COMMENTARY

Politics, Sound Science, and Lyme Disease: IDSA Guidelines Upheld

Paul G. Auwaerter, MD, MBA

Disclosures

June 16, 2010

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Hi, Paul Auwaerter video blogging today on Medscape for Infectious Disease, but I wanted to talk more politics than medicine and more public arena than science. The topic is Lyme disease and as many of you know, there are advocates who believe that so-called chronic Lyme disease is due to persistent Borrelia burgdorferi infection.[1] Advocates of this position think that long-term or combination antibiotic strategies are needed to effect cures for conditions that might be explained by chronic Lyme disease, such as persistent fatigue, musculoskeletal aches, and a variety of other maladies.

The turn to political theater came about more than 2 years ago, when Connecticut Attorney General Blumenthal, who is currently running for senator for the state of Connecticut, decided to investigate the Infectious Diseases Society of America who had put forth guideline recommendations in 2006 on Lyme disease and other tick-borne infections within the United States.[2] Blumenthal alleged that there were conflicts of interest and anti-trust violations. Due to significant legal costs, the Professional Society of the Infectious Disease Society of America elected to settle this. The mode that was selected and mutually agreed upon was an independent commission that would review these guidelines.

In April this independent commission voted unanimously to uphold the 2006 recommendations; this was important for many reasons. First, the panel upheld the general recommendations in the sound science, which was based on more than 1000 citations that were listed in the final report. Probably more significant is the fact that sound science was again examined and upheld as the basis of recommendations for the care of our patients.[3]

Guidelines allow for latitude and are by no means iron-clad or applicable to every patient. More important is that in upholding this vote, the panel sent an important message, one that I hope the media and others will take note of. For example, fair and equal weighting is really not something that other points of view wholly deserve on their own without a sound basis. I am afraid that the media and even the Internet and other sources easily amplify information that is not very soundly reached or based or even practiced widely.

So my gravest concern is that significant resources have been diverted by both clinicians (the people who made up the guidelines) as well as others who review them. The continued vitriol (or political emphasis) that believers of chronic Lyme disease have taken to the state houses, to politicians, and others, do little to advance the cause in the long-term. I think it's important that we emphasize good and sound scientific principles. We should also try to frame and advocate for as much research as possible to try to help patients with Lyme disease or those who are afflicted by persistent problems that are not easily explained.

Lastly, especially for the infectious diseases community and/or fellows in training and others, I would love to see Lyme disease remain a good model to study and help patients. I think it is actually an interesting model for the study of a post-infectious fatigue syndrome that can resemble fibromyalgia or chronic fatigue. It would be great to get further interest in this from our young trainees and other investigators. In fact I think this would likely be the case if we could work together to achieve common goals. Thanks very much for listening.

Lyme Disease Resource Center. Available at: https://www.medscape.com/resource/lyme-disease Accessed June 15, 2010.

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