Divided bodies Lyme disease, contested illness, and evidence-based medicine

The Lyme bacterium, transmitted by a tick, causes systemic disease and a distinctive rash, and yields to adequate antibiotic treatment, which kills the germs and prevents complications. The treatment is considered effective, the germ eradicated. Many patients, however, believe that they suffer from persistent infection (or "chronic Lyme") due to delayed, inadequate, or failed treatment. "Mainstream medicine" and medical insurance providers categorically deny the existence of chronic Lyme. Patients, advocacy groups, and "Lyme-literate physicians" believe as strongly that the condition is real, disabling, and requires long-term treatment. Dumes (women's and gender studies, Univ. of Michigan) used an anthropological and ethnographic methodology to illuminate the deep divide between mainstream medicine and "Lyme-literate medicine." She shadowed physicians and interviewed patients and practitioners to elucidate the controversy, and in the process illuminated the challenge of applying "evidence-based medicine." In five chapters she "maps the controversy," explains treatment and prevention, gives voice to sufferers, and examines chronic Lyme in the context of evidence-based medicine. This book is valuable for its illustration of how some medical paradigms become mainstream, while others disappear. Chronic Lyme, whatever it is, holds up a mirror to evidence-based medicine. Dumes's ethnographic approach provides voluminous details, new insights, and a refreshing alternative to much of the existing literature on the Lyme controversy. Summing Up: Highly recommended. All readers. --Michael Gochfeld, emeritus, Rutgers Robert Wood Johnson Medical School