It’s that time of year when every day I can expect to see at least one patient with a concern about Lyme disease. In Lyme-endemic regions such as Western Massachusetts, where I practice pediatrics, summer brings a steady stream of children to my office with either the classic Lyme rash (erythema chronicum migrans, or ECM), an embedded tick, a history of a tick bite, or non-specific signs or symptoms that may or may not be due to Lyme disease. Sometimes the diagnosis is relatively straightforward. A child is brought in after a parent has pulled off an engorged deer tick, and there is a classic, enlarging ECM rash at the site of the bite. More often the presentation is less clear, requiring detective work and science-based reasoning to make an informed decision and a diagnostic and therapeutic plan based on the best available evidence. Depending on the story, the plan may include immediate treatment without any testing (as in the straightforward case described above), immediate testing without treatment pending test results, or waiting as we watch and see how a rash progresses before doing anything. An example of this latter course of action would be when a patient comes in with a pink swelling at the site of a new tick bite. In this case, it may not be clear if the swelling is a Lyme rash or simply a local reaction to the bite, a much more common occurrence. The classic ECM rash (an enlarging, red, circular, bull’s-eye rash at or near a tick bite) typically develops 1-2 weeks after a tick bite, but can occur anywhere from 3-30 days later. It then expands and darkens over another 1-3 weeks before fading. This classic rash is not the most common rash of Lyme disease, however, as it occurs in only about 30% of cases. Instead, the rash may be uniformly pink or red (or even darker in the center) without the target-like appearance, or may be a linear rash, expanding outward from the tick bite site. In the case of a patient who comes in with a vague, pink swelling within a day few days of a tick bite, we will typically wait and see what happens to the rash. If it is a local reaction, it will likely resolve within another few days. With Lyme disease, the rash will continue to enlarge and declare itself as an ECM rash. Another unclear and not uncommon situation is when a patient comes in with non-specific symptoms such as fatigue, musculoskeletal pains, and headache. If warranted by the history and the physical exam, we may in this case order Lyme testing. This may not give us an answer even if the patient has Lyme disease, because results are often negative in the first few weeks of the disease. In this case, if symptoms persist or evolve, we will repeat the testing in another few weeks at which point true Lyme disease will test positive and can then be treated. The good news is that the treatment of Lyme disease, particularly in the early, localized phase of the disease, is extremely safe and effective with a 14-day course of antibiotics. The testing is also relatively straightforward, with very good sensitivity and specificity when performed correctly. And this is where the bad news comes… (more…)
Posts Tagged Scam
In 1994 Congress (pushed by Senators Harkin and Hatch) passed DSHEA (the Dietary Supplement Health and Education Act). As regular readers of SBM know, we are not generally happy about this law, which essentially deregulated the supplement industry. Under DSHEA supplements, a category which specifically was defined to include herbals, are regulated more like food than like medicinals.
Since then the flood-gates opened, and there has been open competition in the marketplace for supplement products. This has not resulted, I would argue, in better products – only in slicker and more deceptive claims. What research we have into popular herbals and supplements shows that they are generally worthless (except for targeted vitamin supplementation, which was already part of science-based medicine, and remains so).
A company can essentially put a random combination of plants and vitamins into a pill or liquid and then make whatever health claims they wish for their product, as long as they stay within the “structure-function” guidelines. This means they cannot claim to cure or treat a specific disease, but this has proven to be an insignificant limitation on marketing supplements.
It is my unhappy duty to reveal yet another depressing example of dishonest gain in medicine. This time, however, patients were not the only victims. Many healthcare professionals, including physicians, were prey to what has been called “an intellectual property ponzi scheme.”
In a press release dated January 28, 2009, the HealthCentral Network announced the acquisition of a company called Wellsphere from its young CEO, Ron Gutman. Many of my fellow medical bloggers are familiar with Wellsphere as they’ve received countless email form letters from its CMIO, Dr. Geoffrey Rutledge. The form letters are flattering, and suggest that the company would like to feature the blogger’s writing on their platform.
But what happens next is disturbing – to become a member of Wellsphere, bloggers provide access to their blog’s RSS feed. Hidden in the fine print is the blogger’s consent for Wellsphere to publish the entire feed (in other words, all of the blogger’s written work) and that once it’s published on their site, they own the intellectual property rights to it.
Astonishingly Wellsphere convinced some 1700 bloggers to join their network, and have now sold their site (which is comprised almost entirely of blog post content) to HealthCentral Network for an undisclosed amount, likely in the millions.
How much did the health bloggers get for their writing? As far as I know, zero dollars.
Is this the biggest scam ever pulled on health bloggers? You decide. The Wall Street Journal health blog reports:
As for the thousands of bloggers HealthCentral picks up with the merger, there is already grumbling in the blogosphere that Wellsphere built its business on health bloggers who don’t benefit from the deal. “But most are happy and we hope with all our resources and quality-content background we will really strengthen these engagements,” Schroeder told us.
Interesting statement from Schroeder – “most are happy.” He clearly hasn’t read the comments section of my blog. If there ever were a time for the medical/science/health blogosphere to rise up “Motrin moms-style,” it would be now. You may Tweet in protest by entering your comment with “#wellsphere” on Twitter. Or kick it old-school here in our comment section.
If you have any additional information, feel free to post it in the comments section below.
Here is the introductory form email sent out by Dr. Rutledge: