Doctors need accredited information on Lyme borreliosisBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4727 (Published 16 July 2012) Cite this as: BMJ 2012;345:e4727
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If the BIA had NHS Evidence Accreditation for guidance production the BIA Position Statement1, which is guidance in all but title, would have been very different.
NHS Evidence requires that guidance be developed using rigorous methods clearly demonstrating a systematic search for evidence and an acknowledgement of uncertainties. Inclusive stakeholder involvement and consideration of the risks in formulating guidance are two important steps in the accreditation process that are conspicuously lacking in the BIA document.
We are concerned that, given the current state of knowledge and the international controversy involving Lyme disease, there was no dissent among the full membership of a professional body such as the BIA. We find it unacceptable under such circumstances, that the BIA Council seems prepared to accept lack of dissent as evidence of agreement.
The BIA statement will have been reassuring for microbiologists and infectious disease consultants with little direct experience of Lyme disease but much experience of trying to cope with the fall-out from the controversy. A recent paper by Cottle et al 2 reported that during a 5 year period one of the major infectious diseases clinics in the country had seen a mere 0.5% of the England & Wales laboratory confirmed Lyme disease cases. We wonder if this limited experience, perhaps coupled with unfamiliarity with the broader medical and scientific literature may have been a key determinant in the evident lack of dissent from BIA members.
1. British Infection Association. The epidemiology, prevention, investigation and treatment of Lyme borreliosis in United Kingdom patients: a position statement by the British Infection Association. J Infect 2011; 62:329-38.
2. Cottle LE, Mekonnen E, Beadsworth MBJ, Miller a RO, Beeching NJ. Lyme disease in a British referral clinic. QJM : monthly journal of the Association of Physicians. 2012 Feb 1; 1–7.
Competing interests: No competing interests
Pearson and Huyshe-Shires refer to the “unaccredited” nature of the British Infection Association (BIA) position paper on Lyme borreliosis. In particular, they suggest that doctors “could more usefully be directed to the Lyme Disease Action website, which is accredited to the Department of Health’s Information Standard”.
We would like to make clear that the BIA has never sought Department of Health’s Information Standard accreditation and, at present, has no plans to do so. We consider such accreditation to be unnecessary for the quality assurance of our position paper which was based on the best available guidelines from Europe and the USA, all of which have been published in peer-reviewed scientific journals.
The BIA represents a substantial proportion of the body of Medical Microbiologists and Infectious Diseases Physicians within the United Kingdom. The BIA position paper was written with the full involvement of its members. There were two consultations on the paper, the first with the BIA Council and the second with the full membership. At no point was there any dissent on the general content or principal messages of the paper. We believe therefore, that the BIA position paper is a true reflection of the opinions and knowledge of the relevant body of medical professionals in the United Kingdom and is consistent with extant guidelines that have been produced to the highest accreditable degree of rigour that would satisfy the National Institute for Health and Clinical Excellence (NICE) accreditation system as administered by NHS Evidence
The BIA continues to commend the position paper as a source of information for patients and doctors who want to understand the present state of knowledge about Lyme borreliosis and who wish to avoid the non-evidence based and sometimes emotive writings that continue to confound the literature on this subject. The BIA is committed to supporting research and further understanding of Lyme borreliosis, and is engaged with the James Lind Alliance and Lyme Disease Action and other organisations to establish and agree priorities for further research into true uncertainties surrounding the diagnosis and management of the disease.
P.Cowling Guidelines Secretary, British Infection Association
J. Stockley President, British Infection Association
P.Moss President-Elect, British Infection Association
A. Miller Consultant Infectious Disease, Liverpool. BIA representative on James Lind Alliance review of Lyme Disease
Competing interests: none
1. Pearson S and Huyshe-Shires S. Doctors need accredited information on Lyme borreliosis. BMJ 2012; 345:e4727.
2. British Infection Association. The epidemiology, prevention, investigation and treatment of Lyme borreliosis in United Kingdom patients: a position statement by the British Infection Association. J Infect 2011; 62:329-38.
Competing interests: No competing interests