The reporting of complex medical conditions by the mainstream media can be misleading and, ultimately, confusing to the patient. Inaccurate information can potentially interfere with the delivery of appropriate healthcare by creating a question of credibility. In other words, confrontation between the healthcare practitioner and the patient may arise based on what a patient may have read or been told about the treatment for a particular condition.
Fibromyalgia is one such condition that gets its fair share of reporting – both factual and fictional. This article, published in Science-Based Medicine, is a perfect example related to the question of credible medical reporting.
Science and medicine reporting is hard. In this space and otherswe’ve dealt with some of the problems that arise when “generalist” reporters try to “do” science and medicine. And now, CNN has shut down its science unit. Given the increasing complexity of medical and scientific knowledge, this is very bad news.
As a fine example of poor medical reporting, let’s look at a local business magazine. The article, called “The Fatigue Factor”, is about fibromyalgia, and manages to get it wrong from the very beginning.
Some medical reporting is destined to be bad simply because the topic is too complex for a generalist reporter. But sometimes, a reporter succumbs to journalistic sloth. In this story, for instance, if the reporter had spoken to a recognized local expert rather than a self-proclaimed expert, she would have written a much different article.
Let’s start with the headline:
A relatively new muscle malady, fibromyalgia is no figment of the imagination
This is a forgivable mistake. Fibromyalgia is not a “muscle malady”. It is a syndrome of musculoskeletal pain not associated with any tissue pathology or laboratory abnormalities. When physicians hear “muscle disease” the assume there is muscle pathology that can be measured by EMG or seen under a microscope. This is not the case with fibromyalgia.
But let’s move on to the body of the article. A good health reporter gives a patient anecdote to put a human face on the story, and this reporter does just that:
L. M., a 36-year-old therapist from S., believes she may have been suffering from some form of fibromyalgia most of her life. “I was tested for mono many times, my legs ached, and I couldn’t get answers why,” she says. M. was finally diagnosed in 1999, after having physical therapy for sciatica. There were also terrible headaches, thyroid problems, severe menstrual cycles, carpal tunnel syndrome, irritable-bowel syndrome, insomnia, and aches and pains all throughout her body. She was extremely sensitive to varying temperatures, as well. (identity redaction mine. –ed.)
From this report, it’s not at all clear what the patient is suffering from. Fibromyalgia may be on the list, but fibromyalgia is a diagnosis of exclusion, meaning you much rule out any other cause for symptoms before invoking this vague syndrome. And what are the symptoms of fibromyalgia?
Widespread muscle pain, fatigue, and multiple tender points. That’s it. That can of course apply to many conditions, but many physicians will invoke fibromyalgia when all other diagnoses have been ruled out and the discomfort persists. Others may simply toss the diagnosis out somewhat indiscriminately.
As we’ve learned, vague syndromes without clear pathologic explanations are favorite targets of quacks. Fibromyalgia has always been a controversial diagnosis, not least because there is no clear way to be sure it exists. The patients we label with fibromyalgia probably constitute a range of different patients with different pathologies. Some consider it a “trash can diagnosis”, meaning that when you run out of diagnostic ideas, the patient gets thrown in a bin with other patients who have similarly stumped their doctors.
(Read Full Article)
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