Friday, January 18, 2008

Limits of Health Care, Clinical Uncertainties - The Old Gray Lady and the Vast Gray Void

On January 15, 2008. the New York Times, known as The Old Gray Lady in journalist circles, published “Drug Approved, But Is It Real?” The Times piece spoke of Lyrica, a drug for fibromyalgia. The article set off a fibromyalgic firestorm. Some doctors aren’t so lyrical about Lyrica, for they say the drug treats a non- disease.

Two days later, the Times printed seven mostly angry letters to the editor under the title “Fibromyalia: The Pain is Very Real.” Doctors, fibromyalgic sufferers complained, don’t feel their pain. The pain, the letters said, is very real, even if no definitive diagnostic test exists.

Similar disorders, without specific tests to prove their existence, are out there. They include chronic fatigue syndrome, chronic Lyme disease, and restless legs syndrome, to name but a few.

In any event, here are my thoughts.

In health care, there looms a vast gray void,
An endless empty space some physicians avoid,

Some docs insist the void is fundamentally psychosomatic,
Others say there’s no void, with pain, disease is axiomatic.

Fibromyalgia isn’t black or white,
For no good test exists to shed light,

On what may be really there,
Or if there’s any there there.

Or whether it’s a disease or some mysterious syndrome,
Or something non-existent where certain minds roam,

Some say fibromyalia, chronic fatigue, and restless legs,
Need new drugs to defuse smoldering disease powder kegs,

Others say we should only pay for what’s evidence-based,
For what experts can prove without a doubt is data-encased.

But still it’s very difficult to be scientifically objective,
To ignore severe pain even when it’s considered subjective.

When patients are in obvious pain,
It’s hard to be in an oblivious vein,

To be scientifically rigorous,
When pain is unambiguous.

Ibuprofen,tylenol, et al
Don’t seem work at all.

In fibromyalia you may not believe
But pain you’re obligated to relieve.

Don’t feel like you’re just a nonscientific jerk,
It’s a Brave New World, it’s marketing at work.

In many ways, it’s the Old World Way,
When the Art of Medicine held sway.

Treating without really knowing may seem like nostalgia,
But remember: not all pain has a specific cause-algia.

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