Book Review

Bull's-Eye: Unraveling the Medical Mystery of Lyme Disease

N Engl J Med 2003; 349:1008September 4, 2003

Article

Bull's-Eye: Unraveling the Medical Mystery of Lyme Disease
By Jonathan A. Edlow. 285 pp., illustrated. New Haven, Yale University Press, 2003. $29.95. ISBN: 0-300-09867-7

Jonathan Edlow's book, Bull's-Eye: Unraveling the Medical Mystery of Lyme Disease, was published at a particularly fitting time. This year marks the 20th anniversary of the discovery by Burgdorfer, Benach, and Barbour of the causative agent of Lyme disease, a spirochete we now know as Borrelia burgdorferi. That discovery pulled together many of the diverse scientific and historic aspects of Lyme disease and set the stage for further research into this spirochete and the diseases it causes. Edlow's book allows the reader to develop a better understanding of this complex illness. However, his book is not just about Lyme disease, and it is not a medical textbook; rather, it is the story of an emerging infection and its history. To quote the author, “This is a tale about scientific inquiry, as it exists in a cultural context.” The title is somewhat misleading, however, because the book, which is beautifully written, is not just about the discovery of Lyme disease, its cause, and the controversies surrounding it. The book is also an exploration of how medical mysteries are solved and of how many observations and discoveries are connected and finally pieced together to yield solutions.

The book is written in a clear, readable style that should appeal to both medical professionals and members of the general public. It offers insights into the way medical science actually works. Edlow discusses not only the parts played by Burgdorfer, Steere, Benach, Malawista, and others in the story of Lyme disease, but also the critical parts played by lesser-known persons. The story of Lyme disease would be very different without the work of European physicians in the 19th and early 20th centuries; two mothers from Lyme, Connecticut, Polly Murray and Judith Mensch; two Navy physicians, William Mast and William Burrows; and an officer from the Centers for Disease Control and Prevention, David Snydman, who worked with the Connecticut Department of Public Health.

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It is important to mention that, especially in regard to its depiction of highly specialized physicians, this book is a cautionary tale. In chapter 9, “The Blind Men and the Elephant,” the author contrasts the views of the Navy physicians, Mast and Burrows, with those of the Yale Rheumatology Group. The two Navy doctors were right: Lyme disease is a systemic infectious disease that responds to treatment with antibiotics, not a new form of arthritis that does not respond to antibiotics. Ultimately, the book clearly points out that modern medical discoveries are not the work of one person. Science and medicine are the work of many people, a series of small discoveries and observations and of connections that lead to new insights. Edlow details how patients, their family members, and scientists and physicians contributed to the knowledge of the illness we now call Lyme disease.

The author also delves into the controversy surrounding Lyme disease. He describes the contrasting views and the failure of academic physicians to be open-minded. I believe that the one flaw in this book is that it does not clearly delineate the risks unconventional approaches pose to patients. Be that as it may, anyone who is curious about Lyme disease or medical discovery in general will find this book interesting reading.

Raymond Dattwyler, M.D.
State University of New York, Stony Brook, Stony Brook, NY 11794
raymond.dattwyler@stonybrook.edu