New England Journal of Medicine, letter to the editor
The appraisal of chronic Lyme disease by Feder et al. requires reevaluation.
To the Editor: The appraisal of chronic Lyme disease by Feder et al. requires reevaluation. The strong recommendations made by the authors are based on a relatively small number of subjects, do not reflect clinical evidence, and do not take into account the International Lyme and Associated Diseases Society (ILADS) clinical practice guidelines.It is time the medical community acknowledged Lyme disease as another example of "clinical equipoise" — an absence of consensus within the clinical community — and established publishing standards accordingly.
When clinical equipoise exists, it is even more critical for the medical community to be able to evaluate conflicting positions, the basis for the medical evidence cited, study criteria, and professional agendas and conflicts of interest that may exist. Only by airing these different points of view will the medical and scientific communities reach a better understanding of controversial topics such as chronic Lyme disease.
Currently, medical experts in support of the ILADS clinical practice guidelines are rarely, if ever, included in the process of scientific reviews. In the spirit of good science, I would suggest that this be changed.
Daniel J. Cameron, M.D., M.P.H.
First Medical Associates
Mt. Kisco, NY 10549
"The term "clinical equipoise," used by Cameron, is difficult to justify in view of the published reports of five double-blind, randomized, placebo-controlled clinical trials that have convincingly demonstrated that antibiotic treatment of post–Lyme disease symptoms is not in the best interests of patients.5 Our article summarizes the consensus among clinicians who practice evidence-based medicine, such as Drapkin, whom we thank for his comments."
Henry M. Feder, Jr., M.D.
University of Connecticut Health Center
Farmington, CT 06030
http://content.nejm.org/cgi/content/full/358/4/428
Dr. Cameron's comments: This response by Dr. Feder is another example of the limits of the difficulty airing these different points of view will the medical and scientific communities reach a better understanding of controversial topics such as chronic Lyme disease. The New England Journal of Medicine 200 word limit did not allow me to discuss the weaknesses of the trials. Dr. Feder failed to point out that ILADS professionals also practice evidence-based medicine as outlined in their published evidence-based practice treatment guidelines. Dr. Feder should have accepted the call for dialogue rather than continue to dismiss differing views.
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Comments (2 posted):
We see the person who has to go against all others opinions, and in the end is finally vindicated. Though with Lyme Disease the longer you have to wait for the validation, the harder it becomes to get treatment without enormous expense as well as frustration.
I was trying to change careers due to physical limitations cause by working to hard. I began to study Auto Cad, I was doing great and had great grades.
Then I contracted Lyme Disease, I was bitten on my head 3 times and did not notice it, I thought the bumps were pimples though I don't ever get them.
When I tried to scratch them it did nothing I finally scrathed them out with a knife. I did not make the connection till I was sick.
I thought it was a flu then the symtoms kept continuing and changed into symtoms I had never felt before.
I lost my concentration, had to take a leave of absence from my courses. I was put on antibiotics for 3 wks, 2 wks later the symtoms came back, again I was put on antibiotics for another 2 wks. The symtoms came back, I went to a Infectious Disease Doctor who gave me more blood tests I showed only 1 band after seeing him and wanting to strangle him he insisted it was not possible to have chronic Lyme. I,m 51 yrs old and after more than a year, I still feel terrible, and cannot return to school.
I'm hoping Dr Cameron can help me and I'am currently trying to find the money to be treated by him, before I wither away. We know our bodies better than anyone, the frustration of misdiagnosis, not being listened to becomes overwhelming.
Thank you,
John C Prizzi
845-639-0579
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