Re: “Nova Scotia’s health system has a handle on Lyme” (Sept. 18 opinion piece by Dr. Robert Strang). I was appalled at the inaccuracy and inadequacy of the information that he is supplying to Nova Scotians — patients and doctors — about Lyme disease.
A 2012 Health Canada report states that Lyme disease test kits have reliability problems, and that health-care professionals should be aware of these problems. The majority of our doctors and health-care professionals are unaware of these facts.
The Lyme tests we use in Nova Scotia demonstrate approximately 50 per cent sensitivity, which means that they are about as reliable as a coin toss. Unfortunately, in Nova Scotia we still use those same tests to which the Health Canada report was referring. This is a problem.
As the chief medical officer, Dr. Strang should know about these problems. On the product information sheet for the tests, for example, it states the following: “Negative results (either first or second step) should not be used to exclude Lyme disease.” This is because you could actually have Lyme disease, but the test didn’t pick it up.
In many American states, doctors are legally required to notify patients of this fact. The same should be required here. Dr. Strang has been provided with the medical literature indicating these problems, and I have requested that his office, and the Department of Health and Wellness, provide this information to all of our province’s doctors. That request was ignored.
Regarding the testing being accurate in late Lyme disease, Dr. Strang is wrong. The Lyme bacteria by this stage have migrated from the bloodstream into major organs, tissues and joints, and are able to evade the immune system. As such, the immune system has a problem recognizing the bacteria and fails to mount a continued immune response, or musters a response so low that it’s not detectable on the half-reliable test.
Dr. Strang’s statements are unacceptable, especially considering that over 80 per cent of Nova Scotians now live and spend leisure time in tick-endemic areas and are therefore at high risk of contracting Lyme from a tick bite.
In his article, Dr. Strang inferred that there is a test that can indicate whether or not a person has an active Lyme disease infection. This is misleading. In Nova Scotia (and Canada), there is absolutely no test used by our health authorities that can determine the status of infection in a Lyme patient. The tests used (the Whole Cell ELISA, C6 ELISA) can only determine whether or not a person has been exposed to Lyme disease; they cannot detect active infection.
In the past three weeks, a new study authored by Dr. Ralph Hawkins and Dr. Vett Lloyd was published in the peer-reviewed medical journal, Healthcare. Relying on official U.S. and Canadian public health data, this study suggests that only three to four per cent of Lyme cases in Canada are actually officially diagnosed. This means that most Canadians who indeed have Lyme disease are being misdiagnosed and consequently are slipping through the cracks.
It is obvious to me that Nova Scotia absolutely does not, as the headline on Dr. Strang’s opinion piece asserted, “have a handle on Lyme,” when so many patients are unable to receive the care that they need from our doctors here at home.
There is no other reason why anyone would feel the need to spend precious time, energy and money going out of province and country; clearly, they’re obtaining treatment that is being refused here.
That refusal is based, in part, on the inaccurate and inadequate information provided by Dr. Strang and the chief microbiologist for Nova Scotia, Dr. Todd Hatchette. This is totally unacceptable. Why aren’t they asking themselves why so many of these patients actually get better after treatment in the U.S.?
Dr. Strang also makes a categorical statement regarding Lyme being passed from mother to fetus: “There is no evidence of this.” There is, actually, over 30 years of evidence documenting mother-to-fetus Lyme disease, not the least of which was documented by Health Canada back in June of 1988, in the Canada Diseases Weekly Report, where it stated, “Transplacental transmission of Borrelia burgdorferi has been documented and may be associated with an increased risk of adverse pregnancy outcomes.”
The authors of that report also published in the authoritative Canadian Medical Association Journal in August 1988. Even the U.S. Centers for Disease Control have acknowledged transplacental transmission and warned of adverse outcomes in untreated mothers-to-be.
Our own Dr. Hatchette co-authored a medical report in 2014 whereby he stated that there have been documented cases of mother-to-fetus transmission. The U.S. Department of Health and Human Services and the National Institutes of Health have also documented mother-to-fetus transmission and advised mothers-to-be to be aware of the possible dangers of infection with Lyme disease during pregnancy.
There are also current (2016) medical school textbooks on mother/fetus infections where Lyme and associated adverse outcomes are described in detail. Indeed, even Dr. Gary Wormser, head of the Infectious Diseases Society of America Lyme Disease Guidelines Review Panel, in his published review of the world’s most authoritative textbook on fetal and newborn infections, has acknowledged the fact of transplacental transmission of Lyme disease.
Mother-to-fetus infection with Lyme disease is not in question. The French National Assembly recently acknowledged that “maternal-fetal infections is possible.” And, earlier this year, the World Health Organization added Congenital Lyme Borreliosis (a baby born with Lyme disease) to the international coding structure for physicians worldwide. Dr. Strang is wrong. Again.
For more information on all of the above, readers are directed to CanLyme.com and LymeHope.ca.
Dr. Strang and Dr. Hatchette are entitled to their own opinions. What they are not entitled to is their own facts. The facts clearly state that testing is as reliable as a coin toss at any stage of Lyme; the facts state persistence of infection is clearly acknowledged and evidenced in the credible and reputable medical literature, and the facts state that transplacental (mother-to-fetus) transmission is possible.
All of this may be an inconvenient truth for Drs. Strang and Hatchette, but continued failure to acknowledge this truth could have very serious health consequences for Canadians.
It is long past time to stop this cult of denial and misinformation regarding Lyme disease that emanates from our government departments and health-care institutions.
Jane Bailey lives in Wolfville. She has science and education diplomas and is a member of The Royal Society for Public Health.