://www.the-scientist.com/?articles.view/articleNo/24742/title/State-official-subpoenas-infectious-disease-group/ |magazine=The Scientist |publication-date=2007-02-07}}</ref> has been criticised as an example of "legislative alchemy", the process whereby pseudomedicine is legislated into practice.<ref name="SBM-Bellamy">{{Cite web |url=https://sciencebasedmedicine.org/legislative-alchemy-2014-so-far/ |title=Legislative Alchemy 2014 (so far) |last=Bellamy |first=Jann |authorlink= |website=]}}</ref> | |||
| == Background == | |||
| <!-- Terminology --> | |||
| The term ''chronic Lyme disease'' is often applied to several different sets of people. One usage refers to people suffering from the symptoms of untreated and disseminated late-stage Lyme disease: ], ] and/or ]. The term is also applied to people who have had the disease in the past and some symptoms remain after antibiotic treatment, which is also called post-Lyme disease syndrome. A third and controversial use of the term applies to patients with nonspecific symptoms, such as fatigue, who show no objective evidence they have been infected with Lyme disease in the past, since the standard diagnostic tests for infection are negative.<ref name="nejm-feder">{{cite journal | title = A Critical Appraisal of "Chronic Lyme Disease" | journal = ] | volume = 357 | issue = 14 | pages = 1422–30 | url = http://www.nejm.org/doi/pdf/10.1056/NEJMra072023 |date=October 2007 | pmid = 17914043 | doi = 10.1056/NEJMra072023 | last1 = Feder | first1 = HM | last2 = Johnson | first2 = BJB | last3 = O'Connell | first3 = S | display-authors = 3 | last4 = Shapiro | first4 = ED | last5 = Steere | first5 = AC | last6 = Wormser | first6 = GP | author7 = Ad Hoc International Lyme Disease Group | last8 = Agger | first8 = WA | last9 = Artsob | first9 = H | format = PDF }}</ref><ref name=IDSA_FAQ>{{cite web | url = http://www.idsociety.org/Lyme_Facts/ | title = Ten Facts You Should Know About Lyme Disease |publisher = ]|date = May 10, 2011| accessdate = June 18, 2013}}</ref> | |||
| <!-- Symptoms --> | |||
| The ] state that some people after a "course of antibiotics will have lingering symptoms of fatigue, pain, or joint and muscle aches. In some cases, these can last for more than 6 months. Although often called 'chronic Lyme disease', this condition is properly known as 'post-treatment Lyme disease syndrome' (PTLDS)".<ref name=cdc_postlds>{{cite web|url=http://www.cdc.gov/lyme/postLDS/index.html |title=CDC - Post Lyme Disease Syndrome - Lyme Disease |publisher=Cdc.gov |date=February 7, 2013 |accessdate=July 5, 2013}}</ref><ref name="Cairns">{{cite journal |vauthors=Cairns V, Godwin J |title=Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms |journal=Int J Epidemiol |volume=34 |issue=6 |pages=1340–45 |date=December 2005 |pmid=16040645 |doi=10.1093/ije/dyi129}}</ref> This is estimated to occur in less than 5% of people.<ref>{{cite book|last1=Bope|first1=Edward T.|last2=Kellerman|first2=Rick D.|title=Conn's Current Therapy 2013: Expert Consult: Online|date=2012|publisher=Elsevier Health Sciences|isbn=1455733342|page=151|url=https://books.google.ca/books?id=SwRBtIPU5yQC&pg=PT151|language=en}}</ref> | |||
| <!-- Cause --> | |||
| While it is undisputed people can have severe symptoms, the cause and appropriate treatment is controversial. The symptoms may represent "for all intents and purposes" ] or ].<ref name=FMWars>{{cite journal |author=Wolfe F |title=Fibromyalgia wars |journal=]|volume=36 |issue=4 |pages=679–83 |date=April 2009 |pmid=19342721 |doi=10.3899/jrheum.081180 }}</ref> A few doctors attribute these symptoms to persistent infection with ''Borrelia'', or co-infections with other tick-borne pathogens, such as '']'' and '']''.<ref name="gaito">{{cite journal|author=Cameron D |title=Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease|url=https://www.guideline.gov/summaries/summary/49320|journal=Expert Rev Anti Infect Ther |volume=12 |issue=9 |pages=1103-35 |year=2004 | doi=10.1586/14787210.2014.940900|author2= Johnson LB||author3= Maloney EL}}</ref><ref name=ISDAReviewPanel/> Other doctors believe that the initial infection may cause an ] that continues to cause serious symptoms even after the bacteria have been eliminated by antibiotics.<ref name=Ercolini>{{cite journal |vauthors=Ercolini AM, Miller SD |title=The role of infections in autoimmune disease |journal=Clin. Exp. Immunol. |volume=155 |issue=1 |pages=1–15 |date=January 2009 |pmid=19076824 |pmc=2665673 |doi=10.1111/j.1365-2249.2008.03834.x}}</ref> A ] looked at several animal studies that found persistence of live but disabled spirochetes following treatment of ''B. burgdorferi'' infection with antibiotics. The authors noted that none of the lingering spirochetes were associated with inflamed tissues and criticized the studies for not considering adequately the different ] and ] of the antibiotics used to treat the animals in the trials versus what would be expected to be used to treat humans. The authors concluded, "There is no scientific evidence to support the hypothesis that such spirochetes, should they exist in humans, are the cause of post-Lyme disease syndrome."<ref name=Wormser2009>{{cite journal |vauthors=Wormser GP, Schwartz I |title=Antibiotic treatment of animals infected with Borrelia burgdorferi |journal=Clin. Microbiol. Rev. |volume=22 |issue=3 |pages=387–95 |date=July 2009 |pmid=19597005 |pmc=2708393 |doi=10.1128/CMR.00004-09 }}</ref> | |||
| <!-- Treatment --> | |||
| Major US medical authorities, including the ], the ], and the ], have stated there is no convincing evidence that ''Borrelia'' is involved in the various symptoms classed as chronic Lyme disease, and advise against long-term antibiotic treatment as ineffective and possibly harmful.<ref name="nejm-feder"/><ref name="idsa guideline">{{cite journal |author=Wormser GP |title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America |journal=Clin. Infect. Dis. |volume=43 |issue=9|pages=1089–1134 | url = http://cid.oxfordjournals.org/content/43/9/1089.full.pdf |date=November 2006 |pmid=17029130 |doi=10.1086/508667 |last12=Fish |first12=D|last13=Dumler |first13=JS |first14=RB |author2=Dattwyler RJ |author3=Shapiro ED |display-authors=3 |last4=Nadelman |first4=John J. |last5=Steere |first5=Allen C. |last6=Klempner |first6=Mark S. |last7=Krause |first7=Peter J. |last8=Bakken |first8=Johan S. |last9=Strle |first9=Franc}}</ref><ref name="pmid17522387">{{cite journal |vauthors=Halperin JJ, Shapiro ED, Logigian E, etal |title=Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=69 |issue=1 |pages=91–102 |date=July 2007 |pmid=17522387 |doi=10.1212/01.wnl.0000265517.66976.28}}</ref><ref name="nih-cld"/> Prolonged antibiotic therapy presents significant risks and can have dangerous side effects.<ref name="mandell_chap242">{{cite book|last=Dolin|first= Gerald L Mandell, John E Bennett, Raphael|title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|year=2010|publisher=Churchill Livingstone/Elsevier|location=Philadelphia, PA|isbn=978-0-443-06839-3|pages=Chapter 242|edition=7th}}</ref> Randomized placebo-controlled studies have shown that antibiotics offer no sustained benefit in people with "chronic Lyme"; with evidence of both placebo effects and significant adverse effects from such treatment.<ref name="Marques">{{cite journal | title=Chronic Lyme Disease: An appraisal | author=Marques, Adriana | journal=Infect Dis Clin North Am |date=June 2008 | volume=22 | issue=2 | pages=341–60 | doi=10.1016/j.idc.2007.12.011 | pmc=2430045 | pmid=18452806}}</ref> An ] called the ] (ILADS)<ref name=Tonks>{{cite journal |author=Tonks A |title=Lyme wars |journal=BMJ |volume=335 |issue=7626 |pages=910–12 |date=November 2007 |pmid=17974685 |pmc=2048873 |doi=10.1136/bmj.39363.530961.AD}}</ref> argues the persistence of ''B. burgdorferi'' may be responsible for manifestations of late Lyme disease symptoms.<ref name="Stricker 2007">{{cite journal |author=Stricker RB |title=Counterpoint: long-term antibiotic therapy improves persistent symptoms associated with Lyme disease |journal=Clinical Infectious Diseases|volume=45 |issue=2 |pages=149–57 |date=July 2007 |pmid=17578772 |doi=10.1086/518853 }}</ref> It has questioned the generalizability and reliability of some of the above trials and the reliability of the current diagnostic tests.<ref name=ISDAReviewPanel>{{cite web | url = http://lymewebcast.idsociety.org/ | publisher = ] | title = Lyme Disease Review Panel Hearing | last = Phillips | first = S | date = 2006-07-30 | accessdate = 2010-12-09 }}</ref><ref name="Stricker 2007"/><ref name="cameron">{{cite journal|author=Cameron DJ|title=Generalizability in two clinical trials of Lyme disease |publisher=Epidemiol Perspect Innov |doi=10.1186/1742-5573-3-12|year=2006|accessdate=19 May 2017}}</ref> | |||
| == Controversy and politics == | |||
| While there is general agreement on the optimal treatment for early Lyme disease, there is considerable controversy over the existence, prevalence, diagnostic criteria, and treatment of "chronic" Lyme disease.<ref name=Tonks/><ref name="Ballantyne 2008"/><ref>, New England Journal of Medicine, March 14, 2013. (This exchange of three letters nicely illustrates the controversy and some of the issues at stake.)</ref> The evidence-based perspective is exemplified by a 2007 review in ''],'' which noted the diagnosis of chronic Lyme disease is used by a few physicians despite a lack of "reproducible or convincing scientific evidence", leading the authors to describe this diagnosis as "the latest in a series of syndromes that have been postulated in an attempt to attribute medically unexplained symptoms to particular infections."<ref name="nejm-feder"/> Most medical authorities agree with this viewpoint: the ] (IDSA), the ], the ] (CDC), and the ] (NIH), advise against long-term antibiotic treatment for chronic Lyme disease, given the lack of supporting evidence and the potential toxicities.<ref name="idsa guideline"/><ref name="pmid17522387"/><ref name="nih-cld">{{cite web | publisher = ] | title = "Chronic Lyme Disease" Fact Sheet | url =http://www.niaid.nih.gov/topics/lymedisease/understanding/pages/chronic.aspx | date = April 17, 2009|archiveurl=https://web.archive.org/web/20150611094755/http://www.niaid.nih.gov/topics/lymedisease/understanding/pages/chronic.aspx|archivedate=11 June 2015}}</ref> | |||
| A minority view holds that chronic Lyme disease is responsible for a range of unexplained symptoms, sometimes in people without any evidence of past infection.<ref name="Ballantyne 2008">{{cite journal |author=Ballantyne C |title=The chronic debate over Lyme disease|journal=Nat. Med. |volume=14 |issue=11 |pages=1135–9 |date=November 2008 |pmid=18989271 |doi=10.1038/nm1108-1135}}</ref> This viewpoint is promoted by many patient advocates, notably an advocacy organization,<ref name=Tonks/> the International Lyme And Associated Diseases Society.<ref name="Stricker 2007"/> Groups of patients, patient advocates, and the small number of physicians who support the concept of chronic Lyme disease have organized to lobby for recognition of this diagnosis, as well as to argue for insurance coverage of long-term antibiotic therapy, which most insurers deny, as it is at odds with the guidelines of major medical organizations.<ref name="Ballantyne 2008"/><ref name="forbes">{{cite news | author = Whelan, David |url = http://www.forbes.com/forbes/2007/0312/096.html |title = Lyme Inc |work = ] | date = 2007-03-12 | accessdate = 2008-06-24}}</ref> | |||
| In 2006, ], the ], opened an ] investigation against the IDSA, accusing the IDSA Lyme disease panel of undisclosed ] and of unduly dismissing alternative therapies and chronic Lyme disease. The investigation was closed on May 1, 2008, without charges when the IDSA agreed to submit to a review of its guidelines by a panel of independent scientists and physicians which would occur on July 30, 2009.<ref name="amnews"/> Views on the motivation and outcome of the investigation varied. Blumenthal's ] described the agreement as a vindication of his investigation and repeated his conflict-of-interest allegations.<ref name=ct_ag_2008>{{cite press release |url =http://www.ct.gov/ag/cwp/view.asp?a=2795&q=414284 |title = Attorney General's investigation reveals flawed Lyme disease guideline process, IDSA agrees to reassess guidelines, install independent arbiter | publisher = State of Connecticut Attorney General's Office | date = 2008-05-01 | accessdate = 2008-06-24}}</ref> | |||
| The IDSA focused on the fact that the medical validity of the IDSA guidelines was not challenged,<ref name=idsa_2008>{{cite press release | url = http://www.idsociety.org/Templates/nonavigation.aspx?pageid=32212256693 |title = Agreement Ends Lyme Disease Investigation By Connecticut Attorney General: Medical Validity of IDSA Guidelines Not Challenged | publisher = ] | date = 2008-05-01 | accessdate = 2017-05-19 }}</ref> and cited mounting legal costs and the difficulty of presenting scientific arguments in a legal setting as their rationale for accepting the settlement.<ref name="cid-danger">{{cite journal |author=Klein JO |title=Danger ahead: politics intrude in Infectious Diseases Society of America guideline for Lyme disease |journal=Clin. Infect. Dis. |volume=47 |issue=9 |pages=1197–99 |date=November 2008 |pmid=18821849 |doi=10.1086/592247 }}</ref> A journalist writing in '']'' suggested some IDSA members may not have disclosed potential conflicts of interest,<ref name = "Ballantyne 2008"/> while a '']'' piece described Blumenthal's investigation as "intimidation" of scientists by an elected official with close ties to Lyme advocacy groups.<ref name="forbes"/> The '']'' described the decision as an example of the "politicization of health policy" that went against the weight of scientific evidence and may have a ] on future decisions by medical associations.<ref name=Kraemer_2009>{{cite journal |vauthors=Kraemer JD, Gostin LO |title=Science, politics, and values: the politicization of professional practice guidelines |journal=JAMA |volume=301 |issue=6 |pages=665–67 |date=February 2009 |pmid=19211474 |doi=10.1001/jama.301.6.665}}</ref> | |||
| The state of Connecticut went on to enact a law on June 18, 2009, "to allow a licensed physician to prescribe, administer or dispense long-term antibiotics for a therapeutic purpose to a patient clinically diagnosed with Lyme disease."<ref name="CT_law">{{cite web | url=http://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=6200&which_year=2009&SUBMIT1.x=0&SUBMIT1.y=0&SUBMIT1=Normal | title = An act concerning the use of long-term antibiotics for the treatment of Lyme disease | work = Connecticut General Assembly | date = 2009-06-18 | accessdate = 2009-07-05}}</ref> The states of Rhode Island,<ref name="RI_law">{{cite web | url=http://www.health.state.ri.us/disease/communicable/lyme/law.php | title = Lyme Disease and the Law | work = Rhode Island Department of Health | year = 2009 | accessdate = 2009-07-05 |archiveurl = https://web.archive.org/web/20050502203519/http://www.health.state.ri.us/disease/communicable/lyme/law.php |archivedate = May 2, 2005}}</ref> California,<ref name=Providence/> Massachusetts,<ref name=Providence>Lisa Rathke for the Providence Journal Jul. 12, 2014 </ref> New Hampshire,<ref name=Providence/> Vermont,<ref name=Providence/> New York,<ref>{{cite web|url=http://www.poughkeepsiejournal.com/story/news/health/lyme-disease/2014/12/18/cuomo-signs-lyme-disease-bill/20576915/|title=Cuomo signs bill safeguarding Lyme treatments|author=John Ferro|date=18 December 2014|work=]|accessdate=29 August 2015}}</ref> Maine<ref>{{cite web|url=http://www.pressherald.com/2015/06/29/maine-legislature-clears-way-for-long-term-lyme-disease-treatment/|title=Maine Legislature clears way for long-term Lyme disease treatment|work=The ] / ]|accessdate=29 August 2015}}</ref> and Iowa <ref>http://www.tamatoledonews.com/page/content.detail/id/603916/Cornfileds--Common-Sense-and-Community.html?nav=5002</ref> have similar laws. | |||
| Massachusetts (2016)<ref>{{cite web|url=http://www.wbur.org/morningedition/2016/08/01/legislative-session-ends|title=Mad Rush On Beacon Hill Sends 4 Key Bills To Baker's Desk As Legislative Session Ends|publisher=Morning Edition - ]|website=wbur.org|first=Steve|last=Brown|date=1 August 2016|accessdate=24 September 2016}}</ref> and Rhode Island (2003)<ref name="state.ri.us">{{cite web|url=http://webserver.rilin.state.ri.us/PublicLaws/law03/law03113.htm|title=Chapter 113|publisher=webserver.rilin.state.ri.us|accessdate=24 September 2016}}</ref> have laws mandating insurance coverage for long-term antibiotic therapy for Lyme disease when deemed medically necessary by a physician.<ref name="state.ri.us"/> In 1999 Connecticut had passed a similar, though somewhat more restrictive law.<ref>{{cite web|url=https://www.cga.ct.gov/2015/pub/chap_700c.htm#sec_38a-518h|title=CHAPTER 700c HEALTH INSURANCE|work=ct.gov|accessdate=29 August 2015}}</ref> | |||
| The expert panel's review was published in 2010, with the independent doctors and scientists in the panel unanimously endorsing the guidelines, stating "No changes or revisions to the 2006 Lyme guidelines are necessary at this time," and concluding long-term antibiotic treatments are unproven and potentially dangerous.<ref name=singer_2010>{{cite news|url=http://www.msnbc.msn.com/id/36721207/ns/health-infectious_diseases/deck/news.mobile.msn.com/ent.mobile.msn.com/en-us/mny.mobile.msn.com/en-us/ |title=No changes to Lyme disease treatment |first=Stephen |last=Singer |agency=Associated Press |date=2010-04-22}}</ref> The IDSA welcomed the final report, stating that "Our number one concern is the patients we treat, and we're glad patients and their physicians now have additional reassurance that the guidelines are medically sound."<ref name=idsa_besttreat_2010> ]. April 22, 2010.</ref> | |||
| Paul G. Auwaerter, director of infectious disease at ], cited the political controversy and high emotions as contributing to a "poisonous atmosphere" around Lyme disease, which he believes has led to doctors trying to avoid having Lyme patients in their practices.<ref name="amnews">{{cite web | url = http://www.ama-assn.org/amednews/2008/06/09/hlsa0609.htm |title = Lyme treatment accord ends antitrust probe | author = Landers, Susan J |work = American Medical News | date = 2008-06-09 | accessdate = 2008-06-24 |archiveurl=https://web.archive.org/web/20080611013743/http://www.ama-assn.org/amednews/2008/06/09/hlsa0609.htm|archivedate=11 June 2008}}</ref> | |||
| == Harassment of researchers == | |||
| In 2001, '']'' reported that ], chief of immunology and rheumatology at ] and a co-discoverer and leading expert on Lyme disease, had been harassed, stalked, and threatened by patients and patient advocacy groups angry at his refusal to substantiate their diagnoses of "chronic" Lyme disease and endorse long-term antibiotic therapy.<ref name="nyt-steere">{{cite news|author=Grann, David |url=https://www.nytimes.com/2001/06/17/magazine/17LYMEDISEASE.html |title=Stalking Dr. Steere Over Lyme Disease |work = ] |date = 2001-06-17 |accessdate = 2008-06-25}}</ref> Because this intimidation included ]s, Steere was assigned security guards.<ref name="uphill">{{cite journal |author=Abbott A |title=Lyme disease: uphill struggle |journal=Nature |volume=439 |issue=7076 |pages=524–25 |date=February 2006 |pmid=16452949 |doi=10.1038/439524a}}</ref> | |||
| == Media == | |||
| A 2004 study in ''The Pediatric Infectious Disease Journal'' stated nine of nineteen Internet websites surveyed contained what were described as major inaccuracies. Websites described as providing inaccurate information included several with the word "lyme" in their domain name (e.g., lymenet.org), as well as the website of the ].<ref name="pmid15626946">{{cite journal | last1 = Cooper | first1 = JD | last2 = Feder Jr | first2 = HM | title=Inaccurate information about lyme disease on the internet | journal=PediatrInfectDisJ | volume=23 | issue=12 | pages=11050–58 |date=December 2004 | pmid=15626946 | doi=10.1097/01.inf.0000145411.57449.f3}}</ref> A 2007 article in '']'' argued media coverage of chronic Lyme disease ignored scientific evidence in favor of anecdotes and testimonials: | |||
| {{quote|The media frequently disregard complex scientific data in favor of testimonials about patients suffering from purported chronic Lyme disease and may even question the competence of clinicians who are reluctant to diagnose chronic Lyme disease. All these factors have contributed to a great deal of public confusion with little appreciation of the serious harm caused to many patients who have received a misdiagnosis and have been inappropriately treated.<ref name="nejm-feder"/>}} | |||
| The 2008 documentary film '']'' opened June 19, 2009, in New York City. This documentary, made by a director whose sister contracted the disease, states that chronic Lyme disease exists.<ref name=wapo_2008>. '']''. June 17, 2008. Retrieved September 12, 2008.</ref> | |||
| In 2010, ] dedicated an episode of his TV series '']'' to the Lyme disease controversy (Season two (2010), episode 201 (8)). | |||
| == See also == | |||
| *] | |||
| *] | |||
| == References == | |||
| {{Reflist|30em}} | |||
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