Book and Film Reviews

Under Our Skin” – a Film Review
Phillip J. Baker, PhD., Executive Director,
American Lyme Disease Foundation (ALDF)
The film entitled, “Under Our Skin”, was produced in 2008, and premiered on June 19th, 2009, at the IFC Center in New York. It depicts the plight of patients claimed to be suffering from a poorly defined condition called “chronic Lyme disease”, and champions the unproven benefits of extended antibiotic therapy for its treatment. Since the guidelines for the diagnosis and treatment of Lyme disease, formulated by the Infectious Diseases Society of America (IDSA), neither recognize “chronic Lyme disease” as a distinct clinical entity nor advocate more than a short course of oral antibiotics for the treatment of Lyme disease, there is some public confusion surrounding this disease.
That confusion encouraged then Connecticut Attorney General (AG) Richard Blumenthal to launch an antitrust investigation of the IDSA guidelines. This culminated in a detailed and extensive review of their validity by an independent panel approved by the AG. The independent review panel, which relied on more than 1,000 published scientific papers in rendering its decision, issued its final report in May, 2010 (1). It unequivocally affirmed that: (a) there is no published evidence to indicate that extended antibiotic therapy is beneficial for the treatment of “chronic Lyme disease”; (b) there is no well-accepted definition of post-Lyme disease syndrome, also known as “chronic Lyme disease”; and that (c) there is no convincing biological evidence for the existence of symptomatic chronic Borrelia burgdorferi infection among patients given recommended treatment regimens for Lyme disease (1).
It was not surprising that the review panel unanimously upheld the IDSA guidelines since the IDSA’s recommendations for the treatment of Lyme disease are in complete accord with those of the European Federation of Neurological Societies, the European Union of Concerted Action on Lyme Borreliosis, the American Academy of Neurology, the Canadian Public Health Network, the German Society for Hygiene and Microbiology, the British Infection Association, as well as those of expert panels from at least 10 European countries (2,3). To deny the existence and validity of such an overwhelming consensus of independent expert opinion, in the absence of convincing evidence to the contrary, is an interesting example of anti-science denialism. It should be noted that an independent appraisal and review of alternative guidelines proposed by the International Lyme and Associated Diseases Society (ILADS) by the British Health Protection Agency found them to be untenable and unsupportive of extended antibiotic therapy (4). Furthermore, Borrelia burgdorferi, the spirochete that causes Lyme disease, does not form cysts or microfilms that render it resistant to conventional antibiotic treatment as suggested by a self-employed “scientist” featured in the film. Lyme disease is not a lethal, life-threatening disease as the funerals and memorial services shown in the film shamelessly and dishonestly portray it to be (5).
In view of these considerations, it is regrettable that some Public Broadcasting System (PBS) stations chose to air this deceptive film whose production was funded largely by contributions from Lyme disease advocates and “Lyme literate physicians” (LLMDs) to advance their unproven views. In so doing, it lends a semblance of credibility to a film that is now years out-of-date, and which recent events have shown its central message to be based on false assumptions. A partisan film such as this can only undermine public health by encouraging naïve individuals to seek unproven remedies from LLMDs to relieve symptoms that, though deserving of appropriate medical treatment and care, may well have nothing to do with Lyme disease. This film was distributed by the National Educational Telecommunications Association (NETA) to PBS for airing on their affiliate stations, free of charge. If that is the case, then PBS got exactly what it paid for – but at the cost of compromising its integrity.
1. Lantos, P.M., Charini, W.A., Medoff, G. et al. “Final report of the Lyme disease review panel of the Infectious Diseases Society of America. Clin. Infect. Dis. 51: 1-5, 2010.
2. Baker, P.J. “Chronic Lyme disease: in defense of the scientific enterprise”. FASEB J. 24: 4175-4177, 2010.
3. British Infection Association. “The epidemiology, prevention, investigation, and treatment of Lyme borreliosis in United Kingdom patients: a position statement by the British Infection Association”. J. Infect. 62: 329-338, 2011.
4. Independent appraisal and review of the ILADS 2004 evidence-based guidelines for the management of Lyme disease; general information reported by the Health Protection Agency, UK. (HPA Review of ILADS Guidelines).
5. Kugeler, K.J., Griffith, K.S., Gould, L.H. et al. “A review of death certificates listing Lyme disease as an underlying or multiple cause of death in the United States”. Clin. Infect. Dis. 52: 364-367, 2011.

“Under Our Skin” – Part 2, a Film Review Re-visited
Near the beginning of the film entitled, “Under Our Skin”, there is a rather poignant scene in which a Forest Ranger, who has been told that he has Lyme disease, is sitting at a table, quixotically examining what appear to be hundreds of vials of prescribed medication. The scene prompts one to ask several questions:
What type of physician, who we later learn is a Lyme literate physician (LLMD), is treating this man?
What is the rationale for the treatment he is receiving? Does it appear that the LLMD is simply guessing, i.e., trying “a little bit of this and a little bit of that”, hoping that something will work? Does it look like good medicine is being practiced?
If any of the medications being given happens to be of benefit, how would one know which one — of the many being taken– is beneficial?
If the patient improves, how can one tell if the improvement is spontaneous (a placebo effect?) and has nothing at all to do with any of the medication taken?
Is this treatment regimen typical of that usually recommended by a LLMD? If so, then what is the standard of judgment for their “literacy” with respect to Lyme disease?
From what body of knowledge do LLMDs derive their literacy and self-assumed competence to treat Lyme disease? How many of them have peer-reviewed publications based on the clinical or basic research they have done on Lyme disease?
How much is all this therapy costing the patient in out-of-pocket expenses? Does one honestly think that a health insurance company should be required to pay for such unorthodox — and obviously unproven– therapeutic approaches that are not evidence-based?
In contrast to the scientific evidence provided in the guidelines for the treatment of Lyme disease by the Infectious Diseases Society of America (IDSA), is such a therapeutic approach based on the results of placebo-controlled clinical trials, or only solicited testimonials?
That pile of pills at the beginning of the film hardly inspires confidence in the clinical knowledge and skills of LLMDs. The producers themselves – and in their own words– provide ample grounds for condemning this film as a slick piece of propaganda of no redeeming value. Only the desperate and gullible would derive comfort from its false and deceptive message that benefits only those who enrich themselves by preying upon such people. At your own peril, beware of those who call themselves LLMDs! Shame on them for the harm that they do and the money they take!

Antibiotics as Anti-inflammatory and Immunomodulatory Agents