N.C. doctor's license on the line over Lyme treatment

HUNTERSVILLE -- Nearly a quarter-century ago, Dr. Joseph Jemsek was the first physician in the Charlotte area to diagnose a patient with AIDS. He became known for devotion to patients often marginalized because of the illness's association with homosexuality and drug use.

Today, the 56-year-old Jemsek is known for treating patients he believes suffer from chronic Lyme disease, a form of the illness the medical establishment doesn't believe exists. Many of his patients test negative for Lyme disease.

The dispute could cost Jemsek his license to practice. In December, the N.C. Medical Board charged him with improperly diagnosing Lyme disease and treating it via long-term courses of intravenous antibiotics, which violates the care standard set by the Infectious Diseases Society of America. The state board will hear the case in June.

"That would be one of the greatest injustices in the history of the state," Jemsek said. "I don't shoot drugs -- I just prescribe too much tetracycline."

It's not just tetracycline that has gotten Jemsek in trouble, but a whole array of antibiotics, administered in varying doses, combinations and schedules, orally and intravenously. His patients say the treatment is the only thing that provides relief from joint pain, fevers, headaches and mental confusion -- a series of symptoms they say other doctors struggle to diagnose and treat.

But many say Jemsek is on a dangerous path.

"There's not a great deal of published evidence that supports prolonged antibiotic treatment," said Dr. Paul Mead, based in Fort Collins, Colo., and the leading Lyme expert for the federal Centers for Disease Control and Prevention. "There is, however, evidence that these treatments can be harmful."

Doctors who diagnose patients with Lyme disease without solid evidence risk missing a correct diagnosis, said Dr. Eugene Shapiro, a pediatrics professor at the Yale University School of Medicine who helped draft the treatment guidelines Jemsek is accused of violating. Long-term antibiotic treatment also carries risk of infection with resistant bacteria and fungi, high costs and encourages the development of antibiotic-resistant "superbugs" that endanger everyone.

"It's not that the people diagnosed with chronic Lyme disease don't have problems," he said. "It's that chronic Lyme disease is not the problem."

Lyme's history

Lyme disease is named after Old Lyme, Conn., where it was first described in 1975. Its most common symptom is a skin rash that appears around the site of a tick bite, and it can be accompanied by fatigue, as well as pains in the joints, muscles, head and neck. In the disease's later stages, it can affect the nervous system and the heart, and cause swelling of joints.

The Lyme bacterium is passed to humans by bites from infected deer ticks; the bulk of cases are concentrated in the northern United States.

In 2005, the most recent year for which data were available, there were more than 21,304 cases reported to the CDC.

IDSA care guidelines, set in 2000, call for a clinical examination of a patient, followed by lab tests that confirm a Lyme diagnosis. Intravenous antibiotic treatments should last four weeks at most.

The IDSA also found no known cause of symptoms exhibited by patients who remained unwell after standard Lyme treatment, concluding there was no evidence they could be helped by long-term treatment with antibiotics.

"In study after study, when patients who carried the diagnosis of chronic Lyme were re-evaluated in university medical centers, over 50 percent had no credible evidence of ever having had Lyme disease," said Dr. Gary Wormser, a member of the IDSA panel, in an e-mail interview.