fuel for the fire

Another Lyme headline. The part that spooks me is the third paragraph.

(excerpted from the Stamford Advocate)
Medical board approves probation, fine for controversial doctor
Associated Press
December 18 2007
HARTFORD, Conn. — A New Haven pediatrician who has been praised by patients but criticized by the medical establishment for the way he treats Lyme disease was reprimanded, fined $10,000 and placed on two years probation by state regulators Tuesday.

The Connecticut Medical Examining Board voted unanimously to impose the sanctions after concluding that Dr. Charles Ray Jones violated care standards by diagnosing Lyme disease in a boy and his sister and prescribing antibiotics based on a phone conversation with their mother, months before he examined them in May 2004.

The board also found that Jones broke standards by failing to reconsider his diagnoses of the children after lab tests came up negative for the tick-borne disease, which can cause painful arthritis, meningitis and other serious illnesses if not treated promptly.

Board members further concluded that Jones was wrong to prescribe antibiotics for nearly a year without repeat exams and without any arrangement with another doctor, because the children lived in Nevada, to monitor for any side effects of long-term antibiotic therapy.

Hartford lawyer Elliott Pollack, who is representing the 77-year-old Jones, said he will appeal the board’s decision.

Other things aside for a moment, I know it’s hard but try, consider that part of the board’s ruling was based on the finding that Dr. Jones “broke standards by failing to reconsider his diagnoses of the children after lab tests came up negative for the tick-borne disease”. I thought that a Lyme diagnosis was supposed to be more based on clinical presentation than lab values. What crazy Lyme-loving website did I get that from? The CDC, among others.

Lyme disease is diagnosed based on symptoms, objective physical findings (such as erythema migrans, facial palsy, or arthritis), and a history of possible exposure to infected ticks. Validated laboratory tests can be very helpful but are not generally recommended when a patient has erythema migrans.

On the CDC Lyme website, this passage continues with a helpful link to the current, detailed recommendations on serological testing for Lyme. If you do click there, what you get is a report called “Recommendations for Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease”.

The Second National Conference on Serological Diagnosis of Lyme Disease was in October of 1994.

I’m going to let you all do the math. You’ll do it faster than me. I nearly had to count it out on my fingers…good thing it wasn’t much older or I’d have run out of fingers!

My point. There are two, or one somewhat bifurcated one depending on how you look at it. My point is that the CT board’s finding engenders and perpetuates too high a level of confidence in serological testing for the clinician dealing with the realities of Lyme presentation. The board’s level of confidence would be well founded if the testing had improved much in the over 13 years since the “current” test performance and interpretation recommendations were made. It has not. I wonder now as I so often do when I read the latest Lyme fueled controversy story (or maybe more appropriately, the latest controversy fueled Lyme story) – Can’t we do better than this?

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