This article by Robert Bransfield, M.D., was published in the Gettysburg Times, May 3, 2002.


            The value and recognition of diversity is a fundamental concept in biology, ethics, politics, and medicine. Preserving the right to a diversity of opinions and preserving the right to ethical treatment approaches based upon this diversity of opinion is critical in protecting the same freedoms in medicine that are guaranteed by the Constitutional in other aspects of our lives. There has been a dangerous and dictatorial trend in medicine to attempt to shift the control of individualized medical decisions away from the traditional patient-physician relationship, and instead towards centralized power systems. These centralized systems are sometimes excessively influenced by bias, bureaucratic confusion and competing financial considerations. In contrast, preserving the diversity of opinion and the traditional ethics of the patient-physician relationship is one of the safeguards that deter the abusive potential of these larger systems.

Lyme disease, mental illness, and other complex and potentially costly diseases, have been pivotal in the power struggles seen in medicine today. As a psychiatrist who treats psychiatric symptoms associated with Lyme disease and other infectious diseases, I am on the front line of this issue every day. I recognize that Lyme disease can be a very complex and serious illness, which may present in many different forms. After performing methodical and individualized assessments and treatment planning of patients with Lyme disease, I am often shocked and puzzled at the resistance these patients encounter from their insurance companies and some other physicians.

Resistance by the insurance industry follows a covertly deceptive path. It begins by asking accounting firms, such as Millman and Robertson, to establish financial “goals” for the treatment of different illnesses. Through a convoluted path, these “goals” become “criteria,” which become “guidelines,” that become “standards.” Erroneous and biased articles taken out of context in the medical literature are then often used as “evidence based” to establish these “goals,” “criteria,” guidelines” and “standards” to deny needed treatment. Since the conversion of financial goals into medical standards and the quoting of the medical “evidence” evolve over a complex and deceptive path, no one is held accountable and responsible for the final biased and inaccurate “standards.” I have evaluated and treated many psychopaths in my career, and this is the most sophisticated scam I have ever seen. The proof of this scam is only seen in rare depositions, whistle-blowing, and internal higher-level documents from the insurance industry.

            The second major area of difficulty is within the medical literature. There are many thousands of articles on the subject of Lyme disease, with considerable disagreement. There is often confusion between the diagnostic criteria used in clinical medicine, the criteria used by the CDC for a case definition for epidemiological purposes, and various criteria used for case definition in some research studies. Although we need to recognize the right to the diversity of opinion in this complex disease, we frequently see opinions based upon a restrictive view of acute Lyme arthritis incorrectly generalized to the long-term effects of Lyme disease upon the body and the brain.

We need to preserve a medical system that protects diversity of medical opinion and freedom for patients to access ethical treatment approaches.


Robert Bransfield, MD

Red Bank, NJ