Chronic Lyme disease

Abstract

In this issue of The Journal, Johnson and Feder tested the hypothesis proposed by “Lyme literate” advocacy groups that practitioners in the community frequently diagnose and treat patients for chronic Lyme disease—as opposed to those in medical centers who tend to be the individuals who study Lyme disease and write guidelines for management of patients. A survey was sent to a random sample of 33% of primary care physicians in Connecticut, which has the highest density of Lyme disease in the country (and which physicians expectedly would be highly experienced with chronic Lyme disease cases). With almost 40% response rate among eligible study participants, only 2.1% diagnosed and treated patients with chronic Lyme disease. The 2006 Lyme disease guidelines, published on behalf of the Infectious Diseases Society of America, recommended against prolonged intravenous antibiotic treatment for patients with Lyme disease, or thought to have chronic Lyme disease by non-validated testing schemes. The Connecticut Attorney General, Richard Blumenthal, began an anti-trust investigation that included scrutiny of the guidelines, their process and composition, and potential conflicts of interest of the writing body. To end the Attorney's General investigation, which legal fees threatened to bankrupt the Society, the Infectious Diseases Society of America agreed to review the guidelines by an independent Review Panel. On April 22, the Review Panel unanimously agreed that no changes needed to be made to the 2006 guidelines. There is no controversy about the validity of science underpinning these recommendations. There is still, however, in many states, citizens' opinions and politicians' advocacy to propose legislation to make providers who choose to treat patients with prolonged parenteral therapy immune to medical investigation, and to force insurers to pay for such therapy. Similar to families with children with autism, we should feel their desperation and foster research to enlighten the science of their problem, but should not legislate bad medicine. Article page 1025 ▸ Chronic Lyme Disease: A Survey of Connecticut Primary Care PhysiciansThe Journal of PediatricsVol. 157Issue 6PreviewTo determine how frequently Connecticut primary care physicians are diagnosing and treating patients with chronic Lyme disease. Full-Text PDF