This anonymous blogger, called Sequoia has been a tremendous help to me. It turns out that the Maryland State Health Department commissioned a task force to study the issue Lyme disease and vector borne illness in the state.
The "Lyme Disease Subcommittee of the Maryland Vector-Borne Disease Inter agency Task Force" issued a paper in March 2007. The title was: Recommendations for the Development of a Strategic Plan for Lyme Disease Prevention and Control in Maryland. It lists "challenges" which include: 1) Frequent difficulty in clinical recognition and laboratory assessments of LD, due to absence of typical LD clinical signs at presentation, or presentation with late LD symptoms.
2) Varying approaches within the medical community regarding best practices for the treatment of LD due to the absence of a consensus. 3) PROVIDER RELUCTANCE TO TREAT PATIENTS FOR LD DUE TO CONCERNS ABOUT LICENCING PENALTIES OR ADVERSE LEGAL ACTION. The report discusses both IDSA and ILADS guidelines. It reports that the Maryland Board of Physicians announced in newsletter in 2005 that "it does not target or restrict the treatment of LD."
It is imperative that the general community of physicians become aware of these controversies and recommendations.