Sunday, May 25, 2014

Governor of Vermont signs Lyme treatment bill accepting ILADS standard of care!

Governor Peter Shumlin signed a bill Thursday aimed at giving doctors more latitude to treat long-term symptoms of tick-borne illnesses, which advocates lauded as a good first step.

"We have one of the highest rates of Lyme disease in America, per capita, and what we know about Lyme disease is that if not detected early it is an extraordinarily debilitating disease that can uproot the life of an otherwise very healthy Vermonter," Shumlin said.

The number of confirmed cases of Lyme disease in Vermont grew from 11 in 2002 to 674 in 2013. Shumlin encouraged Vermonters to become educated about the symptoms of Lyme and check themselves regularly for ticks.

The law requires the state Board of Medical Practice to issue a memo saying that it won't censure clinicians for using alternative methods to treat patients with ongoing symptoms of Lyme and other related diseases.

Lyme disease and other tick-borne illnesses are typically treated upon diagnosis with a two- to four-week course of antibiotics, and if caught early, the disease is unlikely to have lasting health effects. However, if it's not detected early, it can be difficult to diagnose and treat.

There is medical controversy over the benefit of using long-term antibiotics to treat persistent symptoms of those illnesses.

Centers for Disease Control and Prevention guidelines advise against long-term antibiotic treatment. The agency points to studies that show prolonged antibiotic treatments don't lead to better outcomes than placebos and can lead to serious complications.

But the International Lyme and Associated Diseases Society provides guidelines for the treatment of persistent Lyme that include prolonged antibiotics as an effective treatment. The society is a nonprofit medical group focused on the diagnosis and treatment of Lyme and associated diseases.

Advocates said it's difficult to find doctors who will treat their symptoms using longer courses of antibiotics, forcing patients to go out of state for treatment in some cases.

Carol Gardner, a family medicine doctor in Colchester, who frequently treats patients for lingering symptoms of Lyme disease, said the bill gives her peace of mind.

Gardner said she's never experienced any direct pressure from the Board of Medical Practice or the Vermont Medical Society, but she said, "We know they have a more conservative view."

The board's job is to enforce medical standards and because Lyme is an emergent problem, those standards don't endorse alternative treatments, Gardner said.

David Herlihy, executive director the Board of Medical Practice, has said there are no public cases of physicians being sanctioned for prescribing antibiotics to treat Lyme in a way that didn't mesh with the board's guidelines.

Investigations of complaints against physicians only become public when they result in charges or a stipulation against physicians.

Dr. Harry Chen, commissioner of the Department of Health and a past member of the board, has said there are other ways, short of a stipulation, that the board can exert influence on a provider, but he has not seen it used to discourage a specific treatment.

"(The law) removes restrictions, or perceived restrictions, on doctors from being able to practice a range of medical care for people with Lyme," said Sen. David Zuckerman, P/D-Chittenden, who joined the governor, several other lawmakers and activists who pushed for the new law – many of whom suffer from the ongoing symptoms of Lyme or have loved ones who do.

Zuckerman's wife, Rachel Nevitt, attended the bill signing as well. Nevitt has Lyme disease and her symptoms have taken an emotional toll on their marriage and impacted their family business, he said.

Patients like Nevitt suffering with prolonged symptoms can experience severe fatigue, headaches, joint pain and anxiety.

"Prevention is the most important thing, second is early detection," Zuckerman said, adding that he hopes the new law will bring greater awareness of the signs of Lyme among health care providers and the public.

Bernadette Rose has struggled with persistent symptoms of Lyme and spent nearly a decade advocating for legislation to protect physicians and increase education around alternative treatments.

She said the bill is a step in the right direction, but she hopes the medical community will include the guidelines for treatment endorsed by the International Lyme and Associated Disease Society as part of continued education for physicians.

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