Unhelpful Criteria Sets For “Diagnosis” and “Assessment of Severity” of Fibromyalgia
Bibliographic record
Abstract
In this issue of The Journal Dr. Wolfe and colleagues introduce 2 new and different protocols (there have been many prior versions) to identify what they call “fibromyalgianess”1,2. In what ways are the new proposals unhelpful? Dilution (the inclusion of milder cases changes prognosis); inconsistency (multiple diagnostic strategies identify different patients); loss of specificity [later criteria sets lose information and fail to discriminate symptoms of rheumatoid arthritis (RA), fibromyalgia (FM), systemic lupus erythematosus (SLE), and osteoarthritis (OA)]; and loss of the ability to recognize FM concurrent with other diseases. Statistical approaches are used that do not make most efficient use of the information available. More fundamental is the continuing distraction from the obligation to accurately identify the origins of pain and choose appropriate treatments3. The odyssey was not without purpose or logic. FM has been described as a spectrum disorder. But there are 2 quite separate spectra. One is a continuous spectrum expressing severity, with FM separated from lesser chronic pain by arbitrary cutpoints. The other is better described as a palette of characteristic symptoms, found to be associated with FM however defined. Many of these statistically significant associations were found in the 1990 Classification Criteria study4. Sleep disturbance, fatigue, morning stiffness > 15 minutes, paresthesias, anxiety, headache, prior depression, irritable bowel syndrome, sicca symptoms, urinary urgency, dysmenorrhea history, and Raynaud’s phenomenon are all listed in Table 6 of the 1990 paper. Because symptoms other than widespread pain were not embedded in the Criteria, the statistical strength of the association of these and other symptoms associated with FM could be tested independent of the 1990 Criteria. Other links were added later, including cognitive problems (“Fibrofog”)5, “dizziness,” jaw pain6,7, and low abdominal pain. If this symptom profile … Address correspondence to Dr. H.A. Smythe, 2 Heathbridge Park, Toronto, Ontario M4G 2Y6, Canada. E-mail: hasmythe{at}rogers.com
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.034 | 0.096 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.005 | 0.002 |
| Science and technology studies | 0.003 | 0.009 |
| Scholarly communication | 0.007 | 0.010 |
| Open science | 0.006 | 0.006 |
| Research integrity | 0.010 | 0.032 |
| Insufficient payload (model declined to judge) | 0.005 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".