Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
To the Editor.—Physicians have a primary responsibility to protect patients, rather than payers, from harm. The article by Dr Fix and colleagues1 only addresses the cost of treating early-stage Lyme disease (LD). Only 5 of the 242 patients received intravenous antibiotics within the brief span of the study. To calculate the total cost of an illness, it is necessary to calculate the cost of treatment and the cost of illness. Vanderhoff2 has previously calculated the cost of treating late-stage Lyme disease. Clearly, if the $47595 spent on 232 patients in the study by Fix et al1 prevents only one case of chronic LD, it is a total cost saving in terms of both money and patient suffering.
Much of the indirect cost of treatment of LD is a result of cognitive, psychiatric, and neurologic impairments as a result of late-stage disease. Chronic LD has contributed to mental disorders, suicide, aggressive behavior, automobile crashes, and diminished productivity.3 Potential impairments from chronic LD to individuals in positions of high responsibility (eg, airplane pilots, railway engineers) are a particular concern.
In his Editorial, Dr Barbour4 refers to guidelines established by "experts." These experts appear to be forming their opinions without adequate consideration of the patient's subjective complaints, the physician's observations, the community, and the growing body of psychiatric literature that further recognizes the consequences of inadequately treated LD. It is an error to infer that informed patients are merely hypochondriacal antibiotic addicts.
Are the real experts community physicians with the long-term responsibility to treat chronic LD or basic science researchers, administrators, bureaucrats, and insurance company consultants removed from the full human impact of this disease? Barbour's experts are not viewed as true experts in clinical issues by many physicians who have experience treating patients with chronic LD (unpublished data, 1998). Physicians need to retain their roots in traditional medicine, obtain a thorough history and perform a careful examination on these patients,5 and never defer total clinical judgment to dogmatic, ethically suspect guidelines.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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