Infectious Diseases Society of America - Lyme Disease Treatment Guidelines

Lyme Disease Treatment Guidelines

The IDSA recommends against long-term antibiotic treatment for Lyme disease, arguing that it is ineffective and potentially harmful. The American Academy of Neurology and National Institutes of Health similarly recommend against such treatment. However, a minority view holds that chronic Lyme disease is responsible for a range of medically unexplained symptoms, sometimes in people without any evidence of past infection. Groups of patients, patient advocates, and physicians who support the concept of chronic Lyme disease have organized to lobby for recognition of this diagnosis, as well as to argue for insurance coverage of long-term antibiotic therapy. Such groups have been critical of the IDSA guidelines on Lyme disease. Both sides of the argument were outlined in the 2008 American documentary film Under Our Skin.

In 2006, Connecticut Attorney General Richard Blumenthal announced an antitrust investigation against the IDSA, accusing the IDSA Lyme disease panel of undisclosed conflicts of interest and of unduly dismissing alternative therapies and "chronic" Lyme disease. Blumenthal's investigation was closed on May 1, 2008 without charges when the IDSA agreed to submit its guidelines for review by a panel of independent scientists and physicians. Views on the motivation and outcome of the investigation varied. Blumenthal's press release described the agreement as a vindication of his investigation and repeated his conflict-of-interest allegations. The IDSA pointed to the closure of the investigation without charges, and the fact that the medical validity of the IDSA guidelines was not challenged. The IDSA cited mounting legal costs and the difficulty of presenting scientific arguments in a legal setting as their rationale for accepting the settlement. A Forbes piece described Blumenthal's investigation as "intimidation" of scientists by Blumenthal, an elected official with close ties to Lyme advocacy groups. The Journal of the American Medical Association described Blumenthal's investigation of the IDSA as an example of the "politicization of health policy" against the weight of scientific evidence, and voiced concern over a chilling effect on future decisions by medical associations.

Pursuant to their agreement with Blumenthal the IDSA guidelines were reviewed by an independent panel subject to strict conflict-of-interest guidelines and vetted by a medical ethicist. The panel supported the original IDSA guidelines, finding that "chronic Lyme disease" and "post Lyme syndrome" lack clear definitions and convincing biological evidence. Further, the report emphasized that several prospective clinical trials of prolonged antibiotic therapy for persistently symptomatic patients uniformly showed evidence of harm without convincing evidence of benefit. Nonetheless, some groups have continued to criticize the IDSA guidelines after the 2012 review.