- There are many different kinds of medical tests that were mentioned in this chapter; would you trust the results from all tests equally? Please explain with an example.
- What point is she trying to make by focusing on Lyme disease?
Friday, May 20, 2011
EPTAS after chapter 8
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I would definitely not trust the various medical tests discussed in this chapter equally. In fact, the only tests mentioned that I would trust at all would be those that Dr. Bockenstedt used to find an alternate diagnosis for Carol Ann: blood tests for bacterial infections and X-rays for rheumatoid arthritis. Those seemed fairly decisive and indicative that the only possible diagnosis was polymyalgia rheumatica (though ironically, that diagnosis was made only by eliminating every other option, including Lyme disease). I would not trust the test for Lyme disease at all. There are actually two tests that have to be made, the ELISA test and the Western blot test, which already suggests some inexactness. More importantly, neither one actually tests for the bacteria itself; both test for the matching antibodies, meaning there is a huge margin of error. If the tests are done before the body has time to produce the antibodies, they will be falsely negative. The ELISA test can also show false positives in response to the presence of bacteria that are related to but distinct from the Lyme disease bacteria. The Western blot test is also imprecise, because it tests for antibodies that match the building-block proteins of the bacteria, and these proteins can be the building-blocks for other bacteria too. And furthermore, the longevity of the memory cells that the immune system produces after fighting off Lyme disease means that a person can test positive for Lyme disease years after their body has eradicated the bacteria. The point that Dr. Sanders is making with the example of Lyme disease is that diagnoses are not made by tests, they are made by a good thought process. Yes, the tests can sometimes indicate whether a person has Lyme disease, but they are so convoluted and error-prone that alone, they should neither confirm nor deny that diagnosis. What is more important is to consider not only a patient's symptoms but also their full medical history, current lifestyle, and the multitude of other diseases that could cause similar symptoms.
ReplyDelete- Dan Cohen Period 4
ReplyDeleteThis chapter was filled with controversy. We tend to assume that the tests that we use in medicine today are fool-proof and that they always work. However, some tests, such as the tests for Lyme disease, are highly controversial and do not work with a simple yes/no answer. For Lyme, there are a series of requirements and if the patient scores 5/10 or higher, there is a good chance that they have Lyme. I think it is a little strange that Dr. Sanders makes it seem that there is absolutely no chance for a person to have Lyme if their score is less than a 5. I think that Dr. Sanders makes an excellent point in this chapter but that the same time I know a lot about the controversy (my sister is going through what Carol Ann went through with antibiotics)and I think that you have to read this chapter and its arguments about Lyme with a grain of salt for consideration.
Dr. Sanders is trying to make the medically important point that "Lyme literate" doctors tend to rely on a broad set of symptoms and make a diagnosis that way. Sanders says that these doctors give their patients some kind of certainty on a diagnosis and that makes the diagnosis believable. Patients do not ever want to hear "I dont know" from their doctors and they will be willing to believe a shaky diagnosis in order to be certain.
I want you guys all to know from a personal perspective what this controversy is really like. My sister had Lyme disease almost 8 years ago and the same symptoms came back suddenly. Sanders misses a key point that Lyme literate doctors argue. The study that Sanders cites in this chapter is viewed as flawed by the lyme literate doctors because they believe that only extremely long-term antibiotic treatment (longer than the 6 weeks that was given to the patients) can be successful in treating long term lyme. Sanders might dismiss this belief as part of the mindset that she opposes but the "Lyme literate" doctors have had success with long term antibiotic treatment. I am just saying this so you guys know the other side of the argument as well.
In terms of using a "get 5 out of 10 and you have Lyme disease" test, I find that extremely iffy. That's barely enough to convince me I have a disease. Also, in Dr. Davidson's case, he doesn't even follow the 5 out of 10 guideline. He tells her she's positive of Lyme disease even though she only has 3 out of 10 antibodies. I feel like that's very bad practice. How does this help his patient at all?
ReplyDeleteBy focusing on Lyme disease, she made it clear how testing can both help and hinder doctors in making good diagnoses. In the case of Lyme disease, the test hinders the creation of a better diagnosis because the not so credible test persuades so many people that they have a phantom disease. However, other tests and research point out that chronic Lyme disease is an unlikely diagnosis.
Chapter 8 of EPTAS is about the difficulties of testing accurately for Lyme disease. Neither of the two tests for Lyme disease described in the chapter seem all that reliable to me, and I would certainly be hesitant to trust either of their results alone in making a diagnosis. Because of the ambiguity of both the ELISA and Western blot tests, which can have both false positives and false negatives (if the disease is treated too early on), I would not be likely to trust them completely, and even less if there were evidence of a different ailment provided by other tests, like x rays.
ReplyDeleteBy focusing on Lyme disease, Dr. Sanders is trying to make a point about the ambiguity of medical test results. I also thought the extremely heated nature of the controversy over "chronic Lyme disease" was very interesting. The mainstream doctors' dismissal of the "Lyme literate" doctors' views (which did seem pretty justified) and the "Lyme literate" doctors' fervent adherence to these views illustrated how difficult it can be to come to a consensus in medicine, even when the evidence seems relatively clear. The fact that the "chronic Lyme disease" had such a huge effect on patients' lives (and on doctors' reputations and jobs) made the debate so emotionally fraught that it was difficult for both patients and doctors to figure out what was in the patients' best interests.
Alyssa Park Period 3
ReplyDeleteIn chapter 8, Dr. Sanders addresses the problems of diagnosing patients by focusing on a specific case of Lyme disease. After reading about the tests carried out to test for Lyme disease, I was surprised and a little disappointed that there were doctors out there who would try to trick both their patients and themselves into believing that the diagnosis for Lyme disease was pretty definitive when in fact the tests proved virtually nothing. The two most used tests, ELISA and the Western blot test, do not seem adequate at all to conclude that someone should or shouldn’t be treated for Lyme disease. As Dr. Sanders says on p. 175, these tests measure the number of antibodies and not the number of bacteria cells, which are the cause of this disease. If I were the patient and knew how my doctor tested for Lyme disease, I would definitely not trust my diagnosis. Unfortunately in Mary Ann DeVries’ case, her doctors convinced that she had Lyme disease, even though her test results didn’t clearly point to a case of this disease. It is disappointing that doctors would be so liberal in prescribing medicines that can have serious consequences, leaving the patient in a worse state than he or she had originally been in.
By focusing on Lyme disease, Dr. Sanders is trying to illustrate to the reader that while many of us completely trust our doctors to make correct diagnoses, in several cases these diagnoses could be incorrect and may result in dangerous consequences if not corrected soon. Using a specific story in which such a diagnosis was close to ending in disaster, Dr. Sanders skillfully convinces the reader that this fear of uncertainty is actually a serious problem even in our current society, a problem that we should definitely not look over. She is also suggesting that doctors focus on coming up with more accurate, trustworthy tests that will allow us to make more certain diagnoses for cases like Lyme disease.
This chapter focused much on the difficulties and ambiguity of modern medical tests; particularly, Sanders devoted much of this chapter to discussing the inadequacies of tests for Lyme disease. I found it quite interesting that Lyme disease is this difficult to test for, for I previously assumed that it was a simple blood culture. Two main tests for Lyme disease Sanders mentions in this chapter are the ELISA (enzyme-linked immunosorbent assay) and the Western blot test. The former focuses on the antibodies one’s immune system produces when invaded by the Lyme bacteria. The latter test attempts to search the body for proteins that make up the Lyme bacteria. Both of these tests have standards set by the CDC that try to differentiate a positive result from a negative one. However, I feel as though the ELISA is less reliable than the Western blot test, despite the gross limitations of both tests. The ELISA is trying to find antibodies that the body produced as a result of the Lyme bacteria. Sanders makes the point that antibodies hang around for years and can lead to a false positive. Second, if one were to get rid of the infection via antibodies, one could never be sure on had the disease in the first place. On the other hand, I feel like the Western blot test does a little bit of a better job in terms of testing for Lyme disease. The Western blot test tries to find the proteins that the Lyme bacteria are made up of, and a positive for more than 5 proteins strongly suggests one has contracted Lyme disease. I feel that the results of this test are much more dependent on whether one currently has Lyme disease, and will be more reliable (most of the proteins are only around during infection). In terms of results, I feel that these tests did a pretty poor job of testing for something definitively. That lack of definitiveness is one of the main points of this chapter.
ReplyDeleteI feel as though Sanders is trying to tell everyone that not every common disease is simple. This chapter shows how one of the most common and treatable diseases can become a nightmare of controversy and debate if doctors cannot agree on tests and symptoms, especially if the tests and symptoms themselves cannot agree. Sanders has shown that the reality of diagnosing and treating simple diseases is a complicated one, and that the proper diagnosis can still fail if doctors are so willing to compromise. Specifically, I think that the stories of Carol Ann and Will Hammer show how Lyme disease can be easily misdiagnosed, especially when doctors throw a bunch of symptoms and “padded” test results together to fit an easy diagnosis.
In this chapter Dr. Sanders focuses on the problems of testing for Lyme disease. After reading about the ELISA and Western blot tests and their indefinite/inaccurate results it shocks me that we have not found a more accurate and honest way of diagnosing Lyme disease. As dr. Sanders has said before we are currently undergoing massive changes in the medical field through the discovery of new and effective technology; given that, I feel that we should have progressed beyond a point scaled test to diagnose a possibly fatal diseases.
ReplyDeleteHowever, I think Dan touches on an extremely relevant and pressing issue; and that is societies pressure on doctors to be all knowing, all curing, and unwavering. Patients go to a doctors with the expectation of leaving with a diagnosis, a medication and in a few days, cured. But this mentality is rash and amateur. While i do believe that there may be a better way to administer the diagnostic process of Lyme disease, and there is a better way to deal with a pushy patient than to simply saying yes or no, I do think that society has put a great deal of pressure on doctors to have the sole task of diagnosis the problem fast and resolute and handing over the all curing medication.
In Ch. 8, Dr. Sanders illustrates the difficulty of correct diagnosis by using an example of lyme disease, mentioning several tests that are used as a diagnostic tool, such as ELISA and Western Blot. I agree that a sense of relief can come from a diagnosis, because it provides at least a definite answer to the seemingly endless process of diagnosing a disease. However, the seemingly arbitrary nature of the two tests used to diagnose lyme doesn't give me much faith in their ability to diagnose something. As Dr. Sanders states, ELISA can often come up with false positives. Furthermore, Western Blot works on a point-scale, where 5/10 or above is identified as a case of lyme. What if someone had 4/10? This seemingly random cut-off point wouldn't give me any security in terms of a diagnosis, and I would be hesitant to trust two vague tests. Dr. Sanders also discusses the argument over the "chronic lyme," which may or may not be an illness to begin with. The vague nature of both the diagnosis and the knowledge of the disease would leave me very hesitant to trust any diagnosis or explanation of symptoms, because it seems like doctors themselves aren't too sure.
ReplyDeleteUsing lyme as an example for the larger problem of diagnostic tests as a tool for a diagnosis illustrates the struggle quite clearly. We follow Carol Ann in the stressful process of searching for a diagnosis, and are able to see the many times doctors essentially ignored or dismissed her. Lyme is definitely representative of a larger trend, that represents often vague tests that are too heavily relied on, and controversy on medical facts that often leaves thousands of patients caught in the middle, without any real answers.
In chapter 8, Sanders discusses the ambiguity of diagnosis through testing, specifically in the case of Lyme disease. There is no definitive test for Lyme disease, and most doctors diagnose through two tests (if the patient is positive in both, he/she is diagnosed with the disease). Yet the two tests don't test the presence of the disease its self, only the antibodies the body produces in response. Many of the doctors presented in the chapter who are "Lyme literate" don't seem to understand the complexities of the two tests, and often diagnose based on less than firm results of one rather than both tests. If I was ever forced to diagnose (or accept a diagnosis), I would trust the results only if multiple tests showed up firmly positive, and if all other diagnoses were ruled out. I would also try to get a second (third?) opinion on the diagnosis to make sure that other possible diseases and paths of treatment had been ruled out.
ReplyDeleteI think that Dr. Sanders discusses Lyme disease in such great detail because it clearly demonstrates the nuances and imperfections of medical diagnosis. Though the example of Lyme is extreme in terms of its lack of clarity, it shows that medical tests are far from perfect. Before reading the book I had thought that most diagnoses were fairly clear, and that tests would be able to show most diseases. Yet the chapter made me see just how nuanced the process of diagnosis is, made me doubt some of the seeming securities of medicine. Sanders discussed the painstaking process that so many, including Carol Ann, had to go through in order to receive a diagnosis that proved unhelpful and expensive. I think the example of Lyme shows exactly how irksome medical procedures can be. Her many examples of Lyme literate doctors also show the necessity of finding doctors who are well educated and trained in a specific field (its shocking to think that so many could be leading their patients astray).
The topic of a "5 out of 10" disease that the author brings up is hardly accurate. Just because a patient exhibits a certain amount of symptoms does not mean in any way that they DO without a reasonable doubt have lyme disease.
ReplyDeleteI believe that the use of lyme disease in particular was advantageous to the author because lyme disease and the used examination perfectly accentuated the problems that these ineffective exams have inherent.
Tests for Lyme disease are difficult to interpret results from because the bacteria, burgorferi, doesnt grow well in culture and therefore cannot be easily diagnosed. Instead, doctors perform tests depending on the body's response to infection. The first test, ELISA, detects antibodies and invading bacteria in a person's blood. However this test cannot distinguish between burgorferi and its look-alike bacteria. Therefore a second test is needed, called the Western blot test. This test also looks at antibodies. The standards for interpreting the Western blot test are if hte person is found to have antibodies up to five out of the ten proteins commonly tested for, then the patient is considered to have Lyme disease. I would not trust the results from these tests, doctors themselves aren't confident interpreting the results. For example, in the case of Carol Ann, even with the tests showing only three instead of five proteins, she was considered to have Lyme disease because doctors wanted to be able to have a firm diagnosis.
ReplyDeleteThe example of Lyme disease is used because of the nature of the bacteria is so hard to detect. The diagnosis for this has historically become a controversy and serves as a prime example of the "phantom disease" epidemic in medicine. Doctors trying to satisfy themselves and the patient will force a diagnosis instead of leaving both parties trapped in unsettling uncertainty.
As Sanders stated in this chapter, it would not be a great idea to trust any one of the Lyme disease tests on its own, because no single test can rule out the other possibilities. However, if all the tests agree on whether or not the patient has Lyme disease, I guess those tests would have to be trusted, mostly because at that point there is nothing better to go on. Those tests are still in use simply because they are the most accurate/only tests currently existing that could possibly even try to confirm a diagnosis of Lyme disease. However, the tests may be more or less accurate depending on how exactly the doctor uses them, as shown in the case of Carol Ann. I guess that the best test of a diagnosis is whether the treatment that follows it actually treats the patient. If the problem lasts for two years through all the antibiotic treatments as it did for Carol Ann, then I think the patient and doctor should probably consider other possibilities for a diagnosis.
ReplyDeleteI think that, by focusing on Lyme disease, Sanders is trying to highlight the problem of the inaccuracy of tests and the controversy that they cause. Lyme disease is perfect for the case that she is trying to present because even after the various ways of coming to a diagnosis, that conclusion can be very shaky. There is also evidently a huge amount of controversy surrounding the tests, as well as the nature of the disease itself.
After reading about the ELISA and the Western blot tests, I am not so sure I would trust the results. Because the Lyme disease bacteria don’t grow well in culture, doctors test for the disease through detecting antibodies to the invading bacteria. But this test is not accurate, as it can’t differentiate between the Lyme bacteria and several others. Thus, a second test is administered: one which looks for antibodies to the individual proteins of the Lyme bacteria. Although the usage of these two tests together increases the chance of a correct diagnosis, they are still by no means accurate or trustworthy, as demonstrated in Carol Ann’s story.
ReplyDeleteDr. Sanders uses Lyme disease as an example of the controversial aspects and unreliability surrounding tests of a hard-to-diagnose disease. Lyme disease demonstrates the limitations of diagnostic testing. She also uses it to demonstrate how humans, and doctors are no exception, are uncomfortable with uncertainty. This discomfort could easily be a factor in the unwillingness of the “Lyme literate” doctors to accept the evidence that “chronic Lyme disease” doesn’t exist and shouldn’t be treated with continued antibiotics. Although test results can be reassuring, they are not always reliable. Carol Ann took comfort in Dr. Davidson’s confirmation of her Lyme disease diagnosis, despite the unreliability and inconsistent pattern of the symptoms.
In ancient times, doctors relied on history taking and physical examination to make diagnosis. Nowadays, doctors are relying more and more on diagnostic tests and imaging to make diagnosis. Generally speaking, I think that the medical tests could be trusted. Medical tests, however, have to be used with caution. When we use a medical test, we need to be aware of the accuracy of the test since there is no perfect test. We need to know how frequently the test will show up negative in patients who truly have the diseases. On the contrary, we need to know how often the test will show up positive in patients who do not have the disease. We should also interpret the test in the right context. As Dr Sanders mentions in the chapter, a negative test early on in Lyme disease has no meaning. The use of treatment may also render the test negative.
ReplyDeleteDr Sanders uses Lyme disease because it is a controversial disease. Confirmatory tests are not far from accurate. People could have recurrent symptoms for years even when there is no active infection. Doctors in mainstream medicine have no solutions. A handful of doctors(ie Lyme literate) offers slight hope to desperate patients although the approach is not supported by studies. Dr Sanders is right. Doctors do not feel comfortable with uncertainties or “no answers”. When a patient does not present like the textbooks describe, he will be abandoned being told that “ all your symptoms are in your head”. In cases like this, doctors should recognize the limitation of medicine and be willing to help the patient by providing tender,loving , and care even when he does not fit into any category.
In chapter 8, Lisa Sanders focuses on Lyme disease to convey two specific things. First, Sanders discusses ELISA and the Western blot test, both of which search for Lyme disease, to further accentuate the fallibility of diagnostic tests (to, ultimately, empower the physical examination, in case we didn't get it the first seven chapters). Second, she examines Carol Ann’s failed treatment plan (as prescribed by Dr. Davidson) to debunk the phantom illness of “chronic Lyme disease” and the treatment plan intended to “cure” it. The main issue with tests like ELISA and the Western blot test is that they fish for Lyme disease indirectly. As cited by Sanders, several complications can arise when looking for antibodies instead of actual bacteria. It takes some time for the antibodies to appear in the afflicted individual’s blood, so although the patient may exhibit all the symptoms of Lyme disease, the tests may still come out negative if they are conducted in the early stages of the disease. Furthermore, the antibodies linger long after the disease itself has been eliminated, a fact that may lead physicians to believe their patients still have Lyme disease when they, in fact, don’t. We are obviously led by Sanders to believe these tests to be highly unreliable.
ReplyDeleteAlthough Sanders is quick to vilify Davidson and his actions, she does not take the liberty of recommending what Davidson should have done. Yes, Davidson only found antibodies to three of the ten proteins found on the bacteria associated with Lyme disease. Sincerely, he acted on a hunch, and came up short. In this chapter Sanders even makes sure to establish the fact that neither the symptoms the patient presents nor the tests themselves are reliable, surefire indicators of Lyme disease. So what was Davidson supposed to do? Be a better diagnostician, according to Sanders. As per usual, Sanders portrays Bockenstedt, the one who makes the correct diagnosis, as the warm, sympathetic physician who values the physical examination and listens to the patient’s story “without interrupting.” However, the only difference between Bockenstedt and Davidson is that she gets a heads up on the fact that two years of Lyme disease antibiotics proved to be a bust. Quite plainly, Sanders viewed Davidson’s error as an opportunity to claim that he and his “Lyme literate” buddies were wrong about “chronic Lyme disease” and she was right.
I would not trust the results from all tests equally; the traditional Lyme disease tests Sanders describes, for example, seemed less than reliable. The ELISA and Western blot test combination would make more sense to me if they weren't searching for the antibodies instead of the bacteria, and the fact that they can't even reliably find the specific antibodies for Lyme disease is also not promising. They provide so many ways for a diagnosis to go wrong that I don't think I would trust them at all on their own.
ReplyDeleteSanders focuses in on the complexities of testing for Lyme disease because there happen to be a lot of them, and there's a lot of controversy surrounding the "Lyme literate" specialists to this day. Because the Lyme disease tests are so uncertain and because there can be a lot of confusion and mystery surrounding diseases that perhaps resemble Lyme disease but are in fact something else entirely, there are a lot of opportunities for patients to get mixed up and receive incorrect diagnoses, so it's a prime example of people accepting any diagnosis simply because they want to be cured. It demonstrates how some doctors (the "Lyme literate") will capitalize on the worries of the quick-to-believe, and how more reliable tests are much needed for some illnesses.
I thought this chapter was really interesting and highlighted a very crucial point: the ambiguity of medical tests (as stressed by the two tests for Lyme disease). The ELISA and Western Blot tests are both incredibly inconclusive, posing a difficulty in believing the diagnosis that comes from either of the tests. I actually worked specifically with the Western Blot and ELISA tests last summer (but with HIV) and can personally vouch for the ambiguity of the tests. The ELISA test results are reported back as a number, so the primary issue there is the cut off point (you have to say that a concentration of however many ng/mLs and above is positive, anything lower than that is negative) which is really just an arbitrary number and leaves a lot of room for error. For Western Blotting, after having separated the proteins, the results are based on the presence of bands representing differently massed proteins (or the lack thereof). These bands signal certain proteins in tissues and cells, and the diagnosis is based off of how clearly you can see a band representing a specific protein, and the results can very often be difficult to read (the bands can be extremely light and can easily lead to false positives). So, from personal experience, even though not testing for Lyme Disease, I can say that these tests being the basis of a diagnosis is a very worrisome topic.
ReplyDeleteI also thought that the controversy described by Dr. Sanders about the "Lyme Literate" doctors vs. mainstream doctors was interesting - and emotional. Not being able to have unwavering trust in one's doctor (as it should be) poses a very heavy issue to the patient - given this particiular diagnosis... they want to be healthy and safe, but also don't want a FALSE diagnosis. I can see how this would be a very emotional and trying issue, and really stresses the need for more reliable tests (and doctors).
This chapter really made me question the Lyme disease test. I don't know how I feel about the 5 out of 10 test. I think it's really odd that the doctor didn't even follow the requirements for the test. The ELISA and Western Blot tests were really inconclusive and i think that they seem a little pointless. They might work for some people, but they seem a little mysterious. I think that Sanders focuses on Lyme disease because it is so controversial. If she had focused on a different disease, she would not have been able to make the point that some tests are not accurate. I was also surprised that Sanders didn't talk in great detail about physical exams. First time. I do not trust the Lyme disease test as much as I would trust the tests for another disease because it is so controversial.
ReplyDeleteThis chapter raised several interesting questions for me: would I rather have a test that has a high chance of false positive but might save my life, or would it be better to read the results differently and possibly avoid expensive and possibly unnecessary treatment. I certainly believe that it is, indeed, wise to use both the Western blot test and ELISA. My trust for the combined tests would be greater than the sum of my trust for them individually. That being said, they both seem fairly inaccurate. When compared for tests for other diseases, the tests for lyme disease seem terrible.
ReplyDeleteI believe that she focuses on lyme disease because it represents a huge problem in the medical community. My childhood friend moved to Canada several years back and was diagnosed with lyme disease. In Canada, it's not recognized as an official sickness, so she went undiagnosed for several years before getting results from here in the United States. As a result of the failure of the Canadian government to recognize the lyme tests as conclusive, she went untreated in the early stages, which are often the most crucial for this disease. I think she meant to prove that we simply just don't have all the answers figured out and we can't necessarily trust the diagnoses of every doctor. (This is why it is wise to seek a second opinion.)
As we've seen in pretty much every chapter to date in EPTAS, the physical exam is extremely important. Historically, that was all doctors in older times had to go off of in most cases and now, some worry it is becoming obsolete. This is not to say that tests are not useful tools, only that they have to be taken with a grain of salt. In most cases, tests like ELISA and western blot that were described in the chapter, are most accurate and effective when the doctor already has a good understanding of the disease. Tests might come back negative if the patient is tested too early when they have lyme disease. A doctor being aware of this might make all the difference.
ReplyDeleteI think what Sanders was trying to do most by using Lyme disease as an example was to show truly how inaccurate even the most experienced doctors can be. There is no perfect way to train every single doctor in the medical field especially with all the new developments that have happened in the last decades. It is difficult for everyone to come to terms with the fact that if they should fall ill, there is a chance they would not get the help, treatment, and diagnosis they need.
In this chapter, Dr. Sanders discusses the inaccuracy of testing, especially focussing on Lyme disease. By following tests such as the ELISA and Western Blot tests, doctor's are coming to ambiguous conclusions on how to diagnose their patients. When a patient receives a 5/10 or higher on the test, they are diagnosed with Lyme disease, however this is also implying that anything lower is therefore not Lyme disease. I agree with Kai, that it is surprising that with all the technological innovations occurring in the field of medicine, doctors are unable to come up with a much more accurate and reliable test than this 5/10 scale. I also agree with Dan, that a lot of this inaccuracy in the testing is almost encouraged by patients who believe in it. Patients do not like to think of their doctor's as unknowing. So when a doctor tells a patient, with full confidence, even if he/she is unsure of the diagnosis, that the patient has or does not have Lyme disease, a patient will believe it. And this easy persuasion does not encourage doctors to search for more accurate tests.
ReplyDeleteI found it troubling that the ER doctor was so quick to jump to the conclusion that Carol Ann DeVries was suffering from Lyme disease, putting her on intense medication without even takingn the time to perform a physical examination on her or ruling out other possible illnesses. Then again, when the antibiotics were not alleviating the pain she was feeling in her joints and the weakness she was feeling throughout her body, Dr. Davidson the Lyme specialist opted to continue putting her on antibiotics, trusting his knowledge of the typical symptoms of Lyme disease and the fact that it is particularly common in that region to diagnose DeVries. When her results came back negative, but the doctors decided to rule her case as positive anyway, I realized how unreliable the system of testing for Lymes really is. The 10 point system for the ELISA gives little more certainty of having the disease than does the first doctors rushed diagnosis.
ReplyDeleteOut of all the tests mentioned in this chapter, there are a couple that I would probably be less likely to trust. Neither the ELISA nor the Western blot test seemed particularly helpful for diagnosing lyme disease, as neither test is specific to lyme disease. Testing for a body's response to a disease rather than the actual cause of the disease does not seem like the best method for diagnosis, especially as it can go wrong so many times. I would be more likely to trust the results from the test for PMR- although, as the author points out, there is no test for PMR. If doctors can rule out all alternatives, and a patient's symptoms match the typical symptoms for a disease, I do think that is a valid method for diagnosing a patient.
ReplyDeleteBy focusing on lyme disease, I think Sanders was trying to illustrate the failings of the medical profession to understand a disease, and therefore their misguided attempts to cure said disease. Even though we usually trust doctors completely, the fact is that they are only human, and they can't know everything, and we can't expect them to. However, I don't think that the way they handle lyme disease- by giving out unconfirmed diagnoses, and years of antibiotics that don't help- is the way for them to act.
Looking back on the numerous tests discussed in in Chapter 8, I think I would have a difficult time trusting the results from the various tests equally. Each test is different (as it tests different things and provides different results); therefore I think that trusting the wide array of tests equally is not reasonable. For example, although the ELISA and Western blot tests are testing for the same disease (Lyme disease) they give different results that still cannot fully be trusted in making a diagnosis. The ELISA test detects antibodies to the foreign bacteria or virus in a person’s blood, but it cannot tell the difference between the bacteria that causes Lyme disease (Borrelia burgdorferi) and its relatives that appear to be the same. Because of this, a positive result to the ELISA test does not guarantee that the patient has Lyme disease. The second test—the Western blot test—also looks at antibodies, but it cannot identify some of the proteins that make up the Lyme bacteria. Also, these two tests look at antibodies, which makes it difficult to diagnose Lyme disease in its early stages.
ReplyDeleteI think that by using Lyme disease as an example, Dr. Sanders is trying to make the point that many diseases don’t have a test (or tests) that can immediately lead to a diagnose. Her focus on Lyme disease illustrates an example of a disease that is difficult to diagnose because of the tests that are not completely reliable.
I wouldn't trust the tests that Dr. Sanders describes in the chapter individually. as she points out several times in the chapter, the two types of tests that test for Lyme diseases only test indirectly, by looking for antibodies produced by the body to fight off Lyme disease (in the case of ELISA), or by looking for specific proteins produced by the lyme disease bacteria (as in the Western Blots test). In addition, the Western blots test has to be administered several times, in order to ensure that all of the relevant proteins are present. In conclusion, i wouldn't trust the results of each test individually, but combined they can make an accurate diagnosis.
ReplyDeleteI think that by using Lyme disease as an example, Dr. Sanders is trying to make the point that it's not necessarily the individual tests that make the diagnosis, but how the doctor connects the dots between the information provided by the tests
In chapter 8, Sanders further delves into the process of diagnosing patients by discussing Lyme disease and the tests that are used to determine if a patient has it. Although as a patient I would prefer the sense of relief and hope provided to me by a sure diagnosis, I don’t trust either the ELISA or the Western Blot tests for Lyme disease. The Western Blot scale operates on a 10 point system, in which a score of 5 out of 10 is enough to determine that the patient has Lyme disease. This test seems sort of random because the of the cutoff point being 5 and also the fact that Dr.Davidson tells his patient that she has Lyme disease when she only had 3 points just exemplifies the uncertainty that goes along with this test. Dr. Sander’s uses Lyme disease to emphasize the point the diagnostic process and diagnostic tests are chalk full of vagueness and ambiguity. This example shows that patients cannot always get the answer they need or want from their doctors and that the ineffectiveness of these tests hinder doctors from being able to fulfill that need/want.
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