In addition to the limitation described above, I feel that another should also be incorporated.

In order to compare quality of life and healthcare utilization across various disease states and the general population, the authors extracted data from prior published literature. It is not clear how similar or different these populations were and there was not an effort to quantify these differences. A more appropriate means of comparison would have been to send the same survey as given to the Lyme Disease group to patients with CHF, asthma, diabetes, etc and make these comparisons within the same sample. Because the estimates provided likely come from such a different frame, these comparisons as presented are highly suspect and a description of this limitation would be useful in this section.

Thank You