I'm unsure why I've been voted down here- if shminux's friend wants a version of a report similar in quality to what metamed can provide she can ask her physician if the physician has up-to-date (or an other research aggregator) access. If the physician doesn't, its potentially a measure of quality (which can otherwise be hard to judge), and she should get a referral to an academic medical center, which will definitely have something like up-to-date available. This seems to me like decently practical advice for those who have insurance, but don't have the money for metamed. I'm still relatively new so I'm requesting explicit feedback to improve the quality of my posts.

Edited to Add: According to the company, > 90% of American academic hospitals already have subscribed to Up-to-Date, so getting a referral to an academic center has a great chance of getting you to someone with already-paid-for-access to this sort of report.

You meant $1 mil, right?

Current prior: nothing has helped so far, so the odds of something she missed ended up being useful is pretty low.

This assumes she's good at sifting through the massive expanse of information available, and good at implementing the suggestions therein. These are two extremely questionable assumptions. Knowing nothing about her except that she has severe fibromyalgia and that she's the friend of a frequent poster on LW--two factors that hardly seem very relevant, and I'd put the likelihood of those two assumptions holding up to be very low. Quite bluntly, most people have no idea what's really out there. The Internet is a vast space.

No, because -$100k is much more than 20 times worse than -$5k.

If the estimate of helpfulness is, say, 1% (that's pretty optimistic)

Saying 1% is extremely optimistic... about the quality and competence of the medical profession as encountered by average people with mildly unusual conditions.

That assumes they find only one thing that she hasn't tried. I have a sister with fibro and some cursory googling on my part suggests that there are so many theories out about what's wrong and what can bring relief that it's difficult to believe that a systematic search by good researchers will only turn up a single thing that she hasn't tried. That said, you're right that 1% helpfulness is probably pretty optimistic.

I'm surprised as well. I expected to be downvoted to -2 or so pretty quickly, and stay around there.

As for your disagreements, I should stress that what I said is perhaps the absolute most important thing for the average person with a health issue like that to hear. All too many people get hung up on trying to target the problem specifically, when they're dealing with an issue where doing so is not practical. Day after day, they ask, "What causes fibromyalgia? What are the new treatments suggested for it?" They remain fixated on these questions, while they sweep all sorts of other symptoms under the rug--random symptoms like headaches or splitting nails, which may be coming from the same source.

As for the Google hits, I'm not sure why you're calling them suspect. Jon Barron is one of the best alternative health writers out there, the Weston A. Price Foundation has a huge following, PaleoHacks is perhaps the best forum on paleo (which is a diet and lifestyle with a massive following), and the other link is a blog that I've seen cited a bunch of times in paleo circles as being someone who is less likely than average to fall for various forms of silliness.

Is this enough evidence to suggest you should read the links and take them seriously? No idea. They have a lot of links within them though. My goal was to as quickly as possible find some articles that put the conditions for 'tab explosion' in place in a way I thought would be beneficial. Generally when conventional medicine doesn't have the answer, the best place to look is where people are talking about paleo. Even stereotypically non-paleo things like raw vegan juicing, such as the Gerson Diet, will come up in paleo circles--quite simply because it seems to work.

They see significant self-reported pain reduction in about 30% of the patients vs 20% for placebo.

That's not how I read the abstract. It's not % of patients, but % of pain reduction, whatever that means. I assume they're referring to some self reported numeric pain scale.

The percentage of responders for "significant pain reduction" was 32% naltrexone vs 11% placebo , which strikes me as significant. If I had serious pain, and someone offered me a "widely available, inexpensive, safe, and well-tolerated" treatment with a 30% chance of "significant pain reduction" I'd be all over it. Your mileage may vary.

To sum up, there is zero reason to try it specifically, except maybe as one of the many random things to try in desperation.

Really? "Zero reason"? So you predict equal efficacy as a random treatment, such as spinning around and squawking like a chicken?

Plenty of reasons. You don't have to like them or know of them. I wasn't attempting or claiming to prove anything, just trying to point you to some information I thought would be helpful. I hope she finds something.