In view of the authors’ uncertainty over diagnosis, surely the first
port of call to facilitate a reliable diagnosis would be to the obvious:
reliable diagnostic criteria.
Unquestionably, the best available clinical diagnostic criteria were
published in 2003 by Carruthers et al. (
http://www.cfids-
cab.org/MESA/ccpccd.pdf).
Referring to a comparison study executed using these criteria, one
expert in the field observed that:
"The selection of diagnostic signs and symptoms has major
implications for which individuals are diagnosed with ME/CFS and how
seriously the illness is viewed by health care providers, disability
insurers, rehabilitation planners, and patients and their families and
friends.
I hope the results of this comparison study will encourage more
physicians to USE THE CANADIAN CLINICAL CRITERIA".
(Leonard A. Jason, Ph D Director: Center for Community Research,
DePaul University, Chicago IL Board of Directors: American Association for
Chronic Fatigue Syndrome - An Overview of the Canadian Consensus Document
http://www.mefmaction.net/documents/me_overview.pdf).
Giving fair consideration to the beliefs Wessely S, Chalder T, White
PD, Sharpe MC, Prins J, Bleijenberg G and their colleagues hold about
myalgic encephalomyelitis, the authors of the Canadian Guidelines have
remarked that:
"There is much that is objectionable in (their) very value-laden
(second) hypothesis, with its implied primary causal role of cognitive,
behavioral and emotional processes in the genesis of ME/CFS.
This hypothesis is far from being confirmed, either on the basis of
research findings or from its empirical results.
Nevertheless, the assumption of its truth by some has been used to
influence attitudes and decisions within the medical community and the
general cultural and social milieu of ME/CFS.
To ignore the demonstrated biological pathology of this illness, to
disregard the patient's autonomy and experience and tell them to ignore
their symptoms, all too often leads to blaming patients for their illness
and withholding medical support and treatment.
It is unlikely that the CBT and GET studies that were included in the
recent review (Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD,
Pamirez G. JAMA 2001) of treatments dealt with comparable homogeneous
groups since different inclusion and exclusion criteria were used in
selecting the test patients and control groups".
Given that medical science is mostly an international collaborative
enterprise, with repercussions on public health everywhere, perhaps the
authors could clarify why it is that they believe:
“It is (therefore) a welcome relief that the National Institute for
Health and Clinical Excellence (NICE) has just published clinical
guidelines on the diagnosis and management of this disease”, when these
Guidelines allow fatigue and a headache to be diagnosed as myalgic
encephalomyelitis?
Individuals suffer because of misdiagnosis, and medical science
involving the ‘misdiagnosed’ throws up yet more misleading data,
ultimately ruinous to individuals, medical research, and economies.
There can be no excuse; the ground work has been laid by Carruthers
et al., and yet four years later it is being destroyed in the UK and the
US.
Logic would dictate that individuals are trying to prevent discovery.
The authors of this BMJ editorial go on to imply that "chronic
fatigue syndrome" was the name "given" to name myalgic encephalomyelitis.
Quote: "The uncertainty inherent in making a diagnosis of chronic
fatigue syndrome (CFS) is reflected by the variety of names (such as
myalgic encephalomyelitis; ME) it has been given."
The authors may or may not be aware of the fact that it was the other
way around.
Myalgic encephalomyelitis was 'given' the name 'CFS'.
