Dr Derek Enlander: The Canadian Consensus criteria are not perfect but the inclusion of physical criteria may be unpalatable for those of a psychiatric bent

BMJ rapid response:

Re:Will adopting the Canadian criteria improve the diagnosis of chronic fatigue syndrome?
Derek Enlander, Physician
ME/CFS center New York

Dear Editor

With all due respects to my colleagues Prof Peter White et al, the recent NICE and Pace studies used criteria (Oxford criteria etc) that complicated rather than simplified the diagnosis. The cohorts by virtue of these criteria were in reality non specific fatigue. The Canadian Consensus criteria are not perfect but are in my opinion the best criteria we have in making the clinical diagnosis of Myalgic Encephalomyelitis. In this instance it rules out the psychiatric psychosomatic patients that might be included in the NICE and PACE studies. These studies paid attention to a relatively non accepted Oxford list of Criteria.

The statement that the diagnosis of M.E. is difficult is of course accepted, making the diagnosis less difficult by dropping differential diagnoses is not acceptable.

The inclusion of physical criteria may be unpalatable for those of a psychiatric bent. However over the past few years, we have multiple papers that show CVS, neurological and immunological abnormalities which portray M.E. as physical problem.

Derek Enlander MD
New York

1. Godlee F. Ending the stalemate over CFS/ME. BMJ 2011;342:d3956

2. Crawley, E, White PD et al ; reply Ending the stalemate over CFS/ME. BMJ 2011;342:d3956.

3. Carruthers BM, Jain AK, De Meirleir KL, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical working case definition, diagnostic and treatment protocols. Journal CFS 2003;11:18- 154.

4. National Institute for Health and Clinical Excellence. Clinical guideline CG53. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management. London, NICE, 2007. http://guidance.nice.org.uk/CG53.

5. Jason LA, Evans M, Porter N et al. The development of a revised Canadian myalgic encephalomyelitis chronic fatigue syndrome case definition. Am J Biochem Biotech 2010;6:120-135.

6. Reeves WC, Lloyd A, Vernon SD, et al. International Chronic Fatigue Syndrome Study Group. Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution. BMC Health Serv Res 2003;3(1):25.

Competing interests: Author of The CFS HandBook (www.amazon.com), a book portraying certain Physical aspects of M.E.

Submit rapid responsePublished 20 July