Hasn't the BMJ always done this sort of thing? Who can forget Caroline Richmond's Princess Aurora and the wandering womb?
Myalgic encephalomyelitis, Princess Aurora, and the wandering womb. (nih.gov)
All that the author is telling me in that link is that she despises patients.
But it also tells me that, when patients feel ill, physically or mentally, they desperately want to know what is wrong with them, and I think this is entirely understandable and reasonable but doctors, and society generally, don't. If I feel ill and the only diagnosis I get is a brush off and a prescription for anti-depressants it means that I have no control whatsoever over the quality of my own life.
I wonder how many women who were diagnosed with neurasthenia in the 19th and early 20th centuries were anaemic, for example. I would suggest the percentage could have been very high. But based on that link above, doctors now make fun of those patients from 100 - 200 years ago because they are now assumed to have been mentally ill or lazy or attention-seeking. If they were poor they were assumed to be lazy and if they were rich they were assumed to be attention-seeking.
But anaemia is still a catastrophically common health problem according to the WHO :
https://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_data_status_t2/en/
I think, with hindsight, that I've been low in iron my entire life. I've had ferritin tested perhaps every 5 - 10 years on average. When levels are low enough for a doctor to pay attention and prescribe iron supplements (and that level has to be
really, really low) I've been prescribed 2 - 3 months worth of iron supplements and have never, as far as I can recall, been re-tested and re-prescribed after the prescription was finished. A few years ago I discovered I could buy iron-supplements of the type that doctors prescribe without a prescription in UK pharmacies. I also found out that I could do an iron panel with a finger-prick blood test (privately without a doctor being involved). I started treating myself and testing myself regularly, and it took me nearly two years of supplementing at maximum dose to get my ferritin to the middle of the reference interval. I then needed to take iron a few times a week just to maintain it at that point.
Fixing my own low iron unexpectedly eliminated my anxiety. If it worked for me it could well work for others. Anti-depressants never did this. The other thing about the whole "iron supplements vs anti-depressants" question is that the NHS always wants to save money. How is putting people on anti-depressants that they never come off of a good decision from an economical point of view? Iron supplements will do a better job, make the patient feel a lot better and, more importantly, they actually work at improving mental health, whereas anti-depressants very rarely do. And eventually, the patient may be able to stop taking iron supplements without withdrawal effects at all.
