Many people have questions about the IDSA panel, its selection and where we are in the process. This posting I will attempt to answer some of the more common questions.

Many people have questions about the IDSA panel, its selection and where we are in the process.  In this posting, I will attempt to answer some of the more common questions.

When was the panel announced and why wasn’t there any advance notice?

The panel was announced Monday morning, the 26th of January, 2009.  Applications for the panel closed on October 1, 2008.  The timing of the selection of the panel was within the control of the IDSA which gave no pre-warning of the announcement.  I picked up the announcement on the IDSA website Monday morning when I awoke.  The panel list on Monday included 10 names, including Arthur Weinstein, who was subsequently removed from the panel.

Were conflicts of interest prohibited?  What is a conflict of interest?

What constitutes a conflict of interest is subject to discretion and line drawing on the part of the ethicist.  He did not consider “organizational” affiliation (e.g. being a member of the IDSA or being past president of the IDSA) as creating a conflict.   He also did not consider the concept of bias (opinions, viewpoints, etc) as a conflict of interest.  This means that Parsonnet’s “IDSA speak” statements were not considered as a conflict.  You may recall that in the past some of those who have sat on IDSA Lyme disease panels have had monetary conflicts of interest related to the then on-going Lyme vaccine, Lyme patents, or Lyme diagnostic tests.  If any of the panel members has this type of direct conflict of interest, it could be important and I would encourage you to contact me privately at lbjohnson@lymedisease.org if you have information that suggests this.

Who selected the chair of the panel?

The settlement agreement provides that the chair of the panel be selected by the IDSA Standards Practice and Guidelines Committee.  This person must have been cleared by the ethicist as being free of conflicts of interest.  The person selected as the chair, Carol Baker, has served as President of the IDSA in the past, and her ability to consider the matter objectively may be impaired by her allegiance to the organization.   The ethicist determined that Carol Baker did not have a conflict of interest and did not regard her organizational affiliation (past president IDSA) as a conflict.  In addition to not having a conflict of interest, the chair may not have published about Lyme disease.

How were the panelists selected?

The agreement calls for the panelists to be selected by the Chair and the IDSA Standards Practice and Guidelines Committee.  The panelists must have been cleared by the ethicist as being free of conflicts of interest. The ethicist did not consider short term treatment bias (e.g. “IDSA speak”) as a ground for exclusion from the panel.

Why were treating physicians excluded from the panel?

The ethicist rejected physicians who derived more than $10,000 per year from treating Lyme patients from the panel on the basis of a conflict of interest.  Normally, a conflict of interest occurs when a competing secondary interest may interfere with the physician’s ability to place the concerns of the patient paramount. While physicians are incentivized to treat patients under common fee for service arrangements, these interests are generally regarded as being aligned with those of the patient care.  Marc Rodwin, the author of Medicine, Money, and Morals, and an expert on physician conflicts,  lists 7 potential conflicts of interest physicians may have in treating a patient.  Notably, fee for service is not among those listed.  We strongly disagree with the ethicists interpretation of this.

Wasn’t there a requirement that the panel be balanced?

The settlement agreement does require that the panel be balanced.  We believe that the panel cannot be balanced unless treating physicians are included in the panel and that the concept of bias (beliefs, opinions, predispositions) matters in this context.

Why was Arthur Weinstein removed from the panel?

Dr. Weinstein had published Lyme disease guidelines.  The settlement agreement precluded those who had previously published guidelines from serving on the panel and the IDSA may have removed him for that reason.

What happens next?

The next step in the process is the selection of evidence for the panel to review.  The timing of this process is within the control of the IDSA. The period for submitting evidence is 60 days after the IDSA announces it is accepting evidence.