Wacky Wonk of the West whines again

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Spanky
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Wacky Wonk of the West whines again

Post by Spanky » Fri 18 Jun 2010 19:31

The Wonk, predictably, along with Dr. Stricker, has issued a "peer-reviewed" "research" article...which appears to be the equivalent of a little-league mom screaming at the umpire as to why junior got robbed, got a bad call at the plate.

Nah. You LOST. 8-0, was the final score. No runs, no hits...lots and lots of errors.

Anyway, here is where you can find the entire text of the thing:

http://www.peh-med.com/content/pdf/1747-5341-5-9.pdf

You might want to have a look if you are experiencing difficulty getting to sleep recently. This appeared at the Wonksite, and then disappeared:
LYMEPOLICYWONK: IDSA guidelines: A cautionary tale about development of clinical practice guidelines

Dr. Stricker and I have published a new peer-reviewed article on the flawed IDSA Lyme guidelines development process, the antitrust investigation, and the lack of impartiality in the mandated review process run by the IDSA. (Johnson L, Stricker R. “The Infectious Diseases Society of America Lyme guidelines: A cautionary tale about development of clinical practice guidelines,” Philosophy, Ethics, and Humanities in Medicine;5:9 2010.) The article is open access and may be freely distributed. The two lead in quotes set the stage. The first is by one of the nation’s founding fathers, Thomas Jefferson: ‘Without health, there is no happiness’. The second quote is by Thucydides and speaks to power and its abuse. ‘The strong do what they can; the weak endure what they must’.
Nonetheless...it is sort of morbidly curious in some respects, as it seems to give a sense of what the dysfunctional thinking is behind some of the Wonk's antics actually are...so...here are some things that I found curious:
Traditionally, there has been no legal remedy for a flawed guideline development process.
However, in October 2007, the Attorney General of Connecticut launched a ground-breaking
antitrust investigation into the development of Lyme disease treatment guidelines by IDSA, one
of the largest medical societies in the United States [2]. As discussed below, antitrust law is
concerned with abuses of power by those who have it. Ultimately, antitrust laws focus on
actions by ‘dominant’ organizations that constrain consumer choice and employ ‘exclusionary
conduct’ to suppress the views of competitors
. In medicine, guidelines that limit the access of
patients to treatment options may constrain consumer choice. The emphasis of antitrust law in
the context of treatment guidelines is on the fairness or integrity of the guideline development
process.
Well, no. We don't in the United States, normally use legal process to attack the expression of views of others...or proceed against them on that basis under the antitrust laws. We don't subject "monopolies of opinion" to antitrust scrutiny.

And whatever claims of the "unprecedented" nature of the antitrust action or what its "conclusions" were...none of that has ANY legal signifigance, whatever. NONE. None of that was ever judicially sanctioned in open Court. There was never even a judicial opinion that this type of "investigation" was at all appropriate under applicable antitrust laws.

Antitrust laws have evolved as a reaction to MARKETPLACE competition...unfair competition within the economic, capitalist system. They are meant as a legal remedy to a monopolistic ECONOMIC abuse.

http://en.wikipedia.org/wiki/Competition_law
Competition law, or antitrust law, has three main elements:

1.Prohibiting agreements or practices that restrict free trading and competition between business. This includes in particular the repression of free trade caused by cartels.

2.Banning abusive behavior by a firm dominating a market, or anti-competitive practices that tend to lead to such a dominant position. Practices controlled in this way may include predatory pricing, tying, price gouging, refusal to deal, and many others.

2.Supervising the mergers and acquisitions of large corporations, including some joint ventures. Transactions that are considered to threaten the competitive process can be prohibited altogether, or approved subject to "remedies" such as an obligation to divest part of the merged business or to offer licenses or access to facilities to enable other businesses to continue competing.
Wonkin' on...
IDSA guidelines may serve as a proxy for the standard of care applied by medical boards in
unprofessional conduct actions. Before commencing an action, medical boards commonly refer
potential actions out for ‘expert’ review by members of IDSA [17]. In addition, IDSA-affiliated
physicians testify against non-complying physicians in unprofessional conduct actions
[18].
When organizations wield this amount of power, they can run afoul of antitrust law if they
attempt to exclude competing viewpoints, fail to control conflicts of interest, and restrict
consumer choice.
And does that then, somehow implicate the IDSA as a whole? Ridiculous.
IDSA contends that it does not intend for its guidelines to be applied as mandatory treatment
protocols [20]. However, the guidelines do not provide for treatment options or the exercise of
clinical discretion, and they fail to acknowledge the existence of divergent treatment approaches
[10].
Blatantly false.
The authors of this article stand on the minority side of this debate, and the first author was
instrumental in developing the antitrust theory with a colleague, Richard Wolfram, a New York based
antitrust attorney, and in presenting that theory to the Connecticut Attorney General. Each
of the authors serves on the board of directors of CALDA and ILADS, although this article has
been written in their individual, rather than organizational capacities
.
In addition both presented
testimony before the IDSA Lyme guidelines review panel.
ROTFL. Yeah, we are 'just folks', here...not wearing our CALDA hats,now, at all. Oh, no.... But when an IDSA member testifies in a disciplinary hearing? LOL. Nonsense. Absolute blithering hypocrisy.

(I mean do you, can you, believe that one? LOL...translation: "well, yeah, Dr. Stricker treats patients with longterm antibiotics, the advisability of which is directly at issue, here...and he sits on the board of a business/public advocacy organization that I run and am a salaried employee of, that advocates the longterm use of antibiotics...but we are NOT talking about OUR financial interests, here...no...we have ascended the mountain and are only talking at the highest ethical, philosophical heights of legal-medico type-stuff"). :lol:
According to Richard Wolfram, the antitrust attorney in New York who was involved in the
investigation,
‘Because standard setting by competitors supplants competition, the process must
be fair, open, and not subject to any bias by participants with economic interests in stifling
completion, especially when the standard-setting is done by an association…that is highly
influential or dominant in the relevant market place’[17].
Say what? What do you mean "?

"...involved in the INVESTIGATION"?

How? In what way? You mean that this pal of the Wonk's was involved, worked on the investigation itself? And by the way...here is what the Wonk had to say about this, some time ago on the Wonksite:
In Fall of 2005, I received a call from my husband who was attending a high school reunion in Texas. He was having coffee with an old high school friend, Richard Wolfram, an antitrust attorney based in New York. My husband set his cell phone on speaker and placed it in the middle of the table, saying, “I think you two need to talk about antitrust and the IDSA.” With that began a collaborative effort between Richard and me to develop the antitrust theory that would become the basis for the investigation.

Three months into the project, my husband died and Richard relentlessly prodded me to continue with the project. With the antitrust legal framework in hand, we needed to capture the interest of an Attorney General who had the vision and intestinal fortitude to launch an investigation. Time for Lyme, which had assisted with the Connecticut Attorney General Lyme hearings in 2004 contacted their office and arranged a meeting for Richard and me to discuss a potential investigation. From developing the theory and working out the factual base to fielding issues in the settlement, including panel selection, presenter selection, timeframes, and even viewing issues for the hearing, we could not have undertaken this effort without Richard’s assistance.

My legal efforts on the project were provided without charge as a CALDA volunteer. Richard donated an enormous amount of time at no charge and his other legal costs were provided at a substantial discount. The legal costs were borne by CALDA,
http://www.lymedisease.org/news/lymepolicywonk/179.html

When she says that the costs of Richard's work were "borne by CALDA"...I assume what she MEANT to say was that the costs were borne by the contributions of Lyme patients.

(Cont'd. below).
Last edited by Spanky on Fri 18 Jun 2010 21:31, edited 7 times in total.

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Spanky
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Re: Wacky Wonk of the West whines again

Post by Spanky » Fri 18 Jun 2010 20:10

But maybe we FINALLY get some hints, clues, ideas of what the Wonkin' notion of conflicts involved in the process actually were:
While conflict of interest abuses related to medications used to treat diseases are well known,
conflicts may extend to any commercial area of medicine. As pointed out in a previous forum
[7], the IDSA Lyme guidelines restrict the definition of the disease and mandate laboratory
testing.
Guidelines that restrict the definition of a disease can favor vaccine developers when
they serve to increase the reported rate of effectiveness for a vaccine.
Guidelines that mandate
testing for diagnosis of a disease promote the interests of those who hold patents on diagnostic
tests. Guidelines that deny treatment to patients further the financial interests of insurers and
their consultants. Attorney General Blumenthal found that the IDSA Lyme guidelines panel had
financial conflicts of interest in each of these areas [2].
This, to me, is just incredible. In the true sense of the word "incredible" as not being capable of belief.
These are NOT even apparent or perceived conflicts. It looks as though what they are saying is that some of these "opinion leader researchers" MAY have, in essence, "laid down on the job" in order to POSSIBLY increase the value of potential vaccines.

Blatant, blithering, babbling IDIOCY. Complete "maybe, could be" speculation, AT BEST. GEEZ. You mean THAT is what it was? Oh, my...

More...

Conflicts of Interest
One of the paramount deficiencies identified by Sniderman and Furberg in guidelines
development arises from conflicts of interest. The Institute of Medicine (IOM) defines a conflict
of interest as ‘a set of circumstances that creates a risk that professional judgment or actions
regarding a primary interest will be unduly influenced by a secondary interest’ [25]. This
determination requires identifying a primary interest and a secondary interest. The primary goal
of medicine that should stand at the center of treatment guidelines is to ‘[improve] health by
providing beneficial care to patients’ [25]. Secondary interests ‘may include not only financial
gain but also the desire for professional advancement [and] recognition for personal
achievement’ [25].

This emphasis on primary versus secondary interests arises from the
divergent goals of medicine (improving patient health outcomes) and commerce (ensuring a
financial return to shareholders) [25].
Not all conflicts are of equal severity. The IOM suggests that conflicts should be assessed by
considering both the likelihood of adversely affecting the primary interest and the seriousness of
the harm caused by the conflict:

Likelihood depends on the value of the secondary interest, the scope of the relationship
between the professionals and the commercial interests, and the extent of discretion that
the professionals have. Seriousness depends on the value of the primary interest, the
scope of the consequences that affect it, and the extent of accountability of the
professionals [25].
Yeah...see, when you are knocking down big bucks for treating Lyme with extended antibiotic therapy...that gives you a powerful economic stake in the outcome of the debate. Talking about an actual, direct financial conflict. Not a "maybe", what if type...

But you simply cannot argue that ILADS is a "market competitor" out of one corner of your mouth...and then insist that they don't have a vested interest out of the other...you tend to look like a fool.

Now, see how the Wonk just can't get that concept:
Potential panelists were screened for conflicts of interest by an outside ethicist, Howard A.
Brody, Director of the Institute for Medical Humanities at the University of Texas Medical
Branch in Galveston. The fact that an ethicist screened panel members for potential conflicts of
interest does not mean that these conflicts were removed from the process. For one thing,
Brody, who was paid by the IDSA for his services, surprisingly excluded from the panel any
physician who earned more than $10,000 per year from treating Lyme disease [
63]. The primary
interest of patient guidelines is to provide improved patient treatment outcomes, and it is difficult
to see how physicians who treat patients on a fee-for-service basis would have a secondary
competing interest".
No, it ain't hard at all to see how they have a "secondary competing interest"... and a much more substantial, direct one than that alleged by the Wonk. Like everyone else, they like to eat. And treating patients beyond IDSA Guidelines butters their bread.

Finally:
On April 22, 2010, the IDSA review panel released its report [68]. Despite the voluminous
testimony presented by ILADS, the panel voted almost unanimously to uphold the guidelines
without exception. Carol Baker, the panel chair and former president of IDSA, stated that for 69
guideline recommendations the panel found that each was “medically and scientifically justified
in light of all the evidence and information and required no revision.” The panel report expressed
concern that prolonged use of antibiotics puts patients in danger of serious infection while not
improving their condition.
Yes.

And the Wonk may have been the only one out there who was "waiting on tenterhooks" for that one.

And that's because the Wonk still cannot focus on the narrow issue at hand (as good lawyers are taught to do)...

...which was simply whether the best scientific evidence currently available supported longterm, or extended antibiotic therapy...or not.

Not surprisingly, the Review Panel found that it does not.

I cannot begin to imagine how this thing qualifies as a "research" article...or who, in their right mind, would willingly admit that they "peer-reviewed" it.

Martian
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Re: Wacky Wonk of the West whines again

Post by Martian » Fri 23 Jul 2010 21:22

Check http://www.peh-med.com/content/5/1/9/comments for comments on:

The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines - Lorraine Johnson and Raphael B Stricker
Philosophy, Ethics, and Humanities in Medicine 2010, 5:9doi:10.1186/1747-5341-5-9


For example this comment:
Bottom Line: Patient Choice is Paramount

Phyllis Mervine (17 July 2010) California Lyme Disease Association


The Infectious Diseases Society of America (IDSA) Lyme guidelines place commercial interests above quality of patient care, leaving seriously ill patients without effective treatment options. The narrow IDSA diagnostic criteria miss half the cases of Lyme disease, and up to half or more of the patients treated according to these guidelines remain ill. This is not acceptable.

The IDSA guidelines understate the seriousness of chronic Lyme disease, comparing ongoing Lyme symptoms to the "aches and pains of daily living." In contrast, peer-reviewed published studies show that people with chronic Lyme disease have disability and pain comparable to that of people with congestive heart failure and post-surgical pain, respectively. Schoolchildren with Lyme disease are classified as disabled and qualify for accommodations under Section 504 of the Americans with Disabilities Act. Deaths related to Lyme disease have also been reported.

The IDSA guidelines overstate the risks of long-term antibiotic treatment. Long-term treatment under the care of a qualified health care professional has been found to be safe and effective for a number of infectious diseases. The guidelines limit clinical judgment and hold physicians to arbitrary and unproven formulas. The IDSA-endorsed practice of terminating treatment despite persisting symptoms may result in advanced neurological injury, disability and death and constitutes medical negligence.

The California Lyme Disease Association (CALDA) recommends that patients with Lyme disease see a doctor affiliated with the International Lyme and Associated Diseases Society, who will individualize their treatment plan and consider patient preferences. Patients have the right to make informed choices based on their own personal values, just like patients with cancer or other diseases. In our opinion anything less is immoral, illegal, and inhumane.

Phyllis Mervine, EdM
President, CALDA
Editor-in-Chief, Lyme Times

Competing interests

None

Note that the commentators claim not to have competing interests.

X-member
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Re: Wacky Wonk of the West whines again

Post by X-member » Fri 23 Jul 2010 23:41

When IDSA start to talk about biofilm colonies, CWD/L-form, immuno deficiencies (both primary and secondary due to chronic infections perhaps?) and when they understand cystform, then I (maybe) will listen to them!

When IDSA mention all the cases that already have died from Lyme, then I (maybe) will listen to them!

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