When we began filming UNDER OUR SKIN, we had no idea that Dr. Joseph Jemsek, the North Carolina physician treating our main character, Mandy, would end up embroiled in a courtroom battle every bit as dramatic as Mandy’s struggle to regain her health. In 2006, Dr. Jemsek was the only Lyme specialist operating “above the radar” in the southeastern United States, and his clinic was admitting an average of 80 new patients a month, from 46 different states. Dr. Jemsek, an infectious disease specialist who had been treating AIDS patients since 1983, started noticing a growing number of very sick Lyme patients in his clinic around 2000. Using strategies he had learned from treating AIDS opportunistic co-infections, he began having good outcomes treating Lyme patients with long-term combinations of antibiotics. But Dr. Jemsek's vocal criticism of the Infectious Disease Society of America (IDSA) and its rigid position that 2 to 4 weeks of antibiotics cures Lyme disease, soon got him into trouble. After an email from a disgruntled Lyme patient ended in the hands of Dr. Allen C. Steere and Dr. Gary Wormser, lead authors of the IDSA Lyme guidelines, Dr. Wormser forwarded it with the header “Lyme Disease IV antibiotic treatment, Insurance Fraud in NC,” to the CDC, who in turn forwarded it to Curtis Ellis, Director of Investigations, North Carolina Medical Board. Once an investigation was opened, the board was at liberty to pull all of Dr. Jemsek’s Lyme patient files, looking for violations of the IDSA “standard of care,” which takes on the force of law in North Carolina, even though Dr. Jemsek followed the alternative ILADS Lyme guidelines. (ILADS guidelines cite evidence that’s supports this position: “The duration of therapy should be guided by clinical response, rather than by an arbitrary (i.e., 30 day) treatment course.” In the end, Dr. Jemsek’s license was suspended but “stayed” for a year, meaning he could continue to practice medicine under tight restrictions. However, Blue Cross Blue Shield of North Carolina seized the opportunity to follow up on the medical board’s judgment with a $20 million lawsuit, for Dr. Jemsek’s alleged “unnecessary” antibiotic treatments. (For more details, read the article, “Struggles Continuing Amidst Lyme Wars.”) Meanwhile, the CDC reports that Lyme disease cases continue to rise in the South, with North Carolina and South Carolina cases rising 71% and 55%, respectively, from 2006 to 2007. What's more, there is another Lyme-like disease, called Southern Tick-Associated Rash Illness or STARI, for which there is no accurate diagnostic test. This disease is spreading rapidly in this region, and like Lyme, it is treated with antibiotics. Dr. Jemsek, who has been in bankruptcy proceedings since 2006, was forced to close his practice in North Carolina. He has reopened his clinic in Fort Mill, SC, and currently has a three-month backlog of patients waiting to see him. One North Carolina Lyme patient summarized the impact of the Jemsek hearings: “I saw the chilling results after Dr. Jemsek was called on the carpet. Doctors in North Carolina live in fear of prosecution and countless chronically ill and infected people live without medical care. A doctor there told me that Dr. Jemsek was brilliant and may be proven correct in 20 years, but in the meantime, doctors can't risk losing their licenses by treating chronic Lyme disease.” For more on the climate of fear surrounding treating Lyme patients, watch the UNDER OUR SKIN video clip “Physicians under attack.”