Published in January 2011, some 6 months later than expected, this review of ILADS guidelines is not so much the “appraisal” that it claims to be, but an attempt to find every possible bad point.
It is a pity that those who maintain they are protecting our health cannot take a more rational, responsible attitude and look at what underlies the ILADS guidelines. As just one example, taken from the executive summary under Diagnostic Criteria, the (unnamed) panel says:
“ They also include neurologic features such as demyelinating disease, neuropsychiatric presentations and sometimes motor neurone disease, but do not offer any evidence to substantiate a causative role for Borrelia burgdorferi infection in these conditions.”
As “The review process included a detailed assessment of the guidelines’ content” at the very least the HPA panel should have looked for references before issuing a statement that implicitly denies any evidence of a causative role for Bb in these conditions. They would have found, for example:
1. Antibiotic responsive demyelinating neuropathy related to Lyme disease. Grissold & Vass. Neurology. 2010 Mar 16;74(11):935
2. A protracted course of neuroborelliosis, the debate continues. Huda et al J Neurol Neurosurg Psychiatry 2010;81:e41
3. Motor neuron disease features in a patient with neuroborreliosis and a cervical anterior horn lesion. H De Cauwer et al, Acta Clin Belg. 2009 May-Jun;64(3):225-7.
The consequences of this sort of statement are either that doctors will believe it, and fail to diagnose patients or doctors will, from their own evidence, disbelieve it and lose trust in the HPA. It is hard to believe that the HPA thinks either of these situations is desirable.
This review appears to be an attempt by the HPA to justify their entrenched stance, rather than an attempt to genuinely evaluate a set of guidelines. Although it would be interesting to do a parallel exercise for the HPA web pages, this is drawing us into a tit-for-tat reactive situation which is not productive, wastes time and evades the real issues.
Throwing stones is not the answer and it is disappointing that the HPA believes it is.