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  • Gooznews takes on conflicts in guidelines

    Gooznews posted an interesting commentary on guidelines, conflicts of interest in guideline development and over reliance on expert panels when there are gaps in evidence. Merrill Goozner is a health care ethicist and this is not the first entry on his blog that has caught my attention. You might want to check it out. His post is premised on the recent article by Sniderman in the Journal of the American Medical Association (recent issue), which does a remarkably job outlining the problems with control in evidence based medicine, how "opinions" of the panel members are recharacterized as "science" in the form of evidence based guidelines. Some of the comments to Goozner's post are interesting. One person responds that "Evidence-based medicine has morphed into pharma-based medicine and HMO-based medicine". I thought Goozner's post was a good opportunity to point out some of the problems with the IDSA guidelines. My comment follows:

  • Weinstein Off the IDSA Guidelines Review Panel!

    Arthur Weinstein's role on the IDSA's Lyme guidelines review panel was short lived. Today's list of panel members posted on the IDSA website excludes him. Patient groups were alarmed when he was included in the IDSA's panel list posted by the IDSA on Monday. Weinstein was at NYMC with Dr. Gary Wormser, who was the chair of the 2006 IDSA guidelines panel, which the Connecticut Attorney General investigated and found had been riddled with conflicts of interest , excluded divergent points of view and suppressed scientific evidence. Weinstein was a co-author on the Klempner study, on the safety monitoring board for the vaccines, and involved in the flawed western blot testing (Dearborn Conference). His removal from the panel is a step in the right direction for Lyme patients.

  • TOUCHED BY LYME: A roadmap for Lyme disease

    When my family and I needed to quickly come up to speed about Lyme disease several years ago, I looked for a book that would take me by the hand and explain all the complex stuff I needed to know. I never found one at the time. I wish I’d had a copy of The Lyme Disease Solution, by Kenneth Singleton, MD, MPH. (Brown Books, 2008). Dr. Singleton himself suffered from undiagnosed Lyme disease for eight years. Now, having recovered his own health, he works as a Lyme disease specialist in Maryland.

  • IDSA Announces New Guidelines Panel–Balanced or Biased?

    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.)

  • Bias and patient autonomy—what’s the connection

    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.

  • Opinion based medicine

    For those who haven’t read, the recent New York Times article, "Plenty of Guidelines, but Where's the Evidence?" by D. Sanghavi, M.D., I suggest you check it out. Sanghavi discusses the problems caused by centralized guidelines in medicine particularly when there is an evidence gap—when guidelines are based on opinion rather than a careful review of all of the evidence. And, this issue of centralization of medicine through guidelines is becoming more important as the push for national health care heats up.

  • Conflicting views on conflicts—throwing the baby out with the bathwater

    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.)

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