GUIDELINES BASED MAINLY ON OPINION SHOULD NOT DENY TREATMENTS

Many Recommendations Within Practice Guidelines Not Supported by
High-Quality Evidence, Study Finds

Science Daily (Jan. 10, 2011) — More than half of the recommendations in
current practice guidelines for infectious disease specialists are based
on opinions from experts rather than on evidence from clinical trials,
according to a report in the January 10 issue of Archives of Internal
Medicine, one of the JAMA/Archives journals.

Science Daily

"As with individual research studies, providers should critically evaluate guidelines and the evidence on which they are based and how relevant recommendations are locally at their institutions and in their patients," Dr. Powers concludes. "Especially for subspecialists, guidelines may provide a starting point for searching for information, but they are not the finish line. The fact that many recommendations are based on opinion should also serve as a call to future researchers to critically evaluate and study the questions that need better answers."

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The controversy over the Infectious Diseases Society 2006 Lyme disease Guidelines are a very good case in point.

'The controversy over Lyme disease came to a head in
November 2006 when IDSA released new guidelines severely
limiting treatment options for patients with persistent Lyme
symptoms. The guidelines were so restrictive that the
Attorney General of Connecticut initiated an unprecedented
investigation into potential antitrust violations by IDSA, the
dominant infectious disease society in the United States, in
its formulation of the guidelines. The investigation found
significant conflicts of interest and suppression of data in the
guidelines development process. Raphael B Stricker, Lorraine Johnson ref here

Several of the presentations at the Review of the IDSA 2006 Guidelines contested the level of evidence used to formulate those Guidelines.

Daniel Cameron MD, MPH IDSA Hearing Presentation here

No evidence to limit most treatment
options on “not recommended” list
The 2006 IDSA panel:
• Did not cite Level 1 or II evidence
• Did not give specific reason why agent/modality on list
Panel’s conclusion: “Selected antimicrobials, drug
regimens, or other modalities not recommended for the
treatment of Lyme disease”
is NOT supported