Dr. Lowe: Most rheumatologist I’ve talked to are much like your golfing buddy: they operate in their care of fibromyalgia patients on false information they’ve been fed by what I call “old-guard rheumatology fibromyalgia researchers.” These guys, the old-guard, are rheumatologists who’ve conducted studies of fibromyalgia patients through the last several decades, but who’ve failed to figure out the causes of fibromyalgia. In my opinion, the old-guard has long since lived out any usefulness in the fibromyalgia line of study. In fact, I believe behavioral features of this clique have long been a major obstacle to progress in the field.

It’s clear to me what threw the old-guard off track in their search for the causes of fibromyalgia: they accepted without question false information promoted by the endocrinology specialty. That false information is that the TSH is failsafe in identifying which patients have too little thyroid hormone regulation and which ones don’t. The old-guard appears incapable to dislodging that false proposition from its collective mind. Rather than useful knowledge, it’s a concretized prejudice that has misguided them all through their failed pursuit of an understanding of fibromyalgia.

Having dealt with the old-guard for too many years, I firmly believe that they’ll never consider that fibromyalgia is possibly related to too little thyroid hormone regulation. Unfortunately, the old-guard’s prejudice against that possibility is reinforced by arrogance. Prejudice and arrogance is a double whammy block against acquiring new scientific knowledge. It makes up the type of rigid mind set that lead physicist Max Planck in the early twentieth century to state:

The history of science bears this out. Because of the fact, I believe that the overall population of fibromyalgia patients will make great strides toward recovery only when the old-guard has died and no longer impedes the advancement of knowledge in the field.

The high level of arrogance and prejudice among the old-guard has caused them to unscientifically ignore data that has been readily available to them. Consider, for example, their failure to pay attention to a finding my colleagues and I reported in Medical Science Monitor in 2006.[2]

In that study, along with resting metabolic rates, we compared the fibromyalgia test scores and the TSH levels of 15 fibromyalgia patients with those of 15 healthy controls. In our study report, we pointed out that regression statistical analysis showed that our fibromyalgia patients’ average TSH level accounted for 29% of the variability in their pain distribution (r = 0.5334, p = 0.0406).[1,p.CR285] This means that the patients’ TSH levels were a strong predictor of the patients’ pain distribution.

Regarding this particular finding, my colleagues and I wrote in the report, “In this study, the TSH level positively correlated with patients’ pain distribution . . . In view of previous studies showing a high incidence of primary [hypothyroidism] in [fibromyalgia], the positive correlation between the TSH level and pain distribution raises the possibility that the pain distribution in [fibromyalgia] is associated with primary [hypothyroid].”[2,p.CR286]

This is an important study finding for the debate over whether too little thyroid hormone regulation is the main cause of what we call fibromyalgia. It’s especially important for those (including the old-guard rheumatology fibromyalgia researchers) who believe that the TSH is the be-all and end-all for diagnosing hypothyroidism. Predictably, not a single member of the old-guard has bothered to comment on the finding. I would be surprised to learn that a single one of the group has even bothered to read the published paper and learn of our objective findings.

This shows a lack of integrity among some of the old-guard. Back in the early and mid-1990s, they told my research colleagues and me that they’d seriously consider our thyroid hypothesis when we published the results of controlled studies. Well, we’ve published controlled studies, but they’ve totally failed to follow through with their assurance—even though signed receipts from the postal service prove that we’ve brought study reports directly to their attention.

The old-guard still dominates the fibromyalgia field. And most practicing rheumatologists, such as your friend, look to it for an accounting of the available scientific evidence on fibromyalgia. But as long as these physicians look to the old-guard, they’ll remain incompletely informed about the full scope of the scientific evidence. They’ll hear only the information that the old-guards’ prejudicial minds allow them to hear. As a result, the listening physicians will continue to fail to relieve the suffering of fibromyalgia patients, and thereby contribute to the unnecessarily sustained suffering of patients as what I believe is the legacy of the old-guard.

I believe your reply to your rheumatology friend should be not to listen to the narrow slice of information that the old-guard doles out to him. He should learn from the old-guards’ failures and not prejudicially pick and choose what evidence to attend to and which to ignore. Instead, he should study the full research literature. By doing so, he’ll be complying with the first rule of scholarship in science: to consider all of the relevant evidence before claiming to reach a scientifically-based conclusion about the subject under study. By doing this, he’ll admirably distinguish himself from that aging clique of old-guard rheumatology fibromyalgia researchers who, through their linger predominance in the field, still perpetuate the pain, fatigue, and other symptoms of millions of forsaken fibromyalgia patients around the world.
 

References

1. Quoted in Thomas Kuhn, The Structure of Scientific Revolutions. Chicago, University of Chicago, 1970.

2. Lowe, J.C., Yellin, J., et al.: Female fibromyalgia patients: lower resting metabolic rates than matched healthy controls. Medical Science Monitor, 12(8):CR1-CR8, 2006.