“ And I think my head is burning, & in a way I’m yearning, to be done with all this measuring of proof…“ Dr Nick Cave sums it up well. For want of a diagnostic test for fibromyalgia, the malaise is investigated by a process of elimination. This takes years, and an average of 3.7 doctors shopped (since the majority consider their training inadequate for the purposes of diagnosis : Perrot & Choy, 2012). Sponsored studies paint the illusion of progress towards a solution. Announcements of conclusions are promoted in the media with ‘Breakthrough’ in the headline, yet FM remains a syndrome of unknown causality. The diagnostic criteria of the 1990 American College of Rheumatologists for specified points of pain was loosened somewhat in 2010, and cynics point to the opportunity thus afforded for a greater market. With no prospects for a cure, palliative medications represent a secure financial investment for pharma with each and every case.
Buffington and Hackshaw et al described in the august journal (Aug 2013) of the Royal Society of Chemistry a promising analysis for catabolites in blood, explaining “Because accurate FM diagnosis is so crucial for improved patient outcomes, reliable disease markers are urgently needed.” Unfortunately, in excluding fibromyalgia from the Flinders University immunological bloods bank that opportunity for investigations is closed. Prof Roberts-Thomson justifies the selectivity on the grounds of funding. So let’s look at the business case. If Australian prevalence is assumed typical at 3% (let’s ignore the advice by the Mayo clinic that diagnosed patients are only the ¼ tip of an iceberg) there’s 0.6 million sufferers here. Dr Guymer surveyed Monash outpatients to find 41% were on disability due to FM, and if we take the income protection lower limit of $3000/month as a minimum loss in productivity then $20m per day is an extremely conservative estimate of the cost to this nation. That’s a lot of research dollars.
Looking in the wrong places is condemned as unethical waste of resource by Sir Iain Chalmers, knighted for services to medical ethics : “The pharmaceutical industry, for example, does research for its primary need – to fulfill its overriding responsibility to shareholders to make a profit…… Yet only rarely in recent decades has this commercially targeted approach led to important new treatments, even for ‘mass market’ disorders. Rather, within groups of drugs, industry has usually produced many very similar compounds – so-called ‘me-too’ drugs.” His book Testing Treatments is readily accessible, in its entirety.
Quite a clever illusion being created by the healthcare industry, which really doesn’t seem to be up to the challenge.