ILADS Responst to IDSI

Discussion in 'Lyme Disease Archives' started by jarjar, Oct 26, 2006.

  1. jarjar

    jarjar New Member

    Sherwood Gorbach, M.D., Editor
    Clinical Infectious Diseases
    Tufts University School of Medicine
    200 Harrison Avenue
    Boston, Massachusetts 02111

    Subject: Retraction of The clinical assessment, treatment, and prevention
    of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical
    practice guidelines by the Infectious Diseases Society of America.

    Dear Dr. Gorbach:
    On behalf of the membership of the International Lyme and Associated
    Diseases Society (ILADS), I am submitting a formal request for retraction of
    the article, The clinical assessment, treatment, and prevention of Lyme disease,human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America (hereafter referred to as the Lyme guidelines article, which has n published electronically in your journal (1).

    ILADS is requesting retraction of the Lyme guidelines article because the authors of the article employed exclusionary data selection that substantially biased the resulting diagnosis and treatment recommendations while ignoring opposing or dissenting views about these recommendations.

    As with research articles tainted by data selection, the Lyme guidelines article threatens to harm patients and patient care due to the biased methodology used by the authors, and this threat can only be avoided by formal retraction of the article.

    The attached analysis of key points in the Lyme guidelines article demonstrates that the authors of the article made statements that either
    reflected significant selection bias of published data or ignored published evidence that
    conflicted with their opinions.

    Nowhere is this more apparent than in Dr.
    Klempner's analysis of the three NIH-funded Lyme treatment studies, which elevates and relies on the findings of his own study while dismissing the results of two other studies that conflict with his findings.

    Other statements about the erythema migrans (EM) rash, Lyme testing methodology, antibiotic
    treatment of chronic Lyme disease, Lyme disease in pregnancy and Lyme disease in Southern states all reflect a biased view of Lyme disease that is either unsubstantiated or refuted by available peer-reviewed published literature.

    It is disturbing that ten of the central recommendations in the guidelines
    are supported by evidence ranked that is,recommendations based on the weakest
    level of evidence”opinion.

    In light of the controversy surrounding Lyme
    disease diagnosis and treatment and our evolving understanding of the disease,it is inappropriate to dictate medical care based on such weak evidence. The panel of authors was selected to exclude divergent points of view from
    patients, from treating physicians in other medical societies, and even from physicians within IDSA itself.

    The failure of the authors to disclose
    dissenting views presents a false sense of consensus on an issue that is in fact highly
    controversial, misinforming patients and physicians alike about available treatment options and denying the exercise of clinical discretion and individualized medical decision-making that is central to any complex illness.

    Although the Lyme guidelines article boasts 405 references, many of the dissenting references are either glossed over or ignored in the text.

    In addition, as of the date of publication of the Lyme guidelines article there were 18,537 articles about tick-borne diseases listed on Medline, so the referenced articles represent only 2% of the available literature. The remaining 98% of these articles often present opposing or conflicting views of Lyme disease,
    and thus the data selection by the authors is even more striking.

    We are aware that retraction of medical publications is generally reserved
    for research articles that violate principles of scientific integrity (2).

    Scientific integrity has been defined as commitment to truthfulness, to
    personal accountability and to vigorous adherence to standards of professional
    conduct (eg, accuracy, fairness, collegiality, transparency) (3).

    Clinical guidelines from societies as powerful as IDSA are generally accepted as accurate,
    fair, collegial and transparent, and they rapidly become the standard of medical care in our country. It is wholly inappropriate and dangerous for guidelines to be formulated using exclusionary tactics, flagrant data selection,
    biased opinions sweepingly strong recommendations based on the
    weakest category III evidence.

    We feel that the same principles of scientific
    integrity that apply to medical research should also apply to practice guidelines.

    In our opinion, the Lyme guidelines article does not reflect accuracy,fairness, collegiality or transparency and should be retracted.

    We propose the following:
    1. Immediate retraction of the published Lyme guidelines article.

    2. Formal notification of the CDC and other medical societies that the
    guidelines article has been retracted.

    3. Formation of a widely diversified Lyme guidelines committee that bases
    its recommendations on the strength of the underlying evidence.

    4. Reformulation of the Lyme guidelines article to reflect a more balanced
    view of tick-borne diseases, taking into account the existing evidence-based
    ILADS guidelines article listed by the National Guidelines Clearinghouse (4).

    5. Submission of the reformulated guidelines article for outside peer review
    to a medical journal that is independent of IDSA.

    xxxxxxx xxxxxxxx, MD
    President, ILADS
  2. victoria

    victoria New Member

    that none of this at this time is going to happen... sigh, hate being so pessimistic!