Table 1 Problems with IDSA Lyme Disease Guidelines

Conflict of interest¹

Key panel members had financial interests related to Lyme disease patents, diagnostic tests, pharmaceutical (vaccines) interests, and insurance consulting fees.² Citation by panel members of their own research was high (40%).

Overreliance on expert opinion¹

38 of the 71 recommendations in the guidelines depend on the weakest Level III evidence, namely 'expert opinion'.³

Artificial unanimity of recommendations¹

The panel excluded competing viewpoints voiced by community physicians and members of its rival, ILADS.²

Specialty society self-publication¹

The guidelines were published in an IDSA journal and were not submitted to normal peer review that would include divergent viewpoints. Letters to the editor critical of the guidelines were not published.

Failure to acknowledge legitimate controversy¹

The controversy over Lyme disease was well known, but physicians with divergent viewpoints were excluded from participation on the panel and the guidelines failed to mention that other treatment approaches exist.²

Limitations on the exercise of clinical judgment and failure to provide treatment options⁴

The guidelines impose severe restrictions on the exercise of clinical judgment and fail to provide treatment options despite a weak evidence base.

Academic researchers setting medical protocols⁵

The IDSA panel consisted almost exclusively of academic researchers.⁶