CALDA

Letters

It’s hard to disagree with Dr. Auwaerter’s comment, “We should treat patients on the basis of what we know,” unless you realize that according to an Institute of Medicine estimates, only 4% of medical practice is based on firm evidence. At least half is based on no evidence at all, although interestingly, some consensus exists even in the absence of evidence. It goes to show that even doctors are not immune from strongly held, unsupported opinions.

Therefore Dr. Auwaerter’s suggestion that no one receive any treatment whatsoever without “knowledge,” presumably in the form of level I evidence, i.e. double-blind, placebo-controlled clinical trials, would set 21st century medical practice on its head and cause untold suffering to millions.

As Johnson and Stricker point out in their article, “Treatment of Lyme disease: a medicolegal assessment,”(2004) it’s hardly a practical solution as we can’t ask millions of sick people to wait for clinical trials to be performed, before we will treat them.

A diverse group of experts at the International Lyme and Associated Diseases Society therefore pool their experience with treating thousands of people with Lyme and other recently discovered tick-borne co-infections to arrive at a consensus treatment protocol. Patients are forgiving of doctors who treat them with respect, even when they don’t know all the answers. At least they admit they don’t know and offer the patient informed choices. What patients can’t forgive is condescension, arrogance and close-mindedness from doctors who know less about Lyme disease than they do.