Posted on 05/13/2008 12:12:14 AM PDT by antonia
DanburyNewsTimes
Article Last Updated: 05/12/2008 04:14:20 AM EDT
Lyme disease care under fire
Medical groups differ on courses of treatment
Connecticut
By Robert Miller Staff Writer
In the battle over how best to treat Lyme disease, a new settlement between Attorney General Richard Blumenthal and a major medical group might seem to offer at least a little hope of expanded treatment for those with the tick-borne disease.
That, however, would involve a change in the lines of debate over the disease, and it's not clear there will be any yielding.
The settlement, reached this month between Blumenthal and the Infectious Diseases Society of America, provides for a review of the IDSA's guidelines for treating Lyme disease -- guidelines that a second group of doctors, the International Lyme and Associated Diseases Society, say are strict and inflexible to the point of harming some patients.
But the IDSA's guidelines will remain unchanged until that review ends. And while the review process will include the participation of an ombudsman, the guarantee that opposing voices will get their say, and hearings that will be broadcast on the Internet, they may not yield a single change, said Dr. Eugene Shapiro, a pediatrician, epidemiologist and professor of investigative medicine with the Yale School of Medicine in New Haven.
Asked last week if the IDSA guidelines could remained unchanged after the review, Shapiro said flatly, "Yes."
" If the scientific data recommends a change, we'll be happy to change," Shapiro said. "But we have 25 years of research on Lyme disease. We feel very comfortable the guidelines will stand up to any scientific scrutiny."
Doctors who are opposed to the IDSA guidelines said they believe there's at least a chance their position -- that infection from the Lyme disease bacteria Borrellia burgdorferi can create a chronic illness that needs long-term treatment with antibiotics -- will gain some credence with the review panel.
" I hope it will lead to an improvement to patient care," said Dr. Steven Phillips of Wilton, who has been one of the doctors opposing the strict guidelines in favor of those in which doctors can tailor treatment to individual patients.
Phillips is a past president of the International Lyme and Associated Diseases Society, which believes there is ample scientific evidence to treat people for chronic Lyme disease.
" We've looked at the same evidence as IDSA and come up with significantly different conclusions," said Dr. Daniel Cameron of Mount Kisco, N.Y., the current president of the group.
This isn't a merely a spat between two opposing medical groups.
In a press release, Blumenthal's office pointed out that insurance companies now use the IDSA guidelines to restrict care for patients and refuse to pay for long-term antibiotic care.
" It's a good way to have people denied insurance," said Maggie Shaw of Newtown, a member of that town's Lyme Disease Task Force. "It also puts the fear factor in doctors.
" Here are two standards of care, but only one gets recognized," Shaw said. "It's because of the stranglehold the IDSA has on this."
The settlement between Blumenthal and the IDSA came after Blumenthal sued the group -- which represents about 8,000 infectious disease specialists in the United States -- in 2006 for antitrust violations.
Blumenthal said his investigation discovered many examples of conflicts of interest among the doctors who wrote the IDSA guidelines. He also said they refused to "accept or meaningfully consider" any evidence concerning chronic Lyme disease in writing the 2006 guidelines and blocked the appointments of scientists and physicians who differed with the IDSA view that all Lyme disease can be treated with two to four weeks of antibiotics and that chronic Lyme disease does not exist." Our focus has not been on medicine but the process," Blumenthal said. "There may ha
ve been violation of the law and it's my job to enforce the law." Dr. Sam Donta, a Massachusetts-based infectious disease spe
cialist, was on the panel that drew up the IDSA guidelines. Donta said he refused to sign off on the guidelines when the group refused to acknowledge that chronic Lyme disease is a problem.
--The issue should not be whether there's chronic Lyme disease, but why we're seeing these patients," he said
The review process established in the settlement, Blumenthal said, will be "fair, open and free of conflict." Donta said Friday he hopes to serve on the panel.
But in its own press release on the settlement, the IDSA emphatically denies there was any "significant" conflict of interest on the part of any of the doctors who wrote the 2006 guidelines, or that they excluded conflicting points of view while writing them.
In fact, Shapiro said, having stricter guidelines means doctors who follow the IDSA protocols see patients fewer times and prescribe only short-term regimens of generic antibiotics.
Shapiro said the IDSA agreed to the settlement simply to end any attempt by Blumenthal to take the case to court.
" The alternative was spending a lot of money in an expensive lawsuit," he said.
Shapiro said all the scientific evidence on long-term treatment of Lyme disease, including five double-blind studies in which some patients got antibiotics and others a placebo, show that long-term antibiotics did not cure the symptoms that people include in the diagnoses of Lyme disease.
" It's not that data isn't there. It is," he said, pointing out that 95 percent of all Lyme cases are successfully treated with only two or three weeks of standard antibiotics.
But Cameron said the double-blind studies, all with a small number of patients, only show that Lyme disease is complicated.
" The evidence is quite mixed," he said.
And the trials often look at the effect of just one type of antibiotic on patients, Donta said.
" If one doesn't work, do you say all antibiotics don't work?," he asked. "If one cancer drug stops working, do you not try and find another? There's insufficient information in the guidelines for physicians to make a decision."
Phillips of Wilton said many peer-reviewed articles published in medical and scientific journals make the case that chronic Lyme disease does exist.
What they hope the new review of the IDSA guidelines do, they said, is take all this into account and give doctors a chance to treat each case individually, rather than with a one-size-fits-all approach.
" Let the doctors have some flexibility," Cameron said.
Contact Robert Miller
bmiller@newstimes.com
or at (203) 731-3345.
LYME DISEASE
The most common tick-borne illness in the United States.
Caused by a bacterial spirochete, Borrelia burgdorferi.
Spread to humans by the bite of the black-legged tick, aka the deer tick.
Can cause fever, headache and muscle ache in early stages.
Often, but not always, is accompanied by a rash spreading from the site of the tick bite.
In most cases is cured by a few weeks of antibiotics.
If untreated or undertreated, Lyme infection can cause arthritic pain and swelling of the knees and joints.
Number of reported U.S, cases in 2006: 19,931.
Number of cases that might actually exist could be up to 10 times the number of reported cases.
There is debate whether chronic Lyme disease -- a long-term infection that can cause fatigue, memory loss, depression, loss of vision and hearing, arthritis and heart ailments -- exists.
2007 Northwestern Connecticut Lyme disease cases
Bethel -- 14
Bridgewater -- 7
Brookfield -- 11
Danbury -- 22
Kent -- 26
New Fairfield -- 17
New Milford -- 73
Newtown -- 36
Redding -- 20
Ridgefield -- 30
Roxbury -- 8
Sherman -- 7
Southbury -- 16
Washington -- 15
Source: State Department of Public Health
One of the prettiest and most underrated actresses of the 50s, Diane Varsi, died of Lyme Disease...
Very good article. I hope that we continue to see the follow-up to this denial by Shapiro et al that they conspired to exclude the doctors who are on the front lines, and who KNOW that this is not a simple disease that goes away with 14-21 days of antibiotics. I had to travel to NY from CT to be treated by an ILADS doctor after my family doctor kept telling me that I had the flu in July. Only after I fortunately developed a rash (at the same time, I became sick enough to have heart troubles and not be able to walk unassisted, unbelievable to a 20-year old athlete!) did I go back, and they offered me 21 days of (too) low dose antibiotics and no more. It’s crazy. And would you believe that same family doctor is not offering prophylactic doxy doses for those bitten by deer ticks < 72 hrs ago?! Lyme causes strokes, heart problems, joint problems, etc.... and I can’t for the life of me figure out why there aren’t any R&D efforts going on to get a more reliable test, let alone a treatment! There is tons of money to be made here - over 50% of the deer ticks in this part of the state are infected.... and as we encroach on their habitat even more, more people are going to get sick. Attention Pharma!!!!!!!!!!
In brief: the often-cited Klempner study took a very small number of patients who had already had treatment failures with antibiotics (meaning they were difficult cases for whom antibiotics don't work well), then treated them for only 30 days with an IV antibiotic and for only two months with oral doxycycline, and then did a subjective symptom survey of the patients and other subjects who received placebo instead of antibiotics.
The study's authors then proclaimed that because the survey results didn't differ between the treated patients and those who received placebo, this proves that long-term antibiotics don't do anything for Lyme.
In reality, the study didn't really treat it's patients with anything remotely resembling 'long-term antibiotics', and picked an oral antibiotic that frequently fails to show results in those patients who experience antibiotic treatment failures. There were many other flaws- the Verim Research analysis summarizes some of them on page 6 and 7 of the PDF, which are a good introduction to the entire issue of Lyme treatment controversy.
Chronic Lyme patients who are lucky enough to have access to a lyme-literate doctor are often treated with 6 months to many years of antibiotics. For those for whom simple treatment doesn't work (and for some people it's specifically doxycycline or amoxycillin that don't work), doctors may progress to using combinations of antibiotics, or longer treatment with IV. Doxycycline is a first step for many patients but when it doesn't work more expensive antibiotics, and combinations of antibiotics, are usually prescribed by knowledgeable doctors such as members of International Lyme and Associated Diseases Society (www.ilads.org ).
The Klempner study was designed with many built-in conditions that seem designed to predispose it's small sample size of subjects to treatment failure, and the IDSA guidelines authors seemed to base their guidelines literature review on similar studies, hand-picked to prove their extreme position. When the 2006 guidelines were announced, the ILADS president produced a statement that there were something like 1800 good studies on Lyme treatment in existence, but that the IDSA guidelines authors had hand-picked the worst 400 to prove their point.
Dr Shapiro, Why would you turn tail and run if you are correct. Why don't you beg to go to court so you can prove to the whole world that you are the correct party.
The link below will explain why you can't go to court. One of our members wrote a time line of the IDSA work. Click on the link and go to IDSA time line of corruption.
After reading the IDSA time line of corruption ask your self if Lyme is cured in 21 days. Also,Read the papers from both camps that show treatment failure along with documents that prove the current testing will miss about %85 of cases at the web site www.lymecryme.com
If you know the test is about as good as a toss of a coin, then how do you prove that lyme is killed off??
ping
ping (for me too)
Ping whether you like it or not.
That is why my daughter, who is an RN, calls it "practicing medicine."
Carolyn
ping and there should be more like this discussing other medical issues.
These deer ticks are about the size of a grain of ground black pepper and are very extremely to difficult spot. I found that the best what worked best for me is short pants and liberal applications of insect repellant to skin clothing and shoes. Long pants just make it too difficult to spot the ticks or feel them once they get on you.
Avoid being bitten by a tick at all costs. They trasmit a whole host of parasites. If you are working in the yard. Take your clothes off when you are done, put them in the washer and take a shower while examining yourself for ticks. Rather than use a line trimmer for transitional areas of yards, switch to herbicide. Mow your lawn regulary so it doesn't get too high.
Lyme was only discovered in the 1970's. Prior to that, anyone with it was probably misdiagnosed with a variety of autoimmune contitions.
I've long suspected the legendary Marine sniper Carlos Hatchcock actually had an undiagnosed parasitic infection rather than autoimmune condition. Makes since for a man whose profession required that he lay on the jungle floor for days motionless all the time while being feasted on by insects.
As a doctor friend says:
Ticks are the most dangerous animals in Missouri.
The Infectious Diseases Society of America is well known.
I never heard of the International Lyme and Associated Diseases Society.
Long term antibiotic therapy promotes resistance to antibacterial drugs and can cause secondary fungal infections, e.g. thrush, vaginal candidiasis, systemic candidiasis, as well as secondary bacterial infections, e.g. Clostridium difficile enterocolitis which can cause toxic megacolon.
I would appreciate it if someone could show me 2 randomized, double blind, placebo controlled studies on chronic lyme disease treated with antibiotics.
That is why my daughter, who is an RN, calls it "practicing medicine."
Carolyn
We don't hear much about the 'art of medicine' these days, but excellent doctors know what it means. Patients figure it out, too, for the art of medicine transcends all else when an sick individual confronting death or disability looks to the physician and asks, "What's right for me?"Practicing medicine can be summed up in four principles: Mastery. Individuality. Humanity. Morality. By mastery, I mean expertise, not just experience; wisdom more than knowledge; and a creative way of thinking, ever alert to the reality that sickness is not as obvious as it seems. True mastery also encompasses the humility to listen and the studiousness to always learn and question.
The same but different. "Personalized medicine" is today's lingo for this, enabled and stimulated by human genomics and pioneering therapies that seek out and target differences among diseases commonly thought to be the same. Balancing commonness with individuality means uniform practice guidelines (beloved by billers and bureaucrats) are not chiseled in stone. And the best doctors respect but are not hidebound by statistical means that may fall short of responding to "What's right for me?"
So this is what we get in 2008 from the and the state of CT: The Infectious Diseases Society of America (IDSA) "the IDSA's guidelines for treating Lyme disease -- guidelines that a second group of doctors, the International Lyme and Associated Diseases Society, say are strict and inflexible to the point of harming some patients. "
Beware of nationalized healthcare!
“Beware of nationalized healthcare!”
Say it again...louder!
Many people who have taken the antibiotic long term treatment for their chronic Lyme Disease have enjoyed great success. If the medical profession would include a daily or even twice daily dose of Acidophilus and a cautionary diet which would included yogurt and no sugars, many of the digestive track problems, caused by the antibiotic killing the good gut bacteria, would be avoided. As for the fungal problems, it maybe that they could also be avoided by environmental considerations and exposures. maybe by just being sure not to touch or go into the the public arena would keep those chances of infection down when one is more vulnerable to such contaminations.
It seems to me that we all need to quit fiddling around and come up with a real cure. There are too many people who get lyme disease and too many who are told that there is nothing to be done for them; or worse yet, are given the medical profession's most insipid blow-off when they have no answer; that it is all in the patient's mind.
If there are no more Borrelia burgdorferi or antibodies be found according to the tests, and there are still problems how can the medicals be so arrogant as to assume that their test are absolutely accurate? The tests never are.
How is it that we know of the Borrelia burgdorferi, yet may or may not detect their presence accurately? Right there we can see that there is a huge problem with the research. They want us to believe that they can screw around with the genetics of our food, yet they can not account for this living organism, a huge giant bacteria compared to a gene, let alone the parts of a gene.
I am no scientist, but when we are given absolute, unconditional restrictions by some doctors, and than others enjoy success while ignoring these restrictions, and the ones who insist on the restrictions are also saying that they have no answers; that's not science, that's not mastery, that's about power. And power struggles should have no place in a patient's health.
The Centers for Disease Control and Prevention (CDC) consider Lyme disease the fastest growing vector-borne disease in the USA. By conservative estimate, the number of new Lyme disease infections per year maybe ten times higher than the 17,730 cases reported to the CDC during 2000 [1,2]. ~ http://www.ilads.org/files/ILADS_Guidelines.pdf
Sometimes I wonder if the greenies didn't come up with this to keep everyone out of the woods. But then I wonder how they can stand by while much of the wildlife is endureing life being coated in ticks.
We need to focus: [Ticks have many natural predators in the environment. Several wasp species will parasitize ticks, one species in particular (Ixodiphagus hookeri) has been studied quite extensively. The female wasp lays her eggs inside an engorged nymph. After the wasp eggs hatch, the larvae feed on the tick's internal tissues and then emerge, killing the tick in the process. Many species of spiders will also eat ticks if they can find them. Also, there are a variety of fungi and nematodes that also feed on and kill ticks while they are molting in the soil. Some of these organisms (in particular the fungus, Metarhizium anisopliae) are beginning to be intensely studied for their pathogenic effects. Birds will certainly eat ticks that they encounter during foraging. The most notable is the helmeted guineafowl, Numida meleagris. Studies have shown that these birds will readily forage on ticks (engorged and nonengorged).
Unfortunately, none of these organisms have any real success in controlling tick populations. In fact, some of them are only found in areas where ticks are super abundant. Hence, biological control agents are not yet ready for widespread use in tick management programs. The thought in some recent studies has been to augment some of these natural predators with other natural enemies. However, these studies have also met with varting degrees of sucess. Ideally, a well-designed tick control strategy would employ some use of natural enemies, mixed with targeted acaricide application, habitat modification and perhaps even host reduction. However, the right combination of these efforts will most certainly vary from one location to the next and be dependent upon available resources.] ~ http://www.visitmonmouth.com/mosquito/control.html
Many people who have taken the antibiotic long term treatment for their chronic Lyme Disease have enjoyed great success. If the medical profession would include a daily or even twice daily dose of Acidophilus and a cautionary diet which would included yogurt and no sugars, many of the digestive track problems, caused by the antibiotic killing the good gut bacteria, would be avoided. As for the fungal problems, it maybe that they could also be avoided by environmental considerations and exposures. maybe by just being sure not to touch or go into the the public arena would keep those chances of infection down when one is more vulnerable to such contaminations.
These problems that you bring up as reasons not to use antibiotics as a long term solution to lyme disease are side effects of a treatment that often has success where nothing is offered as a replacement treatment. This medical establishment considers chemotherapy to be the treatment of choice for many cancers and it is far more destructive to the body. It works by slowly killing someone, hoping that the diseased cells, the unhealthy cells will succumb before the person dies from the treatment. Now they can often finely focus it, but that is only a recent improvement.
Studies have shown that most patients diagnosed with chronic Lyme disease either have no objective evidence of previous or current infection with Borrelia burgdorferi or are patients who should be classified as having post-Lyme disease syndrome, which is defined as continuing or relapsing nonspecific symptoms (such as fatigue, musculoskeletal pain, and cognitive complaints) in a patient previously treated for Lyme disease. Despite extensive study, there is currently no clear evidence that post-Lyme disease syndrome is caused by persistent infection with B burgdorferi. Four randomized placebo-controlled studies have shown that antibiotic therapy offers no sustained benefit to patients who have post-Lyme disease syndrome. These studies also showed a substantial placebo effect and a significant risk of treatment-related adverse events. Further research to elucidate the mechanisms underlying persistent symptoms after Lyme disease and controlled trials of new approaches to the treatment and management of these patients are needed.
That link is to the complete article, not just the abstract. Enter chronic (lyme disease or borreliosis) into PubMed's query box. I'd start with review citations.
Perhaps it's analogous to poststreptococcal glomerulonephritis and the rheumatic heart disease folks used to get after strep throat. That's an autoimmune reaction after the strep pyogenes throat infection thought to be due to molecular mimicry.
By NICK RAVO
Published: May 3, 1988
LEAD: As warm weather and another tick season approach, health officials and citizens groups are pressuring state and local governments in Connecticut, New York and New Jersey to mount an aggressive fight against the rapid growth of Lyme disease.
In addition, 13 years after the disease was first identified in this country in Lyme, Conn.,companies have begun marketing pesticides aimed at its carrier, Ioxdes dammini, the deer tick. And researchers are trying to perfect a simple blood test for the difficult-to-diagnose disease, which can result in severe and prolonged symptoms and neurological and heart disorders.
Those efforts have been spurred by an increased understanding of the sometimes debilitating disease, which is spreading in infected areas.
''The public is finally becoming more aware about this disease,'' said Dr. Bernard W. Berger, a dermatologist in Southampton, L.I., who has treated hundreds of patients. ''They have demanded from politicians and health departments that they provide some sort of leadership in trying to control this illness.'' Disease Has Moved Inland
The pressure to increase funds for Lyme disease programs is strongest in areas where the illness is widespread: Connecticut, northern Westchester County in New York and in eastern Suffolk County on Long Island. Several private task forces have been formed in these areas.
Last week one of those private agencies, the Connecticut Task Force on Lyme Disease Awareness, in conjunction with the Arthritis Foundation, began educating people, particularly children, about the disease.
''One of the big things here is to tell people that it's not just a disease confined to coastal areas,'' said Nancy Vineburgh of West Hartford, a task force coordinator. ''It has moved inland.''
Colin Offenhartz of Chappaqua, N.Y., who has helped organize such a group in Westchester County, believes that fund efforts have been hampered because people who have not been affected by the illness often consider it a ''local pocket disease'' that strikes only a few isolated areas.
''We're trying to build up pressure so people realize it's not just a localized disease,'' he said. ''A lot more people are exposed to it than anyone realizes. People are getting it and are being told by their physician that they have something else.'' Money and Information
''It's absolutely stunning,'' said Assemblyman Richard Brodsky, a Democrat from Greenburgh who has been active in obtaining funds to fight the disease in New York. ''In places where it's endemic, knowledge about the disease is high. But in other places, people think you're crazy.''
In New York, where health officials believe that there have been more than 3,000 cases of Lyme disease since 1983, the Legislature appropriated $610,000 for research and the creation of a Tick-Borne Disease Institute, which will coordinate prevention, testing and treatment efforts. Last year it allocated $83,000 for research.
In New Jersey, where 217 cases were reported in 1986 and 327 in 1987, the Health Department is developing a proposal for education and treatment that may be submitted to the Legislature this year. So far legislators have not earmarked funds for the disease.
In Connecticut, which is believed to have the most cases in the region, the total is unknown because until this year doctors were not required to report cases and a shortage of funds prevented the state from collecting data in the last two years. In 1984 there were 444 known cases; in 1985 there were 614. Better Than Previous Years
The Connecticut General Assembly recently approved $200,000 to fight Lyme disease, compared with $20,000 last year. Half of the new money will be used for research; the remainder will help increase staffing of projects at the state's Department of Health.
''It's a good start,'' said Barbara Salthouse, a Public Health Committee legislative aide who has done extensive research on Lyme disease. ''It's better than anything we've gotten before.''
Lyme disease is a bacterial illness that has been fatal in only two cases, both of which had complications. From 1980 through 1986, the Federal Centers for Disease Control in Atlanta reported 5,692 cases in 35 states. Officials there estimate that the number of cases is increasing by 1,500 a year.
They also warn that the actual number may be significantly higher because the illness is often misdiagnosed or not reported to health officials.
The disease, which can affect horses, dogs and cows, as well as humans, is considered most prevalent on the Eastern Seaboard from Maryland to Massachusetts. Besides eastern Long Island and northern Westchester, the disease is unusually common along the Connecticut shore. #5,000 to 6,000 Cases ''I've seen an average of about two new patients a week since the last week in March,'' said Dr. Robert E. Levin, a rheumatologist in New London who has treated hundreds of Lyme disease patients. ''I think the total number of people that have gotten this disease in this state since it started has got to be at least 5,000 to 6,000.''
The most common symptom of the disease, usually visible a month after a deer tick bite, is a red rash, shaped like a bull's-eye, around the bite. Up to 30 percent of those bitten, however, do not develop the rash. Other early symptoms include joint pains resembling arthritis, fever, fatigue, headaches, nausea and vomiting.
The disease usually responds, after varying lengths of time, to antibiotics and sometimes disappears without medication. Left untreated, though, other symptoms can develop from weeks to years later. They include arthritis, facial paralysis, neurolgical problems and irregularities in heart rhythm. Most of those can be reversed with treatment, doctors say.
Some researchers fear that the disease may mimic a variety of other illnesses, like multiple sclerosis, brain tumors, Alzheimer's disease and amyotrophic lateral sclerosis, better known as Lou Gehrig's disease. Infection also does not give a victim immunity from reinfection, and in some cases the disease may reappear after seemingly successful treatment. Insufficient Evidence
Moreover some patients fail to develop the antibodies that might help a physician diagnose infection, and current blood tests for the disease have been marred by a high percentage of inaccurate results. Researchers at Cambridge Bioscience in Worcester, Mass., have developed what they believe is a more effective and much simpler blood test that will be available for researchers this summer.
So far most of the efforts to stop the spread of the disease are aimed at killing or repelling deer ticks. This spring, EcoHealth Inc. of Boston is test-marketing to 5,000 homes in northern Westchester a pesticide, Damminix, which its creators believe can eradicate a vast majority of ticks.
The product consists of cardboard tubes filled with cotton balls treated with an insecticide called permethrin. The tubes, which cost $195 for 50, are put out in a grid, 50 to an acre. White-footed mice, which are believed to be the primary carrier of the infection to the ticks, carry the balls to their nest, where ticks are often found in their larval and nymphal stage - the stages that present the greatest danger to humans.
Some researchers, though, are skeptical about the product, noting that it has not been tested widely and that mice have not been definitively shown to be the sole vector for the disease.
''It's like trying to control cockroaches in an apartment building,'' said Terry Schulze, a researcher with the New Jersey Health Department. ''Unless everybody does it, it's not going to be too effective.'' No Miracle Products
Another product is called Permanone, a permethrin-based tick repellent used on clothing by the Army. The repellent has not been approved by the Federal Environmental Protection Agency for general use, but its manufacturer, Coulston International of Easton, Pa., hopes for Federal approval by October 1989.
Meanwhile the product has been approved for special local use by 23 states, including New Jersey, and is being considered for approval in Connecticut. In New York an application was denied in 1984. State officials said the repellent did not qualify for special local use. They also questioned its effectiveness and believe the product could cause rashes.
In Suffolk County, however, health officials and local groups have urged the state to reconsider its decision. In Connecticut, which approved Permanone early last month, state environmental officials said they had no evidence suggesting the product could cause skin irritation.
''It is important for users to know that this is something that is sprayed on clothes - not something that is sprayed on the body,'' said Bradford R. Robinson, a senior environmental analyst with the State Department of Environmental Protection.
Researchers are also studying the application of the pesticide Sevin to kill adult ticks before they can lay eggs. Among its drawbacks are the need for precise seasonal timing in application and the need for special spraying equipment.
Many property owners have also called for a reduction in deer populations as a way of stopping the ticks. Many biologists, however, caution that the animal plays a far less significant role in the spread of the disease than the field mouse.
Authorities on the disease say the best precautions to take for avoiding the disease include clearing lands that are often used for recreation and, when entering any tick-infested area, wearing long pants, socks and other protective clothing - preferably white, so tiny nyphal and larval ticks can be spotted. The use of any pesticide containing the chemical Deet also is recommended.
As for miracle products that would wipe out the ticks or the disease in the near future, Mr. Schulze said, ''I don't see anything coming immediately.''
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