I know all of my state representatives, and I like them. I like my doctor, too. But I rarely confuse her with my state reps. I would like to think that the great majority of my fellow Granite Staters similarly can distinguish their physicians from their political representatives.

At least that was true before an overwhelming number of members of our House of Representatives decided to dabble a bit in medicine. They might argue that theirs was a vote of compassion. No doubt it was.

But it was also, in a sense, practicing medicine when - without a whole lot of in-depth study - 300 members of the House took it upon themselves to set medical standards for the diagnosis and treatment of what some call chronic Lyme disease.

Forget the considered opinion of the New Hampshire Medical Society; forget the Centers for Disease Control or the Infectious Diseases Society of America or the National Institutes of Health or any other number of blue-ribbon outfits concerned with medical standards and practices who seriously question whether such an ailment as "chronic" Lyme disease even exists. And never mind that standards of practice are normally overseen by the state Board of Medicine.

With their diagnosis - there is such a disease and we know how to treat it - our legislators waded bravely if perhaps unwittingly into one of the thorniest thickets of medical practice today that they - and you - likely had never heard of, at least before it landed on the agenda of the House of Representatives. What happened is a look at successful grassroots lobbying and of the advantages and the limitations of a political system where genuine citizen legislators work long hours for little pay and labor over hundreds of bills, many complex, with almost no research support.

The bill in question dealt with chronic Lyme disease - if, in fact, there is such a thing as chronic Lyme disease. That "if" and all it entails hints at a long-simmering medical fight now turning sharply political.

Some context: Most of us know Lyme disease as a nasty illness spread by deer ticks. That's why we slather ourselves with Deep Woods Off when we venture into the weedy outdoors. The disease can be at least temporarily debilitating - with a wide range of symptoms - and the standard treatment is a course of antibiotics, perhaps repeated. If the infection is not discovered promptly, it can do damage that lingers and can cause yet more problems after the infection itself has been cleared by antibiotics.

A small number of doctors, though, maintain there is a condition called chronic Lyme disease, a persistent ailment that can exist, sometimes eluding detection, for years. They propose a variety of remedies, some unconventional. One they favor particularly is extended treatment - over months and even years - with powerful (and expensive) antibiotics, often administered intravenously. And they have attracted the fervent loyalty of people who are sick and suffering and genuinely believe that this treatment offers their only hope for lives without pain.

Most established medical authorities and researchers who study infectious diseases and formulate treatment protocol for a vast array of illnesses maintain that no such thing as chronic Lyme disease exists. For the most part, controlled studies conducted by the NIH and others have failed to confirm its existence or the efficacy of the various proposed treatments.

And they strongly recommend that prolonged treatment with strong antibiotics is not appropriate, may well stand in the way of correct diagnosis and may itself cause serious health issues, even death.

Defying establishment

People who believe they suffer from chronic Lyme want to defy the medical establishment and to protect the doctors who treat them from being disciplined for providing treatment that falls outside of normal medical guidelines. (Not, mind you, that any New Hampshire doctor has ever been disciplined for treating Lyme disease with long-term antibiotics.)

The Lyme sufferers have begun campaigns in various states to legislate legal protection for the doctors they believe help them. In New Hampshire it took the form of HB 1326, which initially was sent, as all House bills are, to a committee. After due deliberation the committee decided that the subject was complex and overwhelmingly recommended it be set aside for further study. After all, one committee member explained reasonably, we are not doctors.

Committees are where the hard work of the huge House is really done. Normally committee recommendations are followed.

Not this time.

Powerful activism

While the Health and Human Services Committee was conscientiously doing its work, the Lyme activists were, well, active. And organizing. Turns out - surprise! - that the internet is a marvelous vehicle for sharing information and organizing. For political movements, for families doing genealogical research, for collectors of political trivia. So why not for sufferers of various diseases?

Chronic Lyme patients and their New Hampshire supporters burned up cyberspace, rallying allies to inundate lawmakers with e-mails and phone calls, cautioning petitioners that to be really effective they should target their own legislators, not send e-mail blasts. They urged the bill's advocates to avoid scripts and to use their own words, to describe their own experiences and suffering. They published times of hearings, directions to the Legislative Office Building, even locations of parking lots. Vast numbers showed up for hearings. And the stories of patients - suffering Granite States who felt abandoned by conventional medicine - were indeed deeply moving.

Sympathy vote

Understandably, legislators' hearts melted. By a vote of 300 to 56, they voted that a Lyme diagnosis wasn't dependent on a laboratory test confirmation of the disease and that no doctor could be disciplined for prescribing long-term antibiotic therapy for Lyme patients. Take that, medical establishment! From here on in, we decide standards of medical practice.

The bill still has to pass the Senate (where the state's director of public health services, Dr. José Montero will oppose it) and the scrutiny of Gov. John Lynch, but its passage in the House was a significant victory for its supporters.

This isn't a good era for science generally, as creationists are eagerly seeking common cause with climate change deniers, and medical science isn't being spared skeptical scrutiny. Suspicion and even fear of vaccines - once viewed as medical marvels capable of saving millions of lives - are growing. The chronic Lyme controversy could almost be a symptom of our age.

Apricot pit cure

Interestingly, not too many years back, the center of a much larger storm of medical controversy was a substance called laetrile, derived from apricot pits. More than 50 years ago, laetrile became a sensation, touted as a sure cure for cancer. The medical establishment said it was nothing of the sort, insisting there wasn't a scintilla of evidence it worked and denouncing it as a hoax designed to separate desperately ill people from their money.

But the harder medical authorities within the U.S. government resisted attempts to get medical approval for laetrile, the more its fame spread. Sick Americans poured over the southern border to seek treatment - expensive, of course - at hastily established laetrile clinics in Mexico. Iconic actor Steve McQueen, terminally ill with lung cancer, fled to one clinic and announced from his bed that he believed he had been cured. Several months later he was dead, but that didn't stem the clamor for laetrile.

In the 1970s it reached fever pitch as campaigns arose across the nation to win approval, state by state, for the manufacture and use of laetrile. After an intense lobbying effort and heart-rending testimony by cancer sufferers, New Hampshire in 1977 became one of some 20-odd states whose legislature passed - and governor signed - a law explicitly allowing doctors to treat cancer patients with laetrile without fear of medical sanction. That was the last time, until now, that our Legislature waded into the tricky business of setting medical standards of practice.

For those who wonder, the laetrile bill was quietly repealed in 1983.