Another week in the books at Atlanta Hyperbaric and two interesting things happened: First, an article came out on maternal age and autism and second, a patient was referred with chronic Lyme disease. We, of course, treat autism and keep an open mind about Lyme disease.
The autism study should be much admired by epidemiologists. The study group comprised nearly 5 million births in California between 1990 and 1999 and more than 12,000 autism cases. With such large numbers–assuming they are reasonably accurate–the findings should be pretty reliable. Mothers who gave birth when they were 40 or older had a 51% increased risk of having a child with autism compared with those who were 25 to 29, the largest age group. Paternal age effected autism rates only if mothers were younger than 30. Maternal age, however, accounted for just 4.6% of the autism incidence while over the same time frame, overall autism incidence increased by a factor of 6. In other words, according to the authors, rising maternal age definitely seems to contribute to the increase of autism cases, i.e., is a risk factor for autism, but only accounts for a fairly small proportion of all the increased number of autism cases being seen.
Chronic Lyme disease is about as controversial a topic as there gets in Medicine. Dr. Allen C. Steere, the discoverer of Lyme disease, reported death threats in 2001 because he took a very public position that people diagnosed with chronic Lyme disease generally don’t need to be treated with more than a month of antibiotics; because of his stature and reputation, many insurers stopped paying for the antibiotic treatments and State regulatory authorities started going after physicians writing the prescriptions. Dr. Steere’s position in July 2008 on chronic Lyme disease appears unchanged.
Regular readers of this blog have probably figured out by now that I am a libertarian. For the uninitiated, my definition of a libertarian is basically someone who believes that all problems on Earth are caused by government. All problems. Even dog fleas (see page 7.) If a patient wants IV antibiotics for chronic Lyme and a physician wants to prescribe them, I don’t see why the government needs to stick its metaphorical nose into the issue. I may not believe the antibiotics will have any beneficial effect and, indeed, I suspect chronic antibiotics have harmful effects under these circumstances, but I won’t condemn either the physician or his patient. To me, the marketplace solves this problem better than any bureaucrat and I believe the market never errs, if allowed to be free. And, please don’t bring up the wastefulness argument because that spills over into another topic entirely and has nothing to do with whether a doctor should be allowed to prescribe antibiotics when the State says he shouldn’t.
If you think that treatment of chronic Lyme disease with antibiotics is controversial, you can imagine the literature on hyperbaric oxygen treatment for this condition. At least there have been no death threats: It is uncommon for insurance companies to pay in the first place and no one proposes–yet–to interfere with this doctor-patient relationship.
Over the years, I have treated with hyperbaric oxygen about half a dozen patients who carried the diagnosis of chronic Lyme disease. These patients all had positive blood tests for Lyme, several had documented erythema chronicum migrans, all had multiple courses of both intravenous and oral antibiotics and all continued to have long standing complaints of severe fatigue, sleep disturbance, headaches or cognitive problems. In other words, all of these patients had acute Lyme disease at one point in their lives and then developed chronic, nonspecific symptoms. Everyone of these patients has sworn to me that the hyperbaric oxygen treatment helped their symptoms.
Is there any scientific evidence that hyperbaric oxygen helps patients with chronic Lyme disease? I am only aware of one study, and the only thing I can make of it is that hyperbaric oxygen harmed no one–rarely does it ever–and more than 80% of the patients claimed their symptoms improved. There is at least a scientific rationale behind the use of hyperbaric oxygen treatment: The spirochete that causes Lyme disease is sensitive to a high-oxygen environment. Under hyperbaric conditions, there can be no place in the human body for the Lyme spirochete to hide from oxygen levels that should be able to kill it. Let’s see how my new patient does.