Background Clinical practice guidelines are developed to assist in patient care. Physicians may assume that following such guidelines means practicing evidence-based medicine. However, the quality of supporting literature can vary greatly.
Methods We analyzed the strength of recommendation and overall quality of evidence behind 41 Infectious Diseases Society of America (IDSA) guidelines released between January 1994 and May 2010. Individual recommendations were classified based on their strength of recommendation (levels A through C) and quality of evidence (levels I through III). Guidelines not following this format were excluded from further analysis. Evolution of IDSA guidelines was assessed by comparing 5 recently updated guidelines with their earlier versions.
Results In the 41 analyzed guidelines, 4218 individual recommendations were found and tabulated. Fourteen percent of the recommendations were classified as level I, 31% as level II, and 55% as level III evidence. Among class A recommendations (good evidence for support), 23% were level I (1 randomized controlled trial) and 37% were based on expert opinion only (level III). Updated guidelines expanded the absolute number of individual recommendations substantially. However, few were due to a sizable increase in level I evidence; most additional recommendations had level II and III evidence.
Conclusions More than half of the current recommendations of the IDSA are based on level III evidence only. Until more data from well-designed controlled clinical trials become available, physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions.
Author Affiliations: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
seekhelp
Frequent Contributor (5K+ posts)
Member # 15067
posted
Is this actually coming from a NON-LLMD? That would be interesting.
Posts: 7545 | From The 5th Dimension - The Twilight Zone | Registered: Mar 2008
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METALLlC BLUE
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This is an "independent" source. IDSA got Owned.
-------------------- I am not a physician, so do your own research to confirm any ideas given and then speak with a health care provider you trust.
Toxic mold was suppressing our immune systems, causing extreme pain, brain fog and magnifying symptoms. Four days after moving out, the healing began. Posts: 2007 | From NY/VT Border | Registered: Aug 2010
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Ann-OH
Frequent Contributor (5K+ posts)
Member # 2020
posted
Thanks, Momlyme and LimeLymey!
It just says that the study was not commercially funded.
The two authors work for Drexel U. in Philadelphia. There is no mention of a grant. That might show up if we can get hold of the full text.
"Author Affiliations: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. "
The info on funding was for Dr. Powers, who added an editorial to the article on some sites. He has very wide commercial backing!!!
Hope we can find the full text. That should list the particular Guidelines they studied.
posted
Conclusions: More than half of the current recommendations of the IDSA are based on level III evidence only. Until more data from well-designed controlled clinical trials become available, physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions.
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Thanks for sharing these articles! LymeNet friends rock!
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METALLlC BLUE
Frequent Contributor (1K+ posts)
Member # 6628
posted
While it may be true that this isn't specific to Lyme, we know based on the wording of the news articles and "defense" by the IDSA President that it's "very very very probable" that Lyme Disease is high on the list of which this study is indirectly pointing.
Read these words by Diane Olson and tell me I'm not dead on:
Diana Olson, spokesperson for IDSA, pointed out that all recommendations list the degree of evidence on which they are based.
"Clinicians understand when there is really rock-hard evidence behind our recommendations and when there isn't," she told Reuters Health, adding that some guidance is better than none at all.
"The public can have absolute confidence in these guidelines," she added. "They remain the best that science and medicine have to offer."
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This came from a Reuter's news article which was published today.
Now let's view what Olsen had to say regarding the Lyme Disease guidelines debaucle on November 28th of 2006 to News Times.
Diana Olson, spokeswoman for the infectious diseases society, said the 14 doctors who worked on the guidelines -- led by Dr. Gary Wormser, an infectious disease specialist at Westchester Medical Center/New York Medical College -- studied more than 400 published medical reports on Lyme disease before coming to their conclusions.
"This is the best science has to offer,'' she said.
Olson said the society could not take into account things like patients' anecdotal accounts of their Lyme disease treatment in writing the guidelines. Nor, she said, did it concern itself with whether insurance companies would pay for treatment outside those guidelines.
She also said that guidelines are just that, and that patients and doctors are free to find different treatments that work best for them.
She also said the society is cooperating fully with Blumenthal's office."
She said this countless times to different media when describing the IDSA's approach to upholding the Lyme Disease guidelines. She hasn't said it about other infectious diseases as far as I've observed.
Here is another:
THURSDAY, Nov. 9 (HealthDay News) -- Battle lines have been drawn over new clinical guidelines on spotting and treating Lyme disease.
Depending on whom you talk to, the new recommendations from the Infectious Disease Society of America are the "best that science has to offer" on the illness, or a medical "travesty" that will lead to the suffering and even death of those affected by the tick-borne disease.
The former view is held by Dr. Gary Wormser, the infectious disease specialist who chaired the panel that drew up the new guidelines, which are published in the November issue of Clinical Infectious Diseases.
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They just keep repeating the same thing to the media, when the reality is, it's not the best, it's opinion by those who have violently opposed the longer term treatment of Lyme Disease. They are the same individuals who show up to court trials of Lyme Literate Physicians who are persecuted by Medical Boards and Insurance Companies who report them (based on treatment which is outside the standard of care, which is......(drumroll) guidelines which are merely "suggestions" by individuals with opinions, not studies using "science."
They mention using over 400 studies to draw their conclusions about forming the Lyme Disease Guidelines. Do you know how many studies actually exist regarding the relevant factors surrounding Lyme Disease? 18,000 +
Hmmm, best that science has to offer. Really? More like best "opinion of those in power have to offer."
-------------------- I am not a physician, so do your own research to confirm any ideas given and then speak with a health care provider you trust.
Ann-OH
Frequent Contributor (5K+ posts)
Member # 2020
posted
I am still trying to find the full text of this. Anyone have any clues about where to go for that? I really don't want to pay for it. Thanks, everybody. Ann - OH
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