LYMEPOLICYWONK: Researcher finds IDSA treatment guidelines long on opinion and short on science
IDSA guidelines are long on opinion and short on science. This is the stunning conclusion made by an infectious disease specialist at Drexel University, Dong Lee, MD in a poster presentation at the recent IDSA annual conference. Dr. Lee’s analysis is based on a broad review of 30 guidelines published by the IDSA between 1994 and 2009. More than half of the recommendations made by the IDSA in these guidelines were not supported by science.
According to a recent Medscape article, Dr. Lee stated that of the 1408 IDSA guideline recommendations he reviewed, “more than half were based on level III evidence, which is from expert opinion or not supported by properly controlled trials.” Lee said that guidelines should not make strong recommendations in the absence of strong evidence. But of the 589 strong recommendations he reviewed, only 14% were supported by strong evidence. A second independent study also presented in a poster session at the IDSA annual meetingby Abdur Khan, MD, assistant consultant at King Fahad Medical City in Riyadh, Saudi Arabia corroborated these findings. Khans study, which reviewed recommendations in 65 IDSA guidelines found 55% of the recommendations were supported only by opinion, not by science.
This conforms with an analysis of the IDSA Lyme guidelines by Dr. Elizabeth Maloney that found that while the guidelines contained 71 recommendations, 38 are based on level III evidence—namely expert opinion. In addition, the IDSA panel ignored and failed to consider the clinical experience of physicians who treat longer or with different protocols. In fact, the Connecticut Attorney General found that the divergent viewpoints were excluded from the panel. When divergent viewpoints are excluded from a panel, any consensus based on “expert opinion” is essentially a rigged vote. Recommendations that are long on opinion and short on science should not replace the judgment of the treating physician.
If you can spare a few minutes, I recommend a full read of the Medscape article .
You can contact Lorraine Johnson, JD, MBA at lbjohnson@lymedisease.org.
Did I read this right? I can hardly believe my eyes! Dr. Lee presented this at the IDSA conference? That's incredible! I'm astounded and amazed that he was allowed to give this presentation there. This is very encouraging news…could it be possible that the IDSA is actually willing to take a good, hard, honest look at themselves (or, at least, at some of their guidelines-writing panel members)? Perhaps there is hope that there are some good people left out there in places of power, after all. Thank you for blogging about this, Lorraine! I love reading your blog and articles…you just make such good darn sense. All the best-liz