Re: on diagnosis of Lyme, Anna YOU are wrong

[EMAIL PROTECTED] ([EMAIL PROTECTED]) wrote in message news:<[EMAIL PROTECTED]>...
> There has been, for several years a preposterous suggestion floating
> around that the removal of OspA from the research/surveillance data
> amounted to some sort of criminal act.

Yes, that has been the context of the discussion here over the last
couple of weeks --is it or is it not a CRIME? This is a fruitless
avenue of pursuit, I agree. Continuing to ask whether this is a crime
--which it is not-- just obfuscates the important issue: What impact
has the narrowed and circumscribed serological definition for
surveillance had on the ability of Lyme patients to obtain a diagnosis
and treatment?

Practically speaking, doctors DO use tests to decide whether or not to
treat. Removal from the surveillance standard of Osps A and B, which
are upregulated in chronic patients while other antigens are
downregulated, makes it less likely that such patients will pass the
bar for "positivity" on a Western blot. This is indeed relevant since
these late stage patients often have complex presentations. Therefore,
without the confirmatory Western blot many physicians will not treat
them. Your argument that the test is meaningless because they were
only tested due to clinical symptoms in the first place is foolish
--it has nothing but NOTHING whatsoever to do with the real world. And
again, you are misapprehending the guidelines for clinical diagnosis
in your assertions. In the real world, lack of a confirmatory test
often means that treatment will be withheld from these late stage
individuals.

OspA was removed in part because it was a vaccine candidate. It was
removed in part because it did not register as one of the 10 most
frequent bands in Dressler's skewed group of patients. It was removed
because it was very reactive and sticky and created messy blots even
before the vaccine. In general it was problematic --but removing it
was injurious to many of the sickest patients. This really is not in
dispute, except by you.

I am trying to veer away from discussion of whether this was a crime
--although it is true the discussion started there-- because this
unprovable and ridiculous assertion has obscured the actual import of
what amounts to an artificially narrowed disease definiton imposed
over the course of years.  What formula is used to determine the
"positivity" of a Western blot, and are the statistics driving that
formula valid? It is relevant that these Osps were removed --but the
"crime issue" is just a red herring that prevents people from
understanding why. Relevance accrues because, in this very political
disease, the removal of OspA was in part a political act that helped
to eliminate those patients pushing the outside of the envelope in
terms of clinical presentation. Removal helped to buttress a certain
view of what the disease looked like. It facilitated the Osp A
vaccine. It also caused patients to suffer. Removal of these osps from
the serological standard was one of many discrete steps that, in
aggregate and over the course of about 15 years, led to a narrowing of
the diagnostic and treatment guidelines and the associated creation of
a large population of chronic patients.

Scientifically, justification for removing this Osp was subject to
furious debate on the floor in Dearborn Michigan at the time it
occured--NOT because it was a crime, but because those present at the
debate understood the clinical implications for patients. Removal has
subsequently been a matter for discussion in mainstream peer-review.
It is not irrelevant. If discussion of this issue on this board is
limited ONLY to whether or not a crime has been committed well, then,
no one is likely to understand all I have just said.

I understand you are a lawyer --and that is your focus. I am trying to
shift away from that here, particularly, because even as legal issues
are clarified (to those who had any question) other aspects remained
unilluminated and I did not want to leave it like that.

GG