I was interested to read Zubek’s letter in CMAJ.1 Most doctors in Canada are aware of the National Guideline Clearinghouse (NGC), a federal agency of the United States Department of Health and Human Services responsible for providing the most up-to-date clinical guidelines to physicians.
The NGC also removes clinical guidelines that are no longer relevant, that do not meet the Institute of Medicine’s standards for clinical practice guidelines, including a systematic review of the evidence, or that have not been revised in the past five years.2
In January 2016, the NGC removed the Infectious Diseases Society of America (IDSA) guidelines on Lyme disease for these reasons.3 In a scathing report on the standard of clinical guidelines in North America, the Institute of Medicine specifically referenced the IDSA guidelines on Lyme disease as a prime example of what not to do.4
Now, the only evidence-based, peer-reviewed guidelines on Lyme disease that conform to (and exceed) the Institute of Medicine’s clinical guideline standards and are available on the NGC website, are the International Lyme and Associated Diseases Society guidelines for Lyme disease.5