Monday, August 29, 2011

3 Antiscience letter and conflicts of interest

Since I finally had the opportunity to read the full text of the antiscience and Lyme disease advocacy letter in the Lancet, someone asked me if the letter had any stated conflicts of interest attached to its full text version.

Yes, it does - and here is the stated conflicts of interest portion:

Conflicts of interest
PGA has served as a consultant for Oxford Diagnostics and has participated in expert testimony in two medicolegal suits about possible Lyme disease. He has equity interest in Johnson & Johnson, no products of which are referred to in this article. RJD is part owner of and has stock in Biopeptides Corporation, no product of which is referred to in this article, has received payment for providing expert testimony in malpractice cases and holds patents on vaccine and diagnostic technology with SUNY at Stony Brook Biopeptides. JSD has received support for travel to meetings from DiaSorin and has licence of US patent 5,955,359 to Focus Diagnostics; none of these declarations are directly related to the contents of this article. JJH has served as an expert witness in several medicolegal cases concerning Lyme disease and has equity in Abbott, Bristol-Myers Squibb, Johnson & Johnson, and Merck; no products from these companies are referred to in this article. EMcS was a former programme officer for Lyme disease at the US NIH. RBN has served as an expert witness in malpractice litigation involving Lyme disease. EDS is a board member of the American Lyme Disease Foundation, for which no compensation is received. He has reviewed medical records for the Metropolitan Life Insurance Company and has provided medicolegal testimony. GPW is a board member of the American Lyme Disease Foundation for which no compensation is received, has served as an expert witness in malpractice cases involving Lyme disease, has research grants from the NIH/Immunetics, BioRad, DiaSorin, and BioMerieux to study diagnostic tests for Lyme disease, none of which is mentioned in the manuscript, and has equity in Abbott, a company not known to have any approved product for Lyme disease. JSB, RJD, JSD, JJH, RBN, EDS, ACS, and GPW have served on the panel for the 2006 IDSA Lyme disease guidelines. JSB, SO'C, SKS, ACS, and AW declare that they have no conflicts of interest.


Related to this, here are your questions of the day:

Does having these conflicts of interest affect how the authors of the letter act in the treatment of Lyme disease, if the authors engage in determining the outcome of insurance cases for Lyme disease treatment, develop vaccines and diagnostic tests, and write up guidelines for the treatment of Lyme disease? At what point does one say that one has a conflict of interest versus because one is considered an expert they are called upon to make these decisions by others? How does one separate the two?

In the Lyme disease controversy, Lyme disease patient advocates have pointed out IDSA Lyme disease guideline panelists' conflicts of interest in the past, and in the full text of this letter, the authors pointed out conflicts of interest being held by ILADS members. Is pointing out these conflicts of interest being done in the interest of fairness or in order to engage in a negative campaign against the other party?

Is there anyone out there who is free of conflicts of interest who is involved in the Lyme disease controversy? How do you know they are free of conflicts of interest?

Now that this letter has created a stir in the Lyme disease patient community, what's next? For anyone who has read the full text of the original letter, what is the best next step for resolution of this controversy? Brainstorming is welcome.

Addendum: Regarding Abbott, see this link on their research assays and ask why there isn't a better diagnostic test available for patients.

3 comments:

  1. The Abbott test is based on PCR, and they tested it on ticks. If it were used on patient samples, it wouldn't be any more sensitive than Bb PCR is currently. That is, sensitivity would be low because it's unusual to get a sample with spirochetal DNA in it, except from an EM biopsy.

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  2. Loakley,

    Thanks for your feedback on the Plex test from Abbott. I got the impression earlier that was specifically for PCR and was interested in it because it sounded like it was designed to pick up more than one organism at once from a single sample. The way things are done now, determination for coinfections are run through different tests. So it wasn't just a question of sensitivity for me but whether or not a test could accurately detect more than one infection from a single sample.

    EM biopsies seem to be the best way to get spirochetal DNA - but I wonder how often one takes one? I would think that evidence of an EM is enough to diagnose a patient and treat them. Biopsies are of research benefit, though.

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