Lyme Testing Not Much Better Than Guessing

A recent article in the British Medical Journal (BMJ) shows that the two tier testing system endorsed by the Centers for Disease Control and Prevention (CDC) has a high specificity (99%) and yields few false positives. This means if they are both positive, you almost certainly have it.

The problem is if the tests are negative. The tests have a uniformly miserable sensitivity (56%)—they miss 88 of every 200 patients with Lyme disease. By comparison, AIDS tests have a sensitivity of 99.5%—they miss only one of every 200 AIDS cases. In simple terms, the chance of a patient with Lyme disease being diagnosed using the commercial tests approved by the Food and Drug Administration and sanctioned by the CDC is about getting heads or tails when tossing a coin, and the poor test performance assures that many patients with Lyme disease will go undiagnosed.

It is totally NOT acceptable to leave 44% of people with Lyme disease unnecessarily crippled because our tests are hopelessly inadequate. This is where the art of medicine comes in. If a CFS/Fibromyalgia patient's symptoms and history are suggestive of Lyme or other antibiotic sensitive infections, I believe an empiric trial of antibiotics is warranted to see if they help. This has been shown to be helpful in other conditions such as Rheumatoid Arthritis. Amazing how some doctors say that this is much too dangerous a therapy to try in these horribly disabled folks—unless they also have dreaded zits (acne), in which it is OK to give the treatment for years!