Wednesday, April 07, 2010

Push-polling the medical literature

I'm a person with many medical problems, none of which are doctors. As a feminist and sometimes invalid, I'm supposed to feel mistreated by the medical system. While I do have the being a freakish lady thing working against me, I also have a background in science working for me. In general, I'm a well-informed consumer of medical services, and my doctors know it. Being sick makes medicine as a subject pretty compelling, so I read a few medical blogs, including Kevin, MD. The mood around Kevin's is pretty darn anti-patient, and this post was the last straw for me. Take out the words you'd skip on a google search, and you get a title that says chronic pain patients are disobedient children. Patients with weird conditions: threat or menace? The quote from the article that really got me was

“The study of life-course influences on chronic pain is still in its infancy,” the researchers said.

This layperson is not surprised at the results, nor is she suspicious of their validity. I'll bet the researchers had a similar perspective when they put the study together. If a field is still in its infancy, why start with something you are pretty sure will make patients look bad*?

I'll give practitioners and researchers the fact that chronic pain is a sticky wicket; there are addicts out there seeking drugs from you just cuz they want 'em, and the process of sifting them out insults the people you're really trying to help. An objective diagnosis is a hard sell without blood tests or x-rays. Things get a lot simpler when you can say that the distinction isn't important to make because it's all in the "real patients'" heads. So you look for some data that support that conclusion. I respect the fact that many docs take up this challenge and treat sufferers of chronic pain, but I still feel pretty betrayed seeing this hostility laid so bare.

I don't really go in for "a few bad apples" explanations, mostly because of this talk by Dan Ariely [He talks about how almost everyone cheats a little, but there are only a few Lynndie Englands out there, so the aggregate adds up to a lot of cheating. Subtitles are available for the video]. I want a reasonably skeptical doctor. In case all this waffling doesn't make it clear, I am not willing to unequivocally condemn a whole group of medical professionals.

[I got rid of a bunch of equivocating stuff down here, because it was boring the hell out of me. Ambivalence: who cares?]

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