April 10, 2000

The differences that exist among doctors diagnosing and treating Lyme disease are the topic of a commentary by a UConn Health Center physician in the April edition of the journal Pediatrics.

In the article, Henry M. Feder Jr., a professor of family medicine and pediatrics at the Health Center, recounts a public hearing on insurance coverage for Lyme disease at the Connecticut state Capitol. During that meeting, it became clear that community-based physicians favored open-ended, prolonged treatment for Lyme disease, using oral and/or intravenous antibiotics; academically-based physicians, however, favored a short course of treatment with oral antibiotics and rarely used intravenous therapy.

Feder, who spoke at the hearing against the prolonged therapy, says scientific studies have determined that three to four weeks of a single oral antibiotic is an effective therapy for patients with Lyme disease. And, he added, the Academy of Pediatrics and the College of Physicians endorse these standards of therapy.

"I believe patients and physicians should know there is a difference of opinion among physicians treating Lyme disease," Feder says. "I believe more research is needed, but I am confident in the propriety of the academically based guidelines for diagnosis and treatment of Lyme disease."

Diagnostically, Feder says, differences exist between the two groups as well. Community-based physicians believe chronic Lyme disease is common, and diagnosis is often based on symptoms; the results of the Lyme disease test are not always considered. Academic physicians, on the other hand, believe that chronic Lyme disease is uncommon, symptoms are specific and that Lyme disease test results must prove positive to warrant treatment.

More is at stake here, however, than academic reputation or insurance coverage or money, says Feder. The academic community believes the dangers of prolonged intravenous therapy outweigh the benefits and that therapy must be directed by what research and science have proven. Patient testimonies supporting long-term therapy are compelling, but they need to be confirmed.

Feder notes that there are guidelines for Lyme disease diagnosis and treatment and that when these guidelines are followed, the medical outcomes are excellent. He also says that although some Lyme disease patients do not believe traditional treatment helped them, it is vital to conduct further studies to evaluate these personal experiences. Until the results of such studies are available, he advises patients to stick to the traditional course of treatment.

"It's important for patients to understand that there are two schools of thought on Lyme disease," Feder says. "They should find out what those differences are before agreeing to long-term therapies."

Jane Shaskan