BMJ rapid response:
Re:Re:Will adopting the Canadian criteria improve the diagnosis of chronic fatigue syndrome?
Ellen M Goudsmit, Health Psychologist
UEL
As all ME and CFS specialists are aware, the Canadian criteria published in 2003 were revised in 2010 to address some of the flaws described in the BMJ and elsewhere.
They include a number of improvements. For example, they were designed for use in both clinical practice and research. (The CDC case definition was formulated for research alone).
Secondly, they are limited to six criteria with a comparatively concise list of examples to improve diagnostic precision.
Thirdly, the physician does not have to plough through a whole issue of a journal but can get the essential details on one page of A4. It's focused, evidence-based and infititely more accurate than what went before.
If the scientific process is to take its course, practitioners and researchers need to be aware of important developments and adapt their practice where it is in the patients' interest to do so. The new criteria may not be perfect, but CFS is a complex disorder and if IBS has Rome III, why can we not give some serious consideration to Canada II?
Jason LA, Evans M, Porter N et al. The development of a revised Canadian Myalgic Encephalomyelitis Chronic Fatigue Syndrome case definition. American Journal of Biochemistry and Biotechnology 2010; 6 (2): 120-135.
Dr Ellen Goudsmit C.Psychol FBPsS
Competing interests: None declared
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Published 20 July 2011
2010 Revised Canadian Myalgic Encephalomyelitis Chronic Fatigue Syndrome criteria.pdf
This revised canadian criteria is still poor science and poor policy for ME patients. It confounds cfs and ME, to the detriment of ME patients who desperately need diagnosis and treatment as soon as possible after onset of their disease, and who are permanantly damaged by graduated exercise. The fact that the revised canadian has as its first and mandatory criterion chronic fatigue makes it useless for anything but chronic fatigue patients. We must all ask who actually benefits from its use.
ReplyDeleteYou are absolutely right, the other thing you don't need to diagnose ME is at least six months of etc.
ReplyDeleteThe sooner you diagnose the better.
All you need is an abnormally delayed muscle recovery after doing trivial things etc.
The revised canadian criteria is poor science and poor policy for ME patients.
ReplyDeleteIt confounds cfs and ME, two very different illnesses.
Its first and mandatory criterion is chronic fatigue. ME patients need prompt diagnosis and careful management of their devastating disease which is made irretreivably worse by the current treatments for cfs or cfs/me. We also must have good science working for us, which means scientists must use strict ME diagnostic criteria, One must demand to know who benefits from mixing up two very different diseases.
Don't know who can judge that the latest criteria are 'poor science'. It's not for ME as decribed by Ramsay. Separate criteria are being devised for that. Research criteria already exist. However, most doctors still acept the assumption of equivalence, ergo, the CCC. The International ones also miss the essential, core symptom's of classic ME. But then, no one asked a ME specialist. ME criteria do not require a six months wait as it's an acute illness that tends to become chronic but doesn't always. For research, it helps to exclude those with the more common post glandular fever or flu debility. But we now have a choice. Oxford was bad science. We're moving in the right direction.
ReplyDelete