Maine’s physicians and patients need every tool available to help deal with the increasing prevalence of debilitating Lyme disease in the state.
A bill that would protect physicians from professional censure for prescribing long-term courses of antibiotics, which have shown promise for treatment of chronic Lyme, was the subject of a public hearing before a legislative committee last week.
LD 422, sponsored by Rep. Deborah Sanderson (R-Chelsea) would bar the Maine Board of Licensure in Medicine from revoking or suspending doctors’ licenses to practice for putting Lyme patients on long-term antibiotics.
Others states dealing with high rates of Lyme disease, primarily in the Northeast, have adopted similar laws after doctors there faced fines and the prospect of being put on probation. Maine is the last state in New England that has not done so.
Testimony was given last week at a hearing before the Joint Standing Committee on Labor, Commerce, Research, and Economic Development.
Those lining up in support of the bill spanned the entire length and breadth of the social and political spectrum in Maine.
Dennis Smith, executive director of the Board of Licensure in Medicine, testified against the bill. Admitting that the treatment of Lyme disease is complicated, he said the issue is driven by emotion as well as science. The position of his organization, outlined in his prepared statement, is that “dramatically deviating from the standard of care as outlined by the Infectious Diseases Society of America (IDSA) and potentially placing patients at risk of complications or even death from high doses of antibiotics should not be supported.”
He also worried that the bill, while filed with good intent, would “eliminate the board’s ability to take action against a physician who may be treating Maine residents unprofessionally ….”
Speaking about her own multi-year struggle with Lyme, Emily Bracale of Bar Harbor submitted testimony that limiting doctors to only following the IDSA guidelines is exactly why the law needs to be changed. “There is plenty of scientific evidence refuting their claims that Lyme is hard to get and easy to treat,” she said.
Other testimony from the medical community was mixed.
Dr. Beatrice Szantyr, who filed testimony on behalf of the Maine Medical Association, explained that the group is neither for nor against the bill. The reluctance to take a position one way or the other, she explained, was a result of a lack of consensus within her organization’s legislative committee.
Testifying later on a personal note, however, she urged the bill be passed. Physicians such as herself, with decades of experience dealing with the complex diagnosis and treatment of Lyme, should have the freedom to do as they and their patients see best, even if their decisions put them at odds with the medical establishment.
“This bill does not limit appropriate action on the part of licensing board to protect the public,” she said. “This bill does respect reasonable practice within the training, experience and judgment of licensed clinicians. It recognizes the value of views which may be in the minority, but still are within a reasonable range of a physician’s professional judgment.”
As proof that the medical establishment often drags its feet when conventional wisdom is confronted, opponents point to the long battle to acknowledge that ulcers are caused by the helicobacter pylori bacteria, not by stress or eating spicy foods. The establishment counters that it eventually came around on that issue in a little more than a decade. For those suffering daily from the ravages of Lyme disease and for whom a long-term course of antibiotics seems to be working, another 10 years will be much too long to wait.
Fortunately, healthcare professionals in the Mount Desert Island area are on the lookout for Lyme. Early diagnosis and treatment are keys to avoiding long-term health damage. There are hundreds of different strains of Lyme bacteria. The most common test looks for only one. Time after time, patients have found themselves being bounced around between clinicians with few answers to why the feel so sick.
While the standard course of antibiotics is a month long, some cases, especially after years of misdiagnosis, can be stubborn, requiring higher doses and longer treatment.
Barring a higher level of government commitment to developing a vaccine or researching more effective treatments for Lyme, officials should do everything possible to allow doctors to treat their patients as they see best free of possible political repercussions.
Despite the protestations of the licensing board, which consists of just six physicians out of more than 2,200, if an over-prescription of antibiotics or a failure to properly monitor the administration of those drugs rises to the level of true negligence, they still would be able to act. However, the bill would provide sufficient protection to doctors worried about upsetting the established paradigm.
The committee has yet to schedule a work session on the bill then making a recommendation to the full legislature.
Sanderson’s bill does not order doctors to recommend a specific treatment. It does not mandate insurance companies to pay for it, a move that can lead to increased costs for consumers. What it does is add a layer of protection to the patient-doctor relationship, an improvement that removes a potential political and regulatory roadblock that could delay Lyme disease sufferers from getting the relief they so desperately need.