Take a look at the action and follow the thread, which threatens to be lively and play out like Quick Draw McGraw with alot of back and forth. Here is Dr. Gershon’s piece.
Antitrust law is concerned with constraints of trade that foreclose consumer choice. Guidelines developed by medical specialty societies that have monopoly power (like the IDSA) can become de facto legal standards for the practice of medicine. When they foreclose treatment options and the exercise of clinical judgment, they constrain consumer choice.
Typically, laws are passed in the United States through a democratic process that allows many groups to have a voice in the law before it is passed. Antitrust laws make an exception to guidelines or standards that are developed by groups that have expertise in an area (for instance, computer chips and medicine) so long as they play fair. The reason for this exception is that the level of expertise required in these areas makes it reasonable for "experts" rather than laymen to be setting the rules.
Patients think that the IDSA guidelines are harmful to their health because physicians, hospitals, and insurers rely on them to deny patients access to the care they vitally need to restore their health. Patients believe that the IDSA guidelines violate one of the cardinal rules of medicine, “First do no harm.” Depriving seriously ill patients of treatment is an egregious harm. But do the IDSA guidelines violate their own rules? Indeed, they do.
I suppose it was inevitable. The IDSA, due to inattention (hey, it happens with age), lack of oversight, control, or, shall we say, “iron fist” over its members, permits not one, but TWO poster sessions at its last annual meeting that point out that—drum roll—the IDSA guidelines across the board (not just Lyme guidelines) are just—well, not based on science or evidence for the most part. Thomas File, the author of this article, is on the board of the IDSA and he is with Summa Health System: He takes the IDSA defense and explains why evidence is not necessary for evidence based guidelines..
In April, MyLymeData had its first patient conference with the theme of “Overcoming Lyme Disease.”…
We are waiting for the final resolution of the National Guidelines Clearinghouse (NGC) determination regarding whether they will pull the outdated IDSA guidelines from their website. Members of both the House of Representatives and the Senate have called for their removal. If you haven’t signed our petition calling for this, please do. We have over 19,000 signatures on it so far. Our understanding is that the IDSA listing on the NGC is now being reviewed by higher ups on the organizational chart, namely the Agency for Healthcare Research and Quality (AHRQ)). Meanwhile, the NGC is calling for public comments on their guideline inclusion policy. We sent off our list today. Here’s the long and short of it.
Most of you know the hearing on July 30th before the IDSA hearing panel was about "contested recommendations" in the IDSA 2006 guidelines. These are recommendations and language in the IDSA guidelines that we contest or take issue with. They are important because they provide the road map for what the IDSA hearing panel must review. Contested recommendations must be evaluated by the panel. In order to remain in the guidelines, a supermajority (7 of the 9 panel members) must find that the contested recommendation is supported by the medical/scientific evidence presented at the hearing or otherwise submitted.
