This is in response to Dr. Seth Gordon’s letter (April 2) concerning the treatment of Lyme disease.
He wrote: “From where I sit, most of the primary care practitioners and infectious disease specialists in this community have a similar approach to the prevention, diagnosis and treatment of Lyme disease.”
From where the Centers for Disease Control and Prevention sits, 56 percent of 6,506 Lyme patients surveyed were treated with antibiotics beyond one month, meaning that the “similar approach” in treatment is not to follow the Infectious Diseases Society of America guidelines.
He also wrote: “many of those practices (treating longer) do not meet the current standard of care.” But the IDSA guidelines state, “(These guidelines) are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of America considers adherence to these guidelines to be voluntary. …”
The guidelines were never supposed to be the sole standard of care. And there are differing guidelines, such as by the International Lyme and Associated Diseases Society and by Samuel Donta, MD.
Lyme science is still unfolding and, at a recent Massachusetts General Hospital symposium (presenters included the head of The Lyme Research Center at Columbia University Medical Center), Lyme was characterized as often persistent in the face of a “standard” antibiotic course.
I hope physicians will rely on evidence-based medicine, defined as a triad of science, clinical judgment, and patient values.
Rather than relying on a pre-defined standard, I hope all physicians will be guided by the patient’s response to treatment.
Sharon Hawkes, Lenox, Mass.
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