Dr Wormser’s Rigid Persistence

In Michael Specter’s piece in The New Yorker magazine, “The Lyme Wars” (July 1, 2013), Dr Gary Wormser continues to dig his own hole on the dead question of the persistence of Borrelia burgdorferi.

“Right now, in the published literature, there is no evidence of persistence in humans, and if there were I would say, ‘So what?’ ” he told me recently. “You would have to show me that the spirochetes continue to produce disease and you would have to show me that they would respond to antibiotics.”

Attention should revert to his phrase ‘no persistence in humans‘.  Dr Wormser has chosen his words carefully.  According to the Information Superhighway — “Persistence of Lyme Disease Despite Antibiotic Treatment” (PDF) — there have been 77 peer review studies between 1977 and 2012 confirming the hypothesis of the persistence of Borrelia burgdorferi in ANIMALS.  So, Dr Wormser is technically correct if officiously precise in his syntax.

His precision should hold him well, oh, for about a few more winters.  The most recent study cited, “Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection” (2012, PLoS One journal) — also known as the “Embers-Barthold monkey study” — foreshadows similar results in favor of persistence coming soon from any number of human studies going on now in a research university near you — notably, Johns Hopkins.

Dr Wormser’s petulant flourish, “… and if there were [scientific evidence of persistence in humans] I would say ‘So What?'” also merits parsing.  It’s a mean-spirited and defensive statement that betrays his disgust at the suffering of patients (as well as his lack of exposure to them) and his fear in anticipation of being caught out very soon.  One career, you feel, is on the wane unless Dr Wormser has unimaginable resources & influence ready to stem the deluge when the levee breaks, as new Borrelia burgdorferi culture testing methods threaten to produce > 90% sensitivity and approximately 100% specificity.  What then, my mellifluous medic?

I’ll tell you what then!  The number of reporteds at the CDC will triple in the first year and ten-tupple in the second year as the latent Chronic Lyme cases — forgive me, “Post-Lyme Treatment Syndrome” cases — mark to market.

This topic of persistence is so rich that it continually inspires more and more questions.  For example, if there has been such a wealth of ANIMAL studies, why ARE there so few HUMAN studies on Borrelia bergdorferi‘s persistence?  Is it because the Wormsers and the Steeres, not to mention the other careerists on the masthead of the IDSA guidelines, have bullied career-minded professionals away from the persistence hypothesis?  Just as they bullied all the Lyme-Literate MD’s out of the Commonwealth of Massachusetts, the length of which we were forced to drive every six weeks for two years to reach a competent professional?

The overarching question I have about Gary Wormser is, in a world of uncertainty, where does Gary Wormser’s confidence come from?  When so few responsible questions have been posited about Lyme in the ivory tower, the answer is that his confidence cannot possibly emanate from science.  Although “science” remains Dr Wormser’s persistent coward’s refuge.

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