A rather opinionated reader made me aware of a disturbing issue. In Connecticut–the state whose city of Lyme gave the name to the tick-borne disease–the Attorney General decided that the nation’s foremost infectious disease experts have their heads up their arses. Apparently responding to pressure from questionable advocacy groups, the AG launched an “investigation” into the Infectious Disease Society of America’s Lyme disease treatment guidelines. The excuse for the investigation was alleged anti-trust violations.
Let’s step back a little. As discussed yesterday, there is some controversy surrounding so-called “chronic Lyme disease”. The overwhelming majority of experts agree that there is no role for long-term antibiotics. There has been no evidence to support either the diagnosis of chronic Lyme disease (as it is used by advocacy groups and some physicians) or the use of expensive and dangerous therapies to treat it. The guidelines on treatment of infectious diseases issued by the ISDA are just that—guidelines. Physicians are not required to follow these guidelines, but insurance companies often use them to determine what therapies they will pay for. These guidelines are, however quite influential, as we physicians count on our specialist colleagues to help sort out these difficult issues.
The CT AG decided that these guidelines were tainted by anti-trust violations. I’m not sure how evidence-based guidelines put together by a diverse group of experts can violate anti-trust laws, which were designed to prevent corporate monopolies, but the AG tried to pull it off.
More below the fold—>
Among the accusations: (See both the AG’s report and the IDSA’s response.)
1) The IDSA allowed for conflict of interest on the panel. This is both untrue, not mandated by law (apparently), and prima facie ridiculous. The panel recommended against expensive treatments—cui bono?
2) The panel failed to take into account divergent opinions. The panel did consider all of the evidence. Just because they disagreed with the fringe opinions doesn’t mean they didn’t consider them.
3) The panel’s recommendations were suspiciously similar to other medical society’s opinions (the American Academy of Neurology). So if medical experts agree on an issue, it’s an anti-trust violation rather than scientific consensus.
The good news is that the CT AG and the IDSA have reached an agreement. The current Lyme guidelines will stand, the IDSA will reevaluate them independently, and the Attorney General will leave them alone.
This troubles me, and it should trouble you. When a state government tries to strong-arm physicians and scientists to bring science more in line with the opinions of special interest groups, science-based medicine is in danger, and so are you.