In one critical response, the writer said that in order to support the existence and treatment of CLD, the following conditions need to be met:
- Develop a precise definition of what is meant by “chronic Lyme disease” so that it can be distinguished unequivocally from other medical conditions with similar symptoms.
- Provide direct and unequivocal evidence that a patient suspected of having chronic Lyme disease really has a persistent B. burgdorferi infection that justifies antibiotic therapy.
- Demonstrate, from the results of published, peer reviewed, randomized, placebo-controlled trials, that extended antibiotic therapy is beneficial and safe for the treatment of chronic Lyme disease.
Back on LN, one of the questions I posed was, "What is chronic Lyme disease?". I posted it in all seriousness, wanting to know what people's responses were and why, in part because I was looking for consensus on the definition from the patient perspective.
This is still an exercise I think worthy of working on - to make an effort to fulfill these three conditions in order to support or refute what is actually happening with CLD and put an end to the protracted arguments about it.
I realize that the patient perspective and responses are only one piece that can define what is meant by CLD, and microbiologists and clinicians must confirm and define the condition - but patients' experience of their own illness and empirical evidence around it form a chunk of the data on which definitions by professionals rest.
But back to the above... How can anyone go about systematically providing the evidence required to meet these three conditions?
How many other diseases and conditions have been defined with precision, as is asked of CLD in #1? How many have not been defined with precision, but still meet the definition of a disease?
Is #2 just about proving Koch's postulates? Yes or no? How can this be done with a xenodiagnosis study? Without a xenodiagnosis study? Remember, not all emerging diseases have had to fulfill all of Koch's postulates to be defined as they are.
Does #3 conditionally rest on the evidence of #2? This is something I always wondered and asked myself.
Each of these three conditions to be met has its own challenges in providing evidence. How would you go about meeting these conditions, if money were no object and you had time to set it up yourself?