Map of life expectancy at birth from Global Education Project.

Tuesday, January 15, 2008

It's all in your head

As I was intending to get back to the mind/body thing, along comes a fortuitous hook: Pfizer, the same people who give you the whorish Dr. Jarvik hawking an expensive statin that is no better than its far cheaper generic competitors (even though he has no relevant expertise and has never practiced medicine), is now marketing a new drug for fibromyalgia.

To us medical sociologists, fibromyalgia is an endless source of fascination. Like the psychiatric "diseases," it is diagnosed based on a checklist of self-reported, qualitative and subjective symptoms. There is no known etiology and there are no physical findings whatsoever. So there is raging controversy over whether there is any such "disease" as fibromyalgia.

People who suffer from the symptoms are generally highly offended by this controversy, and they are particularly offended by suggestions that the cause of the disorder is located in the brain. They think that saying its causes are psychological is to devalue or even deny their suffering, or to blame them for their own condition. Alex Berenson tells you in the above-linked article, they feel vindicated by FDA approval for marketing the drug called Lyrica to treat fibromyalgia. Berenson correctly draws an analogy with depression, which also has had its status as a specific disease enhanced by marketing of drug treatments. (He's maybe a bit sloppy on the exact history there, as antidepressant drugs and corresponding etiological theories go back to way before Prozac.)

But here's where us sociologists pick up the BFH* of deconstruction. Suppose the complaint does indeed stem from processes in the brain? What if one proposed explanation is correct -- that sufferers are hypersensitive to the pain signals that our nerves are always sending under ordinary circumstances? Sitting here at my desk, I have an ache in my lower back, my left hand, and my right foot, my eyes itch, and my neck is a bit stiff. I'll notice little tweaks and shoots of pain here and there now and then, but only if I'm not concentrating on something else. All of these sensations are minor and I completely ignore them most of the time. If you do a careful inventory and really pay attention, I'm pretty sure that you will make the same discovery.

Now, if someone could not ignore a level of discomfort that everybody feels all the time, for whatever reason, would that make their suffering unreal? Would that make them somehow responsible for it? The cause would be in the brain, of course, but does that mean the problem doesn't exist, or doesn't deserve respect? Why would that constitute denial or disparagement? Would that make their problem not a "disease"? And why would it matter?

Would it make the problem somehow other than physical? After all, the brain is a physical organ, it's part of the body, and something physical is happening in the brain -- whether it be in the neural wiring, or firing patterns, or chemical environment, or all of the above -- that we don't currently have any way of directly observing but which is nonetheless certainly real.

Why is that fundamentally different from a strep throat, or cancer, or a torn ACL? And why, if you had that problem, would you fiercely resist that particular explanation? Think about it, and then think about further implications.

*That's a carpenter's term for a really big hammer. You can figure out what the F stands for.

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