Sunday, October 9, 2011

Hello Doctor! I have something to say!

I copied the entire statement here so that I could comment to certain points.  Highlighted in  Yellow are points I'm speaking to. My comments are in Blue.

Pennsylvania Medical Society Statement to House Human Services Committee regarding HB 272 

Read Full Text Here:

Testimony on House Bill 272
Chairman DiGirolamo and members of the House Human Services Committee, I am John Goldman, MD, an Infectious Disease Specialist practicing here in Harrisburg, Pennsylvania. In addition, I also oversee the internal medical residency program at Harrisburg’s Pinnacle Hospital.

I wish to thank you for the opportunity to testify before you today on a topic that I believe merits your careful consideration. To begin, I should tell you that the Pennsylvania Medical Society opposes House Bill 272.

In a nutshell, House Bill 272 attempts to come to the aid of those with Lyme disease. If passed, this bill would create the Lyme and Related Tick-Borne Disease Education, Prevention, and Treatment Act. While the desire to help these patients is laudable, the bill as written may actually be harmful to those with the disease.  
(Throw in a little Fear Mongering for added effect.)
(Laudable..That word was thrown in to help belittle the situation and belittle the people involved in the passing of this Bill.)
As a result, the Pennsylvania Medical Society opposes it.

Within the bill is language that would statutorily endorse the use of long-term antibiotic therapy for the treatment of Lyme disease by mandating that health insurance policies cover that treatment.

(Laws do currently exist that mandate insurance coverage for the treatment of many other diseases including cancer and aids and TB.  This is not a new practice and not just regarding Tick borne diseases.)

Unfortunately, research on this type of treatment is not proven and the overwhelming consensus of the medical community does not agree with it. Ironically, more and more physicians are significantly curbing the unnecessary use of antibiotics given the serious and growing problem of antimicrobial resistance.

(What happened to the recognized problem of incomplete treatment of a bacterial infection being the cause of resistance?  Syphilis, TB and other infections were proven to survive past the usual 10-14 days of antibiotics.  It was proven then that the surviving bacteria became resistant, therefore it was recommended to use antibiotics until infection was completely clear.  That begs another problem doesn’t it?  How to prove or disprove current infection?  This doctor is basically saying if it can’t be proven; even if the patient is still obviously sick, do nothing.)

The Centers for Disease Control (CDC) is an excellent resource for information regarding the prevention, symptoms, diagnosis and treatment of Lyme disease. Similarly, the National Institutes of Health (NIH) and the Infectious Disease Society of America (ISDA) have done a great deal of research on Lyme disease and should be referenced when considering the merits of House Bill 272. All three of these respected organizations continue to recommend treating Lyme disease with a relatively short course of antibiotics such as doxycycline, amoxicillin or cefuroxime axetil.   

(Now, ask yourself, where do the treatment recommendations come from originally? Go to each website of the agencies mentioned and they each refer to the IDSA guidelines.  The decision was not based on their own research and determination. They are following what the IDSA is putting out.)

Nowhere do these organizations endorse the long term use of these medications for treating Lyme disease.  
(They do however; endorse the long term use of antibiotics for malaria, TB and acne. And they do endorse the use of picc lines to administer the most toxic substance available to “cure” cancer.) 

Please consider the following two excerpts from an article entitled “Inaccurate Information About Lyme Disease On The Internet,” published in The Pediatric Infectious Disease Journal, Volume 23, Number 12, December 2004:

(Also please consider the source.  Who wrote the article and who paid him/her to write it? By bringing that up, is this doctor also saying that in 7 years of improvements made to the access of information online that nothing is changed? )

Persistent B. burgdorferi infection in patients with chronic Lyme encephalitis has not been demonstrated. Chronic subjective problems such as fatigue, headache, irritability, poor concentration, poor memory, arthralgias or myalgias do not indicate chronic Lyme disease. Some of these subjective symptoms may occur after Lyme disease and may be termed “post-Lyme syndrome.” These symptoms may be unrelated to Lyme disease and have not been shown to respond to antibiotic treatment.

The Infectious Diseases Society of America practice guidelines do not include treatment options for chronic Lyme disease because persistent infection has not been demonstrated. Combinations of antibiotics, prolonged courses of antibiotics or unusually high antibiotic doses should not be used to treat Lyme disease, because they may be harmful and have not been shown to be more effective than standard therapy. 

(Note the term, May be Harmful.  Based on what “May” be, patients are being denied further treatment options.  This is where our doctors have been stripped of their freedom to “practice” medicine and the patients have been stripped of their freedom of choice. Informed consent in this situation is of utmost importance.)

Information from the CDC’s Prevention’s Division of Vector-Borne Infectious Diseases indicates that while patients treated with antibiotics in the early stages of the infection usually recover and a few patients may benefit from a second 4-week course of therapy, “longer courses of antibiotic treatment have not been shown to be beneficial and have been linked to serious complications, including death.”

(Every time I see the above “Early Stages” statement it truly puzzles me that they have no numbers or studies to back up the claim that these people were “cured”.   They further make no suggestions or recommendations to doctors for what to do with patients that have gone a long time being undiagnosed.  Many, many stories are out there of patients that were not treated “early” because it was the wrong time of year, doctors not knowing what the rash was, Doctors not treating despite the positive tests because “Lyme disease” is not in their area.  Ticks carry more than Lyme disease and more often than not patients aren’t diagnosed with a vector borne illness for up to years while their doctors look for all the other reasons for the patient’s symptoms.  WHAT THEN DOES THE IDSA RECOMMEND TO THESE PATIENTS? )

So, up front, if we want to do what’s best for the patient, we better be sure that we prescribe the right treatment that’s been clearly proven. Until then, this bill holds great potential of putting patients at risk.

(By “we” he means who?  Is he speaking for my doctor who has seen me personally, performed the tests and looked at the results and is trying to help me get better?)

Equally important, legislative attempts to practice medicine should be avoided. Endorsing questionable medical treatment plans, even indirectly as in House Bill 272, through legislation for Lyme disease or any other disease sets a bad precedent. 

(This bill is not “Endorsing questionable treatments” it is allowing the doctors faced with difficult to treat patients the breathing room to do what they are trained to do.  Practice Medicine.   Patients should be given the freedom to choose treatment plans and be informed of the risks involved, if my doctor and I decide on a plan and I have insurance coverage, my insurance carrier should not decline what my Doctor prescribes.   The reality is that currently my insurance carrier will decline coverage for my treatments based on the IDSA guidelines.  How is it that the IDSA and my insurance carrier can decide my course of treatment without ever examining me or performing a consult with me and my doctor?  Is that not the same as practicing medicine over the phone?  Insurance companies are not paid to determine my choices are they?)

Let’s not put a wedge between patients and physicians through legislation encouraging medical procedures that are scientifically unproven. Physicians need to act in the best interest of their patients without this kind of statutory guidance. 

(I do know my doctor is acting in my best interest when he discusses all options to getting me to better health.  The IDSA would have my doctors license to practice revoked for not following the IDSA guidelines.  Is that not also putting a wedge between my doctor and my health? )

On a more positive note, there is one element within House Bill 272 that the Pennsylvania Medical Society would support with some changes. The bill calls for the establishment of a task force focused on education and prevention of Lyme disease. The Pennsylvania Medical Society applauds that section and would welcome being a resource to help educate both the public and physicians about Lyme disease.

However, we are concerned with the provision that requires the panel’s two physicians to be members of the International Lyme and Associated Diseases Society (ILADS). To our knowledge, this is the only group that supports the use of long-term antibiotic therapy for the treatment of Lyme disease.

(Could it be that this is the only group that does nothing but research on Vector Borne illnesses?  Again, IDSA dances around the fact that the ILADS does not focus on hundreds of other diseases like the IDSA does.  The above comment is much like the kids in the school yard arguing over whom the most popular is based on who can be the loudest.  If I have cancer, I want to see a cancer specialist. If I have a Vector borne illness such as Lyme disease, I want to see a doctor who specializes in that and that only.)
It is also an organization that, according to the above-cited article in The Pediatric Infectious Disease Journal, provides inaccurate information about Lyme disease. In order to assure that the majority viewpoint is adequately represented, we recommend that the task force include at least three physicians, with no more than one affiliated with ILADS. 

(Ok, explain this logic.  Firstly, who determines who the “majority” is?  And secondly, what field of practice is the third doctor on the panel going to be?  Fair and unbiased should be the goal, so you would have one IDSA doctor, one ILADS doctor and who would be the third?)

Thank you again for the opportunity to share with you our concerns about House Bill 272. To the best of my ability, I would be happy to take any questions that you may have.