LYMEPOLICYWONK: Antibiotic Resistance—Holy Cow, It’s the Beef!

In the movie “The King’s Speech”, the Duke of York tells his unorthodox speech therapist Logue that he has “been t-t-treated f-or this by the f-f-finest ph-ph-physicians.” Logue responds: They are idiots. When the Duke protests that “Th-they h-h-have knighthoods”, Logue responds “Well, that makes it official that they are idiots.” He is talking about hubris and arrogance interfering with medicine and science. So it is with “eminence based medicine”–guidelines that hinge upon the opinion, bias and arrogance of physicians that hold a particular viewpoint rather than science. The IDSA has been called to task in research by its own members that find that the IDSA’s guidelines are based mostly on opinion—not evidence.

What happened? The IDSA has issued its official report of the Lyme review panel. “[A] special independent Review Panel has unanimously agreed that no changes need be made to IDSA’s 2006 Lyme disease guidelines.” Let me point out three faults with this statement. First there was no “independent Review Panel”. There was a panel that was selected by the IDSA, which intentionally excluded from the panel physicians who disagreed with their assessment—all community physicians who treat chronic Lyme were excluded from the panel. Second, some changes to the recommendations were proposed by the panel. Third, the determinations were not unanimous. The most important recommendation regarding the requirement of positive serology for diagnosis actually had a 4 to 4 vote split. I will spare you the long read—28 pages of text and give you the bare bones only version. Nothing changed. They are not even sure what the fuss was about, honestly. They never expected the guidelines to change, stacked the panel, paid the ethicist, ran the process, and achieved a foregone conclusion which “validated” their guidelines. Seems like the IDSA fat cat ate the canary.