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

In his book "Bull's Eye", Dr. Jonathan Edlow takes the reader through the medical detective work leading to the discovery of the spirochete Borrelia burgdorferi, the agent responsible for Lyme disease. It also deals with several other tick-borne illnesses such as Rocky Mountain spotted fever, Q fever, and babesiosis. Unlike most readers, I have a unique perspective on this work as a former suffer of Lyme disease due to a tick bite I got while hiking in the St. Croix River valley of Minnesota in 1998. Fortunately, my physician, a gifted diagnostician, promptly tested for Lyme disease, and after a treatment of antibiotics (and anti-inflammatory drugs for the migratory arthritic pain involved), I became Lyme free after a careful prescription and testing regimen. It is with that background that I read "Bull's Eye", and I heartily endorse it as the best historical treatment of Lyme disease I have yet seen. I also have the benefit of being a biologist by education, so I was already acquainted with most of the terminology involved. This book is excellent for Doctors and other medical professionals, and is totally suitable to the layman as well, although someone with limited background may end up re-reading sections and flipping to the Appendix and Glossary occasionally. 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. S

We have AIDS, SARS, West Nile Virus, and other deadly infectious diseases to make headlines. It might seem that a recounting of the search for the cause of Lyme disease and a treatment for it would lack import. Lyme disease is not insignificant; it isn't as deadly as other newsworthy infections, but it has affected hundreds of thousands of Americans, and can cause symptoms from the curious but unthreatening (like a "bull's eye" pattern of a rash) to arthritis, nerve damage, meningitis, and heart disease. _Bull's-Eye: Unraveling the Medical Mystery of Lyme_ Disease (Yale) by Jonathan A. Edlow, M.D., is a valuable addition to the chronicles of detective work that have led to our understanding, and sometimes treating, serious illness. As in most such stories, this is a tale of triumph, but it is muted; there is still a good deal of confusion and ill-will among patients, doctors, and their lawyers regarding the illness.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 t

Its not often a layperson can be introduced to complex science and come away learning, understanding and appreciating technical issues while enjoying the process. Jonathan Edlow accomplishes all this and more. In addition to allowing the reader to quickly and easily learn and understand the subtleties of Lyme disease and a wide range of related medical topics, the author also introduces us to a broad cast of characters: Lyme disease victims, their families and protagonists; sophisticated academic researchers on several continents; medical sleuths with the single-mindedness of hounds on the hunt; and physician-healers struggling to make sense of the unknown and unknowable as they treat their suffering patients. Edlow makes them all real human beings and allows us to get into their minds and see the mystery of Lyme disease from each different viewpoint. Finally, Edlow assembles all this in a fast-paced mystery story decorated with historical examples and analogies that makes it clear to the reader that discovery and history are unfolding in each exciting chapter. Bulls Eye is a great read. If Dr. Edlow can repeat this accomplishment in arenas other than medicine, he will be widely recognized as another John McPhee.

When I received this book and saw "Yale University Press" emblazoned on the back, I thought, "Oh, no" another biased view of Lyme disease coming from the institution long associated with the conservative, repressive view (Edlow calls it "conventional") of Lyme disease. I must admit I was pleasantly surprised. This was a much better book than I expected and the Yale Lyme view is kept in perspective.Edlow does a good job of presenting the politics of Lyme Disease, outlining the positions of the two camps he identifies as the "conventional" and "alternative" in a fairly unbiased fashion. (He even points out the irony of the terms. When it comes to Lyme disease, the conventional side advocates some pretty wacky theories without much scientific basis and the alternative side advocates sufficient antibiotics to control the disease.)I was a little annoyed by Edlow's fawning over Allan Steere, the figurehead of the conventional camp. But read closely and you will see that Steere and his followers have been wrong in just about every one of their initial positions and Steere is given too much credit for his contributions to the science of Lyme Disease. Contrary to Edlow's apologies for him, Steere, arrogance personified, is slow to pick up on the obvious and is most often wrong. Abused patients and other scientists led the charge.This is a minor quibble. There is excellent information on Lyme testing, the vaccination fiasco, and Lyme politics. There is much about the process of medical discovery. Edlow is quite fair and concludes with the real issue -- the conventional camp, holding institutional power, should not be censoring and abusing proponents of alternate viewpoints. If you have Lyme disease, think you might, or know someone who does, read Karen Forschner's book first. If you feel you need some balance, want more background, or are interested in medical sleuthing and politics, read Edlow's, too.

I bought this book to learn more about Lyme disease but was pleasantly surprised that it read more like a detective story than a medical book. The author is able to tell the story about how patients and doctors gradually peeled away the layers of the mystery of Lyme disease in an understandable and entertaining style. More importantly, he exposes how doctors discover any new disease, or promote any new theory. I would recommend this book, not only for those who are interested in Lyme disease or medicine and science, but also anyone who simply wants to read a fascinating, well-told story.