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Doubts Raised About Lyme Disease Treatments

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Many health experts question whether long-term antibiotics are effective in treating Lyme disease, and warn that the overuse of antibiotics could harm patients by encouraging resistance to the germs.

Doubting that so-called ``chronic Lyme disease'' even exists, they point to a federally funded study published in the prestigious New England Journal of Medicine in July 2001 that showed antibiotics work no better than placebos in treating patients who do not recover after the standard two- to three-week treatment.

Yet a smaller number of doctors who treat people in areas such as New York's Hudson Valley, the epicenter of the disease throughout most of the last decade, say they are prescribing the drugs because they work.

If I had another way of treating them, my god, I'd do it, but this is working,'' said Richard I. Horowitz, who sees about 5,000 Lyme disease patients a year at the Hudson Valley Healing Arts Center in Hyde Park.Until this mystery of Lyme disease is completely solved, people should not take sides.''

The controversy has sparked heated debate within the medical community and raised concern among some patients, who fear doctors who believe in long-term antibiotics will be increasingly hard to find.

In recent years, the state body that oversees medical conduct has investigated eight of 11 doctors in New York who are known to provide such treatment, including Horowitz, after receiving complaints that those physicians provided inadequate care.

Spurred by patients' concerns, state legislators have introduced bills to limit the disciplinary powers of the state Office of Professional Medical Conduct.

``It really comes down to being a patients' rights issue,'' said Monica Miller, an Albany lobbyist working on behalf of some Lyme patient groups.

Though Lyme disease is becoming more common, medical experts say it can be tricky to diagnose. Patients may not realize they were bitten by the tiny deer tick that transmits the disease. Nor does everyone develop the bull's-eye rash that is the classic symptom.

Treatment also can be a challenge. The standard course of antibiotics for three weeks or less doesn't work for about 10 percent of patients, said Timothy Sellati, an assistant professor at the Center for Immunology and Microbial Disease at Albany Medical College who is studying why the drugs are sometimes ineffective.

These are the patients Sellati defines as having ``chronic Lyme disease'' - they have tested positive for the bacteria that causes Lyme and can't shake a bug that sometimes causes severe complications such as arthritis, heart inflammation and Bell's palsy.

There's a true group of individuals that have chronic Lyme disease,'' Sellati said.They don't respond well to antibiotics.''

Sellati and other medical experts aren't convinced, however, that those are the patients filling the waiting rooms of doctors who offer long-term antibiotics for persistent Lyme disease.

``There's no question that these people ... have a problem, it's just not due to Lyme disease,'' said Dr. Eugene Shapiro, professor of pediatrics and epidemiology at Yale University, who has researched conventional treatment for Lyme.

Long-term antibiotic treatment can cause harmful complications in some people, including gall bladder problems and even death, Shapiro said.

Joel Kremer, an Albany rheumatologist, said many patients are misdiagnosed with Lyme disease after inconclusive blood tests. Some patients are almost desperate to be diagnosed with Lyme disease, he said, rather than something like chronic fatigue syndrome or fibromyalgia, which are painful, long-term conditions with no cure. Doctors, who may mean well, aren't helping them by offering long-term antibiotics, which do no good.

It's almost become cultish,'' Kremer said.These people have found a safe haven with these doctors.''

Horowitz, who has been questioned but not sanctioned by the Office of Professional Medical Conduct, also believes that patients are being misdiagnosed. But his view is that Lyme disease is too often overlooked, especially when blood test results are inconclusive. He contends he and other ``Lyme-literate'' doctors use antibiotics safely by carefully monitoring their patients.

The New York Health Department contends it hasn't been targeting doctors who treat patients with long-term antibiotics for Lyme disease.

``The department has not taken a position on this particular therapy, which is a matter of dispute within the medical community,'' said department spokeswoman Kristine Smith.

But some advocates, such as the Lyme Disease Association in New Jersey and Manhattan-based Voices of Lyme, aren't convinced. And their concerns have gained support in the New York Assembly, where two bills were introduced this year.

The first, which isn't expected to pass, was sponsored by Queens Democrat Nettie Mayersohn and would prohibit the OPMC from disciplining a doctor specifically for prescribing long-term antibiotics for Lyme disease.

The second, sponsored by Assembly Health Committee Chairman Richard Gottfried, D-Manhattan, would more broadly limit the OPMC's powers and expands doctors' rights in disciplinary actions. The latter passed the Assembly this year and has a companion bill in the Senate.

Meanwhile, research continues on how best to treat the disease.

At New York's Columbia University, Dr. Brian Fallon has received a $4.7 million grant from the National Institutes of Health to determine whether 10 weeks of antibiotic treatment is helpful to some Lyme disease patients.

Until the results are in, Fallon suggested keeping an open mind.

We're dealing with a very complicated organism that is known to be hard to eradicate,'' said Fallon, an associate professor of clinical psychiatry.We have to be humble in the face of the limitations of our knowledge at this point.''


(The Albany Times Union web site is at )

c.2003 Albany Times Union

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