Lyme Article and Letters

For an illuminating view of how doctors fight with one another over Lyme Disease, here's an article and a set of letters published in the Annals of Internal Medicine (The American College of Physicians publishes it).

The entire set of response letters can be found by clicking any of the hypertexted letters links above or by going to the November 2002 volume online and finding the heading for "Lyme Disease Controversy: Use and Misuse of Language" in the Letters section. Similarly, the link above for the article should take you to the PDF of that article, but if it does not, you can try accessing it through the March 2002 volume online.

It's interesting although somewhat alarming to watch doctors argue semantics in what should be a medical debate solved by good solid research. Instead, they evoke half understood philosophical terms and notions like "the dichotomy between rationalism and empirisicm" in an effort to invalidate one another's claims, references, and overall clinical approach.

I didn't realize that med school was heavy with curriculum in philosophy these days. Maybe they can get a certificate in it if they read "Atlas Shrugged".

Empirical evidence of lyme disease:
Recollection of a tick bite
"Flu like" symptoms
A big fucking rash

Positive serum values?
"Borderline" CSF test?
(Are those empirical?)

The rash got bigger and took months to fade. I got bit in June. I could still see it in December. I had a positive ELISA test and my Western Blot was positive for a couple of Lyme specific bands which I understand from every doctor I've spoken to means I had a positive diagnosis of Lyme. But according to the CDC surveillance case definition, I did not have Lyme. Well that's silly, right? The CDC explicitly says "This surveillance case definition was developed for national reporting of Lyme disease; it is not intended to be used in clinical diagnosis." Yes, they do say that. But the Lyme Disease Controversy is so controversial that it has spawned doctors who are too quick to use it to dismiss clinical symptoms and signs. I've met the people who didn't think to take a picture of their rash. The test results get disputed a year later. The symptoms disregarded or explained by "stress" (which fits because by now the patient is a wreck emotionally as well as physically). These types of docs are, I think, just too ready to jump in on the "rationalist" side.

I am starting to think I dislike rationalism. Maybe I just don't like armchair rationalists. Are there any other kinds? Chomsky's approach to human language faculty is also similarly "rationalist". That is, it calls for a nearly complete dismissal of observables in building a theory of cognition (language) as they are "unreliable".

I read Aristotle when I was in college. I was not a good student that first time through, so perhaps I misremember the reading. I recall thinking that some of it was extreme, but I kind of liked Aristotle better than that other stuff (Plato, Socrates). One of my classmates said I had empiricist leanings. I guess. I don't have names for these attitudes, these preferences of perspective. I don't presume to know what they are called in books I haven't yet read. But if I allow the doctors' debate in the Annals of Internal Medicine to define "rationalism" for the immediate and pragmatic context, then I am NOT a rationalist. What does "rationalism" mean to these guys? It seems that it means adhering to "fact" in one's observations, perceptions, and conclusions about the world around them (as in, you wouldn't see a black widow spider in the room if it's a "fact" that black widow spiders don't live in this climate). It means testing only "facts", looking for support for those known "facts", and ignoring, discounting, or in other (statistically?) ways disregarding any data that does not fit with "fact".

But if this is indeed the meaning of "fact", if "fact" means nothing demonstrably more than widely or importantly accepted belief, then how does knowledge grow?

Ah hell, I have to get to school.