Under Our Skin” – a Film Review
Phillip J. Baker, PhD., Executive Director,
American Lyme Disease Foundation (ALDF)
The film entitled, “Under Our Skin”, was produced in 2008, and premiered on June 19th, 2009, at the IFC Center in New York. It depicts the plight of patients claimed to be suffering from a poorly defined condition called “chronic Lyme disease”, and champions the unproven benefits of extended antibiotic therapy for its treatment. Since the guidelines for the diagnosis and treatment of Lyme disease, formulated by the Infectious Diseases Society of America (IDSA), neither recognize “chronic Lyme disease” as a distinct clinical entity nor advocate more than a short course of oral antibiotics for the treatment of Lyme disease, there is some public confusion surrounding this disease.
That confusion encouraged then Connecticut Attorney General (AG) Richard Blumenthal to launch an antitrust investigation of the IDSA guidelines. This culminated in a detailed and extensive review of their validity by an independent panel approved by the AG. The independent review panel, which relied on more than 1,000 published scientific papers in rendering its decision, issued its final report in May, 2010 (1). It unequivocally affirmed that: (a) there is no published evidence to indicate that extended antibiotic therapy is beneficial for the treatment of “chronic Lyme disease”; (b) there is no well-accepted definition of post-Lyme disease syndrome, also known as “chronic Lyme disease”; and that (c) there is no convincing biological evidence for the existence of symptomatic chronic Borrelia burgdorferi infection among patients given recommended treatment regimens for Lyme disease (1).
It was not surprising that the review panel unanimously upheld the IDSA guidelines since the IDSA’s recommendations for the treatment of Lyme disease are in complete accord with those of the European Federation of Neurological Societies, the European Union of Concerted Action on Lyme Borreliosis, the American Academy of Neurology, the Canadian Public Health Network, the German Society for Hygiene and Microbiology, the British Infection Association, as well as those of expert panels from at least 10 European countries (2,3). To deny the existence and validity of such an overwhelming consensus of independent expert opinion, in the absence of convincing evidence to the contrary, is an interesting example of anti-science denialism. It should be noted that an independent appraisal and review of alternative guidelines proposed by the International Lyme and Associated Diseases Society (ILADS) by the British Health Protection Agency found them to be untenable and unsupportive of extended antibiotic therapy (4). Furthermore, Borrelia burgdorferi, the spirochete that causes Lyme disease, does not form cysts or microfilms that render it resistant to conventional antibiotic treatment as suggested by a self-employed “scientist” featured in the film. Lyme disease is not a lethal, life-threatening disease as the funerals and memorial services shown in the film shamelessly and dishonestly portray it to be (5).
In view of these considerations, it is regrettable that some Public Broadcasting System (PBS) stations chose to air this deceptive film whose production was funded largely by contributions from Lyme disease advocates and “Lyme literate physicians” (LLMDs) to advance their unproven views. In so doing, it lends a semblance of credibility to a film that is now years out-of-date, and which recent events have shown its central message to be based on false assumptions. A partisan film such as this can only undermine public health by encouraging naïve individuals to seek unproven remedies from LLMDs to relieve symptoms that, though deserving of appropriate medical treatment and care, may well have nothing to do with Lyme disease. This film was distributed by the National Educational Telecommunications Association (NETA) to PBS for airing on their affiliate stations, free of charge. If that is the case, then PBS got exactly what it paid for – but at the cost of compromising its integrity.
1. Lantos, P.M., Charini, W.A., Medoff, G. et al. “Final report of the Lyme disease review panel of the Infectious Diseases Society of America. Clin. Infect. Dis. 51: 1-5, 2010.
2. Baker, P.J. “Chronic Lyme disease: in defense of the scientific enterprise”. FASEB J. 24: 4175-4177, 2010.
3. British Infection Association. “The epidemiology, prevention, investigation, and treatment of Lyme borreliosis in United Kingdom patients: a position statement by the British Infection Association”. J. Infect. 62: 329-338, 2011.
4. Independent appraisal and review of the ILADS 2004 evidence-based guidelines for the management of Lyme disease; general information reported by the Health Protection Agency, UK. (HPA Review of ILADS Guidelines).
5. Kugeler, K.J., Griffith, K.S., Gould, L.H. et al. “A review of death certificates listing Lyme disease as an underlying or multiple cause of death in the United States”. Clin. Infect. Dis. 52: 364-367, 2011.