J Med Ethics 35:283-288 doi:10.1136/jme.2008.026526
  • Clinical ethics
    • Paper

Attorney General forces Infectious Diseases Society of America to redo Lyme guidelines due to flawed development process

  1. L Johnson1,
  2. R B Stricker2
  1. 1
    California Lyme Disease Association, Ukiah, California, USA
  2. 2
    International Lyme and Associated Diseases Society, Bethesda, Maryland, USA
  1. Dr R B Stricker, 450 Sutter Street, Suite 1504, San Francisco, California 94108, USA; rstricker{at}
  • Received 30 June 2008
  • Accepted 25 February 2009


Lyme disease is one of the most controversial illnesses in the history of medicine. In 2006 the Connecticut Attorney General launched an antitrust investigation into the Lyme guidelines development process of the Infectious Diseases Society of America (IDSA). In a recent settlement with IDSA, the Attorney General noted important commercial conflicts of interest and suppression of scientific evidence that had tainted the guidelines process. This paper explores two broad ethical themes that influenced the IDSA investigation. The first is the growing problem of conflicts of interest among guidelines developers, and the second is the increasing centralisation of medical decisions by insurance companies, which use treatment guidelines as a means of controlling the practices of individual doctors and denying treatment for patients. The implications of the first-ever antitrust investigation of medical guidelines and the proposed model to remediate the tainted IDSA guidelines process are also discussed.


  • Competing interests: RBS serves without compensation on the medical advisory panel for QMedRx Inc. He has no financial ties to the company.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

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