Talk:Lyme disease/Archive 3

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Consensus

I have some thoughts I'd like to share:

1. Wikipedia operates under a number of rules and conventions. I'm pretty sure that when a page is protected, one is supposed to make requests for changes on the talk page.
2. The folks who are interested in presenting the alternate view on the disease type too many words. Please keep your comments shorter, or break them up as I am doing here.
3. I understand people's frustration with being sick, and not getting relief. I understand how they might be motivated to search for answers on their own, to lobby their politicians for help, and to challenge ossified thinking on the part of medical professionals.
4. Some things doctors believe about Lyme disease may turn out to be untrue.
5. Some conspiracy theories may turn out to be untrue.
6. Fortunately, Wikipedia is not in the business of discovering the truth, it is an encyclopedia that uses available reliable sources to construct articles on topics on what is known with a degree of certainty at the present moment.
7. Because of the way Wikipedia is set up, and edited by volunteers (like me) who are not experts, we follow the sources. In the case of a controversy, we get anal about the sources.

any questions? Phlegm Rooster (talk) 21:31, 4 July 2008 (UTC)

Thanks Georgia For Improving on the US Army Source that I added

thank you georgia.. your edits were excellent.. I had a small change-- I had request for quotation for ALL the named sources.. if we are going to get anal as rooster suggests... it should be equal opportunity anality..... "Be all you can be"... why discriminate against the Army? LOL

Rooster.. So.. you are "not sure" about the policy.. then why so heavy handed with me.. an honest volunteer just like you? My advice is that its best to check on the policy before threatening well meaning editors who include scientific sources.... Are you an administrator here?

As volunteers we are equal in the eyes of Wikipedia.... and we should treat each other with dignity and respect.

I agree with you that Wikipedia is not in the business of finding truth.. and that is uses reliable sources.. I am glad that you are not disputing the US army source... and I hope that a simple refernce to the many sources on "Persistence of of infection" be included in this article.

Bringing up the subject of conspiracy theory is random.. but since you brought it up.... there are many valid sources pointing toward Lyme disease having been researched as as a bioweapon... but use of these sources here has been stymied by heavy volunteers who "use rules" to keep these sources out of the page.... What are they afraid of? A source can't bite you... LOL —Preceding unsigned comment added by Freyfaxi (talk • contribs) 21:51, 4 July 2008 (UTC)

"Dignity and respect" then I am a "heavy volunteer" does that mean I am fat or what, and "afraid of" something?

I took out the US Army source again. Harrison's is a respected medical textbook. Antelan's comment above is good. So many respected sources, large studies, reviews, textbook say 80% or higher for the rash. We should not mislead Wikipedia readers and say there is disagreement about this based on an internet brochure and position of a medical fringe group. Also the US Army brochure, it is anonymous authored by the way, says "Up to 40% of people with LD may not have the early skin rash I put the itallics to show this is not a defanite thing, there is also no source for it. Later the brochure says up to 50% of untreated people can get a rash later. I say it is undue to use a brochure and a special interest group like there is disagreement in the medical community. RetroS1mone talk 23:11, 4 July 2008 (UTC)

Freyfaxi, please read WP:POINT. And please try to keep your talk page posts on topic so others can easily follow them. Have you had a chance to read WP:TALK yet? SandyGeorgia (Talk) 23:22, 4 July 2008 (UTC)

Some suggested publiushed references to add in

Ok, I'll propose a couple of references here and see how editors react. I am dipping my toe into the water here and if I don't just hear a bunch of raspberries I'll propose some more:

WHAT I PROPOSE TO ADD TO THE MAIN TEXT: "Innoculation of mice with cystic (L-)forms of B. garnii prepared in culture led to infection, with active spirochaetes isolated from the mice. This was even after the cystic forms had been kept in culture for a month. This suggests the possibility that relapses may occur after long antibiotic treatment has been discontinued."

REFERENCE: Gruntar et al. 2001 Conversion of Borrelia garnii cystic forms to motile spirochaetes in vivo. APMIS, 109(5): 383-8.

WHAT I PROPOSE TO ADD TO THE MAIN TEXT: "A wide range of forms of B. burgdorferi (sensu lato) have been demonstated in culture and in living tissues. In addition to the conventional spirochaete, wall-less mishapen forms and large wall-less 'spores' or L-forms occur, and can be produced under adverse conditions in culture. These have been demonstrated in culture to revert to classic spirochaete forms."

REFERENCE: Phillips S.E. et al. A proposal for reliable culture of B. burgorferi from patients with chronic Lyme disease, even those aggressively treated. Infection 26 (6):364-7. —Preceding unsigned comment added by Roohub (talk • contribs) 08:33, 5 July 2008 (UTC)

• Gruntar I, Malovrh T, Murgia R, Cinco M (2001). "Conversion of Borrelia garinii cystic forms to motile spirochetes in vivo". APMIS. 109 (5): 383–8. PMID 11478686. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Phillips SE, Mattman LH, Hulínská D, Moayad H (1998). "A proposal for the reliable culture of Borrelia burgdorferi from patients with chronic Lyme disease, even from those previously aggressively treated". Infection. 26 (6): 364–7. PMID 9861561.{{cite journal}}: CS1 maint: multiple names: authors list (link)

These are the above references sources. BJ^Talk 09:25, 5 July 2008 (UTC)

All the mouse study shows is that the bacteria survive for prolonged periods in stationary phase. Most bacteria do, that's not unusual and nothing to do with a chronic infection. The paper by Phillips et al was tested in a later paper by a team at NIH Marques et al and the results seriously questioned. The results could also not be replicated by a second group of investigators (link). Since these results are unconfirmed, they could be mentioned but cannot be used to contradict the mainstream view that you cannot cultivate spirochetes after antibiotic therapy (see review). Tim Vickers (talk) 14:22, 5 July 2008 (UTC)

On the content issue, I agree with Tim that these primary sources are fairly obviously cherry-picked, judging by the proposed explanatory text and the failure to properly contextualize them. On a meta-note, I find myself less and less willing to listen to an endless stream of "new" accounts advancing the exact same agenda. Use one account to push this POV; if the arguments are actually convincing, the meatpuppetry won't be necessary. MastCell ^Talk 23:40, 5 July 2008 (UTC)

Mastcell, what are you on about? I am a biologist trying to make a reasoned scientific contribution to this debate. Do you usually respond with such scorn to contributions? I welcome contructive criticism such as Tim Vickers has given... it prompts one to think harder and look more deeply into the more recent literature. But what have you actually said there that helps anything? Please calm down, be civil and make a constructive contribution to the debate. This is supposed to be an intellectual forum, not a bar room for heckling.

Bjweeks and Tim Vickers, thank you for your response. I will try to think more carefully, and look into more recent literature which colleagues tell me contains more robust studies. I think you are indeed right, it does look like L-forms, while offering a possible explanation for persistant Lyme symptoms (so the proposal of persistance is not as ridiculous as some have claimed), cannot conclusively lead to anything yet. My feeling is that a stronger case can be made empirically from recent studies that deal with improvements under treatment - but this is just based on news reports and pers. comms so I am not going to propose anything until I find a good literature source to back it up with. --Roohub (talk) 00:38, 6 July 2008 (UTC)

For the record, it was actually Tim Vickers who made the comment. BJ^Talk 00:45, 6 July 2008 (UTC)

I'm sorry to be the bad guy and sorry if my tone was uncivil. Nonetheless, Wikipedia is not a venue for advocacy, and coordinated attempts to advance a specific agenda are frowned upon. If you are here independently and have coincidentally registered a new account at a time when a dozen other new accounts have been advancing the same arguments as you, soliciting new meatpuppets, and coordinating strategy on off-wiki message boards, then you have my apology. I think one issue worth mentioning is that you seem to have come here with a "case" you want to make, and you're hunting about for any source that might help you make that case. While this is a reasonable approach to general debate, Wikipedia is not a debate forum. We aim only to characterize a debate, for instance by describing the positions taken by various groups and their relative weight, not to set up dueling original journal articles against each other with an editorial spin. Our policy on original research and synthesis explicitly discourages editors from stringing together various primary sources to advance an editorial argument. As far as Wikipedia is concerned, it's a better idea to find the best available secondary sources and go where they lead you. MastCell ^Talk 01:07, 6 July 2008 (UTC)

Mast cell, there is another possible explanation why there are so many suddenly having the impudence to disagree with your viewpoint. Could it be that finding that the main page on Lyme disease has been completely rewritten, and heavily buttressed to one side of the issues, people are have taken an intellectual interest in the subject (regardless of any personal experience with Lyme or whatever) are trying to balance it up a bit? There is a world beyond the US of A, where the possibility that Lyme might be a chronic disease is taken rather more seriously by academics and clinicians alike. And we now have the IDSA being pretty badly slapped for its behaviour. We have, as it is at present, an article packed full of academic references which support the IDSA line, yet there do seem to be a more recent findings suggesting that things are not as simple as they have suggested. The article should acknowledge these and that is what I am hoping to add in, in a civilized way. The way editing has been set up here, of course this has to be a forum for debate: something must be debated before it can approved for addition to the main article. What would you expect? If you dig yourself into an entrenched position, of course you will feel besieged --Roohub (talk) 01:48, 6 July 2008 (UTC)

The world is not split into "IDSA" and "Lyme advocates". There are a host of other medical sources beyond the IDSA that side with the conventional view. We are using these sources, which include major medical textbooks and review articles. Crafting a false dichotomy is not a fruitful line of argumentation here. Antelan^talk 01:57, 6 July 2008 (UTC)

Exactly, Antelan, and I fear that is how Mastcell may be seeing things. I am not in either extreme position in the debate but I can see that IDSA has grossly simplified the picture (as organisations like LLADS have too). So why should we have the straight IDSA line? They seem to claim a monopoly on the truth, whereas there is a wide range of respectable, intelligent opinion out there. At present, the page clearly reads just about like IDSA would want it to. On the other hand we don't want a page that reads like LLADS would want either! --Roohub (talk) 03:55, 6 July 2008 (UTC)

Roohub, I suggest that you stop using this talk page for advocacy, and instead focus on finding high-quality sources for your claims. Soapboxing on talk pages won't change the article; when you present sources, we can discuss them. That's the way Wiki works, and taking bandwidth to advocate a position won't change that, but will weaken your credibility. Present some sources, learn Wiki policies, work within them, and please stop soapboxing on the talk page, because the rest of us work on many other articles besides this one and reading long posts that have little relevance to article changes isn't helpful. SandyGeorgia (Talk) 04:03, 6 July 2008 (UTC)

Roohub, you have been advocating for extreme views here, whereas MastCell has been telling you what the mainstream says. That the mainstream happens to include the IDSA, and that the IDSA has been chastised for its behavior (not its science), does not make the mainstream "wrong". Wikipedia is not here to present truth; it is here to present verifiable, notable information. Antelan^talk 04:21, 6 July 2008 (UTC)

Save your breath. Roohub has been blocked as a sockpuppet of an indefinitely blocked user. Jehochman ^Talk 04:28, 6 July 2008 (UTC)

Worth noting; no further comment other than to reiterate my statements above and agree with those of Antelan and SandyGeorgia. MastCell ^Talk 19:42, 6 July 2008 (UTC)

Intro

It is a false statement that the three controlled, randomized studies found "no benefit" to prolonged or repeated antibiotic treatment. I changed this to "mixed results" because of what the studies themselves actually say:

From Krupp (Neurology, 2003): "Ceftriaxone therapy in patients with PLS with severe fatigue was associated with an improvement in fatigue but not with cognitive function..."

From Fallon (Neurology, Epub 2007): "Across six cognitive domains, a significant treatment-by-time interaction favored the antibiotic-treated group at week 12. The improvement was generalized (not specific to domain) and moderate in magnitude, but it was not sustained to week 24. On secondary outcome, patients with more severe fatigue, pain, and impaired physical functioning who received antibiotics were improved at week 12, and this was sustained to week 24 for pain and physical functioning." Bapb (talk) 20:31, 6 July 2008 (UTC)

A user changed the language to "no consistent benefit" and I reverted because in both studies above, there was consistent physical benefit, no consistent cognitive benefit. "Mixed results" is therefore more accurate. -Bapb (talk) 21:48, 6 July 2008 (UTC)

Here are the three cited sources, with quotes from the "conclusions" section of the abstracts:

• PMID 11450676: "In these two trials, treatment with intravenous and oral antibiotics for 90 days did not improve symptoms more than placebo."
• PMID 12821733: "Additional antibiotic therapy was not more beneficial than administering placebo."
• PMID 12821734: "This study does not support the use of additional antibiotic therapy with parenteral ceftriaxone in post-treatment, persistently fatigued patients with PLS."

This is accurately summarized by saying that these trials found no evidence of benefit. "Mixed results" is in no way "more accurate". I have reverted your edit as incorrect. MastCell ^Talk 23:31, 6 July 2008 (UTC)

No, actually those are not the 3 clinical trials as you claim. Your first two citations are papers which refer to the same clinical trial by Klempner et al. (let's call this #1). This is the trial which found no benefit, something we all agree on.

Your third citation is from the Krupp et al. study (#2) which contains different information in the "results" and "conclusions" sections, if you read the whole published paper and not just the abstract. The "results" section is what I quoted from above, and it clearly states "improvement in fatigue", although there was no cognitive improvement. So while this trial produced a benefit, the authors chose to conclude that antibiotics are not warranted because they did not find cognitive improvement, and they felt the very real physical benefit wouldn't be worth the risk of IV antibiotic treatment. That is a subjective conclusion subject to debate. Now this article's intro section sentence is about results, and these are without a doubt "mixed results" since there was a benefit vs. placebo in terms of fatigue. (If they weren't mixed results, why else did Krupp et al. consider a risk-benefit analysis for physical improvement noted in the study?)

Meanwhile you neglected to mention the third study by Fallon et al. (#3), which again found sustained physical improvement in a subgroup of patients, though only temporary cognitive improvement. Again the conclusions are not at issue here; the fact is that these results (improvement given treatment vs. placebo) must also be characterized as "mixed."

The phrase "no benefit" implies no improvement in the treatment group vs. placebo, and that was simply not the case in Krupp et al. or Fallon et al. I hope these misleading quotations represent misunderstanding of the research and not bad faith. Reverting back. -Bapb (talk) —Preceding comment was added at 03:25, 7 July 2008 (UTC)

The Fallon paper found improvement in borrelia encephalopathy, a recognized part of late disseminated Lyme disease (Stage 3), not "chronic Lyme disease." Antelan^talk 03:50, 7 July 2008 (UTC)

I'd say this is a misleading statement, since those who use the term "chronic lyme disease" generally are referring to what others call 3rd stage Lyme. The debate is simply over whether 3rd stage disseminated infection persists after antibiotic treatment. Meanwhile I did not use the term "chronic lyme disease" here. Fallon's study included patients who tested positive for Lyme disease with persistent symptoms of the "medically unexplained" variety which is exactly the phrase used in the intro. -Bapb (talk) 03:58, 7 July 2008 (UTC)

You may find the editorial comments on that article to be engaging: [1]. To me, this is a textbook example of why, where possible, we prefer secondary sources. (I.e., because people of intelligence and good faith often disagree about interpretations of primary sources). Antelan^talk 04:19, 7 July 2008 (UTC)

The Fallon study says "The majority of the physical self-report measures (fatigue, current pain, physical functioning) indicate interaction effects at week 12 favoring drug over placebo as a function of baseline severity, with the drug effect increasing with higher baseline impairment" The effect is not significant when you compare drug to placebo, p=0.06, "for baseline severity and treatment". Fallon et al go to a model to get a significant effect, "model-based comparisons reveal the main effects of drug vs placebo (p < 0.05) at high levels of baseline severity". So,

• Between groups, no significant differences for drug vs placebo for primary outcome at any time
• Between groups, no significant differences for drug vs placebo for secondary outcomes
• Marginal significance for current pain if you use McGill not total method and model self-reported baseline severity.

When your arguing if p=0.053 is significant and you are getting significance just when you use models and keep slicing your n's by doing baseline groups its a good sign "no consistant benefits" was the right language. RetroS1mone talk 04:27, 7 July 2008 (UTC)

Point well taken, but wikipedia (and certainly the intro to the article) is not the place to debate Fallon's handling of the data or the clinical relevance of his findings. Simply deleting Fallon's study which was published in a major journal (model-based comparison, benefit finding, conclusions and all) because you disagree with his handling of the data is a violation of WP:OR and WP:NPOV. The relevance of his findings may be debatable, but the actual finding of benefit is not. We can argue the methodologies and generalizability of all three studies (including the Klempner study, for which there are also published criticisms) but deleting any of these studies from wikipedia solely based on this sort of criticism is a violation of WP:OR and WP:NPOV.

Meanwhile in the Krupp study, the significance of intention to treat analysis for benefit to fatigue was p<0.001. And even with all possible combinations of the 7 patients lost to follow-up considered, it remained p<0.05. That is a consistent benefit for fatigue in this study (fatigue was the sole clinical criteria for patient selection).

Currently this wikipedia article says these studies found "no benefit" which implies no benefit to treatment vs. placebo by any measure in any study. That's a false statement in clear violation of WP:NPOV. Given Krupp's benefit, Fallon's subgroup benefit and the lack of sustained cognitive improvements, "mixed results" is quite fair and NPOV, and avoids original argument about the relevance of these different findings. -Bapb (talk) 07:10, 7 July 2008 (UTC)

We're not here to reinterpret the medical literature, nor to reargue this debate. Let's consider the talk page guidelines. I'm going to ask for a specific textual change and supporting sources. "Mixed benefit" is a demonstrably incorrect summary of the sources currently cited. If Bapb wants to cite different sources, then we can discuss how to represent them. Perhaps it's better to leave any reference to specific studies out of the lead and simply summarize the views of expert bodies as seen in secondary sources. MastCell ^Talk 06:30, 7 July 2008 (UTC)

Krupp's p<0.001 benefit for fatigue (see discussion above) is hardly my "reinterpretation", it is the published finding. Please explain how a p<0.001 benefit equals "no benefit"?

While I do share your concern about primary vs. secondary sources, there are numerous published criticisms of all three studies and hashing those out those secondary sources would be far messier, especially for an intro section. Both the Krupp and Fallon studies found some "benefit" at statistical significance (not along all measures). This is not my opinion or reinterpretation, it is fact. Clearly the studies have different methodologies and different findings, and I wouldn't suggest that benefits have been found across all studies. That would be a POV stance which I am not taking. In contrast, your argument that "no benefit" has ever been found is a clear violation of WP:NPOV. -Bapb (talk) 07:10, 7 July 2008 (UTC)

Actually, "no benefit" is the conclusion of the authors of the first two studies cited above, while the third concluded that their results "did not support" the use of ceftriaxone. These authors unanimously failed to find a benefit from long-term antibiotic treatment that would justify its use. Those are the explicit conclusions of the study authors, and reflecting them in the article is not POV. I'm fine with other language, like that proposed by TimVickers or by Retros1mone below, so long as it does not obscure the actual conclusions of the study authors. MastCell ^Talk 18:27, 7 July 2008 (UTC)

Wikipedia policy says to use secondary sources to construct articles (WP:PSTS). In the scientific literature, a primary source is a study or experiment, a secondary source is a review article. Phlegm Rooster (talk) 07:13, 7 July 2008 (UTC)

"Mixed results" is not supported and it is POV, but there were some benefits just not consistant. Krupp says "Because fatigue (a nonspecific symptom) was the only outcome that improved and because treatment was associated with adverse events, this study does not support" etc. I suggest, "no consistent benefits to balance a high frequency of serious side effects." With a review for a source what do people think about that? RetroS1mone talk 12:44, 7 July 2008 (UTC)

Sure. MastCell ^Talk 18:27, 7 July 2008 (UTC)

I'm fine with that too. Although I might change this to "A series of randomized controlled trials found no consistent benefit from prolonged antibiotic treatment and observed serious side effects from this therapy." Tim Vickers (talk) 18:58, 7 July 2008 (UTC).

I agree that this is the most clear and unbiased way to summarize these studies. --Charanti^Talk 23:20, 10 July 2008 (UTC)

It looks like I unwittingly waded back into this discussion. The article used the term "no benefit" to describe the results of all 3 earlier trials, which was clearly incorrect due to the Krupp study, as others have also noted above. It also said that the 2008 study had a "statistically insignificant" result, which was also clearly incorrect if you look at the study. FWIW, I'll also agree that "mixed results", too, is not an accurate collective characterization of the 4 studies. I've tried adding in a few hundred more bytes to make things clearer, let me know what y'all think. Pro crast in a tor (talk) 23:05, 17 October 2008 (UTC)

Reading a bit more, actually I do think that "mixed results" would be an accurate way to assess the four studies. The Krupp study selected patients based on fatigue, and showed positive results for treating this fatigue (64% for treated individuals, 16% for placebo). Though there was no significant improvement in cognition, not all patients had cognitive problems upon admission. I've changed the intro & chronic section to reflect this more accurate information. I also think there should be some mention that the 3 studies had a grand total of 221 patients enrolled, too few to make strong conclusions especially given the differences in inclusion criteria between the studies. Pro crast in a tor (talk) 02:23, 18 October 2008 (UTC)

I would suggest that "little or no benefit" is a better summary, and more in keeping with evidence syntheses from reliable secondary sources, per WP:MEDRS. I would be against original research about appropriate patient sample sizes; I haven't done the statistical power calculations, but unless a reliable secondary source has questioned the sample sizes we should not in this venue. I've also trimmed the lengthy blockquote from the Connecticut Attorney General's press release - obviously both the AG and the IDSA have spun the situation as "vindicating" them, but we shouldn't give excess weight to either press release. The facts are straightforward: no charges of wrongdoing were filed, and the IDSA agreed to an independent scientific review of their guidelines. The opinions of each side are relevant but should not be dilated upon at excess length or given excessive authority. MastCell ^Talk 22:50, 18 October 2008 (UTC)

I think that both the "chronic lyme" and "controversy" sections of the article are not detailed enough to give an accurate portrayal of the current state of affairs, and overly generalize and summarize the views of both sides of the debate. I'm of the opinion that both sections need to be expanded, and eventually move into separate Wikipedia entries at some point in the future, which is the direction I suggest we go with this article. I do not believe the AG quote was "lengthy", as it was just three sentences. I agree that a quote from IDSA would also be warranted, though I didn't find a "money quote" in the IDSA press release like the one in the AG press release. I'll review this again later and see if I can add in a 2-sentence quote from the AG and 2 from the IDSA. Thanks for your feedback on the total number of patients comment, and sorry I was unclear, I was not suggesting WP:OR via power statistics, but rather including more details about the studies in the relevant section, and characterizing as "small" the 55 patient Krupp study, and the 37 patient Fallon study. The 4 studies, all rated 1B by WP:MEDRS, are all we really have to go by on chronic lyme, and describing them in more detail seems justified. There are ample primary and secondary sources available. Pro crast in a tor (talk) 00:02, 19 October 2008 (UTC)

We already talked about this. HEre is what I said in July, The Fallon study says "The majority of the physical self-report measures (fatigue, current pain, physical functioning) indicate interaction effects at week 12 favoring drug over placebo as a function of baseline severity, with the drug effect increasing with higher baseline impairment" The effect is not significant when you compare drug to placebo, p=0.06, "for baseline severity and treatment". Fallon et al go to a model to get a significant effect, "model-based comparisons reveal the main effects of drug vs placebo (p < 0.05) at high levels of baseline severity". So,

• Between groups, no significant differences for drug vs placebo for primary outcome at any time
• Between groups, no significant differences for drug vs placebo for secondary outcomes
• Marginal significance for current pain if you use McGill not total method and model self-reported baseline severity.

When your arguing if p=0.053 is significant and you are getting significance just when you use models and keep slicing your n's by doing baseline groups its a good sign "no consistant benefits" was the right language.

So thats what i said in July it is true today to, you have to read the whole article to find out there is not statistical significance. The language I said was "no consistant benefit" that is good I think still. Please do not add more from press releases bc this is just a minor thing between the pro ILADS AG and IDSA and it did not go to trial. It does not have any bearing about science. It is not IDSA against ILADS it is like most doctors that disagree with ILADS!, a fring group why is all the discussion on this article about them and their idea about chronic lyme, I don't get it. RetroS1mone talk 02:50, 19 October 2008 (UTC)

Hi RetroSimone, this Medpage article, a good secondary source, describes the study thusly: "Although the cognitive benefit was transient, the additional course of ceftriaxone produced further improvements in physical functioning and decreases in pain and fatigue among patients with more severe disability at baseline". As MastCell was saying earlier, we should be using WP:MEDRS and rely on secondary sources, not judging for ourselves if there is statistical significance.

To me, this is a pretty clear issue: both the Fallon study (per the above reference) and Kaplan studies found a benefit from treatment, with the Kaplan abstract plainly stating "Patients assigned to ceftriaxone showed improvement in disabling fatigue compared to the placebo group (rate ratio, 3.5; 95% CI, 1.50 to 8.03; p = 0.001)". I don't understand why the article has chosen to focus only on the lack of improvement in cognition, which while quite a bummer for those infected, doesn't mean that the antibiotic treatment had "no benefit" or "no consistent benefit": there was, in fact, a consistent benefit to patients in two of the trials. Of course, Krupp did say that the risks did not outweigh the benefits, which should also be mentioned, but that in no way diminishes the effects of treatment. I also think that this article is not well served by attempting to summarize all four of the randomized, double blind surveys with just four words, "little or no benefit", and we can and should provide more detail about them (not in the intro, of course, but in the section about "chronic lyme").

Finally, regarding "chronic lyme", I could supposition why there is so much discussion about it, but this is not the place for such a discussion. It is clear, however, that there is a lot of interest in the subject of "chronic lyme" based on the large number of reliably sourced articles on this subject. Because of this interest, I think that there should be more material in Wikipedia on this topic, and I'm going to be working on including some of it over the next few weeks (until I get back to work, of course - I did pick my handle for a reason. :) ). . Pro crast in a tor (talk) 09:08, 19 October 2008 (UTC)

I have a couple of problems with this:

• You cite MedPage Today; that article globally indicates that there is no lasting benefit to antibiotic treatment (the headline makes this clear), yet you're cherry-picking material from it to push the benefits of antibiotics. If we have "chosen to focus" on the lack of benefit, that's because reliable expert sources, including the one you cite, have focused there.
• I'm not really happy with the changes to the lead - they seem a bit less readable and even a bit misleading. They basically cite a bunch of primary sources (somewhat inappropriately, I think) to suggest there are some benefits from antibiotics, then follow with the IDSA, CDC, and AAN guidelines. The reader is probably left wondering why those institutions reached their conclusions, given the the primary sources in the preceding sentence. The weight of studies, including those you cite, shows little or no benefit from antibiotics. The AAN, CDC, and IDSA all reached this conclusion. This should be clear from the lead. Transient positive findings can be detailed later, but the current approach seems to selectively quote the primary studies to undermine a huge weight of expert opinion in the field, which is where WP:MEDRS (and our more basic policies like WP:SYN) come in.

I haven't made any major changes yet but would like further discussion on these issues. MastCell ^Talk 04:45, 20 October 2008 (UTC)

Hi MastCell, I'm not attempting to cherry-pick information, rather, I'm including both primary and secondary findings from the study, and lengthening the article in the process. It seems clear that antibiotics do _something_ related to fatigue and/or pain in the double-blind, placebo controlled trials, and I see the current version as an improvement over the "little or no benefit" phrase that was being used before. The MedPage Today study was primarily aimed at encephalopathy, but the secondary finding is just as valid. Again, antibiotics did _something_, and I find it more misleading to omit this fact than include it.

The guidelines for treatment from the IDSA, CDC, AAN, and ILADS should be differentiated from what the studies themselves conclude. The authors of the studies are reliable sources in and of themselves, and there's no need to run them through the filter of these professional groups to reach a conclusion: they can stand on their own. Fallon's study, for instance, makes no conclusions about whether the risks of long-term antibiotics outweigh the benefit from a reduction in fatigue.

I'm not too happy with the lede paragraph, either. The controversy surrounding chronic lyme, which doesn't even have an agreed upon name (!), seems worthy of inclusion in the lede due to the number of journalists that have written on the topic, but it doesn't flow so well right now. I agree that we're using primary med sources too much, and will work on finding some more secondary sources. Pro crast in a tor (talk) 20:24, 20 October 2008 (UTC)

ILADS says chronic Lyme happens and you don't need evidence of infection to do long-term antibiotics. The four studies we argue about, all the people in them have evidence of infection. Most of the people in them already had antibiotics. So more antibiotics for longer doesn't make a difference, so these studies say. The one exception that you are holding on is the Krupp paper where they find a significant improvement in fatigue, guess why, because they count people that did not all ready get any antibiotics for the infection, if you take out those people there is no significant benefit, p is like 0.4!! All the major people say you can take antibiotics for Borrelia for like a month or some thing. So those people that got antibiotic for the first time are getting standard I guess so duh you see an effect. The lead people say if antibiotics don't help it's risky to keep on pumping it into your arm for months. There's little or no benefit from longterm antibiotic when the first treatment didn't help!! RetroS1mone talk 01:39, 21 October 2008 (UTC)

Hello RetroS1mone, it appears to me that you have a very strongly held POV on this issue. I've now cited two secondary sources that back up my interpretation of the primary studies, with not just one, but two studies finding a statistically significant improvement in fatigue. Perhaps it was the antibiotics themselves that caused this, perhaps it was because only some subspecies of borrelia were affected by those specific antiobiotics, but it doesn't really matter what you or I think: it's what the reliable sources say (or, in the case, the secondary sources. Pro crast in a tor (talk) 06:58, 21 October 2008 (UTC)

This edit looks pretty reasonable to me. MastCell ^Talk 17:25, 21 October 2008 (UTC)

Two studies, no improvement. 3rd study, Krupp study, just fatigue improvement for placebo and antibiotic, more for antibiotic but secondary source BAker AJM 2008 says it was unblinded and that is why, bc of big placebo effect. 4th study, Fallon study there is p=0.053 for cognition but it is transient and the analysis is post hoc (Marques et al 2008 Neurology). No improvement in fatigue like Pro says except you start doing subgroup analysis and modeling that is the old trick of slicing your n's until you get some thing you can publish. Neurology did the weird thing of publishing editorial in same edition that was dissing the article I gues they were not comfortible with that! OK so if you understand all that and its still reasonable saying what the lead says now that is ok with me but I disagree. RetroS1mone talk 02:31, 22 October 2008 (UTC)

OK I made some change on the intro and I think it is progressing better if you want to change it ok. Pro I am just trying to get it right that is my POV. Thx. RetroS1mone talk 02:46, 22 October 2008 (UTC)

Opinions on article/talkpage protection

Hello all! I notice that the article and talkpage are both currently semi-protected. The protection policy discourages this; the protections were applied at different times, so I guess it might not have been noticed. At least one of the two should get unprotected so that, if non-autoconfirmed users can't edit the article, they can at least use {{editprotected}}!

Which one should get unprotected? That is, is the main problem to do with article edits or talkpage posts? Or do you think dual semi-protection really is warranted in this case? (N.B.: User:152.2.174.171 already raised a concern about this at User talk:Allemandtando#Lyme Disease if that affects your reasoning)

--_{tiny plastic} Grey Knight ⊖ 07:19, 11 July 2008 (UTC)

Eh, the article and talk page had turned into a smorgasbord of agenda-based meatpuppets recruited from an Internet forum, the semiprotection of both was in response. I am not at all encouraged by the IP in question's note. The article should probably be semiprotected for the immediate future. No opinion about the talk page; we could try unprotection and see what happens, so long as there's an admin somewhere willing to get involved when the meatpuppet brigade returns. I would prefer to have a commitment to admin oversight first and unprotect the talk page second, but that's based on past experience. MastCell ^Talk 20:00, 11 July 2008 (UTC)

Concur (and this should allow time for the recruitees to read and understand Wiki policies). SandyGeorgia (Talk) 20:08, 11 July 2008 (UTC)

Too long 2

I am sorry I don't kow how to use this format and learning from lengthy descriptions is not an p=option for people with impaired short term memory...

What you need to do is be more concise, delete the part about people who think they have lyme symptoms have been proven not to need antibiotics. What has that to do with anything? And it comes right at the top of the article so that a reader may think that a person suffering from lyme that has not had all of the organism wiped out yet (and this is very difficult- it takes ten months to grow the organism in a petri dish) is a hypochondriac.

you need several pages - edit this way-

Tick borne disease

Tick borne disease

1. Borreliosis

a. Lyme (and mention that usually all forms of borreliosis are called lyme, which can lead to misdiagnosis. the deer tick photos are appropriate here.

b. STARI (carried by the Lone star tick and show photos and explain how tests specific for burgdorferi are not relevant to this specific type of borrelia. MASters disease is another name for STARI.

c-d-e any others

2. Erlichiosis

3. Babesiosis

4. Rocky Mountain Spotted Fever.

5-6-7 Etc etc —Preceding unsigned comment added by Cimarroncowgirl (talk • contribs) 00:11, 16 July 2008 (UTC)

I was trying to put this on the page difficulty in diagnosis I apologize again for not knowing how to use the format

the difficulty in diagnosing is in a large degree because the tests are geared toward recognizing one specific type fo the causative organism. Dividing the tick borne diseases in outline form on different pages will help to show why this is true and help people to realize that being tested for onlyone type of borreliosis is not relevant to all of them.

I was misdiagnosed for ten years, because they did not know about Master's disease (STARI) yet.

Cimarroncowgirl (talk) 00:24, 16 July 2008 (UTC)

This applies to difficulty of diagnosis, and protecting the entry from the people who have lyme...Thank you for moving my post to the bottom. I posted on the difficulties of misdiagnosis, and sympathize with you for trying to deal with people suffering from this horrid disease.

I think giving less emphasis (move to less prominent position) or simply deleting the part about "if you just think you still have the disease - don't have active organisms (there is a cyst form that is dormant for long periods of time) then antibiotics don't work for you". (using the general "you" here because that is how the people you are protecting from editing are reading this.) I have been on that list with them and sympathize with both sides in this. —Preceding unsigned comment added by Cimarroncowgirl (talk • contribs) 00:43, 16 July 2008 (UTC)

We do need an article on Southern tick-associated rash illness. Once this is written we can link to it from here. Tim Vickers (talk) 03:34, 16 July 2008 (UTC)

I've started the STARI article. Tim Vickers (talk) 04:17, 16 July 2008 (UTC)

To address another point, I don't think that the controversy over "chronic" Lyme needs so much detail in the lead section, though it should probably be mentioned briefly as a salient aspect of the topic. Certainly the lead paragraph, as a whole, could stand to be improved. MastCell ^Talk 06:34, 16 July 2008 (UTC)

Bot report : Found duplicate references !

In the last revision I edited, I found duplicate named references, i.e. references sharing the same name, but not having the same content. Please check them, as I am not able to fix them automatically :)

• "pmid16995383" :
  • {{cite journal |author=Lane RS, Mun J, Eisen L, Eisen RJ |title=Refractoriness of the western fence lizard (''Sceloporus occidentalis'') to the Lyme disease group spirochete ''Borrelia bissettii'' |journal=J. Parasitol. |volume=92 |issue=4 |pages=691–696 |year=2006 |pmid=16995383 |doi=}}
  • {{cite journal |author=Lane RS, Mun J, Eisen L, Eisen RJ |title=Refractoriness of the western fence lizard (Sceloporus occidentalis) to the Lyme disease group spirochete Borrelia bissettii |journal=J. Parasitol. |volume=92 |issue=4 |pages=691–696 |year=2006 |month=August |pmid=16995383 |doi= |url=}}
• "isbn0-07-159991-6" :
  • {{cite book |author=Fauci, Anthony S. |title=Harrison's Principles of Internal Medicine: Editors, Anthony S. Fauci ... [Et Al.] |publisher=McGraw-Hill Medical Publishing |year=2008 |pages=Chapter 166 |isbn=0-07-159991-6}}
  • {{cite book |author=Fauci, Anthony S |title=Harrison's Principles of Internal Medicine: Editors, Anthony S. Fauci ... [Et Al.] |publisher=McGraw-Hill Medical Publishing |year=2008 |pages=Chapter 166 |isbn=0-07-159991-6 }}

DumZiBoT (talk) 00:04, 9 August 2008 (UTC)

[2]  Done SandyGeorgia (Talk) 05:37, 12 August 2008 (UTC)

Need updates and reputable references

I recently added some information to the controversy section which was deleted by TimVickers. As the article stands now there are multiple references to IDSA (infectious disease society of america) which has done little to no research on there own concerning lyme and has kicked doctors off the board that were involved in research and treatment. It was long known that corruption existed within the organization and recently the conneticut attorney general brought the evidence to light. The article is worded so that it sounds like nothing was ever wrong with IDSA's guildelines which is true because that wasn't what was addressed in the litigation. Had the case been heard completely through the court system it may have taken years to get the guidelines changed, however by coming to an agreement to update the guidelines with ethics counsel present and the previous doctors they kicked off the board the guidelines can be finished much quicker. This means the members of IDSA that violated anti-trust laws stay out of prison, but the people suffering with the diseases can hopefully get treatment in the near future, which was the main purpose of filing suit against IDSA (help citizens rather than hurt them for your own financial gain).

The other issue is there is no mention of the International Lyme and Associated Disease Society (ILADS) which is not affected by corruption within the U.S. medical system since it is international, and is a research based organization consisting of physicians that are actively treating the diseases. I ask that anyone wanting to make updates to the page read the information and studies presented at www.ilads.org as I have asked TimVickers to do. It is the most up to date organization with doctors THAT ACTUALLY TREAT the diseases.

Another point to mention is that the fact was stated that one person died from prolonged IV therapy and it's worded to sound like prolonged IV therapy presents a significant risk. There is no mention of the thousands that die from lyme disease every year because they don't get treatment. This is leaving out the risk factors of not treating the disease. —Preceding unsigned comment added by 24.235.23.77 (talk) 15:36, 12 August 2008 (UTC)

Please take a look at Wikipedia's core policies, in particular, the ones mandating verifiability, neutrality (particularly the avoidance of undue weight), our guidelines on appropriate sourcing, and the policy against . The conflict between the Connecticut Attorney General and the IDSA is covered in the article already, and your summary of it is both heavily slanted and, in many areas, factually incorrect. I find the contention that an international organization is somehow immune from corruption particularly unimpressive. In any case, you are not the first to use Wikipedia as a soapbox for this particular agenda; please review the talk page above. If you have reliable sources that you believe would improve the article, then please discuss them here, but leave out the suspect argumentation and polemics - this isn't the place. The Internet is chock full of other venues to vilify the IDSA, promote ILADS, and so forth. MastCell ^Talk 23:26, 13 August 2008 (UTC)

I know there may be many opinions on this and a tendency to support an organization that has been around a long time now. Yet as I read the information that has been posted it is factually incorrect as written and heavily slanted towards IDSA. I never said ILADS is immune from corruption but it takes a much greater effort to bribe many doctors from a collection of institutions than it does to bribe a handful from IDSA. That's just common sense. This is not a matter of soapboxing this is a matter of correct information and reputable sources which is hard to believe exists when only one organization is referenced. So yes this isn't the place to promote one thing or the other this is the place to state facts. That is why I'm asking that people read current information, use common sense, and reference reputable sources. Statements like those below are worded to sound very reputable and believable to anyone that doesn't understand the dynamics of the organizations. Both of the organizations included the same doctors both of which found evidence supporting long term treatment but disregarded it and removed the doctors conducting the research. Do you not see a problem with this? Multiple references to the same two groups on the same issue, promoting the same opinion?

and most expert groups including the Infectious Diseases Society of America and the American Academy of Neurology have found that existing scientific evidence does not support a role for Borrelia nor ongoing antibiotic treatment in such cases.[7][8]

Thus, most medical authorities, including the Infectious Diseases Society of America and the American Academy of Neurology, have found that there is no convincing evidence that Borrelia is implicated in the various syndromes of "chronic Lyme disease", and recommend against long-term antibiotic treatment as ineffective and possibly harmful.[84][85][7]

And then the paragraph here:

A significant amount of inaccurate information on Lyme disease exists on the Internet. A 2004 study found that 9 of 19 websites surveyed contained major inaccuracies. Sites found to be good sources of accurate information in this study included those of the American College of Physicians, the Centers for Disease Control, the Food and Drug Administration, and Johns Hopkins University (www.hopkins-arthritis.org).[132]

I hope you do realized that these organizations use guidelines from IDSA, even the CDC uses IDSA's guidelines. And who conducted this study? Well if you look at the reference it's another infectious disease doctor. So it's pretty clear what that study considered to be accurate.

Then there are excerpts about doctors being harassed for not treating patients with "chronic" lyme and no mention of the ones that do and have given so many people a chance to live again. Quotes from one of the board members of IDSA yet none from the doctors that were removed from the board becaue they had research and experience that conflicted with idsa obtaining bribes.

So I don't see how you can say anything I have proposed is slanted when what is written currently is so heavily tilted in one direction. I ask you to do some careful reading and talk to doctors outside of IDSA that are involved in research, call the attorney generals office if you don't want to read his evidence on the website.

I'm trying to work with editors rather than simply have them respond lamely and say I'm trying to argue or that presenting information opposing what was written is slanted. Can I ask editors to do some reading. Understand what you're reading and where it comes from. If you don't understand information and can call someone do it, I have. I took the time to investigate and I'm asking that if you don't agree then research for yourself don't simply bash others. This is intended to be a resource for users everywhere not a place to promote opinions. Pryorka82 (talk) 18:32, 15 August 2008 (UTC)

Please have a look at WP:SOAP; MastCell has already explained the sourcing issues. SandyGeorgia (Talk) 19:05, 15 August 2008 (UTC)

I think this is a case of confusing Wikipedia for something it is not. (Note that similar rhetoric is on display at Talk:Babesiosis). Further talk page posts should be focused on material from specific reliable sources and its incorporation into the article. At this point I'm going to remove material which continues to violate the talk page guidelines or which consists of unsourced vilification of the IDSA. MastCell ^Talk 20:19, 15 August 2008 (UTC)

<Removed as a repeat violation of the talk page guidelines>

Pryorka82, please have a look at WP:V and WP:RS, as well as WP:NOTAFORUM. Please use the talk page to discuss specific article edits based on reliable sources. SandyGeorgia (Talk) 19:43, 16 August 2008 (UTC)

I put this answer above by SandyGeorgia back after vandalism by Pryorka82/24.235.23.77 RetroS1mone talk 05:31, 18 August 2008 (UTC)

SandyGeorgia, how can I use the talk page to discuss edits from sources when you delete the sources and clearly didn't read them?? Notorized agreements and press releases from government offices are verfiable and reliable. please have a look at neutrality and using Wikipedia to advance one's own conclusions or agenda I am proposing to either come to agreement on neutral ideas that can be written or delete those that violate the rules of wikipedia presently. The following statements need a counterbalance or need to be deleted as they are used to advance one conclusion and agenda. The last excerpt cited is entiring misleading and inaccurate.

"Most medical authorities—including the Infectious Diseases Society of America (IDSA), the American Academy of Neurology, and the Centers for Disease Control—do not recommend long-term antibiotic treatment for "chronic" Lyme disease, since several trials have shown no benefit whatsoever and the considerable risks of long term antibiotics, especially when given intravenously."

If this is to stay in the article then it needs to be clarified. Since both boards involve the same doctors and the CDC has previously adopted what was suggested by IDSA. Mention can be given to recommendations by many other organizations that oppose this view and the trials that have been conducted.

"In 2001, the New York Times Magazine reported that Allen Steere, chief of immunology and rheumatology at New England Medical Center and a 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.[131] Because of death threats, security guards were assigned to Steere.[71]"

If this is to stay then mention should be given to the patients of treating doctors that have had to search for a new doctor, or face permanant disability or death as a result of not recieving treatment. The problem with each side of the situation should be presented, not one side that mocks the other.

"A significant amount of inaccurate information on Lyme disease exists on the Internet. A 2004 study found that 9 of 19 websites surveyed contained major inaccuracies. Sites found to be good sources of accurate information in this study included those of the American College of Physicians, the Centers for Disease Control, the Food and Drug Administration, and Johns Hopkins University (www.hopkins-arthritis.org).[132]"

If this is to stay then it should be mentioned that these organizations adopt IDSA guidelines and these are not multiple sources. —Preceding unsigned comment added by Pryorka82 (talk • contribs)

Wikipedia is not a venue for advocacy or righting what you consider to be errors, corruption, etc on the part of various medical bodies. We report what reliable sources have said, and we represent views in proportion to their acceptance among experts in the field. If there are medical organizations as prominent as the IDSA, AAN, CDC, etc who believe differently, then those views could be juxtaposed. ILADS is not as prominent as the IDSA and does not represent the weight of expert opinion in the field - that doesn't mean they're "right" or "wrong" on a specific issue, but it is a fact and lengthy post after post will not change that fact.

Similarly, if the New York Times reports that Lyme researchers are being stalked, harassed, and threatened by patients egged on by advocacy groups, then that is reflected here on Wikipedia as a notable facet of the issue. If a similarly prominent and reliable source reports that patients are suffering "disability or death" because their physicians adhere to the IDSA's recommendations, then it would presumably also be noteworthy here.

I confess that multiple rounds of sockpuppet and meatpuppet accounts pushing the exact same issues and attempting to use Wikipedia as a platform to advocate the same narrow and minoritarian agenda have worn down my patience, so I will leave things there and allow other editors to chime in from here on. I'm not the final word on things - I'm one editor - but I suspect you're going to hear similar objections from others. MastCell ^Talk 06:18, 18 August 2008 (UTC) MastCell ^Talk 06:18, 18 August 2008 (UTC)

"If a similarly prominent and reliable source reports that patients are suffering "disability or death" because their physicians adhere to the IDSA's recommendations, then it would presumably also be noteworthy here."

I've tried this, and it was deleted. I try to balance things and present a neutral point of view, but you tell me you're tired of me trying to follow wikipedias rules. The simplest thing to do is just remove the statements that advocate this narrow point of view and violate neutrality and be done with it. Pryorka82 (talk) 18:17, 19 August 2008 (UTC)

I disagree with essentially all of the assertions in your second paragraph. I have the sinking feeling that you have either not read or not read carefully the policies which you're citing. The bottom line is that Wikipedia functions by consensus. Please feel free to either a) address my concerns and try to convince me, or b) pursue dispute resolution. MastCell ^Talk 07:29, 20 August 2008 (UTC)

Tick removal

There was a chap on Oprah [cease knee-jerk reaction please] yesterday who recommended removal of a tick by gently pushing the body to one side before plucking the body off (ie, separately from the head which can then be removed as required subsequently). The reason given was to prevent regurgitation of the contents of the tick (ie, viruses, foreign blood elements, whatever) back into the victim if the tick is squeezed (ie, tweezered) or otherwise agitated. Although this explanation makes sense to this layman, not being a medical person nor being associated with any tick or Lyme related entities, I would welcome the assistance of an expert on ticks who could weigh in and lend an opinion on the veracity of Dr. Oz's comments. JimScott (talk) 07:13, 20 August 2008 (UTC)

Discrimination and Disgust

I find it very unfortunate, as a 10 year sufferer of the disease, that coverage of the hundreds of doctors, laboratories, and studies which support an alternative diagnosis and treatment protocol is considered "advocacy". Essentially half of the story of Lyme Disease is missing and labeled "advocacy." In covering World War II, would you similarly leave out coverage of all the opposing armies for fear of "advocating" them? Why is the neutrality of the CDC and the IDSA presented as axiomatic? How can the editors prove the neutrality of the medical journals they site? "Peer reviewed", as a label, does not in itself prove the probity of the "peers". I'm sure I will be answered with suggestions to look at various wikipedia decorum pages, but my argument is clearly aimed at the improvement of the article.

I find the constant occlusion of coverage of actual Lyme sufferers and doctors to be discriminatory in keeping with the Americans with Disabilities Act. This is on the same level as sexism/racism, and I hope that the editors can arrest their doctrinaire approach before they bring disgrace and possibly lawsuits to both wikipedia and themselves. It is becoming more obvious why so many people have come to distrust the information on wikipedia. If a few users can arrest and misuse an issue in such an offensive way, how can one trust the comprehensiveness of articles found here? Again, I hope that instead of lawyering with WP policies, the editors take time to respond to each of my points individually and directly. I also hope they realize that there is a community of sufferers and doctors who are deeply offended by the one-sided nature of this article.--N88819 (talk) 09:42, 22 August 2008 (UTC)

• Wikipedia doesn't report the "truth", it reports what reliable secondary sources say about a topic. Phlegm Rooster (talk) 09:47, 22 August 2008 (UTC)

• Also, please carefully read WP:LEGAL. Threatening legal action - explicitly or implicitly - against Wikipedia may result in an indefinite block on your account until your legal issues with the foundation have been resolved. EyeSerene^talk 10:41, 22 August 2008 (UTC)
  • I hate to refer you again to Wikipedia's policies, but I think that the answers to your complaints can be found there. Wikipedia does not vouch for the "neutrality" of the CDC or IDSA. Wikipedia collates information from reliable sources. According to our definitions of verifiability and reliability, the CDC, IDSA, AAN, New Engalnd Journal of Medicine, and so forth qualify by virtue of their professional stature and as widely acknowledged representatives of expert opinion in their respective fields. Whether you, or I, or anyone consider the CDC or IDSA "neutral" or "biased" is a personal value judgement, but the prominence and stature of these organizations makes their view of the issue noteworthy and relevant to our article.

    You're advancing a particular viewpoint and agenda specific to a handful of advocacy organizations. That viewpoint is notable and should be covered here, but such coverage needs to provide appropriate context as described in this website's policies. It is not "discriminatory" to indicate that the weight of published expert opinion favors one interpretation over another, and that is the gist of our coverage.

    I find it particularly odd that you implicitly threaten legal action against Wikipedia and against specific editors in the same breath with which you ask us to avoid "lawyering" (meaning reference to this site's behavioral and content policies). This is not the finished version of the article, and there is room for more detail on the differences between the IDSA/AAN/CDC view and that of ILADS, for instance. I would welcome specific suggestions for how our coverage could be improved. However, instead of abusing multiple accounts, recruiting agenda-based editors from a web forum, threatening legal action in order to influence this site's coverage, using this site as a soapbox to broadcast your agenda, and so forth, I would encourage you to look at the site's policies and make suggestions or arguments based on them. If you find me, or other editors, intransigent, then Wikipedia has dispute resolution pathways to garner outside input and move things forward. MastCell ^Talk 19:11, 22 August 2008 (UTC)

Laboratory testing

Given the effort a few threads above to promote a FISH test from Igenex, I took a look through the Interwebs. There is a well-described issue with the reliability and reproducibility of laboratory testing for Lyme disease which may warrant mention here (incidentally, there is probably enough reliably sourced material for a standalone article on Igenex, but that's another story). Please peruse the following:

• Unproved Lyme Disease Test Prompts Warnings, from the New York Times in 2005. Mentions Igenex by name.
• Lyme, Inc. from Forbes (already cited, mentions Igenex)
• PMID 11182109 ("Intralaboratory reliability of serologic and urine testing for Lyme disease"): Specifically tested Igenex urine ELISA and reported that "The results of urine antigen testing in the 10 control subjects were not reliable" and led to contradictory and false-positive results at a much higher frequency than that reported in Igenex's literature.

Several of the other sources (IDSA statement, New England Journal of Medicine article) also reference the problem of test reliability and false-positive results leading to overtreatment. MastCell ^Talk 20:10, 25 August 2008 (UTC)