The doctor who wrote the now classic 1990 paper defined fibromyalgia as widespread pain, mostly of middle-aged women, of unknown origin, without definite physical or laboratory findings now claims he was wrong, that the disease does not exist. He accurately predicted that Lyrica, on which Pfizer spent $50 million in 2007 to advertise, and the other drugs taken to relieve sufferers will be consumed by millions of people who do not need them. Yet advocacy groups, many partly supported by drug companies, and tens of thousands of physicians who treat fibromyalgia estimate that 6-12 million Americans suffer from the disorder.
Dr. Nortin Hadler, a rheumatologist and professor of medicine at the University of North Carolina who has written extensively on fibromyalgia, stated, “These people live under a cloud. And the more they seem to be around the medical establishment, the sicker they get.” Dr. Frederick Wolfe, the lead author of the original paper referred to above, and Director of the National Databank for Rheumatic Diseases, referred to by the New York Times (Jan.14, 2008), says he has become cynical and discouraged about the diagnosis, and now considers the condition a physical response to stress, depression, and economic and social anxiety.
The argument over fibromyalgia brings up many thorny questions I have previously addressed in my newsletters. See also this on the “medicalization of America and “disease mongering.” Once the argument over the existence of a disease, disorder, or diagnosis is apparently accepted, even if later it is the subject of controversy, it receives an ICD-9 code (the International Classification of Disease) and is officially recognized.
Fibromyalgia did achieve code recognition as 729.1, a subclassification, “Other disorders of soft tissues, myalgia and myositis, unspecified,” thus allowing its entry into statistical respectability. The definition, however, is imprecise, if not confusing. (To be fair, many ICD-9 codes employ the word “unspecified.”) Does a name or a billing code give an entity a medical reality? Can a condition be fictitious or invented?
Reduced to the ultimate choice for the medical establishment, if not the public: Do we ignore millions of patients by depriving them of their disease and possible treatment, or do we save them from the exposure to another potentially risky drug and billions of dollars of needless medical attention?