How Real Is “Restless Legs Syndrome”?

The first time I saw a TV commercial about Restless Legs Syndrome, I was pretty sure it was a spoof. I figured I had stumbled across a prime-time Saturday Night Live special and was seeing a well-done fake ad. It was pretty funny, I thought — Restless Legs Syndrome, ha! Who thinks of this stuff? Of course, it turned out to not be a joke at all, but rather a pharmaceutical ad — for Requip, I think. And then I thought, Now this is what Direct-to-Consumer advertising is made for. You make up a disorder, give it an easygoing name, and voila: drug sales.

Oh, cynical me.

Writing in the New York Times, Nicholas Wade reports that researchers in Germany and Iceland have identified a genetic link to the condition, which “should help scientists understand the biological basis of the disorder.”

Not everyone is yet persuaded. Wade cites a recent report in the journal PLoS Medicine by two Dartmouth researchers, Steven Woloshin and Lisa Schwartz, called “Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick.” These skeptics, Wade writes, “argued that its prevalence had been exaggerated by pharmaceutical companies and uncritical newspaper articles, and that giving people diagnoses and powerful drugs were serious downsides of defining the elusive syndrome too broadly.”

Here is the lead of their report:

Life can be hard. Sometimes you feel sad or distracted or anxious. Or maybe you feel a compelling urge to move your legs. But does that mean you are sick? Does it mean you need medication?

Maybe, maybe not. For some people, symptoms are severe enough to be disabling. But for many others with milder problems, these “symptoms” are just the transient experiences of everyday life. Helping sick people get treatment is a good thing. Convincing healthy people that they are sick is not. Sick people stand to benefit from treatment, but healthy people may only get hurt: they get labeled “sick,” may become anxious about their condition, and, if they are treated, may experience side effects that overwhelm any potential benefit.

When asked to comment on this newest genetic finding, Woloshin stuck to his guns, telling Wade he “wouldn’t change a thing” in his PLoS Medicine article.

Which makes it sound as if Woloshin still pretty much thinks of Restless Legs Syndrome as, well, a joke.


mgroves

Sometimes I get a low-level charlie horse type of pain before I fall asleep, but I think it's probably a symptom of my terrible diet and lack of exercise, and not something I need freaking drugs for.

Mack

@1:

Nighttime leg cramps aren't the same thing, and can often be relieved with a magnesium supplement, or including more magnesium and other minerals in the diet. And yeah, more exercise can't hurt. (-:

drglom

I am a physician. I meet diagnostic criteria for having RLS. It is annoying, but if i were filling out a questionnaire or survey, i would not describe myself as anything other than sickeningly healthy. I do not take any medicine for it, other than occasionally tonic water. (we used to prescribe quinine for this condition, and patients marvelled at its effectiveness, but the fda decided it was unsafe.) I agree with Mr. Dubner and the other authors. Life is full of discomfort. I have empathy toward patients with this condition, but i try to steer them away from drugs.

obvioustroll

Well, it's never occurred to have my wife medicated, but at least once or twice a week, she gets spasms in her arms as she falls asleep. This can be painful (for me) because she'll have her arm around me and when her arm goes rigid, her nails can dig in pretty hard.

The "treatment" for this is for me to say "honey, you're doing it again." Which is pretty much her treatment for my snoring.

rbender

I've never been a fan of prescription drug commercials precisely because they try to convince healthy people that they're sick. Now I have another reason to dislike them - the potential backlash against people who actually do suffer from problems.

I've had Restless Leg Syndrome since I was a child. It's a difficult to describe feeling. Something like a cross between butterflies-in-the-stomach (except in your legs) and being stuck in the cramped back row of a plane, even when you're lying down in bed. During the worst nights it could keep me up for hours. I tried to describe the feelings to my parents and my doctor but it was always dismissed as "growing pains" or my imagination. I actually started to wonder if it was all in my head until I saw a story about it on the news in the mid 90s. It was really a moment of revelation for me to finally hear someone else describe the exact problems that had been plaguing me for years.

A neurologist prescribed some Parkinsons-related drugs for the problem. One helped for awhile but the problems came back, even with higher doses. A second drug made me sick. I gave up on it for awhile and just continued living with the sleep problems. I've seen some of the recent drug commercials and whenever I mention my problem, people are quick to mention hearing about the new drugs on TV. I'm still cynical about RLS medication after my previous experiences, but considering trying the new ones. A recent blood test turned up the low blood iron issue (but a subsequent test showed it was normal again) so I'm looking into that first.

So sadly, after a lifetime of poor sleep, Restless Leg Syndrome has not been a joke for me. Now I got to wonder if I mention the problem to people, are they going to think I'm just being influenced by TV commercials.

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bmmullen

What's your take on the apparent over-diagnosis of ADD/ADHD? It is pretty well documented among children, but most people don't realize that almost any college student who has taken a psychology class can easily fake the symptoms and "fail" the written test used in diagnosis. These students are then often prescribed Adderall. With their parents and health insurance paying for the drug, they can keep some pills for personal use and sell the leftovers to their peers.

These drugs are so prevalent on college campuses that they can sell for as little as $1-$2 per pill, which is enough to give you energy for a night of studying (or partying).

The National Institute of Drug Abuse has done at least 1 study on the level of Adderall abuse at college campuses, finding that more competitive schools have higher rates of usage.

(I am a 23 year old college grad who has witnessed these things first hand)

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Jazzalto

The nighttime spasm thing happens to both my husband and myself. However, when we started exercising regularly it has all but gone away. I think we keep creating disorders that we cause by our inactivity.

sflattem

I have RLS...for me it is not a spasm (electrical nerve discharge), nor charlie-horse leg cramp (I take calcium-magnesium-zinc tablet for that), nor the text book creepy-crawly sand-in-your-blood feeling that I had 50 years ago, I must move my legs to feel comfortable.

Without taking Requip, I move my legs almost constantly, trying to get comfortable. I also wake up with the same symptoms and have difficulty falling back to sleep.

With Requip, there is no leg-movement discomfort. I agree that most of the Rx commercials are aimed at the consumer asking the doc for meds to fix problems that either exist or may not exist. Assumedly, the doc will determine if the patient really does have said ailment.

I wonder how many people have symptoms of a medical problem and never go to the doc, for whatever reason, but now are informed of what they may have...and receive treatment.

One could say about Rx infomercials the same about the internet, or television, or the newspaper, telephone...a tool for good or bad... caveat emptor.

"Life is tough...however it is a lot tougher if you are stupid"

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kallen2078

I have a friend with this condition. She puts two bars of soap (no kidding) at the foot of her bed & no longer has problems. Pretty bizarre, but it beats popping pills.

furiousball

What about how when I wake up my mouth tastes like a baby tiger made a number two in it while I was sleeping?

cposey

Like you, when I first saw this commercial, I thought surely it was a SNL sketch based on Seinfeld's "Jimmy Legs." Of course, for me, if it's in Seinfeld, it must be true!
But seriously, I put this "syndrome" in the same category as another contrived, American-made syndrome, ADD/ADHD. (I know I'm opening a can of worms here-I'm OK with that.) No doubt, those afflicted with RLS (and by that, I mean those who have paid good money for Proquip) would passionately disagree with you about the reality and severity of their plight, just as those who have been instructed that they have ADD/ADHD (and their parents and prescribing doctors) would. I believe it all boils down to the fact that Proquip, Adderall, etc. make more business than pharmacological sense.

svannoy

Direct to consumer marketing of drugs is a fascinating topic, one for which a freakonomics analysis could be enlightening. If you want to consider a more rigorous investigation of this topic, check out

"Kravitz, R. L., Epstein, R. M., Feldman, M. D., Franz, C. E., Azari, R., Wilkes, M. S., et al. (2005). Influence of patients' requests for direct-to-consumer advertised antidepressants: a randomized controlled trial. JAMA 2005 Apr 27;293(16):1995-2002."

It is not a trivial issue, depression is a highly debilitating disease. Unfortunately, it is under treated in many who need help, and at the same time over treated for those who are just looking for a quick fix to life's inevitable ups and downs. So while we (as health care professionals) try to increase treatment access to those who truly need it, we have to balance our efforts by trying not to over treat. In the study sighted above, it appears that direct to consumer marketing of antidepressants increases the likelihood that a primary care provider will do a more thorough assessment of depression symptoms, and will be more likely to treat depression when it is appropriate. At the same time, they are also more likely to prescribe a medication. The conclusions aren't simple.

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danweber

The obscure diseases that I or someone close to me has are totally real.

The obscure diseases that other people have are just bupkis.

(This is meant to be read ironically.)

jjoe7pak

Can anyone say Viagra, Cialis, Levitra? I thought so.

fochsenhirt

@ 6 and 11:

As an adult who suffers from ADD, I'm actually not offended by your attempts to support your "RLS is not real" argument by claiming ADD is not real either. That's because it is quite possible to simultaneously believe that these diseases are real, that too many people are treated for them and that the pharmaceutical companies contribute to the overmedication through advertising. The evidence certainly suggests that some people have the symptoms designated RLS, and that for some people, the only way they can sleep is with Requip. Other people are probably actually suffering from poor diet or stress or lack of exercise, for which there is no easy pill to pop, so lazy doctors and lazy patients prescribe an inappropriate medication.

The same is true for ADD/ADHD. Some kids really do suffer, and if you're not treated as a child (as I wasn't), you suffer as an adult. For these patients, Adderall or its ilk make all the difference (for me, it's actually Concerta, but the point is the same). Lots of kids, however, end up on a stimulant because their parents or their school don't want to deal with their behavior. That's unfortunate, but it doesn't mean that people who really suffer shouldn't get help.

Finally, any physician prescribing a stimulant based on a "written test" or description of symptoms isn't doing their job. It's not the recommended treatment protocol - I didn't get started on Concerta until after a family history with input from people other than me and a review of school and medical records.

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egretman

I've made a lot of money in the ETF, BBH. So I would appreciate it if you all would shut up about ineffective drugs and ridiculous diseases. Why do you care if RLS is a scam or not as long as I make money?

jedberg

I can tell you that RLS is real. I have it, my brother has it and my dad has it. My dad was one of the first people to be diagnosed with the disorder, because our family doctor was one of the initial researchers back in the early 90's. His RLS is so bad that he takes an anti-seizure pill every night, and before he was diagnosed, my mom would wake up with bruises because she got kicked so hard in the middle of the night by dad.

My brother and I have a more minor form of it, so we don't take pills, but our girlfriends would certainly call you crazy if you denied its existence.

frankenduf

I have restless soul syndrome- is there a pill I can take for it?

discordian

KRAMER: Yeah, because she's throwing off my whole sleep. She's got the jimmy
legs.

ELAINE: (confused) Jimmy legs?

Kramer raises one leg and judders it in the air, as illustration.

KRAMER: Jimmy leg.

ELAINE: (grasping the concept) Ohh.

DigitalAutumn

Thank you DanWeber, exactly right. It's easy, but rather silly, to assume that a condition one hasn't heard of before is contrived by the pharm industry. Perhaps we don't all know everything there is to know?

There are lots of conditions that would sound strange and perhaps ridiculous if we didn't know about them yet. To assume that they didn't exist until *we* saw a TV commercial about them is a bit silly.