- Patients who do not have Lyme disease are diagnosed with
it, while many with Lyme escape treatment -- because too many doctors order
blood tests for Lyme disease at the wrong times.
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- That was one of the conclusions of a study by doctors
from the Wisconsin Division of Public Health, the Centers for Disease Control
and Prevention, and the Marshfield Clinic Research Foundation, published
in the current issue of the Annals of Family Medicine.
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- The study found only 20 percent of test requests were
appropriate, and at least 27 percent were inappropriate. Others were considered
discretionary.
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- New Paltz resident Lenise Heroy experienced the confusion
of Lyme testing first-hand this summer. She had a bulls-eye rash, fatigue
and joint pain but her blood test was negative for Lyme disease.
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- ''The whole thing is so confusing,'' she said. ''It was
a pretty lousy experience.''
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- Consequences feared
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- Lyme disease patient advocates are concerned the study
will discourage doctors from diagnosing, testing for or treating the disease.
A big part of the problem is the test itself, both agreed, because it often
suggests sick patients are healthy, and healthy patients are sick.
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- The study surveyed doctors who ordered 408 blood tests
between October 1999 and September 2000 at two Wisconsin laboratories.
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- About 2.8 million Lyme disease blood tests are done each
year, at a cost of more than $100 million. While the results from the two
labs may not reflect nationwide trends, authors said it's reasonable to
expect they do.
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- The simple message, for both patients and physicians,
is that the Lyme test is often incorrect, said Dr. Alan H. Ramsey, assistant
clinical professor at the University of Wisconsin Department of Family
Medicine, and the study's lead author.
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- ''False-positive and false-negative results do occur,''
he said. ''Clinicians can reduce the risk of misdiagnosis by using LDSTs
(Lyme disease serological tests) appropriately.''
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- Wisconsin, like the Hudson Valley, is rife with disease-infested
ticks.
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- Columbia and Dutchess counties lead the nation in Lyme
disease incidence, and more than 1,000 Dutchess residents are diagnosed
every year. Ticks, tiny woodland arachnids, can transmit Lyme and other
diseases, like ehrlichiosis and babesiosis.
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- Variety of symptoms
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- Lyme disease can cause joint pain, fever and fatigue,
and more serious complications if not treated properly.
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- Antibiotics are often effective, but the length of treatment
has been controversial.
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- Tests should be ordered when patients show symptoms that
could be Lyme-related, like joint, neurological, or cardiac symptoms, the
researchers wrote.
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- Tests should not be ordered only because patients were
bitten by ticks or live in a tick-infested area, and should not be used
to see if treatment was effective. Also, if a patient displays the bulls-eye
rash characteristic of Lyme, there is no need for the test because the
rash is better proof.
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- Those guidelines concern Pat Smith, in part because insurance
companies sometimes require positive blood tests to cover the cost of treatment.
Ultimately, the New Jersey-based Lyme Disease Association president said,
research must be funded to find an accurate test.
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- ''Though we all know Lyme testing is inaccurate,'' Smith
said, ''this (study) puts our doctors in a bad position because they're
often told they need to use lab tests to back up a Lyme diagnosis.''
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- http://poughkeepsiejournal.com/today/frontpage/stories/fr082304s2.shtml
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