What about "evidence-based medicine"? was ILADS guidelines now online -

From: Phyllis Mervine (pmerv_at_direcway.com)
Date: 11/30/04 

Date: 30 Nov 2004 12:51:41 -0800

The Role of Evidence and Consensus in Medicine. The amount of
attention "evidence-based" medicine has garnered is disproportionate
to the relatively small role that it plays in medical practice. Most
medicine, even widely accepted medicine, is not based on rigorous
scientific studies. The Institute of Medicine (IOM), which has
prepared national standards for guideline development, considers the
hypothetical data set forth in Figure 1 indicative of how scientific
evidence and consensus might be distributed across the entire range of
health care services.[123] Medical services for which there is strong
scientific evidence constitute only 4% of total medical services
provided, while 51% of services have poor or lack supportive
scientific evidence. Clearly, the bulk of medical practice is about
managing uncertainty in the absence of dispositive research. [124]

A recent article indicates that only 20% of medical practice is
confirmed by rigorous scientific research.[125] Although some argue
that this percentage is unduly pessimistic, no one disputes that most
of medicine is not reflected in controlled studies.[126] For example,
many well accepted practices, like cardiopulmonary resuscitation,
close observation of suicide risk patients, blood transfusion,
surgical treatment of low back pain, and the treatment of meningitis
with antibiotics, have no rigorous and little non-rigorous science to
support their use. [126, 127] Similarly, most advances in surgery
result from clinical innovations on the part of the treating
physician, and the "off-label" use of prescription medications is well
accepted[121]. These practices show how dangerous the leap is from
"without substantial evidence" to "without substantial value."[126]

FROM Johnson L, Stricker RB. Treatment of Lyme disease: a
medicolegal assessment. Expert Rev Anti Infect Ther. 2004
Aug;2(4):533-57.

For your own copy of the entire article, send $15 to CALDA, PO Box
1423, Ukiah CA 95482.

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