Featured Published Papers
by Dr. Daniel Cameron
Dr. Daniel Cameron has published and presented more than 30 scientific papers, covering a range of topics in the tick-borne disease field. Many papers have been featured in lectures in the United States, Europe and Canada.
Rhee H, Cameron DJ. Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview. International Journal of General Medicine. 2012 February; (5):163 – 174.
The capability of microorganisms to cause and exacerbate various neuropsychiatric pathology is also seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), a recently described disorder attributed to bacterium Streptococcus pyogenes of group A beta-hemolytic streptococcus in which neurologic tics and obsessive-compulsive disorders are sequelae of the infection. In the current overview, Lyme disease and PANDAS are juxtaposed through a review of their respective infectious etiologies, clinical presentations, mechanisms of disease development, courses of illness, and treatment options. Future directions related to immunoneuropsychiatry are also discussed.
Cameron DJ. Proof that chronic Lyme disease exists. Interdiscip Perspect Infect Dis. 2010;2010:876450.
The evidence continues to mount that Chronic Lyme Disease (CLD) exists and must be addressed by the medical community if solutions are to be found. Four National Institutes of Health (NIH) trials validated the existence and severity of CLD.
Despite the evidence, there are physicians who continue to deny the existence and severity of CLD, which can hinder efforts to find a solution. Recognizing CLD could facilitate efforts to avoid diagnostic delays of two years and durations of illness of 4.7 to 9 years described in the NIH trials. The risk to society of emerging antibiotic-resistant organisms should be weighed against the societal risks associated with failing to treat an emerging population saddled with CLD.
Cameron DJ. Obstacles to trials of chronic Lyme disease in actual practice. Minerva Med. 2009 Oct;100(5).
I am writing in response to a recent letter to the editor of Medical Minerva signed by Dr. Gary Wormser and a number of his colleagues, which challenged the design of a double-blind randomized placebo-controlled clinical trial (RCT) that I reported in 2008. My report presenting the results of the RCT described the severity of chronic Lyme disease (CLD) and openly acknowledged the obstacles to completing a trial in actual practice. I clearly described the RCT as “exploratory”, citing a higher than expected dropout rate due to the severity of the illness itself.
Cameron DJ. Insufficient evidence to deny antibiotic treatment to Lyme disease patients. Med Hypotheses. 2009 June; (72)6:688-91.
This hypothesis suggests that physicians should consider the limitations of the evidence before denying antibiotic treatment for Chronic Lyme Disease (CLD). Physicians who deny antibiotic treatment to CLD patients might inform their patients that there are some clinicians who disagree with that position, and then offer to refer them for a second opinion to a doctor who could potentially present a different point of view. The hypothesis also suggests that health care insurers should consider the limitations of the evidence before adopting policies that routinely deny antibiotic treatment for CLD patients and should expand coverage of CLD to include clinical discretion for specific clinical situations.
Cameron DJ. Clinical trials validate the severity of persistent Lyme disease symptoms. Med Hypotheses. 2009 Feb;72(2):153-6.
If the QOL of life for these patients is as poor as for patients with other serious chronic diseases, their symptoms need to be addressed by their doctors. Studies differ as to the precise cause of Persistent Lyme Disease Symptoms (PLDS), the most effective treatments, and whether a cure is possible. But the fact that there is disagreement is not a license for physicians to ignore or turn away patients complaining of PLDS, or to dismiss their symptoms as purely psychosomatic. For physicians, the goal or purpose of treating PLDS should be the same as their purpose in treating other chronic illnesses that result in a poor QOL: vigorous pursuit of a cure, and where a cure proves impossible, amelioration of patients’ symptoms and suffering.
Cameron DJ. Severity of Lyme disease with persistent symptoms. Insights from a double-blind placebo-controlled clinical trial. Minerva Med. Minerva Med. 2008 Oct;99(5):489-96.
A total of 84 adults with Lyme disease with persistent symptoms (LDPS) were studied; 52 received amoxicillin and 34 received placebo. The subjects received either placebo or amoxicillin 3 g per day orally for 3 months. The SF-36 was used as the outcome measure of the patient’s perceived Quality of Life (QOL). For subjects enrolling in this RCT, the average SF-36 physical component summary (PCS) of QOL (40+/-9, range 29-44) and mental component summary (MCS) of QOL (39+/-14, range 23-46) were worse than the general USA population and worse than individuals with diabetes, heart disease, depression, osteoarthritis or rheumatoid arthritis. The improvements in the SF-36 measure of QOL for subjects randomized to amoxicillin vs. placebo was significant (46% vs 18%, P=0.007).
Cameron DJ. An appraisal of “chronic Lyme disease”. New England Journal of Medicine. 2008 Jan;24;358(4):429-30.
To the Editor: The appraisal of chronic Lyme disease by Feder et al. requires reevaluation. The strong recommendations made by the authors are based on a relatively small number of subjects, do not reflect clinical evidence, and do not take into account the International Lyme and Associated Diseases Society (ILADS) clinical practice guidelines.
Currently, medical experts in support of the ILADS clinical practice guidelines are rarely, if ever, included in the process of scientific reviews. In the spirit of good science, I would suggest that this be changed.
Cameron DJ. Lyme disease Clinical Trial – Consequences of Delayed Treatment, J Eval Clin Pract. 2007 Jun;13(3):470-2.
This trial included 100 adolescents and adults who were treated in a community-based setting from July 1997 to January 2000. This is the largest case-controlled study to examine subjects confirmed by the CDC’s recommended two-tier diagnostic criteria. …. The majority (60%) of cases (cases 1, 3–5, 7, 11–15) with delayed treatment conformed to CDC epidemiological standards, presenting with a rash, Bell’s palsy, or arthritis.
Treatment delay was strongly associated with treatment failure for patients with Lyme disease. The average 1.8 years treatment delay were consistent with previous reports of treatment delays spanning 6 weeks to 3 years.
The poor outcome after treatment delay supports the hypothesis that treatment delay is a major risk factor for developing chronic Lyme disease. Clinicians were urged to avoid treatment delay to avoid unnecessary suffering and expense. Education programs are recommended to help clinicians recognize and treat Lyme disease at onset.
Cameron DJ. Lyme disease Clinical Trial – Generalizability in Two Clinical Trials of Lyme Disease, Epidemiol Perspect Innov. 2006 Oct 17;3:12.
In their article in The New England Journal of Medicine, Klempner et al. failed to discuss the limitations of their clinical trials. … The poor outcome cited in these trials may be explained by having selected patients who had undergone delayed treatment or multiple treatments unsuccessfully. These selection factors were not addressed by the studies’ authors, nor have they been discussed by reviewers. The trials have been over-interpreted by the NIH.
Cameron DJ, Gaito A, Harris N, Bach G, Bellovin S, Bock K, Bock S, Burrascano J, Dickey C, Horowitz R, Phillips S, Meer-Scherrer L, Raxlen B, Sherr V, Smith H, Smith P, Stricker R; ILADS Working Group. The ILADS Working Group. Evidence-based guidelines for the management of Lyme disease. Expert Rev. Anti-infect. Ther. 2(1), 2004.
Guidelines of the Infectious Disease Society of America (IDSA) fall short of meeting the needs for diagnosis and treatment of individuals with chronic Lyme disease. IDSA Guidelines fail to take into account the compelling, peer-reviewed, published evidence confirming persistent, recurrent and refractory Lyme disease and, in fact, deny its existence.