Targeting Lyme

David Birnbaum (Applied Epidemiology, North Saanich, Canada)

Clinical Governance: An International Journal

ISSN: 1477-7274

Publication date: 30 September 2014



The purpose of this paper is to describe recent passage of a private member's bill that can put Canada on a different path from the USA in attempting to resolve conflict that arose over how an influential clinical practice guideline for Lyme disease was developed.


Narrative review.


Critical appraisal of pertinent scientific literature is fundamental to the production of evidence-based practice guidelines. Perception of fairness and transparency in a guideline development process is fundamental to wide acceptance. Allegations of conflicts of interest and excluding opposing views in development of Lyme disease guidelines led to legislative interventions after insurers started basing denial of claims and licensing boards started responding to complaints against physicians whose treatment regimens were inconsistent with guideline statements on chronic Lyme disease. Opposing sides are both faced with limitations in available research evidence. Claims and counterclaims about availability of impartial subject matter experts free of vested interests arose; however, this has been compounded by failures in communication channels. Perhaps most importantly, and the focus of this viewpoint, wide perception among those afflicted of a flawed guideline development process makes it unlikely that all sides can reach agreement on this path. Canada, unlike the USA, is taking steps to include all stakeholders (including representatives of the medical community and of patients’ groups) in a review meeting to develop a comprehensive national framework.

Research limitations/implications

This situation provides a noteworthy example of defining best practice in the difficult situations where stakes are high, diagnostic tools are flawed, some of those identified as experts have vested interests, and patients with unmet needs feel excluded.


The next steps in Canada bear watching, both in terms of potentially resolving key conflicts around the one guideline document in question, and also as a potential model for a more successful guideline development process.



Birnbaum, D. (2014), "Targeting Lyme", Clinical Governance: An International Journal, Vol. 19 No. 4, pp. 360-365.

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