From the Departments of Medicine and Microbiology, University of California, Irvine.
The reported incidence of Lyme disease, an arthropod-borne infection,
is about the same as another spirochetal infection, syphilis.1
But Lyme disease receives far more public and media attention than the sexually
transmitted infection does.2 However, this
attention is not hard to understand: Lyme disease is primarily a disorder
of suburban, educated middle- and upper-class people. Lyme disease can be
as disabling as syphilis, but there usually is not a stigma to having Borrelia burgdorferi infection. The demographics of Lyme
disease also make it likely that those at risk of infection would be comparatively
knowledgeable about the disease and may even have opinions about how to manage
it. Does this level of interest—a set of patient expectations and perhaps
even demands—influence care itself? In this issue of THE JOURNAL, the
article by Fix and colleagues,3 while not directly
answering that question, does reveal a possible consequence of patient expectations.
The article also demonstrates that laboratory tests and antibiotic therapy—whatever
the driving force behind them—often are not consonant with expert advice
about Lyme disease care.
Barbour AG. Expert Advice and Patient ExpectationsLaboratory Testing and Antibiotics for Lyme Disease. JAMA. 1998;279(3):239-240. doi:10.1001/jama.279.3.239