Wednesday, July 2, 2008

Merck? Schering?

I tried to give Pfizer a tip several months ago, but I haven't heard from them yet.

Here's my next big idea: Advantage for people.

This is my fourth summer in practice. It's clear that my practice sees more and more Lyme disease every year. Last summer I started catching some in kids too. Reported cases to the CDC have increased from 600 to over 1200 in my state. Likely some of this is increasing awareness, therefore increasing testing and increasing reporting, but the general sense is that the real disease burden is on the rise as well.

Lyme disease is carried by deer ticks. Generally, they need to be attached for at least 24-48 hours in order to infect the host. Unfortunately, they are so darned tiny that it's often very unclear how long they've been attached.

What scares me is not the disease that we catch, but the disease that we miss. I'm certain there are huge numbers of subclinical infections that never come to the attention of patients. Then there is a lot of mild disease that is interpreted as viral infection and allowed to resolve spontaneously. Full blown primary Lyme is pretty uncomfortable and most people seek medical attention, but even with that, presentations can be atypical and difficult to diagnose.

To boot, the testing for Lyme is far from ideal. False positives and false negatives abound. And trust me, no one wants to mess with secondary or tertiary Lyme, manifestations that can come up years and years later.

So, let's go for prevention. How about a monthly pill, a la Advantage for pets? Maybe they could even make it taste good so that we could apply it directly to patients' noses to be licked off.


rlbates said...

Dr Smak, I'd use it. I have often wished there was something like Frontline (the tick/flea stuff for dogs) or the Advantix (as you mention) for me (us humans) to use. I get more tick bites than my dog, because he is protected.

Laurie Anderson, RNP said...

A number of years ago I was the recipient of the Lyme vaccine, before it was pulled from use because of adverse events. In the two years prior to being immunized I had test-positive, active Lyme three times. I have never had it since and as far as I can tell I have had no ADR, although it is a good excuse for my sometimes "old-timers" memory ;>)

I work in a fairly busy ED in Southern Rhode Island. Although I am generally very judicious in my Rx's of antibiotics, I have a very low threshold for writing for 3 weeks of doxy, especially after mid May. Do my colleagues and I over treat? Probably. But as you point out missing disease is much worse and in an endemic area chances of exposure are very high.

Anonymous said...

My horse gets an immunization shot for Lyme disease every year. Why not humans?

hlnc (although not anymore!)

Dr. Smak said...

HLNC (aka Robbie's girlfriend),

Several years ago there was a Lyme vaccine, but due to poor efficacy and concern regarding side effects it was eventually pulled from the market. I'm sure someone is still thinking about it.

Give Robbie a big horsie kiss from me,

Teresa said...

Wow, this is soooo on-topic for me. I just pulled a tick off of me today. It was tiny and still pretty flat.

I found one a couple of weeks ago on me, also tiny, but fully engorged.

I think they are lone star ticks, so I'm more worried about RMSF than Lyme.

I really, really wish they had Frontline for humans. I had actually thought about getting some and just putting it down my spine, ha. But I'm afraid it might be dangerous (the instructions I saw a decade ago said to wear gloves when you apply it to your dog).

webhill said...

Just to be clear, Advantage is not a pill, it's a topical :)

I've been informed by some of my australian colleagues (I am a veterinarian in the USA) that Frontline is pretty good for human head lice.... not that they advocate our using it illegally or anything :)