Lyme Disease Practice and Research

• Page 1
• Page 2
• Page 3
• Page 4
• Page 5
• Page 6
• Page 7
• Page 8
• Page 9

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.