How long exactly to dry them? Well, today’s Boston Globe features a delightful story about a Braintree teenager, Jacqueline Flynn, who set out to find out, and whose preliminary research suggests that ticks can be killed in just five minutes of drying at low heat.

That discovery by the 16-year-old Braintree High School student has won top local science prizes and has caught the attention of scientists at the Centers for Disease Control and Prevention, the nation’s massive health watchdog.

As part of its tick prevention recommendations, CDC literature urges tumbling tick-infected clothing in a dryer on high heat for at least an hour as one way to eliminate the bloodsucking arachnids. But the agency had not studied the method further…

“This could have significant implications for Lyme disease prevention,’’ said Christina Nelson, an epidemiologist at the CDC’s office in Fort Collins, Colo., who became intrigued by the teenager’s finding. “If it is true that five minutes in a dryer kills ticks vs. a full hour, that is a lot easier for people, and that could also spark further investigations.”

With tick season, and thus Lyme disease season, soon upon us, however, we wouldn’t want to draw half-cooked conclusions and under-dessicate any of the little buggers. So I checked in with tick expert Tom Mather of the University of Rhode Island and its TickEncounter Resource Center.

He confirmed that a fairly quick spin in the dryer can kill nymphal deer ticks that carry Lyme disease, as the TickEncounter Resource Center has been recommending:

TickSmart™ Tip #1: DRY CLOTHES FIRST – THEN WASH
Most ticks are VERY sensitive to dryness. The very first action to take after working in the yard is to strip clothing off and throw it in the dryer. Deer ticks are most susceptible, while American dog ticks, Lone Star ticks and other Amblyomma species are more robust. To be sure that each species achieves fatal crispiness, leave clothes in the dryer on high for 15 minutes.

In our study, gas dryers got hotter than electric dryers, so you might want to add 5 minutes if you own an electric dryer. Believe it or not, ticks were not killed by washing, even in hot water. Clothing just left in the hamper or on the floor may put the next person to touch it at risk. Dry first – then wash.

And Prof. Mather added more research details in an email:

We showed that nymphal blacklegged ticks [a.k.a. deer ticks] were the most sensitive to dessication (easiest to kill in dryer) of all tested, followed by adult deer ticks, nymphal Lone Star ticks, and then adult Lone Star ticks and Am. dog ticks. We found that gas dryers ran a little hotter and that as little as 5 minutes was sufficient to kill the deer ticks but that to kill all of the Lone Stars and dog ticks, 10 minutes was required. For good measure, 10 minutes in the electric dryer for all was recommended (but probably overkill). We had temperature records as well. Ours were field-collected ticks. We applaud Jacqueline’s innovation; her observation is consistent with our findings…

It’s never too early to start thinking about measures to prevent Lyme disease, which is now endemic across Massachusetts. Check out other helpful TickSmart tips here.

Parts of Lyme disease are clear: It’s caused by bacteria, which are carried by ticks, and it’s a growing problem across much of the United States.

And parts of Lyme disease are so contentious that people talk about “the Lyme Wars.”

Chronic effects from Lyme disease — including terrible fatigue, trouble thinking and pain — constitute the central Lyme Wars battlefield, and the central practical issue is whether chronic sufferers should take long-term antibiotics. Mainstream medical experts warn that the longterm antibiotics are dangerous and ineffective; some patients and doctors disagree.

Now comes the latest salvo, in the New England Journal of Medicine: A gene study that found that in Lyme patients with relapses, the bacteria were different the second time around, and thus the recurrence must be due to a new infection by new bacteria rather than a relapse from bacteria that lingered in the body despite antibiotic treatment.

In an accompanying editorial, Lyme disease pioneer Allen Steere writes: “The issue of relapse versus reinfection has a broader context because of patient-advocacy groups that promote months or years of antibiotic therapy for ‘chronic Lyme disease.’” But, he writes, there is no evidence of a persistent Lyme infection, and “the weight of evidence is strongly against persistent infection as the explanation for persistent symptoms in antibiotic-treated patients with Lyme disease.”

The New England Journal study is here, and an accompanying editorial is here. NPR reports on the research here, and the New York Times here.

It will be interesting to see how the Lyme disease advocacy community responds. Personally, I find it comforting that if I do catch Lyme disease, it now seems somewhat less likely that I’ll suffer endless relapses despite antibiotic treatment. But I feel no less sympathy for the people who struggle for years on end with Lyme diseases’s effects, whatever the cause.

Sunday’s Boston Globe cites Curt’s story in a masthead editorial: “Lyme disease vaccine deserves a second look.” It reads in part:

Never-proven claims that the Lyme vaccine caused arthritis and other symptoms scared off some patients and raised the possibility of big legal judgments. For the manufacturer, the limited sales didn’t justify the risks.

But with a decade of hindsight, people in the areas most affected by Lyme disease deserve a second look. Not everyone will be accepting; opposition to the measles, mumps, and rubella vaccine has become entrenched among some parents, even as the research that initially fueled it has been discredited. Yet it’s precisely because of that controversy that medical authorities, the media, and the general public may weigh claims by vaccine critics more carefully.

As Lyme disease cases continue to emerge, public health authorities in New England need to lead the drive to bring existing vaccines back — or promote research on new and better ones.

Debate about the Lyme vaccine remains; some patient advocates challenge the claims that the vaccine was safe. But perhaps this Globe editorial and Curt’s story will add new impetus to the discussion about vaccines in the new state commission on Lyme disease. Curt blogs about his story here.

The final segment in WBUR’s week-long Lyme disease series is not about Lyme disease at all. It’s about the rising threat from what I think of as Lyme’s evil henchmen, rare but dangerous infections that are also carried by ticks and have been known, in the worst cases, to prove fatal.

See the full story, by WBUR’s Steve Brown, here: Emerging tickborne diseases causing concern in Mass. We also posted a recent report on state public health officials’ concern that though these other tick-borne diseases are relatively rare, they’re growing very quickly, roughly doubling in the last year.

Am I fear-mongering? Oh, yes, and I’m not done yet; I have some excellent help. Read this horrifying tale that appeared in the Boston Globe in May. Written skillfully by Jennifer Crystal, an Emerson College student, it describes a long-misdiagnosed case of what turned out to be not just Lyme disease but co-infections of babesia, ehrlichia and bartonella. She ended up bedridden for two years.

Steve Brown quotes Cape Cod entomologist Larry Dapsis: “These ticks can carry more than one pathogen. In fact, with these nymph stage ticks that are basically the size of a poppy seed, in our research, we find that upwards of 15 percent of these ticks can be carrying Lyme plus one of these other two pathogens.”

Dapsis says anaplasmosis is especially prevalent in the Berkshires; babesiosis is concentrated mainly on and around Cape Cod and the islands (see the map below.)

Jennifer blogs here about co-infection with other tick-borne illnesses on lymedisease.org:

Before tick-borne illness became my way of life, I had never heard of babesia, ehrlichia or bartonella, either. These parasitic infections are difficult to pronounce, let alone spell or comprehend. It’s easy to brush off what we don’t understand as not important, but sweeping these illnesses under the carpet is an egregious error that we cannot afford to make.

A single tick bite can deliver a number of co-infections, the most common being the aforementioned three. Unfortunately, the presence of these coinfections can complicate treatment immensely. Babesia, for instance, which is related to malaria, requires completely different drugs than Lyme. When a Lyme patient doesn’t respond to treatment, it may be due to undiagnosed and untreated co-infections.

It’s time to include co-infections in our Lyme awareness efforts. This is a tall order for words that don’t exactly roll off the tongue. My writing professor, fed up with trying to sound out babesia, finally exclaimed, “I can’t pronounce it. Let’s just call it babelicious.”

To which I would respond: Whatever works for you, professor. Just keep it in mind when you’re in tick territory.

In the course of the reporting for WBUR’s week-long series on Lyme disease, it has been extremely difficult to find local mainstream doctors willing to speak publicly about it. Lyme disease is surely one of the more controversial issues in American medicine, but is the atmosphere around it really that daunting and toxic? Here, Kathleen shares her experience and the perspectives of specialists.

By Kathleen McNerney
Guest Contributor

It’s passionate. It’s personal.

Thousands of people in Massachusetts are diagnosed with Lyme each year.

According to Dr. Gary Wormser, an infectious disease doctor at Westchester Medical Center and professor at New York Medical College, a year or more after those patients receive the standard treatment for Lyme disease, about 10 to 15 percent complain of chronic fatigue, aches and pains, or cognitive impairment. (One study cited by the Centers for Disease Control and Prevention puts that figure at 10 to 20 percent.)

Those patients who suffer ongoing symptoms are central to a debate in the medical community.

“It’s important to realize that the central controversy surrounding Lyme disease is that individuals have quite different perspectives on what Lyme disease is and also what chronic Lyme disease is,” said Wormser.

The majority of doctors and researchers say Lyme disease is caused by a tick-borne infection called borrelia burgdorferi that is easily treated with a round of antibiotics. But a small group of doctors raise questions about the tests used to diagnose Lyme and say that the infection is persistent, wreaking havoc on people’s bodies.

The debate is intense. So intense, in fact, that very few doctors in the mainstream want to speak publicly about it.

For WBUR’s series Living with Lyme, we reached out to dozens of specialists in Massachusetts to try to get the mainstream perspective (getting the alternative perspective was fairly easy).

Several didn’t return repeated phone calls. One administrative assistant said, “If you don’t hear back, it means that he’s not interested.” Two doctors would only speak off the record. One said he didn’t want to have a formal interview because “If you say something wrong, people pounce.” For him, it was too volatile an environment to speak publicly: “My job is not to debate, but explain what I think” based on scientific evidence.

Another doctor said it was a “lose-lose situation” to speak publicly and possibly jeopardize his research because there is so much animosity out there from patients and doctors who believe that Lyme is a chronic condition — that the bacteria is still operating in a patient’s system long after the initial antibiotic treatment.

Wormser of New York Medical College explained the strong feelings from patient advocates and so-called “Lyme-literate” doctors this way:

“Fundamentally, we have a lot of patients in the general population who have non-specific and quality-of-life-impairing symptoms. It’s just a fact of life, and these patients are frustrated and I don’t blame them because the mainstream medical community often doesn’t have the answers they want. They can’t be given a specific diagnosis or a specific therapy and they’re suffering and don’t know where to turn. So you can imagine the appeal when they go to a doctor that says, finally, ‘I know what you have. The other 25 doctors that you’ve seen have missed the diagnosis completely. You actually have chronic Lyme and I sort of know what to do.’

“And here’s what they tell them: ‘I’m going to give you these antibiotics long term and if you feel better, great. If you feel worse, that’s also indicative that the antibiotics are working. … And if you have good days and bad days, well, chronic Lyme is hard to treat.’ So really any outcome that the patients experience therefore is consistent with the presumed diagnosis of chronic Lyme. So you can imagine the situation that patients are put in.

“Patients have illnesses, sometimes they have waxing and waning periods on their own. Sometimes the sense that somebody’s actually looking after them and seeing them on a regular basis is very comforting and actually helpful and may be therapeutic. But the data that antibiotics actually would have a logical role in post-Lyme symptoms aren’t there. And the data on the actual effects beneficially of treatment are ambiguous at best or negative in the studies that have been done.”

And that rancorous debate isn’t helping patients, Wormser said.

“It would be nice if there could be some common ground and agreement as to how to go forward and try to prove or disprove what people seem to be thinking,” he said. “But from the mainstream perspective, the data are very strong that there’s no role for long-term antibiotics and there’s no evidence of chronic persistence of borrelia burgdorferi in humans in North America. And we’ve looked quite hard to find evidence of this.”

And the other side of the aisle, so to speak, agrees on the need for common ground.

Dr. Daniel Cameron is the former president of the International Lyme and Associated Diseases Society, which holds that Lyme is a chronic condition. This is a position represented by a small group of doctors.

“I think a second look at the literature will say, ‘Listen, these people are sick, there’s plenty of evidence.’ We have to move beyond the soundbites on both the ILADS and IDSA [mainstream Infectious Diseases Society of America],” he said.

“I feel that doctors are torn between those two organizations, the IDSA and ILADS,” Cameron continued. “They’re also torn when their local infectious disease doctor might complain or the medical board is questioning their treatment, so doctors don’t look at the evidence like they should, they look to the right or the left.”

Cameron wants more studies about people suffering these kinds of symptoms and more open dialogue among doctors about Lyme disease.

And there may be some room for agreement. Some of the doctors on the IDSA side told me that it might be good to have a diagnostic test that seeks out the bacteria itself, rather than the body’s response to the bacteria. Wormser said there could be a benefit in a test that clearly shows an active infection.

And, he said, it is also important to figure out what is causing about 20 percent of the general population to suffer symptoms like chronic fatigue and pain, which can be misdiagnosed as Lyme disease by doctors who either don’t test or don’t use standardized testing.

“If we had the answer for those kinds of symptoms, even symptomatic treatment that would eradicate them with a high degree of reliability, we would do so much good for so many people,” Wormser said.

Yikes. Tomorrow I will venture deep into what some call the Lymelands, moderating a panel on the week-long WBUR series, Living with Lyme. It’s at Fenway Health at 1340 Boylston Street in Boston; it’s free and there are still a few seats left — please come if you can! And if you can’t, the event will be live-streamed and then archived on WBUR.org.

Whether you can make it or not, I’d deeply welcome questions that you’d like to pose to our panel. It includes a prevention expert, a state legislator who’s spearheading state efforts to fight Lyme disease, and a clinical psychologist with both personal and professional knowledge of the patient’s perspective.

To sign up for the event (it’s free but you need to register) please click here. To send in a question, just click on the “Get in touch” rectangle at the very bottom of CommonHealth, or email me at careyg@comcast.net. Hope to see you — or your question — there!

Please forgive this overdose of tick talk, but WBUR is running a series on the dramatically growing problem of Lyme disease this week, and it strikes me as a particular public service to highlight this useful bit of information from Sacha Pfeiffer of All Things Considered:

If you find an engorged deer tick on you, and it’s likely that it’s been there more than 24 hours — and thus long enough to transmit Lyme disease — it’s now accepted medical practice in areas where Lyme disease is endemic (like all of Massachusetts) to give you a single preventive dose of antibiotics aimed at stopping the infection before it takes hold.

Sacha’s full interview with Dr. Jonathan Edlow, an emergency physician at Beth Israel Deaconess Medical Center, about treatment for possible exposure to Lyme, is here: What to do if you think you’ve been exposed to Lyme disease. Dr. Edlow is the author of “Bull’s-Eye: Unraveling the Medical Mystery of Lyme Disease.”

Key excerpt from the interview:

So if there’s a concern that a patient may have been exposed to Lyme disease, but it’s too early for that patient to have symptoms, what is the treatment?

The treatment for a tick bite — assuming that the tick has been on you for at least 24 hours, it hasn’t been on you for more than 72 hours, and it’s a deer tick — would be 200 milligrams of doxycycline for an older child or an adult. Treatment at that stage is really to prevent Lyme disease.

But if a person is showing Lyme symptoms, such as a rash or a fever and muscle aches, is that patient beyond the window of time in which a small dose of antibiotics can possibly help?

That’s correct. The 200-milligram dose of doxycycline is to prevent Lyme disease. What you’re describing — having symptoms of a rash or a fever — that’s established Lyme disease and requires a longer course of antibiotics.

It’s a question many people naturally ask, particularly dog owners: Why is there a canine Lyme disease vaccine but not a human one? WBUR’s Curt Nickisch answers that question beautifully today in his story about the rise and fall of the human vaccine that was briefly available in the late 1990s. It includes an interview with Dr. Allen Steere, a giant in the field of Lyme disease research who is now at Massachusetts General Hospital. It portrays a classic story of what seems to be a greater public good falling victim to our litigious, commercial, sometimes anti-science society. And it raises the (apparently dim) prospect that the vaccine will be resurrected, or a better one developed.

Warning: Even though after reading this piece you’ll understand the back-story of why no human vaccine is currently available, you may still be asking, “But why, why, why?”

No one denies that Lyme disease can have long-term effects. The controversy arises around whether the Lyme infection can persist after antibiotic treatment, and whether longer-term antibiotics help. This is the nub of what some call the Lyme Wars, pitting some patients and a contingent of doctors against mainstream medical findings and guidelines. And today, we got a taste of the wars on WBUR’s air, with Barbara MacLeod’s harrowing story on Morning Edition and then, on All Things Considered, the beginnings of a response from Dr. Mark Drapkin, an infectious disease specialist at Newton-Wellesley Hospital and a professor at the Tufts University School of Medicine. On Friday, we’ll hear him explain why he believes Lyme is not a chronic disease, but why people can have lingering effects from the infection.

The Lyme wars tend to get nasty. Barbara MacLeod was brave to tell her story, and Dr. Mark Drapkin is courageous to represent the mainstream infectious disease specialist’s point of view. I can’t wait to hear his fuller interview on Friday.

[Note: Live in Lincoln? Have a case of Lyme disease to report? Go to the interactive map here]

It’s a cardinal rule of writing that you’re supposed to “show, not tell,” and the same is true in radio. But as a self-indulgent blogger, I’d like to just hammer for a moment on the central point I tried to convey in today’s lead-off piece in WBUR’s Lyme disease series.

And that is, that though Lyme disease has been around for quite a while in coastal areas of Massachusetts, it has spread in the last few years across the entire state, most notably into the Metro West/495/128 region. And as it spreads, Lyme — and the fear of Lyme — permeates the fabric of our communities, changing our lives. (And for the very unlucky, ruining their lives, as you’ll hear in tomorrow’s piece.)

After a recent “tick talk” at the 19th-century Bemis Hall in Lincoln, a few audience members lingered, and I asked them how Lyme disease has affected life in Lincoln — a Metro West town whose Lyme disease burden is clearly heavy but by no means exceptional. A few voices:

Sarah Bishop: “I’m a preschool teacher in town and I’m finding that I’m not taking the children into the woods the way I used to. I’m afraid to even play on our playground. and kids are spending far too much time in front of screens and yet I am afraid to take them back to nature.

“The saddest thing was the other day, I heard one of my kids say — I had called them to come back and they said, ‘Oh, yeah, that’s right, we can’t go into the woods, there are ticks.’ And I thought, ‘Ohhh, but I want you to go into the woods and I want you to get lost there and explore there, and create things there,’ and yet I’m scared to death to take them there. And I actually did pick a tick off one of my preschoolers last week, it was in the corner of his eye, just in the fold of the skin. It’s awful.

Janice Phillips: “I live on the south side of Lincoln, and everyone on my road has had it at least once. And if you do any gardening at all, it’s a serious problem, and I’m a gardener. It’s tough. So we do what we can in terms of preventing. We spray our shoes with permethrin and we tuck our socks over our pants legs and examine ourselves every day. And take prophylactic doxycycline if we find an embedded tick. And you just hope for the best.”

Ruth Adams: “A lot of people in Lincoln have been ill, as well as their pets, and I think it affects everybody. We’re very aware of it in Lincoln. It seems to be a problem for chronic Lyme disease, people are getting it more than once or maybe they never got rid of it. One of my dogs died two years ago of it. So I think it’s a very serious disease. I think it used to be swept under the carpet a lot by medicine, I can honestly say that, and I think now it’s coming out a little bit and we’re more aware. There’s more education. It’s really necessary.

We’re very active. Because so many people in town have had Lyme disease, really have had an active case, or their children, or their grandparents.”