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The IDSA panel list for the Lyme disease guidelines review panel were announced on Monday. The IDSA has a history of stacking its guidelines panels with like-minded experts and excluding divergent points of view. For patients this has meant limited or no treatment options. Imagine a prostate cancer panel of surgeons only—radiation, hormone treatment and watchful waiting might no longer be viable treatment options. How well-informed would surgeons be of alternatives to surgery? After the antitrust investigation launched by the Connecticut Attorney General, the IDSA was forced, as part of its settlement agreement, to have its 2006 Lyme disease guidelines reviewed by a new panel. The 2006 panel was riddled with conflicts of interest, exclusion of divergent viewpoints, and suppression of scientific evidence. (Click on title to read full article.)

Everyone is entitled to their own opinion. So why do we care about bias in medical guidelines? Because opinion should not dictate patient care. Think of the prostate cancer patient who sees the surgeon who recommends surgery, the radiologist who recommends radiation treatment, and the internist who recommends watchful waiting. Everyone knows that one’s position depends on where one sits. The surgeon may genuinely prefer surgery and when he recommends it to his patient, the patient realizes that he is, after all, talking with a surgeon and that surgeons are likely to favor surgery. He also knows that he can walk down the street a bit and talk with the radiologist and get his perspective. The point is that even though the patient is given conflicting advice, at the end of the day the decision is his. He chooses among treatment options and the physicians respect his decision. This is called autonomy—a recognition that patients are entitled to make choices among health care options.

Conflicts of interest are not good for medicine. Why? Because when a physician has a conflict a secondary considerations (such as a lab referrals, vaccine research grants, or revenues from proprietary diagnostic tests) may compete and trump concerns about the best care for the patient. The last Lyme disease guidelines by the IDSA suffered from an abundance of conflicts of interest and no oversight. In fact, the Attorney General found extensive conflicts of interests among the IDSA panel that developed those guidelines. (Click title to read full article.)

In May 2008, after an extensive investigation, the Attorney General announced a settlement of the antitrust investigation into the IDSA guidelines development process. The settlement requires that the IDSA put together a new panel free from conflicts of interest, permit the introduction of evidence opposing its viewpoints, and hold a public hearing (aired live on the Internet) on controversial recommendations of the guidelines panel.