Contested credibility of fibromyalgia within medical, legal, and insurance contexts
Bibliographic record
Abstract
Fibromyalgia (FM) is a controversial diagnosis that has been associated with considerable personal and occupational disability. The difficulty in determining the credibility of reported pain and disability in FM has perplexed the various disciplines involved in this process. The purpose of this dissertation was to take a multidisciplinary approach and examine the complexities of FM as faced by patients, the medical and legal system, and the insurance industry. Two independent, yet related, studies comprise this dissertation, each examining aspects of the various perspectives involved in disability claims for FM. Study 1 was more exploratory in nature and involved a systematic review of every trial-by-judge litigated FM claim in Canada (N=194) up to 2003. The cases were examined in relation to demographic, insurance, and credibility factors. The demographic factors revealed a gender disparity of women (84%) plaintiffs, and a disproportionate number of FM cases litigated in British Columbia (61%). Insurance related factors indicated that although surveillance information played a role in disability determinations for FM, the credibility of that information was central to the amount of award granted. Plaintiff credibility played a similar role, indicating that plaintiffs perceived as more credible were typically granted greater awards. An examination of medical expert credibility revealed that judges appear to perceive experts as more credible overall than plaintiffs, regardless of the expert's familiarity level with the plaintiff. The purpose of Study 2 was to examine the phenomenology of exaggeration and the deliberate portrayal of excessive disability in patients with FM. Fifty-four patients with FM completed a variety of psychological, physical, functional, and symptom validity measures twice. In one session, patients were instructed to complete the tests and measures in a manner that was "normal" for them, while patients were instructed to "exaggerate" pain and disability associated with FM in the other session. There were medium to large differences associated with exaggeration on some of the self-report measures of physical, functional, and psychological status. The subjects did not, however, exaggerate on the symptom validity tests. Although multiple cutoff scores exceeded single test scores in the identification of exaggerators in most cases, the false negative rate remained moderate to high. These findings suggest that patients with FM can exaggerate their disability on self-report measures in a plausible manner.
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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 | 0.018 | 0.062 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.006 | 0.021 |
| Scholarly communication | 0.010 | 0.007 |
| Open science | 0.001 | 0.006 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".