This NY Times article was just published about the role of guidelines in health care, and applies to the 2 standards of care for the diagnosis and treatment of Lyme disease (The IDSA and ILADS guidelines). The IDSA guidelines have not been updated since 2006, and do not contain the most up to date scientific research. In The Analysis of Overall Level of Evidence Behind Infectious Diseases Society of America Practice Guidelines, by Dong Heun Lee, MD and Ole Vielemeyer, MD, published in the Archives of Internal Medicine in 2011 (Arch Intern Med. 2011;171(1):18-22), they analyzed the strength of recommendation and overall quality of evidence behind 41 IDSA guidelines released between January 1994 and May 2010 and concluded that “more than half of the current recommendations of the IDSA are based on level III evidence only (opinion). Until more data from well-designed controlled clinical trials become available, physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions. On the other hand, the ILADS guidelines that were just published in a peer reviewed medical journal this past year, used a rigorous evidence assessment scheme (called GRADE), that were recommended by the Institute of Medicine (IOM), incorporating both up to date peer reviewed science with patient preferences. The IDSA guidelines do not work in clinical practice for those Lyme patients suffering from chronic persistent symptoms, and the recent CDC data published in 2013 showed that over 50% of physicians do not treat Lyme Disease using IDSA guidelines, and treat for longer periods than one month, consistent with ILADS guidelines. The author points out in this NY Times opinion piece that We have to get smarter about how we try to improve medical care. I believe the next phase of quality improvement will be a move away from homogenizing care and toward personalizing it.. The Lyme-MSIDS model described in my book Why Cant I Get Better? is an example of personalized medicine. There are up to 16 overlapping medical conditions which can simultaneously impact a patients health, and no two patients are exactly the same. Addressing individual variations in an illness through doing a comprehensive history and physical, laboratory evaluation and differential diagnosis, while applying the 16 point MSIDS map, helps the majority of my patients suffering from chronic tick-borne illness to improve their health. Although guidelines can be useful, a one size fits all model simply does not work in the practice of medicine. nytimes/2014/12/11/opinion/dont-homogenize-health-care.html?smid=tw-share&_r=1
Posted on: Sun, 14 Dec 2014 16:58:08 +0000
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