The barriers to the accurate diagnosis of Lyme disease start with the patient's presentation for medical assistance. When patients present and give a clear history of a tick bite, they're often greeted with a rebuff, as Liz has already suggested—“Lyme disease doesn't exist here; you don't have a picture; you didn't bring the tick in, etc.”—so that often patients are dismissed at the outset.
Later on, blood testing may be done. The blood testing that is done in Canada, the present gold standard test, is a test called C6 ELISA, which in its best performance carries about a 75% sensitivity for the diagnosis to be established. It's a screening test. That means that 25% of people who have the disease are going to be dismissed on the basis of a screening test that isn't sensitive enough.
The people who pass that phase then go on to have a second test called a Western blot, which in its best performance, particularly in the later stages, has about an 80% sensitivity, which means that overall, 60% of the people who have blood testing are going to be identified, in the best-case scenario, as having a positive test result.
Then we have to embark on treatment. Many doctors are either not educated or are reluctant to prescribe the durations of antibiotics that are required to achieve satisfactory treatment of this disease. It is well established, furthermore, that if treatment is discontinued before symptoms are gone, relapse is almost universal.
The gaps or barriers in treatment, then, have been right from the time that the patient presents for care through the investigation and treatment paradigm. There are financial barriers, because many of the treatments require personal financial expense. Some of the investigations, because they're not offered by our health system, for reasons that have yet to be explained well to me, need to be done internationally at patient expense, so there are expense barriers. Often these patients are mobility challenged, and so they can't come to doctors' visits and can't get to the laboratory as frequently or as easily as they should.
There are myriad barriers to addressing this disease, Ms. Sidhu.