The special article by Sigal1 entitled "The Lyme Disease [LD] Controversy" crystallizes the issues associated with the problem of LD in New Jersey. As a group of private practice physicians specializing in infectious diseases in an area in New Jersey where LD is hyperendemic, we have similar concerns. We would like to emphasize several of his points and make some suggestions.
As Sigal suggests, more physician education is needed. However, in our community some physicians are reluctant to accept the facts reported by Sigal despite repeated personal contacts and exposure to educational programs. The misconceptions described by Sigal are strongly held by these physicians, who view them as necessary to accommodate patient needs and concerns. This is similar to the common practice of prescribing antibiotics for viral upper respiratory tract infections. Patients have developed certain expectations, and the physicians wish to accommodate their customers for fear of losing business.