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Another shot fired--letter in re AAN Guidelines
Another shot fired--letter in re AAN Guidelines
(Borrowed from LNE and Dr. R.S.) (Thanks, Dr. S...and for kind
comments, as well).
Interesting...if you notice... Johnson and Stricker note three of the
panelists were carryovers from the IDSA panel, as well as the Chair.
But the AAN panel is comprised of nine...so, three plus the chair...
(assuming the chair votes)...is only four, not a majority. (Still,
with the Chair...you would think they could easily pick-up a fifth).
I suppose that their argument that the Chair could control the panel
has some validity on an intuitive level...but it seems somewhat
speculative, doesn't it?
Did the Chair, in fact, manipulate the panel? Do they present any
evidence that this actually happened?
Or...is this just something that Johnson and Stricker are ARGUING
MIGHT have happened?
Are they suggesting that ALL previous panel members should not have
participated?
If so, why?
They also seem to suggest that the AAN Guideline process was somehow
manipulated to corroborate the IDSA, which was under "investigation"at
the time.
Again, seems like speculation.
===============================================================
PRACTICE PARAMETER: TREATMENT OF NERVOUS SYSTEM LYME DISEASE (AN
EVIDENCE-BASED REVIEW): REPORT OF THE QUALITY STANDARDS SUBCOMMITTEE
OF THE AMERICAN ACADEMY OF NEUROLOGY Neurology 2008;70;1719-1720
To the Editor: We wish to point out a serious ethical problem with the
recently adopted Lyme disease treatment guidelines of the American
Academy of Neurology (AAN).1
These guidelines have been touted as an “independent corroboration” of
the Lyme guidelines published by the Infectious Diseases Society of
America (IDSA) in November 2006.2 Nothing could be further from the
truth. The IDSA and AAN guidelines committees were clearly not
independent in terms of personnel or philosophy.
The AAN guidelines were put together by a committee of nine members,
three of whom also served on the IDSA Lyme guidelines panel, including
the chairman of each committee. The overlapping chairs virtually
assured that the form and substance of the AAN guidelines would be
like-minded—essentially a repackaging of the IDSA guidelines—by
controlling the panel selection and scope of the process. AAN
published its guidelines after the Attorney General of Connecticut
launched an unprecedented investigation into potential anti-trust
violations in the IDSA guidelines formulation.
The AAN guidelines were, not surprisingly, quickly endorsed by IDSA
and presented to the medical community as “independent corroboration”
despite the overlapping panels and questions raised by the Connecticut
investigation. Thus the timing of the AAN guidelines and the IDSA
endorsement compounded the conflict of interest for both
organizations. Two medical societies, IDSA and the International Lyme
and Associated Diseases Society (ILADS), have published peer-reviewed,
evidence based guidelines listed by the government sponsored National
Guidelines Clearinghouse and offering divergent treatment approaches
for Lyme disease.2,3 Under the IDSA guidelines recapitulated by AAN,
patients who fail to respond to the IDSA protocols are denied longer
antibiotic treatment. In contrast, the ILADS guidelines consider these
patients to have chronic Lyme disease and provide the only viable
treatment option for them.
The conflicting guidelines have established two standards of care for
Lyme disease.4 Responsible medical societies have an obligation to
acknowledge scientific uncertainty and lack of consensus when
controversy exists regarding the treatment of medical conditions such
as tick-borne diseases.4 It is unacceptable to repackage the
beleaguered guidelines of another medical society and allow
overlapping panel members with clear conflicts of interest to control
the process. To ignore the conflicts of interest in these
circumstances represents a serious ethical breach that discredits AAN
and misleads the broader medical community, which relies on the
ethical accountability of guidelines panels.5
Raphael B. Stricker, Lorraine Johnson, San
Francisco, CA
Disclosure: The authors report no conflicts of interest.
1. Halperin JJ, Shapiro ED, Logigian E, et al. Practice parameter:
treatment of nervous system Lyme disease (an
evidence-based review): Report of the Quality Standards
Subcommittee of the American Academy of Neurology.
Neurology 2007;69:91–102.
2. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical
assessment, treatment, and prevention of Lyme disease,
human granulocytic anaplasmosis, and babesiosis:
clinical practice guidelines by the Infectious Diseases Society
of America. Clin Infect Dis 2006;41:1089–1134.
3. Cameron D, Gaito A, Harris N, et al, and the ILADS
Working Group. Evidence-based guidelines for the
management of Lyme disease. Expert Rev Anti-Infect
Ther 2004;2(1 suppl):S1–13.
4. Johnson L, Stricker RB. Treatment of Lyme disease: a
medicolegal assessment. Expert Rev Anti-Infect Ther
2004;2:533–557.
5. Steinbrook R. Guidance for guidelines. N Engl J Med
2007;356:331–333.
(Borrowed from LNE and Dr. R.S.) (Thanks, Dr. S...and for kind
comments, as well).
Interesting...if you notice... Johnson and Stricker note three of the
panelists were carryovers from the IDSA panel, as well as the Chair.
But the AAN panel is comprised of nine...so, three plus the chair...
(assuming the chair votes)...is only four, not a majority. (Still,
with the Chair...you would think they could easily pick-up a fifth).
I suppose that their argument that the Chair could control the panel
has some validity on an intuitive level...but it seems somewhat
speculative, doesn't it?
Did the Chair, in fact, manipulate the panel? Do they present any
evidence that this actually happened?
Or...is this just something that Johnson and Stricker are ARGUING
MIGHT have happened?
Are they suggesting that ALL previous panel members should not have
participated?
If so, why?
They also seem to suggest that the AAN Guideline process was somehow
manipulated to corroborate the IDSA, which was under "investigation"at
the time.
Again, seems like speculation.
===============================================================
PRACTICE PARAMETER: TREATMENT OF NERVOUS SYSTEM LYME DISEASE (AN
EVIDENCE-BASED REVIEW): REPORT OF THE QUALITY STANDARDS SUBCOMMITTEE
OF THE AMERICAN ACADEMY OF NEUROLOGY Neurology 2008;70;1719-1720
To the Editor: We wish to point out a serious ethical problem with the
recently adopted Lyme disease treatment guidelines of the American
Academy of Neurology (AAN).1
These guidelines have been touted as an “independent corroboration” of
the Lyme guidelines published by the Infectious Diseases Society of
America (IDSA) in November 2006.2 Nothing could be further from the
truth. The IDSA and AAN guidelines committees were clearly not
independent in terms of personnel or philosophy.
The AAN guidelines were put together by a committee of nine members,
three of whom also served on the IDSA Lyme guidelines panel, including
the chairman of each committee. The overlapping chairs virtually
assured that the form and substance of the AAN guidelines would be
like-minded—essentially a repackaging of the IDSA guidelines—by
controlling the panel selection and scope of the process. AAN
published its guidelines after the Attorney General of Connecticut
launched an unprecedented investigation into potential anti-trust
violations in the IDSA guidelines formulation.
The AAN guidelines were, not surprisingly, quickly endorsed by IDSA
and presented to the medical community as “independent corroboration”
despite the overlapping panels and questions raised by the Connecticut
investigation. Thus the timing of the AAN guidelines and the IDSA
endorsement compounded the conflict of interest for both
organizations. Two medical societies, IDSA and the International Lyme
and Associated Diseases Society (ILADS), have published peer-reviewed,
evidence based guidelines listed by the government sponsored National
Guidelines Clearinghouse and offering divergent treatment approaches
for Lyme disease.2,3 Under the IDSA guidelines recapitulated by AAN,
patients who fail to respond to the IDSA protocols are denied longer
antibiotic treatment. In contrast, the ILADS guidelines consider these
patients to have chronic Lyme disease and provide the only viable
treatment option for them.
The conflicting guidelines have established two standards of care for
Lyme disease.4 Responsible medical societies have an obligation to
acknowledge scientific uncertainty and lack of consensus when
controversy exists regarding the treatment of medical conditions such
as tick-borne diseases.4 It is unacceptable to repackage the
beleaguered guidelines of another medical society and allow
overlapping panel members with clear conflicts of interest to control
the process. To ignore the conflicts of interest in these
circumstances represents a serious ethical breach that discredits AAN
and misleads the broader medical community, which relies on the
ethical accountability of guidelines panels.5
Raphael B. Stricker, Lorraine Johnson, San
Francisco, CA
Disclosure: The authors report no conflicts of interest.
1. Halperin JJ, Shapiro ED, Logigian E, et al. Practice parameter:
treatment of nervous system Lyme disease (an
evidence-based review): Report of the Quality Standards
Subcommittee of the American Academy of Neurology.
Neurology 2007;69:91–102.
2. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical
assessment, treatment, and prevention of Lyme disease,
human granulocytic anaplasmosis, and babesiosis:
clinical practice guidelines by the Infectious Diseases Society
of America. Clin Infect Dis 2006;41:1089–1134.
3. Cameron D, Gaito A, Harris N, et al, and the ILADS
Working Group. Evidence-based guidelines for the
management of Lyme disease. Expert Rev Anti-Infect
Ther 2004;2(1 suppl):S1–13.
4. Johnson L, Stricker RB. Treatment of Lyme disease: a
medicolegal assessment. Expert Rev Anti-Infect Ther
2004;2:533–557.
5. Steinbrook R. Guidance for guidelines. N Engl J Med
2007;356:331–333.
Re: Another shot fired--letter in re AAN Guidelines
On May 21, 10:30 pm, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
> Raphael B. Stricker, Lorraine Johnson, San
> Francisco, CA
(Okay...this is admittedly severely sophomoric and juvenile, but I
just can't help myself...I was just noticing that it is kind of funny
to see Stricker's name next to "Johnson"...
On May 21, 10:30 pm, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
> Raphael B. Stricker, Lorraine Johnson, San
> Francisco, CA
(Okay...this is admittedly severely sophomoric and juvenile, but I
just can't help myself...I was just noticing that it is kind of funny
to see Stricker's name next to "Johnson"...
Re: Another shot fired--letter in re AAN Guidelines
On May 22, 9:42 am, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
> On May 21, 10:30 pm, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
>
> > Raphael B. Stricker, Lorraine Johnson, San
> > Francisco, CA
>
> (Okay...this is admittedly severely sophomoric and juvenile, but I
> just can't help myself...I was just noticing that it is kind of funny
> to see Stricker's name next to "Johnson"...
LOL, you mean next to Longrange Johnson?
On May 22, 9:42 am, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
> On May 21, 10:30 pm, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
>
> > Raphael B. Stricker, Lorraine Johnson, San
> > Francisco, CA
>
> (Okay...this is admittedly severely sophomoric and juvenile, but I
> just can't help myself...I was just noticing that it is kind of funny
> to see Stricker's name next to "Johnson"...
LOL, you mean next to Longrange Johnson?
Re: Another shot fired--letter in re AAN Guidelines
On May 22, 3:30 pm, chronichel...@yahoo,com wrote:
> On May 22, 9:42 am, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
>
> > On May 21, 10:30 pm, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
>
> > > Raphael B. Stricker, Lorraine Johnson, San
> > > Francisco, CA
>
> > (Okay...this is admittedly severely sophomoric and juvenile, but I
> > just can't help myself...I was just noticing that it is kind of funny
> > to see Stricker's name next to "Johnson"...
>
> LOL, you mean next to Longrange Johnson?
Well...I mean it, of course, in pointed reference to Dr. Stricker's
alleged tenure as a "male enhancement" specialist. "Johnson", being a
euphenism for the...part of the male that typically gets enhanced in
such a procedure.
Sure..,it 's a totally cheap, below the belt, shot...but that's what
I'm here for.
On May 22, 3:30 pm, chronichel...@yahoo,com wrote:
> On May 22, 9:42 am, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
>
> > On May 21, 10:30 pm, the 3rd Man <derdrittemann2...@yahoo,com > wrote:
>
> > > Raphael B. Stricker, Lorraine Johnson, San
> > > Francisco, CA
>
> > (Okay...this is admittedly severely sophomoric and juvenile, but I
> > just can't help myself...I was just noticing that it is kind of funny
> > to see Stricker's name next to "Johnson"...
>
> LOL, you mean next to Longrange Johnson?
Well...I mean it, of course, in pointed reference to Dr. Stricker's
alleged tenure as a "male enhancement" specialist. "Johnson", being a
euphenism for the...part of the male that typically gets enhanced in
such a procedure.
Sure..,it 's a totally cheap, below the belt, shot...but that's what
I'm here for.
