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September 23/30, 1998

Diagnosis, Treatment, and Prevention of Lyme Disease—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor


Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

JAMA. 1998;280(12):1049-1051. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-12-jbk0923

In Reply.—I agree with Dr Anderson that "fear of litigation can distort medical decision making." However, it is important to distinguish the situation of a patient who presents with a tick bite and is worried but asymptomatic from that of a patient who presents with symptoms of an illness that may or may not be LD. It is true that physicians have been sued in the second situation, that is, for not making a diagnosis of LD. But the article by Dr Fix and colleagues and my Editorial were not about making a diagnosis of LD in a case of illness. The issue was antibiotic prophylaxis and serologic tests for a tick bite. At this point the evidence that prophylactic antibiotic therapy would provide more benefit than harm to the patient in the first case is equivocal.1 If there is benefit beyond anxiety relief, it likely holds only in areas with a high risk of LD transmission, such as Connecticut. In most areas of the country the risk of LD transmission is low or nonexistent.2 Surely most patients are capable of understanding that a treatment is more likely to cause adverse effects than it is to prevent a disease, especially if an unfounded concern is first allayed.

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