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The 'fibromyalgia wars' rage on Toronto Star May 13 2010

Discussion in 'Fibromyalgia' started by shrewsbury, May 15, 2010.

  1. shrewsbury

    shrewsbury member

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    The 'fibromyalgia wars' rage on
    Judy Gerstel

    [if/sb: This looks like a fairly balanced article after my cursory glance. If that's true, she might be a good person to approach re getting ME/CFS coverage. Anyone know her or have media contacts?]

    It's not just patients who are fighting fibromyalgia (FM). It's a
    battlefield for physicians and academics, too.

    'The Fibromyalgia Wars,' an article by Kansas rheumatologist Fred
    Wolfe, was published a year ago in the prestigious international
    Journal of Rheumatology, a Toronto-based publication edited by
    Duncan Gordon, clinician at Toronto Western and University of
    Toronto professor of medicine.

    'FM is a bitterly controversial condition,' writes Wolfe. 'It pits
    patients, pharmaceutical companies, some specialty physicians,
    professional organizations, and governmental agencies - groups with
    substantial political and economic power who benefit from the
    acceptance of FM - against the large majority of physicians,
    sociologists, and medical historians in what we call the
    'fibromyalgia wars.' The wars are fought over a series of questions
    that concern the legitimacy of the diagnosis.'

    The condition that came to be known as fibromyalgia almost 25 years
    ago has had a long and controversial history. In the past, because
    it affects mostly women, it was considered a variant of hysteria,
    a catch-all term used widely by what was then the male medical
    establishment.

    It was likely FM that one-time U.S. Surgeon-General William Hammond
    was describing in 1886 when he made the following observation,
    suggests Gerald Weissmann, editor of the FASEB Journal of The
    Federation of American Societies for Experimental Biology: 'Spinal
    Irritation is characterized by multiple tender spots distributed
    over the female body, probably caused by sexual excess...'

    For much of the 20th century, the 'clinical entity causing chronic
    and disabling pain' - as it's described in a U.S. National Institute
    of Health publication - was referred to as 'fibrositis.' People have
    also referred to the disorder in the past as 'rheumatism' and it's
    been lumped together with chronic fatigue syndrome.

    While there's finally agreement on what to call it, not everyone in
    the 21st century agrees that it exists as a 'real' illness, focusing
    instead on the psychosocial aspect of it. Naysayers, writing in the
    Journal of Rheumatology, have called FM 'the medicalization of
    misery' and declared that 'pain is real, fibromyalgia isn't.'

    University of North Carolina professor and rheumatologist Nortin
    Handler has called FM 'a social construction' and suggests that it's
    a case of how 'a person with widespread chronic pain... chooses to be
    a patient with widespread chronic pain.'

    There's no doubt, says Toronto rheumatologist and journal editor
    Gordon that people with FM 'are dealing with chronic pain. No one
    can deny that.' But, he says, 'Many factors are at work in its
    causation, having to do with things like level of education,
    psychological stress, divorce, previous trauma like auto accidents,
    social and cultural factors, a host of things in the background.
    It also has to do with attitude. That's where behavioral modification
    comes in: changing patients' attitudes and mind so they can
    de-emphasize (the pain) and get on with their lives.'

    Gordon remains somewhat neutral in the 'fibromyalgia wars,'
    acknowledging both the credibility of the diagnosis and disorder but
    also acknowledging the importance of underlying social, cultural and
    attitudinal factors. As far as cause and effect, he suggests, 'It's
    a case of the chicken-and-the-egg.'

    Steadfastly and outspokenly critical of the naysayers, is Dan Clauw,
    professor of rheumatology and psychiatry at the University of
    Michigan and director of its Chronic Pain and Fatigue Research Center.
    'I don't think the controversy will ever go away,' he says. ''The
    wars' are largely among older physicians who developed their beliefs
    about fibromyalgia early in life. They haven't changed their views
    over 20 years in spite of a tremendous amount of data negating many
    of their arguments. And most naysayers are old males and that's
    probably not accidental. I do think there is a gender bias.'

    He says they're not looking at or acknowledging the data which reveals
    'a strong biological underpinning' including, he notes, 'brain imaging
    studies showing objective abnormalities' and 'increased sensitivity to
    pain.' And yet, as with other chronic disorders, there are social and
    cognitive factors, he says. 'The key symptom seems to be multifocal
    pain,' he explains, 'plus the presence of other somatic symptoms,
    fatigue, insomnia and memory problems. Other interrelated symptoms are
    irritable bowel syndrome and tension headaches.'

    Clauw says the marketing of such drugs for fibromyalgia such as Lyrica,
    and the physician education that accompanies the new drugs, have given
    more legitimacy to the diagnosis. Before, he says, 'Only about 50 per
    cent of physicians in the U.S., when asked, 'Do you believe there is
    such a thing as fibromyalgia?' would answer, 'Yes.' Now, it's around
    85 per cent.'

    The FM drugs have also provided physicians with an efficient way to help
    patients.

    'Rhuematologists are good at diagnosing fibromyalgia,' says Clauw, 'but
    many don't like to treat it because it takes more time.'
    And for investigators, says Toronto rheumatologist Gordon, 'it's a
    challenge. But what is real is the pain for persons who have it and
    doctors should be interested at least in making the diagnosis and
    reassuring patients.'

    --------
    (c) 2010 Toronto Star

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