We couldn't agree more with Dr. Ehrlich's final comment that suggests we eliminate this unnecessary banter about the fibromyalgia label and "worry about the pains." In fact, we also agree that those patients meeting American College of Rheumatology classification criteria for fibromyalgia (1) may not have a discrete disease but are at the extreme end of a continuum of patients with chronic musculoskeletal pain. Our concern is that most who advocate abandoning the fibromyalgia construct also would like to abandon this group of patients. We would reiterate that regardless of whether a label is attached to these individuals, research into the physiology of chronic musculoskeletal pain is a critically important endeavor in the field of rheumatology.As with many critics of the fibromyalgia construct, Dr. Ehrlich veils his discomfort regarding patients with the fibromyalgia symptom complex by posing a legitimate concern surrounding societal or legal issues. In this case the issue raised is that assigning labels such as fibromyalgia may have an adverse impact on patient outcome. Unfortunately, there are few data that directly address whether this is the case or not. In direct opposition to Dr. Ehrlich's view, recent data reported by White et al show that assigning a label of fibromyalgia to individuals with chronic widespread pain has no meaningful adverse affect on clinical outcome over the long term (2). There are also data, however, suggesting that any disease label may have a detrimental impact on patient behavior. In a study of workers in an occupational setting, Haynes et al demonstrated more than two decades ago that detecting and labeling even an asymptomatic disease (hypertension) markedly increased absenteeism from work (3).Dr. Ehrlich seems to suggest that labels may be more harmful in cases in which the etiology of the symptoms reported by the patient has yet to be clearly understood. Stated another way, he proposes that syndromes characterized by subjective symptoms should not be given a label that implies those who have the symptoms are abnormal, perhaps in contradistinction to syndromes characterized by alterations of easily measured variables. It is not clear to us why this should be the case, unless one questions the veracity of self-reported symptoms. Furthermore, even when a variable is objective, the definition of what constitutes abnormal may change over time (e.g., hypertension, hypercholesterolemia, obesity) as new research changes our understanding of human physiology.The implications of Dr. Ehrlich's proposition to eliminate semantic terms from our clinical vernacular would be enormous. As he himself notes, the symptoms do not go away; the label only changes. If we discard the fibromyalgia label, then we should logically reject other labels such as migraine headache, dyslexia, all psychiatric disorders, etc. This would require a tremendous paradigm shift in how we practice clinical medicine, since the aggregate data suggest that approximately half of the visits to primary care physicians are fo...