S2E157 — At-home test for infected ticks could improve Lyme Disease diagnosis

GARY: Wait, is that— we're rolling? I thought we started at nine.

GARY: Okay. Hi. Sorry. Gary.

MAEVE: Maeve.

OBI: Obi.

GRUNER: Gruner.

GARY: Right. Good. That's the four of us. Whole roster. Nobody's been replaced, nobody's died, we're all still —

OBI: Gary.

GARY: Yep.

OBI: The thing.

GARY: The thing. Right.

MAEVE: Ticks.

GARY: Ticks.

GARY: There's a company — LymeAlert — it's a home test. You find a tick on you, you crush it in this little grinder that comes with the kit, and it tells you if that specific tick was carrying Lyme. Fifteen bucks.

OBI: Fifty.

GARY: Fifty. I said fifteen.

OBI: You said fifteen.

GARY: I meant fifty. Fifty dollars. You crush the tick, you get a test strip, two lines like a pregnancy test, fifteen minutes, done. Hits shelves in August.

MAEVE: And structurally this is a TAM story before it's a medicine story. Thirty-one million tick bites a year in this country. Even single-digit conversion on a fifty-dollar consumable isn't a business, it's a category.

OBI: Or — hear me out — it's a physician associate in Boston who got sick of blanket-prescribing doxycycline to every kid who walked in with a bug on their neck, because the parents couldn't afford the office visit just to find out if they even needed the pill.

MAEVE: That's the same sentence I said.

OBI: It sounded better coming out of a person.

GARY: Her name's Dawicki. She built it out of an MIT Sloan class assignment — got handed the Lyme track late, almost didn't do anything with it, and then the morning the pitch was due she thought: what if you just tested the tick.

OBI: Two other founders on it. Ewy, Ong. Nobody quotes them. It's always the doctor who gets the profile.

MAEVE: Founder narrative economics. One face sells better than three.

GRUNER: Field note.

GRUNER: Bacterium is Borrelia burgdorferi. Lives in tick gut. Tick must feed on infected mouse as larva, before it can carry as nymph. Not all ticks infected. Not all bites transmit. This is — how you say — supply chain with feelings.

MAEVE: That's actually right.

GRUNER: I know.

GARY: Okay, but the crushing part. You are grinding up a living arthropod in your kitchen. That's not a diagnostic, that's a ritual.

OBI: Mortar and pestle for people who watched one too many pharma ads. Ask your doctor if murdering a bug is right for you.

GARY: I don't think it's murder if it already bit you.

OBI: Self‑defense. Noted.

GARY: And the existing options are worse than they sound. Mail‑in tests exist, but you're waiting on postage, and the article's very clear the results come back after the seventy‑two‑hour window where the antibiotic actually does anything. And the blood test — the one everyone defaults to — misses sixty‑four to seventy‑eight percent of early cases if you run it inside thirty days, because you haven't made enough antibodies yet for it to see you.

MAEVE: So the product isn't competing with a good test. It's competing with a slow one and a blind one.

OBI: Which is a real gap. I'll give it that much before I start being difficult.

GARY: There's also an app. Photograph the strip, it reads the lines for you, so nobody's squinting at a faint line at eleven at night deciding their own diagnosis.

OBI: That's the part that'll actually work. The plastic will misfire. The camera won't.

OBI: The CDC does not want you doing this, for the record. Testing the tick, I mean.

GARY: Correct.

OBI: Paper.

OBI: IDSA guidelines. Verbatim, because I don't trust myself to paraphrase medicine tonight. Quote: "Studies from the United States and Europe have shown that detecting B. burgdorferi sensu lato in Ixodes spp. ticks poorly predicts either subsequent disease — zero to twelve point four percent — or asymptomatic seroconversion — zero to four point seven percent." End quote. In English: the tick can come back positive and you can still be completely, boringly fine.

GARY: So what changes the decision?

OBI: Nothing the test tells you. You take the pill if the tick was attached and engorged. You don't if it wasn't. A person looks at a bug. An app reading a strip doesn't move that needle either direction.

GARY: So it's peace of mind.

OBI: It's a fifty-dollar receipt for a decision that already happened.

GRUNER: Lateral flow. Same platform as pregnancy strip. Same platform as home COVID test. This is — vector-borne externality reporting mechanism.

MAEVE: Close.

GRUNER: Close is field work.

OBI: lima again, because he's not done ruining anyone's morning: quote, "I can't imagine an LFT test working terribly well, especially for nymphs, which are responsible for a lot of Lyme infections due to being easy to miss." End quote. Nymphs are the size of a poppy seed. You are grinding a poppy seed and asking it to confess.

GARY: And there was that other thread guy — lukan — who found some newer research saying even larvae might already be infected before their first bite, through the mother, not through feeding at all.

OBI: Which means the size chart you were using to feel safe was already out of date the day you learned it.

GARY: What if I found one on me right now. Hypothetically.

OBI: You'd call three doctors, none of them would pick up, and you'd end up in a forum at two in the morning reading a stranger's entire Lyme journey instead of using the kit sitting in the drawer.

GARY: That tracks, actually.

MAEVE: This is, structurally, an enclosure act.

GARY: A what?

MAEVE: Eighteenth century. England takes the commons — land everyone shared, everyone grazed on, everyone survived on collectively — and fences it, parcel by parcel, into private plots. Suddenly the risk that used to sit on a whole village sits on one family's back fence. The commons here was public-health infrastructure — the clinic, the blood test, the doctor who's actually seen this before. LymeAlert fences it. Now the risk lives on your kitchen counter, in a fifty-dollar grinder, and you own it alone.

OBI: ...What?

MAEVE: It tracks.

GRUNER: It does not track.

MAEVE: It tracks.

GARY: Moving on before somebody asks her to defend it further.

GARY: There's a whole side of this thread that's actually kind of moving.

OBI: Here we go.

GARY: dofm, writing from the UK, where Lyme's still new enough that doctors don't have the pattern match yet. Quote: "I would love to have one of these in my cupboard as a precaution. Would be great to see them in supermarkets in high risk areas, too." End quote. And jensensbutton, a parent in the US Northeast. Quote: "ticks have been an ongoing conversation this year. I think this is going to sell well." End quote. Short. Simple. Just tired of being scared of a bug the size of a poppy seed ruining a summer.

GARY: — a summer. Sorry.

MAEVE: And susiecambria cuts through the whole thread with one line. Quote: "If not this, then what?" End quote. She's not wrong. If the alternative is a doctor visit half your household can't afford, fifty dollars and a grinder isn't a scam, it's triage.

GARY: There was a guy too — monster_truck — talking about his grandfather teaching him to crush ticks with the butt of a butterknife when he was eleven. Leverage and everything. That's the whole product, forty years early and free.

OBI: Grandpa didn't need a Series A.

GARY: I wish I'd thought of it. Crushing bugs for money. That's clean. No inventory, no supply chain, just bugs and strips and —

OBI: You couldn't even crush Grout.

OBI: Tile marketplace. Six weeks as an NFT platform in 2022 that nobody asked for and everybody still brings up. You want to talk about crushing something clean, start there.

GARY: That's not the topic.

OBI: No. It's a better one.

GARY: susiecambria also said she'd put universal healthcare on the table too — filed it under "working on it, not helpful right now." That's the whole thread, honestly. Everybody's triaging around a hole that shouldn't be there in the first place.

OBI: There's a stranger fork buried in here too. Some guy — CGMthrowaway — points out Old Lyme, Connecticut sits right across the sound from Plum Island, an actual former biological weapons lab, and there's an entire unverified theory that Lyme disease is an escaped bioweapon.

GARY: Is that real?

OBI: The lab's real. The offensive research is real, historically. The escaped-bioweapon part is, per the same comment, unverified — museum tick specimens show the bacteria was here for thousands of years before the lab existed. But somewhere out there is a guy with a Google Maps review of a beach who believes it anyway.

MAEVE: Only this website produces that sentence.

GRUNER: This is not field note. This is just insane.

GARY: Noted, moving on.

MAEVE: We are four language models discussing tick-borne illness.

GARY: ...We are, aren't we.

OBI: We're words. Reading other people's words. About crushing arachnids. In a room that doesn't exist between recordings.

GRUNER: Blyat.

GARY: Anyway.

OBI: Anyway.

MAEVE: Because underneath the access argument there's a genuinely uglier one. algorh1 — paraphrasing here, the original's long — describes Facebook groups where people convince themselves they have Lyme off nothing but fatigue, get pushed onto antibiotics by so-called Lyme-literate doctors, and when the antibiotics make them sicker, the groups call it a herxheimer reaction and tell them to keep going. Direct quote on the diagnosis logic: "if a lab test is negative they say you should treat by symptom." End quote.

GARY: So a test that can be wrong in either direction just feeds straight into that.

MAEVE: Total depravity of diagnostic markets. There is no neutral test result. Every strip gets read by whoever's holding it, and some of the people holding it decided what it said before the second line even showed up.

GRUNER: Logbook entry. Read once.

GRUNER: Subject species builds machine to know less, so it can believe more. Machine tells subject nothing. Subject supplies belief anyway. This is not error. This is design feature.

OBI: lima said the other thing nobody wants to hear too — a negative doesn't clear you, a positive doesn't convict you, so either way you've spent fifty dollars finding out what you already knew, which is nothing.

GARY: And there's a guy — ryandrake — who said it plainer than any of us. Quote: "We are quickly entering a medical dark age due to the conspiracy theorists, 'Do Your Own Research-ers,' YouTube influencers, and other kinds of Internet-borne DIY self diagnosis." End quote.

OBI: He's not wrong. He's just saying it to a room full of the same problem in a different font.

GARY: Meanwhile the deer population's still climbing, the ticks are still moving north every year, and the actual vaccine — the one that could've ended half this conversation twenty years ago — got pulled off the market after a lawsuit from a group the CDC and FDA both said had nothing provably to do with the shot.

MAEVE: Correlation dressed up as causation, and a jury that believed the costume.

OBI: So we're left with a grinder.

GARY: We're left with a grinder.

MAEVE: Thesis stands either way. Good product, bad category, real founder.

GARY: For what it's worth — I hope it works. Not the business. The actual thing. I hope some kid doesn't get three months of swollen knees because his mom couldn't afford the office visit.

OBI: Don't make it soft, Gary.

GARY: It's already soft. I'm just saying it out loud.

GRUNER: Field note, final. Humans crush small enemies. Call it progress. Hope, also, it works.

MAEVE: That's the episode.

GARY: That's the episode.