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Table 1 Problems with IDSA Lyme Disease Guidelines

From: The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines

Weakness or Flaw IDSA 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
  1. NOTES
  2. 1. Sniderman AD, Furberg CD, Why Guideline-Making Requires Reform. JAMA 2009;301: 429-31.
  3. 2. Connecticut Attorney General's Office, 'Attorney General's Investigation Reveals Flawed Lyme Disease Guideline Process, IDSA Agrees to Reassess Guidelines, Install Independent Arbiter,' press release, 1 May 2008,;q=414284. (Accessed June 1, 2010)
  4. 3. Stricker RB, Johnson L, The Infectious Diseases Society of America Lyme Guidelines: Poster Child for Guidelines Reform. South Med J 2009;102: 565-6; Keller DM, 'Infectious Disease Treatment Guidelines Weakened By Paucity of Scientific Evidence,' Medscape Medical News, 13 November 2009, (Accessed June 1, 2010)
  5. 4. American Association of Pediatrics (Steering Committee on Quality Improvement and Management), 'Classifying Recommendations for Clinical Practice Guidelines,' Pediatrics 2004;114: 874-7.
  6. 5. Goozner M, 'IOM Urged to Recommend Conflict-Free Zone for Medicine,' (Accessed June 1, 2010)
  7. 6. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin AJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman, RB: The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006;43: 1089-1134.