http://www.easthamptonstar.com/20001116/news5.htm
State Investigates Lyme Doc
By Susan Rosenbaum
Dr. Joseph J. Burrascano, an East Hampton internist who treats people who have Lyme disease, could lose his medical license if, after a series of hearings that began in October, a New York State Health Department panel were to find him guilty of misconduct.
The 49-year-old doctor, who has diagnosed and treated up to 10,000 patients for Lyme and other tick-borne diseases over 20 years, acknowledged yesterday that a New York State Office of Professional Medical Conduct investigation that began in 1999 "threatened" him "on several levels."
Another Long Island physician who treated chronic Lyme patients, Perry Orens of Quogue, who practiced general medicine and cardiology in Great Neck for 40 years, was ordered to surrender his license a year ago after a similar panel of two physicians and one layman found him guilty of negligence, excessive testing, and poor record-keeping.
Doctors Divided
Dr. Burrascano maintained this week that differences among doctors over how to treat Lyme disease have no place in the Office of Professional Medical Conduct, which was "set up to deal with issues such as inappropriate billing or behavior."
The disease, particularly its chronic manifestations, has split the medical community, putting some academics and insurers on the side of limited antibiotic treatment - generally no longer than a month - and others, like Dr. Burrascano, favoring long-term courses of antibiotics in conjunction with herbs, vitamins, nutritional supplements, even time in a hyperbaric chamber.
"Physicians associated with the insurance industry who don't agree with us are trying to get us to stop doing what we're doing," Dr. Burrascano said yesterday, adding, "They've tried to libel and slander people like me to settle a scientific debate."
Supporters Rally
Dr. Burrascano has testified three times so far, including last Thursday, at hearings in Manhattan that are expected to continue though the spring. At issue are the charts of nine patients with Lyme about which complaints were filed. The identities of patients, the complainants, and those who sit on the panel are confidential.
Several hundred supporters - patients of Dr. Burrascano and some 50 other American physicians who share his views on treating chronic Lyme disease - staged a rally in Manhattan last Thursday. Two of them, Debra Gulnick of Montauk and Jean McCoy of East Hampton, were among them.
Dr. Burrascano has said that "every physician in the country who treats the way I do is being investigated," and believes that he has been under suspicion since a 1993 Congressional hearing where he questioned the propriety of Lyme disease research funding by the federal Centers for Disease Control and Prevention and the National Institutes of Health.
Two Views
Again yesterday he questioned the federal agencies, saying that in the mid-1980s, when AIDS and Lyme disease emerged as public health problems, a decision was made putting the infectious diseases branch of the National Institutes of Health in charge of AIDS research, while immunology and arthritis specialists would guide Lyme research.
Immunologists, Dr. Burrascano said, view the disease as a "simple infection," think Lyme disease tests should be designed and used for "immunology factors, and view the so-called post-Lyme syndrome as a dysfunction of the immune system."
But tests for an immune disorder "miss one-half to one-third of all Lyme infections," and in cases of chronic Lyme "no studies show that a month of antibiotics is curative."
Long Or Short Term?
Dr. Burrascano's approach to chronic Lyme is a departure from the "Practice Guidelines for the Treatment of Lyme Disease" that the Infectious Diseases Society of America, made up of infectious disease specialists from around the country, released two weeks ago.
The society's guidelines conclude that "there are no convincing published data showing that repeated or prolonged courses of oral or [intravenous] antimicrobial therapy are effective for" patients with chronic Lyme disease or post-Lyme disease syndrome.
The guidelines agree with the approach endorsed by the Centers for Disease Control and the National Institutes of Health.
Resistant Strains
They also reflect a concern throughout the medical community about overuse of antibiotics. "It has not been shown," they note, "nor is it anticipated that B. burgdorferi" - the spirochete that causes Lyme's symptoms - "will develop resistance to antibiotics, but the indiscriminate use of antibiotics exacerbates the problem of antibiotic-resistant community-acquired infections with other bacteria."
Dr. Burrascano has posted a 33-page document, "Diagnostic Hints and Treatment Guidelines for Lyme and Other Tick Borne Illnesses" of his own on a Web site titled Lymenet.org.
In it, he recommends intravenous antibiotic therapy for up to 10 weeks, followed by intramuscular antibiotic treatment until "no active disease" can be found.
A Life Saver?
Some patients, on antibiotics for months, say the therapies Dr. Burrascano have prescribed have made all the difference in their lives.
"I know when I crash that he'll be there," said Mrs. Gulnick of Montauk, who has been his patient since 1989, and who demonstrated her support for him in New York last week. Mrs. Gulnick has had Lyme disease since the 1970s and was treated for several years by Raymond Dattwyler, M.D., at Stony Brook University Medical Center Lyme Disease Center.
Dr. Dattwyler, who was among the authors of the Infectious Diseases Society's guidelines, testified as the state's expert on Lyme at Dr. Orens's State Health Department hearings.
He is an adviser to the C.D.C. and to the federal Food and Drug Administration, which approves drugs for use by the nation's physicians.
