Rockpointe Tards Criticize Blumenthal Lyme Fraud Lawsuit
Mort Zuckerman
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Subject: Rockpointe Tards Criticize Blumenthal Lyme Fraud Lawsuit
Date: Jul 14, 2010 2:59 PM
ARTICLE BELOW
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I suspect this report (below) was ghost-written;
no one should pay any attention to this company.
If you check out Thomas Sullivan's background, you
can see it is in business and not science.
The "deception" is in that 1) the term
"Lyme disease" refers to what happened
at Dearborn, MI, to falsify the testing,
and 2) the Lyme tards of IDSA tried to give
people the failed HIV vaccine as a Lyme
vaccine, knowing it did not protect
against "Lyme" because it is an immune-
suppressing antigen.
This report is not anything to worry about.
When IDSA can tell us what OspA is,
then we'll listen. But for TLR2-agonizing
OspA to be the failed Tuberculosis, Borreliosis,
and HIV vaccines and for IDSA to think they can
simultaneously claim to be "infectious diseases
specialists" is hilarious.
Kathleen M. Dickson
http://www.actionlyme.org
http://www.relapsingfever.org
========================================
http://www.policymed.com/2010/05/richard-blumenthals-lyme-deception.html
Richard Blumenthal’s Lyme Deception
Connecticut Attorney General Richard Blumenthal has a problem and it
is just not his military record that he is exaggerating about. He has
also exaggerated in promoting his medical/scientific agenda. Mr.
Blumenthal believes that all relationships with industry constitute a
conflict of interest. In doing so he forced a medical society to
spend over a half a million dollars and countless hours of staff and
voulenteer time defending themselves against trumped up anti-trust
charges for issuing clinical guidelines and the state resources on the
hopeless investigation.
Over the last four years he has been attacking a renowned group of
scientists over Lyme’s Guidelines designed to help patients.
Recently those attacks have been discredited by an independent review
of the guidelines and an excoriation of the scientists involved. But
Blumenthal has remained conspicuously quite on this issue.
The Infectious Diseases Society of America (IDSA)[1] represents
physicians, scientists and other health care professionals who
specialize in infectious diseases. IDSA’s purpose is to improve the
health of individuals, communities, and society by promoting
excellence in patient care, education, research, public health, and
prevention relating to infectious diseases.
One of the many responsibilities of IDSA is to create disease practice
guidelines, which are systematically developed statements to assist
practitioners and patients in making decisions about appropriate
health care for specific clinical circumstances.[2] In 2000, and
updated in 2006 the IDSA released their guidelines for Lyme disease
entitled “The Clinical Assessment, Treatment, and Prevention of Lyme
Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical
Practice Guidelines by the Infectious Diseases Society of America.”[3]
[4]
Despite a multi-year investigation by Connecticut Attorney General
Richard Blumenthal regarding IDSA Lyme disease guidelines, an
independently appointed review panel agreed in its 2010 final report
that all of the 69 original IDSA recommendations were "medically and
scientifically justified."[5] The investigation, which was heavily
charged by patient advocacy groups and Mr. Blumenthal’s individual
advocacy for Lyme disease, revealed that politics and patient beliefs
have no place in guideline making committees.
Lyme Disease
Lyme disease, which was first identified in the Connecticut town of
Old Lyme in 1981, is caused by bacteria related to syphilis that enter
the body through a tick bite. The typical Lyme infection responds to
simple antibiotics, although symptoms like arthritis and fatigue may
linger in a subset of patients.
Researchers at academic medical centers who study the disease say that
chronic Lyme, or post-Lyme, is not very common, hard to detect and not
treatable with any further doses of antibiotics.
Over 20,000 cases of Lyme disease are reported annually[6], although
patient advocates assert that diagnostic testing may fail to identify
up to 50% of patients with Lyme disease.[7]
IDSA's 2006 Guidelines recognized that some patients who have had Lyme
disease have persistent symptoms, including musculoskeletal pain,
chronic fatigue, and cognitive problems sometimes called "brain fog."
But panel members agreed that there was no convincing evidence that
persistent B. burgdorferi infection causes the symptoms and there is
no evidence that it can exist undetected.
As a result, IDSA proposed calling the symptoms "post-Lyme disease
syndrome" and suggested a definition. Basically, the IDSA guidelines
found “no convincing biologic evidence” for chronic Lyme infection.
The guidelines also recommended against antibiotic therapy beyond
short-term treatment of acute infections.
Treatment for Chronic Lyme Disease
While patient advocate groups believe treating chronic Lyme disease
with long-term antibiotics is effective, various studies and
experiences show the contrary. For example, an early study identified
25 patients with gallstones or bile blockage resulting from antibiotic
treatment of unsubstantiated chronic Lyme.[8] In another more recent
study of infused antibiotics published in the New England Journal of
Medicine, the study was cut short after Lyme sufferers with persistent
symptoms did not respond to a course of antibiotics any better than
they did to a placebo.[9]
One patient getting antibiotics had a pulmonary embolism; another had
gastrointestinal bleeding. In addition, a 2007 review article in the
NEJM noted that "chronic Lyme disease, which is equated with chronic
B. burgdorferi infection, is a misnomer, and the use of prolonged,
dangerous, and expensive antibiotic treatments for it is not
warranted."[10]
There was also a paper in the Annals of Internal Medicine called
chronic Lyme a "functional somatic syndrome," similar to other
nebulous ailments like Gulf War Syndrome, chronic fatigue and
fibromyalgia. Another study in the same journal found that 60% of Lyme
disease patients lacked any evidence of previous or active Lyme
infections. Some of these patients suffered from depression, arthritis
or other diseases.[11]
Then there are the cases of various doctors who have been disciplined
for treating patients with Lyme disease, such as Dr. Joseph Jemsek,
who received a "suspension with stay" after a patient of his ended up
in the intensive care unit after his antibiotic infusion regime to
treat her Lyme disease (Lyme, Inc.). Vithaldis Shah, a New Jersey
doctor, had his license yanked for five years in 1993 for sickening
Lyme patients with long-term antibiotic treatments and receiving a
payment from the infusion company. In 1996 a doctor in Michigan was
suspended after conspiring with a home infusion company and
misdiagnosing Lyme patients.
There was also a 2000 study that described the death of an anonymous
woman from complications arising from treating unsubstantiated Lyme
with antibiotics (Lyme, Inc.). Even in Connecticut, Dr. Charles
Jones, a pediatrician, is under investigation by the state medical
board for prescribing, over the phone, antibiotics for chronic Lyme to
two children in Nevada, a desert state with few ticks.[12]
Advocates however point to “studies of chronic Lyme disease that show
a failure rate of 26% to 50%, using the short-term antibiotic
approaches currently advocated by IDSA.”[13] One group, the
International Lyme and Associated Diseases Society (ILADS), a
physician’s group established in 1999 and closely allied with patient
advocates, even published its own Lyme treatment guidelines
recognizing chronic Lyme and endorsing long-term treatment with
antibiotics in 2004.[14]
Connecticut Investigation
Soon after the guidelines were published, patient advocacy groups
reignited a 20-year-old war over whether persistent infection with the
Lyme pathogen, Borrelia burgdorferi, is responsible for long-term
symptoms resembling fibromyalgia. The physicians and patients who
insist that the symptoms are a chronic form of Lyme infection,
treatable with long-term or repeated courses of antibiotics, were
outraged with the 2006 guidelines. To address this controversy, the
New Jersey-based Lyme Disease Association, Connecticut-based Time for
Lyme and the California Lyme Disease Association took their concerns
to Connecticut Attorney General Richard Blumenthal, who has long
supported efforts by chronic-Lyme enthusiasts.
In 1999, he held a hearing on whether health insurance companies were
improperly denying coverage for Lyme treatment. He helped draft a
state law assuring patients access to prolonged antibiotic therapy,
and has been active in patient groups, including a term on the
advisory board of Time for Lyme, according to the organization’s co-
president, Diane Blanchard. He has also criticized the state's health
department for underreporting Lyme infections.
After meeting with chronic-Lyme activists, Blumenthal initiated an
antitrust investigation in November 2006 to determine whether IDSA's
guidelines were an illegal attempt to monopolize medical treatment of
patients with potentially Lyme-related symptoms.[15] In response,
IDSA maintained that it had developed the 2006 Lyme disease guidelines
based on a proper review of the medical/scientific studies and
evidence by a panel of experts in the prevention, diagnosis, and
treatment of Lyme disease.
On May 1, 2008, Blumenthal and the IDSA reached an agreement to end
the investigation, in part because the Federal Trade Commission and
Department of Justice had previously stated a policy that medical-
society guidelines do not inhibit competition.[16] Under the Agreement
and its attached Action Plan, the 2006 Lyme Guidelines remained in
effect, and the Society agreed to convene a Review Panel to determine
whether the 2006 Lyme Guidelines were based on sound medical/
scientific evidence and whether these guidelines required change or
revision.[17] The Review Panel was not charged with updating or
rewriting the 2006 Lyme Guidelines and any recommendation for update
or revision would be conducted by a separate IDSA group.
IDSA was responsible for paying the costs in conducting the re-
evaluation, but it did not pay any fines or penalties, and the
agreement is not an admission of wrongdoing. The costs for numerous
meetings, conference calls and legal fees, cost the association close
to $1 million. In his press release about the agreement Blumenthal
stated that the society’s 2006 guidelines “process lacked important
procedural safeguards requiring complete reevaluation -- in effect a
comprehensive reassessment through a new panel.” Blumenthal's findings
include the following:
* The IDSA failed to conduct a conflicts of interest review for
any of the panelists prior to their appointment to the 2006 Lyme
disease guideline panel;
# Subsequent disclosures demonstrate that several of the 2006 Lyme
disease panelists had conflicts of interest;
# The IDSA failed to follow its own procedures for appointing the 2006
panel chairman and members, enabling the chairman, who held a bias
regarding the existence of chronic Lyme, to handpick a likeminded
panel without scrutiny by or formal approval of the IDSA's oversight
committee;
# The IDSA's 2000 and 2006 Lyme disease panels refused to accept or
meaningfully consider information regarding the existence of chronic
Lyme disease, once removing a panelist from the 2000 panel who
dissented from the group's position on chronic Lyme disease to achieve
"consensus";
# The IDSA blocked appointment of scientists and physicians with
divergent views on chronic Lyme who sought to serve on the 2006
guidelines panel by informing them that the panel was fully staffed,
even though it was later expanded;
# The IDSA portrayed another medical association's Lyme disease
guidelines as corroborating its own when it knew that the two panels
shared several authors, including the chairmen of both groups, and
were working on guidelines at the same time. In allowing its panelists
to serve on both groups at the same time, IDSA violated its own
conflicts of interest policy.
The agreement to reevaluate the 2006 IDSA guidelines by a new society
committee raised questions about conflicts of interest involving
members of the expert panel IDSA had appointed to develop the 2006
guidelines. Specifically, five of the 14 committee members had
disclosed outside financial relationships with drug and diagnostics
companies as well as having served as expert witnesses in malpractice
cases involving Lyme disease, and one member was paid to review
disability claims for Metropolitan Life Insurance. No other panelists
indicated relationships with insurance firms. IDSA denied that any of
these relationships were relevant to the guidelines.[18]
In fact, Gary Wormser, M.D., of New York Medical College in Valhalla,
N.Y., who chaired the 2006 IDSA guidelines panel, refuted Blumenthal’s
claims. He asserted that "panel members had no financial interests
that would have affected, or been affected by, recommendations in the
guidelines.” Specifically, he noted how the guidelines recommended
generic drugs and generic diagnostic tests, evidence that “panel
members do not stand to profit from any recommendation in the
guidelines.” Essentially, panel members “denied themselves and their
colleagues an opportunity to generate a significant amount of revenue
when they recommended against expensive, repeated, long-term
antibiotic therapy."[19]
Blumenthal also criticized what he called "improper links" between
IDSA's panel and one convened by the American Academy of Neurology
(AAN), which also publishes guidelines on Lyme disease treatment
because the infection can penetrate the central nervous system and
cause neurological symptoms. AAN’s guidelines, which were published
online in May 2007, recommended against prolonged courses of
antibiotics for “post-Lyme syndrome,” because “most available data
argue against persistent B. burgdorferi infection in patients who have
received what are normally curative courses of antimicrobial
therapy.”[20]
Although three members served on both panels (John Halperin of New
York University School of Medicine and Atlantic Health System in
Summit, NJ; Yale’s Eugene Shapiro, M.D., and Dr. Wormser), AAN did not
re-evaluate its Lyme guidelines, and rejected Blumenthal's allegation
of "improper links." The organization asserted that the similarity
between the two sets of guidelines is a good thing, because it
"avoided conflicting and potentially confusing professional guidance.”
AAN General Counsel Murray Sagsveen added that “Blumenthal failed to
consider that evidence-based collaboration should actually lead to
similar diagnosis and treatment of a disease among specialties.”[21]
2008 Review Panel
To determine the new committee, IDSA and Blumenthal jointly selected
Howard Brody, M.D., Ph.D., of the Institute for the Medical Humanities
at the University of Texas Medical Branch in Galveston and author of
the anti industry book and blog Hooked on Ethics, Medicine and Pharma,
to fill the post of "ombudsman" to oversee the conflict-of-interest
review. Dr. Brody primarily helped draft a thorough four-page
disclosure form and other procedures for evaluating conflicts of
interest and screened all applicants based on their personal practice
patterns and practice incomes. He wanted to ensure that the Review
Panel[22] Chairperson was without any beneficial or financial interest
related to Lyme disease, any financial relationship with an entity
that has an interest in Lyme disease, and any conflict of interest.
The goal was to create a panel that represented "a balanced variety of
perspectives" and included at least one physician who treats Lyme
disease patients. If an applicant had combined financial or beneficial
interests that exceeded $10,000, in the products or concepts addressed
in the guidelines, IDSA considered those to bias a participant’s
judgment. The Chairman chosen was also required to be trained in
infectious diseases, but may not have published a viewpoint on Lyme
disease diagnosis or treatment. A committee member who served on
earlier Lyme guideline panels was prohibited from selection.
Eventually, Carol J. Baker, MD, of Baylor College of Medicine in
Houston, Texas, was chosen as the Review Panel Chair, along with eight
other review panel members (one panel member retired due to family
illness, leaving a total of eight).[23]
After the panel members were announced, patient groups released a
joint statement calling the new panel “unbalanced and biased,” and
they specifically took issue with the Brody recommendation and
exclusion of physicians who made more than $10,000 treating Lyme
disease.
Pat Smith, president of the Lyme Disease Association, noted how 18
physicians who treated persistent Lyme applied to the panel and were
all excluded (Annals of Neurology).
IDSA noted that anybody making substantial amounts of money treating
people with long-term antibiotics has a clear conflict of interest in
the outcome of this board’s deliberation,” and as a result did not
meet the criteria.
After approximately two years, the Review Panel published the Final
Report of the Lyme Disease Review Panel of IDSA) on April 22, 2010. In
conducting their review, the Panel held a public input period of more
than 80 days to allow the public to submit information and to ensure
that all points of view were taken into consideration. The Panel
received submissions from approximately 150 individuals or
organizations, including various sources of information (e.g. medical
records, DVDs, etc).
The Review Panel held an all-day open public hearing on July 30, 2009,
in Washington, DC, to offer a forum for the presentation of relevant
information on the diagnosis and treatment of Lyme disease. An open
application process was held to identify hearing presenters. Thirty-
five applications were received and were reviewed and approved by the
AG’s Office to determine the final list of presenters for the July
hearing. Two patients and 16 physicians or researchers were chosen to
present. The hearing was broadcast live via webcast, on the IDSA
website and transcripts, slides, and testimony were posted.
In addition, Panel members and staff used PubMed and the Cochrane
Collaboration Library for research to look for various terms
associated with Lyme disease, and reviewed full-text articles. All
together, the panel reviewed over 1,000 sources of information.
Each Review Panel member was then assigned a section of the 2006 Lyme
Guidelines and was tasked with the careful review of the evidence and
other information submitted and/or presented relevant to that section.
All Review Panel members were required to comprehensively review the
section on Post-Lyme Syndromes. The Panel met several times in person
and via conference call, to present the findings of their research on
their assigned sections. An open discussion among Panel members took
place, and each member made an individual determination as to whether
each recommendation in the 2006 Lyme Guidelines was medically/
scientifically justified in light of the evidence and information
collected and provided, and whether or not a change or revision was
needed. Each member’s vote was recorded.[24]
Accordingly, after a review of the 2006 guidelines, the panel agreed
that all of the 69 original recommendations were "medically and
scientifically justified" in the light of the evidence.[25] The
agreement had stipulated that any committee recommendation would
require a 75% "supermajority" vote. The vote was unanimous (8-0) for
68 out 69 of the recommendations. The recommendation approved by a 7-
to-1 margin specifically regarded the issue of chronic Lyme disease.
For that particular issue, the panel recommended that when the 2006
Lyme Guidelines are next updated, to change the phrase “no convincing
biologic evidence” to something more specific, such as “reports
purporting to show the persistence of viable B. burgdorferi organisms
after treatment with recommended regimens for Lyme disease have not
been conclusive or corroborated by controlled studies.” The panel also
stated that to date, drug-tolerant reservoirs of B. burgdorferi,
including intracellular cystic forms, has not been shown to correlate
with symptom persistence, nor has eradication of these forms been
shown to correlate with symptom improvement.
According to Dr. Baker, the panel’s Chair, the review panel came down
on the side of patient safety because "what they found after a
thorough review of all the evidence is that there was significant risk
for patients treated beyond about four weeks, and certainly for
patients treated for years with intravenous therapy."[26] This view is
shared by the CDC[27] and NIH.[28] She further added that not only is
the treatment costly and unlikely to have a benefit, but the catheter
increases the risk of bloodstream infections that can require
intensive care and may even cause death.
Specifically, the report tells physicians that the symptoms often
blamed on chronic Lyme disease -- arthralgias, fatigue, and cognitive
dysfunction -- are seen in many conditions, so that it is "clinically
imprudent to make the diagnosis of Lyme disease using these
nonspecific findings alone."
On the other hand, the panel added, some classic complications of Lyme
disease -- aseptic meningitis, AV nodal block, inflammatory arthritis,
and cranial or peripheral neuropathies – that can be "sufficiently
convincing as to constitute an." The panel said that exception should
be used only when other diagnoses for a patient have been excluded or
are unlikely.
Panel member Paul Lantos, MD, of Duke University Medical Center, said
it's important for physicians faced with a putative case of chronic
Lyme disease to keep an open mind and not rely in previous diagnoses.
He noted that he has treated several patients who thought they had
chronic Lyme disease and turned out to have other serious conditions,
such as endocarditis and multiple sclerosis.
Discussion
There is no doubt that Lyme disease is real, and affects the lives of
thousands of people and their families. But this case exemplifies the
politicization of health policy, with elected officials advocating for
health policies against the weight of scientific evidence. In fact,
as an article in the Journal of the American Medical Association
(JAMA) entitled “Science, Politics, and Values: The Politicization of
Professional Practice Guidelines,” explained, advocacy groups and
Blumenthal “should have sought other answers” when high quality
research repeatedly was inconsistent with the group’s hypotheses.[29]
While it is understandable that in times of pain and suffering people
will look for answers, insisting on a link between the symptoms and
chronic infection as evidence to call for long-term antibiotic
treatments is contrary to scientific evidence. As Kraemer and Gostin
point out, “the scientific process is not democratic, and no amount of
desire for different results can establish them.” Instead, as David
Volkman, an emeritus professor at the State University of New York at
Stony Brook pointed out, what is needed are better diagnostic tools
and objective science.[30]
The IDSA case “sets a precedent for politicians representing the views
of aggrieved constituents to challenge the recommendations and
guidelines of professional societies.”[31] It raised the possibility
that any state attorney general can challenge a clinical practice
guideline that is disfavored by the politician’s constituents. This
opens the door for “special-interest organizations to influence
clinical practice guidelines to reflect their political objectives
rather than accepted, peer-reviewed literature.” As Robert Buchanan,
a medical-antitrust attorney in Boston correctly noted, “medicine must
advance by debate, not hampered by lawsuits."[32]
Upon the announcement of these results, IDSA president Richard
Whitley, MD, of the University of Alabama at Birmingham, said he
thought Blumenthal had been "misguided by the activists," and that his
“contention against IDSA was neither justified nor warranted."[33] As
a result, the outcome has clearly shown that the guideline making
process must be closely protected to “assure that the process and the
science are not subverted by advocacy groups or their political
representatives.”
In addition, the American Medical Association (AMA) House of Delegates
introduced a resolution after the final report to “Support an
Independent Clinical Practice Guideline Development Process.”[34] The
resolution recognized how patient groups and policy makers concerns
can “improperly influence the clinical practice guideline development
process, and also sanction ineffective (and potentially dangerous)
medical treatments.” The AMA also asserted that efforts by policy
makers and patient groups “not only hinder the ability of physicians
to provide safe and effective medical treatments to their patients but
also politicize the clinical practice guideline development process.”
As a result, the AMA’s resolution supported the authority of medical
professional organizations to develop clinical practice guidelines
that are based on sound science and medical evidence. The resolution
also opposed all efforts to improperly influence or politicize
guidelines, and opposed all efforts to legislate the practice of
medicine by mandating coverage of or otherwise sanctioning the
provision of medical treatments that are proven to be ineffective and
potentially harmful.
After the panel announced its final report, Blumenthal gave a
statement saying that his office was "reviewing the IDSA's
reassessment of its 2006 Lyme disease guidelines to determine whether
the IDSA fulfilled the requirements of the settlement."[35] This is
a stark contrast to his 2008 statement “Attorney General's
Investigation Reveals Flawed Lyme Disease Guideline Process, IDSA
Agrees To Reassess Guidelines, Install Independent Arbiter in which
he made a presumptive statement that conflicts of interest in the
guideline creation process as “flawed”.
The Lyme Disease Association, Inc. (LDA) was disappointed with IDSA’s
announcement,[36] especially after significant attention was brought
to Lyme disease when a documentary titled “Under Our Skin” was
released in 2008.[37]
Conclusion
Although the failure of Mr. Blumenthal’s political investigation
brought negative attention towards guideline making committees, the
outcome provided irrefutable evidence that the current guidelines
process is valid. This is despite the accusation by anti industry
academics, politicians and others that guidelines committees need to
eliminate members with relationships with industry. That by and large
because they are committees and not independent judgments, and that
these committees are working on reliable peer reviewed evidence to
make their recommendations.
Patients depend on their doctors to follow guidelines in their
practice to ensure evidence-based treatment. Doctors depend on those
guidelines to establish the best plan for their patients based on
scientific evidence. Investigations like Mr. Blumenthal’s with no
legal basis show just how much time and money can be wasted reviewing
a perfectly legitimate document, when those funds could have been
spent on research.
Attempting to control the guideline creation process leaves
politicians and others open to accusations of rationing health care,
and as the IDSA case demonstrates, politics has no place in
determining scientific evidence. Moreover, routing out all perceived
“conflicts of interest” is meaningless, and potentially harmful to the
guidelines process.
Guidelines are created by committees of dedicated physicians, and with
the Standards for Developing Trustworthy Clinical Practice
Guidelines[38] being considered, the Institute of Medicine (IOM) must
pay close attention to the IDSA investigation that found no evidence
of a conspiracy to shift guidelines. What IOM should weigh in
determining their new standards is how the IDSA case demonstrated that
patients and politicians are easily influenced by antidotal evidence.
If politicians continue to investigate proven scientific evidence,
“medical and public confidence in guidelines will be irreparably
damaged, the guideline development process will be “chilled,” and
members will be discouraged from volunteering to author guidelines.”
Note to Lyme Patients, I have several close friends who have had
complications due to the disease, all have recovered but some were
quite serious. I completely understand your concerns and do not hold
that guidelines should be used to deny coverage by insurance
companies.
This article was written to point out that writers of clinical
guidelines by and large are honest people and that this case proves
conflict of interest is not an issue in guidelines development.
[1] http://www.idsociety.org/MI/about_idsa.htm
[2] http://www.idsociety.org/Content.aspx?id=9088
[3] 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 Disease Society of America. Clin Infect
Dis. 2006;43(9):1089-1134.
[4] http://www.idsociety.org/Content.aspx?id=3744
[5] http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/19699
[6] http://www.forbes.com/forbes/2007/0312/096.html
[7] http://www.prweb.com/releases/2009/07/prweb2669004.htm
[8] http://www.forbes.com/forbes/2007/0312/096.html
[9] Klempner MS, Hu LT, Evans J, Schmid CH, Johnson GM, Trevino RP,
Norton D, Levy L, Wall D, McCall J, Kosinski M, Weinstein A. “Two
controlled trials of antibiotic treatment in patients with persistent
symptoms and a history of Lyme disease.” N Engl J Med. 2001 Jul
12;345(2):85-92.
[10] http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/10092
[11] http://www.forbes.com/forbes/2007/0312/096.html
[12] http://www.forbes.com/forbes/2007/0312/096.html
[13] http://www.prweb.com/releases/2009/02/prweb1941044.htm
[14] http://www.ilads.org/files/ILADS_Guidelines.pdf
[15] http://www.idsociety.org/Content.aspx?id=16515
[16] http://www.ct.gov/ag/cwp/view.asp?a=2795&q=414284
[17] http://www.ct.gov/ag/lib/ag/health/idsaagreement.pdf
[18] http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/10092
[19] http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/10092
[22] http://www.idsociety.org/Content.aspx?id=16523
[23] http://www.idsociety.org/Content.aspx?id=16526
[24] http://www.idsociety.org/Content.aspx?id=16521
[25] http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/19699
[26] http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/19699
[27] Lyme disease treatment and prognosis. CDC Web site.
http://www.cdc.gov/ncidod/dvbid/lyme/ld_humandisease_treatment.htm.
[28] Chronic Lyme disease. National Institute of Allergy and
Infectious Diseases Web site. http://www3.niaid.nih.gov/topics/lymeDisease/understanding/chronic.htm.
[29] Kraemer, JD. Gostin, LO. “Science, Politics, and Values: The
Politicization of Professional Practice Guidelines. JAMA. 2009;301(6):
665-667 (doi:10.1001/jama.301.6.665)
[32] http://www.forbes.com/forbes/2007/0312/096.html
[33] http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/19699
[34] http://www.ama-assn.org/assets/meeting/2010a/idsa1.pdf
[35] http://www.ct.gov/ag/cwp/view.asp?A=2341&Q=459296
[36] http://www.lymediseaseassociation.org/
[37] http://www.underourskin.com/film.html
[38] http://www.iom.edu/Activities/Quality/ClinicPracGuide.aspx
Posted by Thomas Sullivan on May 18, 2010 at 10:58 PM in Clinical
Research, Guidelines, State Policy | Permalink
Technorati Tags: Clinical Guidelines, Connecticut Attorney General,
exaggeration, Infectious Disease Society of America, Lyme’s Disease,
Richard Blumenthal, scholarship., tell the truth
KMDickson
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