by Dr. Bill Rawls
The new draft guidelines for the prevention, diagnosis, and treatment of Lyme disease from the Infectious Diseases Society of America (IDSA) overlooks vital information for treating chronic Lyme disease effectively and will inevitably leave patients in the lurch.
Dr. Bill Rawls critiques the guidelines below, and encourages you to share your feedback with the IDSA through the public comment period, which ends September 9th, 2019. Learn more about chronic Lyme here.
Hello, this is Dr. Bill Rawls. This morning, I spent several hours reviewing the new recommendations by the Infectious Disease Society of America on Lyme disease, all 70 pages of it. My assessment? Not a whole lot has changed.
The authors reviewed a lot of evidence, but it was restricted to evidence from the scientific journals, which is valuable, but I don’t think they looked at every bit of the evidence. I’ve been reviewing all of the evidence surrounding Lyme disease for 10 to 20 years now, and I think most researchers have a tendency to cherry-pick the information that actually supports their point of view.
They also excluded any information that was outside of the scientific literature, and I consider any kind of information valuable. So we have thousands and thousands and thousands of people that have struggled with Lyme disease that have made their journeys public. I think all of that information is valuable and shouldn’t be ignored.
You can only fit so much in the journals, and it’s a particular style of information that doesn’t always tell the story. All of the evidence they were looking at was isolated to conventional therapies and diagnosis, and most people who are struggling with Lyme disease know that the diagnostics are somewhat limited — the testing only has certain value in certain cases — and that antibiotic therapy is fairly limited.
About half of the document was devoted to addressing prevention and treatment of acute Lyme disease. I think for most of that information, they were right on the money. I agreed with everything they said about prevention, and their treatment guidelines for acute Lyme with antibiotics I thought were reasonable, though I think many experts would have something to say about limiting antibiotics to only 10-14 days for an initial infection with Lyme disease.
Where they missed on that was that they made the assumption that antibiotics always eradicate the microbes, and that’s been proven not to be the case. A study came out very specifically in 2018 in a group of 12 patients who were symptomatic beyond antibiotic therapy. They had tested positive for Lyme disease. They received antibiotics. In a high percentage of those patients, they were able to find live spirochetes in the body.
So that initial treatment with antibiotics is well-known not to completely eradicate the microbes. Now, granted, most of the IDSA document was sorted out before 2017, so they weren’t aware of that study. But experts have been showing evidence and having a high suspicion that antibiotics don’t completely eradicate Borrelia or possibly any of the tick-borne microbes for a long time.
They did, in the document, thoroughly address neurological Lyme disease and cardiac manifestations, Lyme carditis. But again, they pretty much limited antibiotic therapy to 21 days, and suggested that was going to cure everybody, same thing with Lyme arthritis. In my practice and my experience over the years, that’s far from being the case. A lot of people continue having symptoms despite the initial antibiotic therapy, and later they don’t respond to antibiotic therapy.
Another big limitation of the study is, they really don’t address a large portion of people who don’t remember a tick bite, didn’t have symptoms early on, and show up later with a positive Lyme test. They don’t address that in the document at all.
Similarly, they don’t address people who were treated with antibiotics and developed symptoms later, very well. They mentioned that about 10%-20% of people do develop symptoms despite antibiotic therapy, but it’s probably not the microbe and continued antibiotics isn’t going to do anything.
Where this document really falls short is addressing chronic Lyme disease and chronic microbial infections that are associated with chronic illness. This is a big deal, and that’s probably the largest population of people identifying with Lyme disease out there, and they basically, in this document, just completely ignore it. They also don’t make that fundamental distinction between acute illness and chronic microbial illness, which I think is so fundamentally important. You have to do that.
Acute illness is the immune system’s reaction to a microbe when it first enters the body when it first enters a host. That is very different than a chronic infection. In chronic infection, the microbe has been there and the immune system has been disrupted or compromised in such a way that it can’t keep the microbe in check. Very, very different than acute infection.
So a chronic infection isn’t going to respond to antibiotics. With acute infections, typically when people respond to antibiotics it’s because their immune system is working. So that is a key factor. You have to have an intact immune system that’s working properly for antibiotics to do their job. The antibiotics can’t do the job by themselves.
So if you’ve got a chronic infection, your immune system isn’t working and, therefore, antibiotics are going to only do so much good. If you keep pounding yourself with antibiotics, it’s just going to disrupt the normal flora of the body.
I expect a lot of people are going to be disappointed with these recommendations. Nothing has changed, and thousands of people are going to be left without clear treatment guidelines. I’m right there with you.
That’s why I spend so much time writing about chronic Lyme disease and alternative therapy options. If you identify with chronic Lyme disease, you can get well. You can get your life back. But you’re probably going to have to go beyond conventional therapy options.
Please take the time to go through my website or get a copy of my book, Unlocking Lyme, so you know what you’re dealing with. Take care.