Thursday, 1 September 2011

DR BRANSFIELD SPEAKS OUT TO PA LYME DISEASE HEARING

Testimony for Public Hearing on Pennsylvania House Bill #272 – Lyme Disease and Related Tick-Borne Disease Education, Prevention(From Dr Robert Bransfield, distinguished psychiatrist, and the President of ILADS:)

Thank you for the opportunity to testify today. I am the President of the International Lyme and Associated Diseases Society, President of the New Jersey Psychiatric Association, a member of the Board of Trustees of the Medical Society of New Jersey, an Associate Professor at RWJ-UMDNJ Medical School, a researcher and a physician who treats patients with Lyme disease, including many from Pennsylvania. I represent the physicians who have the long term responsibility of treating patient with Lyme and associated diseases. I am in strong support of House Bill #272 and reference is made to my August 22, 2010 letter supporting this legislation last year.

In the 1600s Dr Thomas Wynne, William Penn’s physician and the first speaker for the Pennsylvania Assemblies who was also my ancestor treated a smallpox epidemic threatening the early immigrants to Pennsylvania. Today we have a different epidemic—Lyme disease. The recently released CDC Lyme statistics lists Pennsylvania and New Jersey as the two states with the most reported and confirmed new cases of Lyme disease in 2010 (PA: 3805, NJ: 3712 reported & PA: 3298, NJ: 3320 confirmed). The CDC and others recognize the formally reported cases are a small fraction of the actual cases which, according to the CDC, may be 10X the number of reported cases while the research of Boltri demonstrates the actual number of cases may instead be 40X the number of reported cases which would represent over 150,000 new cases of Lyme disease in Pennsylvania in 2010. Clearly prevention has failed. Some will be effectively treated, however a significant that are not adequately treated will progress into chronic illness resulting is a burden of disability, illness and suffering that could have been prevented by earlier diagnosis and treatment. Four National Institutes of Health (NIH) trials documented the severity of chronic Lyme disease symptoms these patients report. One trial described the pain as severe as post surgery patients and fatigue as disabling as seen in multiple sclerosis.

We in mainstream medicine strongly support any program that promotes advancement of public awareness, physician education, research, more accurate diagnosis and adequacy of treatment. As a psychiatrist I often see the failures of our medical system, the most severe late stage symptoms of Lyme and associated diseases are neuropsychiatric and that is why I became involved with Lyme disease. The psychiatric consequences of inadequately tick-borne diseases include a number of severe and disabling mental illnesses, autism, developmental disabilities, dementia and violent behavior. There are some infectious disease physicians and others in the medical community who have minimal training in psychiatry and do not understand that most mental illness is physical injury that impairs brain functioning and many of the so called ―subjective and non-specific∥ symptoms of Lyme disease are objective with adequate testing and are symptoms of sickness syndrome associated with chronic infection. No one on the IDSA guideline panel was knowledgeable about psychiatry and they inappropriately dismissed patient’s symptoms as the –―“aches and pains of daily living”. Refer to the attached list of over 250 peer reviewed medical journal articles supporting this statement.

The National Institute of Health, the CDC and scientists studying the etiology of disease all recognize a growing body of peer reviewed studies published in mainstream scientific journals that demonstrate many common diseases of unknown origin are in fact the result of the presence of slowly acting infections caused by viruses, bacteria or protozoa. Infections are often a cause of many chronic illnesses. Evidence presented during the legally mandated review of the restrictive Lyme guidelines of the Infectious Diseases Society of America (IDSA) has confirmed the potential for persistent infection with the Lyme spirochete, Borrelia burgdorferi, as well as the complicating role of multiple tick-borne coinfections and failure of short-course antibiotic therapy. In addition evidence was submitted that there are mechanisms of persistent infection that allow parasites to evade the immune system and complex interactions between multiple infections. We need to progress forward in medicine and not be hampered by outdated beliefs.

There are two opposing standards of care regarding Lyme disease which are supported by two opposing views and two opposing sets of guidelines—ILADS and IDSA. ILADS, the International Lyme and Associated Diseases Society, is evidence based and defines Lyme disease in a broader and more comprehensive manner and recognizes the limitations of current testing and the complexity of treatment while the IDSA definition is restrictive and places greater confidence in current testing and short courses of antibiotic treatment and a recent review by Lee and Vielemeyer ―found a relative paucity of good quality evidence behind current IDSA guidelines. We academicians, researchers and clinicians within ILADS and those following our guidelines that bear the responsibility to treat these patients recognize the limitations of current testing the complexity, chronicity and seriousness of these problems. The average physician inappropriately uses the CDC surveillance case definition as diagnostic criteria. The CDC website clearly states ―This surveillance case definition was developed for national reporting of Lyme disease; it is not intended to be used in clinical diagnosis. The Lyme ELISA has only a 46-56% accuracy rate and the Chair of the recent Virginia Task Force on Lyme Disease and Other Tick-Borne Diseases recently stated: "Doctors here in Virginia are committing malpractice by saying the ELISA test is sufficient. Their report is submitted with my testimony. There are multiple other problems with lab testing that I can expand upon. Evidence based medicine recognizes all treatment decisions are a risk vs. benefit clinical assessment that is made using the best scientific evidence available, clinical judgment and patient considerations. There is evidence some patients clearly benefit from longer courses of antibiotics and inadequate treatment of infectious diseases encourages antibiotic resistance. Although all medical treatments have risks, there is considerable evidence that inadequate treatment has been linked with autism, serious neurological, psychiatric, and other disease and death. Acne is treated for years with some of the same antibiotics used for Lyme disease. What gives distant third parties the right to oppose medically necessary treatments for Lyme disease?

We have a serious problem that cannot be ignored. It is puzzling why there is opposition to a bill that establishes a task force to investigate Lyme disease and other tick borne infections, to develop a program of public and professional education and to allow adequacy of treatment and insurance coverage. An increasing number of physicians are successfully treating patients with chronic Lyme and associated tick-borne disease with treatments that are effective and beneficial – allowing patients to have a better quality of life. As physicians we took an oath to protect our patients from harm. Laws, governmental policy and insurance mandates should complement our oath and not oppose it. Texas recently passed Lyme disease legislation because Senator Harris required 17 months of treatment and the previously restrictive IDSA based regulatory policy only allowed one month. As a senator he was able to circumvent regulations by receiving his antibiotics from 17 different physicians, but the average working person lacks this capability. This issue is best summarized by Dr. Benjamin Rush, signer of the Declaration of Independence and personal physician to George Washington who stated—―Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship to restrict the art of healing to one class of men and deny equal privileges to others: The Constitution of this Republic should make a special privilege for medical freedom as well as religious freedom. Although it has been stated politicians should not meddle in medical matters, government has a responsibility to protect basic freedoms including the freedom to access to medically necessary care.

Sincerely,

Robert C Bransfield, MD, DLFAPA

President International Lyme and Associated Diseases Society

President New Jersey Psychiatric Association

Board of Trustees Medical Society of New Jersey

Clinical Associate Professor Robert Wood Johnson UMDNJ Medical School

Associate Director Psychiatry Riverview Medical Center

Chair of Psychiatric Quality Assurance Riverview Medical Center

Board Certified American Psychiatry and Neurology in Psychiatry

Certified in Psychopharmacology by American Society of Clinical Psychopharmacology

Distinguished Life Fellow American Psychiatric Association

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