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May Awareness Guest Blog – An Interview with Kenneth Liegner, MD
May Awareness LDA Guest Blogger
Dr. Kenneth Liegner is a Board Certified Internist with additional training in Pathology and Critical Care Medicine, practicing in Pawling, New York. 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 issued proposing application of acaricide to deer for area-wide control of deer-tick populations as a means of reducing the incidence of Lyme disease. He has authored In the Crucible of Chronic Lyme Disease – Collected Writings & Associated Materials, a documentational history of the struggle to characterize the nature of Lyme disease in the late 20th and early 21st centuries, published November 2015.
He served two terms on the Board of Directors of the International Lyme and Associated Diseases Society (ILADS), is on the Scientific Advisory Board of the Lyme Disease Association, Inc, and is on the Medical Advisory Board of the Global Lyme Alliance. He is a member of The American Association of Physicians and Surgeons.
He was the first physician to apply disulfiram in the treatment of Lyme disease and published his experience with his first three patients in the peer-reviewed journal Antibiotics, May 2019.
He was co-author on a landmark pathologic study of tissues from a person with chronic Lyme disease and co-author of the ILADS evidence-based definition of chronic Lyme disease.
This May Awareness Guest Blog delves into the intricacies of Lyme disease with Kenneth Liegner, MD, a Board Certified Internist with specialized training in Pathology and Critical Care Medicine. In this interview, Dr. Liegner shares his journey into the world of Lyme disease, its evolving treatment, and his ongoing efforts to improve diagnostic methods and therapeutic solutions. He discusses the critical role of thinking holistically, patient advocacy, and the importance of organizations such as the Lyme Disease Association, Inc. in raising awareness and funding research. Dr. Liegner offers valuable insights and reflections on tackling one of the most challenging and misunderstood diseases of our time.
An Interview with Kenneth Liegner, MD
1. How did you get interested in specializing in Lyme and tick-borne diseases?
I started a solo private office-based practice of internal medicine in Armonk, NY with some critical care at the local hospital (Northern Westchester Hospital, Mt. Kisco, NY) around 1985. Unbeknownst to me at the time, northern Westchester was becoming a ‘hot-bed’ of Lyme disease and some of the earliest cases of Lyme meningitis were diagnosed there. I knew virtually nothing about Lyme disease at the time, other than the name and the story of its discovery by Allen Steere in Lyme, CT. Then I began seeing cases of the illness, which, really no clinician in Westchester could avoid. I found them extremely puzzling and challenging. They didn’t behave the way they were supposed to! Symptoms would keep coming back despite application of ‘recommended’ antibiotic treatments. Gradually, through trial and error, I found it was necessary to extend the duration of treatment: first doubled, then later on tripled, quadrupled and finally, for some, adopted a somewhat ‘open-ended’ (not necessarily never-ending) approach. In the early 1990s, there was a very convivial and collaborative approach between clinicians and academicians and everyone was excited to be learning about this new disease.
Things changed dramatically with the 1995 Dearborn conference and the roll-out of the Lyme vaccine, LYMErix, following which a very rigid ‘construct’ of Lyme disease was promoted as dogma. This had not previously been the case. Care for persons with Lyme disease was a ‘niche’ needing to be filled, and I filled it. My background in critical care (and anatomic pathology) was very suitable for grappling with a multi-system illness that required thinking holistically about the entire organism/person and not just isolated ‘organ systems’ into which many of the sub-specialties and sub-specialists in medicine were ‘siloed’. I was fortunate to be able to collaborate with many of the finest researchers in both academia and at CDC & NIH resulting in publication of some important abstracts and papers. This was very gratifying and intellectually stimulating. There was a sense of community and shared effort at the time.
2. What do you see as the biggest difference(s) from when you began focusing on Lyme and where we are today?
I started practice towards the end of the so-called ‘Golden Age’ of Medicine. A time when private practice was prevalent, physicians worked for the patient and the Hippocratic Oath was revered. Paul Starr accurately predicted the ‘coming of the corporation’ in his excellent book, The Social Transformation of American Medicine. The advent of the hospitalist system also dramatically changed the nature of hospital medicine, where primary physicians no longer followed their patients in the hospital, guiding their care, watching out for their best interests and arranging optimal consultations. This served insurance company and hospital CEO corporate interests, enabling ‘efficiencies’ of care and a higher throughput, but completely broached often decades-long doctor-patient relationships. Hierarchical structures in hospital systems, including Pharmacy & Therapeutics Committees, helps explain why it remains, to this day, so difficult for persons with Lyme and tick-borne diseases to get personalized care within the hospital setting as well as within vertically-integrated corporate healthcare settings.
3. What are you most excited about in today’s treatment and/or hope for Lyme and other tick-borne diseases?
There is growing awareness of the complexity of tick- and vector-borne diseases. Meticulous scientific studies at the bench-level, with animal studies and also in clinical reports, elucidate a range of mechanisms that may be operative in maintaining illness. This raises consideration of novel interventions to improve people’s quality of life, which is paramount. Stalwart efforts by the patient community has resulted in government recognition that far greater financial and scientific resources are needed in this field. Recalcitrant refusal to acknowledge the important role of persistent borrelial infection despite prior application of antibiotic treatment is frustrating and impedes progress in devising solutions. Despite some improved funding, a much greater level is needed.
4. Why is it important for LDA and other nonprofits to increase awareness for Lyme disease and other tick-borne illnesses?
Many medical, scientific, and societal problems vie for attention and compete for government resources. The voice of patients expressed individually and through patient advocacy and educational organizations to their legislative representatives at local, state, and national levels is extremely important. Due to limited government resources, not all investigators are able to secure grants or funding even when their work is highly meritorious. There remains an important role for private funding of research.
5. Please share any past reflections or your experiences with the LDA. . .
The LDA has held annual scientific conferences of high quality for decades. Collaborations with academicians, various branches of the Federal and State governments as well as clinicians has raised awareness of and respect for concerns of patients and the public. LDA’s financial support of scientific research has enabled innumerable published peer-reviewed articles listed on PubMed, advancing medical knowledge, ultimately improving patient care. The volunteered efforts of Pat Smith and the support staff of the LDA and its affiliates represent the highest embodiment of ideals of service.