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Institute of Medicine (US) Committee on Lyme Disease and Other Tick-Borne Diseases: The State of the Science. Critical Needs and Gaps in Understanding Prevention, Amelioration, and Resolution of Lyme and Other Tick-Borne Diseases: The Short-Term and Long-Term Outcomes: Workshop Report. Washington (DC): National Academies Press (US); 2011.

Cover of Critical Needs and Gaps in Understanding Prevention, Amelioration, and Resolution of Lyme and Other Tick-Borne Diseases

Critical Needs and Gaps in Understanding Prevention, Amelioration, and Resolution of Lyme and Other Tick-Borne Diseases: The Short-Term and Long-Term Outcomes: Workshop Report.

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Preface: A Walk in the Woods

Lyme disease and many other tick-borne diseases (TBDs) are zoonotic diseases in which a pathogen moves from an animal host to a person through ticks. Scientists now understand the complexities associated with such disease transmissions, including the role of ecosystems as it relates to the life cycle of the pathogen.

A walk in the woods in certain geographic areas of the United States constitutes a risk factor for exposure to Lyme disease or other tick-borne illness. The same phrase, a “walk in the woods,” is also a metaphor for a process of conflict resolution. A “walk in the woods” is a model named for the classic 1982 saga of two Cold War nuclear arms reduction negotiators from the United States and Russia who broke an impasse in their talks by accompanying each other for a walk in the woods around Geneva, Switzerland, leading them to new insights and compromise, and ultimately a newly crafted agreement based on shared interests. This saga was later immortalized in a Broadway play symbolizing the advantage of interpersonal bargaining and interest-based negotiation.

It was obvious to participants at the workshop that a significant impasse has developed in the world of Lyme disease. There are conflicts within and among the science; policy; politics; medicine; and professional, public, and patient views pertaining to the subject, which have created significant misunderstandings, strong emotions, mistrust, and a game of blaming others who are not aligned with one’s views. Lines in the sand have been drawn, sides have been taken, and frustration prevails. The “walk in the woods” process of conflict resolution or a similar process seems necessary for creating a new environment of trust and a better environment for more constructive dialogue to help focus research needs and achieve better outcomes. Such a process does not imply a compromise of the science but rather is needed to shift to a more positive and productive environment to optimize critical research and promote new collaborations.

Pamela Weintraub spoke eloquently about her personal experience and her family’s challenges with Lyme disease. Ms. Weintraub also made the point that the impasses and mistrust that exist have been instrumental in impeding progress toward developing solutions by creating an environment that is unproductive and even accusatory. Thus, a “walk in the woods” seems to be in order not only in considering factors in disease transmission but also as a process by which to find common ground, align interests, and develop a national strategy to address the complex and serious issues of TBD, including Lyme disease.

The committee believes that the project will provide a snapshot of the state of the science for TBDs, but it recognizes that not all topics could be covered in as much depth during a 2-day workshop as would be satisfying to the committee or the scientific community. Furthermore, the committee was cognizant of the societal issues that could affect the scientific agenda, but we did not allow the controversy to affect the scientific discussion. During the process, the committee also noted a lack of precision in describing research. In the report, the committee has not attempted to impose uniform terminology or definitions, opting to retain those employed by the individual speakers. The committee realizes that the lack of precise, uniform terminology is hampering the reporting and the discussions of stages of Lyme disease and other tick-borne diseases. Although the committee was not charged to produce recommendations, we hope that this body of work will result in further discussions of research gaps, opportunities, and priorities.

Many individuals and organizations contributed to this report. The committee thanks the authors of the commissioned papers, who worked diligently over the summer and the early fall to produce the extensive background that contributed to discussions at the workshop. The committee also thanks the presenters at the workshop, the members of the research community, and the public who shared their perspectives before and during the meeting, as well as the many individuals who participated in other public forums, on phone calls, and by e-mail. We understand and appreciate the negative impact that some of these diseases have on the quality of peoples’ lives. The convergence of science with real-life situations has highlighted both the need for more scientific knowledge and the serious societal issues and challenges that need to be addressed through scientific advancements.

The committee also extends its thanks to Sandra Hackman for providing preliminary drafts of some of the presentations; to Trevonne Walford for ensuring that the meetings and listening sessions ran smoothly and providing research and writing support; to Pam Lighter for assisting with the committee formation and background information; to Rita Deng for collecting initial data on the federal programs; to Andrea Bankoski for analyzing the federal program data; and to Carol Mason Spicer for drafting sections of the report and helping to provide critical comments. Hope Hare was instrumental in preparing the document for review and publication. We also thank Christine M. Coussens, who was the study director for the project. Together with Rose Marie Martinez, the board director, Christine helped the committee navigate the sociobiology issues. Although this was a challenging assignment, the committee welcomed the opportunity to help improve understanding of this group of diseases and, more importantly, to improve the lives of those who have been profoundly impacted by them.

Copyright © 2011, National Academy of Sciences.
Bookshelf ID: NBK57012


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