"accurately, is that all he has proved is tha he was unable to cultivate
the
speciees of Borrelia found in th Amblomma ticks.  He refers to this a "the

incompetence of A. americanum as a vector of B. burgdorferi has been
documented."  First, he does not say how many ticks were used.  Two,
Three,
five hundred.  This makes a difference in whether or not the conclusion is

valid. "

 You bet. I did not type out the whole article( fingers can only do so
much!);  the methods, etc. can be obtained simply by writing for a reprint
from the author.

Although Barbour tends to shy away from discussing the presence of Bb in
the Lone Star tick [remember this is an academic ( Ah, academia where
argument is the name of the game), and he is going to bias his article -
that is why we need others like you - to critique his presentations],  I
think it is important to note that he makes the observation that other
Borrelia species may well cause Lyme-like disease(as defined by symptoms).
I don't read this as diminishing the existence of Lyme disease, just
adding a more complex flavor to it.  I'm not defending all of Barbour's
statements (I question a lot of this article and much of his past
pronouncements concerning LYme).  I think it pompous to suggest that his
new Borrelia is causing all of these cases, for starters;  however, to
actually recognize that there are other Borrelia that cause Lyme symptoms
does'nt strike me as a wrong approach.  After all Borrelia
hermsii(relapsing fever) is a {*filter*} is of a disease that mimics Lyme or
is "Lyme-like" symptoms.  Certainly more knowledge about that disorder
shouldn't diminish  Borrelia burgdorferi knowledge.  These are all
tick-borne diseases afterall.

Rita

Phyllis T.

"  I think it is healthy to examine authors' conclusions in light of
the data they based them on.  So often they make sweeping statements that
get
accepted and then someone like those of us in the Lyme groups sees the
fallacies and points them out to others."

It is not only healthy, it is essential to understand that we must
approach  any article with a questioning mind. This is the life-{*filter*} of
science. This is how a scientist is trained. I'm a rusty old physiologist,
but I assure you that I was put under the most rigorous training to tear
apart all articles from background to conclusions - to know the literature
as fully as possible - and to argue, discuss, debate.  Unfortunately most
people do not realize that this is what science is about; they believe in
the "sweeping generalities" or the "facts"(which really are hypotheses,
discussions, conclusions - interpretations); No, things ARE open to
attack; and yes, all of us -trained scientists or not, have every right to
"Question Authority".  Especially if that authority is unworthy (and of
course, "unworthy" is open to interpretation, but I feel it is generally
applied to those individuals who have a great deal of status conferred
upon them based on politics not knowledge).

And yes, Barbour et al. do agree that Bb has been truly cultured from Aa
in only one study.  Arguments are made for other attempts at isolation,
but questions arise usually reflecting methodolgy.  He wants his B.
lonestari to be the big cheese, obviously, and perhaps it will be; this
should not imply that research on Bb in Aa be dropped.  Nor does  he imply
not treating.

Rita

Rita, I find your posts most helpful.  Thank you.

Hugh

I always enjoy reading your thoughtful postings, and of course the articles
that you post. I'm glad you emphasized the need to read the  articels on Lyme
(any aspect of it) critically.  I firmly believe that, too, and I do it all
the time!  I was trained in science,too, and spent a lot of years as a teacher
of epidemiology, where we always critiqued research and compared the findings
of various studies.  

I did not read Barbour's work to mean that research on Bb in Aa should be
dropped, but I did come away with the fear that those treating Lyme patients
might get the idea that since he and his colleagues only cultivated  Bb from
Aa in a small number of ticks, that the probability of contracting Lyme from
Aa is not as great as if one were bitten by a deer tick.  I reacted to this
because of personal experience with doctors who told me I was bitten by the
"wrong" kind of tick and I was left untreated for a long time, until *I* dug
out support for the fact that "my" tick could carry the disease.  I did not
mean to be unfair to Dr. Barbour, but to alert readers of the article to the
fact that he included, that more research is needed on Aa.  Just as Steere et al
have caused problems for Lyme sufferers whose treatment is limited to 2 - 4 weeks
ks because of his writing, I would hate to see other patients denied treatment
(or have it delayed) because of the type of tick involved.

 You have brought up a good point.  Those of us with a research or science
background could offer a big contribution to our Lyme friends by posting our
critiques of Lyme research.  Not that we are always right, either, but we can
provide lots of cooking.net">food for thought.

Phyllis T

I do understand; listen, it's the experience that we all have that is so
invaluable.  Only so much can be gotten from the literature; but the
astute clinicians and excellent docs who LISTEN to their patients, know
that is where the understanding and learning begins and ends.  As for
being bitten by the "wrong " kind of tick; these {*filter*}s carry so much
disease that only a fool would say that.  If the possiblity exists that Aa
can carry a number of different Borrelioses, then, to me, that would
indicate that there is even a greater chance of catching something evil;
therefore a greater need to treat even if the exact treatment protocols
are not delineated.  To do otherwise is unethical.

" I did not
mean to be unfair to Dr. Barbour"

He's got a good enough ego; he can handle it.  If he makes a blanket
statement, he knows he is open to attack;  academics are grown for
argument. It's a game to those whose lives do not depend on the working
outcomes of their research.

" Just as Steere et al
have caused problems for Lyme sufferers whose treatment is limited to 2 -
4 weeks
ks because of his writing, I would hate to see other patients denied
treatment
(or have it delayed) because of the type of tick involved."

AMEN.  So his work should be interpreted to suggest that it is even more
imperative to treat someone if bitten by such a tick.  Not less.  Make the
doctors learn that idea.

. " Not that we are always right"

Right is relative.  But aiming toward solutions that utilize research
results in the context of astute clinical assessments( that is, unless
they shoot some more of our beloved docs), would ideally result in proper
and ETHICAL  treatment of patients.  And NEVER let up on those who those
who would wish us away. NEVER.

Rita

Going thru the Lyme experience has given a lot of us new skills in advocating
for ourselves and for other Lymies.  Sometimes I think WE are the real experts
in the disease.  

At least Barbour, along with the other authors of the tick article posted
above, seems to have softened the dogmatic statement about the Lone Star tick
not being an entirely believable vector of Bb.  Maybe someday he and they will
have to retract their statement and acknowledge that other kinds of ticks and
arthropods carry the disease.  Do you think they will thank the patients for
enlightening them?  Heh, heh.  

Phyllis T.

   I just finished reading Barbour et al.'s February article and it
doesn't seem all that objectionable to me, but maybe I'm missing
something. This is the way I see things: For years, there has been a
Lymish illness in the South whose causative agent is somewhat
problematical. The apparent vector is the Lone Star tick (Aa), although it
is also clear that Ixodes scapularis ticks are biting people also.
(According to the "conventional wisdom," southern Ixodes scapularis ticks
don't bite people).

   Clinically, this disease is Lyme disease, according to Masters and
Donnell. The CDC doesn't seem to agree. Masters also insists that
serologically this is Lyme disease, which the the CDC definitely disputes.
This is all old news. The main sticking point for the CDC is that nobody
has successfully cultured Bb from either ticks or people in Missouri, so
they refuse to call this Lyme disease. An obvious possibility in a
situation like this would be that there is a similar borrelia, with
different growth requirements, that is causing this disease.

   Now Barbour comes along and says that's exactly what's happening. They
find a new borrelia in Aa that's uncultivable and which is almost
certainly the cause of the southern outbreak. They do genetic testing and
find that it is indeed a borrelia, although it's a little surprising that
this new bug is actually genetically closer to some strains of relapsing
fever borreliae than Bb. But hey, whatever.

   Anyway, this all seems pretty feasible to me. It seems that there are
many strains of borreliae that can cause Lyme disease, just as there are
over a dozen separate species that cause relapsing fever. In the latter
case, there are some minor differences in clinical presentation, but
they're all called "relapsing fever." So why can't we have the same
situation with Lyme disease?

   That the CDC refuses to call this disease "Lyme disease" is just a
semantic issue, as far as I am concerned. And whether or not Bb actually
exists in the South is still an open question, probably. But I think that
Barbour's work is pretty nifty -- elegant and certainly consistant with
the facts as generally recognized.

   So what did he say or write that got everyone's dander up? Please let
me know.

Thanks,
Carl

Raccoons have been shown to have antibodies to Bb in TN

I believe that the problem was that some folks felt that since  B
lonestari and not Bb was found, this could perhaps hinder treatment of
their Lyme.  

Rita

   An "isolate" means that the organism was successfully grown in culture
and isolated from other microbes and contaminants. To my knowledge, Bb has
never been isolated in Missouri. Nor has any other borrelia, for that
matter, including the new one that Barbour has described. I've never heard
Ed Masters claim that anyone isolated any borrelia in Missouri.

Carl Brenner

Since I think I am the one whose dander was up, I'll respond.  I reacted to
excepts Rita posted from Barbour's article (he was the primary author) in
Hournal of Infectious Diseases, 173:403-9, 1996, "Identification of an
Uncultivable Borrelia in the Hard Tick, Amblyomma Americanum: Agent of a
Lyme-Like Illness".  In this article, which I have not had a chance to read in
full, he says, "the incompetence of A. amblyomma as a vector of B.
burgdorferi has not been documented...Attempts to axenically cultivate the Aa
spirochetes in media that support the growth of Bb and several other Borrelia
species, such as the relapsing fever agent B hermsii, have been unsuccessful.

"Two hypotheses can be postulated from these observation:  First, the
spirochete in Aa is not Bb, and second, in some areas of the US, there is an
infection that mimics features of Lyme disease but is caused by another
tickborne agent."  He proposes that the agent is B lonestari and not Bb and
refers to the ensuing disease as a "Lyme-like illness".

This dismissal of the possibility that Aa can carry Bb because it has not been
cultivated in lab media astounds me.  I venture a hypothesis that the disease
is true Lyme and that the lab methods are not recined enough to successfully
culture it.  To label this a Lyme-like illness overlooks that possibility.

This bothers me greatly, because I was bitten by a university-identified Aa,
which I still have, and soon after the bite, developed an erythema migrans
rash followed by a host of classic Lyme symptoms.  My Western Blot test (which
I posted about once before) showed six positive IgG bands and three positive
IgM bands.  My physician (a Lyme specialist) has diagnosed me as having Lyme
and is treating me.  From what I've read, Lyme should be diagnosed on the
basis of the clinical picture, rather than on serolgy. The missing link in
this is that I have not had the tick tested for Bb (PCR test), mainly because
I've read that the test is not entirely reliable.

The article by Barbour et al in the Feb. JAMA that you refer to, is more
moderate in tone but mentions a concern that I share, that cases of Lyme may
go unreported because the offending vector may not belong to the "accepted"
list of ticks.  Of course, other cases, such as those with mild symptoms may
be unreported also.  I would think that the scientists who write such articles
would leave open the pssibility that the so-called "Lyme-like illnesses", may
indeed be bona fide Lyme cases.  Or else, the definition of Lyme disease might
need to be revised.

So that's what was behind my posted message that Rita responded to, and which
you quoted.

Phyllis T.