The Senate gave preliminary approval to a bill that aims to protect Vermont doctors from censure by state regulators if they prescribe long-term antibiotics for lingering symptoms associated with 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.
Sen. Claire Ayer, D-Addison, said the bill does not attempt to legislate clinical guidelines or wade into a medical debate, it merely allows clinicians to furnish the care they see fit without fear of professional repercussions.
The bill, which received unanimous support in Senate, would require the medical practice board to issue a memorandum giving doctors the latitude to prescribe long-term antibiotics for patients with ongoing symptoms ascribed to tick-borne 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.
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, said during testimony 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.
However, advocates for the bill, mostly those suffering with symptoms ascribed to chronic Lyme or their families, said the board exerts behind the scenes pressure on doctors not to prescribe long-term antibiotics.
Dr. Harry Chen, commissioner of the Health Department, opposes the legislation, but has acknowledged the epidemic proportions of Lyme and other tick-borne illness in Vermont.
Vermont had 386 confirmed cases of Lyme disease in 2012, according CDC data, down from the number in 2011 but precipitously higher than levels from a decade ago. Advocates believe the number of infections is much higher, because Lyme can be difficult to diagnose and symptoms are often attributed to other causes.
Sen. David Zuckerman, D-Chittenden, whose wife suffers with lingering symptoms from a tick-borne illness, praised the legislation as a step in the right direction.
But he said the state could be doing more to prevent the spread of Lyme and other tick-borne illnesses.
“The key thing the Lyme community would like to see is a greater focus on prevention,” Zuckerman said.
They would also like to see the state take steps to improve early diagnosis of tick-borne illnesses, he said, and more education for primary care doctors on alternative diagnostics.
