A special commission appointed to study Lyme disease in Massachusetts recommends extensive education for medical professionals and the public, more funding for prevention, and changes in hunting laws to control the deer population. Released on Thursday, Feb. 28, the report also urges state officials to consider pesticide spraying, and removal of tick habitat.
The 21-member panel included public health officials, medical experts, legislators, and representatives of the public. State Senator Dan Wolf, whose district includes Martha’s Vineyard, was one of the panel members.
The legislative committee that called for the special commission in 2011 described Lyme disease as a public health crisis, and it issued a strongly worded call for action.
“The state’s official response to Lyme disease can be characterized as haphazard at best,” the committee chairman wrote. “The state budget currently does not earmark any public funds for prevention, treatment or education. The Massachusetts Department of Public Health (DPH) cannot itemize what it spends on Lyme disease. Only a few local Boards of Health have any significant plan or programs. As a result, millions of dollars are lost in employee absences due to Lyme disease. Each year, hundreds of school children miss school. Millions of dollars are spent in medical care. At present, no one has a clear plan or recommendation for treatment, prevention or education.”
Education = prevention
The Special Commission to Conduct an Investigation and Study of the Incidence and Impacts of Lyme Disease cited education as a top priority, for both the public and the medical community.
The panel’s authors wrote that differences of opinion in medical options have hampered effective treatment.
“Although there is general agreement that published guidelines have never been intended to replace clinical judgement, the differences in approach to treatments have led to a continuing controversy that has significantly impacted the delivery of care of Lyme patients,” the authors wrote.
The panel recommended that state officials consider the costs and benefits of allowing more people to hunt with crossbows, and reduce the archery safety zone to within 150 feet of a dwelling. They reason that those changes in current regulations would result in more deer taken by hunters.
Deer are the major carriers of the ticks that cause Lyme disease. Currently, state law prohibits archery hunting within 500 feet of an inhabited building, which eliminates much of the land where deer can be taken. The report said a similar plan in New Jersey reduced tick-borne diseases, and did not result in more hunting accidents.
Tracking ticksThe Massachusetts Department of Public Health (DPH) tracks the incidence of Lyme disease through automated reports from labs that test blood samples. But those results are difficult to interpret without clinical reports from the doctors who treat the individual patients. A lack of standardization in lab reports and a substantial backlog in testing make it difficult to assess exactly how widespread the disease is in any given year, according to the report. DPH confirms from 2,000 to 4,000 cases each year, but the agency estimates the actual incidence of the disease is five to ten times higher.
On Martha’s Vineyard, the town boards of health are currently using insurance data and information from local pharmacies to get a better picture of the incidence of Lyme disease. They are compiling statistics on how much doxycycline, the antibiotic most often used to treat Lyme disease, is prescribed. That study should be complete in the next 6 to 12 months, according to the report.
Using a previous study conducted on Nantucket, the panel concluded that people who visit Massachusetts coastal communities for two weeks or less are unlikely to contract Lyme disease, and that closer surveillance of visitors is unwarranted.
Potential benefits of better Lyme disease surveillance include a more accurate measure of how well various methods of disease prevention work, justification for funding for research and prevention programs, identification of high-risk areas to better target environmental prevention efforts, and aggressive education campaigns.
Even with inconsistent data, it is clear that Lyme disease is a scourge that has reached epidemic proportions in all areas of Massachusetts, and it’s getting worse.
“Regions of particularly high incidence include Cape Cod and the Islands,” the report’s authors wrote. “Although annual reports through Massachusetts DPH may fluctuate, the trend is not encouraging: the incidence of tick-borne disease is on the rise, both numerically and geographically. Massachusetts ranks among the most highly endemic states, with incidence rates that placed it in second place in the nation in 2008.”
Insurance dilemmaThe special commission also noted issues with insurance coverage. The panel contends that restrictive insurance guidelines interfere with a patient’s right to receive treatment and sabotage legal protection for doctors.
“While some patients who contract Lyme disease in Massachusetts are treated effectively, numerous other patients encounter issues around receiving adequate treatment while others encounter difficulty accessing their prescribed treatment often due to the denials of insurance companies and the high costs associated with treatment,” the authors wrote.
The report included dozens of anecdotes illustrating difficulties with insurance coverage, including one family that went to extraordinary lengths to get treatment.
“A family with several sick members sought treatment for Lyme disease from a practitioner outside of their insurance network, because they had been unable to find someone inside their network who would treat them. They had to drive over two hours for this care, pay for it out-of-pocket, and take out a second mortgage to cover it.”
The commission questioned whether insurance company restrictions on the length of antibiotic treatment hamper effective therapy, in some cases.
How to fix itThe report advocates four areas of focus to reduce the public health risk: vaccination, education, environmental controls, and funding.
The special commission advocates research to develop a vaccine that could prevent Lyme disease and other tick-borne diseases, and it encourages legislators to implement tax breaks for Massachusetts-based companies to provide an incentive for research and clinical trials.
The report concludes that it would be nearly impossible to reverse the environmental factors, such as reforestation and suburban expansion, that have caused an increase in Lyme disease. But it recommends aggressive management of the one factor that can be controlled, deer population. The report suggest more hunting, deer fencing, and pesticide applications as proven methods to reduce the number of disease-carrying ticks.
The report also recommends an extensive educational campaign. “Personal protection, in particular, is a tool that can have immediate results in reducing risk,” the authors wrote. They said current education and warning campaigns are inadequate.
“There is little coordination or consistency in message selection or source, deliver emphasis, or sensitivity to seasonal dynamics of tick encounter risk. Moreover, few programs use concepts promoting behavior change in a consistent or effective way.”
The special commission called for more funding for education of the general public and the medical community, including funding to hire a full-time professional health educator.
The commission noted that federal funding for an educational program in Barnstable County resulted in slower rates of growth for Lyme disease than those in other areas in Massachusetts, but that funding recently ended.