Wednesday, December 12, 2018

New Critical Book on Lyme Disease Educates Lawyers and Judges

            In a new book, the author, a journalist, explains Lyme Disease, posits that the medical establishment has improperly rejected the proposition that the malady can become chronic, and theorizes that the spread of the disease is due to climate change.  See Lyme: The First Disease of Climate Change, by Mary Beth Pfeiffer. Island Press.  2018.  288 pp.  See also  https://www.thefirstepidemic.com/ 

            The book, in detailing what she calls the “four myths” about Lyme Disease, supplies the attorney with a wealth of information with which to prepare for cross-examination of a physician who cleaves to the view of most experts, who insist that the condition is easy to test for, diagnose, and treat; and who reject the proposition that it can become a long-term problem for victims. The book treats occupational injury contraction only briefly, though the author does reference veterinarians, highway workers, and soldiers-in-training as individuals who are at high-risk for incurring the disease.

            Like at least one other reviewer (Times Literary Supplement, 9.21.2018), this reader was unable to say that the author makes out her case that a conspiracy exists to quash research into the disease; the plausibility of such an effort seems weak, and the purported arrogance and villainy of the medical establishment seems overstated.

            Still, the book is a tour de force of critical thinking about how medicine and society have responded to what appears to be an increasingly hazardous medical condition. It is valuable reading for the workers’ compensation specialist. In this regard, Lyme Disease is a challenge for both the insurance industry which underwrites risks and the lawyers who seek to obtain benefits for disease victims. Employers and insurers, in general, deny claims when causation is not obvious, and are wary of claims of chronic conditions that are suspected of having their genesis in non-work-related and/or superseding maladies. These two anxieties are at a high pitch in the Lyme Disease debate. Further, experts apparently differ over whether current testing for Lyme Disease is dependable. The author spends a whole chapter on this latter issue.  

            The accuracy of diagnosis, and physician cynicism over the authenticity and cause of chronic problems, are major themes of Pfeiffer’s book. Rarely does a chapter pass without accounts of physicians purportedly misdiagnosing Lyme, instead ascribing chronic problems to such things as fibromyalgia, chronic fatigue syndrome, malingering as to school attendance, and modern-day neurasthenia (the accusation is that chronic Lyme is a “middle-class malady”). These are all phenomena of workers’ compensation claims handling and litigation.

            Lyme Disease is incurred by the bite of a tick which is itself infected by the bacteria Borrelia burgdorferi. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440571/. The main culprit is the Blacklegged Tick, a species of anthropod parasite that, given our rapidly warming planet, is expanding its range northward deeper into the U.S., particularly the northeast. Pennsylvania, indeed, is a jurisdiction which is said to have an increased number of infections every year.

            It is notable that the bite of the tick is not communicating to the victim venom, as with the bite of a snake or spider. Instead, the tick itself has incurred the bacteria from sucking the blood of mammals like infected deer and mice, and even of birds.

            It is deer that are the most visible culprit. Suburban sprawl continues its remorseless extension into wooded areas, and fewer predators exist to cull the herds. The result is a burgeoning deer population which in turn infects the ticks who are so voracious for their blood – and which in turn infect humans. The disease can be highly debilitating, though physicians believe that antibiotics, particularly a course of doxycycline, can cure most cases. See https://www.hopkinsarthritis.org/arthritis-info/lyme-disease/lyme-disease-treatment/.

            It is on this point, however, that significant dispute among physicians exist. The author charges that the condition has been “minimized, underestimated, and politicized to the point that doctors” fear treating it aggressively with antibiotics. The Centers for Disease Control and the Infectious Diseases Society of America (IDSA) in this regard, reject the proposition that the condition can be chronic, and have established restrictive, evidence-based guidelines that should be followed in identifying and treating the malady. (As to the CDC, see https://www.cdc.gov/lyme/diagnosistesting/index.html.)

            Members of the International Lyme & Associated Diseases Society, on the other hand, believe that Chronic Lyme exists, and argue for long-term use of antibiotics as the remedy. They argue that Lyme should be taken much more seriously, and caution that the disease can cause injury to an individual’s central nervous system.  

            As foreshadowed above, the author posits that four myths surround Lyme Disease. These are (1) that Lyme is overdiagnosed; (2) that Lyme Disease Testing is reliable; (3) that Lyme Disease is hard to contract; and (4) that Lyme Disease is easy to treat. Pfeiffer seeks to debunk these myths in her book, which has the added feature of 20 pages of references.

            Many resources exist about Lyme Disease, particularly online, but the workers’ compensation specialist will be well-prepared for encounters with claims in this area by a close examination of Ms. Pfeiffer’s critique.          

           

https://lawprofessors.typepad.com/workerscomplaw/2018/12/new-critical-book-on-lyme-disease-educates-lawyers-and-doctors-.html

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