Review of Feeling tired all the time by Dr Joe Fitzgibbon

First published in Medicine Weekly in summer 2003:

Preliminaries: Of course, as Kevin Myers never tires of saying, doctors ‘are the most conscientious, underpaid and overworked group in Irish life’, and they never feel tired. So this book ‘has been written for the layperson’ (blurb), and this review, written for the doctor, either encourages you to recommend or discourages you from recommending it to your patients. It’s evidently quite a successful publication because this is its second outing (‘Completely Revised & Updated’ as the cover boasts), and apparently ‘feedback from the first edition [1993] was very encouraging. Many said they enjoyed the simple and concise style of writing.’ (Preface.)

Just so you know: ‘Dr Fitzgibbon is an Allergist with a research interest in fatigue. He is author of the bestselling Could it be an Allergy? and practises in Galway and Dublin.’ (Blurb.)

Chapter 26 begins: ‘Having read through the previous chapters, you may be left wondering where to start in your pursuit of relief’, and features a list of measures your patients could try, divided into Lifestyle Issues (Cut out caffeine, smoking and alcohol; Get more sleep; Take more exercise; Eat healthier food; Deal with causes of stress; Do relaxation exercises) and Medical Issues (Investigate food intolerance; Consider gut fermentation control; Try an allergy-free holiday; Consult a doctor – ‘preferably one with a particular interest in fatigue states’.) There’s a bizarre string of ideas bizarrely expressed in the last item: ‘You will probably be asked to see a psychiatrist! Go. Let them ask you all the questions they want, and be honest with your answers. You have nothing to hide. But before you go, ask your specialist if you fulfil the diagnostic criteria for Chronic Fatigue Syndrome , and enquire about parasites.’

But whatever about the rushed ending, the book’s opening has an idea that, as they say, does not compute: a ‘hypothetical survey’. Maybe it’s because I was feeling particularly tired when I read the book, but I could not understand what the purpose of hypothesising a survey could be, even in the context of simplifying for the lay. Fitzgibbon has hypothetical patients being questioned by hypothetical researchers. Academic!

The results of the hypothetical survey? Out of a population of 2,000, 500 complained of significant fatigue, of whom 100 sought medical help, of whom 70 were given psychiatric attention (and improved!), 5 had a physical condition behind the fatigue, and 25 defied diagnosis but are labelled with either chronic fatigue syndrome, fibromyalgia or idiopathic fatigue. Other explantions – sleep, diet, germs and chemicals – come in for separate treatment by Fitzgibbon under the heading ‘Forgotten Causes of Fatigue’, and ‘do not appear in our survey because the researchers didn’t ask about them!’ (I blame the editors.)

Unfortunately, Fitzgibbon is not our Sherwin B. Newland, but the book is undoubtedly useful.


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