farmdoc's blog post number 264

Chronic fatigue syndrome. Fibromyalgia syndrome. Multiple chemical sensitivity syndrome. Repetitive strain injury. When I was a medical undergraduate in the 1960s, these conditions were absent from the curriculum. So they’ve all emerged in the last 40 years. And, pointedly, there’s no objective means of diagnosing them, i.e. no objective physical examination abnormality, and no confirmatory laboratory or imaging test. You’d think that with the current sophistication of scientific techniques, if these conditions were of organic origin then medical science would detect abnormalities. But it hasn’t, and so an impartial scientific observer must question these conditions’ existence as physical entities. An article in the latest Medical Journal of Australia also questions the existence of attention deficit hyperactivity disorder – ‘the most common psychiatric clinical presentation in childhood’. It rues ‘the increasing tendency of psychiatry to transform what many regard as normal emotional responses to life’s stresses and traumas into psychiatric disorders’. And it postulates ADHD has been wrongly validated (i.e. reified) as a ‘true entity’ – for several reasons including the opportunity to prescribe drugs for it. Global ADHD drug expenditure rose ninefold to US$2.4b in the decade ending 2003. This process of creating medical ‘diseases’ for commercial gain – coined ‘disease mongering’ – is the topic of an article in the latest Internal Medicine Journal. It’s yet another reason to tread carefully, rely only on hard evidence, and ignore snake oil salesmen.