Data versus belief

2

Category : Medical Rants

Many patients want to blame someone or something for their health problems (or even their perceived health problems). We see this often with drug side-effects. Readers of this blog can turn to any new drug discussion, then read the comments section. Any perceived side effect automatically is blamed on the drug. However, studies which include placebos generally show sizeable side effects from placebos. This makes the data driven physician wary of attributing symptoms to drugs, until we collect appropriate data.

Most physicians that I know have remained skeptical about “Gulf War Syndrom”. The British Medical Research Council has concluded that this syndrome does not exist. Gulf War Syndrome ‘does not exist’

The MRC report, which reviewed all scientific research into the veterans’ illnesses, is quoted as concluding: “There is no unique Gulf War Syndrome.”

It said symptoms suffered by veterans were similar, despite varying exposures to vaccination, nerve agents, oil fire smoke and other potential hazards.

“In short there is no evidence from UK orientational research for a single syndrome related specifically to service in the Gulf,” the report states.

The symptoms – which include tiredness, headaches, lack of concentration, memory loss and numbness or weakness – were shared by non-Gulf veterans, the scientists said.

They accepted that Gulf veterans were at increased risk of suffering from post-traumatic stress disorder, but since this affected about 3% of them it could not have caused the illnesses of all those claiming to have Gulf War Syndrome – a much larger group.

Depression and alcohol are much more important health risk factors,” the report is quoted as saying. ‘No case’

Patients and veterans groups do not want to hear this message. They are not interested in the data and scientific inquiry.

The study was dismissed by the Gulf Veterans and Families Association, which said: “How can the MRC say that Gulf War Syndrome does not exist when it appears in the Royal College of Medicine encyclopaedia?”

Having a “Gulf War Syndrome” to blame ones symptoms on makes life simpler. We all would rather blame than accept responsibility for our own health behaviors. Belief trumps data for many in our society. As a physician I must favor the data approach. Only through careful investigation of data can we discover medical truth. Anecdotes are interesting, but not scientific proof.

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Comments (2)

You wrote: “Having a “Gulf War Syndrome” to blame ones symptoms on makes life simpler. We all would rather blame than accept responsibility for our own health behaviors.”

Two correct statements, but which ought not be so tightly linked. Linking them is unnecessary, pessimistic, counter productive, and unsympathetic.

Everybody desires a diagnosis. A diagnosis reduces the ambiguity and hence the fear. It offers some hope that a cure may follow. People cling to a diagnosis.

I can’t tell you how often, in my line of work, I’ve recieved solid negitive reenforcement from others for announcing that last week’s diagnosis has turned out to be in error. Back sliding!

It’s a commonly observed fact that people ascribe the good to self and the bad to other. It may be delusional but that doesn’t make it less common nor does it take away from how good it makes one feel. Pointing out this self delusion to others is delightfully recursive.

Accusing the patient of doing this for selfish reasons is only constructive if the patient responds well to scolding. I find that unlikely, most people stiffen their resolve in the face of scolding.

Stepping back, the problem of ‘fad diagnosis’ is an interesting problem in general.

Patients have a desperate desire for diagnosis. They thrash around looking for one. (I’m amused to note that ‘blame’ and ‘diagnosis’ aren’t really very different).

What’s facinating to me is how common ‘fad diagnosis syndrome’ is. High demand generates supply. All fields get a lot of ‘fad diagnosis syndrome’ since they all have hard painful intractible problems for which there is strong undercurrent of desire to get them resolved. Up pop fad diagnosis and treatments to scratch that itch.

It’s striking how critical the solidarity of the group around the diagnosis becomes. Membership in that group provides both some comfort against the misery of the problem and a way to focus the energy created by the fear and pain of the affliction.

Meanwhile the professionals scoff. Strangely that invigorates some memebers of the fad diagnostic community. It gives the group something to target their activist energy at.

It’s a very bitter irony that by accumulating the data that shows that a given fad diagnosis is in fact bogus you reward is to increase the misery in the shortterm. You hurt the people in the community around that diagnosis. You hurt them when you take their hope. You hurt them when you take their support group. All you leave them with is their symptoms, and no diagnosis. Bummer.

The Gulf War article reminds me of the bizarre situation with Dr. Allen Steere (the discoverer of Lyme disease) and the patients who are threatening him because he won’t buy into their theories about the alleged chronic form of the disease.