Lyme Policy Wonk

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.

The IDSA is now accepting applications from clinicians and scientists for a seat on its new Lyme disease guidelines review panel, which will consist of 8-12 members (including the chair) “who, as a group, reflect a balanced variety of perspectives and experience across a broad range of relevant disciplines, ranging from clinical experience in treating patients with Lyme disease to experience in investigating the best methods to diagnose and treat Lyme disease or other infectious diseases.”

On May 1, 2008, the Connecticut Attorney General announced a landmark settlement against the Infectious Diseases Society of America in connection with its guidelines for treating Lyme disease. The IDSA guidelines are relied upon by insurers throughout the nation to deny seriously ill patients treatment for chronic Lyme disease. The Attorney General found substantial conflicts of interest among the panel members on the IDSA guidelines who held commercial interests related to diagnostic tests, vaccines, and insurance. In addition, the Attorney General found that the panel suppressed scientific evidence and excluded opposing views from the panel.

In May 2008, the IDSA agreed to re-evaluate its guidelines as part of the settlement agreement for an antitrust investigation by the Attorney General of Connecticut, which found significant conflicts of interest on the original panel, suppression of scientific evidence, and exclusion of panel members with opposing viewpoints. This is the first time a guidelines panel has been forced to re-examine its guidelines under antitrust law.