Welcome to Doctor Speedy and Me

Welcome to the NICEGUIDELINES BLOG

I decided to start this blog in order to follow up on some (negative) buzz generated by a recent Guideline from NICE, an Institute in the UK. It is supposed to be the National Institute for Health and Clinical Excellence, and is supposed to advise doctors, other health professionals and patients what to do with certain medical problems. Unfortunately they often create confusion instead of clarity.

And their recent ME guideline was outdated before the ink was dry.

ME is also called CFS, Chronic Fatigue Syndrome, but the two are not the same. Many medical problems will cause fatigue. Just like many medical conditions will cause shortness of breath (SOB). And with the last everybody will understand that it is important to know what is causing the problem, for example your heart or your lungs, and that you can't say SOB is SOB. But that is what is currently happening with ME and CFS. The main controversy, does it exist or not was settled by the WHO (World Health Organisation) a long time ago. And ME is a neurological condition. A severely disabling one as well. About one third of patients are bedbound. Many for the rest of their life. They are also the forgotten group, because no surveys etc are done involving these patients. If you want to know who has ME and who is just tired as some people call it, just go and visit a bedbound ME patient. Ask about muscle pain, how his brain is working etc. And you will soon know, it is more than being tired. Just like Alzheimer's is more than being forgetfull.


NICE have now finely acknowledged that ME exist, but just like many others they have been very selective in what they have read and what they call evidence.

Most doctors you will find, find it very difficult to read a medical article critically. But you don't need to know much about statistics to know a few of the basics. Why was this group of patients selected and why were others excluded, what happened to the people that abandoned their treatment and why etc. Just a few basic and very simple questions. Even adding up is often difficult. If you start with 160 patients, the total at the end needs to be 160 again. But often it isn't. You see, we can all read those papers instead of just looking at the conclusion and believing every word the authors have written.

Just read an article in your favorite news paper, about for example your soccer or baseball team and see if the reporter has seen the same match as you? And did he? Did he miss something, did he call a ball that was out in and vice versa? Just some basics.

But we as doctors are not very good at those simple things. For one we don't have time, as we are busy seeing patients. On the other hand we are taught many things in Med School, but critical reading doesn't feature high on the agenda.

Strange if you think about it. If five drug companies send their rep to promote their antidepressant, they will all tell you their pill is the best in the business, and they all have brilliant graphs etc to illustrate this statement. But are all five the best? The answer is simple, there is only one NUMERO UNO.

Just like there is only one Maradonna, one Pele and one Cruyff.

So, more another time. Energy is up.