#1 Who set up CMA to hurt Lyme patients?

[Guest guest]

> THIS REPORT DOES NOT REFLECT OFFICIAL CMA POLICY.

>

> FOR ACTION

>

>

> REPORT TO THE BOARD OF TRUSTEES

> FROM THE

> COUNCIL ON SCIENTIFIC AFFAIRS (CSA)

> ALLAN D. SIEFKIN, MD, CHAIR

> NOVEMBER 21, 2002

>

>

> The Council on Scientific Affairs (CSA) responded to a request from CMA's

> Center for Government Relations with regards to pending legislation.  This

> report presents for the Board's consideration the matters acted upon by

> the Council.

>

> I.    Lyme Disease

>

> Background

>

> SB 2097 proposed to add a physician member to the State's Lyme Disease

> Advisory Committee - a member to be named by the CMA.  The intent language

> of the bill sites statistics and information that were challenged by some

> physicians.  Opponents to the bill believe that the existing tests and

> treatments for Lyme disease were inaccurate and dangerous to patients.

> While the bill language itself was not too controversial, it did bring to

> CMA's attention the fact that there were two schools of thought regarding

> the testing and the treatment of Lyme disease and thus, the future

> appointment to the Advisory Committee could be controversial.  [Note:  The

> bill was ultimately vetoed by the Governor.]

>

> Specifically there are two controversial issues:

>

> 1.    Some physicians believe the urine antigen test, albeit not FDA

> approved, is the appropriate diagnostic test for Lyme Disease while other

> physicians disagree.

>

> 2.    Many doctors believe a three-week course of antibiotics is

> appropriate to treat Lyme Disease while others believe long-term

> antibiotic treatment is necessary.

>

> Accordingly, in anticipation of the bill's passage and a future request

> for the CMA to name a candidate, the CSA was asked to help by researching

> the current mainstream approach for the diagnosis and treatment of the

> disease in order to tease out the controversy.

>

> CSA Action

>

> A solicitation was sent out by mail on June 7, 2002 to the ten members of

> the Internal Medicine Scientific Committee and to the eight members of the

> Preventive Medicine and Public Health Scientific Committee of the CSA.

> Each member was asked to respond to four specific questions crafted to

> find a consensus opinion of the appropriate diagnostic test and treatment

> of Lyme disease.  The specific questions were:

>

> 1.    Are there current published " consensus guidelines or position

> papers " available on the diagnosis and treatment of Lyme disease?  If not,

> are there " expert opinion papers? "   If these current recommendations are

> available in the literature, is there any reason they are not applicable

> to the management of Lyme disease within California?

>

> 2.    What is the " state of the art " for diagnosis of Lyme disease;

> specifically what is the accuracy of currently available laboratory tests?

> What is the role, if any, for the urine antigen test in the diagnosis or

> treatment of Lyme disease?

>

> 3.    Is there evidence that long-term antibiotic treatment (beyond a 3-4

> week course) is of any value?

>

> 4.    Do you know of specific experts in this disease within the CMA that

> could serve as a physician member on the Lyme Disease Advisory Committee?

>

> Conclusion

>

> The overwhelming consensus of all the respondents is that there is not a

> role for the urine antigen test in diagnosing Lyme disease; that

> serological tests are the " state of the art. "   Additionally, the

> respondents felt there was no scientific evidence that long-term

> antibiotic treatment was of any value.  As far as naming an expert, Dr.

> Barbour of UC Irvine was the most recommended, however he is not a CMA

> member.  At this time, there is no clear recommendation for a CMA

> representative.  (Note:  individual responses are available upon request.)

>

> RECOMMENDATION 1:    That CMA's position on treatment of Lyme Disease be

> that there is no current scientific evidence supporting the use of the

> urine antigen test in diagnosing Lyme Disease and that current evidence

> supports a short-term course of antibiotics to treat Lyme disease rather

> than long-term antibiotic treatment.

>

> Estimated Cost to CMA:  Within Budget

>