LETTERS

socioeconomic status or repeated exposure to large numbers 2. Ehrlich GE. Whiplash and other useful illnesses [book review]. JAMA. 2002; 288:2617-2618. of other children. 3. Baschetti R. Chronic fatigue syndrome, decreased exercise capacity, and ad- Jack L. Paradise, MD renal insufficiency. Arch Intern Med. 2001;161:1558-1559. 4. Kuratsune H, Yamaguti K, Sawada M, et al. sulfate Department of Pediatrics deficiency in chronic fatigue syndrome. Int J Mol Med. 1998;1:143-146. Children’s Hospital of Pittsburgh 5. Hunt PJ, Gurnell EM, Huppert FA, et al. Improvement in mood and fatigue af- Pittsburgh, Pa ter dehydroepiandrosterone replacement in Addison’s disease in a randomized, double blind trial. J Clin Endocrinol Metab. 2000;85:4650-4656. Financial Disclosure: Dr Paradise has received research support, honoraria, con- sulting fees, and speakers bureau compensation from GlaxoSmithKline and Pfizer. In Reply: Fibromyalgia and CFS describe sociopathies, chronic 1. Burke P, Bain J, Robinson D, Dunleavy J. Acute red ear in children: controlled pain, and tiredness in an urban social context much given to trial of non- treatment in general practice. BMJ. 1991;303:558-562. 2. Kaleida PH, Casselbrant ML, Rockette HE, et al. Amoxicillin or myringotomy or imitative behavior and symptom amplification. The patients truly both for acute : results of a randomized . Pediatrics. 1991; have pain, but I believe that its severity and persistence are iat- 87:466-474. 3. Maw AR, Bawden R. Tympanic membrane atrophy, scarring, atelectasis and rogenic, promoted by patient support groups, lawyers, and their attic retraction in persistent, untreated otitis media with effusion and following allies in the medical profession. These diagnoses have become ventilation tube insertion. Int J Pediatr Otorhinolaryngol. 1994;30:189-204. 4. Pichichero ME, Berghash LR, Hengerer AS. Anatomic and audiologic sequelae a profitable industry, but not profitable for the patients who after tympanostomy tube insertion or prolonged antibiotic therapy for otitis me- are offered a prognosis that they can not get well and will worsen dia. Pediatr Infect Dis J. 1989;8:780-787. 5. Goldblatt EL, Dohar J, Nozza RJ, et al. Topical ofloxacin versus systemic amoxicillin/ and be disabled, along with a variety of medicines that do not clavulanate in purulent otorrhea in children with tympanostomy tubes. Int J Pe- work. The supposed laboratory abnormalities are shared with diatr Otorhinolaryngol. 1998;46:91-101. people who do not carry the diagnoses, and it would be to the 6. Paradise JL, Rockette HE, Colborn DK, et al. Otitis media in 2253 Pittsburgh- area infants: prevalence and risk factors during the first two years of life. Pediat- patients’ benefit to abandon these illegitimate names and dis- rics. 1997;99:318-333. solve the advocacy groups; they might then be able to get bet- ter. Authors from within different disciplines have effectively Organic vs Cultural Explanations of denied the existence of fibromyalgia and CFS and provide ample Chronic Fatigue Syndrome and Fibromyalgia documentation for the iatrogenic exacerbation of chronic pain that the diagnoses and those who espouse them produce.1-4 The To the Editor: In his book review of Whiplash and Other Use- book by Malleson5 helps undermine the concepts that errone- ful Illnesses,1 Dr Ehrlich2 was dismissive of patients with such ously gave rise to these diagnoses. distressing disorders as fibromyalgia and chronic fatigue syn- George E. Ehrlich, MD drome (CFS). Besides claiming that these conditions are “pseu- Division of Rheumatology doillnesses” and that their symptoms are “illogical com- University of Pennsylvania plaints,” Ehrlich finds “delightful” the book’s offensive Philadelphia suggestion that what accounts for those “untenable diag- noses” is the “abundant compensation” paid for them. 1. Wessely S, Hotopf M, Sharpe M. Chronic Fatigue and Its Syndromes. Oxford, England: Oxford University Press; 1998. Chronic fatigue syndrome shares many features with Addi- 2. Showalter E. Hystories: Hysterical Epidemics and Modern Media. New York, son disease and, thus, may have an endocrine component.3-5 NY: Columbia University Press; 1997. 3. Hadler N. Occupational Musculoskeletal Disorders. 2nd ed. Philadelphia, Pa: Riccardo Baschetti, MD Lippincott Williams & Wilkins; 1999. Fortaleza, Brazil 4. Ferrari R. The Whiplash Encyclopedia: The Facts and Myths of Whiplash. Gaith- ersburg, Md: Aspen Publishers Inc; 1999. 1. Malleson A. Whiplash and Other Useful Illnesses. Montreal, Quebec: McGill- 5. Malleson A. Whiplash and Other Useful Illnesses. Montreal, Quebec: McGill- Queen’s University Press; 2002. Queen’s University Press; 2002.

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