Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / What's the deal with ticks?

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What's the deal with ticks? · Wellness, Actually with Emily Oster & Perry Wilson, MD

• 0:00
  Speaker 1: So Perry. When I was in college and my brother
• 0:04
  Speaker 1: was also in college, we came home one year for
• 0:07
  Speaker 1: Thanksgiving and my brother had a cold, and you know
• 0:11
  Speaker 1: people get sick whenever he's a college student. He has
• 0:14
  Speaker 1: a cold. It kind of goes on for a little while,
• 0:16
  Speaker 1: and then it's like the day before Thanksgiving. My parents
• 0:19
  Speaker 1: are like, you still have this cold? Like what do
• 0:21
  Speaker 1: you think it's just a cold. He's like, yay, yeah,
• 0:23
  Speaker 1: I think it's just a cold. There is one other
• 0:26
  Speaker 1: thing it could be, oh like like what and he's like, well,
• 0:29
  Speaker 1: I was hiking in lime, Connecticut, and then later I
• 0:33
  Speaker 1: found a tick and then I noticed this very specific
• 0:37
  Speaker 1: kind of rash on my back. It looks like a bullseye,
• 0:41
  Speaker 1: so it could be something like lime disease. And my
• 0:44
  Speaker 1: parents were It was like a moment which now I
• 0:47
  Speaker 1: reflect on as a parent, where they're just like, are
• 0:49
  Speaker 1: you kidding? It's like the day before Thanksgiving and now
• 0:52
  Speaker 1: we have to call our friends and be like, how
• 0:54
  Speaker 1: can we get some doxy cyclic? So teenage boys the worse,
• 1:00
  Speaker 1: if anything, totally, is.
• 1:02
  Speaker 2: There anything worse than a teenage boy trying to take
• 1:04
  Speaker 2: care of their own health or ticks in lime Connecticut,
• 1:08
  Speaker 2: and there's nothing.
• 1:09
  Speaker 1: It was so it was so specific, and today we're
• 1:12
  Speaker 1: going to talk about ticks and there are many, many problems.
• 1:15
  Speaker 2: Oh, it's our creepiest episode so far, creepy Crawley episode
• 1:21
  Speaker 2: of wellness actually, but you know, coming to you here together,
• 1:25
  Speaker 2: we're party still Broadcast Center in Connecticut, birthplace of lime disease.
• 1:30
  Speaker 1: No better place to discuss ticks. So far, the room
• 1:33
  Speaker 1: has no ticks. But we'll have to say how things evolved.
• 1:39
  Speaker 1: I'm Emily Aster, I'm an economist and a data expert.
• 1:42
  Speaker 2: And I'm Perry Wilson, I'm a medical doctor.
• 1:44
  Speaker 1: It's Thursday, August twentieth, twenty twenty six, and this is wellness.
• 1:49
  Speaker 2: Actually, because you're getting a staggering amount of health and
• 1:52
  Speaker 2: wellness information nowadays from every source imaginable, and some of
• 1:56
  Speaker 2: it is awesome.
• 1:58
  Speaker 1: And some of it is well well actually both Fortunately,
• 2:03
  Speaker 1: we're both people who know how to read studies, how
• 2:06
  Speaker 1: to parse the data, and can tell you what's worth
• 2:08
  Speaker 1: thinking about and what you can safely ignore.
• 2:11
  Speaker 2: But before we dig in, a note that this podcast
• 2:13
  Speaker 2: is for educational purposes and should not be construed as
• 2:16
  Speaker 2: medical advice. We don't know your unique situation, so talk
• 2:19
  Speaker 2: to your doctor for personal health decisions.
• 2:23
  Speaker 1: This week, we're asking what's the deal with ticks Perry
• 2:27
  Speaker 1: and I will give the official smash or pass if
• 2:29
  Speaker 1: I think we're going to pass, but let's see, and
• 2:31
  Speaker 1: then we'll get to your question of the week. But first,
• 2:34
  Speaker 1: let's do the health news roundup after the break.
• 2:48
  Speaker 2: And we're back with the health news of the week.
• 2:51
  Speaker 2: First bit of health news. I needed to get your
• 2:53
  Speaker 2: opinion on Emily because I saw this and I was like, oh,
• 2:56
  Speaker 2: it turns out I'm the best parent ever. Okay. So
• 2:59
  Speaker 2: a study shows that less unsupervised physical activity and more
• 3:06
  Speaker 2: screen time in childhood is associated with better cognitive outcomes
• 3:12
  Speaker 2: in adolescents. Okay, So less physical activity, more screen time,
• 3:17
  Speaker 2: smarter kids. I'm doing great. My kids waking up and
• 3:22
  Speaker 2: picking up an iPad while they eat their like process
• 3:25
  Speaker 2: cereal is high quality parenting. We probably shouldn't even discuss it.
• 3:29
  Speaker 2: Let's move on to our next helf item. So fine,
• 3:32
  Speaker 2: what's your.
• 3:32
  Speaker 1: Opinion of Okay, So we have seen so much data
• 3:37
  Speaker 1: in the other direction, and I am always crapping on
• 3:40
  Speaker 1: that data because you see a lot of DA that
• 3:43
  Speaker 1: says screens are bad and physical activity is good, and
• 3:46
  Speaker 1: most of that is just driven by biases, other differences
• 3:49
  Speaker 1: between families, et cetera. This study is also bad, but
• 3:55
  Speaker 1: it is it's in the other direction bad. And this
• 3:58
  Speaker 1: this study has both the problem that all the other
• 4:01
  Speaker 1: studies do, which is that it's got parents who are
• 4:04
  Speaker 1: different in different ways. It's very small, it's like a
• 4:07
  Speaker 1: few hundred people, so it's not that important. But it
• 4:09
  Speaker 1: also has a very very important problem, which is that
• 4:14
  Speaker 1: in all of their analyzes they control for a baseline
• 4:20
  Speaker 1: cognitive metric, so it's like the outcome is a is
• 4:24
  Speaker 1: like cognition now, and then they have some controls for
• 4:27
  Speaker 1: like how much physical activity and screen time you have,
• 4:30
  Speaker 1: but there's also a control for when they enrolled you
• 4:32
  Speaker 1: in study initially what your cognition was, and so that's
• 4:36
  Speaker 1: actually soaking up like almost all the variation because there's
• 4:39
  Speaker 1: so much correlation over time, and when you soak up
• 4:43
  Speaker 1: all that variation, you get a lot of random noise out.
• 4:47
  Speaker 2: In that really just on the margins.
• 4:49
  Speaker 1: So it's really just on the margins. And then small
• 4:52
  Speaker 1: biases and differences will drive stuff, and some most of
• 4:55
  Speaker 1: their stuff is not significant. There's like a little p
• 4:58
  Speaker 1: Hackings paper has a lot of problems, but that is.
• 5:00
  Speaker 2: Getting a lot of press though.
• 5:02
  Speaker 1: You got a lot of press because people love people
• 5:03
  Speaker 1: are like you. They will like people love to hear
• 5:06
  Speaker 1: what they think already is. They love to hear they're
• 5:09
  Speaker 1: doing a good jobs.
• 5:09
  Speaker 2: Zee Commanuel has a whole book about why it's healthy
• 5:11
  Speaker 2: to eat ice cream.
• 5:12
  Speaker 1: Right, and people like that. That book sold really well. Yeah,
• 5:15
  Speaker 1: because people want to hear that what they're doing is okay,
• 5:18
  Speaker 1: and what you're doing probably is okay. But this study
• 5:20
  Speaker 1: doesn't tell you anything about that.
• 5:22
  Speaker 2: Stay tuned for our episode next week where we talk
• 5:25
  Speaker 2: about the benefits of cocaine and methamphetamy.
• 5:28
  Speaker 1: Totally okay. Next up, the AJ updated their cholesterol targets. Yeah,
• 5:37
  Speaker 1: tell me more. Yeah, I mean this is this is
• 5:40
  Speaker 1: not as interesting.
• 5:41
  Speaker 2: It's not the sexiest bit of news, but it is important.
• 5:44
  Speaker 2: The AJA has not updated its cholesterol targets since twenty eighteen,
• 5:49
  Speaker 2: so it's been a fair amount of time, and there's
• 5:51
  Speaker 2: been a lot of research in the interim about the
• 5:54
  Speaker 2: relative benefits of reducing bad cholesterol, typically LDL cholesterol. It's
• 5:59
  Speaker 2: a big document. Go through just some of the highlights.
• 6:02
  Speaker 2: The broad strokes here is that they recommend screening earlier
• 6:06
  Speaker 2: and getting LDL lower for longer. So they actually say
• 6:10
  Speaker 2: that kids should be screened between ages nine and eleven
• 6:13
  Speaker 2: for cholesterol checking, and they sort of reduce their targets
• 6:16
  Speaker 2: across the board, so for people, for everyone, no matter
• 6:19
  Speaker 2: what your cardiovascular risk is, the LDL target is less
• 6:23
  Speaker 2: than one sixty now. And then they recommend a risk
• 6:26
  Speaker 2: assessment system. There's a scoring system called Prevent which input
• 6:31
  Speaker 2: a bunch of stuff like are you smoker, diabetes, other things.
• 6:34
  Speaker 2: It calculates your risk of heart disease in the next
• 6:36
  Speaker 2: ten years, and then there are targets based on the
• 6:38
  Speaker 2: various risk thresholds. The other addition to this from the
• 6:43
  Speaker 2: prior guidelines was that among adults who are on therapy,
• 6:47
  Speaker 2: like on a statin or something to reduce their bad
• 6:50
  Speaker 2: LDL cholesterol, that we should measure APO B, which is
• 6:55
  Speaker 2: a different lipoprotein, a different type of cholesterol that's not
• 6:57
  Speaker 2: typically measured in the screening tests, and that all adults
• 7:01
  Speaker 2: should have LP little a measured once. LP LITTLEA is
• 7:05
  Speaker 2: an interesting little type of cholesterol lipoprotein that clearly is
• 7:10
  Speaker 2: associated with heart disease risk over time. So people with
• 7:13
  Speaker 2: higher levels do have more heart disease over time. We
• 7:16
  Speaker 2: know that. However, it's mediated almost entirely genetically, so as
• 7:21
  Speaker 2: opposed to LDL, which has lifestyle dietary implications, LP little
• 7:25
  Speaker 2: A is like you get what you get, which is
• 7:27
  Speaker 2: why they're only recommending that you measure it once. And
• 7:31
  Speaker 2: actually the therapies to lower LP little A are still
• 7:34
  Speaker 2: are still in the sort of research phases, although I
• 7:36
  Speaker 2: think we'll see some commercialization soon. So yeah, get your
• 7:39
  Speaker 2: cholesterol lower.
• 7:40
  Speaker 1: I guess this kind of cutoff in medicine is something
• 7:44
  Speaker 1: economists like a lot because it suggests good opportunities for
• 7:49
  Speaker 1: figuring out how much different treatments matter, like in the
• 7:53
  Speaker 1: real world. So it's you say, you know the cutoff
• 7:56
  Speaker 1: is one hundred, then doctors treat people with one hundred
• 7:58
  Speaker 1: and one different from people with nine, even though it's
• 8:00
  Speaker 1: super super dominant. We can talk about why, but like
• 8:03
  Speaker 1: that is definitely how it happens. And so when you
• 8:06
  Speaker 1: move these cutoffs, it provides more interesting opportunities for identification.
• 8:10
  Speaker 1: So economists listening, you got like two years, and then
• 8:14
  Speaker 1: you can use these new cutoffs to do stuff exciting.
• 8:17
  Speaker 2: I love a good natural experiment, good natural experiment.
• 8:20
  Speaker 1: Also, I think my LDL is higher than one hundred,
• 8:22
  Speaker 1: so I'm I'm a bit concerned. But let's move on.
• 8:25
  Speaker 2: But I suspect you're not at borderline risk, which is
• 8:28
  Speaker 2: what the one hundred target is. It's one hundred and
• 8:29
  Speaker 2: sixty for people with low risk. Okay, great, yeah, but
• 8:32
  Speaker 2: you can ensue maybe who knows. I know there's family
• 8:34
  Speaker 2: history stuff in the risk score, so you can check
• 8:35
  Speaker 2: it out. All right, has there been a new album drop?
• 8:39
  Speaker 2: If so, be careful because a new study finds a
• 8:44
  Speaker 2: fifteen percent increase in traffic fatalities on the day of
• 8:48
  Speaker 2: a top ten streaming album release compared to the day
• 8:53
  Speaker 2: before or after. So the idea here being we're in
• 8:56
  Speaker 2: our car Taylor drops her new album and we're like
• 9:00
  Speaker 2: just we're rocking out, our eyes are closed, and traffic
• 9:04
  Speaker 2: fatalities go up quite a bit. I think you have
• 9:08
  Speaker 2: a connection to this paper.
• 9:09
  Speaker 1: Yeah. So the senior author on this paper is a
• 9:12
  Speaker 1: guy named Babu Jenna who is at Harvard, who is
• 9:15
  Speaker 1: perfect for the Wellness Actually podcast because Bapu is an
• 9:18
  Speaker 1: mdphd and his PhD is in economics. He was actually
• 9:21
  Speaker 1: my student at Chicago and there aren't very many people
• 9:24
  Speaker 1: with an mdphd in economics. It's an unusual combination of things.
• 9:28
  Speaker 1: But he writes a lot of very interesting papers that
• 9:31
  Speaker 1: have some similarities to this. So he has some papers
• 9:34
  Speaker 1: on how more people die of heart attacks during marathons,
• 9:37
  Speaker 1: not because they are running, but because you cannot get
• 9:40
  Speaker 1: to the hospital if you have a heart attack.
• 9:43
  Speaker 2: Oh, because there's the roads are all closed and stuff.
• 9:46
  Speaker 1: Yeah, marathons are deadly. Look it up. But in this case,
• 9:49
  Speaker 1: what they find is they use this nice identification strategy
• 9:52
  Speaker 1: around album releases, and they show that people are more
• 9:56
  Speaker 1: distracted and it's particularly men. Not that surprising, And I
• 10:01
  Speaker 1: would guess if I had to guess, and I didn't,
• 10:04
  Speaker 1: I don't think they have a lot of heterogeneity by
• 10:06
  Speaker 1: like what type of music it is. But I would guess,
• 10:09
  Speaker 1: like the Noah Kahan album, like people are not you know,
• 10:13
  Speaker 1: like driving going you're just like you're not going ninety
• 10:16
  Speaker 1: or just like cry maybe you're crying. So anyway, Oh
• 10:19
  Speaker 1: that's true.
• 10:19
  Speaker 2: Yeah, Okay, what I wonder you know, I did see
• 10:23
  Speaker 2: in the study that they adjusted for the day of
• 10:26
  Speaker 2: the week and and like the number of subscriptions to
• 10:30
  Speaker 2: the service and stuff. Over time, Like there's obviously confounders here,
• 10:32
  Speaker 2: But what I was kind of thinking is like how
• 10:35
  Speaker 2: sophisticated are record producers or distribution companies in terms of
• 10:40
  Speaker 2: picking that date? Like do they know? Like are they
• 10:44
  Speaker 2: going for a date that's gonna be that's important in
• 10:47
  Speaker 2: a way that we're not adjusting here for and I
• 10:48
  Speaker 2: don't know what it is, Like are they looking for
• 10:49
  Speaker 2: dates that are high literally high traffic? Like do they
• 10:53
  Speaker 2: want to release on dates when there are a lot
• 10:55
  Speaker 2: of people on the road just to get those get
• 10:56
  Speaker 2: those clicks, get those streams? Do not?
• 10:58
  Speaker 1: I think that that is stretching crewdu I mean, is
• 11:01
  Speaker 1: the right question to ask about identification? But I think
• 11:05
  Speaker 1: it is very unlikely that this that surely they are
• 11:10
  Speaker 1: choosing for some reason. But as long as that reason
• 11:12
  Speaker 1: is not about traffic fatalities, which seems less plausible than
• 11:16
  Speaker 1: this identification strategy, is fine, all right, And based on
• 11:21
  Speaker 1: the timing of choosing book releases, I would say it's
• 11:23
  Speaker 1: mostly random. Somebody in the office is like, I've thought
• 11:28
  Speaker 1: about it, and July fifteenth, it's like they're just like.
• 11:31
  Speaker 2: Yeah, all right. Whenever do you worry about kids listening
• 11:36
  Speaker 2: to music when they drive. My daughter is always listening
• 11:38
  Speaker 2: to music and does, like I do, worry that it's
• 11:40
  Speaker 2: one extra I would.
• 11:41
  Speaker 1: Prefer my children never drive, So I'm going to go
• 11:44
  Speaker 1: with I just don't. I don't like the idea of
• 11:47
  Speaker 1: children children driving. I haven't thought about the music part
• 11:51
  Speaker 1: of it, honestly, I'm still getting past the driving part.
• 11:56
  Speaker 1: That is it for the health news of the week. Now,
• 12:00
  Speaker 1: what's the deal with ticks?
• 12:02
  Speaker 2: What's the deal?
• 12:03
  Speaker 1: What's the deal?
• 12:04
  Speaker 2: What's going on?
• 12:05
  Speaker 1: Ticks? Ticks? Why are you here?
• 12:07
  Speaker 3: Oh?
• 12:07
  Speaker 1: Geez?
• 12:08
  Speaker 2: Okay, all right, I have to start with a corrections
• 12:15
  Speaker 2: buds per usually at the at the end of last
• 12:20
  Speaker 2: week's episode, when we said this week is what's the
• 12:22
  Speaker 2: deal with ticks? I think I made a comment like
• 12:25
  Speaker 2: those those bugs, I call them bugs, and you know,
• 12:29
  Speaker 2: the entomololi just get really upset when you call an
• 12:31
  Speaker 2: animal a bug that's not a bug, even like insects,
• 12:35
  Speaker 2: Like there's some insects which are bugs, but not all
• 12:38
  Speaker 2: insects are bugs.
• 12:40
  Speaker 1: Okay, it's like a square and a rectangle.
• 12:42
  Speaker 2: Yeah, but like bug, I thought that bug was a
• 12:44
  Speaker 2: colloquial term for a creepy crawley thing. But there's also
• 12:47
  Speaker 2: like an entomological term for this is not ticks aren't bugs.
• 12:52
  Speaker 2: They're not even insects. They're not even insects. They are
• 12:55
  Speaker 2: a racknids. They're more closely related to spiders than they
• 12:59
  Speaker 2: are to mosquitoes or other blood suckers. That's interesting.
• 13:04
  Speaker 1: That is interesting. Are they so? And also like related
• 13:07
  Speaker 1: to mites, yes, different kinds of mites.
• 13:09
  Speaker 2: Yeah, other iracnid racknin type stuff.
• 13:12
  Speaker 1: Yep, I'm already I don't like I don't like bugs.
• 13:16
  Speaker 1: I guess in this case, that's fine because this isn't
• 13:18
  Speaker 1: about bugs, as previously noted.
• 13:21
  Speaker 2: That crawl on you.
• 13:22
  Speaker 1: They crawl on you.
• 13:24
  Speaker 2: No, agreed, No, this is this is a creepy episode.
• 13:26
  Speaker 1: As we said, all right, so ticks eat blood. They
• 13:30
  Speaker 1: need blood in order to move forward with their life cycle.
• 13:35
  Speaker 1: And when they get on you, they get on and
• 13:38
  Speaker 1: they feed in your blood and they get enormous. They
• 13:41
  Speaker 1: can go like up six hundred times their weight while
• 13:45
  Speaker 1: they suck your juices.
• 13:47
  Speaker 2: It's super gross. I've never had a tick on me
• 13:50
  Speaker 2: that got that big, but I have had like a
• 13:51
  Speaker 2: tick on a dog that is just just gigantic.
• 13:54
  Speaker 1: And yeah, okay, we.
• 13:59
  Speaker 2: Have to stop. We have to take a break already
• 14:01
  Speaker 2: have made it this far.
• 14:03
  Speaker 1: Okay, But it turns out that the stage of the
• 14:06
  Speaker 1: tick that matters the most is the nymph. They're very,
• 14:09
  Speaker 1: very very small, which is which is why they are
• 14:12
  Speaker 1: the most dangerous, because that is the thing that you
• 14:14
  Speaker 1: would not see or it's very hard to see. It
• 14:17
  Speaker 1: looks like a little tiny poppy seed.
• 14:19
  Speaker 2: Yeah, dear tech nymph in particular, which are you know,
• 14:22
  Speaker 2: the main vectors for lime disease, which is which is
• 14:25
  Speaker 2: the big the big one when it comes to tick
• 14:27
  Speaker 2: born diseases, but by no means the only one. And
• 14:30
  Speaker 2: you mentioned that blood meals are necessary to advance in
• 14:32
  Speaker 2: the stage of the life cycle, and like not just
• 14:34
  Speaker 2: the way that well, everyone has to eat to grow bigger,
• 14:37
  Speaker 2: but ticks go from you know, larva to nymph to
• 14:41
  Speaker 2: I think one more stage and then adult, and each
• 14:43
  Speaker 2: of those things needs a blood meal to like unlock
• 14:46
  Speaker 2: the genetic machinery. So they literally level up every time
• 14:50
  Speaker 2: they feed off of someone. And yeah, if you don't
• 14:53
  Speaker 2: get them off, they feed until they get gigantic and
• 14:55
  Speaker 2: then they just fall off on the ground and then
• 14:57
  Speaker 2: go through their next little molting life SiGe and wait
• 15:01
  Speaker 2: for the next blood meal to come by.
• 15:03
  Speaker 1: So for lime disease, which we are going to get to,
• 15:06
  Speaker 1: but we're actually gonna there's a lot to talk about.
• 15:08
  Speaker 1: So we're going gonna start the episode by talking about
• 15:11
  Speaker 1: things that are not lime disease, and then we're gonna
• 15:13
  Speaker 1: get to lime. But for lime, the one thing I
• 15:16
  Speaker 1: will say now is that the tick has to stay
• 15:17
  Speaker 1: attached for something like thirty six to forty eight hours.
• 15:20
  Speaker 1: You actually have quite a long time to remove the
• 15:22
  Speaker 1: tick in lime disease before it would cause disease. Is
• 15:27
  Speaker 1: not going to be true for for every everything else.
• 15:30
  Speaker 1: So we're gonna get to line, but we're gonna start
• 15:32
  Speaker 1: with generally what can happen. Ticks so responsible for many diseases,
• 15:37
  Speaker 1: and they kind of work in three different ways. So
• 15:39
  Speaker 1: I thought, rather than talking about the entire list, we'll
• 15:42
  Speaker 1: say for listeners. Perry had a like spreadsheet and had
• 15:44
  Speaker 1: like forty five rows, and I thought he was gonna
• 15:46
  Speaker 1: we were gonna go through every tick disease, Tick disease
• 15:49
  Speaker 1: number thirty sevens like this episode would be boring, and
• 15:52
  Speaker 1: so instead we're gonna we're gonna focus a little bit
• 15:54
  Speaker 1: on the sort of three ways that the tick can
• 15:57
  Speaker 1: actually impact you your health, impact your health.
• 16:01
  Speaker 2: Yeah, yes, yeah, so I think. I mean, honestly, the
• 16:05
  Speaker 2: tick born diseases are super fascinating. But yes, three big ways.
• 16:10
  Speaker 2: The first thing that a tick can do to make
• 16:12
  Speaker 2: you sick is it can infect you with something, be
• 16:15
  Speaker 2: it virus, bacteria, et cetera. And we'll obviously talk about
• 16:19
  Speaker 2: a sampling of those, but just so you know, there
• 16:21
  Speaker 2: are many more, and we'll miss, uh, we'll miss quite
• 16:24
  Speaker 2: a few of them in the interest of time. The
• 16:26
  Speaker 2: second thing a tick can do is poison you. So
• 16:30
  Speaker 2: we'll talk about some ticks that have substances in their saliva,
• 16:35
  Speaker 2: so non infectious, but nevertheless chemical substances that can have
• 16:39
  Speaker 2: really devastating effects on humans. And the third thing is
• 16:44
  Speaker 2: that they can rewire your immune system. And there is
• 16:49
  Speaker 2: a few themes that have come up in the Wellness
• 16:51
  Speaker 2: Actually podcast when it comes to allergy and immunology, and
• 16:54
  Speaker 2: one of them is this understanding that when you deliver
• 16:59
  Speaker 2: something into your body not through the normal way, like
• 17:02
  Speaker 2: not by eating it, you can get allergic to the
• 17:06
  Speaker 2: substance in a way that you wouldn't get if you
• 17:08
  Speaker 2: ate it. And because ticks are injecting stuff, basically directly
• 17:12
  Speaker 2: into your bloodstream. It opens up the door to all
• 17:14
  Speaker 2: sorts of really interesting allergies. So I think if we
• 17:16
  Speaker 2: hit some representative sampling there before we get to all
• 17:19
  Speaker 2: the lime disease stuff, that would be great.
• 17:20
  Speaker 1: Okay, So we're gonna start with the infection one because
• 17:23
  Speaker 1: it has is actually both the way the lime works
• 17:26
  Speaker 1: and also the way that what I think is by
• 17:29
  Speaker 1: far the scariest tick disease works. So the scariest tick
• 17:35
  Speaker 1: disease I think is poasen. Is that how you saying it?
• 17:39
  Speaker 2: Poson polawson? Yeah, pos and virus, the.
• 17:42
  Speaker 1: Posts and virus, and the post and virus is spread
• 17:45
  Speaker 1: by the same tick as lime disease. It is the
• 17:49
  Speaker 1: black leg deer tick. And this is the thing. There
• 17:53
  Speaker 1: are two really really scary aspects of this. So one
• 17:58
  Speaker 1: is that it can happen very fat. So lime disease
• 18:01
  Speaker 1: needs a very long time this virus for the tick
• 18:04
  Speaker 1: the chick to be attached. And this virus needs fifteen minutes. Yeah,
• 18:08
  Speaker 1: and it is very possible for you to miss I mean,
• 18:11
  Speaker 1: it's very possible to miss a tick for two days.
• 18:13
  Speaker 1: It's really possible to miss it tick for fifteen minutes.
• 18:16
  Speaker 2: One hundred percent. If you see a deer tick on
• 18:19
  Speaker 2: you and it has bitten, like it's not crawling, but
• 18:22
  Speaker 2: it's in and you have to pull it off, and
• 18:25
  Speaker 2: in theory it could have transmitted poots and virus.
• 18:29
  Speaker 1: And the pous and virus is very scary.
• 18:31
  Speaker 2: It's very scary. So all right, if you if you
• 18:33
  Speaker 2: look this up, what you'll find it's that POAs and
• 18:36
  Speaker 2: virus is a virus with no treatment and a ten
• 18:37
  Speaker 2: percent case fatality rate, which is like, oh, so I
• 18:42
  Speaker 2: can walk through the woods of Connecticut where a deer
• 18:44
  Speaker 2: tick abound, and I can have a tick on me
• 18:46
  Speaker 2: for fifteen minutes and then I have a ten percent
• 18:48
  Speaker 2: death rate. This is not entirely true, but the broad
• 18:53
  Speaker 2: strokes and the way the data we have will lead
• 18:57
  Speaker 2: to some people saying these things. So, so what the
• 18:59
  Speaker 2: virus does in most people is nothing. Now, that's not
• 19:04
  Speaker 2: what you'll see when you google. What you'll see when
• 19:06
  Speaker 2: you Google is that polas and virus causes meningitis. So
• 19:08
  Speaker 2: it's a brain inflammatory virus. And indeed, if you develop
• 19:13
  Speaker 2: meningitis from polos and virus, you're going to go to
• 19:17
  Speaker 2: the hospital. You're going to be very sick. It's a virus,
• 19:20
  Speaker 2: so antibiotics don't work. You're going to get supportive care
• 19:24
  Speaker 2: ivy fluids and pain control and fingers crossed. And the
• 19:28
  Speaker 2: case fatality rate is about ten percent, So that's super scary.
• 19:33
  Speaker 2: But most people don't ever get symptoms from it.
• 19:36
  Speaker 1: Yeah, And I think we sort of have to know
• 19:40
  Speaker 1: that that has to be true just based on the
• 19:43
  Speaker 1: base rate. You know, there are many, many, many cases
• 19:47
  Speaker 1: of lime every year spread by the same tick. There
• 19:50
  Speaker 1: are very small number of cases of this, so so
• 19:53
  Speaker 1: far in twenty twenty six there have been thirty. Last
• 19:56
  Speaker 1: year there were seventy six. That's a very small number.
• 19:58
  Speaker 1: Of the US is three hundred and thirty million people.
• 20:00
  Speaker 1: The Northeast has many, many, many tens of millions of people.
• 20:03
  Speaker 1: This is a very small number. And there is some
• 20:08
  Speaker 1: sero prevalence work, which means like testing people to see
• 20:10
  Speaker 1: if there's evidence that they've been exposed to this with
• 20:12
  Speaker 1: suggest much higher rates of exposure, so.
• 20:15
  Speaker 2: Have an antibody to the virus, but you never were sick.
• 20:18
  Speaker 1: Yeah, So one way to think about this is conditional
• 20:21
  Speaker 1: on arriving at the hospital very sick. With this, the
• 20:24
  Speaker 1: fatality rate is quite high. The vast majority of people
• 20:27
  Speaker 1: who get this do not actually develop this virus. So
• 20:31
  Speaker 1: it's not that it's not scary, like it is. This
• 20:34
  Speaker 1: is very scary. It's very scary, but there are many
• 20:38
  Speaker 1: other things that are scarier in the world. Yeah.
• 20:41
  Speaker 2: Yeah, If insofar as this motivates you to like do
• 20:43
  Speaker 2: the anti tick measures, we'll talk about some of the
• 20:46
  Speaker 2: things you can do to prevent getting tick bites, then great.
• 20:49
  Speaker 2: But yeah, don't let keep you up at night.
• 20:51
  Speaker 1: I mean I do if you think, like things like
• 20:52
  Speaker 1: this are very salient to people. When you say, you know,
• 20:55
  Speaker 1: there's a thing that could happen, you get bit by
• 20:57
  Speaker 1: a tick and you could, you know, have a ten
• 20:59
  Speaker 1: percent fatality, that is really scary, and then that lives
• 21:02
  Speaker 1: in your head because people are very poor at understanding
• 21:06
  Speaker 1: small probabilities. The fact that it's seventy six out of
• 21:09
  Speaker 1: you know, seventy five million people, it just feels like, well,
• 21:13
  Speaker 1: it could it could be a chance, it could have
• 21:15
  Speaker 1: could happen. It's like the lottery. It's worth putting it
• 21:19
  Speaker 1: in the space of you know, you are an awful
• 21:20
  Speaker 1: lot more likely to die in a car in your
• 21:23
  Speaker 1: car on the way to the woods than you are
• 21:26
  Speaker 1: to die of a tick that you get in the woods.
• 21:28
  Speaker 1: I'm not saying you should be afraid of going hiking,
• 21:31
  Speaker 1: but like, in the space of risks you're taking, this
• 21:34
  Speaker 1: is very small.
• 21:36
  Speaker 2: The health benefits of going on that hike probably outweigh
• 21:38
  Speaker 2: any risk.
• 21:39
  Speaker 1: Yes, if you did this sort of minute calculation, you're
• 21:42
  Speaker 1: you're on a good path.
• 21:45
  Speaker 2: Absolutely, absolutely, Okay.
• 21:49
  Speaker 1: Yeah, So the second way, so that's tick infections, and
• 21:53
  Speaker 1: there are other diseases that that can be spread by
• 21:57
  Speaker 1: ticks in this same way. Yeah, what's your favorite other infection?
• 22:01
  Speaker 2: I know, No, I mean there's so many interesting tickborne diseases,
• 22:09
  Speaker 2: and I feel like people have their favorites, and someone's
• 22:11
  Speaker 2: gonna be like, you didn't mention rocking mountains about a fever.
• 22:13
  Speaker 2: You didn't mention it antaplasmosis. I think bibeziosis to me
• 22:19
  Speaker 2: because we see this in the hospital not infrequently, and
• 22:22
  Speaker 2: it is the closest thing to malaria that we have
• 22:26
  Speaker 2: in the United States. So bibeziosis is bacterial infection that
• 22:32
  Speaker 2: gets a parasite that gets inside red blood cells. So
• 22:36
  Speaker 2: just like the malaria parasite. I mean, it's not the same,
• 22:39
  Speaker 2: it's a different parasite, but that's its mechanism. It gets
• 22:41
  Speaker 2: in these red blood cells and people come in with
• 22:42
  Speaker 2: severe anemia and actually like very similar symptoms that malaria
• 22:47
  Speaker 2: presents with. So you sort of learn about malaria and
• 22:50
  Speaker 2: medical school because malaria is the biggest killer of humans,
• 22:53
  Speaker 2: infectious these color of humans in the world. And then
• 22:56
  Speaker 2: you know, you come here to Connecticut and you see
• 22:59
  Speaker 2: people coming in with the same symptoms and it'll be bibziosis.
• 23:03
  Speaker 1: There are about one hundred to five hundred cases of
• 23:06
  Speaker 1: this your favorite every year. Okay, great, all right, great
• 23:10
  Speaker 1: for you, But I'm just telling people that's not very
• 23:12
  Speaker 1: very common.
• 23:13
  Speaker 2: Yeah, there is selection bias here too, because a lot
• 23:14
  Speaker 2: of people at thebeziosis will have some kidney dysfunctions, so
• 23:17
  Speaker 2: they call people like me.
• 23:19
  Speaker 1: Okay. So the second thing that ticks can do is
• 23:22
  Speaker 1: they can poison you. And the best poison tick disease
• 23:28
  Speaker 1: is tick paralysis. Yeah, it's the best one because it's
• 23:32
  Speaker 1: super interesting. It's a neurotoxin in the saliva of some
• 23:37
  Speaker 1: kinds of ticks and it causes paralysis.
• 23:42
  Speaker 2: And it causes a very particular type of paralysis. So
• 23:47
  Speaker 2: what it is is it's a flaccid paralysis. So a
• 23:50
  Speaker 2: weakness as opposed to spasticity. So there's kind of two
• 23:53
  Speaker 2: types of paralysis, a weak paralysis that goes from your
• 23:56
  Speaker 2: legs and goes up your body. And if you're a
• 23:59
  Speaker 2: doctor listening to this and you saw a patient that
• 24:01
  Speaker 2: had that pattern of paralysis, you would be like, that's
• 24:03
  Speaker 2: Giambre syndrome because it looks exactly the same.
• 24:07
  Speaker 1: But actually it's ticks. And if you remove the tick,
• 24:11
  Speaker 1: the paralysis goes away.
• 24:13
  Speaker 2: Which is awesome, Which is awesome.
• 24:15
  Speaker 1: And there is an episode of House in which this happens. Yes,
• 24:19
  Speaker 1: there's an episode of House in which there is a person,
• 24:22
  Speaker 1: a teenage girl, and this is what House thinks is happening.
• 24:28
  Speaker 1: And everyone says that he's an idiot because they can't
• 24:31
  Speaker 1: find a tick and they look for a tick and
• 24:33
  Speaker 1: blah blah blah. But then it turns out that her
• 24:35
  Speaker 1: boyfriend had snuck in and he had picked up a
• 24:39
  Speaker 1: tick and they had had sex, and actually the tick
• 24:41
  Speaker 1: was in her vagina and that was what House identified.
• 24:44
  Speaker 1: So for me, this is like suck in my I
• 24:47
  Speaker 1: don't know, I really liked that show. Oh no, I
• 24:50
  Speaker 1: like the show too, And so then the things and
• 24:53
  Speaker 1: that was an episode that suck with me. And also
• 24:54
  Speaker 1: the fact that they always thought it was Wilson's disease,
• 24:56
  Speaker 1: Like every single time it was Wilson's disease.
• 24:58
  Speaker 2: Oh that's funny.
• 24:59
  Speaker 1: It's like not a lot of people. Well anyway, that's
• 25:00
  Speaker 1: a different topic.
• 25:01
  Speaker 2: Yeah, Wilson's is a disease of no relationsition copper metabolism
• 25:05
  Speaker 2: the cause of liver failure. So it is worth it
• 25:10
  Speaker 2: to know for clinicians that if someone presents with Giambret syndrome,
• 25:13
  Speaker 2: that you should do a tick check. Generally we advise
• 25:17
  Speaker 2: looking at the scalp.
• 25:19
  Speaker 1: But I suppose that's why House is a genius.
• 25:22
  Speaker 2: You should do a thing.
• 25:22
  Speaker 1: He doesn't just do the first thing.
• 25:24
  Speaker 2: You should do a thorough tck check if you have
• 25:26
  Speaker 2: a patient with giambre syndrome. But it is cool. The
• 25:28
  Speaker 2: prolyssis goes away within hours of removing the tick, So
• 25:31
  Speaker 2: miracle stuff.
• 25:32
  Speaker 1: All right. Third thing is that the tick can rewire
• 25:37
  Speaker 1: your immune system in this crazy way. And this is
• 25:41
  Speaker 1: the one actually everyone has been talking about. Yeah, or
• 25:45
  Speaker 1: at least one of the diseases that's caused, and this
• 25:47
  Speaker 1: caused by this mechanism, which is alpha gal. Alpha gal
• 25:52
  Speaker 1: has been the talk of Nantucket this summer because one
• 25:58
  Speaker 1: of the things that happens, the thing that happens with
• 26:01
  Speaker 1: this is that you cannot tolerate meat. Yeah, and there's
• 26:07
  Speaker 1: been some discussion, which I think is totally overblown that
• 26:10
  Speaker 1: like the stores on Nantucket have stopped stocking Hamburgers because
• 26:15
  Speaker 1: too many people have alpha, which I don't think is true.
• 26:19
  Speaker 1: But but this is.
• 26:21
  Speaker 2: Like, it's probably the ozempic.
• 26:24
  Speaker 1: I will guess it's but let's, you know, move on,
• 26:29
  Speaker 1: so what like it's but it's totally weird.
• 26:31
  Speaker 2: Oh, it's it's it's it's super fascinating. And I alluded
• 26:34
  Speaker 2: to this earlier that allergies tend to develop when you
• 26:38
  Speaker 2: get exposed to a potential allergen, not through your GI tract,
• 26:41
  Speaker 2: like through some other way. So what alpha gal is
• 26:46
  Speaker 2: is I guess we need to know is that every species,
• 26:49
  Speaker 2: every mammalian species, on the surface of their cells has
• 26:53
  Speaker 2: a sugar called galactose alpha one three galactose except the
• 26:59
  Speaker 2: Old World apes, the Old World primates like us and
• 27:03
  Speaker 2: chimpanzees and gorillas, So we lost that in our evolutionary history.
• 27:06
  Speaker 2: We like the gene to make that sugar just went wait,
• 27:09
  Speaker 2: we do not make it anymore. I don't think it
• 27:11
  Speaker 2: causes us a particular problem.
• 27:12
  Speaker 1: I don't know.
• 27:12
  Speaker 2: That's evolution for you all other mammals except us in
• 27:15
  Speaker 2: the chimpanzees and the gorillas. Okay, so we don't see
• 27:18
  Speaker 2: that protein that sugar in our body, but we eat
• 27:21
  Speaker 2: meat and as long as it goes through our GI tract,
• 27:23
  Speaker 2: that's fine. This tick, and in this case it's the
• 27:27
  Speaker 2: lone star tick primarily in its saliva has galactose alpha
• 27:31
  Speaker 2: one three galactose for other reasons, presumably obviously it's not mammalian,
• 27:35
  Speaker 2: but it injects that into you, and in theory, because
• 27:39
  Speaker 2: it's going in through your skin and not through your
• 27:41
  Speaker 2: GI tract, you can develop analogy to it. What is
• 27:44
  Speaker 2: a little unusual about this allergy is it's not usually
• 27:47
  Speaker 2: full blown anaphylaxis, where like you, I don't know, you
• 27:50
  Speaker 2: have a bite of hamburger and two minutes later you're
• 27:52
  Speaker 2: on the floor. It's usually a hours after, so probably
• 27:58
  Speaker 2: something you probably have to digest, Some stuff got to
• 28:00
  Speaker 2: get into your system for things to happen. And usually
• 28:02
  Speaker 2: the presenting symptoms are GI in nature, like pain, bloating, diarrhea,
• 28:08
  Speaker 2: sometimes vomiting, and because of that time between when you
• 28:12
  Speaker 2: ate and when you got sick is so long it's
• 28:14
  Speaker 2: like not immediately obvious to people that it is analergy.
• 28:18
  Speaker 2: There can be allergic symptoms as well, so it's a
• 28:22
  Speaker 2: really interesting bit of physiology that like we're really only
• 28:25
  Speaker 2: just starting to understand.
• 28:27
  Speaker 1: It is also a place where testing has revealed that
• 28:32
  Speaker 1: a lot of people seem to have been exposed in
• 28:35
  Speaker 1: this way. So they're like, Sarah, there's a test for this.
• 28:38
  Speaker 1: You can test for the serum alpha gal antibody antibody,
• 28:43
  Speaker 1: and when you do that in some sort of places
• 28:46
  Speaker 1: with a lot of chicks, you get actually quite high rates.
• 28:49
  Speaker 1: So somebody did a residual blood donor sample and the
• 28:51
  Speaker 1: seral prevalence was like twenty four percent. Wow. And of
• 28:54
  Speaker 1: course twenty four percent of people in you know, Arkansas, Kentucky, Missouri,
• 28:58
  Speaker 1: and Tennessee are not allergic to.
• 29:00
  Speaker 2: To be devastating to the local economy.
• 29:03
  Speaker 1: And so so you know, and we're seeing like five
• 29:06
  Speaker 1: hundred cases a year diagnosed of this. So I think
• 29:09
  Speaker 1: it's it's one of these places where obviously people have
• 29:12
  Speaker 1: this without actually having having symptoms, and it does go
• 29:17
  Speaker 1: away for most people over time.
• 29:18
  Speaker 2: That's right, that's right. If you if you avoid further
• 29:22
  Speaker 2: tick bites, the symptoms get better. But for some people
• 29:24
  Speaker 2: they can really never eat meet again. And the immune
• 29:27
  Speaker 2: system is an incredibly complex thing, and an antibody tighter
• 29:30
  Speaker 2: is not the same as, you know, a full blown
• 29:32
  Speaker 2: immune reaction, so it can be it can be hard
• 29:34
  Speaker 2: to tease out.
• 29:34
  Speaker 1: But yeah, you know, stay away from those loans to
• 29:37
  Speaker 1: start to so interesting.
• 29:40
  Speaker 2: It is it is.
• 29:43
  Speaker 1: The body is very cool, absolutely, all right. So those
• 29:46
  Speaker 1: are your three big tick approaches. And we're very sorry
• 29:50
  Speaker 1: to the entomologists listeners that we have not covered Perry's
• 29:53
  Speaker 1: spreadsheet of ticks tickborn diseases. But we're going to take
• 29:57
  Speaker 1: a break and when we come back, we're going to
• 29:59
  Speaker 1: talk about line disease. All right, We're back, and we're
• 30:07
  Speaker 1: going to talk about lime, which is the most common
• 30:09
  Speaker 1: tick born disease in the US. It's actually not clear
• 30:14
  Speaker 1: how many cases there are in the year in a
• 30:16
  Speaker 1: given year, but it's in the hundreds of thousands we
• 30:19
  Speaker 1: we think. And lime disease really begins with some moms
• 30:28
  Speaker 1: in Old Lime, Connecticut, who had identified they all had
• 30:33
  Speaker 1: children who had been diagnosed with juvenile arthritism, trid arthritis,
• 30:37
  Speaker 1: which is basically joint like joint pain. And they just
• 30:41
  Speaker 1: felt that was not could not really it didn't seem right.
• 30:45
  Speaker 1: It's not very common. That isn't typically a cluster disease.
• 30:48
  Speaker 2: When why do all these kids have it?
• 30:50
  Speaker 1: And they pushed and pushed and pushed, and eventually a
• 30:53
  Speaker 1: researcher at Yale sort of took them seriously, worked this
• 30:57
  Speaker 1: up and identified a bacteria which was is spread by
• 31:00
  Speaker 1: ticks that was causing this set of symptoms and conditions.
• 31:06
  Speaker 1: And I actually think this story and we can talk
• 31:10
  Speaker 1: much more about the microbiology, but just from a kind
• 31:13
  Speaker 1: of sociological standpoint, this story is the beginning of lime disease.
• 31:19
  Speaker 1: And it's also like the middle and the end because
• 31:23
  Speaker 1: so much of what happens in the discussion of lime disease,
• 31:26
  Speaker 1: particularly around chronic lime, feels like patients feel like they're
• 31:31
  Speaker 1: not being listened to doctors totally by doctors, And this
• 31:35
  Speaker 1: is like it sort of started.
• 31:36
  Speaker 2: It started that way.
• 31:37
  Speaker 1: It started that way. It's DNA and so so that's
• 31:41
  Speaker 1: that's where that's where the start. And this all happened
• 31:43
  Speaker 1: in like the mid mid nineteen seventies early nineteen eighties.
• 31:45
  Speaker 2: Yeah, it was Willy Burgdorfer who actually identified the bacteria.
• 31:50
  Speaker 2: It's called the spier key. It's kind of a spirally
• 31:52
  Speaker 2: shaped bacteria. It's named after him, Brellia burgdor For I
• 31:56
  Speaker 2: we'll hear more about Willie Bergdorfer when we talked about
• 31:59
  Speaker 2: some of the interesting lime disease conspiracy theories that that
• 32:03
  Speaker 2: are out there. But before we get to that, we
• 32:06
  Speaker 2: should just talk about, like what LI disease?
• 32:08
  Speaker 1: What is it?
• 32:09
  Speaker 2: What I think people people probably know? But okay, so
• 32:12
  Speaker 2: we've got this bacteria that lives in a tick. The
• 32:15
  Speaker 2: vector is typically the deer tick. It can be carried
• 32:18
  Speaker 2: by some other ticks. And as you pointed out, the
• 32:20
  Speaker 2: nymph stages where we see most of the transmission, not
• 32:22
  Speaker 2: because it's uniquely infected, but because it's so tiny, poppy
• 32:26
  Speaker 2: seed size, little black thing, super easy and miss, especially
• 32:30
  Speaker 2: in the hair. As you said, it takes a while
• 32:33
  Speaker 2: for it to transmit. That's actually because the tick has
• 32:36
  Speaker 2: to start feeding and process and it actually inject it
• 32:40
  Speaker 2: like metabolizes some of your blood and it puts it
• 32:43
  Speaker 2: back in you. And that's how that takes some time,
• 32:45
  Speaker 2: and it and and that's how we're getting creepy again,
• 32:49
  Speaker 2: but that's actually how the spier keat gets into you.
• 32:52
  Speaker 2: And the entomologists will go out and like take samples
• 32:55
  Speaker 2: of deer ticks and look and just measure the ticks,
• 32:57
  Speaker 2: and about twenty five to fifty percent of them are
• 33:01
  Speaker 2: lime disease positive. So it's like, if you have a
• 33:03
  Speaker 2: deer tick, the chances are it's got lime disease in it,
• 33:06
  Speaker 2: or at least the chances are very good it's got
• 33:07
  Speaker 2: lime disease in it. Clinically, the standard way to define
• 33:14
  Speaker 2: lime disease is we say early or localized lime disease,
• 33:18
  Speaker 2: and then late or disseminated lime disease. And if you
• 33:22
  Speaker 2: see me using air quotes or trying to hedge my
• 33:24
  Speaker 2: bets with the tone of my voice, that's because various
• 33:27
  Speaker 2: other societies have created different staging systems, so this is
• 33:31
  Speaker 2: the most common one. Early localized disease is the rash.
• 33:35
  Speaker 2: It's known as air thema migrants classic target shaped rash
• 33:39
  Speaker 2: looks like a bullseye, looks like a bullseye, correct, and
• 33:43
  Speaker 2: it can be you know, you'll see pictures online that's like, oh,
• 33:46
  Speaker 2: it's clearly a bulls eye. But my daughter had lime disease.
• 33:50
  Speaker 2: I took a picture of like a vague ring shaped
• 33:54
  Speaker 2: thing on her back. I was like, I think this
• 33:57
  Speaker 2: is air thema migrants and I sent it to Repediatrey
• 34:00
  Speaker 2: and they were like, nah, it looks it doesn't really
• 34:02
  Speaker 2: look like that, like it's too faint or whatever. It
• 34:04
  Speaker 2: like wasn't. Yeah, she had limezse so okay. Also in
• 34:08
  Speaker 2: that early period, you can get those flu like cold
• 34:11
  Speaker 2: like symptoms, fatigue, headache and stuff like that, and ideally
• 34:14
  Speaker 2: you want to treat at that point in time. You
• 34:17
  Speaker 2: don't want to let it get to disseminated lime disease.
• 34:20
  Speaker 2: That's where you can get a lot of other symptoms.
• 34:22
  Speaker 2: Now it's spread throughout your body and so you can
• 34:24
  Speaker 2: see symptoms and other organ systems, classically joints. My daughter,
• 34:28
  Speaker 2: because she wasn't treated at the early stage, had a
• 34:30
  Speaker 2: big like joint effusion in her knee. That's how she
• 34:33
  Speaker 2: ended up getting diagnosed. But you can have cardiac abnormalities.
• 34:37
  Speaker 2: Facial palsy is actually fairly common. You know, it can
• 34:41
  Speaker 2: look almost like you have a stroke or something like
• 34:43
  Speaker 2: that with UH because there's some nerve stuff there. This
• 34:46
  Speaker 2: all gets better with treatment. And I will say explicitly
• 34:50
  Speaker 2: you can have lime disease without the rash. So seventy
• 34:52
  Speaker 2: to eighty percent of lime disease cases will have arithema migrants,
• 34:56
  Speaker 2: but not every single one, so you do have to
• 34:59
  Speaker 2: be suspicious.
• 35:01
  Speaker 1: So part of what is complicated here is of course,
• 35:04
  Speaker 1: for some set of people, like let divide a little
• 35:07
  Speaker 1: bit into kind of like the best almost like the
• 35:09
  Speaker 1: best case scenario here, which is you have an identified
• 35:14
  Speaker 1: tick bite, there is a bullseye shaped rash that you
• 35:17
  Speaker 1: notice immediately, and then there is a very clear treatment.
• 35:22
  Speaker 1: There's no testing. We assume that you have lime disease,
• 35:24
  Speaker 1: that you take a dose of doxie cyclin and that
• 35:29
  Speaker 1: fixes the problem. Doxie cyclines and antibatic. It treats deals
• 35:33
  Speaker 1: with the bacteria, and we're and we're good.
• 35:36
  Speaker 2: Yeah, several doses of doctor, several doses.
• 35:38
  Speaker 1: It's like it's yeah, don't just like take one.
• 35:41
  Speaker 2: Well, I mentioned that because there are there are pediatricians
• 35:44
  Speaker 2: who will recommend a prophylactic doxie cycling dose with any
• 35:47
  Speaker 2: tick bite, Like no ration, you got a tick bite,
• 35:50
  Speaker 2: just like take a doxy cyclin. There's not good randomized
• 35:52
  Speaker 2: trial ev it's to support that. So just you might
• 35:55
  Speaker 2: hear it, But that's there is.
• 35:58
  Speaker 1: There is a more complicated question about if your child
• 36:01
  Speaker 1: has been exposed to a tick, should you take the
• 36:03
  Speaker 1: full dose of doxi cyclin as if you have been
• 36:05
  Speaker 1: And there's also some debate.
• 36:09
  Speaker 2: Of antibiotics.
• 36:11
  Speaker 1: So okay, So that's like the sort of I know
• 36:13
  Speaker 1: what's happening. I've fixed the problem in the short term. Fine.
• 36:17
  Speaker 1: It is much more complicated if you have gotten to
• 36:21
  Speaker 1: this later potential phase, particularly if you're not sure it
• 36:28
  Speaker 1: was a tick. So think about the case in which
• 36:30
  Speaker 1: someone's bitten by a tick, the tick is on for
• 36:32
  Speaker 1: a long time, the tick falls off, they don't notice,
• 36:35
  Speaker 1: they never get a rash, and then all of a
• 36:36
  Speaker 1: sudden they have a series of complicated symptoms polsy, nerve pain,
• 36:41
  Speaker 1: disseminated rashes. There's a lot of difference. That's a hard
• 36:46
  Speaker 1: that's a hard diagnostic problem. And the testing here is
• 36:50
  Speaker 1: actually not it's not a single test that for shore
• 36:54
  Speaker 1: tells you what is going on.
• 36:55
  Speaker 2: Yeah, so testing for lime disease, and we're gonna get
• 36:58
  Speaker 2: to this a little bit when we talk about chronic
• 37:01
  Speaker 2: lime disease. So let's carve that out for a minute.
• 37:04
  Speaker 2: Testing relies typically on looking for antibodies against the lime
• 37:10
  Speaker 2: spier key against the bacteria. The FDA and the CDC
• 37:15
  Speaker 2: recommend a two tiered testing system, so they have you
• 37:18
  Speaker 2: do an initial test that is fairly sensitive, so it's
• 37:22
  Speaker 2: going to look like really it'll pick up kind of anything,
• 37:25
  Speaker 2: so a high false positive rate but also a high
• 37:27
  Speaker 2: true positive rate an initial test. If that's positive, then
• 37:30
  Speaker 2: you move on to a secondary test that's more specific,
• 37:32
  Speaker 2: and there's a couple of different approved tests for that,
• 37:35
  Speaker 2: and putting those two things together in an approved laboratory
• 37:40
  Speaker 2: gets you a pretty high ability to detect, but not
• 37:45
  Speaker 2: perfect to detect the disease. I think it's something like,
• 37:48
  Speaker 2: you know, you would detect eighty percent of them, eighty
• 37:51
  Speaker 2: percent of positive infections, and you'd have a false positive
• 37:54
  Speaker 2: rate of like ten percent or so, so it's not terrible,
• 37:56
  Speaker 2: not perfect. What the problem is that they're is an
• 38:01
  Speaker 2: entire ecosystem of unlicensed testing for lime disease and labs
• 38:06
  Speaker 2: that use different thresholds for these antibody levels, which can
• 38:10
  Speaker 2: give rise to false positive rates north of fifty percent.
• 38:14
  Speaker 2: We'll talk about why this ecosystem exists. You mentioned at
• 38:17
  Speaker 2: the beginning that the story of lime is really a
• 38:20
  Speaker 2: story about doctors and patients not seeing eye to eye
• 38:23
  Speaker 2: and a lot of doctors not listening to their patients.
• 38:26
  Speaker 2: And whenever that happens, people come in to fill that void,
• 38:30
  Speaker 2: and some are very well intentioned and some are not
• 38:32
  Speaker 2: so well intentioned. So we'll get there. Testing's not perfect,
• 38:35
  Speaker 2: but not bad.
• 38:37
  Speaker 1: It can miss early on. I mean, antibody tests can
• 38:40
  Speaker 1: miss early on. They can also pick up in like
• 38:44
  Speaker 1: past infection because antibodies maintain for a long time. So
• 38:48
  Speaker 1: not perfect, but there is some testing you can do.
• 38:52
  Speaker 1: This is generally not something you would do. If somebody
• 38:54
  Speaker 1: shows up with a standard rash, they're just given the
• 38:57
  Speaker 1: DICI cycline and.
• 39:00
  Speaker 2: Those people just treat. I know some docs who will
• 39:02
  Speaker 2: treat and test too, just to like have it in
• 39:04
  Speaker 2: the record or something. But yeah, I think if you,
• 39:06
  Speaker 2: you know, you come up with a rash like that.
• 39:08
  Speaker 1: You're getting You're not waiting.
• 39:09
  Speaker 2: You're waiting.
• 39:10
  Speaker 1: You're not waiting in part because the test is most
• 39:12
  Speaker 1: likely to be a false negative early on, before you've
• 39:15
  Speaker 1: mentioned an antibody response, which is why we're giving you
• 39:17
  Speaker 1: the yeah datty cycling. Okay, So before we get into
• 39:22
  Speaker 1: the chronic lime space, I want to ask you a question,
• 39:28
  Speaker 1: Actually I want to I'm not going to ask you.
• 39:30
  Speaker 1: I'm going to ask the Health Secretary of America a question, okay,
• 39:34
  Speaker 1: about whether lime is a bioweapon. Let's hear what he
• 39:36
  Speaker 1: has to say.
• 39:37
  Speaker 4: Clearly, COVID nineteen pandemic and many other global pandemics that
• 39:42
  Speaker 4: we have have come from in a functional research. The
• 39:46
  Speaker 4: RSV epidemics that we have that is the biggest killer
• 39:50
  Speaker 4: of kids in this country today came from these kind
• 39:53
  Speaker 4: of experiments. The lime disease almost certainly came from this
• 39:58
  Speaker 4: kind of research.
• 39:59
  Speaker 1: Okay, So it sounds like it sounds like maybe, yes,
• 40:03
  Speaker 1: tell me where this came from.
• 40:05
  Speaker 2: I have to admit that until I heard RFK Junior
• 40:08
  Speaker 2: say that lime disease is a result of gain of
• 40:12
  Speaker 2: function research and in other places he's described it as
• 40:15
  Speaker 2: like a literal bioweapon, I kind of didn't know this story,
• 40:20
  Speaker 2: and it's really fascinating. So let me let me walk
• 40:25
  Speaker 2: you through why this is like remotely a thing at all,
• 40:30
  Speaker 2: and also tell you why I think it's not a bioweapon.
• 40:32
  Speaker 2: So this all starts in two thousand and four. There's
• 40:35
  Speaker 2: a book by guy named Michael Carroll it's called Lab
• 40:37
  Speaker 2: two fifty seven about the Plumb Island Animal Disease Center,
• 40:41
  Speaker 2: which is on the eastern tip of Long Island. And yes,
• 40:45
  Speaker 2: there is an animal disease research center on the eastern
• 40:48
  Speaker 2: tip of Long Island. And yes they study animal diseases
• 40:51
  Speaker 2: and some tickborne diseases. And lime Connecticut is just across
• 40:57
  Speaker 2: the sound from there. But that's sort of mostly where
• 41:03
  Speaker 2: that story stops, like, we don't have evidence that they
• 41:05
  Speaker 2: were doing any particular experiments with limee there. However, remember Burgdorfer,
• 41:14
  Speaker 2: the guy who discovered Barellia, burgdorf Ride, who discovered the
• 41:17
  Speaker 2: spire keat, so he actually did work at a government
• 41:24
  Speaker 2: facility that did study tickborne diseases. Let me see if
• 41:30
  Speaker 2: I can find the name for you. So it was
• 41:34
  Speaker 2: a program called Rocky Mountain Labs. It was indeed an
• 41:39
  Speaker 2: entomological warfare program. So the US government was interested in, like, hey,
• 41:44
  Speaker 2: can we have insects spread.
• 41:47
  Speaker 1: Diseases by the way, a thing which definitely has happened
• 41:51
  Speaker 1: in the past. I mean, this is how we got malaria.
• 41:55
  Speaker 1: I mean the spread all the.
• 41:58
  Speaker 2: Time insect spread diseases, but we didn't we have a blaria.
• 42:04
  Speaker 2: But yes, biological warfare has happened. There are some, okay,
• 42:08
  Speaker 2: but that's all we have. So we've got the guy
• 42:10
  Speaker 2: who studied tick diseases was also working at the government
• 42:14
  Speaker 2: studying tick diseases. Like of course he was like, if
• 42:18
  Speaker 2: you're going to develop this program, like, maybe you have
• 42:20
  Speaker 2: a guy who knows about tick diseases. But here's the
• 42:24
  Speaker 2: issue with all of this theory is that lime disease
• 42:27
  Speaker 2: was identified in the nineteen seventies. These programs that they're
• 42:31
  Speaker 2: talking about were maybe open in the late in the sixties,
• 42:34
  Speaker 2: but actually lime disease has been around way longer than that.
• 42:38
  Speaker 2: So we have direct evidence of lime disease infection in
• 42:42
  Speaker 2: whitefooted mice from museum specimens. So you go in back
• 42:46
  Speaker 2: of these like little museums and you test the whitefooted mice,
• 42:48
  Speaker 2: and at least as early as eighteen ninety eight we
• 42:51
  Speaker 2: have lime disease in mice. So this is long before
• 42:53
  Speaker 2: the government had any type of biological warfare weapon. The
• 42:58
  Speaker 2: other source of evidence is that genetic sequencing can tell
• 43:02
  Speaker 2: you how diverse Burrellia burgdor fry is. If Burrellia burdorfry
• 43:08
  Speaker 2: were released at a discrete time, let's say in nineteen
• 43:11
  Speaker 2: seventy to in Lime, Connecticut. I don't know why we're
• 43:14
  Speaker 2: doing it, but let's do it. Let's let's affect the
• 43:17
  Speaker 2: people of Lime the genetic similarity because it's only been
• 43:20
  Speaker 2: what fifty years, it would be highly genetically similar to
• 43:23
  Speaker 2: itself as its spread because it had a point source
• 43:27
  Speaker 2: in time. And in fact, it's very diverse, and there
• 43:29
  Speaker 2: are all sorts of methods to tell how long something
• 43:32
  Speaker 2: has been around. And the thoughts are actually that Burrelli
• 43:36
  Speaker 2: Burgdorfry has a long lineage going back millions of years
• 43:40
  Speaker 2: in mammalian species.
• 43:42
  Speaker 1: This is also the dumbest animal like inst to use
• 43:46
  Speaker 1: for a bioweapon, Like mosquitoes are of just a much better,
• 43:49
  Speaker 1: clearly much better bioweapon, right tics, And you've got to
• 43:54
  Speaker 1: leave it on for like two days?
• 43:57
  Speaker 2: Yeah, I mean you had you had one job, evil scientists.
• 44:00
  Speaker 1: Well, let me think, I've got this animal that flies
• 44:03
  Speaker 1: around and bites you immediately, or I have this other
• 44:06
  Speaker 1: one then crawls around and you have to leave on
• 44:08
  Speaker 1: for Oh we're going to go with the crawler. Uh, well,
• 44:10
  Speaker 1: could go wrong?
• 44:11
  Speaker 2: Yeah, yeah, totally, I think So it's not a bioweapon.
• 44:15
  Speaker 2: I guess the question I have for you is like,
• 44:17
  Speaker 2: so why you know so these coincidences, It's hard not
• 44:21
  Speaker 2: to see similar things with COVID nineteen. I'm not getting
• 44:24
  Speaker 2: into lab leak versus not lab leak, but like, you know,
• 44:27
  Speaker 2: there's a virological institute near the place where the epidemic starts.
• 44:32
  Speaker 2: I guess there's a resonance there with lime disease although
• 44:35
  Speaker 2: it's across Long Island. Sound. I don't know why you
• 44:38
  Speaker 2: don't just do it on Long Island, but whatever, But like,
• 44:42
  Speaker 2: is it because lime disease is scary? You know, we
• 44:47
  Speaker 2: know it can have these long term effects potentially, and
• 44:52
  Speaker 2: believing that and that quote from RFK, like he mentioned
• 44:55
  Speaker 2: lime diseas mentioned RSV, he mentioned COVID. All of these
• 44:57
  Speaker 2: things is like potential bioweapons or gain function research, like
• 45:00
  Speaker 2: the result of human human messin with nature. And in
• 45:06
  Speaker 2: some way I'm getting put in my non psychologist talent.
• 45:09
  Speaker 2: In some ways, it's satisfying to people to be like, well,
• 45:11
  Speaker 2: if all these bad things out there that could happen
• 45:14
  Speaker 2: at any time, my kid could get RSV and could
• 45:17
  Speaker 2: be terrible, if they're the result of human mouthfeasance, then
• 45:21
  Speaker 2: there is a future where we can stop that mouthfeasance right,
• 45:24
  Speaker 2: like the good guys can win, whereas if not, if
• 45:27
  Speaker 2: this stuff just happens randomly and like stuff evolves and
• 45:30
  Speaker 2: all of a sudden, we have a pandemic, like we
• 45:33
  Speaker 2: have no control over that. Is that what's attractive about I.
• 45:35
  Speaker 1: Think it's simpler than that. I think it's that people
• 45:38
  Speaker 1: like explanations, and so people want to understand why things
• 45:42
  Speaker 1: are happening, and they want to understand why bad things happen,
• 45:46
  Speaker 1: and the explanation of just like animals have diseases and
• 45:48
  Speaker 1: sometimes you get them is not actually a super satisfying explanation.
• 45:52
  Speaker 1: It's much better to have an explanation like it is,
• 45:55
  Speaker 1: because I mean, I think it's the same reason why
• 45:58
  Speaker 1: people like this idea that there's a conspiracy between you know,
• 46:01
  Speaker 1: big Pharma and big food to give your kids diabetes,
• 46:05
  Speaker 1: as opposed to just saying like food companies are trying
• 46:07
  Speaker 1: to sell stuff and people like to buy delicious food, Like,
• 46:10
  Speaker 1: you know, there's a lot in here where it would
• 46:12
  Speaker 1: be nice to have someone to blame because it would
• 46:15
  Speaker 1: help you organize and understand the world of why bad
• 46:18
  Speaker 1: stuff happens. And I think that's related to the good
• 46:23
  Speaker 1: and evil, but I think almost like just one rung
• 46:25
  Speaker 1: down of complication. I also think in the case of lime,
• 46:28
  Speaker 1: and maybe it's a good pivot to the chronic lime discussion,
• 46:32
  Speaker 1: it lends itself well because of the origin story. Because
• 46:35
  Speaker 1: the origin story is people were being ignored. A lot
• 46:39
  Speaker 1: of the current discussion has focused on this question of
• 46:42
  Speaker 1: like is chronic lime?
• 46:44
  Speaker 2: Are people still being ignored?
• 46:45
  Speaker 1: People still being ignored with this thing, and so to
• 46:48
  Speaker 1: sort of have in the middle, it's not surprising that
• 46:50
  Speaker 1: it's like we're being ignored. And also, by the way,
• 46:53
  Speaker 1: this is the fault of you know, this DoD scientist.
• 46:57
  Speaker 2: So all right, so let's turn to chronic lime disease.
• 47:02
  Speaker 2: And I think we have to define our terms before
• 47:05
  Speaker 2: we get too deep in this because they are going
• 47:07
  Speaker 2: to be people listening who are like, what are you
• 47:09
  Speaker 2: talking about? So first of all, I will say that
• 47:13
  Speaker 2: earlier I talked about late disseminated lime disease. So the
• 47:16
  Speaker 2: lime disease, untreated lime disease that can cause you know,
• 47:20
  Speaker 2: joint swelling, heart problems, nerve problems, brain problems. In some sense,
• 47:25
  Speaker 2: that's chronic lime disease. You've had it for a long time,
• 47:28
  Speaker 2: not years, but you've had it for you know whatever,
• 47:30
  Speaker 2: a few weeks or something. It hasn't been treated and
• 47:32
  Speaker 2: you get these di few symptoms, but that's late disseminated
• 47:36
  Speaker 2: lime disease. That is not what we mean we say
• 47:38
  Speaker 2: chronic lime disease. Medically speaking, the most people will refer
• 47:44
  Speaker 2: to a syndrome called post treatment lime disease syndrome, which
• 47:48
  Speaker 2: is what it sounds like. You had lime disease that
• 47:50
  Speaker 2: was documented, it was treated, your post treatment, and you
• 47:55
  Speaker 2: still have something wrong with you, which is not how
• 47:58
  Speaker 2: this is supposed to go. This is a bacterial infection.
• 48:00
  Speaker 2: You should get antibiotics and be better. That's how these
• 48:02
  Speaker 2: things are supposed to work. But post treatment lime disease
• 48:05
  Speaker 2: syndrome exists. We'll talk about what those symptoms can be,
• 48:08
  Speaker 2: and we need to begin to understand how this weird
• 48:12
  Speaker 2: bacteria can affect your body downstream, even after it's dead.
• 48:16
  Speaker 2: Chronic lime disease, though, is a catchier term than post
• 48:20
  Speaker 2: treatment lime disease syndrome, and not only encompasses post treatment
• 48:24
  Speaker 2: lime disease syndrome people who documented lime treated still sick,
• 48:28
  Speaker 2: but also a much larger group of people potentially without
• 48:33
  Speaker 2: documented lime without a known tick bite sometimes who also
• 48:38
  Speaker 2: have long term symptoms, and they can get caught up
• 48:43
  Speaker 2: in this lime disease ecosystem for a variety of reasons,
• 48:47
  Speaker 2: including the testing issues that we talked about, and the
• 48:54
  Speaker 2: chronic lime disease ecosystem is filled with some very good
• 48:59
  Speaker 2: practitioner who know a lot about infectious disease and lime
• 49:02
  Speaker 2: disease and other tickmore illnesses, and some charlatans unfortunately, And I.
• 49:07
  Speaker 1: Think this space is so hard to talk about. It's
• 49:14
  Speaker 1: so hard to talk about because there are many people
• 49:17
  Speaker 1: who are genuinely suffering and who really deserve better answers
• 49:24
  Speaker 1: and research, and there are also things that are being
• 49:28
  Speaker 1: wildly over sold. And there's a balance between not wanting
• 49:34
  Speaker 1: to say, you know, you are being oversold this thing
• 49:37
  Speaker 1: which is not going to fix your problems, and saying
• 49:39
  Speaker 1: you have no problems. And I think people here you
• 49:42
  Speaker 1: have no problems. This is all in your head. This
• 49:45
  Speaker 1: is like a classic like chronic anything in particularly for
• 49:50
  Speaker 1: women here, so frequently this is on your head, This
• 49:52
  Speaker 1: is all on your head. And then people it's not
• 49:54
  Speaker 1: surprising that people would go out and search for someone
• 49:56
  Speaker 1: who is going to take their very real concerns and
• 50:00
  Speaker 1: This is why we actually need to see what the
• 50:03
  Speaker 1: data says and why this deserves more research rather than
• 50:07
  Speaker 1: being left to you know, Charlotte and who are taking
• 50:10
  Speaker 1: advantage of people suffering.
• 50:11
  Speaker 2: Yeah, yeah, absolutely, So let me just talk about the symptoms. Yeah,
• 50:15
  Speaker 2: here's the problem.
• 50:17
  Speaker 1: They're everything.
• 50:18
  Speaker 2: It's there's a lot of different symptoms that are lumped
• 50:21
  Speaker 2: into both post treatment lime disease syndrome and chronic lime disease. Fatigue,
• 50:25
  Speaker 2: brain fog, joint pain, intermittent rashes, gastrointestinal distress, psychological discernments, depression, mania, psychosis,
• 50:35
  Speaker 2: so hallucinations, and you know these can be debilitating the
• 50:41
  Speaker 2: air people who are unable to walk because of these issues.
• 50:45
  Speaker 2: And yet those are also symptoms that can occur from
• 50:49
  Speaker 2: a lot of other diseases, including other infectious diseases. And
• 50:54
  Speaker 2: there is not a clear diagnostic test or either post
• 51:00
  Speaker 2: treatment lime disease syndrome or chronic lime disease. So we
• 51:04
  Speaker 2: have a bad case definition. And one of the problems
• 51:08
  Speaker 2: with like this comes up with the long COVID discussion
• 51:10
  Speaker 2: a lot. I've criticized the case definition for long COVID
• 51:14
  Speaker 2: because when a case definition isn't narrow, it actually becomes
• 51:19
  Speaker 2: harder to study. And when people were making the case
• 51:22
  Speaker 2: definition for long COVID, everyone was so concerned about having
• 51:27
  Speaker 2: a big tent, right, like, it can be long COVID,
• 51:30
  Speaker 2: if you're tired, it can be long COVID. If you
• 51:31
  Speaker 2: have postural attack cardio syndrome, it can be long COVID,
• 51:34
  Speaker 2: if you have brain fog. It was so diffuse that
• 51:37
  Speaker 2: it actually was difficult to study because you look at
• 51:39
  Speaker 2: biomarker differences and people with and without long COVID, and
• 51:42
  Speaker 2: like they all look the same. But the people with
• 51:44
  Speaker 2: long COVID, it's this very heterogeneous group. So sometimes you
• 51:47
  Speaker 2: actually want a case definition that's super tight, even if
• 51:50
  Speaker 2: it'll exclude people from diagnosis, so that you can actually
• 51:53
  Speaker 2: figure out what the testing should be. And that wasn't
• 51:56
  Speaker 2: done for long COVID. It wasn't done for chronic line.
• 51:57
  Speaker 1: And I think in the case of chronic lime, you know,
• 52:00
  Speaker 1: and in some ways you would think, okay, so part
• 52:02
  Speaker 1: of that should be you know, tick bite and basic
• 52:04
  Speaker 1: like some evidence that you have had acute lime disease.
• 52:09
  Speaker 1: But since our tests for this are potentially false positive,
• 52:12
  Speaker 1: potentially we have a lot of false positives and potentially
• 52:14
  Speaker 1: some false negatives, and because sometimes you get bitten by
• 52:18
  Speaker 1: a tick and then you don't it falls off and
• 52:20
  Speaker 1: you don't know that actually can't be a or at
• 52:24
  Speaker 1: least that's not necessarily a perfect diagnostic criteria. So by
• 52:29
  Speaker 1: leaving the tent open, we don't have a we don't
• 52:31
  Speaker 1: even have that, which would seem like the basic yeah,
• 52:34
  Speaker 1: the sort of first basic yeah.
• 52:36
  Speaker 2: And again you know the pathway for this is you
• 52:39
  Speaker 2: start with the narrow case definition, then you get your
• 52:41
  Speaker 2: diagnostic tests, then you expand those to other people with
• 52:44
  Speaker 2: more like without as classic symptoms, and then you can
• 52:47
  Speaker 2: enlarge the tent. I said several times there's an ecosystem here,
• 52:52
  Speaker 2: and I think what people need to be aware of is, okay,
• 52:55
  Speaker 2: I have if you're in an ambiguous state, you don't
• 52:58
  Speaker 2: remember a tick bite, you didn't have a rash, but
• 53:00
  Speaker 2: you're feeling all these vague symptoms. You can get sort
• 53:04
  Speaker 2: of funneled into, often through social media or through the Internet,
• 53:08
  Speaker 2: to a self described group of practitioners called lime literate doctors.
• 53:13
  Speaker 2: And this is another term that's way too broad because
• 53:17
  Speaker 2: there I know plenty of infectious disease doctors who would
• 53:21
  Speaker 2: call themselves lime literate. I mean, especially here in Connecticut,
• 53:24
  Speaker 2: we have great infectious disease doctors who know everything there
• 53:27
  Speaker 2: is about my giant table of tick porn illnesses. Then
• 53:31
  Speaker 2: there are sort of self described lime literate doctors who
• 53:34
  Speaker 2: are part of this almost like a more shadowy medical
• 53:40
  Speaker 2: adjacent ecosystem. And the reason I keep saying ecosystem is
• 53:44
  Speaker 2: because these doctors refer to each other, so there's there's
• 53:49
  Speaker 2: a sort of circular nature there. These doctors send blood
• 53:53
  Speaker 2: tests to specific labs, so sort of lime literate labs,
• 53:58
  Speaker 2: which often lack FDA clear and sometimes lack clear certification.
• 54:03
  Speaker 2: These labs will run tests that are research tests on
• 54:08
  Speaker 2: the blood to look for evidence of lime disease, look
• 54:11
  Speaker 2: for evidence of the spiralkeat, and often will find evidence.
• 54:15
  Speaker 2: But again we're very concerned about false positives because these
• 54:19
  Speaker 2: are research tests and they set the thresholds for detection
• 54:21
  Speaker 2: very low. There's a lot of cross reactivity, and I've
• 54:25
  Speaker 2: seen patients kind of get drawn into this. They start
• 54:27
  Speaker 2: with vague symptoms, then they get a confirmatory test that
• 54:30
  Speaker 2: tells them they have lime disease, and they go down
• 54:32
  Speaker 2: a treatment pathway which can actually be quite dangerous. Again,
• 54:36
  Speaker 2: this is not to say that they don't have real symptoms.
• 54:38
  Speaker 2: It's not even to say that they don't have lime disease.
• 54:40
  Speaker 1: It's just not.
• 54:41
  Speaker 2: The safe path to obtain the diagnosis and get the
• 54:46
  Speaker 2: right treatments.
• 54:47
  Speaker 1: And there is a treatment that is very common and
• 54:51
  Speaker 1: has been tested repeatedly and doesn't work. So the most
• 54:54
  Speaker 1: common treatment for this is like IVY antibiotics or very
• 55:00
  Speaker 1: high dose, long term, long term IVY antibiotics. And you know,
• 55:04
  Speaker 1: there's a trial in the New England Journal of Medicine
• 55:08
  Speaker 1: which does not see any differences in health related quality
• 55:12
  Speaker 1: of life with people who are given your long term
• 55:15
  Speaker 1: antibiotics versus a shorter course. And this is a long
• 55:19
  Speaker 1: term I mean people are on these antibiotics for like months.
• 55:21
  Speaker 2: Yeah, and at a time. The risks of long term
• 55:25
  Speaker 2: intravenous antibiotics are quite quite high, just to say them
• 55:28
  Speaker 2: out loud. You've got an indwelling catheter, so some right,
• 55:31
  Speaker 2: you got to infuse it somehow. Pickline a central line
• 55:33
  Speaker 2: of some kind that's breaking the skin, so that increases
• 55:36
  Speaker 2: the risk of skin borne bacteria getting into your bloodstream
• 55:39
  Speaker 2: and causing sepsis. You're getting antibiotics, which increases your risk
• 55:42
  Speaker 2: for seedficile, that bad diarrheal infection that happens when you
• 55:47
  Speaker 2: kill off your good, healthy gut bacteria and the bad
• 55:49
  Speaker 2: evil bacteria takeover. You dramatically increase your risk for candida infections.
• 55:54
  Speaker 2: So yeast doesn't get killed by traditional bacteria. If you
• 55:58
  Speaker 2: take an antibiotic, you're at high risk for yeast infections.
• 56:02
  Speaker 2: But those yeast infections can happen in the blood in
• 56:04
  Speaker 2: people with indwelling lines, and they're a disaster. I mean,
• 56:07
  Speaker 2: they really are life threatening. So this approach to therapy
• 56:11
  Speaker 2: is super dangerous. And as you said, there's not just
• 56:14
  Speaker 2: one randomized trial of this in chronic lime disease. There's
• 56:17
  Speaker 2: multiple randomized trials. So some people got placebo and some
• 56:19
  Speaker 2: people got long term intravenous antibiotics, and there's no difference
• 56:23
  Speaker 2: in outcomes. It just doesn't work. And it's one of
• 56:26
  Speaker 2: the red flags I have for people that are going
• 56:29
  Speaker 2: through this and who are you know, seeing a practitioner
• 56:31
  Speaker 2: that's diagnosing them this way. If they get to the
• 56:34
  Speaker 2: point where they want to put a line in you
• 56:37
  Speaker 2: and give you several months of antibiotics, that's really time
• 56:40
  Speaker 2: to get a second opinion. I really think that's a
• 56:42
  Speaker 2: red flag.
• 56:43
  Speaker 1: And I mean I think that the truth is of
• 56:45
  Speaker 1: course there people will say, well I did this and
• 56:47
  Speaker 1: it helped.
• 56:48
  Speaker 2: Oh my gosh, look on Instagram.
• 56:49
  Speaker 1: Yeah, and you know, the placebo effect is really really
• 56:52
  Speaker 1: powerful effect. That is why we need randomized trial data,
• 56:55
  Speaker 1: and especially in a case like this where the potential
• 56:59
  Speaker 1: downsides are very, very very real. He is very important
• 57:03
  Speaker 1: to make these decisions based on actual trial data. This
• 57:06
  Speaker 1: is not you know, taking a sugar pill and just
• 57:09
  Speaker 1: using the placebo effect for.
• 57:12
  Speaker 2: Yeah. There's also some confirmation bias that I've seen happen.
• 57:16
  Speaker 2: So you know, you get your antibiotics and you feel better, Okay, great,
• 57:21
  Speaker 2: that's confirmation that it worked. You get your antibox and
• 57:24
  Speaker 2: you feel worse because you get diarrhea or one of
• 57:26
  Speaker 2: the other many side effects from antibiotic use. There are
• 57:29
  Speaker 2: people say, oh, that's the Gerrish Herzheimer reaction or the
• 57:33
  Speaker 2: community called it jerksing. This is a true thing. So
• 57:36
  Speaker 2: any spira keat for whatever reason when you kill it
• 57:39
  Speaker 2: with so the other common one is syphalis. When you
• 57:44
  Speaker 2: either kill syphlis or lime disease acute lime disease with
• 57:47
  Speaker 2: an antibiotic, the spier keats lies and they release a
• 57:50
  Speaker 2: lot of inflammatory stuff and for about twenty four hours
• 57:52
  Speaker 2: you can get like fevers and chills and stuff. It's
• 57:54
  Speaker 2: more commonly described in syphilis with initial treatment. So that
• 57:57
  Speaker 2: happens in acute limes or can in a subset of
• 58:00
  Speaker 2: people with acute lime disease. But there's there's no real
• 58:03
  Speaker 2: reason to think it would happen in chronic lime disease
• 58:06
  Speaker 2: because we can't isolate the bacteria. Like it's not like
• 58:09
  Speaker 2: we can see the bacteria in your blood that's floating around.
• 58:12
  Speaker 2: It's not there, you know. The tests don't show that,
• 58:16
  Speaker 2: so it's not lising. So but what people will, they'll
• 58:20
  Speaker 2: just attribute any negative symptom to jerk saying, and any
• 58:24
  Speaker 2: positive symptom to getting better, and it becomes this self
• 58:27
  Speaker 2: reinforcing thing. And by the way, here's another red flag
• 58:29
  Speaker 2: if you're seeing one of these practitioners, if they're not
• 58:31
  Speaker 2: taking your insurance. Okay, if you're paying out of pocket
• 58:34
  Speaker 2: for this. These intravenous infusions can cost thousands and thousands
• 58:38
  Speaker 2: and thousands of dollars. And I've seen patients who do
• 58:40
  Speaker 2: it for three months, maybe they feel better, they stop,
• 58:44
  Speaker 2: they feel worse again. They do it for another three months,
• 58:46
  Speaker 2: it can be really financially devastating.
• 58:49
  Speaker 1: Yeah, I mean, I think the last thing I would
• 58:51
  Speaker 1: just want to end on in this in this discussion
• 58:52
  Speaker 1: I think we're going to answer these questions is you know,
• 58:57
  Speaker 1: people are going this route because the medical system has
• 59:01
  Speaker 1: failed them. And so it's I think fine to it's
• 59:05
  Speaker 1: reasonable to say, you know, you shouldn't go this route,
• 59:08
  Speaker 1: but to just say you shouldn't go this route and whatever,
• 59:11
  Speaker 1: so just like live with it is also terrible correct.
• 59:14
  Speaker 1: And so I think there are there was real research
• 59:16
  Speaker 1: that needs to happen, and I think some of it
• 59:19
  Speaker 1: is happening, but you know, real things they need to
• 59:21
  Speaker 1: be done, and people do need to be listened to,
• 59:24
  Speaker 1: and if they were listened to, it would potentially close
• 59:27
  Speaker 1: some of this uh.
• 59:30
  Speaker 2: Distrust exactly that exists. Absolutely. Actually, just today I saw
• 59:34
  Speaker 2: HHS had announced a series of new initiatives towards lime disease,
• 59:38
  Speaker 2: including some research funding directed towards understanding these long term
• 59:42
  Speaker 2: post treatment syndromes. That's good.
• 59:44
  Speaker 1: Yeah. Ross douth that, by the way, has a very
• 59:47
  Speaker 1: good book called The Deep Places. Ross is a columnist
• 59:50
  Speaker 1: for The Times. You had had chronic lime and it's
• 59:54
  Speaker 1: it's an interesting book to read because you know, this
• 59:57
  Speaker 1: is a very broadly scientifically minded person who goes in
• 1:00:00
  Speaker 1: directions that I think he would even he would say,
• 1:00:03
  Speaker 1: we're very unscientific and experimental just in a curve, and
• 1:00:08
  Speaker 1: you can sort of feel the like, I just need
• 1:00:10
  Speaker 1: to figure out something to fix this because it is
• 1:00:12
  Speaker 1: ruining my life.
• 1:00:13
  Speaker 2: Yeah, the desperation, the desperation, and doctors are you know,
• 1:00:19
  Speaker 2: I'll tell you from a from a physician standpoint, it
• 1:00:22
  Speaker 2: is it's really hard to not be able to offer
• 1:00:25
  Speaker 2: a patient something. You know, they come in and it's like,
• 1:00:29
  Speaker 2: you know, they're having all this stuff and I can
• 1:00:31
  Speaker 2: do these tests and if I'm not coming up with anything,
• 1:00:34
  Speaker 2: it feels terrible. But the truth is those are the
• 1:00:39
  Speaker 2: places where research is most needed, and until that good,
• 1:00:43
  Speaker 2: high quality research is done, we are going to see
• 1:00:45
  Speaker 2: a parallel ecosystem emerge. It's it's sort of the natural thing.
• 1:00:49
  Speaker 2: People are going to offer solutions, and I don't want
• 1:00:53
  Speaker 2: to discourage people from exploring any potential solution, with the
• 1:00:57
  Speaker 2: potential exception of long term entreveno standouts, because they really
• 1:01:00
  Speaker 2: can be so harmful and potentially fatal. So that's the
• 1:01:03
  Speaker 2: that's the only one that I really do worry about
• 1:01:05
  Speaker 2: in this space. Otherwise, we just have to do better.
• 1:01:08
  Speaker 2: Listen to your patients, work through if you have to
• 1:01:11
  Speaker 2: go symptom by symptom, go symptom by symptom, get them
• 1:01:14
  Speaker 2: to the right specialists. Figure out other mechanisms, other solutions
• 1:01:19
  Speaker 2: to this.
• 1:01:19
  Speaker 1: Okay, I want to end on a more positive note,
• 1:01:22
  Speaker 1: which is about the vaccine. So you know a lot
• 1:01:25
  Speaker 1: of people, specifically my husband asked me three times a
• 1:01:29
  Speaker 1: week why there's no lime disease vaccine because he hates sticks.
• 1:01:33
  Speaker 2: My dog gets a vaccine, jo your dog.
• 1:01:36
  Speaker 1: Gets one, and amazingly we used to have one. So
• 1:01:39
  Speaker 1: there was a there was a lime disease vaccine called Limericks,
• 1:01:45
  Speaker 1: which was pulled off the market in two thousand and two.
• 1:01:48
  Speaker 1: It did work, there was a litigation backdrop. People said
• 1:01:52
  Speaker 1: they're autoimmune side effects. They just decided it was I
• 1:01:55
  Speaker 1: don't think it made enough money. Honestly, people didn't. People
• 1:01:58
  Speaker 1: didn't want it. But it's bad, not that, but something else.
• 1:02:01
  Speaker 1: There's a new lime diseased vaccine that just complete completed
• 1:02:05
  Speaker 1: its trial in March. Seventy three percent efficacy against infection
• 1:02:10
  Speaker 1: the confidence interval is enormous, sixteen to ninety three percent,
• 1:02:14
  Speaker 1: very big. Not enough people in your trial cases. But
• 1:02:20
  Speaker 1: but you know, it seems like we are moving the
• 1:02:22
  Speaker 1: direction of having this, so Jesse hopefully soon for you
• 1:02:26
  Speaker 1: lime disease. And let me say one other thing before
• 1:02:28
  Speaker 1: we smash our past our ticks, which is you should
• 1:02:31
  Speaker 1: be avoiding ticks moving away from lime disease you want.
• 1:02:34
  Speaker 2: To avoid, Yeah, to get started.
• 1:02:36
  Speaker 1: Okay, So the two things about avoiding ticks. One is
• 1:02:39
  Speaker 1: there's stuff comes in an orange spray bottle you can
• 1:02:44
  Speaker 1: spray and it's called pirethron oh permethrin, and you can spray
• 1:02:49
  Speaker 1: your clothes with it. That's a really good idea if
• 1:02:52
  Speaker 1: you're going to be hiking in tickborn areas, because it
• 1:02:54
  Speaker 1: like repels the ticks off your clothing. Okay, that's a
• 1:02:57
  Speaker 1: really good idea. Bugs spread also works. DT is fine,
• 1:03:02
  Speaker 1: it's not poison. You can use it also perfects you.
• 1:03:04
  Speaker 1: It's mosquitoes. And you should check people for tics. In
• 1:03:07
  Speaker 1: your family. You should check each other for tics. It's
• 1:03:11
  Speaker 1: not gonna fix your powasen problem. But for lime taking
• 1:03:14
  Speaker 1: ticks off if you see them as good and so
• 1:03:17
  Speaker 1: you should check yourself. There's also a really good country
• 1:03:19
  Speaker 1: song with.
• 1:03:21
  Speaker 2: That lyric, check yourself for tics.
• 1:03:23
  Speaker 1: No, it's like I want the lyric is I want
• 1:03:25
  Speaker 1: to check you for tics? And you know it's romantic.
• 1:03:29
  Speaker 1: I guess poor play.
• 1:03:31
  Speaker 2: Sure, primates do groom each other?
• 1:03:35
  Speaker 1: All right, Perry, are you a smash? Are you a smash?
• 1:03:38
  Speaker 1: Your pass on tics?
• 1:03:41
  Speaker 2: I'm gonna pass on tics. I think you should stay
• 1:03:45
  Speaker 2: away from them. I think they should stay away from us.
• 1:03:48
  Speaker 2: You know, I don't know ecologically, do they have some role?
• 1:03:52
  Speaker 4: You know?
• 1:03:53
  Speaker 2: I like, if I could snap my fingers and eliminate
• 1:03:55
  Speaker 2: all ticks, would it cause some horrible like would then
• 1:03:58
  Speaker 2: all of a sudden, like all the ducks would die?
• 1:04:01
  Speaker 2: I don't know, but yeah, pass How about you.
• 1:04:02
  Speaker 1: Emily, I'm a I'm a pass on tics. Yeah, I'm
• 1:04:05
  Speaker 1: a pass on them. That's very cool. Controversial, controversial, controversial,
• 1:04:09
  Speaker 1: take don't like ticks?
• 1:04:12
  Speaker 4: All right?
• 1:04:13
  Speaker 2: When we come back your question of the week and
• 1:04:21
  Speaker 2: we're back with our question of the week. If you
• 1:04:23
  Speaker 2: have a question for us, drop us a line at
• 1:04:24
  Speaker 2: Wellness actually dot FM or mail bag. Question of the
• 1:04:29
  Speaker 2: week is here.
• 1:04:32
  Speaker 3: Hey, Emily and Perry, This is Nate from a Kansas uh,
• 1:04:38
  Speaker 3: simple question, is VO two max a good indicator of
• 1:04:42
  Speaker 3: overall health? Fix?
• 1:04:45
  Speaker 2: Okay, Emily v O two max. This is right down
• 1:04:50
  Speaker 2: the middle for an Emily Oster question, what is VO
• 1:04:53
  Speaker 2: two max? What do you think my VO two max is?
• 1:04:55
  Speaker 2: What is your VO two max? And how good is
• 1:04:59
  Speaker 2: it as an indicat overall health?
• 1:05:00
  Speaker 1: Amazing? Okay, so VO two I'm made for this question. So,
• 1:05:04
  Speaker 1: votwo max is the highest amount of oxygen that your
• 1:05:07
  Speaker 1: body can use during hard exercise. So it is a
• 1:05:11
  Speaker 1: measure of how well your heart and lungs and muscles
• 1:05:13
  Speaker 1: working together. Is the vias volume? O two is oxygen,
• 1:05:17
  Speaker 1: so max is means the maximum?
• 1:05:20
  Speaker 2: Okay.
• 1:05:21
  Speaker 1: So it is a common metric of like aerobic fitness.
• 1:05:26
  Speaker 1: Hire is better, hire is better, higher is better. It
• 1:05:29
  Speaker 1: goes down with age. And the reason this gets a
• 1:05:35
  Speaker 1: lot of attention is if you ran a regression, like
• 1:05:39
  Speaker 1: an analysis of like lunge, so looked at correlations between
• 1:05:43
  Speaker 1: longevity and many other many metrics, you would have this
• 1:05:47
  Speaker 1: loads the strongest. So this is like the highest value
• 1:05:53
  Speaker 1: predictor of things like longevity that we have. Okay, interesting, Yeah,
• 1:05:59
  Speaker 1: And overall strength beats it beats like finger strength. Although
• 1:06:03
  Speaker 1: finger strength. We can get another episode how stupid that is.
• 1:06:06
  Speaker 1: But this is really it beats you know, resting heart rate.
• 1:06:09
  Speaker 1: It beats like bmib like it's really really good, Okay,
• 1:06:12
  Speaker 1: And so what people like to interpret that as like,
• 1:06:15
  Speaker 1: you know, if I changed this, it would be really beneficial.
• 1:06:19
  Speaker 1: I think that that's too far. I think the issue
• 1:06:21
  Speaker 1: is that this is something that moves very readily with
• 1:06:26
  Speaker 1: a lot of the kinds of behaviors we know are effective.
• 1:06:28
  Speaker 1: So this is a this is something you can move
• 1:06:31
  Speaker 1: pretty easily with exercise. And so even when people who
• 1:06:34
  Speaker 1: don't exercise at all exercise for small amounts, you will
• 1:06:37
  Speaker 1: already move their VO two max. And so it's just
• 1:06:40
  Speaker 1: like a very sensitive measure. And so that's why the
• 1:06:43
  Speaker 1: correlation is so good. But and so there are many
• 1:06:47
  Speaker 1: things that you could do to move this which would
• 1:06:50
  Speaker 1: probably be good for you. But like if just one
• 1:06:52
  Speaker 1: day you woke up and nothing else had change and
• 1:06:54
  Speaker 1: all of a sudden, your VIEO two max was highed, Like,
• 1:06:56
  Speaker 1: that's probably not makingful. What's a good number?
• 1:07:00
  Speaker 2: How do I measure it?
• 1:07:01
  Speaker 1: Yeah, so if you have a wearable it will measure
• 1:07:03
  Speaker 1: it will give you a kind of correlationally appropriate but
• 1:07:07
  Speaker 1: noisy and kind of garbage like, but like you're wearable
• 1:07:11
  Speaker 1: to measure this if you really want to measure this,
• 1:07:13
  Speaker 1: like you're in the you know, cycling on or whatever. Yeah,
• 1:07:17
  Speaker 1: you got to get on a like you get on
• 1:07:19
  Speaker 1: a on a treadmill with a mask on, and then
• 1:07:22
  Speaker 1: you like run to exhaustion and that will measure your
• 1:07:25
  Speaker 1: vo your vo two max.
• 1:07:26
  Speaker 2: Don't threaten me with a good time people.
• 1:07:28
  Speaker 1: People don't really people don't really do that. There's no
• 1:07:31
  Speaker 1: reason to do that. But if you have a wearable
• 1:07:34
  Speaker 1: they'll like and you start exercising more. This is a
• 1:07:36
  Speaker 1: number of people will see move. It's like a good motivator.
• 1:07:39
  Speaker 1: I would guess yours is like forty five is okay?
• 1:07:47
  Speaker 2: What's yours?
• 1:07:48
  Speaker 1: Fifty five?
• 1:07:49
  Speaker 2: Oh, all right, that's fine. I don't really know what
• 1:07:51
  Speaker 2: that means, but I'm flattered that you're going to give
• 1:07:53
  Speaker 2: me ninety percent.
• 1:07:54
  Speaker 1: Yeah, it's like, you know, truly like exceptional elite athletes
• 1:07:59
  Speaker 1: will be like the eighties, but that would be like
• 1:08:01
  Speaker 1: very unusual. This sort of average for people is in
• 1:08:04
  Speaker 1: the thirties.
• 1:08:05
  Speaker 2: Have you done the full mask?
• 1:08:07
  Speaker 1: No, No, I didn't. I did consider it, but I had
• 1:08:08
  Speaker 1: trouble finding a lab because I'm crazy, and I ultimately
• 1:08:13
  Speaker 1: decided there was no point in knowing that number except
• 1:08:15
  Speaker 1: to tell you to say it on a podcast and
• 1:08:18
  Speaker 1: just noigher than I am. I'm regretting it, but I
• 1:08:22
  Speaker 1: was able to I was able to assert that I
• 1:08:24
  Speaker 1: was ten point higher than you with no evidence.
• 1:08:26
  Speaker 2: Emily and I are doing a VO two max competition.
• 1:08:29
  Speaker 2: I will probably die. That's it for us today. We
• 1:08:35
  Speaker 2: are actually off. Next week we'll be rerunning a classic episode.
• 1:08:38
  Speaker 2: It's definitely worth a listen, enjoy the end of the summer.
• 1:08:43
  Speaker 1: It was great to see in person today, and I
• 1:08:45
  Speaker 1: want to thank the audio engineer here at Eale, Ryan McAvoy.
• 1:08:48
  Speaker 2: Thanks Ryan.
• 1:08:50
  Speaker 1: Wellness Actually is produced in association with iHeartMedia. Our senior
• 1:08:55
  Speaker 1: producer is Tamar Avishei. Our executive producer at iHeart is
• 1:08:59
  Speaker 1: Jennifer Bassett. Our theme music is by Eric Deutsch, and
• 1:09:02
  Speaker 1: our content is for educational purposes only.
• 1:09:05
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• 1:09:08
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• 1:09:16
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• 1:09:20
  Speaker 2: head over to Wellness Actually dot fm and leave us
• 1:09:23
  Speaker 2: a question for our mailbag or suggest a topic for
• 1:09:25
  Speaker 2: a future show.
• 1:09:26
  Speaker 1: We'll let the influencers have the last word.
• 1:09:29
  Speaker 4: You see class my line, disease turned out to be psychosomatic.
• 1:09:34
  Speaker 1: Does that mean you're crazy? Oh, that means he was
• 1:09:37
  Speaker 1: faking it. No, actually it was a little of both.