At his clinic about 15 miles north of Charlotte, Jemsek cares for hundreds of patients who say they have been ignored, rejected and even ridiculed by other doctors because they suffer from chronic Lyme disease.

But today in a public hearing expected to last two days, prosecutors for the N.C. Medical Board will argue that Jemsek's treatments may hurt his patients. Over objections from hundreds of Lyme patients who say Jemsek has restored their health, prosecutors will urge the board to stop Jemsek from treating Lyme disease, either by revoking his medical license or limiting his practice.

"Dr. Jemsek gave me back my life," said Lane Huggins, 50, of Raleigh, one of about 200 Jemsek supporters expected to attend today's hearing. She said fatigue, muscle aches and other Lyme symptoms caused her to spend most days in bed until his treatment helped her get better.

But the board's prosecutors will describe Jemsek as a reckless doctor making a diagnosis that many medical experts say isn't supported by science. They allege that he improperly diagnosed and treated at least 10 patients in North Carolina with Lyme disease; one or more of those patients will testify against him.

Prosecutors will say that Jemsek put such patients at risk of infections and side effects by using unproven therapies, including powerful antibiotics delivered intravenously for months or even years.

Most physicians and scientists insist even the most severe cases of Lyme disease should be treated with no more than two four-week courses of antibiotics.

"The evidence will show that Dr. Jemsek does not have a reasonable basis for treating these patients as he has been," said Thomas Mansfield, the medical board's lead prosecutor.

The dispute puts Jemsek at the center of a long-standing and acrimonious national debate over the diagnosis and treatment of Lyme disease, a bacterial infection spread by the bite of an infected black-legged tick.

"I'm willing to take on difficult patients, and I think I can help some of them," said Jemsek, 56, an infectious-disease specialist who also treats patients with HIV/AIDS. "I'm in medicine to help people."

The argument

On one side is the medical mainstream, which says diagnosis and treatment should be based on proven science and warns that long-term treatment with antibiotics may be dangerous.

On the other are "Lyme-literate" physicians such as Jemsek, who advocate a learn-as-you-go approach and follow alternative treatment guidelines that consider long-term therapy appropriate. They often diagnose Lyme disease even when blood tests are inconclusive.

Lyme-literate doctors say that's consistent with guidance from the Centers for Disease Control and Prevention, which advises doctors to base diagnosis of Lyme on symptoms. CDC recommends against relying solely on diagnostic tests, which are widely acknowledged to miss many positive cases. Despite the guidance, many doctors and scientists refuse to acknowledge advanced cases of Lyme disease without positive test results.

Over the past several years, state medical licensing boards have weighed in on the debate, targeting doctors who go beyond mainstream standards of care.

Lyme patients and advocates, worried about losing access to sympathetic physicians, have sought legislative support.

In 2002, Rhode Island became the first state to pass a law protecting doctors from being disciplined solely because they provide long-term therapy for Lyme. California enacted a similar law this year.

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