Intended for healthcare professionals

Letters

Widespread body pain and mortality

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7332.300 (Published 02 February 2002) Cite this as: BMJ 2002;324:300

Theories that psychological states cause cancer should be rejected

  1. Andrew Vickers, assistant attending research methodologist (vickersa{at}mskcc.org)
  1. Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, NY, NY 10021, USA
  2. 10 Harley Street, London W1G 9PF

    EDITOR—In attempting to explain the finding that bodily pain is associated with excess mortality from cancer Macfarlane et al make reference to psychological theories of the aetiology of cancer.1 They claim that “the inability to release emotion” may “predispose people to the development of cancer.” So why doesn't everyone in the United Kingdom have cancer? Why does Spain have higher rates of cancer than Japan? Why do Chileans have a comparable risk of cancer to the Chinese?

    In support of their claim the authors cite a 20 year old review, as well as the work of Spiegel et al, whose randomised trial suggesting that psychological treatment aids survival from cancer2 has been repeated with negative findings. 3 4 More recent studies casting doubt on the links between psychological state and cancer are not cited.5 Simplistic theories suggesting that psychological states cause cancer are out of date and should be rejected.

    References

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    Diagnosing fibromyalgia stops doctors from thinking

    1. Michael Wright, rheumatologist
    1. Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, NY, NY 10021, USA
    2. 10 Harley Street, London W1G 9PF

      EDITOR—Macfarlane et al report an increased mortality, particularly from cancer, in people with widespread pain.1 They say that widespread body pain is a cardinal feature of fibromyalgia.

      Fibromyalgia is such a dubious condition that many rheumatologists dispute its existence as a clinical diagnosis.2 People with so called fibromyalgia complain repeatedly and often frustrate their medical attendants. One possible reason for the increased mortality is that they are regarded as “heartsink” patients, so their complaints become less worthy of attention. The early symptoms of malignancy are therefore ignored, leading to late diagnosis. It would be interesting to know whether cancer was more common in this group, or simply death from cancer was.

      Fibromyalgia is a dangerous diagnosis. It stops the doctor thinking.

      References

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      View Abstract