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Lyme Doctors Rally Behind a Colleague Under Inquiry

The New York Times

By HOLCOMB B. NOBLE

November 10, 2000

http://www.nytimes.com/2000/11/10/science/10LYME.html


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A group of doctors who treat Lyme disease and about 400 patients with the disease accused medical boards in several states yesterday of violating doctors' rights to treat the illness in ways they believe are necessary and scientifically valid. They singled out a current unprofessional-conduct hearing against a New York doctor as the latest example.

The doctors and patients said about 50 physicians in New York, New Jersey, Connecticut, Michigan, Oregon, Rhode Island and Texas had been investigated, disciplined or had had their licenses removed over the past three years. This has had a chilling effect on the willingness of other doctors to treat the disease, they said.

The underlying dispute centers on the belief by some Lyme specialists that the best way to treat patients is with long-term antibiotic therapy, instead of the shorter course that is ordinarily the custom.

The doctors' protest yesterday came at a rally in Manhattan in support of Dr. Joseph J. Burrascano of East Hampton, N.Y., who they said had treated more than 7,000 Lyme patients from around the world over the past 15 years. A hearing in New York City on charges brought against Dr. Burrascano by the New York State Office of Professional Misconduct opened last week, and is expected to take several months.

The charges are said to have been based on files of nine patients, and include accusations Dr. Burrascano failed to diagnose or treat them properly or to follow up adequately on their conditions. Five of the patients were at the rally, denying the accusations and expressing indignation that their files had been used without their knowledge. All said Dr. Burrascano had brought them back to health or had improved their conditions after long periods of suffering.

One of the patients, Ruth A. Giglio of East Hampton, 77, said the disease had caused her constant fatigue, arthritic pains, heart palpitations and other symptoms.

"He slowly brought me along, with detailed explanations of what he was planning to do, trying different treatments, different kinds and dosages of antibiotics, trying physical therapy " until I finally returned to my old self," Ms. Giglio said. "To have taken my files and put together any case against Dr. Burrascano is a kind of medical McCarthyism."

Twenty doctors from 10 states, Switzerland and Germany have signed a petition in support of Dr. Burrascano, to be presented to state officials. They called him an "international leader in establishing comprehensive medical and ethical standards for the diagnosis and treatment of chronic illnesses" associated with infectious diseases.

A dispute over how to treat Lyme disease has raged for more than a decade among doctors. One group believes the disease can best be treated, in most cases, with 30 days of antibiotics. The other believes that in perhaps 10 percent of the illnesses, long-term clinical and antibiotic treatment is needed.

Dr. Burrascano's supporters said that medical boards, which decide whether to revoke or suspend medical licenses, have sided inappropriately with one side in an argument that should be fought in medical journals and at conferences.

They also assert that insurance companies and doctors who work as their consultants have financial stakes in the outcome of the dispute. The General Accounting Office, the investigative arm of Congress, is looking into that issue at the request of representatives from areas where Lyme disease is widespread.

Speaking at the rally, Michael Schoppmann, a lawyer from Lake Success, N.Y., said he had represented more than 40 doctors in board hearings in New York, New Jersey and Pennsylvania.

"If a doctor begins to treat patients with Lyme disease in any significant percentage of their total practice," Mr. Schoppmann said, "they are guaranteed to face investigations " either private or governmental or both by managed care, insurance companies and state licensing agencies. The treatment of Lyme disease and its financial implications are the insurance industry's worst nightmare. No one dies from Lyme disease, no one is cured, and many patients require years of expensive treatment."

Dr. Charles M. Cutler, chief medical officer of the American Association of Health Plans, a national trade association of managed care organizations, said overuse of antibiotics could harm patients.

"Our concern is for good quality care," Dr. Cutler said, "and in this instance and others, good quality can cost less. But we have no financial incentive; our overriding intent is to do the right thing."



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