To the Editor:

I was quite dismayed to read the article “On Target with vector-borne infections: Understanding Lyme disease,” which was published in the May 2010 issue. The article is filled with statements at odds with international scientifically accepted facts and supports a fringe view of Lyme's disease that is repudiated by countless published authorities.

The article headlined a supposed “controversy” that “divides the medical community.” This overstates the situation in an attempt to legitimize this fringe view. There is no controversy in the scientific community. The CDC, UpToDate, and any infectious disease textbook that one chooses will not describe a controversy. They do acknowledge a school of thought that is at odds with scientific fact and believe that, for example, there is such an entity as “chronic Lyme disease” that often requires long term parenteral antibiotics.

One of the most egregious misstatements in this article appears on page 25, in the second paragraph: For early disseminated disease a “positive Lyme disease serology is diagnostic.” This is in stark contrast with what the CDC states. UpToDate states in several different places that the diagnosis can never be made on serologic results only and indeed this notion is responsible for misdiagnosis, patient labeling, and overtreatment with parenteral antibiotics.

The author did mention that some of these views are not accepted in the medical mainstream. However, I believe that this article contributes to misinformation and harmful patient care.

Brian Begley, PA-C

Editor's note: If the Infectious Diseases Society of America can acknowledge the existence of the controversy over persistent Lyme disease—and even to use the word controversy, as they do numerous times in their publications and statements about Lyme disease—it is reasonable for JAAPA to do this as well. Like all JAAPA review and CME articles, the Lyme disease article was evaluated by peer reviewers, revised by the author based on the reviewers' comments, and edited and fact-checked carefully. We believe that the published result reflects a responsible and balanced presentation of the various perspectives on Lyme disease and that readers are intelligent enough to read the article and form their own conclusions.