By WILLIAM HATHAWAY And HILARY WALDMAN Courant Staff Writers
March 21 2007
Attorney General Richard Blumenthal has long been a prominent fixture in the impassioned debate over how best to treat Lyme disease.
But a delegation of experts say they want to know why Blumenthal keeps butting in on what they see as the wrong side of that debate - and they want him to stop.
The researchers, from Yale University and the University of Connecticut, are meeting with Blumenthal today in a bid to convince him that he has been misled by advocates who argue that treatment with long-term antibiotics can alleviate the possibly debilitating symptoms associated with the tick-borne disease.
The scientists hold the more mainstream view that the benefits of attacking Lyme with months and months of antibiotics have never been proven - and could be dangerous. They see Lyme as a bacterial infection that can be simply diagnosed and, in most cases, easily treated with a three-to-four-week course of antibiotics.
"To have good science questioned by the attorney general is very disturbing," said Durland Fish, a professor of epidemiology at Yale University.
The latest round in the battle was touched off in November when Blumenthal acknowledged that he had launched an antitrust investigation into the Infectious Diseases Society of America's development of treatment guidelines for Lyme disease.
The guidelines say in most cases a 30-day course of oral antibiotics should be sufficient to cure the disease.
Advocates on the other side of the debate argue that researchers have ignored evidence that Lyme disease can persist for years and require treatment with antibiotics for six months or longer.
Although treatment standards for most illnesses are developed by experts in the field, Blumenthal argued that the process used by the infectious disease society to develop its guidelines was anti-competitive and may have excluded valid scientific research.
Blumenthal said his investigation has uncovered "conflicts of interest that are credible and powerful."
For instance, the chairman of the infectious diseases panel that developed the guidelines, Gary P. Wormser, of the division of infectious diseases at New York Medical College in Valhalla, has received consulting fees from Baxter, a company that is developing a Lyme disease vaccine.
It is possible that Baxter might benefit from the new guidelines, Blumenthal said.
Wormser's relationship with Baxter is disclosed in a journal article outlining the guidelines, as are other potential conflicts of interest of panel members involving consulting fees, patent rights and involvement with existing businesses.
Blumenthal said he is concerned the guidelines could prompt insurance companies to deny payment for long-term antibiotic treatment - a therapy some doctors and patients insist is the only way to help people with intractable Lyme-like symptoms.
The attorney general's position on the issue has put him at odds with people like Fish, one of the authors of the infectious disease society's guidelines, and Dr. Lawrence Zemel, professor of pediatrics at the University of Connecticut and chief of the rheumatology division at the Connecticut Children's Medical Center.
They believe the indiscriminate use of antibiotics can harm patients.
They also note that some doctors make a lot of money prescribing dangerous, long-term antibiotic treatments costing $50,000 or more to desperate patients with no valid evidence that they have Lyme.
The meeting "is really to educate [Blumenthal] about what's science and what is non-science," Zemel said. "Frankly, what Mr. Blumenthal is basing this on is non-science."
Blumenthal counters that he is not questioning the guidelines or advocating any medical position. He said he is only investigating whether the researchers who drafted the guidelines excluded scientific evidence that might support long-term antibiotic use to treat Lyme.
"I am not qualified to make scientific judgments," Blumenthal said. "I am only interested in the process."
But Fish and Zemel say that, for nearly a decade, Blumenthal has encouraged the perception that he favors the "long-term Lyme" camp by appearing at charity fundraising events or rallies organized by advocates who believe Lyme disease often becomes a chronic disease.
Blumenthal "is a hero to the Lyme community," said Diane Blanchard, co-president of Greenwich-based Time for Lyme. "You cannot continue to ignore an entire population of sick people. What are you going to do? Leave patients suffering?"
In 2005, Blumenthal presented an award to New Haven Dr. Charles Ray Jones, who later became the subject of a state disciplinary hearing for allegedly prescribing antibiotics to a child in Nevada without seeing the patient.
Jones has received an outpouring of national support from Lyme disease groups because of his willingness to treat patients suspected of having chronic Lyme with long-term antibiotics.
"Is there a perception that I am advocating a position? Yes," Blumenthal acknowledged. But he insisted the perception is incorrect.
Although Blumenthal says he has taken no position on Jones' disciplinary battle, national publicity about the hearing and his own antitrust investigation have fanned the flames. The Lyme debate has been raging almost since the very first tick-borne spirochete was identified in1983 as the culprit in a rash of arthritis cases in Lyme, Conn., in the 1970s.
There is broad agreement on this much: Most infections of Borrelia burgdorfi, the bacterium that causes Lyme, can be easily cleared up with relatively short courses of antibiotics if treated early after infection.
But after that, common ground is difficult to find.
The long-term Lyme camp believes that the infection can survive early antibiotic treatments and at low, sometimes undetectable levels, cause a host of persistent and debilitating symptoms collectively known as chronic Lyme - fatigue, muscle palsy, arthritis and neurological and cognitive deficits.
Doctors and advocates on that side of the debate argue that standard diagnostic tests often miss the presence of Lyme, leaving it woefully under-diagnosed. Affected patients, they say, needlessly suffer for years although long-term courses of antibiotics would cure them.
They point to studies that suggest bacteria can persist after treatment, and that additional courses of antibiotics can help and should be covered by insurance companies.
But a majority of doctors say there is a clear lack of evidence to support those positions.
They say most patients who have been treated for Lyme and remain ill probably have other treatable diseases such as depression, multiple sclerosis, rheumatoid arthritis or Parkinson's.
Zemel says patients with no evidence of Lyme infection can suffer on two fronts from long-term antibiotic use.
They may develop antibiotic resistance, and their doctors may overlook the real cause of their illness.
Contact William Hathaway at firstname.lastname@example.org Copyright 2007, Hartford Courant [end quote]
They also give a good list of links for Lyme and you can see how to respond to articles in the Courant.
Local experts say they want Attorney General Richard Blumenthal to move over to the mainstream on the Lyme disease debate. Durland Fish, a professor of epidemiology at Yale, and Lawrence Zemel, a professor of pediatrics at the University of Connecticut, told the Hartford Courant last month that Blumenthal's tacit endorsement of alternative Lyme therapies could be hazardous to public health. "To have good science questioned by the attorney general is very disturbing," Fish told the Courant. Blumenthal met with Zemel and two other researchers March 21 but issued no public statement, his office said. "There was a very active dialogue," said Zemel of the meeting, adding that the attorney general seemed open to the doctors' presentation. Blumenthal raised hackles in the medical community last year when he announced an unprecedented antitrust probe of the Infectious Diseases Society of America. He alleged the doctors' group was suppressing dissenting views of the causes and treatment of Lyme. By questioning established Lyme protocols, the attorney general has given support to the "Lyme-literate" community, which argues that Lyme infection at very low levels - often undetectable in blood tests - can cause a host of ailments and should be treated with a lengthy course of antibiotics. Infectious disease experts counter that Lyme can be completely cured with a short course of antibiotics and longer treatments can cause health problems and lead to the rise of drug-resistant bacteria. Blumenthal has also spoken out in support of Charles Ray Jones, a New Haven doctor accused of diagnosing Lyme and prescribing antibiotics without examining the patient first. The state medical board is currently hearing the case against Jones and could revoke his license to practice medicine. Jones issued an appeal to supporters on the Web site Lymesite.com dated March 10 in which he asks for donations to continue his court fight. "My ability to mount an appropriate defense, from a financial perspective, is now in jeopardy," Jones writes. The next hearing Jones' case is scheduled for April 19 in Hartford.
Posts: 1538 | From Planet Earth | Registered: Jan 2005
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This is crunch time, no question. The IDSA is running an Inquistion, and heritics from its doctrines will be treated severely. A shameful and sickening abuse of power. But what to do??
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