King: Watch out for Lyme disease

Lyme disease, dubbed one of the “deadly dozen” by a recent Wildlife Conservation Society report, could skyrocket as global shifts in temperature and precipitation transform ecosystems. Vector-borne diseases such as Lyme are transmitted to humans by insects, and they, like the insects that act as the vectors, tend to be specific to a distinct ecosystem. But climate change may lead to a loss of these natural boundaries — generating a spike in rates of Lyme and other infectious diseases.

The incidence and migration of Lyme disease throughout the upper East Coast and Midwest should be a warning to us. The restoration of the deciduous forests to the eastern United States after their near-total destruction by European immigrants was a crowning achievement of the Conservationist Movement. The new habitat is mostly devoid of large predators, as a result of hunting and other human activities, allowing many large mammals to flourish unfettered. Since Lyme disease is transferred to humans by the bite of the adult deer tick, the prevalence of Lyme disease is correlated with the population of deer. Connecticut is grossly overpopulated with deer, having approximately 60 deer per square mile in a habitat that can sustainably support no more than 10. These are the ideal conditions for the propagation of the disease. (Indeed, Connecticut is the epicenter of Lyme disease. The Constitution State already has the nation’s highest Lyme disease prevalence, and it is rising.)

Lyme disease has been associated with controversy since 1977, when then-Yale physician Dr. Allen Steere reclassified a group of misdiagnosed cases of juvenile arthritis as Lyme arthritis. Dr. Steere named the newly discovered disease process for the location of the patient cluster: Lyme, in southwestern Connecticut. The most recent dispute involves the diagnosis of chronic Lyme disease or post Lyme syndrome. Most scientists and researchers vehemently deny the existence of chronic Lyme disease, citing numerous studies that demonstrate no biological evidence for its existence. Patient advocacy groups dispute the scientific evidence and often enjoy outsized influence over policymakers.

The recent skirmishes surrounding the diagnosis of chronic Lyme disease are a remarkable instance of déjà vu. GlaxoSmithKline’s 1998 LYMErix vaccine was created to address the rising Lyme disease epidemic. Vaccine recipients, often supported by patient advocacy groups, filed class-action lawsuits against GlaxoSmithKline, alleging LYMErix caused health problems; as a result, LYMErix vaccine production ceased in 2002.

Contemporary medical literature described the fate of LYMErix as “a cautionary tale.” Ten years later, the toxic environment surrounding Lyme disease and the LYMErix vaccine makes new significant scientific discourse virtually impossible, as advocates without the appropriate scientific training continue to dominate the discussion.

Lyme disease is indeed a cautionary tale. Scientists must modify their practice of publishing solely for scholarly journals by also communicating their findings to a larger audience. Scientific expertise can contest patient advocacy groups and silence policymakers by demonstrating that these groups aren’t always cognizant of best treatment practices. Given the potential climate-driven ecological changes that could lead to the further increase of a widespread infection, the noxious scientific environment surrounding Lyme disease could become a perfect storm that fuels a significant epidemic.

Leslie King, M.D., M.P.H., is the founding director of Flying Physicians International. She currently is completing a one-year mid-career master’s degree at the Yale School of Forestry & Environmental Studies, focusing on communications

of the impacts of climate change on human health.