Following completion of his medical training and a one-year stint as attending physician on Howard Champion's Surgical Critical Care Service and MedStar Unit at Washington Hospital Center in the District of Columbia, Kenneth Liegner, M.D. returned to Westchester County, home of his Alma Mater, New York Medical College, to start a private practice. Unwittingly, he had 'plunked himself down' in the heart of a burgeoning epidemic of Lyme disease. His patients confronted him with puzzling syndromes that defied 'tidy' formulations of the illness and thrust him in to a Maelstrom of medical controversy.
Lyme disease, a new poorly understood disease, emerged hand in hand with the rise 'managed care'. Physicians caring for persons with Lyme disease, loyal to the Hippocratic Oath and serving what they saw as patients' best medical interests, found themselves on a collision course with a new Corporate Medical Ethic dedicated to maximizing profit.
One practitioner's work over 25 years is presented here along with correspondence with many principals in the field. Documentational in nature and not written as a narrative, the materials, nonetheless, convey the intensity of the struggle to characterize the nature of Lyme disease and the desperate fight for proper diagnosis and treatment upon the outcome of which patients' very lives depended. The volume includes protocols useful as reference materials for patients and practitioners alike, as well as photographic images of many persons important in the history of Lyme disease.
Foreword by Pam Weintraub, Senior Editor of aeon digital magazine and author of award-winning book Cure Unknown: Inside the Lyme Epidemic.
Preface by Paul W. Ewald, Professor of Evolutionary Biology at the University of Louisville and author of Plague Time.
Dr. Kenneth Liegner is a Board Certified Internist with additional training in Pathology and Critical Care Medicine, practicing in Pawling, New York. He is on the medical staffs of Northern Westchester Hospital Center in Mount Kisco, NY and The Sharon Hospital, Sharon, CT. He has been actively involved in diagnosis and treatment of Lyme disease and related disorders since 1988. He has published articles on Lyme disease in peer-reviewed scientific journals and has presented poster abstracts and talks at national and international conferences on Lyme disease and other tick-borne diseases. He has cared for many persons seriously ill with chronic and neurologic Lyme disease. His work has focused on the serious morbidity and (occasional) mortality that can eventuate from this aspect of the illness. He has emphasized the urgent need for widespread clinical availability of improved methods of diagnostic testing and for development of improved methods of treatment for Lyme disease in all its stages. He holds the first United States patent proposing application of acaricide to deer for area-wide control of deer-tick populations as a means of reducing the incidence of Lyme disease. Dr. Liegner is a currently a member of the Board of Directors of The International Lyme and Associated Diseases Society (I.L.A.D.S. www.ILADS.org) and is a member of the Association of American Physicians and Surgeons (www.aapsonline.org).
Ken Liegner’s book, In the Crucible of Lyme Disease, is an encyclopedic collection of letters, abstracts, articles, speeches and stories, lab results and autopsy reports spread out over the 25 years of the Lyme Wars. In her introduction, journalist Pam Weintraub recommends that we read In the Crucible “like scholars read historical documents – one letter, one newspaper story, one record, one artifact and inscription, one report at a time.” Indeed, at over 800 pages, that’s a smart approach, though I found myself drawn through the pages, remembering people from the early days and marveling at the many platforms where our fight for truth and justice have taken place, and when Ken Liegner was front stage center.
Liegner gives the reader a sense of history and reminds us how many times he has stood up for his patients, putting his career on the line, and always careful and thoughtful, documenting details and referring back to the medical literature for support. One must admire a physician with a busy practice who carved out time to write so many journal articles and letters to editors and attend so many conferences.
When Liegner started treating patients with Lyme disease, he was not far from the main stream, however, by 1990, he was diverging from the research establishment, deploring the practice of selectively withholding antibiotics when the tick has been attached only a short time, subjecting patients to what he terms “a kind of Russian roulette.” In a letter to the New England Journal of Medicine he shows his disdain for the standard approach as he argues for prophylaxis of tick bites.
Over the next few years the indefatigable Liegner received a patent for his acaricide dispenser/salt lick, submitted abstracts to several conferences, published editorials and case reports challenging the academic researchers’ conservative views on prophylaxis, diagnosis and treatment. His broad interests reflected the increasingly complicated patients he was seeing in his practice.
Liegner introduces his patient Vicki Logan, whose picture appears on the cover of his book and who had a profound effect on him. An article in a contemporary local paper said he was the only doctor willing to consider Lyme, although Logan didn’t remember a tick bite or a rash.
On August 24, 1993, The New York Times featured Logan in an article, along with the iconic photograph of the doctor at his patient’s bedside. Logan was the case Liegner returned to again and again in his writing. She was his inspiration. He felt for her, he fought for her, he never abandoned her, never gave up trying to restore her to health. He was painfully aware of the insurance provider’s life-and-death control over Logan. When they allowed treatment, she improved. When they denied treatment, she declined. With each relapse she deteriorated even more neurologically.
It is heartbreaking to read the correspondence relating to Logan’s case. Liegner left no stone unturned, but the reader suspects that there will be no happy ending here, and each step so painfully taken forward will soon be pushed back. Still, Logan and Liegne