Althouse: How can the doctors say your illness is only in your head...

October 24, 2006

How can the doctors say your illness is only in your head...

... if stuff that looks "like large flecks of black pepper" is coming out of your skin?

11 comments:

KCFleming said...: I have been expecting the onslaught of Morgellons patients since seeing the USA today article on it this past summer.

The non-dermatolologic symptoms are nonspecific. The dermatologic findings are debatable.

The key question, Is this something, or nothing? remains unanswered. Which is really quite strange if, in fact, people are exfoliating skeins of yarn every day.

This will most likely have the same arc as hypoglycemia, chronic yeast infection, chronic Lyme disease, and multiple chemical sensitivity. After two or three years, only the true believers will diagnose it anymore.

That's my prediction. But I remain open, and skeptical, for now.; 10/24/06, 9:16 AM
Ann Althouse said...: Pogo: Lyme disease is fake (in chronic form)?; 10/24/06, 9:26 AM
bearing said...: Well, let's look at the possibilities here:

(1) There exists a physical cause or pathogen that will be identified before the CDC gives up trying to find it.

(2) There exists a physical cause or pathogen, but it will not be identified before the CDC gives up trying to find it.

(3) The symptoms are psychological in origin.

I see no reason to call the sufferers "stupid." If the outcome is (1), then they're sick and perhaps can be cured with drugs or diet or some other "physical" means. If the outcome is (3), they are mentally ill, and perhaps antidepressants or psychotherapy will help.

And God save them if the outcome is (2), because their doctors will suggest antidepressants and psychotherapy until the cows come home, but it won't help.

(Is anyone else not too impressed with the logic of "If it's a new bug... we'll find it?" Hubris. A better statement is, "We can do nothing for you unless we find a bug."); 10/24/06, 9:47 AM
Anonymous said...: I remember during the silicone implant lawsuit days that women said silicone was seeping out of their skin in various places.

Do toxins seep out of our skin, or is this a common manifestation of neurosis (or wanting a big settlement?); 10/24/06, 9:58 AM
NSC said...: I am not sure, but wasn't all the "silicone implant is causing women to get sick" ultimately proven (proved?) to be wrong?; 10/24/06, 10:33 AM
TMink said...: We often forget that the placebo effect is MEASURABLE. It exists, it is an actual phenomenon. It is called the placebo effect because medical and psychological science do not yet fully understand the mind/body connection. It is not just mentally ill people who effect their body through their thoughts, we all do to a greater or lesser extent. People with amazing physical symptoms that are psychogenic may just be talented in this area.

This is different from faking or malingering. But it helps if we remind ourselves that the "placebo" effect is a measurable, repeatable manifestation of the mind body connection. Not skullduggery, it is good science.

Trey; 10/24/06, 11:44 AM
goesh said...: I think they are all on statins. It sounds reasonable to me. They were probably told to eradicate any cholestrol they had in their veins.; 10/24/06, 12:23 PM
KCFleming said...: Ann,
There is a subset of sufferers of medically unexplained symptoms (fatigue, numbness, foggy thinking, chronic pain) that attribute their symptoms to "Chronic Lyme Disease".

This group differs from post-Lyme disease syndromes of focal neuropathies, headache, achiness, and fatigue which can persist for six months after treatment. Subtle cognitive changes can also occur, suggesting a subclinical central nervous system infection at onset in certain patients.

However, there is little to suggest a "chronic" appelation to most such symptoms after a typical course and serologic tests prove negative. For example, chronic Lyme arthritis more often occurs among the untreated or inadequately treated.

The majority of patients with early features of Lyme disease will be cured by antibiotic therapy. But quite often a "Lyme disease" diagnosis is made based on improper serologic testing, novel diagnostic tests (mostly bogus), misinterpretation of the literature, or clinician "personal experience".

There is usually no evidence of an ongoing symptomatic infection with live organisms in "CLD", which means they have something else, or just "Medically Unexplained Symptoms".

P.S. I just addressed Morgellons(among other MUSs) in a talk this morning for about 400 MDs.; 10/24/06, 1:06 PM
Peter Hoh said...: Human Botfly larva -- it really was all in her head.

http://www.vexman.com/botflyremoval.wmv

The video is not for the squeamish.; 10/24/06, 2:18 PM
KCFleming said...: So a fallacious argument is again proposed.
"Doctors-cause-more-trouble-than-they-cure ", therefore people can knit sweaters under their skin.

Nuts to that. Ed discusses the misdiagnosis of his ESRD. How does that happen? If dyspnea was present at that visit, emphysema would have been in the differential. But since ESRD is purely a medical term and responds to a limited array of very high tech medical devices, I think Ed's complaint has not soured him on MDs entirely. Heck, even Osama is alive (if he is) by the grace of modern medical treatment for ESRD.

"Prescribing medication is a way for doctors to feel good, not necessarily a way for them to help the patient."
Sort of.
There's a demand side to that equation (try refusing a mom antibiotics for her screaming kid with ear pain at 10 p.m.). And then there's empiric trials to treat symptoms. Since the majority of prescriptions are written for hypertension, diabetes, lipid-lowering, asthma, heartburn, allergies, and depression (i.e. testable conditions), I think you are way off base. It sounds more like anecdotal experience by you and close friends.

Yes, much as in law, policework, government, and universities, there are some real idiots in medicine. But since there's hardly a shortage of practitioners, fire the idiots, and find a better one.

And if you yourself know that much more than the MDs, get a degree and share your expertise. A PA can write prescriptions after just 2 years training.; 10/25/06, 7:01 AM
KCFleming said...: Re: "Even flip criticism."
Point taken.
Criticism is in fact warranted. I have my own family horror stories, and harbor no illusions about the general ability of MDs, PAs or NPs. There are some frighteningly smart folks, and some criminally stupid ones. I think our national average is 'mediocre'.

Michael Porter in his new book Redefining Health Care: Creating Value-Based Competition on Results goes into this in detail. In short, the lack of reward or punishment for doing good or bad work leads to generally mediocre care.

As a result, doctors who refuse to hear what patients are saying don't get paid any less than doctors who fulfill that demand, and they stay in business to boot. So if I spend 2 hours with a patient to ferret out why they have chronic pain, and eliminate potentially serious disorders missed in the past, I get paid the same as when I spend 45 minutes and do much less work.

What if hotels operated that way?
Any other business would go under. But our current structure rewards de minimus and punishes detail.
Guess which approach becomes dominant?; 10/25/06, 9:06 AM