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Blog: Lyme Policy Wonk The IDSA panel--Q and A
26 JAN.
Many people have questions about the IDSA panel, its selection and where we are in the process. This posting I will attempt to answer some of the more common questions. (Click title to read full article.)
Conflicting views on conflicts--throwing the baby out with the bathwater 23 Jan
Conflicts of interest are not good for medicine. Why? Because when a physician has a conflict a secondary considerations (such as a lab referrals, vaccine research grants, or revenues from proprietary diagnostic tests) may compete and trump concerns about the best care for the patient.
The last Lyme disease guidelines by the IDSA suffered from an abundance of conflicts of interest and no oversight.
In fact, the Attorney General found extensive conflicts of interests among the IDSA panel that developed those guidelines. (Click title to read full article.)
About Lyme Policy Wonk 25 Jan
Lyme Policy Wonk is a blog that addresses threats to quality health care for patients with Lyme disease by focusing on medico-legal ethics and policy.
I have found that the legal ethical considerations in Lyme disease are at the bleeding edge of health care policy generally and that Lyme is the proverbial canary in the coal mine when it comes to problems in health care policy this nation is facing.
These matters are even more important given the press toward national health care.
This blog focuses on the concentration and abuse of power within medicine and health care research and the damage to Lyme patients created by conflicts of interests in Lyme disease.
Lorraine Johnson,JD, MBA is an attorney advocate, who has published widely on the topic of health care medico-legal-ethics in Lyme disease for the past 5 years.
Weinstein Off the IDSA Guidelines Review Panel! 27 Jan
Arthur Weinstein's role on the IDSA's Lyme guidelines review panel was short lived.
Today's list of panel members posted on the IDSA website excludes him.
Patient groups were alarmed when he was included in the IDSA's panel list posted by the IDSA on Monday.
Weinstein was at NYMC with Dr. Gary Wormser, who was the chair of the 2006 IDSA guidelines panel, which the Connecticut Attorney General investigated and found had been riddled with conflicts of interest , excluded divergent points of view and suppressed scientific evidence.
Weinstein was a co-author on the Klempner study, on the safety monitoring board for the vaccines, and involved in the flawed western blot testing (Dearborn Conference).
His removal from the panel is a step in the right direction for Lyme patients.
Bias and patient autonomy--what's the connection 23 Jan
Everyone is entitled to their own opinion. So why do we care about bias in medical guidelines?
Because opinion should not dictate patient care. Think of the prostate cancer patient who sees the surgeon who recommends surgery, the radiologist who recommends radiation treatment, and the internist who recommends watchful waiting.
Everyone knows that one's position depends on where one sits. The surgeon may genuinely prefer surgery and when he recommends it to his patient, the patient realizes that he is, after all, talking with a surgeon and that surgeons are likely to favor surgery.
He also knows that he can walk down the street a bit and talk with the radiologist and get his perspective.
The point is that even though the patient is given conflicting advice, at the end of the day the decision is his. He chooses among treatment options and the physicians respect his decision.
This is called autonomy--a recognition that patients are entitled to make choices among health care options.
Opinion based medicine 23 Jan
For those who haven't read, the recent New York Times article, "Plenty of Guidelines, but Where's the Evidence?" by D. Sanghavi, M.D., I suggest you check it out.
Sanghavi discusses the problems caused by centralized guidelines in medicine particularly when there is an evidence gap--when guidelines are based on opinion rather than a careful review of all of the evidence.
And, this issue of centralization of medicine through guidelines is becoming more important as the push for national health care heats up.
Attorney General findings--IDSA wrong doing 30 May
In May 2008, after an extensive investigation, the Attorney General announced a settlement of the antitrust investigation into the IDSA guidelines development process.
The settlement requires that the IDSA put together a new panel free from conflicts of interest, permit the introduction of evidence opposing its viewpoints, and hold a public hearing (aired live on the Internet) on controversial recommendations of the guidelines panel.
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