American or Western trained physicians follow something called "Evidence Based Medicine." This means that a treatment is only used if there is science to back it up. The medical community has decided that there are different levels of "evidence." The best evidence comes from rigorous studies at major teaching/research facilities with the results confirmed by further studies at a second such institution. The studies are meticulously controlled through a process called a randomized double blind placebo based method. The results are carefully reviewed by a detailed statistical mathematical process. If the results demonstrate that there is "statistical significance" that treatment A works for disease B, then it is claimed that the treatment is "Evidence Based." The results are "Peer Reviewed" by experts in the particular area under study and published in a major, prestigious journal. Voila: Science has shown that the particular hypothesis which was tested is true. Physicians should use the results in clinical practice in order to follow the "Standard of Care." This was a legal concept which doctors have readily adopted for some unknown reason.
When there is no such research based evidence, a panel of "Experts" may be convened to offer opinions and recommendations. This sort of information acts as a surrogate for information obtained through a scientific process and is frequently referred to as evidence based as well. The evidence is based on opinions and conjecture of experts, who are held in high esteem in the community of physicians at large. These opinions and recommendations also become woven into the standard of care fabric.
The above process is open to criticism. Most medical research is funded by monied interests such as big Pharma. Typically only new drugs or therapies which are patentable and potential "blockbusters" get studied. Frequently the efficacy of the new therapy can only be proven by statistical analysis. This means the benefit may be small. Medical research is difficult because it involves many variables which are hard to control: does the cohort studied really have the same disease, are there genetic differences, do they follow different diets, do they exercises the same amount? and so on. Of course all of these differences are supposed to come out in the wash when the group is studied so that individual differences balance out. Then what does this mean for an individual patient who is not an "average" of the group, but has unique characteristics?
How can opinions substitute for science and be called "evidence based?"
Most questions which clinicians would like answers to are never studied out all. Diseases may be complex and nuanced. The same can be said for treatments. These things are not amenable to the scientific process as described above.
It turns out that patients instinctively distrust this process.
Studies showed that consumers (patients) were spending more money on so called alternative medicine they they were on science based Western medicine, called allopathic medicine.
Patients were taking herbs, consulting with herbalists and homeopaths, taking vitamins and supplements by the handful, going for body therapies of all sorts, going to chiropractors, massage therapists, acupuncturists and seeking out many other alternative and complementary therapies.
Physicians and institutions became cynically aware of the lost revenues. The bastions of scientific medicine like Harvard opened alternative and complementary medicine clinics. Of course they thought it was a bunch of nonsense, they just wanted to capitalize on the potential profits.
If a doctor prescribes herbs and mind-body medicine he is considered a crackpot and left alone.
When doctors start prescribing real medicines, like antibiotics for a supposedly fictitious disease that was another matter.
Most Lyme doctors come from an alternative medical background. That is why many heavily promote herbs, electromedicine and other "off beat" therapies. I approach Lyme from an allopathic perspective. I believe this is more threatening to the status quo. There are limited studies which show that long term antibiotics are beneficial for chronic Lyme. There are no studies showing that prolonged therapy for clinically diagnosed Babesia and other co-infections works. There are certainly no studies which support the use of vitamins and supplements as recommended by many LLMDs. Many therapies commonly used in the "Lyme community" come from word of mouth and anectdotal reports. Lyme clinicians over time, develop an experiential sense of what works. Medicine used to be considered an art and a science. Those physicians who with to rely solely on the science have unfortunately thrown out the baby with the bath water.
IDSA recommendations are opinion, not fact. They have been discredited.
Texts which mainstream physicians follow not only ignore this fact, but they fail to discus the legitamate controversy which has been swirling around the Lyme issue for years.
Hundred of articles and studies related to Lyme disease have been published. The IDSA and mainstream medicine have cherry picked those articles which support their pre-existing conclusions.
Science is a word which in this case without meaning. It is used to cloak an agenda of mysterious origins and purpose. The cynics and disbelievers should at least consider the profit motive. I have a dream that a major teaching institution will open a Lyme treatment center. LLMDs, neurologists, infectious disease experts, immunologists, psychologists, psychiatrists, radiolologists and others will cooperate to treat and research this terrible disease.
You can stop a guy from dreaming can you?