Guidelines matter

Medical science moves on; guidelines need updating because clinicians use them. No-one can believe it is a good thing for clinicians to apply guidelines that are known to be out of date.

Because of this the National Guidelines Clearinghouse (NGC) in the USA requires that American guidelines are reviewed every 5 years. The IDSA guidelines of 2006 are due for renewal but have been re-submitted without change and re-instated on the NGC website until 2015. It seems that NGC have allowed this because they believe that the guidelines underwent review in 2010 – the date of publication of the final report of the Lyme Disease Review Panel of the IDSA.

In fact the IDSA specifically states, on the webpage where you can find the final report, “The Review Panel was not charged with updating or rewriting the 2006 Lyme Guidelines.  Any recommendation for update or revision to the 2006 Lyme Guidelines would be conducted by a separate IDSA group.”

It is important to realise that the review panel did make many recommendations for changes to the guidelines and, despite the press headlines at the time, the panel members disagreed on some very fundamental points. See LDA’s 2010 comment on the final report. It should also not be forgotten that papers have been published during the last 3 years since the panel was convened and science has moved on.

Why does this matter to the UK? Because IDSA guidelines are referenced and recommended by official bodies in the UK including the Health Protection Agency (HPA) and the British Infection Association (BIA).

The IDSA review panel stated in its final report that “caution should be used in extrapolating results from European studies to North American patients, due to the well-established microbiological and clinical distinctions in Lyme Borreliosis on the two continents.” European guidelines all recognise the lack of evidence for treatment recommendations – see our guidelines page for details – but it seems that IDSA carries more weight with UK clinicians.

Patients have lost confidence in organisations that are responsible for protecting their health. And doctors? How do doctors retain confidence if those who provide them with guidelines to use ignore their own rules as the IDSA is doing?

A petition has been raised in the USA by (formerly the Californian Lyme Disease Association) to request that the outdated guidelines be removed. If you feel that guidelines matter, and should not be listed if they are known to be out of date, read this petition and consider signing.

IDSA guidelines are referenced across the world: this is an international petition.