Thursday, February 14, 2008

The Fibromyalgia Fallacy?

Fibromyalgia has been a mystery to me as a medical student. Luckily, I am not alone as rheumatologists seem perplexed by this entity as well. The recent NYTimes article Drug Approved. Is Disease Real? describes Pfizer's release of the first drug approved to treat fibromyalgia, Lyrica. The piece raises the issue of whether pharmacological treatments should be developed for conditions that are not yet well-defined. The most telling quote in the article came from Dr. Frederick Wolfe:

Dr. Frederick Wolfe, the director of the National Databank for Rheumatic Diseases and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.

“Some of us in those days thought that we had actually identified a disease, which this clearly is not,” Dr. Wolfe said. “To make people ill, to give them an illness, was the wrong thing.”

If the researchers who helped define a disease no longer consider it one, one must wonder about the motives underlying the pharmaceutical industry's push into this area. As interesting as the diseases treated in rheumatology are from a pathophysiological point of view, these endless "clinical criteria conditions" that are diagnosed by criteria instead of by signs/symptoms ultimately make it unappealing to me. While I am sympathetic to people who suffer from the constellation of symptoms we term 'fibromyalgia,' scientists should be careful to not overly define an entity that is not yet fully understood as this may do more harm than good. If the cause of the disease is not well-known, then what exactly are these new drugs targeting in the body? Without having a better idea of how these drugs work, and having other options available, the use of the new pharmaceuticals seems a bit dubious to me.

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