Politics and Parasites in Lyme Disease Newspapers in Virginia and Maryland have been filled with stories about

the large numbers of deer roaming through neighborhoods, and the increasing numbers of cases of Lyme disease transmitted by deer ticks. Culling deer may cut down on traffic accidents, but it will not have much impact on human Lyme disease. According to researchers at Johns Hopkins and Walter Reed, the primary source of ticks carrying Lyme disease is the white-footed mouse, and to a lesser degree, lizards. Deer are just the most visible source of Lyme disease. But the big news in Lyme disease this year is not ecological or medical, but political. After the Maryland Assembly passed a bill on Lyme disease public education (HB- 836), out-of-state activists descended on the Senate trying to alter or kill the bill. HB-836 called for the dissemination of information on “the latest consensus guidelines for diagnosis and treatment of Lyme disease.” Activists—led by the New Jersey Lyme Disease Association—thought that meant the updated guidelines of the Infectious Disease Society of America (IDSA), an 8,000-member organization of expert clinicians and researchers. Activists’ letters warned of “unreliable tests, and arbitrary, biased or unsubstantiated theories, studies and guidelines,” though most physicians in Maryland and other states have been using IDSA guidelines since they were first published in 2000. One letter writer even insisted there had been 14 Maryland deaths from tick-borne infections, but when I wrote asking for more information for this column all I heard back was the sound of silence.

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The Senate did not pass HB-836, but it is hard to say whether it was due to New Jersey activists or the crush of 104 other bills. Similar legislative efforts are underway in Pennsylvania where activists are trying to pass Senate bill 722. That bill would undermine evidence-based medical practices for Lyme disease; exempt so-called “Lyme literate” physicians from malpractice censure or prosecution; and force insurance companies to pay for long-term antibiotic treatments, which have been shown repeatedly to be ineffective, costly and occasionally dangerous. “In a crusade that is financially motivated but also decidedly anti-scientific, Lyme advocacy groups are bombarding politicians with messages to ensure their access to expensive care,” the editor of Surgical Infections wrote in an April editorial. The effort to protect private practice physicians who improperly diagnose and treat Lyme disease is particularly troubling. In recent years, many of these “Lyme literate” doctors have been censured by medical boards in New York, North Carolina, Connecticut, and New Jersey; convicted of mail fraud, wire fraud, money laundering, conspiracy, and tax evasion in New Jersey; sued by patients in South Carolina; and charged with murder in Kansas. The co-dependent relationship between activists and “Lyme literate” doctors was detailed in a Forbes magazine story (March 12) entitled, “Lyme Inc: Ticks aren't the only parasites living off patients in borreliosis-prone areas.” The effort to undermine common infectious disease practices by legislative mandates is really a struggle over who pays the doctors’ bills. In the short term, activists may win mandates for their doctors to bill insurance companies for expensive, open-

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ended treatments of Lyme disease. But in the end, you and I will pay the price of those mandates through higher health insurance costs, or canceled policies. No industry is more risk-adverse than the insurance industry. They have abandoned entire regions of the U.S. that are prone to earthquakes and hurricanes. In Maryland this year, Allstate stopped issuing new homeowners policies in coastal areas prone to flooding and storm surges. People with suspected “prior conditions” or genetic predispositions are paying higher premiums for health coverage or being denied coverage outright. When the Lyme vaccine was still available, insurers in Maine decided to pay for vaccinations only in parts of the state considered to be “high-risk” for infection. Faced with the cost of expensive but ineffective treatments for Lyme disease, many insurers are likely to raise rates or cancel policies based on cases of Lyme disease and tick densities in particular counties or zip codes. The entire state of Rhode Island could be impacted, as could most of southern Connecticut, Long Island, Westchester County in New York, large sections of New Jersey, Pennsylvania, Virginia, and Maryland’s Eastern Shore. This seems like a lot of financial and political trouble for a bacterial infection that is seasonal, non-fatal, non-communicable, antibiotic-responsive, and cost the average Maryland patient $281 during 1997-2000. Hopefully, that simple reality will not be lost in the vortex of state politics and activist disinformation. In the meantime, summer is approaching and so are the ticks. Wear DEET repellent, do a tick check, and see www.lyme.com or www.quackwatch.com for additional information.

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