In work that is slowly ambling through the review and publication practice, we show that fibromyalgia is over-diagnosed in women and under diagnosed in men, at least based on post ACR 2010 criteria; and psychosocial symptoms influence physicians more than pain. Selection and confirmation bias permeate the process. And most people diagnosed with fibromyalgia don’t satisfy criteria. In a study in a university rheumatology clinic (manuscript submitted) the agreement between staff rheumatologists (Surely, experts, right?) and published criteria was fair, at best.
While it is easy to mock definitions and diagnostic criteria, perhaps the real meaning of such data is to indicate that fibromyalgia as it occurs in the community is strongly influenced by the needs of physicians, researchers, patients and pharmaceutical companies, and that such influence is part of the de facto definition of fibromyalgia. Oliver Sacks wrote in another setting, but appropriate to fibromyalgia, “I had not properly realized, until this time, the power of wish to distort and deny – and its prevalence in this complex situation, where the enthusiasm of doctors, and the distress of patients, might lie in unconscious collusion, equally concerned to wish away an unpalatable truth.”
Fibromyalgia? O, no! it is an not ever-fixed mark. If this be error, and upon me prov’d, I never writ, nor no man ever lov’d.