Newspaper Article Jan. 6, 2000
http://www.easthamptonstar.com/20000106/news3.htm
Lyme: No Agreement
January 6, 2000
BY SUSAN ROSENBAUM
Controversy has ratcheted up a notch in recent weeks over how to test
for and treat Lyme disease, the tick-borne illness that has long eluded
easy diagnosis and medical management, particularly in its chronic form.
Physicians have disagreed for some time over diagnostic tests for Lyme,
what drugs to use, particularly in cases that may be chronic or
progressive, and how long to use them.
Some Lyme patients and their families say differences in treatment
practices are the reason one Long Island physician, who treated many
East End patients, had his medical license revoked late last year, and
why other doctors who treat Lyme in ways not within longstanding
guidelines worry that they, too, could be put out of business.
Patients Demonstrated
Indeed, more than 100 protesters, including patients who suffer from
what they believe to be symptoms of chronic Lyme, and who fear losing
doctors they believe can help them, demonstrated their outrage at the
Manhattan office of the New York State Health Department's Office of
Professional Medical Conduct, which revoked Dr. Perry Orens's medical
license in November.
A spokeswoman for the Health Department said patients "often protest
the revocation of their doctor's license." Several patients
subsequently declined to name the physicians treating them for chronic
Lyme.
However, in its findings in the Orens case, the medical conduct
office's hearing committee, comprised of two physicians and a physician
assistant, noted that "the fact that the disease involved may have been
Lyme was of little significance. . . . the facts. . . evidenced an
overall pattern of substandard medical care. . . . "
To File Lawsuit
Dr. Orens was charged with 34 specifications of misconduct, including
negligence and incompetence, fraud, and ordering excessive tests and
treatment. He was found guilty of six acts each of gross negligence,
negligence, fraud, excessive testing, and failing to maintain accurate
records.
On Nov. 18, 1999, Tyrone T. Butler, director of the Health Department's
bureau of adjudication, ordered Dr. Orens to surrender his license to
practice medicine.
Dr. Orens has appealed to an administrative review board. Failing
success there, he said, he would file an Article 78 lawsuit in the
Appellate Division of New York State Supreme Court.
Four Days' Notice
Dr. Orens, 72, who practiced general medicine and cardiology in Great
Neck for 40 years, lives in Quogue and began treating Lyme disease
after his daughter was diagnosed with the illness 14 years ago. He told
The Star that he was not board certified in any specialty, and had no
formal training in infectious diseases.
He said Joseph Burrascano, M.D., of East Hampton, who specializes in
Lyme disease, treated his daughter. The two physicians grew friendly as
a result, he said, and Dr. Orens subsequently "began to treat Lyme
patients, hundreds of them," he said. He said he had "only four days to
notify my patients" that he had to close his practice.
Under Suspicion
"I did nothing wrong," Dr. Orens told The Star. "Before I die I am
going to get the truth out."
He added that Dr. Burrascano was "under a similar investigation."
"Every physician in the country who treats the way I do, based on
scientific evidence, is being investigated," Dr. Burrascano said
yesterday. He said he has been under suspicion since testifying at a
United States Senate Committee on Labor and Human Resources in 1993.
At those hearings, he said he "outlined serious improprieties" in Lyme
research funded by the Federal Centers for Disease Control and
Prevention and by the National Institutes on Health.
Political Influences?
In a newsletter called "The Lyme Times," published quarterly by the
Lyme Disease Resource Center, a nonprofit organization in Ukiah,
Calif., Dr. Burrascano is quoted as saying, "On July 2, 1999, I had an
interview with a physician representative of O.P.M.C. and I was able to
fully defend my medical practice."
"However," Dr. Burrascano added, "he and my attorney both said that
there have been instances where political influences from Albany. . .
have reversed the recommendation of the interviewing committee and have
forced disciplinary proceedings to proceed anyway."
Guidelines Near. . .
The Orens case was "bad medical practice - not a Lyme case," said
Raymond Dattwyler, M.D., a professor of medicine and chief of the
Division of Allergy and Clinical Immunology and of the Lyme Disease
Center, a research and treatment facility at Stony Brook University
Medical Center.
An adviser to the Federal C.D.C. and to the Federal Food and Drug
Administration, which approves pharmaceuticals for use by the country's
doctors, Dr. Dattwyler testified at the Orens hearing as the state's
expert on Lyme.
Dr. Dattwyler reiterated that standard treatment of Lyme is two to four
weeks of antibiotic therapy. The treatment, he told The Star this week,
is in line with treatment guidelines about to be published by the
Infectious Diseases Society of America, for which he also acted as an
adviser.
. . . But Still Incomplete
The guidelines, however, are still incomplete, and "confidential,"
according to Gary Warmser, M.D., the chief of infectious diseases at
the Westchester Medical Center, who is compiling them.
Dr. Dattwyler said the Lyme-treatment controversy is among those
doctors who don't practice what he called "evidence-based medicine." To
date, there has been "no [clinical] trial that demonstrates that
long-term treatment is beneficial" to patients with Lyme.
Accusations
"You have to prove that the spirochete [the organism that causes the
illness] is still active," he said. He added that, as with a number of
medical conditions, Lyme symptoms can last long after the initial
infection, taking as long as "six months to a year to heal."
Physicians and patients who refute his approach have accused Dr.
Dattwyler of wielding undue power as an adviser to health insurance and
managed care companies that sometimes decline payment for long-term
antibiotic therapy, including intravenous infusion.
Dr. Dattwyler denied providing any such advice to health care insurers,
saying only that he had once testified as a Lyme expert for the
attorney representing Empire Blue Cross and Blue Shield "in connection
with a contract dispute."
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