Lawmakers on the House Health Care Committee are zeroing in on language for a bill they hope will give doctors protection in treating persistent symptoms of Lyme disease.
Lyme disease and other tick-borne illnesses are typically treated upon diagnosis with a two- to four-week course of antibiotics. There is medical controversy over the benefit of using long-term antibiotics to treat lingering symptoms of those illnesses, however.
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.
Patients in Vermont suffering with prolonged symptoms – such as severe fatigue, headaches, joint pain and anxiety – say doctors in Vermont won’t prescribe longer courses of antibiotics, forcing them to go out of state for treatment in some cases.
They attribute that reluctance to behind-the-scenes pressure from the Vermont Board of Medical Practice to discourage physicians from prescribing antibiotics.
David Herlihy, executive director the Board of Medical Practice, told the committee during testimony last week there were 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.
“There may be other ways short of a stipulation for influencing a provider’s behavior,” said Dr. Harry Chen, commissioner of the Department of Public Health and a past member of the board. Chen said those methods were not used to influence a specific treatment or type of care and typically related to poor record-keeping practices.
The committee was initially split Tuesday over whether its bill, H.123, should include language giving doctors the latitude to prescribe long-term antibiotics in statute or to compel the board to issue a memorandum of understanding with the same language.
“Putting specific treatments into statute is a terrible idea,” said Rep. George Till, D-Jericho. Till, who is a physician, said medical treatments change constantly with new discoveries.
Other members raised concern that requiring the Board of Medical Practice to issue a memorandum of understanding articulating a position it does not support would lead to an enforcement headache.
“I think there has been enough resistance across the board that trusting, basically, a nonbeliever to write a memorandum that satisfies us seems suspect,” said Rep. Chris Pearson, P-Burlington.
By late Tuesday afternoon, Rep. Paul Poirier, I-Barre, broke the stalemate by saying he would throw his support behind the memorandum as long as it was strongly worded.
“If a doctor diagnoses someone with Lyme disease, I want that person to get the treatment that that doctor feels this person needs,” he said, “I don’t want to have the doctor under any pretense, if they said long-term antibiotics is the way, to feel they might have to deal with some kind of censure.”
If the language of the memorandum can give doctors assurance that they won’t face censure simply for prescribing long-term antibiotics, he said he would support the bill.
A straw poll of the members showed they were 7-3 in favor of legislation requiring a memorandum to ensure clinicians have broad discretion to treat Lyme as they see fit, provided they’ve done due diligence and obtained a patient’s consent.
Committee member Rep. Mark Woodward, D-Johnson, was absent Tuesday.
Legislative Council will draft a revised bill, and the committee is likely to vote on it before the end of the week.
