Because Lyme and associated diseases are a complex problem for scientists, practitioners and patients, controversy abounds in the medical profession has to how best to diagnose and treat Lyme disease. For example, some physicians and health agencies deny even the existence of an entity called “chronic Lyme disease.” Additionally, different conclusions have been drawn from peer reviewed research on the disease fueling debate as to whether or whether not to use long-term treatment strategies. All of this has led to an environment in the medical community where there are two standards of care:

1) Some physicians rely on a narrow definition of what Lyme disease is, how it should be diagnosed, and how it should be treated. (An example of this narrow view is the guidelines published by the Infectious Disease Society of America.) As a result these narrow guidelines, physicians will fail to diagnose some patients who actually have Lyme disease. Or, in cases where Lyme is a diagnosis, some physicians will prescribe short-term treatments. When these short-term treatments don’t produce sustained health or better outcomes for the patient, this leads to the conclusion that Lyme was not the problem and other diagnoses are given like fibromyalgia, chronic fatigue, MS, etc.

2) Other physicians use broader clinical criteria for diagnosing Lyme and associated diseases. (An example broader guidelines would be the guidelines published by the International Lyme and Associated Diseases Society.) While diagnostic certainty is being debated in the medical community, some physicians believe it is better to err on the side of treatment because of the serious consequences of failing to treat active Lyme disease. These physicians sometimes use longer treatment protocols and use clinical responsiveness of a patient to specific treatment to assist in diagnosis and follow-up treatment. It is also true, however, that fibromyalgia, lupus, rheumatoid arthritis, etc. often exist alone, without any relation to Lyme Disease, Babesiosis, Ehrlichiosis, or Bartonellosis.  In these cases, a rheumatologist or neurologist or other specialist may be best suited to manage a patient’s care.

At NHIM, we have seen that successful treatment and good outcomes are a result of careful clinical diagnosis, a longer-term treatment plan, and consistent monitoring of the patient’s response to treatment. We agree with and see value in the International Lyme and Associated Diseases Medical Society’s (ILADS) guidelines for diagnosis and treatment.