Bull's-Eye: Unraveling the Medical Mystery of Lyme Disease (Hardcover)

The book is really a medical detective story, and a gripping one at that. It begins with the symptoms of an unknown disease clustered around Lyme, Connecticut in the mid 1970s. Initially believed to be Juvenile Rheumatoid Arthritis (JRA), authorities began questioning that diagnosis after demographic patterns were not consistent with JRA, and the disease exhibited significant clustering (which JRA does not do.) Initially brought to the attention of authorities by two area mothers, Polly Murray and Judith Mensch, their initial concerns were rebuffed. Through their perseverance, ultimately several teams of doctors began investigating the illness, believed to be linked to an insect vector due to the geographic distribution of the illness and the seasonality of the illness. Navy Doctors William Mast and William Burrows were quick to realize the curative effect of antibiotics on the disease, though not all doctors agreed. Notably Dr. Allan Steere of the Yale rheumatology department believed that antibiotics were not indicated until four years worth of data were analyzed. Although in 20/20 hindsight this is an obvious gaffe, I am sympathetic to the conundrum faced by Dr. Steere, as obviously he didn't want to prescribe unnecessary antibiotics. Where I am not sympathetic to Dr. Steere is in his seemingly arrogant, quick dismissal of the Navy doctors and their corporate and medical knowledge, particularly in light of their ninety percent cure rate with antibiotic therapy. I am somewhat academically amused that Steere and the Yale 'experts' were generally incorrect in most of their initial assumptions. Although I am personally grateful for the work of all the researchers involved, including Dr. Steere, I was exceptionally impressed with Mast and Burrows in addition to noted tick expert Dr. Willy Burgdorfer (after whom the Lyme disease spirochete is named) and his efforts to find the agent responsible for the disease. Working with ticks is extremely difficult: they are small, hard, and contaminated with a gazillion things. Isolating the one agent being searched for, in this case an unknown spirochete, is extraordinarily difficult.

Dr. Edlow is an excellent writer and anyone with interest in the medical field would love this book. The doctor who treated my Lyme disease recently left practice. When he left I went to see him specifically to thank him for all his efforts on my behalf and to give him a copy of "Bull's Eye." It was the least I could do.

Lyme disease was first recognized in the US in Connecticut in 1975. It is caused by a corkscrew-shaped bacterium called _Borrelia burgdorferi_, but it is spread by what epidemiologists call a "vector," in this case the deer tick. The flurry of investigation of the disease was sparked by patients who could not get proper answers from their physicians, and were only eventually referred to Yale University, where the departments of rheumatology, epidemiology, and even ecology started investigating. Thus began the effort to get an epidemiological grip on the phenomenon. Gradually the patterns of the illness itself became clearer. There were stages, first a skin rash, then joint pain, but the connection between the two was uncertain. There was associated meningitis, facial paralysis, inflammation of the heart muscle, and disturbance of heart rhythm in some cases. Though Edlow charts the course of greater understanding of the disease, and makes a good case for pure and applied science eventually producing an accurate concept of the disease and its effects, he describes also the missteps and clinical errors, as well as the personality clashes, the human aspects of scientific endeavor which hamper progress.

In fact, the book ends on a rather sad note of discord. Yes, there has been a boom in knowledge about the disease, and Edlow rightly draws on inspiring stories of other epidemiological success, like the connection of cholera to an infected water supply in nineteenth century London, the development of Koch's postulates as a tool for infectious disease investigation, and the degrees of precision in increasingly complicated laboratory tests. Patients with a sense of independence began to question the theories of the disease's course and treatment, and support groups sprouted up. Some of the groups began to favor the conventional school of treatment and the physicians who followed it, while others preferred alternative methods (not alternative as in homeopathy or acupuncture, just alternative to the prevailing theory). There seem to have been organized efforts to censure doctors on one side or the other, some of whom have had to have bodyguards from time to time. There has been acrimony at professional meetings. Edlow found that those who were helpful when he began writing his book in 1993 made themselves unavailable for interview in 2000, presumably because of the politicization of the controversies. Edlow writes, "Nature goes about its business quite independently of those humans who try to uncover its secrets." _Bull's-Eye_ is documentation that nature is hard enough to understand, and human nature gets in the way of even the best scientific efforts.