In the Lymelight: Law and Clinical Practice Guidelines

Susan J.D. Ronn

Disclosures

South Med J. 2009;102(6):626-630. 

In This Article

Abstract and Introduction

Abstract

Almost from the beginning, the Ixodes scapularis and I pacificus, adult deer ticks, have been a breeding ground not only for Lyme disease, but also for political dissent. Most recently, the battleground moved into the arena of clinical practice guidelines. Both camps in the Lyme Wars-the Infectious Diseases Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS)-have published Lyme disease practice guidelines. The guidelines conflict regarding diagnosis and treatment. The state of Connecticut's Attorney General's office conducted an investigation, under antitrust laws, into the development and promulgation of IDSA's 2006 guidelines. In an unprecedented move, IDSA and the AG have entered into a legal agreement that necessitates a rethinking of the guidelines, requiring a new review panel reflecting balanced, conflict-of-interest-free perspectives on Lyme disease.

Introduction

Our investigation was always about the IDSA's guidelines process - not the science. - Connecticut Attorney General Richard Blumenthal[1]

Lyme disease in the United States isn't only about ticks, diagnosis, and treatment. Almost from the beginning, the Ixodes scapularis and pacificus, adult deer ticks, have been a breeding ground not only for disease, but also for political dissent. Most recently, the battleground moved into the arena of clinical practice guidelines. Both camps in the Lyme Wars-the Infectious Diseases Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS)-have published Lyme disease practice guidelines.[2,3] The two sets of guidelines often conflict regarding diagnosis and treatment.

The state of Connecticut's Attorney General's office (AG) conducted an investigation, under antitrust laws, into the development and promulgation of IDSA's 2006 guidelines. In an unprecedented move, IDSA and the AG have entered into a legal agreement that necessitates a rethinking of the guidelines, requiring an ombudsman; a new review panel reflecting balanced, conflict-of-interest-free perspectives on Lyme disease; public hearings; and consensus-building. This intersection of medical practice and the law may hold promise for the beginnings of a resolution for physicians treating and patients suffering from Lyme disease.

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