ME and Incompetent doctors

Just going to the BMJ site and typing in the name of our beloved professor CBT or one of his friends will Get you the most amazing stuff, just read this for a change and be horrified again about the incompetence of…..

Oh, and see if you can come up with the answer to the following question. When were these two letters published in the BMJ???? Just read on and I will answer that question at the end……………

The letters are a response to an article called:

Chronic fatigue syndrome Role of psychological factors overemphasised

Distinguish between syndromes...

EDITOR, - I note that several people writing in the BMJ are still confusing Myalgic encephalomyelitis with the chronic fatigue syndrome.

I wish to clarify matters. From a scientist's point of view the main problem is not the term chronic fatigue syndrome but the various diagnostic criteria that go with it. For instance, the strict Australian definition adopted by Wilson et al is similar to that for Myalgic encephalomyelitis.

As a result, it is reasonably certain that in this article the two names probably refer to the same disease.

The "Oxford" criteria used in Britain, however, are far broader, covering all patients whose severe, unexplained fatigue has been present for at least half of the time and for at least six months. The only other requirements are that the fatigue must have had a definite onset and that it affects both physical and mental functioning. Unlike with the strict Australian definition, no immunological criteria have to be met.

Moreover, there do not have to be appreciable fluctuations in symptoms - still a major criterion for Myalgic encephalomyelitis.

In terms of prevalence, a recent study found that 17 of 686 (2.5%) attenders in general practice fulfilled the Oxford criteria for the chronic fatigue syndrome.

When a further four patients who did not meet the criterion of a definite onset were also included the estimated prevalence increased to 3%. In contrast, the prevalence of Myalgic encephalomyelitis rarely exceeds 1.5 per 1000.

Most patients who fulfil the Oxford criteria suffer not from Myalgic encephalomyelitis but from more common conditions, notably depression, anxiety states, sleep disorders, and fibromyalgia. None of these disorders occur in epidemics, and most are not associated with the neurological and immunological abnormalities found in Myalgic encephalomyelitis.

Does the distinction between the chronic fatigue syndrome and Myalgic encephalomyelitis matter?

It depends.

According to recent research, treatments such as graded exercise which are helpful for the chronic fatigue syndrome do not generally benefit those with Myalgic encephalomyelitis.

On the other hand, combining all the fatigue syndromes together, implying that they share a common aetiology, and treating them in the same way would probably save the NHS and Medical Research Council some much needed money.

At the moment the confusion between the chronic fatigue syndrome and Myalgic encephalomyelitis makes it extremely difficult to interpret research and evaluate clinical trials.

Unfortunately, if authors of editorials do not start to distinguish between Myalgic encephalomyelitis and the other fatigue syndromes this is unlikely to improve.

E M Goudsmit

...and study them separately

Now I know Mrs Goudsmit is a leading psychologist in the UK, but I do not know who the following writer is, but it doesn’t make his/her letter less interesting. Far from it.

N Anderson wrote:

One side favours studying the chronic fatigue syndrome as a single entity, arguing that there is insufficient knowledge at present to differentiate between different chronic fatigue syndromes. This side prefers Sharpe et al's broad definition of the syndrome, which includes depressive illness, anxiety disorders, and the hyperventilation syndrome.

Unsurprisingly, studies that use these criteria find higher levels of depression (or "psychosocial disorders" - yet another woolly term).

The other side focuses more on organic symptoms and, again unsurprisingly, finds lower levels of depression similar to those found in patients with cancer and multiple sclerosis - that is, the levels that might be predicted in any chronic illness.

Until the various chronic fatigue syndromes are each studied in their own right rather than as one huge "dustbin" syndrome we shall make little progress. Findings from research studies that are allegedly of the chronic fatigue syndrome but that use study groups that are not comparable and different methods of assessing depression will continue to contradict each other.”

Amazingly, that was in 1994 and thanks to the woolly woolly talky talky brigade and their ELEVEN MILLION reasons to promote their SILLY flavours, we haven’t improved one iota and the situation for people with ME is as dire as it was ten OR twenty years ago. Many thanks professor CBT and all your s…y friends for continuing to make our lives miserable…...

As if coping with ME is not enough.

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