Carpal Tunnel, Trichinosis, and the Media

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The media continue to feature nonsensical statements about health, probably because health issues sell, and the editors lack appropriate scientific judgment.

The New York Times and the Philadlephia Inquirer editorialized last month about the Supreme Court's recent disabilities decision that cited carpal tunnel syndrome as a repetitive stress injury. First of all, it's not an injury. It is a condition that may result from poor or improper work habits, but, like low back pain in people who lift, it is not an injury. It's usually preventable, is almost always self-limited, and will improve on its own. Carpal tunnel syndrome is a greatly over-diagnosed condition, since there is no scientific means of confirming it. Wrists are being operated on unnecessarily and compensation is being paid for no empirically discernable reason. The evidence that such conditions are over-diagnosed, wrongly attributed, and beloved by trial lawyers and unions is overwhelming. That's why Congress, for once wisely, opposed the late Clinton-era OSHA regulations. Opposition to such tort excesses held up the nomination of the younger Scalia and was considered controversial by his opponents, but science was on his side in this instance.

Another bit of foolishness came to light recently in a letter to the editor of the AMA Archives of Internal Medicine, in which a Seattle-based internist speculated that Mozart died of trichinosis because a letter that Mozart had written to his wife a few weeks earlier mentioned how much he had enjoyed some pork cutlets. This was picked up by press agencies, resulting in articles in newspapers and in TV Guide. But it's nonsense: yes, Viennese like wienerschnitzel, which might be pork or veal. But pigs in the late eighteenth century in Vienna were not fed anything that could give them trichinosis (and their muscles would have had to harbor the trichinella spiralis parasites for human consumers to develop the disease). Wienerschnitzel is never eaten near-raw, and cooking would kill any larvae even if there had been any present. None of Mozart's late symptoms conform to those of trichinosis. He literally drowned, swollen with edema in an extreme fashion that physicians call anasarca, possibly from kidney failure due to amyloidosis (a protein deposition disorder that follows infectious and degenerative diseases like juvenile rheumatoid arthritis, a condition hinted at in Mozart's medical records).

Loose language and loose thinking should not overpower diligent research, and the media should very carefully examine assertions before rushing to publicize them. Responsible journalists should not boost unwarranted public fears of workplace injury or death by pork for the sake of ratings.

George E. Erlich, M.D. is an ACSH advisor.

Responses:

February 22, 2002

This is one of the best concise articles I have read regarding misleading medical diagnoses. Let's see more from Dr. Ehrlich.

Bershad