The origins of the controversy
The diagnosis and treatment of Lyme disease remain controversial. This is partly due to the fact that scientific understanding of this disease remains undeveloped, but also because many fundamental questions remain unanswered. Among other things, there is still no 100% reliable biological marker for diagnosing the disease. Arguments about diagnostic and therapeutic approaches will tend to persist as long as it is impossible to distinguish infection from non-infection, or to identify markers of cure.
Two views
There are currently two philosophies regarding diagnostic and therapeutic approaches to Lyme disease. One is represented by ILADS (International Lyme and Associated Diseases Society) and the other by IDSA (Infectious Diseases Society of America). While IDSA adopts a narrow perspective, defining the disease in strict terms and resorting to limited treatment options, ILADS adopts a broader perspective, considering more clinical judgment in setting up an appropriate treatment plan.
Both groups have published evidence-based guidelines. By contrast, only those from ILADS remain in the U.S. National Guidelines Clearinghouse, as those from IDSA have been deemed obsolete and non-compliant with current standards. While the IDSA voices concern about over-treatment, ILADS points out that treatment decisions should be based on a risk-benefit analysis for each individual, taking into account the health, financial and quality-of-life issues associated with leaving a patient untreated. Any medical treatment carries risks.
Unfortunately, while scientific understanding of Lyme disease will most likely become clearer in the future, today’s patients can’t afford to wait for future research. Until then, clinicians must take care of people with the disease to the best of their abilities. Although practice guidelines can provide a reasonable starting point, recommendations made on a widespread basis should never be substituted for the doctor’s clinical judgment. As every individual is different, the practitioner must establish a good doctor-patient relationship and balance the benefits and risks of the various treatment plans available.
Raising doctors’ awareness
The AQML’s current mission is to raise awareness of Lyme disease among Quebec physicians, and to provide them with training, conferences and tools to help them manage the chronic form of Lyme disease. We are currently seeking to attract ILADS specialists to Quebec in order to facilitate access to the various continuing training events currently taking place internationally.