Problems arising for pwME from additional diagnoses of MCAS, hEDS and POTS. Advocacy discussion.

On that note, @Jonathan Edwards, I think you mentioned earlier in the thread that scientists were easier to bring over than doctors. How can we recruit more scientists?

it needs people who understand both the clinical and scientific knowledge base for ME/CFS contacting likely researchers and presenting the case in a plausible way - one to one in person. I am doing my best to go through all the people i know.
 
My concern is I don't think it is realistic to expect this kind of seismic change in how patients see their illness and diagnosis without a big breakthrough in research. It's not something we on the forum can reasonably effect.

I think that is very pessimistic. There are lots of members here who say they have radically changed their view on how to approach the science since coming here. I think the forum has been hugely effective in that way. It wasn't my idea. The idea of a forum like this came from Mark when it he tried to set it up on Phoenix Rising and was chased away by vested interests. And from Simon and Tom and Graham and Bob and everyone else. I play devil's advocate a lot of the time and it is easier for me to take the flack but this is a hugely successful movement. Being pusillanimous about achieving more seems a bad idea.
 
We all agree that denying care due to the woo can’t be blamed on the patients. But I think we can also acknowledge that limiting the woo would be beneficial for everyone - and the patients and advocates have influence here which they should use responsibly.

All of this is independent of another argument for limiting the woo: it’s not good science or medicine. So regardless of if you agree with my line of reasoning above, the conclusion is the same: anyone involved in ME/CFS should distance themselves from the woo.
There is no plausible way of doing that, though, so the whole issue is moot. It's not possible to reach even a majority, let alone influence them, and it wouldn't change a damn thing anyway, if that excuse went away completely, it would simply be replaced by another, and if that excuse went away too, so would it, and so on and on.

And as an excuse it could actually look plausible if the psychobabble wasn't so completely dominant and unchallenged. A minority of a large population says things that are not backed by evidence, and we get collective punishment for it, all of which is illegal. The health care systems and the institutions of medicine openly promote and implement, to massive harm, blatant pseudoscience. Those things are not remotely the same, they are in fact comically apart from one another.

We know for a fact that none of this makes any difference because of LC. When LC started, those suffering from it were very eager to separate themselves from us and all of this. And they did, and it did them no good, they were just as gaslighted and discriminated against. It makes absolutely zero difference, and it doesn't matter what excuses are offered in secret behind closed doors about it.

If every single thing happened correctly, if we managed to not only reach but convince every single person suffering from ME/CFS to follow this and 'behave correctly' for years, it literally wouldn't change a damn thing. Let's say it happened, and we let it fly for, I don't know, 2-5 years, to wait for all this clearly pent-up resentment at having their expertise challenged to go away, what is the most realistic scenario?

"You know, we don't hear much about those problems anymore. Now that you mention it, I don't think I or any of my colleagues have even seen a single case of this so-called illness, so I guess the fad has finally died down."
 
Can you explain why legal action wouldn't be effective? As you say, there is clear evidence of criminal negligence. Surely there being consequences for this sort of action might make others think twice about discrimination?

Because nobody can prove beyond reasonable diubt that any one person has done harm and the reality is that nobody cares anyway. I doubt many members here think legal action would be realistic. Why isn't Mr Musk already in prison for the pornography on X?
 
I am not making this up guys.
I don't think you are. Those reasons are not coherent, though, and they ultimately don't matter, as we could dutifully follow everything they expect of us, we could 'behave' the way they want us to, and they'd just find another excuse for it. Two things can be true at once.

This is the ultimate problem here: all of this is incoherent and irrational. We try to bring reason to an emotional position, which famously never works.

The bar has been set at one thing and one thing only: a biomarker, a reliable test and biological pathways for treatment. All of which is demanded before the work begins, but we can't get those because the work can't begin without them. It's like having the key to a safe that is itself in a safe, except that safe also has a combination, and the people who can find the combination refuse to do that until we given them the key, and we desperately need what's in the safe, but the people blocking us from it have zero stakes in the matter, and completely dismiss us as real people.

It's a total Catch-22, and there is literally nothing we can say or do, or stop saying or doing, that can change that. Hence why being vindicated changes nothing. Why the whole Cochrane thing failed even though everything we pointed out was acknowledged, then cancelled.

I'd say one mistake you are making here is assuming rationality out of your colleagues. None of this is rational, it's even deeply immoral, and that always causes further deeply emotional reactions.
 
Because nobody can prove beyond reasonable diubt that any one person has done harm and the reality is that nobody cares anyway
Nobody real cares you mean? PwME and their loved ones don't count in this context. Like they say on Succesion: No Real Person Involved. [To clarify I'm not implying you personally think this]

Elon Musk is the richest man on the planet and thus probably beyond the reach of the legal system in this mad world.

I doubt that the no doubt well paid doctors who conspired to deny pwME treatment, which you say you have documented proof of, have access to thise kind of resources.

But it would be counterproductive if we want those particular doctors to treat pwME of course...

I think @rvallee is right. Once there is proof/effective treatment, institutions need to be held to account. Because this is absolutely insane and criminal.

But as for right now, the question is how to find some sharp doctors who see through all this bullshit. I am beginning to despair that there aren't any...
 
Those reasons are not coherent, though, and they ultimately don't matter, as we could dutifully follow everything they expect of us, we could 'behave' the way they want us to, and they'd just find another excuse for it.

But they did matter, as is a documented fact. In 1995, patients with ME/CFS could be referred to UCLH rheumatology and nobody complained. The unit then set up a clinic that welcomed people with hypermobility, 'dysautonomia' etc. By around 2015, because of the experience with that clinic, the consultant staff decided that they no longer wanted to hae anything to do with anyone with a chronic fatiguing illness or research into ME/CFS.

There may have been another important factor in this, but it was also new - the general shift towards GP-based care that meant that hospital based clinics for ME/CFS were closing down everywhere. That has probably taken over as the biggest force in the equation now.

Advocates promoting hEDS/MCAS/POTS as add ons to ME/CFS is by no means the only problem. But apart from anything else it is even confusing the researchers. We had Danny Altmann on the radio talking of Long Covid as a 'multisystem complex disease'. Familiar words? He gets the word multisystem right (not multisystemic, which is incoherent) but sdaly we have no evidence for either LC or ME/CFS being multisystem or complex - they are both probably due to some single specific signal process.
 
I think this whole affair highlights just how cruel medical culture can be.
While sometimes it might feel like it's a bubble thing, something we only perceive because of our unique (it isn't) experience of illness discrimination, this is a huge problem that I keep seeing in other communities, even in discussions on general forums. There is a sub-reddit for chronic illness that leans more towards the 'respectable' illnesses, mostly diagnoses that no physician would reject, and you find the same despair at this cruelty and negligence, the same "have other people also completely given up going to doctors anymore?" and resulting misery.

This is a much broader problem than us. There is the broader psychosomatic context, but it affects literally all of health care, and as best as I can tell mostly in direct proportion to outcomes, at least when it comes to chronic issues. Acute medicine is a completely different ball-game, it's pretty much all chronic health problems that are mismanaged and see widespread dissatisfaction, entirely depending on the efficacy of treatments.
 
But they did matter, as is a documented fact. In 1995, patients with ME/CFS could be referred to UCLH rheumatology and nobody complained. The unit then set up a clinic that welcomed people with hypermobility, 'dysautonomia' etc. By around 2015, because of the experience with that clinic, the consultant staff decided that they no longer wanted to hae anything to do with anyone with a chronic fatiguing illness or research into ME/CFS.

There may have been another important factor in this, but it was also new - the general shift towards GP-based care that meant that hospital based clinics for ME/CFS were closing down everywhere. That has probably taken over as the biggest force in the equation now.
The growth of psychosomatic models during that time explains this far better than the incoherent reasons written down, frankly. This is about the time Wessely was mouthing off and getting a lot of traction, warning about dangerous militants and so on. He and his gang made pwME extremely unpopular, working the press to their benefit, and this is exactly what they wanted out of it: kick us out.

It's very easy to cast off a group of people, to get a larger group to see everything the other group says and does as wrong, standoffish and generally not worth bothering with other than in chasing them out of town. Even medicine can be coached into doing it, and it's pretty much what happened.
 
The bar has been set at one thing and one thing only: a biomarker, a reliable test and biological pathways for treatment. All of which is demanded before the work begins, but we can't get those because the work can't begin without them. It's like having the key to a safe that is itself in a safe, except that safe also has a combination, and the people who can find the combination refuse to do that until we given them the key, and we desperately need what's in the safe, but the people blocking us from it have zero stakes in the matter, and completely dismiss us as real people.
As ever you sum this up so well.
While sometimes it might feel like it's a bubble thing, something we only perceive because of our unique (it isn't) experience of illness discrimination, this is a huge problem that I keep seeing in other communities, even in discussions on general forums. There is a sub-reddit for chronic illness that leans more towards the 'respectable' illnesses, mostly diagnoses that no physician would reject, and you find the same despair at this cruelty and negligence, the same "have other people also completely given up going to doctors anymore?" and resulting misery.

This is a much broader problem than us. There is the broader psychosomatic context, but it affects literally all of health care, and as best as I can tell mostly in direct proportion to outcomes, at least when it comes to chronic issues. Acute medicine is a completely different ball-game, it's pretty much all chronic health problems that are mismanaged and see widespread dissatisfaction, entirely depending on the efficacy of treatments.
Agreed, which is why if we have a breakthrough we need to hold institutions to account, not just for justice and change for pwME but to shine a light on the wider issues in medicine.
 
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The growth of psychosomatic models during that time explains this far better than the incoherent reasons written down, frankly.

But as I have pointed out before, these people had never heard of Wessely or the PACE trial. They cannot have been influenced by them. The more general biopsychosocial influence came in the 1980-2000 period and increased the number of fatigue clinics and popularity of the condition, with young consultants being put on to them.
 
There is no plausible way of doing that, though, so the whole issue is moot. It's not possible to reach even a majority, let alone influence them, and it wouldn't change a damn thing anyway, if that excuse went away completely, it would simply be replaced by another, and if that excuse went away too, so would it, and so on and on.
We could start with the associations, where only a few people have a say in what’s being promoted by them. I’m not saying it’s a quick fix or that other excuses can’t be made for not seeing pwME/CFS, but that is still no reason for not trying to get the associations on board with science.

And we should do what we can for the people that might be willing and able to listen. I’ve made a fool out of myself to doctors too many times before this forum showed my that I was mistaken. I would have liked to avoid that, but I was confident in my knowledge because I was using associations and the doctors/researchers they promoted as sources.

And even if it won’t make the doctors refuse to see pwME/CFS, it might make less patients seek out the woo. That’s worth it in itself.
We know for a fact that none of this makes any difference because of LC. When LC started, those suffering from it were very eager to separate themselves from us and all of this. And they did, and it did them no good, they were just as gaslighted and discriminated against. It makes absolutely zero difference, and it doesn't matter what excuses are offered in secret behind closed doors about it.
The LC communities I was in outright rejected ME/CFS at the start, but they embraced all the woo they stumbled upon. It was far far worse than what I’ve experienced in ME/CFS communities, only some of the pwME/CFS were the ones trying to say that they’ve already been down that road and it leads nowhere.

It plays right into the BPS narrative of imagined illnesses. I know, because I’ve seen LC and ME/CFS advocates do it in public debates. It’s bad strategy - yet another reason to try to do something about it.
 
I assume documents about decisions on the type of patient deemed unacceptable for government funded clinics and the type of research deemed not worth pursuing by government funded research institutions could be obtained through Freedom of Information processes?

I'm just not sure how far they would get us, because institutions surely are free to choose the fields where they feel that they can make the biggest contribution? Normally such decisions would be presented as a positive decisions e.g. 'our institution has the skills to best target care of people with these conditions', rather than negative decisions e.g. 'we can't help/don't want to help these people'.

But still, it sounds as though there are documents that should be made public.
 
There are lots of members here who say they have radically changed their view on how to approach the science since coming here. I think the forum has been hugely effective in that way.
This is a good point, reading threads dissecting papers and such on S4ME is maybe the best advocacy tool we have to directly reach other patients. I'm not sure how to scale it but maybe there's a way.

Some of the factors that I think make S4ME so effective at changing minds are:
- The arguments are not directed *at* you. You can peruse the form and see what people here are thinking, and even if their comments disagree with your beliefs it feels less like an attack because it's not being said directly to you.
- People on here tend to comment with a healthy dose of uncertainty and honesty about the possibility they are wrong or missing something. Seeing people do this encourages and creates a safe environment for others to do the same.
- Perhaps most importantly, S4ME provides a replacement for many of the needs that fringe labels and questionable scientific explanations are currently meeting. Interacting with smart, thoughtful people on here, who either share my condition or are thinking about it seriously, makes the lack of science on it an easier pill to swallow. I'm not sure I could have arrived at my current level of healthy skepticism if I felt like I was totally on my own, the way I did before finding S4ME.

So I'm thinking somehow exporting the *culture* of S4ME would be the thing to do. Actually now that I think about it, @ME/CFS Science Blog does this very well with their posts breaking down papers on social media.
 
Thanks to all participants for this interesting and useful thread.

The forum is immense and I believe these terms have been explicitly discussed, so I apologize if this has been covered. While I understand issues with the term POTS, should patients cease using it?

In my opinion, low-risk medications such as beta-blockers, ivabradine, pyridostigmine, and midodrine may be offered to a patient with POTS, even though the results of small trials have been inconclusive. In fact, this is not just my opinion but is in line with what the European Society of Cardiology guidelines say about POTS.

What should I do to be "a good advocate"? Should I send a letter to the ESC asking them to rename it? Should I try to educate cardiologists rely on S4me instead of ESC guidelines? Should I advocate for something like: "It is OI. We know nothing. There is no solid evidence for treatment."?

To be clearer, POTS diagnosis is recognized by major associations all over the world and it probably helps patients with ME/CFS obtain medications.
 
I think that is very pessimistic. There are lots of members here who say they have radically changed their view on how to approach the science since coming here. I think the forum has been hugely effective in that way. It wasn't my idea. The idea of a forum like this came from Mark when it he tried to set it up on Phoenix Rising and was chased away by vested interests. And from Simon and Tom and Graham and Bob and everyone else. I play devil's advocate a lot of the time and it is easier for me to take the flack but this is a hugely successful movement. Being pusillanimous about achieving more seems a bad idea.
Fair point, after all I am one of those members!
 
Thanks to all participants for this interesting and useful thread.

The forum is immense and I believe these terms have been explicitly discussed, so I apologize if this has been covered. While I understand issues with the term POTS, should patients cease using it?

In my opinion, low-risk medications such as beta-blockers, ivabradine, pyridostigmine, and midodrine may be offered to a patient with POTS, even though the results of small trials have been inconclusive. In fact, this is not just my opinion but is in line with what the European Society of Cardiology guidelines say about POTS.

What should I do to be "a good advocate"? Should I send a letter to the ESC asking them to rename it? Should I try to educate cardiologists rely on S4me instead of ESC guidelines? Should I advocate for something like: "It is OI. We know nothing. There is no solid evidence for treatment."?

To be clearer, POTS diagnosis is recognized by major associations all over the world and it probably helps patients with ME/CFS obtain medications.
I say «I have OI, which means I rapidly start feeling very unwell when sitting or standing».

POTS is problematic because it says that the rise in HR when standing is causing the issues. And the «best practice» seems to be to drink 3L + of water daily, eat lots of salt, use compression garments and various heart medications that are not entirely harmless. Using IV fluids comes with a risk of infection, and it requires resources to be set up.

I would very much prefer it if the associations distanced themselves from Rowe and the other POTS doctors, and rather started talking about OI instead. I have no idea how to make that argument though, because they will just refer to the «experts» or say that the patients want that they talk about POTS.

My cardiologist was pretty fed up with the whole POTS deal, and said he constantly had to educate patients as in getting them to unlearn loads of stuff and say no to all of their proposals. He had to do the same with me, because I saw him before I knew any better than to trust the associations and their favourite practitioners.
 
This is a good point, reading threads dissecting papers and such on S4ME is maybe the best advocacy tool we have to directly reach other patients. I'm not sure how to scale it but maybe there's a way.

Some of the factors that I think make S4ME so effective at changing minds are:
- The arguments are not directed *at* you. You can peruse the form and see what people here are thinking, and even if their comments disagree with your beliefs it feels less like an attack because it's not being said directly to you.
- People on here tend to comment with a healthy dose of uncertainty and honesty about the possibility they are wrong or missing something. Seeing people do this encourages and creates a safe environment for others to do the same.
- Perhaps most importantly, S4ME provides a replacement for many of the needs that fringe labels and questionable scientific explanations are currently meeting. Interacting with smart, thoughtful people on here, who either share my condition or are thinking about it seriously, makes the lack of science on it an easier pill to swallow. I'm not sure I could have arrived at my current level of healthy skepticism if I felt like I was totally on my own, the way I did before finding S4ME.

So I'm thinking somehow exporting the *culture* of S4ME would be the thing to do. Actually now that I think about it, @ME/CFS Science Blog does this very well with their posts breaking down papers on social media.
I am not certainly I agree, sadly. There are many people who encounter S4ME and feel very attacked by what is said here - that few of these join or comment is to be expected. There is a lot of contempt expressed for many of these ideas here, and, whether correctly or incorrectly, many people who have received or come to identify with these diagnoses absolutely understand these as attacks and as dismissal of their suffering. Referring to MCAS as an "imaginary disease" or "woo" tells the person who understands themself to suffer from MCAS that they are a hypochondriac and/or stupid enough to be taken in by charlatans. In the best case scenario, that is, that they understand this discourse not as denying their suffering but as contesting the utility of a particular label for that suffering, the consequence of accepting the positions expressed here means that the patient is cast back out into the wilderness, with no name for what they are experiencing, no community to rely upon, no hope of help, no research being conducted - it means that they are stuck in an abyss of misery and will die there, unacknowledged. None of that is easy to accept.

I am very much in agreement that the present situation will not change until the nature of the problem is understood, until we can put a name to what those who suffer from (what they understand to be) hEDS, MCAS, POTS, etc. and offer them a replacement for those labels, little headway is going to be made. Unfortunately, we are in a catch-22, however, as we are now told that no one will do any research because the sufferers have been stupid enough to believe what medical professionals have told them, and the other medical professionals (and researchers more generally) who are capable of doing the research believe that stupid people deserve to suffer and die.

I am sure this is all old news and has been said before - if that's the case, I apologize. I also apologize that I am short on solutions or suggestions for improvement, for anyone.
 
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