Lyme Project: New England Journal of Medicine, letter to the editor

New England Journal of Medicine, letter to the editor
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Dr. Daniel Cameron on 03 September, 2008 03:15:00
 
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.