United States, in Europe, Eurasia, and Australia. The infectious pathogens are not a single microbial agent, but
a complex of Tickborne diverse Borrelial species (currently in excess of fifty genotyes in the USA). We test blood specimens with approved diagnostic test reagents based on One of the Fifty currently known USA borrelia burgdorferi strains. Implicit in this unitary approach to blood testing is the obvious conclusion that many Borrelia strains in the USA which do not match the CDC reference borrelia burgdorferi strain will be missed. Both easy to diagnose and very difficult to diagnose Lyme
diseases are often accompanied by simultaneously transmitted non-spirochetal pathogens ( "co-infections"). Laboratory testing for co-infections of Lyme borreliosis are
ordered correctly in only a minority of patients, because
their personal physicians rely on one blood test, namely the test which detects patient antibodies to the B31 strain of Lyme borreliosis. Relapse of disease , according to Professor Benjamin Luft of the State University of New York at Stony Brook in expert testimony to the Institute of Medicine,in the year 2010 in Washington D.C., is an expected clinical pathway for many persons afflicted with this disease complex. Untreated Lyme Disease, and incompletely treated Lyme Borreliosis are accompanied by morbidities in the joints, the heart, the eyes and the peripheral and central nervous systems and in other organ systems.
Statistical compliations of the annual case numbers of Lyme Borreliosis in the USA by the Centers for Disease Control and Prevention demonstrate that the disease is spreading
from its originally described epicenter in Connecticut to annually involve 30,000 to 40,000 patients ( Year 2010-2011 conservative estimates from CDC registries) in all states north of the Mason Dixon line extending westward to at least the State of Minnesota.
The actual Southern extent of Lyme Borreliosis is a contentious area where CDC imposed definitions of "what Counts" are at variance with clinical and laboratory diagnoses
of Lyme borreliosis in the Southern USA rendered by patient care physicians, and supported by Serodiagnostic "two tier" seroposiitive test results from Nationally Certified Independent Commercial Clinical Testing Laboratories. In effect the diagnosis of Lyme Borrreliosis in states South of the Mason Dixon line and west of the Mississipi River is actively
and vigorously discouraged by National and State Health Agencies.
Physicians who practice in opposition to this regulatory geographic Dogma are at risk for sanctions against their medical licensure. Politics and Medical science have become inextricably intertwined in the Lyme borreliosis diagnostic arena.
It is sobering to view that 216,000 cases of Lyme borreliosis were diagnosed and treated in the Federal Republc of Germany for calendar year 2009; which is a 6 fold higher Lyme disease case number than the maximal per annum "acceptable" number for USA Lyme disease cases in ANY calendar year.
Physician Failure to diagnose implicitly travels with physician failure to Treat Lyme Borreliosis.
Even the most conservatively polarized factions agree that failure to Treat Lyme borreliosis carries the future potential morbidities in multiple organ systems over a patient's lifetime.
Governmental interposition between the physician and the patient in the diagnostic and treatment equation carries consequences equivalent to untreated spirochetal infection over a patient's lifetime, as demonstrated in a previously Federally mandated clinical policy for treatment in a group of Select patients with spirochetal infection in the USA in the last century.
My professional view is that untreated and undiagnosed
spirochetal infections in the human host in these United States have unfortunate consequences. Better awareness,
Better laboratory testing ( by Gene chip methods for example) and better leadership from the Federal Level and from State Departments of Health will offer
health outcomes for our citizens. Respectfully submitted,
Alan B. MacDonald MD
Sayville, New York