War Is Over. Give Peace a Chance (with apologies to the late John Lennon)

To the Editor: In his recent essay on fibromyalgia syndrome (FMS), entitled “Fibromyalgia Wars,” Wolfe1 paints a picture of this condition as one that epitomizes a conflict between practicing physicians, on the one hand, and an assortment of organized, powerful antagonists including academics, the pharmaceutical industry, patient support groups, lawyers, the Food and Drug Administration, the World Health Organisation, and the American College of Rheumatology. Casting oneself as the underdog is a good ploy for attracting sympathy and more easily enables the use of emotive rather than rational arguments. A “straw man” is erected and then attacked primarily using speculative concepts and ideas derived from a few medical historians. In contrast to the controlling influence of a “pharmaco-academic complex” (p. 672) in FMS portrayed by Wolfe, our personal experience has been that an interest in FMS has typically been regarded by our academic colleagues with politely disguised condescension, if not outright pity. Support groups, at least in Canada, have been politically ineffective, and the pharmaceutical industry was, until quite recently, conspicuous by its absence. The pendulum may have swung somewhat in the past 3 or 4 years, but certainly not as widely as Wolfe would have it. As far as we can discern, Wolfe’s arguments against FMS are as follows: 1. FMS is part of a continuum of pain and other distress and therefore should not be considered a separate entity; 2. The absence of “a specific pathological process”; 3. The socially and emotionally deleterious effects of labeling; 4. FMS is a “socially constructed illness”; 5. The lack of progress in improving the symptoms of FMS. We will briefly address each of these points: FM may well be part of a continuum of pain … Address correspondence to Dr. Nielson, warren.nielson{at}sjhc.london.on.ca or Dr. Harth, harth{at}aimhealthgroup.com