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SUPPLEMENTAL: What do you think is a non-disease? [Full text]

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Rapid Responses published:

Dodgy to say the least

Kieran E Fallon   (15 February 2002)

Peri-menstrual Dysphoric Disorder

Marvin K Malek   (15 February 2002)

Additional non-disease

Hans R. Koelz   (15 February 2002)

Non-diseases

Caroline Richmond   (15 February 2002)

Possible non-diseases

George B. Alcorn   (15 February 2002)

Raised cholesterol levels - a non disease

Malcolm E Kendrick   (15 February 2002)

Bereavement

Om Prakash   (15 February 2002)

non-disease apostasy

Dale Archer   (15 February 2002)

What is a Disease / Complaint?

Lonnie J Perry   (15 February 2002)

Reconsidering Cholesterol and Atherosclerosis

Eric S. Freedland ,MD   (15 February 2002)

Society's stigma spells DISEASE

Dr Rani Pal   (15 February 2002)

Non-disease

Mathai Babu   (15 February 2002)

Non-disease if doctor recognize physiological deterministic chaos.

Stagnaro Sergio   (15 February 2002)

Diastema

Chinelo E Nwokolo   (15 February 2002)

Time warps perception

Susan J Wighton   (16 February 2002)

A non disease

Clare O'Connor   (16 February 2002)

Non-diseases

douglas n salmon   (16 February 2002)

How to use an esteemed medical journal to increase suffering

Margaret Bailey   (16 February 2002)

Non-diseases

Joel M. Kauffman   (16 February 2002)

Lactose intolerance, ignorance, noncompliance

Myrna Y. Munar, Pharm.D.   (16 February 2002)

Re: Raised cholesterol levels - a non disease

Gunnar Lindgren   (16 February 2002)

menopause and pregnancy

Jo A Rosenfeld   (16 February 2002)

Solatic

Jeffrey D Bernhard   (16 February 2002)

Non disease

Sethuraman K Raman   (16 February 2002)

non-disease?

Tom P. Kindlon   (16 February 2002)

Disease Vs. Non-disease: When a non-disease becomes a disease?

Malvinder S. Parmar   (16 February 2002)

Non-Diseases or CO Poisoning?

Albert H Donnay   (16 February 2002)

Arrogance

Anelie J. Walsh   (16 February 2002)

Medicalization.. non-disease.. a view from across the pond

Gary N. Fox   (16 February 2002)

Hypercholesterolaemia - the superior winner

Uffe Ravnskov   (16 February 2002)

Other Non-Diseases??

Patricia S. Blankenship   (16 February 2002)

non disease of the month

John p McCormack   (16 February 2002)

"Non-disease"

Aya Biderman   (16 February 2002)

Non Diseases - A Case of Throwing the Baby Out With The Bath Water?

Dianna Dunbar   (16 February 2002)

Myalgia Encephalitis

Raymond Henry Givan   (17 February 2002)

Dis-ease= Drug-Deficiency

Kenneth M. Jacobie   (17 February 2002)

Who carries the can?

Alexa E McLaughlin   (17 February 2002)

More choices

A Chaudhuri   (17 February 2002)

This exercise is a slippery slope itself

Raymond F Colliton   (17 February 2002)

Domestic violence and Non-disease

seshubabu gosala, Pondicherry   (17 February 2002)

Re: Additional non-disease

Kjell O. Skavdal   (17 February 2002)

Common childhood symptoms

Peter M Jones   (17 February 2002)

Myalgic encephalomyelitis/chronic fatigue syndrome

Domenic A. Tricome   (18 February 2002)

Profit & loss

Raelene J Reeves   (18 February 2002)

here we go again

Paul S Mitchell   (18 February 2002)

Join the queue

Gurli H. Bagnall   (18 February 2002)

Autism as a process of dealing with the world

David N Andrews   (18 February 2002)

Non-Diseases of the Past

Robert D. Tennent   (18 February 2002)

The origin of "Non-Disease"

James A Dickinson   (18 February 2002)

Missing Non disease

Sri S Varman   (18 February 2002)

Re: Common childhood symptoms

zaffar sultan   (18 February 2002)

Age

Dirk Ulbricht   (18 February 2002)

'Wind'

Surinder Singh   (18 February 2002)

Shyness etc

Tim R Anderson   (18 February 2002)

non-diseases

douglas n salmon   (18 February 2002)

Re: Non-diseases

Tim R Anderson   (18 February 2002)

Impacted wisdom teeth

Mahendra Bagur   (18 February 2002)

Stupid Idea Syndrome

Trevor Wainwright   (18 February 2002)

Non-Diseases

Christopher I Stark   (18 February 2002)

non-diseases

Indramani Jena   (18 February 2002)

Bags under eyes

NAEIM ASAAD, Common Road-Langly-SL3 8LB   (18 February 2002)

another non-disease

Mark S CADE   (18 February 2002)

Let's leave dental problems to the dentists!

Sarah David   (18 February 2002)

Non disease or lack of knowledge?

Ann E. Fonfa   (19 February 2002)

Benign Chest Pain and Syndrome X

Colleen McKinnon, Ramsey lk rd. Sudbury, Ontario, Canada. P3E 2C6   (19 February 2002)

Re: Three other responses

Collen Mckinnon, Sudbury, On., Canada. P3E 2C6   (19 February 2002)

Ivan Illich on what is and what isn't a disease

Richard Smith   (19 February 2002)

Re: Two other responses

Colleen McKinnon, Sudbury, Ontario, Canada. P3E 2C6   (19 February 2002)

Chinese restaurant syndrome and penis envy

Caroline Richmond   (19 February 2002)

Miscarriage

Rupak R Roy   (19 February 2002)

Dental signs and symptoms

(Dr) Trevor Watts   (19 February 2002)

another one

Nicola A Cooper   (19 February 2002)

prevalence of non-diseases outside the UK

David W Pitches   (20 February 2002)

Disability

Kevin Reel   (20 February 2002)

...and another

Caroline Richmond   (20 February 2002)

atypical depression

Edward Shorter   (20 February 2002)

Hyperlipidaemia is the champion

Jorgen V Nielsen   (20 February 2002)

Physical-Mental-Social and Spiritual well being

praveen kumar madikonda   (20 February 2002)

non-disease

Phillip I Hodson   (20 February 2002)

Rationing?

Steve Hajioff   (20 February 2002)

Chronic Fatigue Syndrome/M.E. Medical Profession Cops Out

Christopher A. Szabo   (20 February 2002)

The most insideous non-disease

Jeffrey Craig Phillips   (20 February 2002)

Re: Re: Three other responses

Alexa E McLaughlin   (20 February 2002)

Re: Ivan Illich on what is and what isn't a disease

Alexa E McLaughlin   (20 February 2002)

two list additions

Anne Peticolas   (20 February 2002)

CFS vs ME

Jill McLaughlin   (20 February 2002)

ear wax

naeim ASAAD, common road-langley-slough-SL0 0JQ   (20 February 2002)

Criteria for non-disease

Mohan Chawla   (20 February 2002)

Re: Ivan Illich on what is and what isn't a disease

L S Lewis   (20 February 2002)

Laenaac on what is and what isn't a disease

A Chaudhuri   (21 February 2002)

Mitral Valve Prolapse

Hans JM Van Brabandt   (21 February 2002)

sick notes

Antony M Goodwin   (21 February 2002)

Non-disease

Meng-Kin Lim   (21 February 2002)

Re: The most insideous non-disease

Christopher A Weiner   (21 February 2002)

physiological phimosis

Shelton M Kartun   (21 February 2002)

Munchausen syndrome by proxy

Michael D Innis   (21 February 2002)

Non-diseases

Ahmad Reza Rasekhi   (21 February 2002)

Doctor-Thinks-you-have-a-disease syndromes.

Belle Monappa Hegde   (21 February 2002)

old age - a nondisease?

Valmiki Kolmi Nagaraj, Anandhi Nagaraj   (21 February 2002)

Not worthy

Jan Willem de Bruijn   (21 February 2002)

Repetitive Strain Injury

Martin Wilson   (22 February 2002)

A Darwinian concept of non-disease

Kazem Zarrabi, Lund University, 221 84 Lund, Sweden.   (22 February 2002)

Tropical non-diseases

John S. Marr, NA   (22 February 2002)

Everything is a disease?

Alejandro F. Luque-Coqui, Alejandro F. Luque Coqui   (22 February 2002)

Ageing is natural

iona e collins   (22 February 2002)

Re: Re: The most insideous non-disease

David Carvel   (22 February 2002)

low blood pressure

Mónica G Silva   (22 February 2002)

Truth, Justice and our Humanity

Malcolm Hooper   (22 February 2002)

Better to have a 'non-survey' than a 'non-disease survey'

Jeanette L Chapman   (22 February 2002)

Purpose of this exercise

Alexa E McLaughlin   (23 February 2002)

CFS/ME a Non-illness?

Lucy I Dechene   (23 February 2002)

Re: Ivan Illich on what is and what isn't a disease

Gurli Bagnall   (23 February 2002)

The point of this exercise

Richard Smith   (24 February 2002)

Almost none of the above

Peter J Allmark   (24 February 2002)

Smith - Devil's Advocate?

Gurli Bagnall   (24 February 2002)

Labels create legitimacy and produce dependence

Kevin C Murphy   (24 February 2002)

ICD605: Redundant prepuce and phimosis

Hugh P Young   (25 February 2002)

Mythical Malady

Charles Pragnell   (25 February 2002)

What really is the point

Trevor Wainwright   (25 February 2002)

Re: Re: Re: The most insideous non-disease

Christopher A Weiner   (25 February 2002)

Our common sense has atrophied

Julian H Jessop   (26 February 2002)

Elevated Cholesterol Is Not a Disease

Paul J. Rosch   (26 February 2002)

Common Sense

Ian A Miller   (27 February 2002)

Thank you

Dale A. Roose   (27 February 2002)

MIS-DIAGNOSED MSBP

Michael D Innis   (27 February 2002)

The pros and cons of medicalisation

Simon Wessely   (27 February 2002)

In response to Wessely

Gurli Bagnall   (1 March 2002)

Patients' Poll on BMJ Results in Landslide

Jean Linn   (1 March 2002)

Disability is a civil rights issue

Joyce M. Carter, Stephen Marsh, Disability Equality Officer, Liverpool City Council and Liverpool Health Authority, 24 Pall Mall, Liverpool L3 6AL   (2 March 2002)

Disease and non disease in children?

Barbara J Robinson   (3 March 2002)

Is this a useful thing to do?

David J Walland   (8 March 2002)

Re: Is this a useful thing to do?

John P. Heptonstall   (9 March 2002)

The IQOL Indice

Karel A Lyons   (9 April 2002)

what about these others

Alexander Parish   (10 April 2002)

A pathetic attempt at cost-cutting...

Maria Christou   (11 April 2002)

Top 10 Diseases Farce - Why I voted how I did

Trevor Wainwright   (11 April 2002)

What should doctors be doing?

Jon Stone   (11 April 2002)

A Joke, Yes?

Janette A Cobb   (11 April 2002)

One disease should no longer be newly diagnosed, ever

Taimur Shoaib   (11 April 2002)

Non Ilnnesses - another view

Trevor Wainwright   (11 April 2002)

Is this poll supposed to help anyone?

Lynn A Watson   (11 April 2002)

Re: A non disease

Sarah L Davies   (12 April 2002)

it is really a disease!

Elaine s Millard   (15 April 2002)

Shame

Marc G M van Impe   (16 April 2002)

GP's with NON-DISEASE ailments

Vikki Crawford   (17 April 2002)

FIBROMYALGIA

Sylvia M Mills   (25 April 2002)

FURTHER DEFINITION OF A NON-DISEASE

RAJKUMAR K CHETTY   (15 May 2002)

Feel ashamed

Victoria M Whitelaw   (26 November 2003)

BMJ surveys dont speak for the medical profession

John Hopkins, DL5 4SE   (27 November 2003)

Dodgy to say the least 15 February 2002
Kieran E Fallon, Head, Sports Medicine Australian Institute of Sport, Canberra2616 Send response to journal: Re: Dodgy to say the least	Sir, May I add two diagnoses so popular with alternative practitioners - chronic glandular fever and chronic candida infection. Best wishes Kieran Fallon
Peri-menstrual Dysphoric Disorder 15 February 2002
Marvin K Malek, none Barre, VT, USA Send response to journal: Re: Peri-menstrual Dysphoric Disorder	A disease entity created by the manufacturer of Prozac, desiring to find a new market niche for fluoxetine before it went generic. So they invented Peri-menstrual Dysphoric Disorder, and created a new name-- Sarafem--for fluoxetine. Quite a marketing coup! Thanks for the fun exercise!
Additional non-disease 15 February 2002
Hans R. Koelz, Head, Division of Gastroenterology Triemli Hospital, CH-Zurich, Switzerland Send response to journal: Re: Additional non-disease	Chronic fatigue syndrome
Non-diseases 15 February 2002
Caroline Richmond, Freelance journalist Home. SW3 5AQ Send response to journal: Re: Non-diseases	Hyperactivity Seasonal affective disorder Raiding the fridge in the night Oedipus complex Complexes generally
Possible non-diseases 15 February 2002
George B. Alcorn, Rural GP Riverton, S.Australia 5412 Send response to journal: Re: Possible non-diseases	I'm not sure if "candida syndrome" and "burn out" could be considered non-diseases as they seem to have become highly unfashionable diseases at present, but years ago they consumed an inordinate amount of my time. I had difficulty persuading patients that the symptoms they complained of were identical to so many other conditions and that none of them really responded to the "appropriate" treatment recommended by their advocates. Is "allergy to the Twentieth Century" in the same class or is it still a common complaint? I also wonder if low back pain should be a non-disease. The number of treatable causes for this condition is so small as to make it a description of a complaint and not a diagnosis of a disease.
Raised cholesterol levels - a non disease 15 February 2002
Malcolm E Kendrick, Medical director Lifelong Learning Partnership Send response to journal: Re: Raised cholesterol levels - a non disease	It is now widely accepted that a raised cholesterol level must be lowered, and the definition of 'raised' has fallen over the years. It is being proposed that 4.5mmol/l is ideal, on the basis that rural populations e.g. rural Chineses have this choelsterol level, and a very low rate of CHD. Yet from 1980 to 1989, the average cholesterol level in Japan went up, from 4.5 to 5.2, and during this time, the rate of CHD dropped. The cholesterol level in France has risen for the last twenty years, now standing at 6.1, yet the rate of CHD in France has fallen during this time period, and it is a quarter of that in the UK (age-matched), despite identical cholesterol levels. Russia has undergone an epidemic of CHD in the last ten years. This is associated with hypocholesterolaemia and raised HDL levels. In Framingham, a falling cholesterol level was associated with an increasing rate of death from CHD over a fifteen year time period. The average cholesterol level of native, or aboriginal Canadians is 5.1, compared to 6.1 in France yet their rate of CHD is five times as high (age-matched). Emigrant Asian Indians in the USA have lower cholesterol levels than the surrounding Caucasian population, yet three times the rate of CHD. This is despite a 50% rate of vegetarianism, a 1% smoking rate, lower average BP, and significantly less obesity. It is impossible to find any consistent correlation between cholesterol levels and CHD (other than in the extreme condition of FH). I would call a raised cholesterol level a non-disease. Your truly Dr Malcolm Kendrick
Bereavement 15 February 2002
Om Prakash, Head of Dept of Medicine, St MArtha's Hospital, Bangalore India St Martha's Hospital, Bangalore 560009, India Send response to journal: Re: Bereavement	Bereavement is a normal human condition. It is often medicalised and overdiagnosed and treated. What is needed is the social support and understanding to allow the person to cope rather than be treated.
non-disease apostasy 15 February 2002
Dale Archer, Occupational Health Physician Shropshire County Council Send response to journal: Re: non-disease apostasy	chronic fatigue syndrome fibromyalgia neurasthenia adjustment reaction
What is a Disease / Complaint? 15 February 2002
Lonnie J Perry, N/A Warrenton, VA 20187 Send response to journal: Re: What is a Disease / Complaint?	Disease: a condition of the living animal or plant body or one of its parts that impairs normal functioning : SICKNESS, MALADY Complaint: 1 : expression of grief, pain or dissatisfaction 2 a : something that is the cause or subject of protest or outcry b : a bodily ailment or disease 3 : a formal allegation against a party Perhaps we need a more restrictive definition of disease to restrict some of the complaint elements for medical purposes. See: Merriam Webster's Collegiate Dictionary, Tenth Edition
Reconsidering Cholesterol and Atherosclerosis 15 February 2002
Eric S. Freedland ,MD, Medical Director Platinum Fitness Lifestyle LTD; 5 Bessom Street, No. 318, Marblehead, MA 01945 Send response to journal: Re: Reconsidering Cholesterol and Atherosclerosis	Consider the following facts. More than half of all MIs occur in people with normal plasma lipid levels and 40 percent have no warning symptoms1 In fact, angiographic studies indicate that the average stenosis of lesions leading to acute MI is less than 50 percent, with infarction occurring due to rupture of non-occlusive plaques triggering acute thrombosis.2 The beneficial effects of statin agents may be independent of serum lipid levels and can occur before lipid lowering.3-6 In the CARE trial, the risk of an MI was reduced to the same degree whether the cholesterol level was lowered by a large or small amount, i.e., “lack of exposure response.”7 While a number of factors can damage the endothelium and accelerate atherosclerosis, oxidants and free radicals are major initiators of vessel wall damage. Statins have been shown to prevent the activation of monocytes into macrophages, inhibit the production of pro-inflammatory cytokines, C- reactive protein, and cellular adhesion molecules, and decrease the adhesion of monocyte to endothelial cells.8 The benefit of statins may be their anti-inflammatory effect, and the lowering of cholesterol may be an interesting side effect. LDLs appear to be harmful when they are oxidized. Without a pro-oxidant or pro-inflammatory environment perhaps elevated lipids are significantly less of a threat, and perhaps we should be emphasizing the type of plaque, inflammatory milieu, and endothelial dysfunction rather than circulating lipids per se. 1. Braunwald E. Shattuck lecture--cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 1997; 337:1360-9. 2. Ambrose JA, Tannenbaum MA, Alexopoulos D, et al. Angiographic progression of coronary artery disease and the development of myocardial infarction. J Am Coll Cardiol 1988; 12:56-62. 3. Aengevaeren WR. Beyond lipids - the role of the endothelium in coronary artery disease. Atherosclerosis 1999; 147 Suppl 1:S11-6. 4. Ridker PM, Rifai N, Pfeffer MA, Sacks F, Braunwald E. Long-term effects of pravastatin on plasma concentration of C-reactive protein. The Cholesterol and Recurrent Events (CARE) Investigators [see comments]. Circulation 1999; 100:230-5. 5. Nielsen JV. Serum lipid lowering and risk reduction--where is the connection? BMJ 2001; 323 Electronic response to Kmietowicz, Z:1145- BMJ.com. 6. Kendrick M. Finally, proof that statins don't work by lowering LDL. BMJ 2001; 323:1145 (electronic response to Kmietowicz, Z. BMJ.com). 7. Ravnskov U. The Cholesterol Myths: Exposing the fallacy that cholesterol and saturated fat cause heart disease. Washington, DC: New Trends Publishing, Inc., 2000. 8. Koh KK. Effects of statins on vascular wall: vasomotor function, inflammation, and plaque stability [In Process Citation]. Cardiovasc Res 2000; 47:648-57.
Society's stigma spells DISEASE 15 February 2002
Dr Rani Pal, Consultant Neonatal Paediatrician (locum) UK Send response to journal: Re: Society's stigma spells DISEASE	Is Disability a Disease in our society? Discriminate, disqualify, detriment and dispose Illness, Insult, Intimidate and Isolation Sickness, sighs, slighted and slaughtered Eugenics, Equation, Evolution and Exterminate Annoyance, Attitude, Alienate and Axed Sinful, Scorned, Segregate and Slander Excuses, Eye-sore, Evaluate and End
Non-disease 15 February 2002
Mathai Babu, Staff Grade Paediatrician Powys SY18 6EF Send response to journal: Re: Non-disease	Chronic fatigue Syndrome Constipation(non organic) Irritable Bowel syndrome Anxiety disorders Phobias Conduct disorders in children Specific Learning Difficulties
Non-disease if doctor recognize physiological deterministic chaos. 15 February 2002
Stagnaro Sergio, Specialist in Blood, Gastrointestinal and Metabolic Diseases Send response to journal: Re: Non-disease if doctor recognize physiological deterministic chaos.	Sirs, I am very delighted, once again, with BMJ for discussing in April 13 Number the topic "Non-Disease". Really, if doctors around the world would be skilled in Biophysical Semeiotics (http://digilander.iol.it/semeioticabiofisica), it would be senseless to edit such a number by our famous review. Unfortunately, theories nowadays are very different, as regards this original semeiotics, in total disagreement with Claude Bernard et alii. In fact, all biological systems, including the microcirculatory one, are "open" systems, continuously supplied with blood, i.e., material-energy-information, by the related microvessels, and consequently they fluctuate around their equilibrium point in accordance with a deterministic chaotic behaviour. When we are speaking of "Disease" we refer to a defined biological system, involved by whatever disease, which, therefore, loses its physiological degree of deterministic chaos (fractal dimension). In conclusion, a physician experienced in Biophysical Semeiotics, to the question: "What do you think is a non-disease", answers promptly:"A non-disease is the presence of "physiological" deterministic chaos, or normal fractal dimension (3,81), in all biological systems" OF COURSE, I add.
Diastema 15 February 2002
Chinelo E Nwokolo, Staff Grade Forensic psychiatry Chase Farm Hospital Enfield EN2 8JL Send response to journal: Re: Diastema	Diastema, gap teeth.....some think it is a disease... that should be treated....,not everybody! The Ibos of Nigeria see it as a mark of BEAUTY. ( What do you think of Madonna's? Sweet?!)
Time warps perception 16 February 2002
Susan J Wighton, communicable disease nurse Dorset Health Authority BH22 9JR Send response to journal: Re: Time warps perception	Whilst considering the medicalisation of life/health/stigma,perhaps we could consider that disease is inherent in life? As birth and death - perhaps so disease. This could evolve into conception,birth,disease,death becoming normative values instead of anxiety factors. Extrapolating into cancer diagnoses becoming rites of passage - as many potentially life threatening experiences are interpreted within the historical/cultural/magical settings in medical anthropolgy.
A non disease 16 February 2002
Clare O'Connor, gp registrar Kirbymoorside surgery, Tinley Garth, Kirbymoorside, York, YO6 6AR Send response to journal: Re: A non disease	Loss of libido in a post menopausal lady in her sixties, who 'wants something done'. Is this not a normal physiological state?
Non-diseases 16 February 2002
douglas n salmon, gp b20 3he Send response to journal: Re: Non-diseases	impotence erectile failure
How to use an esteemed medical journal to increase suffering 16 February 2002
Margaret Bailey, retired 07871 Send response to journal: Re: How to use an esteemed medical journal to increase suffering	People look to your journal to publish scientifically worthy research, not public opinion polls which show the prejudices and ignorance of your readership and contributors. This is the type of article I'd expect to see in a tell-all rag newspaper - unless, of course, you intend to use the poll results to show just how ill-informed, undignified, and easily swayed by personal bias the medical world can be. Your trite apology ("We are not suggesting that the suffering of people with these 'non-diseases' is not genuine") carelessly increases the harm because it shows that you know exactly how the article will be read. This is certainly a new low for medical journalism.
Non-diseases 16 February 2002
Joel M. Kauffman, Research Professor of Chemistry University of the Sciences in Philadelphia 19104 Send response to journal: Re: Non-diseases	hyperlipidaemia
Lactose intolerance, ignorance, noncompliance 16 February 2002
Myrna Y. Munar, Pharm.D., Associate Professor Oregon State University College of Pharmacy Send response to journal: Re: Lactose intolerance, ignorance, noncompliance	Lactose intolerance, ignorance, noncompliance
Re: Raised cholesterol levels - a non disease 16 February 2002
Gunnar Lindgren, Teacher Gothenburg University Send response to journal: Re: Re: Raised cholesterol levels - a non disease	I think the cholesterol issue together with the money from margarine industry is one of the strongest marketing success ever. The industry has got its advertisments in white gowns in a situation when patients fear for death. I am convinced that the focus as fast as possible should be moved from intake of fat to intake of carbohydrates with high glycemic index instead.
menopause and pregnancy 16 February 2002
Jo A Rosenfeld, Asst Prof Johns Hopkins Baltimore MD 21113 USA Send response to journal: Re: menopause and pregnancy	There are women's conditions that have been medicalized and considered a disease. Thus if the woman after obtaining a consultation does not agree she is non-compliant. Three of these are pregnancy, menopause and contraceptive needs. They require a physician's involvement, prescription, and the woman can be "non-compliant."
Solatic 16 February 2002
Jeffrey D Bernhard, Professor 01655 Send response to journal: Re: Solatic	The term "solatic" is used to describe a person who has a delusional belief that sunlight is causing a rash or an abnormal cutaneous sensation. In some cases there may be a genuine rash or abnormal sensation that can be attributed to a different (non-solar) cause; in some cases there is no detectable rash or physiologically logical sensory disturbance. Bernhard JD, Parrish JA. Nonrashes. II. Solatics. Cutis 29:253, 1982. The term has appeared in the glossary of the last few editions of the Rook/Wilkinson/Ebling Textbook of Dermatology. Champion RH, Burton JL, Burns DA, Breathnach SM. Rook/Wilkinson/Ebling Textbook of Dermatology, 6th ed. Oxford: Blackwell, 1998, p3676.
Non disease 16 February 2002
Sethuraman K Raman, Professor of Medicine Jawaharlal Institute of PG medical education & research, Pondicherry, India. Send response to journal: Re: Non disease	Please add "Worried Well" person.
non-disease? 16 February 2002
Tom P. Kindlon Dublin 15, Ireland Send response to journal: Re: non-disease?	impulsive-desire-to-indulge-in-psychological-speculation syndrome
Disease Vs. Non-disease: When a non-disease becomes a disease? 16 February 2002
Malvinder S. Parmar, Consultant Physician, Director of Dialysis Timmins & District Hospital, Timmins, ON. P4N 8R1. Canada. Send response to journal: Re: Disease Vs. Non-disease: When a non-disease becomes a disease?	Disease: “a condition that impairs normal physiological functioning.” Health: “state of optimal functioning with freedom from disease or abnormality.” Non-disease is a state somewhere between health and disease. Its definition varies depending on the individual and society. An individual might feel that he/she is normal but if his/her behavior is affecting the society’s moral values then that would be considered abnormal by the society. Although it may not be classified as ‘disease’ but it definitely would not be considered ‘healthy’ and would likely be classified as ‘un-healthy’ or ‘non-disease.’ Similarly an individual afflicted with an abnormality that impairs his/her normal functioning would consider himself/herself as ‘having a disease’ but society may not consider him as such because that ailment has not been recognized by the society as a disease for various reasons (no consensus on definition, ambiguous symptomatology, lack of recognition etc.). It is interesting to note that a so-called ‘(ab)normal or sub-normal state’ remains a non-disease until a modality or treatment becomes available. When a drug or therapy for a ‘non-disease’ becomes available then that ailment becomes not only a disease, but an epidemic. Obesity and osteoporosis have been embedded in human culture for centuries and in fact about a century ago, obesity was a sign of good health and prosperity. In the past decade these conditions have become epidemics. Why? Is this really an effort to improve the overall health of the population or has some ulterior motives (financial gains for the ‘interest group(s)’).
Non-Diseases or CO Poisoning? 16 February 2002
Albert H Donnay, President, MCS Referral & Resources, www.mcsrr.org 508 Westgate Rd, Baltimore MD USA 21229 Send response to journal: Re: Non-Diseases or CO Poisoning?	I think it is very telling that more than half the disorders on your list of "non-diseases" are characterized by common--but also commonly overlooked--symptoms of carbon monoxide poisoning, including: Air rage, Anorgasmia, Attention deficit disorder, Brain death, Diabetes, False memory syndrome, Fibromyalgia, Fibrositis, Food intolerance, Gulf war syndrome, Hypoglycaemia, Hypotension, Hysteria, Insomnia, Iron deficiency, Irritable bowel syndrome, Jet lag, Migraine, Multiple chemical sensitivities, Myalgic encephalomyelitis/chronic fatigue syndrome, Obesity, Pain, Personality disorder, Post-traumatic stress disorder, Premenstrual syndrome, Recurrent miscarriage, Restless legs syndrome, Road rage, Seasonal affective disorder, Short stature, Sick building syndrome, Social phobia, Somatisation disorders, Stress, Tension headache, Total allergy syndrome, and Unhappiness. It is for this list and more that CO poisoning has long been known in medicine as a Great Imitator (1). I wonder if any of the physicians who are so quick to dismiss these conditions as non-diseases have ever read any of the literature linking them with CO or ever tested anyone who suffers them for this possibility. Listed below in chronological order by date of their first appearance are 50 more disorders consistent with CO poisoning that have been reported in English medical literature since the seminal discovery of neurasthenia in 1869, which I have shown was most likely caused by CO from gas lighting (2). You may as well add all 50 to your list of "non-diseases" since that unfortunately is still how most of them are regarded by physicians and medical historians (3). 1871 Irritable Heart, aka Da Costa's Syndrome 1892 Hyperaesthesia 1895 Anxiety Neurosis 1904 Phrenasthenia 1906 Psychasthenia 1914 Shell Shock Syndrome 1916 Battle Fatigue, aka Soldier's Heart 1918 War Neurosis 1930 Heat, Cold and Effort Sensitiveness 1930 Allergic Toxemia 1936 Morbid Industrial Fatigue 1938 Neurocirculatory Asthenia, aka Effort Syndrome 1945 Allergic Fatigue 1950 Epidemic Neuromyasthenia, aka Icelandic Disease or Akureyri Fever 1952 Allergy of the Nervous System 1954 Cerebral Allergy 1955 Encephalomyelitis simulating poliomyelitis, aka Royal Free Hospital Disease 1956 Specific Adaptation Syndrome 1956 Benign Myalgic Encephalomyelitis 1957 Epidemic Postinfectious Neuromyasthenia 1965 Familial Dysautonomia, aka Riley-Day Syndrome 1965 Asthenic Neurosis 1966 Psycho-Vegetative Syndrome 1968 Pseudoneurasthenic Syndrome 1969 Idiopathic Hypogeusia 1973 Ecologic Mental Illness 1974 Epidemic Mass Hysteria 1975 Autonomic Dystonia 1976 Neurasthenic Musculoskeletal Pain Syndrome 1978 Mass Psychogenic Illness 1978 Psychic Possession 1978 Chemical Hypersusceptibility 1980 Neurasthenic Neurosis 1982 Familial Chronic Mononucleosis Syndrome 1984 Chronic Active Epstein Barr Virus Syndrome 1984 Chronic Mononucleosis 1985 20th Century Syndrome 1986 Sporadic Postinfectious Neuromyesthenia 1986 Hypersensitivity Syndrome 1987 Darkroom Disease 1988 Chronic Fatigue and Immune Dysfunction Syndrome 1990 Chronic Habitual Hyperventilation Syndrome 1996 Iatrogenic Hypochondriasis 1996 Multi-Organ Dysesthesia 1996 Idiopathic Environmental Intolerances 1997 Chronic Pain and Fatigue Syndrome 1997 Autoimmune Fatigue Syndrome 1998 Toxicant Induced Loss of Tolerance 1998 Chronic Multisymptom Illness 1999 Multi-Sensory Sensitivity, aka MUSES Syndrome in honor of Edgar Allan Poe --Albert Donnay, MHS, Environmental Health Engineer and Certified CO Analyst References (1) Grace TW, Platt FW. Subacute carbon monoxide poisoning. Another great imitator. JAMA 1981;246(15):1698-700 (2) Donnay A. Carbon Monoxide as an Unrecognized Cause of Neurasthenia: A History. In: Penney, D. ed. Carbon Monoxide Toxicity. 2000. Boca Raton FL : CRC Press. (3) Wessely S, Hotopf M, Sharpe M. Chronic fatigue and its syndromes. Oxford: Oxford University Press, 1998.
Arrogance 16 February 2002
Anelie J. Walsh, student Send response to journal: Re: Arrogance	The arrogance of this concept is breathtaking. Had this list been compiled fifty years ago, which illnesses would have been listed? Multiple sclerosis, Crohn's Disease, hypothyroidism...? The medical community's inability to learn from past mistakes - namely, to acknowledge that the vast majority of patients are honestly relating their symptoms and sincerely wish to recover - will doom generations of innocent people to the kind of humiliation and insult this article encapsulates. Unable to perceive their own ignorance, these commentators will enjoy a brief moment in the spotlight sneering at the 'proponents' of 'non-diseases', and utterly fail to advance medical science. And you wonder why the benighted sufferers of their non-diseases resort to 'alternative practitioners'.
Medicalization.. non-disease.. a view from across the pond 16 February 2002
Gary N. Fox, Teaching Faculty St. Vincent Medical Center, Toledo, OH 43608-2691 Send response to journal: Re: Medicalization.. non-disease.. a view from across the pond	At least from the other side of the Atlantic . . . 1. SPORTS PHYSICALS -- required by most school districts for middle school and high school athletes in the U.S. Annually, in the U.S., there are about 20 reported sudden cardiac deaths per year among 2.1 million athletes competing in high school sports. That's a pretest probability of 1/100,000. The author uses a sensitivity for H&P of 6% and specificity 97.8%. For ECG, he uses sensitivity of 70% and specificity of 84.3%. Let's take a sample size of 2.1 million (the number of athletes at risk) and apply a pretest probability of 1:100,000 using the ECG numbers - - 70% sensitivity and 84.3% specificity. Of the 21 folks who are going to die, we'll accurately find 14.7 and miss 6.3 of them. However, we'll have 329,696.7 false-positive tests (compared with the 14.7 true-positives) for a predictive value of a positive test of 0.0045% (that's 0.000045). We'd have to work up 329,696.7 + 14.7 athletes to find the 14.7 who are going to die, while missing 6.3 anyway. Observations: (1) We've got much better uses of the resources, like preventing the slaughter of teens in motor vehicles. (2) You might contend that the screening has eliminated a lot of athletes bound to die, so the numbers would be much higher, say a couple hundred per year if they weren't being eliminated. H&P using the above assumptions identifies 1.26 of the 21 individuals who are going to die, while identifying an additional 46,199.5 individuals with false- positive tests, for a predictive value of a positive test for disease of 0.002727% (or 0.00002727, mostly a reflection of the very meager pre-test probability). Fuller CM. Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med & Science in Sports & Exercise 2000;32:887. Overall, the approx costs per year of life saved: CV-specific H&P $84,000; 12-lead ECG, $44,000; 2D- echocardiogram, $200,000. The 12-lead ECG is the most cost effective preparticipation cv modality of the 3. 2. Work excuses -- off work, return to work. Holleman WL. School and work release evaluations. JAMA 1988;260:3629. Major ethical issues with a confusion about the professional boundaries of medicine, education, and industry. Other issues include confidentiality and truth telling. "Casual absenteeism" -- for minor illnesses -- threatens productivity, morale, and even viability of industry and schools. In the traditional medical relationship, a patient seeking help has no incentive to lie. With the advent of physicians-as-investigators, the rules of the game are changing, and the physician-*employee* relationship threatens to damage the physician-*patient* relationship. Casual absenteeism is an economic problem, not a medical one. Physicians practice bad medicine when they offer slips when the problem is a dishonest employee, an employee with family problems, a poorly structured sickness benefits policy, an unjust pay scale, unpleasant working conditions, or bad employer-employee relations. In most instances, physicians cannot confirm or deny or even determine the extent to which work ability is impaired. 3. Some have listed such things as dyslipidemia/hyperlipidemia as "nondiseases." That is true in that, like hypertension, they are *RISK factors* rather than diseases. Some have listed such things as constipation, which is a *symptom* that may be a matter of lifestyle but can also be a harbinger of underlying disease(s). For "non-disease," I think mostly of the "medicalization" of things that physicians really should play no role. Granted, there are probably some gray areas between risk factors, symptoms, and medicalized non-diseases. But I, for one, want to know about my patients' risk factors and symptoms.... but don't want to waste my time with non-disease. Based on recent articles, we might also talk about medical NON-sense, which might go so far as to bring mammography and PSA measurement into the fray.
Hypercholesterolaemia - the superior winner 16 February 2002
Uffe Ravnskov, Independent researcher Magle Stora Kyrkogata 9, S-22350, Lund, Sweden Send response to journal: Re: Hypercholesterolaemia - the superior winner	In a competition for being the commonest non-disease in the world, no one can stand comparison with hypercholesterolaemia. Together with its many cousins in the lipid family, it includes at least a third of the Western population, if not more (1). Non-disease is rarely met by non-treatment. Unfortunately so, because not a single life has been saved by the boring diets and the toxic drugs that have been used since many years in millions of people (2). The new cholesterol lowering drugs, the statins have saved some, but the number is small in comparison with the number of treated non-patients. That the statins do benefit is taken as proof that hypercholesterolaemia is a disease although all evidence has shown that the statins do not operate through cholesterol lowering. Indeed, statins may benefit, not because of, but in spite of their cholesterol lowering, because high cholesterol may protect against disease. This was the conclusion from the finding of a lower than normal coronary and total mortality seen in several pedigrees of individuals with familial hypercholesterolaemia (3). The sad paradox is that by treating non-diseases we may create real ones. 1. Executive Summary of the third report of the National Cholesterol Education Program (NCEP)expert panel on detection,evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001; 285: 2486-97. 2. Ravnskov U. The cholesterol myths. Washington DC: New Trends Publishing; 2000. 3. Sijbrands EJG, Westendorp J, Defesche JC, de Meier PHEM, Smelt AHM, Kastelein JP. Mortality over two centuries in large pedigree with familial hypercholesterolaemia: family tree mortality study. BMJ 2001; 322: 1019- 23.
Other Non-Diseases?? 16 February 2002
Patricia S. Blankenship, retired USA, 36854 Send response to journal: Re: Other Non-Diseases??	You have really opened a can of worms. This topic will evoke angry responses from non-medicos who read your journal on-line. What about these in your list: Diabetes? Easy to prove if one has this malady. Hypotension? Ask people who faint easily. Warts? Can one not believe one's own eyes? Varicose veins? These hurt and can cause long term circulatory problems. Stress -- Measure the cortisol pre and post stress. Pet scans. Give us a break here. Stretch mark, Polycystic ovary syndrome, and Positive cervical smear, Premenstrual syndrome, Recurrent miscarriage, Fibrocystic disease of the breast, Calcium deficiency -- These must have been submitted by a man. Restless legs syndrome -- Anyone who ever underwent anesthesia or has a brain disorder may develop nocturnal myoclonus. Or are brain disorders also non-diseases? Obesity -- See current gene studies. Where in the world did this list come from? Migraine -- NOT A DISEASE? Please! Halitosis -- while not usually treated, this is frequently caused by bacterial infestations in the upper pharynx. A bacterial infection is not a disease? Astigmatism -- Can be measured and treated. I see you have included Chronic Fatigue Syndrome / ME / BME and Fibromyalgia as non-diseases. At least a million people in the US suffer from these diseases. Peer reviewed publications from NIH and CDC support these conditions as diseases. Maybe you should define disease instead of non-disease - this exercise at your web site is ludicrous without definitions. You must be defining disease in a very different way than most primary care doctors and patients. I think you should add Arrogance and Chronic Ego-Centrism to your list of true diseases, if this is your best effort. I could go on, but won't. Not worth the effort. Patricia S. Blankenship
non disease of the month 16 February 2002
John p McCormack, GP registrar Westport, Co. Mayo. Ireland Send response to journal: Re: non disease of the month	Autistic Enterocolitis. A makey uppey diseasey namey attempting to give scientific kudos to a postulate based on fewer cases than I have changes of underpants.
"Non-disease" 16 February 2002
Aya Biderman, Deputy Head of Department Dept of Family Medicine, Ben-Gurion University, Beer-Sheva, Israel Send response to journal: Re: "Non-disease"	Domestic violence is another "non-disease" with important implications on health
Non Diseases - A Case of Throwing the Baby Out With The Bath Water? 16 February 2002
Dianna Dunbar, none (have a BSc (hons) Health and Community Studies also personal interest. Home code: (UK) BA21 3SB 20 Send response to journal: Re: Non Diseases - A Case of Throwing the Baby Out With The Bath Water?	Having read the list of 'non-diseases' I'm not at all sure I fully understand the rationale behind it. However - as a person who experiences chronic fatigue syndrome, fibromyalgia, obesity and several other 'conditions' included on the list - I do have a vested interest in the outcome. I fully accept that the 'medicalisation' of certain diseases, illnesses, and conditions has impacted negatively on those who experience them. Moreover, I also accept that there are certain situations whereby it might be better not to treat certain conditions. However, I would argue this to be true of both diseases and 'non-diseases' and can comprehend no automatic correlation between disease = treatment and 'non-disease' = no treatment. A cursory glance at the list would appear to highlight this. The condition of having 'Big ears' is listed and I guess very few people would argue that having 'big ears' is a disease. Therefore, its inclusion as a 'non-disease would seem to pose few problems. However, this does not mean that one can automatically assume that the condition requires no treatment. That decision would surely depend on various factors including the extent to which the condition impinges on the life of the person experiencing it. Conversely, cancer is (arguably) a disease that often benefits from highly aggressive treatment though there are also many situations where, for a variety of reasons, it might be better to treat