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Generally, American voters are not at “extremes.” However, if we think about voters as having positions on a checklist of issues(national and global economy, foreign policy, environmental protection, education, housing & urban development, etc.), it appears that voters are becoming more consistent in their positions— either with conservative positions across most/all categories or with liberal positions across most/all categories. (See a variety of recent Pew Research Center studies that are longitudinal in scope.)The implication of that consistency is that the political center is being vacated. This is interesting because there are still strong advocates for moderation who consider themselves to be “conservative” or “liberal.” They’re making the assumption that if a political candidate has more of a mix of conservative and liberal positions, they would be more electable. And that relies on the assumption that voters move away from the requirement for a candidate to match 100% of their political positions in order not to feel disenfranchised.One thing I’ve found interesting is that a majority of one demographic may have consistently liberal (for example) positions but consider themselves to be moderates. It’s all a matter of perspective. How this factors into voting, I don’t know.Republican Strategist Rick Wilson is pushing for a thoughtful blend of positions for Republicans. The Democratic National Committee is encouraging candidates to listen to their local voters and to put together a platform based on those voters’ balance of concerns. In other words, commit to representing the people who elect you. (What a concept!) Of course, there are certain basic tenants that would make someone run as a Democrat or Republican, but a Democrat in New York City should not have the same positions on all issues as a Democrat in Ames, Iowa, or El Paso, Texas. Ditto for Republican candidates in Silicon Valley, California, Casper, Wyoming, or Baltimore, Maryland.Wilson points to this move by the DNC as something the Republicans should be adopting. He is strongly not in favor of certain national politicians whose political strategy is to please those farthest toward white fundamentalist male nationalists with no college education to the extent and to ignore the priorities of people of color, people of non-fundamentalist Christian beliefs, women, and middle-class college-educated voters. (This is an over-simplification on Wilson’s part, but he’s talking about statistical averages, not all individuals within a demographic.) He is pushing for regional sensitivity and commitment to representing local priorities.It’s clear to me that many voters feel alienated, but I’m not sure whether that’s because candidates are not 100% aligned with their positions, because they’re too consistently liberal/conservative, or because the voters themselves hear the rhetoric of a candidate being “extreme” while they consider themselves to be moderates. I don’t think there’s good data on this, but perhaps another respondent will have citations with answers.

Okay - the background to this is that nobody has proved that Morgellons is delusional, despite many journalist articles and even the wikipedia page on the topic saying definitively that it is a delusion. Also there is new research which suggests that it is actually related to digital dermatitis, a disease of cattle. The few remaining researchers are all converged on this as their main hypothesis. I will go into this in a bit more detail in a moment.If this is right then the precautions are the same as for Lyme disease though the details of the disease are different. The main thing is to be careful to remove ticks immediately if you are bitten by them. If you do it within a few hours of getting the tick, apparently the chance of getting Lymes is minimal. I use the O'Tom tick twister myself - its a really easy way to remove them far easier than tweezers.Watch out for a spreading circular rash like this.If you see anything like that, go to the doctor right away. Lyme disease - and Morgellons also if it is connected - can be stopped right in its tracks so long as you get a strong dose of antibiotics - and not just any antibiotic, it has to be a particular type of very strong antibiotic, as soon as the rash appears. I actually live in a tick area myself and got a rash like this earlier this summer. I went to the doctor, got my medicine and it vanished quickly, within a few days. Of course then you continue to the end of the course of antibiotics.Also, you can’t be infected by others with Morgellons, if this is the right answer.For anyone who has Morgellons - if this hypothesis is correct - you may have been in a Lyme disease tick district in the past. If it is right, Morgellons doesn't start up immediately after the tick byte. The spirochetes have to get into the fibroblasts first before they start generating the fibres that cause the problems. It is easy to forget a tick bite and you don't always get the red rash (though I think you usually do) and it is also easy to get a rash and not think much of it and not notice that it is that circular shape or just not know its significance.So now more on the background.MEDICAL CAVEATSince this is an answer on medicine, I feel I need to give a medical warning. First there are many other conditions that are easily confused with Morgellons (putting aside for one moment the question of whether Morgellons is a disease or a delusional condition). I suggest that if you think you have the condition, that you talk to your doctor first and go through all those tests. Morgellons is an extremely rare condition, just a few in a hundred thousand have it. The chances are you have something else, which the doctor will be able to treat.Then, if you get no success and think you may have the condition, there's the Morgellons Disease Foundation which is a patients advocacy organization for this condition. I'd get in touch with them or visit their facebook page or go to their conferences to find out more - it's a whole lot better than getting advice from strangers on internet forums or science blogs or quora at least.So this answer is not meant for patient support. It is just about the scientific aspect of this. Could it be that the researchers are right, and that there is a connection with Lyme disease? How did we get into this situation where the medical establishment is sure that there is no connection, and yet this group of researchers and many patients are convinced that there is?I don't have Morgellons myself and at the time I first wrote this material I didn’t know anyone with it. Since then of course I have been contacted both via comments and privately by Morgellons suffers. This is from an article I wrote on Science20CENTERS FOR DISEASE CONTROL (CDC) SURVEYAt first, you get the impression that it was all cleared up by a big survey published in 2012. Their conclusions were so definite you wonder why anyone could doubt it.This was an initiative of the Obama administration. Before 2012, then there was a variety of views on this, with several different scientific hypotheses being explored, and it wasn't yet considered a "closed book" by the medical establishment. After a lot of agitation by patient advocacy groups, then a large study begin, in 2008, concluding in 2012. But when this came out, it was a great disappointment to those who thought it is a real disease, because the researchers came out conclusively in favour of the delusion hypothesis.This is what they wrote:"This comprehensive study of an unexplained apparent dermopathy demonstrated no infectious cause and no evidence of an environmental link. There was no indication that it would be helpful to perform additional testing for infectious diseases as a potential cause. Future efforts should focus on helping patients reduce their symptoms through careful attention to treatment of co-existing medical, including psychiatric conditions, that might be contributing to their symptoms."You can understand that this seemed to close the book on the subject for the medical establishment.However if you look at the study a bit more closely, then it's not quite so clear a matter as it first seems.The main problem the CDC study faced is the low prevalence of the disease, only 3.65 cases per 100,000 of the population they studied. Also at the time they did the study there were many different competing hypotheses about what caused Morgellons, so they didn’t have a single hypothesis to test.In that four year period, after spending hundreds of thousands of pounds on the survey, they found a total of 41 patients with the condition. More than ten thousand dollars per patient was spent on this survey - doing something like this is an expensive undertaking.They themselves point out several limitations to their study. Also some of the researchers who were already researching into the condition at the time of the survey offered several criticisms of it.Harry Schone summarizes these criticisms in one of the sections of his University College Londonthesis "Learning from Morgellons" (for a History and Philosophy of Science Masters)"It is indeed true that the CDC were being cautious, that they found no positive evidence for the claims made by Morgellons sufferers, but it does not mean that the study can go without critical appraisal. Although expensive and lengthy, the research only clinically evaluated 41 people. Furthermore, since the population was selected by criteria other than self-identification it has been argued by critics of the study that some of those included did not have or even consider themselves to have Morgellons. The validity of these criticisms may rest on somewhat pedantic points, but what is certainly true is that an awful lot of reading between the lines has been passed off as something more substantial."See Learning from Morgellons, Harry Quinn Schone, Masters thesis for UCL (University College London), see Harry SchoneAnd if you go and read the report itself, then they also point out limitations in their own report. Amongst other issues they point out that there was no clear diagnostic test for the condition or established tests for it, so leading to possibilities of reporting biases and misclassification. Also, they weren't able to follow the patients over a long period of time.The paper itself is not nearly so conclusive in tone as the summary of it might suggest.This is what they say at the end of the discussion section:We were not able to conclude based on this study whether this unexplained dermopathy represents a new condition, as has been proposed by those who use the term Morgellons, or wider recognition of an existing condition such as delusional infestation, with which it shares a number of clinical and epidemiologic features. We found little on biopsy that was treatable, suggesting that the diagnostic yield of skin biopsy, without other supporting clinical evidence, may be low. However, we did find among our study population co-existing conditions for which there are currently available therapies (drug use, somatization). These data should assist clinicians in tailoring their diagnostic and treatment approaches to patients who may be affected. In the absence of an established cause or treatment, patients with this unexplained dermopathy may benefit from receipt of standard therapies for co-existing medical conditions and/or those recommended for similar conditions such delusions infestationThat doesn't read to me like a paper that completely closes the book on the topic, leaving no possibility for any future research on it.For details see the discussion section of the Plos One paper.THE NEW HYPOTHESIS, A CONNECTION WITH CHRONIC LYME DISEASEAt the time of the CDC report, there were many competing scientific hypotheses for Morgellons. So the CDC were quite right to say that there was no single clear diagnostic criteria to use, or tests.However, now it seems that the researchers have converged on a single hypothesis. Which seems, scientifically, quite a reasonable one. The Mayo Clinic Page page about Morgellons refers to this group of researchersThere are maybe a dozen or so researchers involved in this research. But one of the main proponents of this hypothesis is Marianne J. Middelveen, MDes, a Veterinary Microbiologist from Alberta, Canada. She made a connection with a disease of cattle, called Bovine Digital dermatitiswhich has similar symptoms - and in that case, it is well established that there are microfilaments of keratin and collagen which form beneath the skin.She analysed the filaments that form beneath the skin of sufferers, and found out that these also are made of keratin and collagen.She also found spirochetes, which are usually associated with Lyme disease in humans.These get their name because of their spiral shape:See Borrelia burgdorferi NEU2011 on MicrobeWikiYou can listen to her talk about her researches in the One Radio Network morning show with Patrick Timpone here: Marianne Middelveen, Morgellons DiseaseAnd the main paper is here: "Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients"It turns out that Borrelia burgdorferi has a preference for infecting fibroblasts and keratinocytes which are cells in your body, in the epithelium, that create keratin and collagen - components of your skin. So they are a part of a healthy skin.Her hypothesis is that the spirochetes hides from the antibiotics inside the cells that produce these materials and this can influence gene expression (which genes get turned on or off), so something goes wrong with gene regulation, leading to these cells producing too much collagen and keratin, creating these fibres in the skin, which then cause the irritations and sores. They may be able to hide in these cells for many years on end, before something changes and triggers an outbreak of Morgellons.But some patients continue to get symptoms for many years afterwards. The suggestion is that the spirochetes can sometimes hide from the antibiotics, and then continue to cause problems long after the disease is normally considered to be cured.This has the same issue as Morgellons, that the treatment for chronic lyme disease is a long term course of antibiotics. Most medical authorities advise against this method of treating it. See Lyme Disease Controversy (wikipedia)..The problem here is that though the mechanisms of persistence in Lyme disease are well established in animal studies, dogs mice and rhesus macaques, there is a lot of controversy about whether the same processes happen in humans.There are two views here, the view of the CDC that humans are different from the animals, and one month of antibiotics will get rid of Lyme disease, and the view of ILADS (the International Lyme and Associated Diseases Society) that persistent lyme disease is a problem.Marianne Middelveen says she has chronic lyme disease herself (though she doesn't have the symptoms of Morgellons). As a microbiologist she can culture it in a special growth medium, and (after maybe a month) she can see the Lyme bacterium swimming around, and do DNA studies, and molecular stains and techniques to definitely identify it as Borrelia Burgdorferi (they use antibiotics to eliminate other microbes).WHY DIDN'T THE CDC FIND THE SPIROCHETES?In their 2015 paper, Middelveen and her co researchers say that the CDC study had limitations which could explain why they didn't find the spirochetes"The search for spirochetal pathogens in that study was limited to Warthin-Starry staining on a small number of tissue samples and commercial two-tiered serological Lyme disease testing as interpreted by the CDC Lyme surveillance criteria. It should be noted that only two of the patients in our study group were positive for Lyme disease based on the CDC Lyme surveillance criteria and yet Borrelia spirochetes were readily detectable in this group of 25 MD patients."They attribute their success in detecting Borrelia burgdorferi and closely related spirochetes to several factorsClear diagnostic criteria for patient selection: fibers visible underneath unbroken skin or embedded in or projecting from skin, documented by a healthcare providerAbility to culture spirochetes in vitro to increase opportunity of detectionHigh spirochetal load for the lesions, similar to lesions in cattle with BDDUse of molecular hybridization and PCR methods, able to detect spirochetal DNA in picogram range.WHAT ABOUT THE COTTON FIBRES FOUND BY THE CDC?The authors agree that the cotton fibres extracted by the CDC are unrelated to the disease, and are probably from clothes and swabs. However they say that the fibres they study are a different phenomenon. They are almost microscopic in many people, 10 microns to 40 microns wide. They may require 60 times magnification to be seen clearly, and can be found beneath unbroken skin. The fibres they found were made of keratin and collagen, not cotton. See Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients,WHAT ABOUT THE DELUSIONS?Some of the patients do start to get many different ideas about their condition and may think they are infected by insects, or other things.Here I'm summarizing some earlier papers on the topic. The researchers agreed with the CDC that these incorrect beliefs can occur, but differ in their understanding of the cause / effect connection. Based on patient reports and observations, they believe that the physical symptoms occur first, and the psychosomatic disorders follow later.Lyme disease is also implicated in some neurological conditions so that may also be a factor. In more detail, the ILADS chronic lyme disease checklist for preliminary diagnosis for physicians lists amongst possible symptoms of chronic lyme disease including confusion, difficulty thinking, poor short term memory and attention, disorientation, speech errors such as wrong words and misspeaking, mood swings, anxiety and panic attacks, also:Psychosis (hallucinations, delusions, paranoia, bipolar)"(Note, there are many other symptoms in the check list such as joint pain, fevers, etc and some patients will have some and some will have others.To be diagnosed as chronic lyme disease according to these guidelines - the illness also has to be present for at least a year, must have major neurological effects such as encephalitis, meningitis etc or active arthritis - and the patient must still have active infection with B. burgdorferi even if previously treated with antibiotics)In particular, in support of their view that the condition may cause the higher prevalence of delusions rather than the other way around, these researchers say that they found no evidence of a higher occurrence of pre-existing psychosomatic disorders in this group of patients than there is in the population at large (0.03%), which in their view distinguishes this group of patients from usual cases of delusional parasitosis.LEADING EDGE RESEARCHIt is leading edge research. Just a few studies by a small group of researchers. Following standard scientific practice, then researches like this need to be confirmed by other researchers in other studies. And at this stage, it could as easily be refuted as confirmed.But - with most researchers convinced that the CDC report has "closed the book" on this topic area, research in this area is bound to be slow.Perhaps their report has sometimes been used in ways that suggested it is more conclusive than it really was.In this situation, surely we need to continue this research. If it did turn out that these researchers are right after all, then it is awful if patients who have a real disease are just being treated for anxiety and neurosis.On the other hand it is also pretty bad I think that some patients feel they have to self medicate with antibiotics made for animals, without the precautions needed to make sure they are not harming their health in the process.Long term use of antibiotics has potential to harm your internal organs. It is not something to do on your own, you must get a doctor to do it for you, and monitor the effects closely to make sure you are not being damaged. But the doctor faces the issue of possible malpractice if it is not an accepted treatment. Some doctors are willing to do this kind of treatment for chronic lyme disease even though it is controversial.And if this treatment is actually not doing them any good, this also maybe can be shown conclusively in future research. The CDC reports has enough caveats in it that you can understand patients and researchers not being convinced that it has totally closed the book.And maybe some other treatment found in its place if it is a real condition, once they understand it better. Hopefully more research will help with all this.ANNUAL CONFERENCE ON MORGELLONSFor those who are really keen to find out more, there's an annual three day conference for researchers to present and discuss their findings, including investigations of this hypothesis of a Lyme disease connection. It is held in Austin, Texas, and the eighth conference in 2015 hadtwelve presenters.This is sponsored by the Charles Holman Morgellons Disease Foundation, which is a 501(c)3nonprofit organization committed to "advocacy and philanthropy in the battle against Morgellons Disease" Its director is Cindy Casey-Holman and the organization is named after her deceased husband Charles Holman. It also has a facebook page.The Morgellons Research Foundation was the primary patient advocacy group in the 2000s. This was founded by Mary Leitao, a biologist from Pennsylvania, but is no longer active.See also:Marianne Middelveen, Morgellons Disease Marianne Middelveen talking about her researchFIND OUT MOREMystery Of Morgellons - Disease Or Delusion - Scientific Hypothesis Of Connection With Lyme Diseasewhich also has many other cites.DON’T BELIEVE WIKIPEDIA ON THIS TOPICIf you go to the Wikipedia article on Morgellons then it just says categorically that it is delusional parasitosis. Do be aware that articles on wikipedia are sometimes very biased. (Though many others are excellent).I’ve been trying for some time to get them to change it. I tried to get them to add this paragraph somewhere in the article:"Not all scientists agree that the CDC closes the book on Morgellons. There is research still continuing by a number of scientists based on the hypothesis that it is a disease similar to bovine Digital dermatitis which is a known disease of cattle. These researchers report discovery of spirochetes in the wounds and fibres containing a mix of keratin and collagen as for bovine dermatitis. [cites]. This research is minority view and controversial."But they were having none of it. You can see the discussion on the talk page if you want to see how it went. I stopped this time after another wikipedia editor (not an admin) threatened to get me topic banned if I continue to present my reasons for changing the article.WARNING - PLEASE DON’T TAKE PART IN THE MORGELLONS TALK PAGE DEBATE IN WIKIPEDIA AS A RESULT OF READING THISIf any of you reading this feel tempted to try to join in that debate, please don’t. Wikipedia has a strict rules against canvasing and if anyone joins in as a result of reading what I say here they will fall under canvasing also perhaps proxy editing, getting both you and me in trouble. So I have to warn all readers of my articles not to get involved.But - I can without any problems just tell you that in my view the Morgellons article on Wikipedia is very biased, presenting the CDC report as if it closed the book when it certainly didn’t, as you can see from this answer.SEE ALSOThe material in this answer comes from my Science20 article: Mystery Of Morgellons - Disease Or Delusion - Scientific Hypothesis Of Connection With Lyme Disease which has many cites to the academic medical literature which you can follow up to find out more.That in turn originated as an article I wrote for wikipedia but they merged it away and after trying very hard to get them to include some of the material, I gave up and then I wrote this article instead - of course in a more entertaining science blog fashion.I’ve also copied this answer with some editing as it is a different question, to my answer to What research is being done on the potential pandemic of Morgellons?

Summary first then I’ll go into details. The background to this is that nobody has proved that Morgellons is delusional, despite many journalist articles and the wikipedia page on the topic saying definitively that it is a delusion. The CDC were not able to do so as they are a disease research institution and not expert on psychological diagnoses.One thing that complicates this is that Lyme disease is well known to cause mental illness with over 250 medical articles linking tick borne diseases with mental illness. So it’s not that surprising if Morgellons sufferers have mental conditions. It’s thought that the spirochete infects the nervous system causing these symptoms.Also the CDC report didn’t disprove that it is a disease either. Though very expensive, because of the way it was conducted and the rarity of the condition, it only evaluated 41 patients. It cost more than $14,000 per patient evaluated. Also they didn’t ask if the patients they studied had Morgellons so it is not even clear how many of those 41 thought of themselves as having Morgellons. It was also done at a time when there were many competing hypotheses so they didn’t have a single theory to test.The report itself, especially if you read the report itself, is far less conclusive and more hedged about with discussion of the limitations of the study than the CDC summary of it. It doesn’t claim to have closed the book on the subject and has been assumed by many to have established much more than it actually did. It’s also been criticized for not using the most sensitive tests for spirochetes available. More on all this below.Also there is new research only in the last few years, which suggests that it is actually related to digital dermatitis, a disease of cattle, which the CDC did not test for as nobody thought of it in those terms back then. The few remaining researchers are all converged on this as their main hypothesis. This is peer reviewed research in mainstream medical journals. I will go into this in a bit more detail in a moment.If this is right then it is not spread from one person to another. Rather it has a similar cause to Lyme disease though the details of the disease are different. The main thing is to be careful to remove ticks immediately if you are bitten by them. If you do it within a few hours of getting the tick, apparently the chance of getting Lymes is minimal. I use the O'Tom tick twister myself - its a really easy way to remove them far easier than tweezers.Watch out for a spreading circular rash like this.If you see anything like that, go to the doctor right away. Lyme disease - and Morgellons also if it is connected - can be stopped right in its tracks so long as you get a strong dose of antibiotics - and not just any antibiotic, it has to be a particular type of very strong antibiotic, as soon as the rash appears. I actually live in a tick area myself and got a rash like this earlier this summer. I went to the doctor, got my medicine and it vanished quickly, within a few days. Of course then you continue to the end of the course of antibiotics.However it is not a pandemic in the sense of a disease you can catch from others, as you can’t be infected by others with Morgellons, if this is the right answer.Probably the reason more people are coming forward with it is just that before it didn’t have a name and they were isolated individuals who were suffering from it and told by their doctors that it was delusional parasitosis or the doctor just didn’t know what it was - like any rare disease that only affects a tiny fraction of the population. Now they have a word they can rally around and they can make contact with other sufferers with similar symptoms which they could never do before. So I doubt if it is becoming more common, just more reported.People with Morgellons generally turn out to have been in a Lyme disease tick district in the past. If the hypothesis is right, Morgellons doesn't start up immediately after the tick byte. The spirochetes have to get into the fibroblasts and keratinocytes first before they start generating the fibres that cause the problems. The fibers themselves are created by your own body in response to the spirochetse. It is easy to forget a tick bite and you don't always get the red rash (though I think you usually do) and it is also easy to get a rash and not think much of it and not notice that it is that circular shape or just not know its significance.So now more on the background. First if you are a medical professional / academic and just want to read the latest research, this paper is a good summary, published September 2016: Morgellons disease: a filamentous borrelial dermatitis | IJGMMEDICAL CAVEATSince this is an answer on medicine, I feel I need to give a medical warning. First there are many other conditions that are easily confused with Morgellons (putting aside for one moment the question of whether Morgellons is a disease or a delusional condition). I suggest that if you think you have the condition, that you talk to your doctor first and go through all those tests. Morgellons is an extremely rare condition, just a few in a hundred thousand have it. The chances are you have something else, which the doctor will be able to treat.Then, if you get no success and think you may have the condition, there's the Morgellons Disease Foundation which is a patients advocacy organization for this condition. I'd get in touch with them or visit their facebook page or go to their conferences to find out more - it's a whole lot better than getting advice from strangers on internet forums or science blogs or quora at least.So this answer is not meant for patient support. It is just about the scientific aspect of this. Could it be that the researchers are right, and that there is a connection with Lyme disease? How did we get into this situation where the medical establishment is sure that there is no connection, and yet this group of researchers and many patients are convinced that there is?I don't have Morgellons myself and at the time I first wrote this material I didn’t know anyone with it. Since then of course I have been contacted both via comments and privately by Morgellons suffers. This is from an article I wrote on Science20CENTERS FOR DISEASE CONTROL (CDC) SURVEYAt first, you get the impression that it was all cleared up by a big survey published in 2012. Their conclusions were so definite you wonder why anyone could doubt it.This was an initiative of the Obama administration. Before 2012, then there was a variety of views on this, with several different scientific hypotheses being explored, and it wasn't yet considered a "closed book" by the medical establishment. After a lot of agitation by patient advocacy groups, then a large study begin, in 2008, concluding in 2012. But when this came out, it was a great disappointment to those who thought it is a real disease, because the researchers came out conclusively in favour of the delusion hypothesis.This is what they wrote:"This comprehensive study of an unexplained apparent dermopathy demonstrated no infectious cause and no evidence of an environmental link. There was no indication that it would be helpful to perform additional testing for infectious diseases as a potential cause. Future efforts should focus on helping patients reduce their symptoms through careful attention to treatment of co-existing medical, including psychiatric conditions, that might be contributing to their symptoms."You can understand that this seemed to close the book on the subject for the medical establishment.However if you look at the study a bit more closely, then it's not quite so clear a matter as it first seems.The main problem the CDC study faced is the low prevalence of the disease, only 3.65 cases per 100,000 of the population they studied. Also at the time they did the study there were many different competing hypotheses about what caused Morgellons, so they didn’t have a single hypothesis to test.In that four year period, after spending hundreds of thousands of pounds on the survey, they found a total of 41 patients with the condition. More than ten thousand dollars per patient was spent on this survey - doing something like this is an expensive undertaking.They themselves point out several limitations to their study. Also some of the researchers who were already researching into the condition at the time of the survey offered several criticisms of it.Harry Schone summarizes these criticisms in one of the sections of his University College Londonthesis "Learning from Morgellons" (for a History and Philosophy of Science Masters)"It is indeed true that the CDC were being cautious, that they found no positive evidence for the claims made by Morgellons sufferers, but it does not mean that the study can go without critical appraisal. Although expensive and lengthy, the research only clinically evaluated 41 people. Furthermore, since the population was selected by criteria other than self-identification it has been argued by critics of the study that some of those included did not have or even consider themselves to have Morgellons. The validity of these criticisms may rest on somewhat pedantic points, but what is certainly true is that an awful lot of reading between the lines has been passed off as something more substantial."See Learning from Morgellons, Harry Quinn Schone, Masters thesis for UCL (University College London), see Harry SchoneAnd if you go and read the report itself, then they also point out limitations in their own report. Amongst other issues they point out that there was no clear diagnostic test for the condition or established tests for it, so leading to possibilities of reporting biases and misclassification. Also, they weren't able to follow the patients over a long period of time.The paper itself is not nearly so conclusive in tone as the summary of it might suggest.This is what they say at the end of the discussion section:We were not able to conclude based on this study whether this unexplained dermopathy represents a new condition, as has been proposed by those who use the term Morgellons, or wider recognition of an existing condition such as delusional infestation, with which it shares a number of clinical and epidemiologic features. We found little on biopsy that was treatable, suggesting that the diagnostic yield of skin biopsy, without other supporting clinical evidence, may be low. However, we did find among our study population co-existing conditions for which there are currently available therapies (drug use, somatization). These data should assist clinicians in tailoring their diagnostic and treatment approaches to patients who may be affected. In the absence of an established cause or treatment, patients with this unexplained dermopathy may benefit from receipt of standard therapies for co-existing medical conditions and/or those recommended for similar conditions such delusions infestationThat doesn't read to me like a paper that completely closes the book on the topic, leaving no possibility for any future research on it.For details see the discussion section of the Plos One paper.THE NEW HYPOTHESIS, A CONNECTION WITH CHRONIC LYME DISEASEAt the time of the CDC report, there were many competing scientific hypotheses for Morgellons. So the CDC were quite right to say that there was no single clear diagnostic criteria to use, or tests.However, now it seems that the researchers have converged on a single hypothesis. Which seems, scientifically, quite a reasonable one. The Mayo Clinic Page page about Morgellons refers to this group of researchersThere are maybe a dozen or so researchers involved in this research. But one of the main proponents of this hypothesis is Marianne J. Middelveen, MDes, a Veterinary Microbiologist from Alberta, Canada. She made a connection with a disease of cattle, called Bovine Digital dermatitiswhich has similar symptoms - and in that case, it is well established that there are microfilaments of keratin and collagen which form beneath the skin.She analysed the filaments that form beneath the skin of sufferers, and found out that these also are made of keratin and collagen.She also found spirochetes, which are usually associated with Lyme disease in humans.These get their name because of their spiral shape:See Borrelia burgdorferi NEU2011 on MicrobeWikiYou can listen to her talk about her researches in the One Radio Network morning show with Patrick Timpone here: Marianne Middelveen, Morgellons DiseaseAnd the main paper is here: "Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients"It turns out that Borrelia burgdorferi has a preference for infecting fibroblasts and keratinocytes which are cells in your body, in the epithelium, that create keratin and collagen - components of your skin. So they are a part of a healthy skin.Her hypothesis is that the spirochetes hides from the antibiotics inside the cells that produce these materials and this can influence gene expression (which genes get turned on or off), so something goes wrong with gene regulation, leading to these cells producing too much collagen and keratin, creating these fibres in the skin, which then cause the irritations and sores. They may be able to hide in these cells for many years on end, before something changes and triggers an outbreak of Morgellons.But some patients continue to get symptoms for many years afterwards. The suggestion is that the spirochetes can sometimes hide from the antibiotics, and then continue to cause problems long after the disease is normally considered to be cured.This has the same issue as Morgellons, that the treatment for chronic lyme disease is a long term course of antibiotics. Most medical authorities advise against this method of treating it. See Lyme Disease Controversy (wikipedia)..The problem here is that though the mechanisms of persistence in Lyme disease are well established in animal studies, dogs mice and rhesus macaques, there is a lot of controversy about whether the same processes happen in humans.There are two views here, the view of the CDC that humans are different from the animals, and one month of antibiotics will get rid of Lyme disease, and the view of ILADS (the International Lyme and Associated Diseases Society) that persistent lyme disease is a problem.Marianne Middelveen says she has chronic lyme disease herself (though she doesn't have the symptoms of Morgellons). As a microbiologist she can culture it in a special growth medium, and (after maybe a month) she can see the Lyme bacterium swimming around, and do DNA studies, and molecular stains and techniques to definitely identify it as Borrelia Burgdorferi (they use antibiotics to eliminate other microbes).WHY DIDN'T THE CDC FIND THE SPIROCHETES?In their 2015 paper, Middelveen and her co researchers say that the CDC study had limitations which could explain why they didn't find the spirochetes"The search for spirochetal pathogens in that study was limited to Warthin-Starry staining on a small number of tissue samples and commercial two-tiered serological Lyme disease testing as interpreted by the CDC Lyme surveillance criteria. It should be noted that only two of the patients in our study group were positive for Lyme disease based on the CDC Lyme surveillance criteria and yet Borrelia spirochetes were readily detectable in this group of 25 MD patients."They attribute their success in detecting Borrelia burgdorferi and closely related spirochetes to several factorsClear diagnostic criteria for patient selection: fibers visible underneath unbroken skin or embedded in or projecting from skin, documented by a healthcare providerAbility to culture spirochetes in vitro to increase opportunity of detectionHigh spirochetal load for the lesions, similar to lesions in cattle with BDDUse of molecular hybridization and PCR methods, able to detect spirochetal DNA in picogram range.WHAT ABOUT THE COTTON FIBRES FOUND BY THE CDC?The authors agree that the cotton fibres extracted by the CDC are unrelated to the disease, and are probably from clothes and swabs. However they say that the fibres they study are a different phenomenon. They are almost microscopic in many people, 10 microns to 40 microns wide. They may require 60 times magnification to be seen clearly, and can be found beneath unbroken skin. The fibres they found were made of keratin and collagen, not cotton. See Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients,WHAT ABOUT THE DELUSIONS?Some of the patients do start to get many different ideas about their condition and may think they are infected by insects, or other things.Here I'm summarizing some earlier papers on the topic. The researchers agreed with the CDC that these incorrect beliefs can occur, but differ in their understanding of the cause / effect connection. Based on patient reports and observations, they believe that the physical symptoms occur first, and the psychosomatic disorders follow later.Lyme disease is also implicated in some neurological conditions so that may also be a factor. In more detail, the ILADS chronic lyme disease checklist for preliminary diagnosis for physicians lists amongst possible symptoms of chronic lyme disease including confusion, difficulty thinking, poor short term memory and attention, disorientation, speech errors such as wrong words and misspeaking, mood swings, anxiety and panic attacks, also:Psychosis (hallucinations, delusions, paranoia, bipolar)"(Note, there are many other symptoms in the check list such as joint pain, fevers, etc and some patients will have some and some will have others.To be diagnosed as chronic lyme disease according to these guidelines - the illness also has to be present for at least a year, must have major neurological effects such as encephalitis, meningitis etc or active arthritis - and the patient must still have active infection with B. burgdorferi even if previously treated with antibiotics)In particular, in support of their view that the condition may cause the higher prevalence of delusions rather than the other way around, these researchers say that they found no evidence of a higher occurrence of pre-existing psychosomatic disorders in this group of patients than there is in the population at large (0.03%), which in their view distinguishes this group of patients from usual cases of delusional parasitosis.LEADING EDGE RESEARCHIt is leading edge research. Just a few studies by a small group of researchers. Following standard scientific practice, then researches like this need to be confirmed by other researchers in other studies. And at this stage, it could as easily be refuted as confirmed.But - with most researchers convinced that the CDC report has "closed the book" on this topic area, research in this area is bound to be slow.Perhaps their report has sometimes been used in ways that suggested it is more conclusive than it really was.In this situation, surely we need to continue this research. If it did turn out that these researchers are right after all, then it is awful if patients who have a real disease are just being treated for anxiety and neurosis.On the other hand it is also pretty bad I think that some patients feel they have to self medicate with antibiotics made for animals, without the precautions needed to make sure they are not harming their health in the process.Long term use of antibiotics has potential to harm your internal organs. It is not something to do on your own, you must get a doctor to do it for you, and monitor the effects closely to make sure you are not being damaged. But the doctor faces the issue of possible malpractice if it is not an accepted treatment. Some doctors are willing to do this kind of treatment for chronic lyme disease even though it is controversial.And if this treatment is actually not doing them any good, this also maybe can be shown conclusively in future research. The CDC reports has enough caveats in it that you can understand patients and researchers not being convinced that it has totally closed the book.And maybe some other treatment found in its place if it is a real condition, once they understand it better. Hopefully more research will help with all this.ANNUAL CONFERENCE ON MORGELLONSFor those who are really keen to find out more, there's an annual three day conference for researchers to present and discuss their findings, including investigations of this hypothesis of a Lyme disease connection. It is held in Austin, Texas, and the eighth conference in 2015 hadtwelve presenters.This is sponsored by the Charles Holman Morgellons Disease Foundation, which is a 501(c)3nonprofit organization committed to "advocacy and philanthropy in the battle against Morgellons Disease" Its director is Cindy Casey-Holman and the organization is named after her deceased husband Charles Holman. It also has a facebook page.The Morgellons Research Foundation was the primary patient advocacy group in the 2000s. This was founded by Mary Leitao, a biologist from Pennsylvania, but is no longer active.See also:Marianne Middelveen, Morgellons Disease Marianne Middelveen talking about her researchFIND OUT MOREMystery Of Morgellons - Disease Or Delusion - Scientific Hypothesis Of Connection With Lyme Diseasewhich also has many other cites.DON’T BELIEVE WIKIPEDIA ON THIS TOPICIf you go to the Wikipedia article on Morgellons then it just says categorically that it is delusional parasitosis. Do be aware that articles on wikipedia are sometimes very biased. (Though many others are excellent).I’ve been trying for some time to get them to change it. I tried to get them to add this paragraph somewhere in the article:"Not all scientists agree that the CDC closes the book on Morgellons. There is research still continuing by a number of scientists based on the hypothesis that it is a disease similar to bovine Digital dermatitis which is a known disease of cattle. These researchers report discovery of spirochetes in the wounds and fibres containing a mix of keratin and collagen as for bovine dermatitis. [cites]. This research is minority view and controversial."But they were having none of it. You can see the discussion on the talk page if you want to see how it went. I stopped this time after another wikipedia editor (not an admin) threatened to get me topic banned if I continue to present my reasons for changing the article on its talk page. They could have done that by claiming that I was promoting fringe science in a medical article, which can get you a swift topic ban on Wikipedia. The admins that judge those cases are never specialist in the topic area, don’t follow up cites, make their judgements swiftly, and will just accept what the majority of editors on the talk page say about whether it is fringe science. For more on this see the section on Morgellons in my answer to Is Wikipedia biased?WARNING - PLEASE DON’T TAKE PART IN THE MORGELLONS TALK PAGE DEBATE IN WIKIPEDIA AS A RESULT OF READING THISIf any of you reading this feel tempted to try to join in that debate, please don’t. Wikipedia has a strict rules against canvasing and if anyone joins in as a result of reading what I say here they will fall under canvasing also perhaps proxy editing, getting both you and me in trouble. So I have to warn all readers of my articles not to get involved.But - I can without any problems just tell you that in my view the Morgellons article on Wikipedia is very biased, presenting the CDC report as if it closed the book when it certainly didn’t, as you can see from this answer.SEE ALSO(slightly edited version of my answer to Robert Walker's answer to How do I get infected with Morgellons disease? )The material in this answer comes from my Science20 article: Mystery Of Morgellons - Disease Or Delusion - Scientific Hypothesis Of Connection With Lyme Disease which has many cites to the academic medical literature which you can follow up to find out more.That in turn originated as an article I wrote for wikipedia but they merged it away and after trying very hard to get them to include some of the material, I gave up and then I wrote this article instead - of course in a more entertaining science blog fashion.