至今在我的 “蜱” 系列, 我们从全球领先的专家认为蜱传疾病学 (包括莱姆病) 可能是今天存在的最复杂，最实质性的全球性医学研究的挑战，他们威胁要称霸全球卫生保健的明天. 解决方案是很难找到，因为细菌难以诊断和治疗，由于经常需要对复杂的多学科的方法.
国际旅行, 全球变暖和剔移民不断增加，这些疾病的全球发病率. 在许多国家, 政府和医生不够熟悉的疾病. 甚至当医生告知合理, guidelines for treatment remain globally controversial. 最终，, 患者患有莱姆及相关疾病越来越病情加重.
比较是经常的蜱传疾病的危机和艾滋病在1980年间取得. 与艾滋病, solutions to the problem require achievement of the goals of global cause awareness and robust funding for research. In the 80’s, 传达的信息都是关于名人名言, 服饰, 街头抗议和传统媒体. 今天, 由于技术和开拓互联网的车辆，如人群资金, 群众的力量，带来的变化是迅速成为莱姆事业最大的武器. “社交网络的用户数量在全球将从增加 1.47 在十亿 2012 以 1.73 今年十亿, 它预计将上升到 2.55 十亿到2017年，” explains ILADS (国际莱姆病及相关疾病协会) marketing consultant Laurie Martin. Martin has recently helped ILADS launch “美国的力量实现变革. 加入狮吼,” 尖端的号召行动的社交媒体活动，强调了世界各地的人们统一用一个声音的力量沟通的莱姆病的意识的重要性.
在来自世界各地的今天寻求解决方案, 我继续分享莱姆病在中国新闻, 德国, 法国, 澳大利亚, 波兰, 挪威, 瑞士和美国. 我对医生加盟. 鸥赫茨伯格, 全科医师的澳大利亚皇家学院谁是院士说学院的代表在最近成立的临床咨询委员会的莱姆病在澳大利亚, 澳大利亚的首席医疗官主持; 何. 理查德·霍洛维茨, 备受期待的新书之一，在美国最重要的莱姆病医生和作家, 为什么我不能得到更好的?: 解决莱姆和慢性疾病的奥秘 (圣. 马丁的新闻, 下降, 2013); 尚塔尔佩兰, the Producer of a new documentary on the global Lyme epidemic coming at the end of October (联合出品法国道 5); 博士. 狮子座Ĵ. 乳木果三, ILADS总裁.
理查德, you recently spoke at the International Lyme Disease conference in Strasbourg. What did you learn about the incidence of Lyme disease in France? 在那里诊断和治疗许多差异，在法国医学界的做法从美国的做法?
理查德·霍洛维茨 (美国): The incidence of tick-borne diseases in France is rapidly rising. 斯特拉斯堡是法国称为阿尔萨斯 - 洛林地区, 这是接近黑森林在德国, 其中超过一百万例莱姆病已被诊断，在过去几年. 许多谁住在这方面的病人告诉我，他们已经患莱姆病的整个生命.
莱姆病的法国医学界的立场是相似的，在美国: 他们分歧的正确途径诊断和治疗. 一些法国医生遵循莱姆病的诊断和治疗疾病预防控制中心的指导方针. 医生和研究人员在斯特拉斯堡并不认同这种方式，因为有疏螺旋体的多株 (导致莱姆病的有机体) 不能用目前可用的筛选测试中发现. 这些措施包括莱姆病螺旋体狭义, 伯氏afzelii, 伯氏garinii, 伯氏valaisiana, 和伯氏spielmanii. 血液测试，以检测莱姆这些不同的菌株往往不交叉反应, 导致假阴性结果. 因此，一些法国医生，尽管负面验血治疗, 并且发现，抗生素延长课程提高他们的病人’ 健康.
我们也有不同的种类和莱姆病菌株和合并感染在美国. 我们可以通过提高我们的测试中，包括这些不同的感染和通过扩大研究新的有效的治疗改善的蜱源性感染的诊断和治疗的美国教义, 因为许多患者仍长期病患者.
ILADS and others have stated that Lyme disease is the fastest growing vector borne disease globally. Why do you believe we aren’t making more progress in addressing the key diagnostic and treatment issues?
鸥赫茨伯格 (澳大利亚): There is great variability in the clinical presentation of Lyme and associated diseases. 线性, 一个生物体一种疾病的笛卡尔范式不适合这个情况. 我们需要思考不同我们的生物学的各个方面，以了解如何以及为什么这种疾病的发生. 从环境毒素的外部影响的权利，通过在我们的内部激素环境的微妙变化, 都是潜在的相关.
生物体本身pleiomorphic, 这, 除了其免疫抑制动作, makes single antibody or antigen detection methods particularly unreliable.
Extrinsic factors would include lack of funding and direct or subtle opposition to the concept of chronic Lyme and associated diseases. The reasons underlying these factors continue to be the subject of debate, books and film.
何. 利奥三世乳木果 (美国): To properly and effectively diagnose and treat any disease one must first understand the pathogenesis of the disease. This requires extensive research and financial commitment on a global scale. 目前, the world of Lyme is much like the world of AIDS in the early 1980s, with a subset of dedicated researchers and clinicians working tirelessly to advance the understanding of the disease. Their work is often misunderstood by those who hold a myopic view of the disease and its prolonged impact on the physical and neuropsychological system. Given the numbers of individuals who are affected with this disease annually, nationally and internationally, it is a travesty that so little research money has been dedicated to understanding Lyme and other tick-borne illnesses. 艾滋病诊断和治疗的进步来了后，才研究的持续期, heavily funded both nationally and internationally. This same requirement is needed for Lyme, which affects approximately four times the number of people that AIDS affects.
尚塔尔佩兰 (法国): The main problem, 我认为, is that it is one of the most complicated diseases man has ever met. The bacteria are difficult to find and difficult to eradicate. It’s not a disease for specialists but for good GPs who can consider the whole person before making a therapy program “à la carte,” considering many factors. Lyme disease forces doctors to change methods, to spend a long time and to follow patient reactions to treatment closely. It is time consuming and not rewarding as often treatment fails. It’s not a very nice and tame disease. Lots of doctors refuse to treat Lyme disease.
And from the chemical industry’s point of view, it’s much more interesting to treat life long fibromyalgia with corticoids and pain killers (expensive medicines) than treat Lyme, often the cause of fibromyalgia, with cheap out of patent antibiotics.
Gull, can you provide any data presented at the Australian Lyme Literate Doctors meeting? How many sick patients are involved?
鸥赫茨伯格 (澳大利亚): The Lyme Disease Association of Australia reports on its website that at least 15,000 people with Lyme disease diagnoses in Australia (and conservative estimates suggest another 200,000 undiagnosed people). I have no way of verifying the accuracy or otherwise of this data.
Are you aware of any countries where government health agencies have acknowledged the diagnostic and treatment issues and put policies in place that better support Lyme patients (versus the conservative approach of the CDC and IDSA)?
尚塔尔佩兰 (法国): In Poland, doctors are allowed to treat patients the way they wish, and if you’re bitten, there are places where you can bring your ticks for analysis to see if they are infected.
在德国, doctors can also treat patients as they think best, including plants, low frequency therapies, long term antibiotic treatments… but social security won’t pay for treatments outside IDSA guidelines. 所以，, as everywhere else, it’s a disease for the rich.
Switzerland has recently become aware of the problem. There are prevention leaflets and posters everywhere in medical centers and pharmacists. Doctors are informed.
Norwegian scientists are very advanced in the research on Borrelias. The country is also under IDSA’s guidelines but politicians are trying to open the debate and patients groups are very active.
何. 利奥三世乳木果 (美国): I am not aware of any countries that have taken such action. 事实上, most of the countries have relied on the IDSA guidelines without understanding that there is a contrasting point of view offered by ILADS guidelines.
理查德, the Chinese government invited you to discuss emerging tick-borne diseases (especially babesiosis) in their country. How serious is the problem there and how is the Chinese medical community addressing it? What can the US medical community learn from China’s approach to these diseases?
理查德·霍洛维茨 (美国): China is having a significant problem with tick-borne diseases, just as we are in the US. I was informed that up to six percent of their population (many living in rural areas) has been exposed to Lyme disease. Since the diagnosis was made with presently available testing (like the ELISA test), which is known to be unreliable, the incidence may actually be much higher.
The Chinese government is addressing this problem by holding interdisciplinary round table discussions with experts from different areas in medicine. I was invited for my expertise in Lyme disease and co-infections, specifically Babesiosis, which is a malaria type organism being found in ticks. They discovered cases in China, which didn’t fit the textbook description for the disease, and wanted my opinion on the presently available diagnostic and treatment options. We had experts from their National Academy of Sciences, Chinese CDC, as well as specialists in different areas of medicine sit around a table and discuss these various tick-borne illnesses. It was intellectually stimulating and rewarding to see concerned physicians, scientists and top government officials come together to address the worldwide epidemic of tick-borne diseases in an open scientific forum.
我们在美国可以从中国的做法持自己的多学科的科学会议学习, 那里的研究人员, clinicians and specialists come together with government officials to tackle this global epidemic. Nothing short of this will be able to affect the type of changes desperately needed in research, treatment and health care policy for tick-borne diseases.
For more information on The Power of Us Campaign: http://www.ilads.org/lyme-powerofus.php
Photos courtesy of ILADS, ç. M. 鲁宾博士. 理查德·霍洛维茨.
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