York Conference June 2004 - Dr David Owen

One of the things that became clear to me early on was a need for patient education. If they knew about ticks, they would know the dangers and could take action. It's not been mentioned much so far, but I think we all agree that treatment of early disease is more effective than late disease, and may abort it completely – though I don't think we have the data on that.

In order to look at this, I took the family practice where I work in Wales, and I did a survey of just 100 patients with the idea of doing a larger survey later. Because clearly if we're looking for funding – and ultimately funding is needed to make any changes – we need to show that there are basic problems like lack of Lyme awareness in the community.

So I set out to do 100 consecutive patients – this was done last September – to ascertain if there was much awareness about Lyme disease and ticks. The practice I'm in is what I describe as semi-rural. In fact, it's in the middle of a mountain surrounded by forest and sheep, and sheep are quite commonly seen walking down the street next to the practice. So these people are what I would say are at risk of Lyme disease. Perhaps as many as 5-10% have Lyme disease, but I can't diagnose it and I can't treat it for obvious reasons.

So, for the survey, I asked 3 q uestions at the end of a routine consultation which was about something else.

There were 46 males, mean age 44.7.

There were 54 females, mean age 49.4.

Certain patients were excluded:

Age under 16

People with communication difficulties

People with emotional distress at the time.

There was 100% co-operation in the patients who fulfilled the inclusion criteria.

The questions asked were quite simple:

Do you think you could recognize a tick as opposed to an insect?

Are you aware of having ever been bitten by a tick?

Have you heard of the condition of Lyme disease?

And these questions were asked verbally. If the response to any of these questions was 'yes', further questioning was undertaken to confirm that they could recognize a tick, or if they had received a bite, where they received it and when, and whether they were aware that Lyme disease was caused by ticks.

The results were interesting.

32 out of 100 apparently were able to recognize ticks – 20 from ticks on pets, 7 from a bite to themselves or a relative, 3 from TV programmes (one of whom had seen a horror film called 'Ticks' which I've never heard of), and 2 from ticks on farm animals.

68 out of 100 didn't think they could recognize a tick. They had no idea what I was talking about.

85 out of 100 had never heard of Lyme disease.

Of the 15 who had heard of Lyme disease, none of them were aware it was anything to do with ticks.

4 out of 100 reported a tick bite to themselves, and out of those 4, none of them had heard of Lyme disease.

When I looked at these 4 cases and asked them further questions, it was interesting. 1 reported a bite from a tick from a pet. 3 reported a tick bite during army training.

Conclusions:

- Knowledge about Lyme disease among the general public is extremely poor, even among those who know they've been bitten by a tick. This has important Public Health implications.

These results astonished me, and clearly many have thought about the link between Lyme disease and gulf war syndrome, but at the time I did this, I hadn't, but it immediately suggested itself to me. So I had to go and have a look into that. The question it led me to ask was:

Q. Does the military exhibit any illnesses which might be the result of tick bites?

A. Well, so-called Gulf war syndrome.