Wednesday, August 24, 2005

Restless leg syndrome-unrecognized epidemic or drug company hype

This sounds a lot like my recent posting on bipo*r disease and allegation of physician underdiagnosis and it should since it is another example of the same issue.
This time we look at an article in a recent Archives of Internal medicine and a reporting of that article in Internal Medicine World Report ( August 2005).16,00 patients were given questionnaires re:RLS. Weekly symptoms were reported by 773 patients ( 5 % of the 15, 391 patients who completed the questionnaires.) Apparently 337 reported discussing their symptoms with their physician but only 21 had received a diagnosis of RLS.
Realizing full well that the plural of anecdote is not data, I still have a urge to relate my experience in seeing patients in an internal medicine practice for over 35 years. No patient had a complaint that could be referable to RLS diagnosis ( not to say they didn't have it , they just didn't complain of it) and only two gave me the history of that disorder having been diagnosed elsewhere and were on treatment. One of the two gave me a web site to learn about the disorder. A 3/4 page ad is found in the same issue of Internal Medicine World report informing the reader about the "first and only FDA-approved treatment for moderate to severe Primary RLS", namely ropinirole- trade name Requip which is a dopamine agonist.FDA gave approval in May 2005. The manufacturer of ropinirole is listed as a source of funding for the study; its name is not mentioned in the article. To the extent that patients complain of RLS symptoms and are not counseled about it and perhaps offered the option of medication and have their serum iron levels measured, the physicians are not doing their job.(articles and lectures on RLS-locally there have been a number of "free" dinner lectures on RLS by a local movement disorder specialist-seem to not emphasize in their mentioning of the association of RLS and low iron that at least post menopausal women and all men should be evaluated for GI bleeding if the iron is
Maybe there is an almost epidemic of RLS and maybe docs are fairly clueless about the whole thing, but in light of the events of the last few years regarding revelations about drug company manipulation of the medical informational process, you just have to be a little skeptical.
On a possibly related note, there seems to be a flurry of recent publications-typically from the medical education companies-about the putative mechanistic reason(s) behind the reported increased prevalence of macrolide resistance and the apparent theoretical advantage of a new antibiotic class-the ketolides- in that regard.