EDITORIAL: State mandate is wrong way to treat Lyme disease

June 21--Local legislators face an incredibly difficult task in this year's budget debate with proposals tacked on to both the House and Senate versions requiring insurers to fund long-term antibiotic treatment for Lyme disease.

It's not the money that's the real problem. It's the fact that lawmakers are being asked to play doctor -- and few of them have the knowledge and experience to do so.

Lyme disease, spread by ticks, is a serious disease that is prevalent throughout the North of Boston area. Andover, North Andover and Haverhill have been hit hard; so have Beverly, Ipswich and Gloucester. State health officials say it has reached epidemic levels.

In early stages, the disease causes rashes and flu-like symptoms, but it can lead to more serious complications, including crippling pain, headaches and other problems. The treatment is antibiotics.

But the medical community is divided over what some refer to as chronic Lyme disease, when symptoms do not disappear after the usual round of antibiotics. Suffering patients are clamoring for long-term use of antibiotics, but most insurers refuse to pay for continued treatment, which can run up to $5,000 a month.

If this were just a case of the big, bad insurance companies heartlessly refusing to pay the bills, it would be an easy call for legislators. The problem is that doctors are not sure there is any benefit to continuing antibiotics for these patients, and there are negative consequences.

Chief among them is the overuse of antibiotics, which has led to the evolution of bacteria that are resistant to even our most powerful drugs. The Centers for Disease Control cites this as "one of the world's most pressing public health problems." The overuse and misuse of antibiotics poses a risk to all of us.

Were it clear that continuing, long-term antibiotic therapy could cure patients who continue to feel ill after finishing the usual round of antibiotics, that risk might be worth it. But it's not clear. The American College of Rheumatology recommends against long-term use of antibiotics for Lyme disease. There is division in the medical community over whether there is even such a thing as chronic Lyme disease and, if so, whether it can be cured by continuing with antibiotics.

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It's not something most laymen can resolve. And in the absence of clear evidence that the benefit of such therapy outweighs the risk, it is premature for legislators to step in and decide that medical issue for everyone.

The Massachusetts Medical Society is among the medical groups opposed to the proposed legislation, citing a "discomfort with the level of clinical management of the treatment of an infectious disease by the Legislature, especially an area with such limited scientific and clinical consensus."

This doesn't mean that insurers should not consider exceptions in individual cases. There may well be instances when doctors feel a particular patient could benefit from another round of antibiotics.

But legislators, though trying to help patients, should be wary of requiring insurers to pay for questionable treatments across the board, simply because exhausted patients are clamoring for them. There's a better way to practice medicine, and it's not through an add-on to the state budget.

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