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My Left Nutmeg

CT Pediatrician to be Sanctioned for Lyme Disease Treatment

by: CTPatriot

Sun Dec 02, 2007 at 20:24:22 PM EST


( - promoted by ctblogger)


Elizabeth Ellis, of Arlington, Mass., attends Jone's licensure hearing with her three children, Andrew, 9, Louisa, 7, and Olivia, 5, all of whom Jones has treated for Lyme disease. The woman in black is Susan Marra, Jones' naturopath.  (Shana Sureck, Hartford Courant)

In my recent commentary, "Attack of the Chronic Lyme Denialists", I explained how there is a battle raging over the diagnosis and treatment of Lyme disease, particularly with regard to whether Lyme related symptoms that do not resolve after 30 days of antibiotics (the currently accepted "standard of care") are the result of ongoing infection or some other undefined condition. I also described how a small but powerful cabal of academic researchers whose beliefs lie on the short term treatment side of the debate have chosen to settle the issue not through rigorous science, but rather through brute political force.

Perhaps the most insidious way such force has been employed is through the use of state medical boards to drive uncooperative clinical doctors out of practice. Successfully removing just one chronic Lyme doctor instantly puts an end to the insurance claims of hundreds if not thousands of patients, and puts and end to the need for assistance from countless local hospitals wishing nothing to do with treatment methods which they consider unnecessary and dangerous.

Such is the case with Dr. Charles Ray Jones, who has successfully treated thousands of children suffering from chronic Lyme disease. Jones has spent the last year of his life not only seeing patients 6 to 7 days a week, but also regularly commuting from his New Haven area medical practice to Hartford for disciplinary hearings resulting from a complaint filed by a divorced father seeking to gain custody of his children and avoid responsibility for medical expenses that the mother could not afford.

CTPatriot :: CT Pediatrician to be Sanctioned for Lyme Disease Treatment

It was the kind of complaint which should have been easily recognized for what it was -- an attempt by an angry parent to manipulate the system for personal gain -- and dismissed. That the Connecticut Department of Public Health, which is responsible for the licensing and discipline of doctors in that state, chose to do otherwise raises serious concerns about their ability to function as an impartial arbiter of the law. It also raises serious concerns as to their relationship with Yale University, the UConn Children's Hospital, and the chronic Lyme denialists who hold sway at both institutions.

After 8 hearings and months of deliberations, it would appear that the chronic Lyme denialists have achieved the first step in their goal of taking down Dr. Jones:

In a decision with national implications for how suspected cases of Lyme Disease are treated, a state physician review panel is recommending that controversial pediatrician Charles Ray Jones be reprimanded and put on two years' probation for his diagnosis and treatment of two Nevada children.
And what exactly is he guilty of with regard to those two children?

"Dr. Jones is being charged with improperly diagnosing and treating Lyme Disease after having treated and cured two children whose health was of great concern to their mother for years,'' said Jones' attorney, Elliot Pollack. "Instead of being sanctioned, he should be complimented.''
For close to 15 years, the chronic Lyme denialists have participated in efforts to punish doctors who refused to follow their protocols. Through those efforts, a number of highly regarded Lyme doctors were put on trial by medical boards all over the country. Some lost their licenses, some were sanctioned, some escaped punishment, and some saw what was happening to their peers and preemptively stopped treating Lyme patients. One, Dr. John Bleiweiss of NJ, a pioneer in the treatment of chronic Lyme disease, was driven to suicide. For those who chose to stand and fight to the bitter end, the costs have proven staggering with trials that extended for months and legal bills in the $100,000+ range regardless of the outcome.

The medical board investigations of chronic Lyme doctors in at least one state, New York, were so numerous and egregious that the state legislature was compelled to pass a resolution demanding that their state's licensing board, the Office of Professional Medical Conduct (OPMC), cease and desist from taking sides in a medical dispute for which there currently exists no definitive answer (more information on the case against OPMC can be found here).

Dr. Lawrence Zemel, a longtime chronic Lyme denialist, and one who has played an active role in the efforts to investigate and punish chronic Lyme doctors, makes clear what the goal of these prosecutions is and has always been:

"This decision sends a message to very small cadre of physicians who do not conform to standards of care for diagnosing and treating Lyme Disease,'' said Dr. Lawrence Zemel, chief of rheumatology at Connecticut Children's Medical Center and professor of medicine at the University of Connecticut School of Medicine.
This heinous message is not only an outrage against the "small cadre of physicians" to which Zemel refers, but against all physicians whose treatment methods fall outside the recognized standard of care for a given illness, particularly when competing standards of care exist (as they do with Lyme disease), when such alternative standards of care are supported by published, peer-reviewed science (as they are with Lyme disease), and when related alternative treatment methods result in measurable improvements to patient health (as they do with Lyme disease). Dr. Zemel and his colleagues, rather than behaving like compassionate, dedicated scientists, are instead behaving like a pack of rabid thugs in suits, willing to kneecap anyone who has the temerity to disobey their dictates.

Ironically, on the same day that Dr. Jones' recommended punishment was announced, news broke regarding a new study published by the infamous chronic Lyme denialist, Dr. Allen Steere, which concluded that Lyme disease infection, in some cases, is not eradicated by the mainstream treatment protocols (the very same ones that Steere mandates through his authorship of the IDSA Lyme disease treatment guidelines), requiring several months additional treatment to achieve a cure. 

Perhaps Dr. Steere should be the next one dragged before his state's medical board for violating the accepted standard of care. Or perhaps, more appropriately, Steere and the rest of the chronic Lyme denialists should be put on trial for child abuse. Because if Dr. Jones is forced out of his practice, there will be no pediatricians left who are willing to take on the difficult cases of children with chronic Lyme disease. He is the only one that remains.

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This makes me crazy! (4.00 / 1)
My son had chronic Lyme (his initial course of antibiotics after be diagnosed with Lyme - 2 WEEKS!!) until he saw Dr. Jones.

If it weren't for Dr. Jones, he'd probably STILL have Lyme.


You and Me Both (0.00 / 0)
If it wasn't obvious from my commentary, I am truly incensed by what they are doing to Dr. Jones. Rumor has it that Dr. Eugene Shapiro, pediatric Lyme researcher (and chronic Lyme denialist) from Yale, has had a vendetta against Jones for a long time. That the state health department chose Shapiro as their expert witness against Dr. Jones says a lot about their ability to remain impartial, not to mention their insistence that Jones' case is not about his Lyme disease protocols.

The irony here is that it is because of the failure of Shapiro and his colleagues to alleviate the ongoing symptoms of their Lyme patients that has filled the waiting room of Dr. Jones office. And unlike Shapiro, Dr. Jones has succeeded in helping countless children regain their health.

I've yet to meet a parent whose child was not helped by Dr. Jones, and who has not sung his praises. Having met him and seen a documentary focused on his practice, I can see why. He is cut from the Marcus Welby mold. What's happening to him is tragic.


[ Parent ]
Curious (4.00 / 1)
What's your take on Granny Rell's new Lyme program?

http://www.acorn-online.com/ne...

It certainly sounds earnest, but of course there's the question of which perspectives her officials are choosing to empower. Anything stand out in there?

–7.25 / –7.28

http://imgs.xkcd.com/comics/tw...


Well Intentioned But Falls Short (4.00 / 1)
Rell's new program that was announced in that article is intended to improve the state's ability to quantify the incidence of Lyme disease in CT and to increase efforts at protection and prevention. It is not going to deal with treatment issues, though I think it's pretty clear where the state health department stands on that issue.

The sad thing here is that we had an excellent incidence reporting program in CT until 3 years ago or so, when federal funding assistance was withdrawn. At the time, all diagnostic labs were required to report CDC positive Lyme disease tests to the state. The annual reported cases at the time were in the 4500 range, and climbing.

When that program was ended (despite a firestorm of protest from the Lyme patient community), the state changed its reporting requirements, leaving labs out of the loop and instead asking doctors to report cases voluntarily. The first year using this method saw reported cases drop by approximately 2/3 from ~4500 to ~1500 (great way to make an epidemic appear to have been brought inder control, don't you think?).

Bowing to pressure, the state health department promised to implement a new program which would enable labs to report cases electronically to the state. They've missed the deadline at least once. I suspect Rell's program is intended to put a bandaid on this situation as she is only planning to use Quest and no other labs for now. Quest is far from the only lab conducting Lyme disease tests. This is why I say that her efforts fall short.


[ Parent ]
Lab tests and single lab results don't look good to me (4.00 / 1)
It's really important to understand the extent to which lab tests form the sole centerpiece of the Rell proposal and also which tests are being used/what methods of administration and interpretation.  There is room for mischief.

There are a couple of basic problems with 1) relying on lab tests as sole means of identifying presence of Lyme disease and 2) relying upon testing from one lab.   Per a Tom Grier piece cited below, the most commonly used Lyme tests are antigen tests that are used because they are cheap and easy to do.  Originally, the tests were used to screen for subjects for medical research, where the desire was to find the most well defined lyme cases.  They basically test the body's reaction to an infection's presence.  They don't "see" Lyme per se.

See the following from the  ILADS Guidelines for Lyme Disease:

16. Sensitivity limitations of testing.
Treatment decisions should not be based routinely or exclusively on laboratory findings [2,25]. The two-tier diagnostic criteria, requiring both a positive ELISA and western blot, lacks sensitivity and leaves a significant number of individuals with Lyme disease undiagnosed and untreated [29,30]. These diagnostic criteria were
intended to improve the specificity of tests to aid in identifying well-defined Lyme disease cases for research studies [31]. Though arbitrarily chosen, these criteria have been used as rigid diagnostic benchmarks that have prevented individuals with Lyme disease from obtaining treatment.
Diagnosis of Lyme disease by two-tier confirmation fails to detect up to 90% of cases and does not distinguish between acute, chronic, or resolved infection [21].  The CDC considers a western blot positive if at least 5 of 10 IgG bands or 2 of 3 IgM bands are positive [31]. However, other definitions for western blot confirmation have been proposed to improve the test sensitivity [30,32-36]. In fact, several studies showed that sensitivity and specificity for both the IgM and
IgG western blot range from 92 to 96% when only two specific bands are positive [34-36].

That means that it is very important to be clear what tests are being used (including which antigens for ELISA), how the tests from Quest are intended to be used (good choice for that intention?):  Exactly what are they are intended to measure?  By only using antigens that rarely come up with a Lyme positive, the Rell project  could use the ELISA test to prove a preconceived notion that Lyme is overstated, but the data used would not be solid data.  They could initially be used for one purpose and then inappropriately used for another.  The use of one lab, and a restrictive method of reading the results (leave out the two Western Blot test lines that tend to reliably indicate Borrelia burgdorfii, and which the CDC protocol does NOT include), could be misused together to undercount Lyme in CT or to attempt to discredit practitioners who treat chronic Lyme.

Next, problems with using just one lab.  the whole notion of solely relying on lab testing has other accuracy problems before we get to that point:  Some research has shown that test results from one lab don't necessarily come out the same as other labs.  More from Tom Grier, citation to follow:

This lack of consistency in laboratory accuracy was borne out in Lori Bakken's ELISA test study. This study showed that more than 50% of the time, labs could not correctly or consistently replicate identical results in identical triple-paired serum samples highly positive for Lyme antibodies. This is despite claims by labs of being 99% specific and accurate. However, what is accurate by laboratory definition has nothing to do with accuracy as a diagnostic test to determine the presence or absence of active infection in a patient.  

It's not clear to me why that is.  However, Tom Grier elucidates another difference between labs in a very user friendly, clearly explicated piece, the antigen issue  here:

The Main Drawbacks of Using Elisa Tests for Lyme Disease:
First, each lab can have their own version of an ELISA test, using different enzyme-linked antigens that are used to trap specific anti-Lyme antibodies in the patient's blood. When an enzyme is the presence of the correct anti-Lyme antibody, there is an enzymatic color change that occurs which is read by a machine. If the lab chooses antigens that do not reflect the same set of antibodies that the patient is producing then the test will fail to detect Lyme disease. The individual that tests negative with one lab's test may have a have detectable Lyme antibodies if another lab's ELISA test is given employing a slightly different set of antigens.

Think of it like this: If you take a gold fish bowl and drop a paperclip and a penny into the bowl and then use a magnet to find the paper clip, you cannot conclude that there is no other metal in the bowl. The magnet is simply incapable of detecting the penny. The same is true if you look for the wrong antibodies in a Lyme patient, the test can detect one antibody but not another.

What tests and which bands of the Western blot would Quest use?  More from ILADS:

The ELISA screening test is unreliable. The test misses 35% of culture proven Lyme disease (only 65% sensitivity) and is unacceptable as the first step of a two-step screening protocol. By definition, a screening test should have at least 95% sensitivity.

Of patients with acute culture-proven Lyme disease, 20-30% remain seronegative on serial Western Blot sampling. Antibody titers also appear to decline over time; thus while the Western Blot may remain positive for months, it may not always be sensitive enough to detect chronic infection with the Lyme spirochete. For "epidemiological purposes" the CDC eliminated from the Western Blot analysis the reading of bands 31 and 34. These bands are so specific to Borrelia burgdorferi that they were chosen for vaccine development. Since a vaccine for Lyme disease is currently unavailable, however, a positive 31 or 34 band is highly indicative of Borrelia burgdorferi exposure. Yet these bands are not reported in commercial Lyme tests.

In case you didn't get it, I'm suggesting that a study that bases its results primarily on a single lab's test results of what have become the most common tests for Lyme may be flawed.  

It's important to watch to make sure the study is not really a dog and pony show with a preconceived intention as to the result, or switching sports metaphors, the playing field is not being set at a slant for the policy decisions that would follow.


[ Parent ]
Great Explanation (0.00 / 0)
Peas, thanks for digging up and attaching all that info. Most people have no idea how seriously flawed the currently accepted standard Lyme disease tests are. Aside from lab to lab variance, and the fallibility of antigen based tests, it is also important to add that some Lyme disease patients, for various reasons, never develop measurable antibodies to the Lyme bacteria.

According to the CDC, the Lyme tests are to be used for "reporting purposes only". Yet the chronic Lyme denialists and their IDSA guidelines utilize these tests for diagnosis as if they are gold standards.

Having seen so much of the scientific data perverted and misused by these people over the last 15 years, I think you're right to be concerned about Rell's future intentions. If the test data is ONLY used in an effort to quantify the incidence of Lyme in CT, and the year to year increase or decrease in number of reportable cases, then I am less concerned.

One thing is for sure. What we're doing now to track the incidence of the disease is a joke.


[ Parent ]
Many, many cases go under the testing radar - some other thots (4.00 / 1)
So let's not fool ourselves into thinking we are counting Lyme cases by counting positive tests.  It is almost inevitable that the methodology will be separated from the numbers counted and all kinds of proclamations made about those stats.

We lend credibility to the tests as a valid measure when we bandy about ELISA or Western blot statistics as if they are valid measures.  They do NOT measure lyme per se, as I understand it - they do a sort of proxy measure of the body's reaction to an agent.  

When we rely in counting lab tests as the starting point for this diease, imho we lend credibility to a representation of the disease as a solid object, eminently quantifiable, when its many symptoms an possible places in your system where it can show up are about as solid as quicksand.

I note that the Rell program will "follow up" with 5500 doctors, and it's not completely clear if that number is 1) for all tested (whether pos or net) or 2) a followup only for those whose patients who tested positive.  

If ALL doctors are followed up, regardless of whether the Lyme test came out positive or negative, the Lyme test could become the prompt to identify ask the doctor for his/her diagnosis, thus making test-negative lyme cases trackable.  The entire phenomenon requires ALL types of cases to be descriptively tallied so that the entire phenomenon can be understood.  It would be possible e.g. to tally the results "symptoms plus X test positive", "Symptoms + responsive to antibiotics but test negative" etc..  

As we learn more about how to detect the illness, we may be able to review these stats with a different eye.

People who are chronic sufferers are going to fall through the cracks in any new testing as over time, since it is reported that they may stop showing as positive on certain tests (Western blot, I think).  his has been interpreted to mean there is no disease present, when in fact it may have retreated to an undetectable locale in the body at the time of testing.

To play devil's advocate for a moment, asking doctors to detail and report their diagnoses into a politically charged witch hunt atmosphere is NOT likely to produce a lot of quality data.  Otherwise, doctors will see themselves having the same legal bills as Dr. Jones if they dare report that they diagnosed & treated a Lyme case without positive (though specious) test results.

The whole thing is quite insidious, as could be a patient education system that defines the illness as the IDSA sees it, teaches people to expect short term antibiotics as the treatment of choice,  and terrifies people into not continuing antibiotics - people who may be at risk of neurological complications if the Lyme continues unabated.


[ Parent ]
UConn Professor Emeritus Calls Jones "A Victim Of Political Pressure" (0.00 / 0)
From a letter to the editor in the Dec. 3rd Hartford Courant,
David Krutchkoff, professor emeritus of oral pathology at the University of Connecticut School of Dental Medicine writes:

The main point is that the board has yielded to political pressure within the medical community and has castigated Dr. Jones to soothe the ruffled feathers of those who don't like to see their medical opinions questioned - how petty and unbecoming of a professional board in a position of authoritative review.

Connecticut is fortunate to have physicians of Dr. Jones' caliber in its ranks and, if anything, he should be commended for his professionalism rather than scapegoated for his courage to stand for what he believes to be medically proper.

for the entire letter: http://www.courant.com/news/op...


Thank You! (4.00 / 1)
An excellent article, followed by some very informative comments.

 
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