A doctor on the Eastern Shore known for treating people with Lyme disease has been put on indefinite probation by the Virginia Board of Medicine and permanently banned from prescribing narcotics.
The action is the latest in a string of medical cases involving prescription painkillers, and it's also the latest salvo in a national controversy about the treatment and existence of what some refer to as chronic Lyme disease.
Dr. Geoffrey Gubb, who has a family practice in Belle Haven, was accused by the board of treating 15 patients with high-powered pain drugs while failing to monitor their condition or properly document diagnoses.
Gubb, 73, has until Oct. 16 to ask for an appeal on the matter. If he declines, the order will become final that day.
In an interview last week, Gubb said he has decided to close his family practice at the end of the month. He said he treats about 800 patients, most of whom are from Virginia, Maryland and Delaware. About 600 of them have Lyme disease, he said, and many crossed the Chesapeake Bay Bridge-Tunnel from Hampton Roads to get a type of treatment that most doctors refuse to prescribe because it goes against recommended guidelines.
Lyme disease is a bacterial infection transferred to humans through the bite of an infected deer tick. Symptoms vary but usually include joint and muscle aches, headaches, fatigue and fever.
Most mainstream scientists and doctors say the disease, which is on the increase, can be cured with antibiotics in less than a month. But there's a group of people with long-term health problems who call their condition chronic Lyme disease. And there's a small group of doctors, including Gubb, who believe that in some cases the bacteria slip into the bloodstream and produce an ailment that can come and go, and linger for months or years.
These doctors advocate and prescribe long courses of antibiotics. Because of the ongoing pain symptoms, they say, narcotics also can be part of the treatment.
The Infectious Diseases Society of America and the American Academy of Neurology, however, say that there's no scientific evidence to support this theory, and that the prolonged use of antibiotics and prescription painkillers is dangerous.
Spurred in part by an investigation by the Connecticut attorney general, the infectious disease society appointed an independent panel to review its treatment guidelines for Lyme disease. In April, the panel concluded there was no scientific evidence to support the prolonged use of antibiotics. Further, the panel said, symptoms attributed to "chronic or persistent Lyme disease," such as fatigue and cognitive problems, are seen in many other clinical conditions and are also common in the general population.
"It would thus be clinically imprudent to make the diagnosis of Lyme disease using these nonspecific findings alone," the panel noted.
Dr. Edward Oldfield, chief of the infectious disease division at Eastern Virginia Medical Center, said diagnosing a condition that the society doesn't recognize is troubling on several fronts. One is the risk of misdiagnosis. The person's symptoms could be caused by conditions such as cancer or lupus, and a misdiagnosis would delay treatment. Prolonged use of antibiotics also can lead to side effects such as nausea and IV infections. Also, there's the cost of a treatment that scientific evidence has not shown is effective.
"It's not that these people do not have real symptoms, but that medicine does not have a solution for them," Oldfield said.
The guidelines were criticized by groups that advocate the long-term treatment, such as the International Lyme and Associated Diseases Society.
In Connecticut, where Lyme disease was discovered in the mid-1970s, a law was passed last year allowing doctors to prescribe long-term antibiotics in treating "persistent Lyme disease" without fear of sanctions from state health regulators.
Earlier this year, the National Capital Lyme and Tick-Borne Disease Association asked state legislators in Virginia to pass a similar bill. The bill, however, was passed over in committee after concerns were raised about whether the measure would lead to treatments that could mask - or cause - larger health problems.
"It's very disturbing to see clinical guidelines based in scientific evidence politicized," Oldfield said.
More than 100 supporters, however, showed up at a February hearing in Richmond on the matter, saying they must travel hours to find treatment for what they call chronic Lyme disease. Some said they live in fear that their doctors will be put out of business by medical regulators.
One key difficulty with Lyme disease is that the blood test used to diagnose it is not always conclusive and is riddled with false positives.
In some regards, the condition has similarities to fibromyalgia, another mysterious pain ailment that can be difficult to diagnose. Some critics regard these conditions as psychosomatic, at least in some cases, another frustration to those who suffer from chronic pain.
But the diagnostic fuzziness also provides an opportunity to abuse prescription painkillers, a problem one federal agency estimates has surged by 400 percent during the past decade.
Board of Medicine documents show that Gubb had prescribed narcotics for periods ranging from seven months to more than two years, failed to develop treatment plans, and in some cases did not examine the patient.
In one case, a patient had received narcotics prescriptions from other health care providers during the same period. In another case, Gubb prescribed narcotics by telephone.
Gubb said he has changed his record-keeping and taken a class in pain management. He also has "weeded out" people he believes were abusing painkillers.
"Pain treatment is a basic human right," he said. "Undertreatment and nontreatment of pain is malpractice, so you're damned if you do and damned if you don't."
The case came to the board's attention, Gubb said, after a Maryland pharmacist reported him when filling a prescription for one of Gubb's patients. He said it was the second time he's been investigated by the board.
Gubb and his lawyer, Michael Goodman, said they are still reviewing his options regarding the Virginia board's action. However, Gubb said he has already told his patients with Lyme disease he is closing up shop.
One of those patients, 45-year-old Lisa Lane, had been seeing Gubb for more than three years. She said she'd been struggling with pain and fatigue for about a year before that, and a client of hers suggested she see Gubb.
He diagnosed her with Lyme disease and put her on IV antibiotics and prescription painkillers. She moved from Newport News to the Eastern Shore to be nearer to him, so she was upset when she found out he is no longer able to treat her.
She ran out of pain patches a week ago. "I wake up in the night screaming in pain," she said.
Lane said she believes hers is one of the cases cited in the Board of Medicine investigation that led to Gubb's probation. "They say it's because of him writing the scrips, but I think they are persecuting Lyme doctors."
www.hamptonroads.com
In wake of the AMA finding against Eastern Shore Lyme's disease specialist Dr. Geoffrey Gubb, several of Gubb's patients have come out in support of the specialist.
Gaines says that if you plan to spend time outdoors, be sure to wear long clothing and tuck your pants into your socks. Cover yourself with insect spray that works for ticks. Check for ticks immediately and if you find one, remove it promptly with tweezers. In some cases, early symptoms of Lyme disease include a large circular rash at the site of the tick bite, accompanied by chills, fever, headache, fatigue, stiff neck, swollen glands, and joint pain.