The Costs of Lyme Disease-Reply

McCaulley makes an important point: in many practices, even those based in and near areas endemic for Lyme disease, that diagnosis is often missed and may not even be considered. This concept, which has been dealt with in a previous article,¹ was one of the major points made at the National Clinical Conference on Lyme Disease² and, in fact, is one of the goals of the extant, broad, clinical literature on Lyme disease. However, in clinical practice in endemic and near-to-endemic areas, a larger problem is overdiagnosis and overtreatment.^3-5

It is critical that the diagnosis of Lyme disease be considered when appropriate, a point made in the article under discussion³ and in previous discussions of overdiagnosis.¹ Lyme disease should be included within the differential diagnosis when prudent clinical practice suggests that it is a plausible explanation of the patient's problems. However, the diagnosis should not