Fibromyalgia: The Answer Is Blowin' in the Wind (continued)
symptoms of illness and pathophysiologic changes consistent with illness, irrespective of their specificity, must be considered ill. Can you truly tell an individual complaining of feeling hot and having a core temperature of 43°C that they are not ill because fever is not a specific finding?
And second, recently published research in a prospectively followed, representative community cohort of adults newly diagnosed with FM found that the FM label itself does not cause worsened future outcome(32). These individuals did not act more ill. They actually reported fewer symptoms over time. They did not use more health services. And the majority continued working.
Hence, the FM label is flawed, admittedly. But it does not stand out in this regard. Numerous other diagnostic labels, such as SLE and RA, are equally flawed. Should they be discarded as well?
Perhaps the most volatile concept inducing venomous responses against FM is that of disability. This issue has not only medical, but also strong medicolegal implications. Some have argued that the only reason that FM exists is that an overly generous compensation system is in place that is ripe for the picking by individuals who claim to be too ill to work. (It takes no imagination at all to see how this anti-FM agenda might be pushed aggressively by those health care providers among us whose incomes come largely from performing independent medical evaluations for insurance companies.) However, evidence now exists to rebut even this contention.
The recently published study in which FM was found to be even more prevalent among Amish than non-Amish populations should serve as an antidote against such venom. Moreover, the finding of FM in the Amish should not be considered surprising. Previously published general representative (randomized) population studies have demonstrated FM to be more common in countries in which compensation availability might be expected to be less (for example, Pakistan(33), Poland(34), and South Africa(35)) than in countries in which compensation availability might be expected to be greater (Sweden(36), Denmark(37), Finland(38)).
Nonetheless, the venomous attacks continue(39,40). One author even insinuates that the motives of the Amish Study investigators were purely political, and hence the results might somehow have been manipulated(41). And yet, the same author seems to take no exception to the endless armchair philosophizing of so many who have claimed, while making no attempt to gather any evidence to support their contentions, that FM is a compensation-driven illness.
Why? Why is FM unrelentingly held up to a level of scrutiny to which no other musculoskeletal disorder is held? Some authors, such as Ehrlich, Hadler, and A.S. Russell(42)*, (*Not to be confused with
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