Opposes HB 290

IDSA Opposes HB 290 during the 2010 legislative session.

February 9, 2010

The Honorable Peter A. Hammen

Committee on Health and Government Operations

Maryland House of Delegates

6 Bladen Street

House Office Building, Room 241

Annapolis, MD 21401-1991

Dear Delegate Hammen:

I write on behalf of the Infectious Diseases Society of America (IDSA) to urge you to

oppose the enactment of Maryland House Bill No. 290, which implicitly sanctions the

use of long-term antibiotic therapy to treat Lyme disease by protecting providers who

prescribe such therapies from disciplinary action. In urging your opposition to this

legislation, our primary concern is to ensure the best quality in patient care and to

protect the public’s health and safety. To this end, we believe it is critically important

that you be fully apprised of the widespread consensus within the medical and

scientific community about the appropriate treatment of Lyme disease, as well as the

medical community’s concerns about unproven, potentially harmful treatments for so

called “chronic” Lyme disease that are advocated by a small group of physicians.

IDSA represents more than 9,000 physicians and scientists and is widely recognized

as the pre-eminent authority on infectious diseases (ID) in the United States. The

Society's members focus on the epidemiology, diagnosis, investigation, prevention

and treatment of infectious diseases in the U.S. and abroad. Our members care for

patients of all ages with serious infections, including Lyme disease. In 2006, IDSA

published revised practice guidelines for the clinical assessment, treatment, and

prevention of Lyme disease. The development of guidelines requires the review of

scientific and medical literature. IDSA’s guidelines were developed by a 14-member

panel of infectious diseases clinicians and researchers, including physicians with

many years of clinical experience treating patients with Lyme disease.

As you know, Lyme disease is a tick-transmitted infection that can cause non-specific

symptoms such as muscle and joint pain, fevers, chills, fatigue, and difficulties with

concentration or memory loss. Some patients may continue to experience these

symptoms even after a course of antibiotic therapy has killed the Lyme disease

bacterium.

A small group of physicians have diagnosed such patients as having “chronic” Lyme

disease. Many of these so called “chronic” Lyme diagnoses are supported by

laboratory tests that are not evidence based and are not regulated by the Food and

Drug and Administration. Such diagnoses and treatments are not supported by the

IDSA practice guidelines, nor are they supported by Lyme disease guidelines

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published by the American Academy of Neurology, nor by publications from the Centers for

Disease Control and Prevention, the National Institutes of Health, the American College of

Physicians, and the American Academy of Pediatrics, nor by the vast majority of experts in the field

of ID medicine in this country and abroad. Even more troubling, physicians who diagnose

“chronic” Lyme disease often advocate treating patients with repeated or prolonged courses of oral

or intravenous antibiotics that have no proven value other than an anti- inflammatory response in

some individuals, and may in fact do more harm than good.

The premise for prolonged antibiotic therapy for Lyme disease is the notion that some spirochetes

can persist despite conventional treatment courses, thereby giving rise to the symptoms ascribed to

chronic Lyme disease. Not only is this assertion microbiologically implausible, there are no

convincing published scientific data that support the existence of chronic Lyme disease. Rather,

carefully designed studies of Lyme disease have demonstrated that there is no difference in the

measured improvement between patients receiving placebo and patients treated with antibiotics.

Most importantly, not only is long-term antibiotic therapy for Lyme disease unnecessary, but

the scientific evidence suggests that it may be dangerous, leading to potentially fatal infections

of the bloodstream as a result of intravenous treatment. Far from improving the patient’s

quality of life, prolonged antibiotic therapy may actually increase the patient’s suffering. Also,

although the bacteria that causes Lyme disease does not acquire resistance to antibiotics, long-term

antibiotic exposure can lead to drug-resistance among other microorganisms, creating “superbugs”

that cannot be treated with currently available drugs.

Notwithstanding the vast majority of ID physicians’ belief that the medical evidence related to

appropriate Lyme disease treatments is clear and accurately reflected in IDSA’s Practice Guidelines

for the Treatment of Lyme Disease, the Society recently reached an agreement with the Connecticut

Attorney General to conduct a special and comprehensive review of the scientific and medical

evidence related to Lyme disease treatments—this review is currently underway. IDSA believes

that it is far better to allow time for this review to be completed rather than prematurely sanctioning

potentially harmful treatment modalities through ill-advised state legislation.

While IDSA opposes enactment of House Bill 290 for the reasons stated above, it would support

efforts to hold public hearings on Lyme disease. IDSA believes that such hearings could play an

important role in educating Massachusetts legislators and citizens about the controversy surrounding the

treatment of Lyme disease. However, in order to ensure that legislators get a science-based assessment

of appropriate treatments for Lyme disease, IDSA strongly urges you to invite board-certified ID

specialists who support evidence-based medicine to testify at all public hearings and we would be

happy to provide the names of such individuals.

For more information on Lyme disease and the recommendations by the vast majority of experts in

the field, please visit websites for IDSA (www.idsociety.org), the Centers for Disease Control and

Prevention (www.cdc.gov), the National Institute of Allergy and Infectious Diseases

(www.niaid.gov), the American Academy of Neurology (www.aan.com) or the American College

of Physicians (www.acponline.org).

I hope you will contact Mark Leasure at IDSA if you have questions or would like the names of

board-certified ID physicians who may be willing to provide further guidance on appropriate

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treatments for Lyme disease. Mr. Leasure may be reached at (703) 299-0200 or via e-mail at

mleasure@idsociety.org.

Sincerely,

Richard Whitley, MD

President, IDSA

Enclosures:

IDSA’s Practice Guidelines for the Treatment of Lyme Disease

David Whelan. “Lyme Inc. Ticks aren't the only parasites living off patients in borreliosis-prone

areas.” Forbes, March 12, 2007.

Feder et al. A Critical Appraisal of “Chronic Lyme Disease.” New England Journal of

Medicine, October 2007.

Jason Feifer. “Combat Zone. There's No Neutral Ground in War Of Information About Lyme

Disease.” Washington Post, May 15, 2007; HE01.

Jamie Talan. “A Rift Over Lyme Disease. Experts are split over diagnosis and treatment of the tick-

borne illness.” Newsday, May 22, 2007.

To see letter click HERE.

http://www.idsociety.org/Content.aspx?id=10016