NYT Trivializes ‘Nebulous’ Pain of ‘Middle Aged Women’

For the millions of women in America debilitated by chronic pain, the page one article in Monday’s (January 14) New York Times was like a punch in the gut, taking their quest to get medically treated back decades.

With a tone of barely hidden scorn, the article reinforced the most vicious Civil-War Era stereotypes of women in pain as hypochondriacs, hysterics and layabouts.

The story, by Alex Berenson, “Drug Approved. Is Disease Real?” debated the reality of the specific disease of fibromyalgia. The news hook was Pfizer’s desired promotion of its new drug Lyrica to treat fibromyalgia, and the Times’ question if this was just a marketing scheme to cash in on desperate women.

A red flag is that, as the article described early on, fibromyalgia primarily affects women — and even worse, ” middle-aged women.” Combined with the fact that pain is invisible, and it is a primarily female disease (like most pain and fatigue disorders), the burden of proof the article demands for fibromyalgia patients is unduly heavy, laden with double standards that other patients do not face.

Another immediate red flag was that Berenson immediately added that these patients are likely to suffer from “other similarly nebulous conditions, like irritable bowel syndrome.” First of all, Berenson has used the world “nebulous” to show his own bias; this was not a quote from a source. Meanwhile, Berenson fails to consider the basic medical concept of co-morbidity, or of one brain chemistry imbalance underlying one disorder as likely to cause others. This follows the old “logic” that to discredit a woman’s pain, a doctor would show that she complained about “too many ailments” and had “somatization disorder.” This meant that after a certain number of problems, she was just a hypochondriac seeking attention — and all of her complaints were invalid. But neurologists now widely accept the co-morbidity model that logically demonstrates that if one person is wired with one pain disorder, she is wired to have others.

Before reading the article, I knew the skeptical tone it would take by the caption under the picture of a female patient sitting in her bed. The caption described the woman as not having fibromyalgia, or being diagnosed with it, but that she “says she has fibromyalgia.” Through the ages, researchers have documented how doctors are more likely to say a male patient “has pain” but a female patient “says she has pain.”

Like other pain disorders, fibromyalgia has also been disbelieved because it’s invisible. In every society, doctors judge the reality of the pain according to how it can be detected by their current diagnostic tools, always considered absolutely definitive. (In the Victorian era, anything not detectable by a microscope, then considered the ultimate in high tech, was the litmus test.) But just in the past decade, we have developed very sophisticated brain scans tracing blood flow that indeed do demonstrate that patients diagnosed with fibromyalgia have brains more sensitive to pain. Berenson admits this, but then quickly disqualifies it as an argument because doctors admit they “cannot determine who will report having fibromyalgia by looking at a scan.”

This is a double standard. With such scans, doctors can also trace differences in processing activity, for example, in the brains of people with depression. But like with pain disorders, doctors do not use the scans for actual diagnosis. These scans are mainly used for research purposes, not to treat patients with complex neurological problems, that can’t be traced to one particular action in the brain.

This critique also follows the old paternalistic pattern that a woman’s pain is not real until a doctor declares it so. Her word is not enough.

Gladly, at least online, today the Times published some sound critiques of the article. And various established advocacy groups, such as the National Fibromyalgia Association , have published defenses. But the damage of this page-one story is already done.

This entry was posted on Friday, January 18th, 2008 at 11:10 am and is filed under Health & Sexuality, Science. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.