Re: IDSA GUIDELINES ATTEMPT TO NARROW THE DEFINITION OF LYME DISEASE AND PROMOTE A LEGAL STANDARD OF CARE THAT CAN BE USED BY INSURANCE COMPANIES AND STATE MEDICAL BOARDS


pmerv@xxxxxxxxxx wrote:


NO, Phyllis...a medical "standard of care" and a LEGAL "standard of
care" are two different, (although somewhat related), entities.

Here is a thumbnail definition of the legal standard from Wikipedia (US
law principles):
---------------------------------------------------------------------------------------------------------------------------
"In tort law, the standard of care is the degree of prudence and
caution required of an individual who is under a duty of care. A breach
of the standard is necessary for a successful action in negligence.

The requirements of the standard are closely dependent on
circumstances. Whether the standard of care has been breached is
determined by the trier of fact, and is usually phrased in terms of the
reasonable person. It was famously described in Vaughn v. Menlove
(1837) as whether the individual "proceed[ed] with such reasonable
caution as a prudent man would have exercised under such
circumstances".

In certain industries and professions, the standard of care is
determined by the standard that would be exercised by the reasonably
prudent manufacturer of a product, or the reasonably prudent
professional in that line of work. Such a test (known as the 'Bolam
Test') is used to determine whether a doctor is liable for medical
malpractice.

A special standard of care also applies to children, who are held to
the behavior that is reasonable for a child of similar age, experience,
and intelligence.
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You simply CANNOT establish a "legal" standard of care through passing
advisory GUIDELINES from a committee of a private professional medical
association.

It just don't work that way.

Nope.

What you said above is incorrect and VERY misleading.


Post-Lyme Disease Syndromes

There is no well-accepted DEFINITION of post-Lyme disease
syndrome. This has contributed to confusion and controversy and to a
lack of firm data on its incidence, prevalence, and pathogenesis. In an
attempt to provide a framework for future research on this subject and
to reduce DIAGNOSTIC ambiguity in study populations, a DEFINITION for
post-Lyme disease syndrome is proposed in these guidelines. Whatever
definition is eventually adopted, having once had OBJECTIVE EVIDENCE of
B. burgdorferi infection must be a condition sine qua non. Furthermore,
when laboratory testing is done to support the original DIAGNOSIS of
Lyme disease, it is essential that it be performed by well-qualified
and reputable laboratories that use recommended and APPROPRIATELY
VALIDATED TESTING methods and interpretive criteria. Unvalidated test
methods (such as urine antigen tests or blood microscopy for Borrelia
species) should not be used.

So?

Isn't that exactly what they've always said?

What has changed that warrants this drastic doom and gloom approach?

And isn't that correct? There really is no firm definition, is there?

There is NO CONVINCING BIOLOGIC EVIDENCE for the existence of
symptomatic chronic B. burgdorferi infection among patients after
receipt of recommended treatment regimens for Lyme disease. Antibiotic
therapy has not proven to be useful and is not recommended for patients
with chronic (⩾6 months) subjective symptoms after recommended
treatment regimens for Lyme disease (E-I).

Again, isn't this what they have always said?

And...notice the word "convinvcing"...this qualifying adjective
actually seems to acknowledge that there is EVIDENCE...just not
"convincing" evidence...so actually, you might interpret that as a step
forward.
...


In many patients, posttreatment symptoms appear to be more related
to the aches and pains of daily living rather than to either Lyme
disease or a tickborne coinfection. Put simply, there is a relatively
high frequency of the same kinds of symptoms in "healthy" people.

Well, that's not particularly tactful or helpful, but does that
warrant a protest and a trip to the AG's office?

Hell, anyone who has been through this probably knows their GP is
capable of thinking that sort of thing all by themself.

There is sensitivity to having complaints labeled as
"subjective"...because the patient knows they are real, but the patient
needs to understand that, in context, this means that they are either
incapable of independent verification, or that they may not be unique
or specific to this particular disease or condition.


Remember that these are the OPINIONS of a private professional medical
organization.

Aren't they entitled to their FREEDOM OF SPEECH?

...

Unfortunately, it is apparent that the term "chronic Lyme disease" is
also being applied to patients with vague, undiagnosed complaints who
have never had Lyme disease. When adult and pediatric patients regarded
as having chronic Lyme disease have been carefully reevaluated at
university-based medical centers, consistently, the majority of
patients have had no convincing evidence of ever having had Lyme
disease, on the basis of the absence of objective clinical,
microbiologic, or serologic evidence of past or present B. burgdorferi
infection [253, 268, 295-298].


Well, that seems to be their OPINION or conclusion, there...and I
really do not have enough information to be able to say one way or the
other whether it is accurate or not.

In essence, are many cases of Lyme over-diagnosed?

Who knows?

But again, Phyllis...isn't THAT what they have been saying since, at
least, 1993?

AGAIN, WHERE IS THE THING IN THESE VOLUNTARY GUIDELINES THAT IS SO
DRASTICALLY AWFUL (AND NEW) THATY PUTS EVERYONES'S LIVES IN DANGER?

HUH?

WHAT IS GOING ON HERE?

.

Relevant Pages

  • Roanoke Response 2005: Standard of care for Lyme is under dispute
    ... Medicine was accurate but incomplete ("Shining a light on Lyme ... the charges of improper patient care stemmed from ... treat patients suffering from Lyme disease. ... At issue is the standard of care followed by most physicians (Centers ...
    (sci.med.diseases.lyme)
  • Re: vaccinations
    ... What, specifically, in the standard protocol for care of pertussis ... and measles do you object to? ... denied the patients fresh air and even water. ...
    (misc.health.alternative)
  • Lyme Disease: Two Standards of Care
    ... Lyme Disease: Two Standards of Care ... The central difficulties in the diagnosis and treatment of Lyme disease ... treat patients, not by treatment guidelines.Moreover, more than ...
    (sci.med.diseases.lyme)
  • Re: D programming language
    ... Don't care, maybe nice to have. ... Function overloading: Standard. ... Resizeable arrays: ... Multiple Inheritance: Big disadvantage! ...
    (comp.programming)
  • Re: the real issue in the Jones case
    ... medical board in the country without exception), ... say that Lyme patients do NOT have access to care. ... But it IS the standard of care. ... congenital Lyme is common, just argue that it happened here. ...
    (sci.med.diseases.lyme)