Wednesday, February 07, 2007

TRIP Database and Lyme Disease

An interesting e-mail landed on my desk asking me to remove a guideline from the TRIP Database. The guideline in question being Infectious Diseases Society of America practice guidelines for clinical assessment, treatment and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis. We link to this guideline via the American government's National Guideline Clearinghouse. The reason for this request:

"I feel it is wholly inappropriate that this document is still on this website and being used as reference guide. The authors of this document have been subpoeaned by Conneticut Attorney General in the US over the likelihood of the breaking antitrust laws because of biased and warped content of this document, furthermore the document does not take into account of any other medical practises for the treatment of Lyme Disease and is not peer reviewed, please remove this document immediately as their could be legal consequences ensuing by practioners following this protocol."

It caused me some concern as this is the first time someone has asked for material to be removed. So I did a bit of digging round:

1) It does appear that the Connecticut DA is looking into this.
2) There appears to be a great deal of controversy around Lyme disease (see, for instance The Dirty Truth About Lyme Disease Research or wikipedia entry The Lyme controversy).
3) The person contacting me stated that the guideline had not been peer-reviewed, yet I found that the peer-reviewed journal 'Clinical Infectious Diseases' published the guideline in 2006 (click here).

Some final thoughts:
  • Ultimately, we (at TRIP) are not in a position to arbitrate on this one, the Connecticut DA appears to be.
  • The statement "innocent until proven guilty" springs to mind.
  • Unless anything substantial appears as long as the National Guidelines Clearinghouse contain the guideline, so shall we.

5 comments:

Anonymous said...

It's important to note that all "peer-reviewed" journals are not created equal, and it's widely acknowledged in the medical community that the peer review system is broken in some cases.

The journal 'Clinical Infectious Diseases' is published by the IDSA, the same entity that sponsored the guidelines. There is no open-minded scientific review going on here; the IDSA reviewers support one another's minority view on Lyme disease.

In fact, if you review the 400 or so citations at the back of the IDSA guideines, you'll find that almost 200 of those journal articles were written by the guideline authors, guideline reviewers, or employees of the authors. It's the old boy network at its finest. This is not an even-handed review of the 8,000 articles on Lyme disease. It's a small group of like-minded researchers circling their wagons around their flawed concepts of the disease, ignoring the vast body of conflicting literature that's mostly coming out of Europe.

What's more, if you research the financial entanglements of the guideline authors, 11 out of 14 of them have active relationships with Lyme vaccine and test kit manufacturers. It's in the best fiscal interests of these companies and their "on the take" IDSA researchers to support the status quo -- insensitive tests that work with upcoming vaccines, which miss the vast majority of the positive Lyme cases. In the meantime, patients suffer.

This is why the CT attorney general is investigating the IDSA guideline authors. Their "evidence-based" medicine is tainted by profit motive.

jon said...

Thank you for that input. The last thing I want to do is get overly involved in this debate. It's not our area of expertise. As mentioned I think two main issues:

1) The legal system will weigh up the relative merits of both 'sides'.

2) Innocent until proven guilty.

Anonymous said...

Then why don't you also include the ILADs guidelines, which are also posted on the National Guidelines Clearinghouse site?

http://www.ilads.org/files/ILADS_Guidelines.pdf

Anonymous said...

Here's the link to the ILADS guidelines in the National Guideline Clearinghouse:

http://www.guideline.gov/summary/summary.aspx?doc_id=4836&nbr=003481&string=lyme

jon said...

This is where it gets a bit strange! Do a search for Lyme Disease, restrict to 'Guidelines - North America' and it's the top response.

I feel an apology is in order