Under Our Skin

The film argues that persistent infection with Lyme disease is responsible for a variety of debilitating symptoms. It presents advocates of the position, including "chronic Lyme" pressure group International Lyme and Associated Diseases Society (ILADS). This position is rejected by major medical bodies including the Infectious Diseases Society of America and the American Academy of Neurology, who do not recognize "chronic" Lyme disease as a legitimate diagnosis.

The film follows six individuals, including major league ball player Ben Petrick who report chronic symptoms, which they attribute to persistent Lyme infection. The majority of the film is devoted to the storyline of these patients and their reported recovery. At the same time, the film presents advocates of long-term therapies for chronic Lyme disease and briefly presents the position of the Infectious Diseases Society of America (IDSA).

The second half of the film focuses primarily on state medical board investigations of Joseph Jemsek and Ray Jones, two physicians who prescribe long-term antibiotics for chronic Lyme disease, a practice generally recognized to be dangerous and without provable benefit.{{cite journal |author=Wormser GP |title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America |journal=Clin. Infect. Dis. |volume=43 |issue=9|pages=1089–1134 | url = http://cid.oxfordjournals.org/content/43/9/1089.full.pdf |date=November 2006 |pmid=17029130 |doi=10.1086/508667 |last12=Fish |first12=D|last13=Dumler |first13=JS |first14=RB |author2=Dattwyler RJ |author3=Shapiro ED |display-authors=3 |last4=Nadelman |first4=John J. |last5=Steere |first5=Allen C. |last6=Klempner |first6=Mark S. |last7=Krause |first7=Peter J. |last8=Bakken |first8=Johan S. |last9=Strle |first9=Franc|doi-access=free }}{{cite journal |vauthors=Halperin JJ, Shapiro ED, Logigian E, etal |title=Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology |journal=Neurology |volume=69 |issue=1 |pages=91–102 |date=July 2007 |pmid=17522387 |doi=10.1212/01.wnl.0000265517.66976.28|doi-access=free }}{{cite web | publisher = National Institute of Allergy and Infectious Diseases | title = "Chronic Lyme Disease" Fact Sheet | url =http://www.niaid.nih.gov/topics/lymedisease/understanding/pages/chronic.aspx | date = April 17, 2009|archive-url=https://web.archive.org/web/20150611094755/http://www.niaid.nih.gov/topics/lymedisease/understanding/pages/chronic.aspx|archive-date=11 June 2015}} Jemsek was investigated based on the complaints of 10 patients who described "nightmarish experiences" as a result of his treatment; he was supported by a number of patients and advocacy organizations.{{cite news | work = Forbes | first = David | last = Whelan | title = Lyme Inc. | date = March 12, 2007 | access-date = January 7, 2010 | url = https://www.forbes.com/forbes/2007/0312/096.html}} The board found that Jemsek had departed from standard medical practice and had failed to inform patients that his treatments were unorthodox; his medical license was suspended with stay, allowing him to continue practicing medicine.{{cite news | author= Stephen Barrett, M.D. | year=2009|title = Joseph Jemsek, M.D. Charged with Unprofessional Conduct | access-date = 19 May 2017| url = http://www.casewatch.org/board/med/jemsek/charges.shtml}} Facing a lawsuit from an insurance company, Jemsek declared bankruptcy and closed his medical practice.{{cite web | work = Salon.com | title = Beyond the Multiplex: Under Our Skin | first = Andrew | last = O'Hehir | date = June 20, 2009 | access-date = January 7, 2010 | url = http://www.salon.com/ent/movies/btm/feature/2009/06/20/roundup/index.html|archive-url=https://web.archive.org/web/20090628033107/http://www.salon.com/ent/movies/btm/feature/2009/06/20/roundup/index.html|archive-date=28 June 2009}}

The final act of the film focuses on Connecticut Attorney General Richard Blumenthal's antitrust investigation of the IDSA Lyme disease guidelines. Blumenthal issued a press release in May 2008 stating that his investigation "uncovered serious flaws" in the development of the IDSA guidelines, although Blumenthal declined to file any charges.{{cite press release | url = http://www.ct.gov/AG/cwp/view.asp?a=2795&q=414284 | publisher = Connecticut Attorney General Office | title = Attorney General's Investigation Reveals Flawed Lyme Disease Guideline Process, IDSA Agrees to Reassess Guidelines, Install Independent Arbiter | date = May 1, 2008 | access-date = January 7, 2010}} Under pressure of mounting legal fees, the IDSA agreed to submit its Lyme disease guidelines to an independent review, which supported the scientific validity of the IDSA guidelines.{{cite press release | publisher = Infectious Diseases Society of America | title = Agreement Ends Lyme Disease Investigation by Connecticut Attorney General | url = http://www.idsociety.org/Templates/nonavigation.aspx?pageid=32212256693 | date = May 1, 2008 | access-date = 19 May 2017}}{{cite journal|author=Lantos PM|display-authors=etal|title = Final Report of the Lyme Disease Review Panel of the Infectious Diseases Society of America | journal=Clin Infect Dis|year=2010|volume=51|issue=1|pages=1–5|doi=10.1086/654809|pmid=20504239|doi-access=free|hdl=10161/4154|hdl-access=free}} The expert panel's review was published in 2010, with the independent doctors and scientists in the panel unanimously endorsing the guidelines, stating "No changes or revisions to the 2006 Lyme guidelines are necessary at this time," and concluding long-term antibiotic treatments are unproven and potentially dangerous.{{cite news|url=http://www.nbcnews.com/id/36721207/ns/health-infectious_diseases/|archive-url=https://web.archive.org/web/20150604022218/http://www.nbcnews.com/id/36721207/ns/health-infectious_diseases/|url-status=dead|archive-date=June 4, 2015|title=No changes to Lyme disease treatment |first=Stephen |last=Singer |agency=Associated Press |date=2010-04-22}} The case was described in Forbes as "intimidation" of the medical community by the Attorney General, and in JAMA as an example of "elected officials advocating for health policies against the weight of scientific evidence."{{cite journal |author=Kraemer JD, Gostin LO |title=Science, politics, and values: the politicization of professional practice guidelines |journal=JAMA |volume=301 |issue=6 |pages=665–7 |date=February 2009 |pmid=19211474 |doi=10.1001/jama.301.6.665 }}

The film concludes with vignettes of two patients discussing their claimed recoveries.{{cite news |work=New York Times | title = Ticked Off | first = Stephen | last = Holden | access-date = January 6, 2009 | date = June 19, 2009 | url = http://movies.nytimes.com/2009/06/19/movies/19under.html}}

The New York Times described the film as a "polemic" and "inflammatory." Variety wrote that the film "sides with those advocating unconventional treatments, [but] gives gatekeepers from Infectious Diseases of America [sic, actually Infectious Diseases Society of America] their say."{{cite web|url=https://variety.com/2008/film/reviews/under-our-skin-1200522763/ |title=Review: 'Under Our Skin'|author=Alissa Simon|date=2 May 2008|access-date=19 May 2017}} The Baltimore Sun described it as "full of suspicions, assertions, and anecdotes; it’s low on science and objectivity".{{cite journal| pmc=4489928 | pmid=21867956 | doi=10.1016/S1473-3099(11)70034-2 | volume=11 | issue=9 | title=Antiscience and ethical concerns associated with advocacy of Lyme disease | year=2011 | journal=Lancet Infect Dis | pages=713–9 | last1 = Auwaerter | first1 = PG | last2 = Bakken | first2 = JS | last3 = Dattwyler | first3 = RJ | last4 = Dumler | first4 = JS | last5 = Halperin | first5 = JJ | last6 = McSweegan | first6 = E | last7 = Nadelman | first7 = RB | last8 = O'Connell | first8 = S | last9 = Shapiro | first9 = ED | last10 = Sood | first10 = SK | last11 = Steere | first11 = AC | last12 = Weinstein | first12 = A | last13 = Wormser | first13 = GP}}

According to review aggregation site Rotten Tomatoes, as of December 2019, the film has received 26 positive reviews and 6 negative reviews for a score of 81% positive reviews from the site's approved critics; the average rating is 6.7/10. The critical consensus reads: "A scathing indictment of the American medical system, Under Our Skin is timely, frightening stuff."{{cite web | url = http://www.rottentomatoes.com/m/under_our_skin/ | publisher = Rotten Tomatoes | title = Under Our Skin (2009) | access-date = December 3, 2019}} On Metacritic, it has a rating of 63/100 based on 13 reviews, which the site categorizes as "generally favorable reviews".{{cite web|url=https://www.metacritic.com/movie/under-our-skin|title=Under Our Skin (2009)|work=Metacritic|access-date=December 3, 2019}}

• Finalist, Audience Choice Award, Tribeca Film Festivalhttps://www.csindy.com/coloradosprings/theres-a-lot-of-money-being-made/Content?oid=1146287 // Colorado Springs Independent, January 15, 2009.
• Winner, Best Documentary, Sonoma International Film Festival 2009{{cite web|url=http://www.sonomafilmfest.org/film-festival-news.html?cat=2009|title=Sonoma International Film Festival News & Updates|website=www.sonomafilmfest.org|archiveurl=https://web.archive.org/web/20171213084654/https://sonomafilmfest.org/film-festival-news.html?cat=2009|archivedate=December 13, 2017}}

• The Quiet Epidemic

{{Reflist|2}}

• {{Official website|http://www.underourskin.com/}}
• {{IMDb title|1202579}}

Category:2008 films

Category:Medical controversies in the United States

Category:2000s English-language films

Category:2008 documentary films

Category:Pseudoscience documentary films