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NEW:
Geographic Distribution of Ticks in the United States - CDC Maps 2012
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Analysis of References Used for 2006 IDSA Lyme Disease Guidelines

The evidence clearly shows extreme bias in the selection of references for the IDSA 
Lyme disease guidelines. The previous opinions of the authors were used to support 
the current opinions of the authors. IDSA continues to claim this is “evidence based 
medicine.”

The “evidence based medicine” claim does not factor in any supporting studies 
which may have been designed to achieve a desired outcome to support opinions.

This analysis was prepared for the Connecticut Attorney General Lyme disease 
antitrust investigation in 2008.

Major sections of the IDSA Lyme disease guidelines are in capital letters in blue. 
Subsection titles are in bold font.

TICK BITES AND PROPHYLAXIS OF LYME DISEASE

670 references available on PubMed using the search term “prophylaxis Lyme disease.”

84 references cited by IDSA authors.

84/670 or 12% of available references cited by IDSA authors.

41/84 or 49% of references written by IDSA authors.

59/84 or 70% of references written by IDSA authors and associates.


Reference Analysis of Subsections

Options Considered and Evidence To Support Recommendations

Option 1: antimicrobial therapy for all persons who remove vector ticks
(I. scapularis
or I. pacificus) that have become attached.     

  • 39 references

  • 20 by authors of the 2006 Lyme disease guidelines

  • 6 by collaborators or associates (Schwartz, Rahn, Gerber, Dennis, Luger, Luft, et al)

  • 43 references available on PubMed using search terms “lyme disease + tick removal.

  • Numerical analysis not meaningful since 24 of the IDSA references do not appear to be 
    directly relevant to the topic in this subsection.

Options Considered and Evidence To Support Recommendations

  • Option 2: antimicrobial therapy only for persons believed to be at high risk for Lyme 
    disease (e.g., those removing a nymphal or adult
    I. scapularis tick after 36 h of attachment). 

  • 20 references

  • 5 by authors of the 2006 IDSA Lyme disease guidelines

  • 9 by collaborators or associates (Sood, Telford)

  • 306 references available on PubMed using search terms “lyme disease + therapy + 
    tick bite.”

  • 20/306 or 7% of available references cited by IDSA authors.

  • 5/20 or 25% of references written by IDSA authors.

  • 14/20 or 70% of references written by IDSA authors and associates.

  • 10 IDSA references do not appear to be directly relevant to the topic in this subsection.

  • Options Considered and Evidence To Support Recommendations

  • Option 3: antimicrobial therapy only for persons who develop erythema migrans or other 
    clinical manifestations of Lyme disease or other tick-transmitted infections. 

  • 11 references

  • 8 by authors of the 2006 IDSA Lyme disease guidelines

  • 1 by collaborator or associates (Sigal)

  • 295 references available on PubMed using search terms “lyme disease + therapy + 
    erythema migrans.”

  • 11/295 or 4% of available references cited by IDSA authors.

  • 8/11 or 73% of references written by IDSA authors.

  • 9/11 or 82% of references written by IDSA authors and associates.

  • 5 IDSA references do not appear to be directly relevant to the topic in this subsection.

  • Options Considered and Evidence To Support Recommendations

  • Option 4: antimicrobial therapy for all persons who seroconvert from a negative to a 
    positive test result for serum antibodies against
    B. burgdorferi when acute and 
    follow-up serum samples are tested simultaneously.     

  • 14 references

  • 8 by authors of the 2006 IDSA Lyme disease guidelines

  • 2 by collaborators or associates (Dennis, American College of Physicians Lyme guidelines))

  • 130 references available on PubMed using search terms “lyme disease + therapy + 
    positive test.”

  • 14/130 or 11% of available references cited by IDSA authors.

  • 8/14 or 57% of references written by IDSA authors.

  • 10/14 or 71% of references written by IDSA authors and associates.

  • 3 IDSA references do not appear to be directly relevant to the topic in this subsection.

EARLY LYME DISEASE

Reference Analysis of Subsections

Background and Diagnosis of Erythema Migrans

  • 24 references

  • 15 by authors of the 2006 Lyme disease guidelines

  • 2 by collaborators or associates (Benach, Johnson BJ, Nowakowski, Rahn, Schoen, Schwartz, 
    Clinical Infectious Diseases)

  • 951 references available on PubMed using search term “erythema migrans.”

  • 24/951 or 3% of available references cited by IDSA authors.

  • 15/24 or 63%% of references written by IDSA authors.

  • 17/24 or 71% of references written by IDSA authors and associates.

  • 5 IDSA references do not appear to be directly relevant to the topic in this subsection.


Background and Diagnosis of Early Neurologic Lyme Disease

  • 30 references

  • 25 by authors of the 2006 Lyme disease guidelines

  • 1 by collaborators or associates (Journal of Infectious Diseases)

  • 330 references available on PubMed using search term “neurologic lyme disease.” 
    (62 references available on PubMed using search term “early neurologic lyme disease.”)

  • 30/330 or 9% of available references cited by IDSA authors.

  • 25/30 or 83% of references written by IDSA authors.

  • 26/30 or 86% of references written by IDSA authors and associates.

  • 6 IDSA references do not appear to be directly relevant to the topic in this subsection.

Evidence to support treatment recommendations.     

  • 16 references

  • 7 by authors of the 2006 Lyme disease guidelines

  • 4 by collaborators or associates (Wilske, Clinical Infectious Diseases, Journal of Infectious 
    Diseases)

  • 167 references available on PubMed using search terms “lyme disease + therapy + 
    positive test.”

  • 16/167 or 10% of available references cited by IDSA authors.

  • 7/16 or 44% of references written by IDSA authors.

  • 11/16 or 69% of references written by IDSA authors and associates.

  • 0 IDSA references do not appear to be directly relevant to the topic in this subsection.

Background and Diagnosis of Cardiac Manifestations of Lyme Disease

  • 11 references

  • 3 by authors of the 2006 Lyme disease guidelines

  • 1 by collaborators or associates (Sigal)

  • 265 references available on PubMed using search terms “lyme disease + cardiac.”

  • 11/265 or 4% of available references cited by IDSA authors.

  • 3/11 or 27% of references written by IDSA authors.

  • 4/11 or 36% of references written by IDSA authors and associates.

  • 0 IDSA references do not appear to be directly relevant to the topic in this subsection.

Background and Diagnosis of Borrelial Lymphocytoma

  • 9 references

  • 3 by authors of the 2006 Lyme disease guidelines

  • 3 by collaborators or associates (Wien Klin Wochenschr, Zentralbl Bakteriol)

  • 29 references available on PubMed using search terms “lyme disease + therapy + 
    positive test.”

  • 9/29 or 31% of available references cited by IDSA authors.

  • 3/9 or 33% of references written by IDSA authors.

  • 6/9 or 67% of references written by IDSA authors and associates.

  • 0 IDSA references do not appear to be directly relevant to the topic in this subsection.

LATE LYME DISEASE

Reference Analysis of Subsections

Background and Diagnosis of Rheumatologic Manifestations of Lyme Disease

  • 17 references

  • 14 by authors of the 2006 Lyme disease guidelines

  • 2 by collaborators or associates (Sigal, Journal of Infectious Diseases)

  • 186 references available on PubMed using search terms “rheumatism + lyme disease.”

  • 17/186 or 9% of available references cited by IDSA authors.

  • 14/17 or 82% of references written by IDSA authors.

  • 16/17 or 94% of references written by IDSA authors and associates.

  • 4 IDSA references do not appear to be directly relevant to the topic in this subsection.

Background and Diagnosis of Late Neurologic Lyme Disease

  • 41 references

  • 27 by authors of the 2006 Lyme disease guidelines

  • 7 by collaborators or associates (Coyle, Kaplan, Malawista, Journal of Infectious Diseases)

  • 330 references available on PubMed using search term “neurologic lyme disease.” 
    (56 references available on PubMed using search term “late neurologic lyme disease.”)

  • 41/330 or 12% of available references cited by IDSA authors.

  • 27/41 or 66% of references written by IDSA authors.

  • 34/41 or 83% of references written by IDSA authors and associates.

  • 14 IDSA references do not appear to be directly relevant to the topic in this subsection.

Background and Diagnosis of Acrodermatitis Chronica Atrophicans

  • 14 references

  • 5 by authors of the 2006 Lyme disease guidelines

  • 4 by collaborators or associates (Zentralbl Bacteriol Microbiol, Journal of Infectious Diseases)

  • 322 references available on PubMed using search term “Acrodermatitis Chronica 
    Atrophicans
    .”

  • 14/322 or 4% of available references cited by IDSA authors.

  • 5/14 or 36% of references written by IDSA authors.

  • 9/14 or 64% of references written by IDSA authors and associates.

  • 0 IDSA references do not appear to be directly relevant to the topic in this subsection.

POSTLYME DISEASE SYNDROMES

Reference Analysis of Subsections

Outcomes evaluated.     

  • 4 references

  • 0 by authors of the 2006 Lyme disease guidelines

  • 3 by collaborators or associates (Schoen, Clinical Infectious Diseases, Journal of Infectious 
    Diseases)

  • 9 references available on PubMed using search term “post-lyme disease syndromes.”

  • 4/9 or 44% of available references cited by IDSA authors. (Note; none of the PubMed 
    references are cited by the IDSA authors.)

  • 4/9 or 44% of references written by IDSA authors.

  • 4/9 or 44% of references written by IDSA authors and associates.

  • 4 IDSA references do not appear to be directly relevant to the topic in this subsection.

Background and diagnosis of patients with post–Lyme disease syndromes.     

  • 48 references

  • 24 by authors of the 2006 Lyme disease guidelines

  • 8 by collaborators or associates (Gerber, Malawista, Rahn, Schoen, Sigal, Clinical Infectious 
    Diseases, Journal of Infectious Diseases)

  • 14 references

  • 5 by authors of the 2006 Lyme disease guidelines

  • 4 by collaborators or associates (Zentralbl Bacteriol Microbiol, Journal of Infectious Diseases)

  • 20 references available on PubMed using search term “post-lyme disease syndrome.”

  • NM of available references cited by IDSA authors. (IDSA references greater than available 
    PubMed references.)

  • 24/48 or 50% of references written by IDSA authors.

  • 32/48or 67% of references written by IDSA authors and associates.

  • 30 IDSA references do not appear to be directly relevant to the topic in this subsection.

Post–Lyme disease syndrome, posttreatment chronic Lyme disease, and chronic Lyme 
disease.     

  • 27 references

  • 9 by authors of the 2006 Lyme disease guidelines

  • 12 by collaborators or associates (Coyle, Dennis, Krupp, Radolf, Rahn, Schoen, Sigal, American 
    College of Physicians)

  • 14 references

  • 730 references available on PubMed using search term “chronic lyme disease.”

  • 27/730 or 4% of available references cited by IDSA authors.

  • 9/27 or 33% of references written by IDSA authors.

  • 21/27 or 78% of references written by IDSA authors and associates.

  • 14 IDSA references do not appear to be directly relevant to the topic in this subsection.

Do viable B. burgdorferi persist in tissues despite antibiotic treatment?     

  • 55 references

  • 16 by authors of the 2006 Lyme disease guidelines

  • 6 by collaborators or associates (Barbour, Barthold, Malawista, Marques, Journal of Infectious 
    Diseases)

  • 80 references available on PubMed using search term “B. burgdorferi persistence.”

  • NM of available references cited by IDSA authors. (Only 3 of available references are 
    cited by the IDSA authors.)

  • 16/55 or 29% of references written by IDSA authors.

  • 20/55 or 36% of references written by IDSA authors and associates.

  • 19 IDSA references do not appear to be directly relevant to the topic in this subsection.

Evidence to support treatment recommendations

  • 14 references

  • 3 by authors of the 2006 Lyme disease guidelines

  • 4 by collaborators or associates (Barthold, Kaplan, Krupp, CDC (citations provided by IDSA)

  • 384 references available on PubMed using the search term “chronic lyme disease 
    treatment.” (32 references available on PubMed using search term “
    B. burgdorferi 
    persistence + treatment
    .”)

  • 14/384 or 4% of available references cited by IDSA authors.

  • 3/14 or 21% of references written by IDSA authors.

  • 7/14 or 50% of references written by IDSA authors and associates.

  • 3 IDSA references do not appear to be directly relevant to the topic in this subsection.



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