NY Times Article

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May 3, 2008

Doctors to reassess antibiotics for 'chronic Lyme' disease

By THE ASSOCIATED PRESS

Filed at 12:14 a.m. ET

HARTFORD, Conn. (AP) -- Patients who believe they suffer long-term

problems from Lyme disease are claiming victory over a national

doctors group. The Infectious Diseases Society of America has agreed

to review its guidelines, which say there's no evidence long-term

antibiotics can cure ''chronic Lyme'' disease -- or even that such a

condition exists.

The agreement settles an unprecedented antitrust investigation by

Connecticut's attorney general over the matter. The doctors group

makes clear that current guidance for treating Lyme disease remains

in place.

But that didn't stop claims of success by the attorney general and

people who believe they suffer long-term effects of the tick-borne

disease.

''It's a great victory for patients,'' said Pat , president of

the Lyme Disease Association, a national nonprofit group based in New

Jersey. ''It's time that Lyme patients got the respect they deserve.''

The agreement, announced Thursday, calls for the doctors group to

form a new panel of experts to review standards for treating Lyme

disease. The Infectious Diseases Society says it agreed to the deal

in part because the panel must be made up of doctors and scientists.

Lyme disease can be hard to diagnose with its vague, flu-like

symptoms; the most obvious sign is its trademark round red rash.

Usually, it's easily cured with a few weeks of antibiotics. Those not

promptly treated can develop arthritis, meningitis and other serious

illnesses.

About 20,000 new cases of Lyme disease are reported every year, but

experts believe the annual total may be five times higher.

Connecticut leads the nation in reported cases and has been a

battleground in the national debate over treatment. Lyme disease is

named after the Connecticut town of Lyme, where the illness was first

discovered in 1975. And the state is home to a number of people who

claim they suffer long-term problems from Lyme disease -- problems

that many doctors are unable to confirm or treat.

The Infectious Diseases Society says it's never been proven whether

these patients still have Lyme disease or something else. The group

continues to defend its standards, which say short-term antibiotics

are effective for nearly all patients. Long-term antibiotics are

unproven and potentially dangerous, because overuse of the drugs can

lead to drug-resistant infections, the society says.

''We are confident that our guidelines for the diagnosis and

treatment of Lyme disease represent the best advice that medicine

currently has to offer ... and we look forward to the opportunity to

put to rest any questions about them,'' said Dr. Poretz, the

society's president.

The society will consider a variety of scientific evidence and

determine whether the 2006 guidelines are justified or need revision.

The guidelines are important because they discourage adequate

treatment, advocates of chronic Lyme sufferers say. Perhaps just as

significant is that insurance companies refuse to pay for long-term

antibiotics to treat chronic Lyme.

''We are delighted with this settlement,'' said Diane Blanchard of

Greenwich, who said she was sick with Lyme disease for 10 years

before a long-term antibiotic treatment relieved her symptoms in the

late 1990s.

''The IDSA guidelines are now clouded by this decision. My greatest

hope is that patients will regain their right to treatment,'' said

Blanchard, now co-president of the advocacy group Time for Lyme.

Philadelphia-based health insurer Cigna Corp. said it is reviewing

the agreement to see if any changes in policies are needed. Cigna

covers up to 28 days of intravenous antibiotic therapy for Lyme

disease and, like many insurers, cites the Infectious Diseases

Society's guidelines in its coverage plan.

Cigna does not pay for ''repeated or prolonged'' courses of

antibiotics, saying they are ''experimental, investigational or

unproven.''

Connecticut Attorney General Blumenthal and advocates say the

agreement is the first time the medical establishment has bowed to

the pressure of a potential court fight and agreed to re-evaluate

care standards.

''My main goal all along has been a process that is fair, open and

free of conflicts of interest,'' Blumenthal said.

Blumenthal said his investigation found that some of the 14 experts

who approved the 2006 guidelines got consulting fees, research grants

and stock ownership from drug companies and other businesses that

have a stake in the treatment and diagnosis of Lyme disease.

He would not name the panel members or the companies. He said the

backgrounds of the new experts looking at the guidelines will be

checked for any potential conflicts.

The issue involves antitrust law, Blumenthal said, because the panel

excluded some opinions and evidence that may have supported other

treatments in development, including vaccines.

Blumenthal's office did not take a position on the proper treatment

of the disease or whether chronic Lyme disease exists.

The Infectious Diseases Society denied any conflict of interest.

''Panel members do not stand to profit from any recommendation in the

guidelines,'' the group said in statement. ''In fact, the panel

members denied themselves and their colleagues an opportunity to

generate a significant amount of revenue when they recommended

against expensive, repeated, long-term antibiotic therapy.''

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On the Web:

Centers for Disease Control and Prevention:

http://www.cdc.gov/ncidod/dvbid/lyme/

Infectious Diseases Society of America: http://www.idsociety.org/

Lyme Disease Association: http://www.lymediseaseassociation.org/

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