UK BACME ME/CFS Guide to Therapy 2025

I think it would be useful for any of us with professional viewpoints to formulate thoughts on the guide. I am expecting to feed in to the committee effort to critique it. But I am also wondering about the possibility of something beyond that. Maybe the ideal thing would be get a critique from a group of professionals with rehabilitation expertise (I am accredited but did not focus on rehab) to publish something in a journal such as BMJ. There is likely to be resistance but it may be worth a try. Ilora Finlay would be a good person to recruit but she might not want to get involved.
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Run out of thumbs. We've needed a paper like this forever.
 
Thank you @PhysiosforME for picking this up and taking action.

It would be wonderful if there could be a clinician led response to this stuff. I think it needs to go wider than just this particular document to look at the whole package of what is being rolled out for ME/CFS and Long Covid that I summarised here on the thread about an NIHR funded project led by Prof Manoj Sivan at Leeds who is leading the Long Covid side of the rehab story and has been funded to find ways to combine LC and ME/CFS rehab style services and apps:

Sigh. It's all coming together in the worst possible way. This links with other discussions we've had
The ELAROS app for LC is the digtal platform developed with Prof Manoj Sivan who is leading this Heritage project and is prof of rehab medicine.
The BACME ME/CFS guide for therapists is intended to integrate with and use:
The MEA ME/CFS Tyson led clinical assessment toolkit and the MEA app to be released in December.
It's like it's all been planned to culminate in this whole disastrous synchrony between Sivan, BACME and the MEA to stitch us up with totally unsuitable therapist led clinics and apps.
Can we also get the psycholgists organisation people creating an ME/CFS guide that @Joan Crawford is involved in to join with an effort to get a clinician response published in a medical journal?

I think it's still worth us trying to create a forum response that we can send to ME/CFS organisations in the UK and beyond, as well as to the bodies responsible for all this mess.

Sadly the MEA seems totally embedded in the whole project now, and is unlikely to support us, but maybe with other ME/CFS organisations disagreeing with them, they will start to see they have taken a seriously wrong turn. We can but try.
 
I found this document which includes Bacme's views of the biological basis of ME ( which seems to be focussed on what they call dysregulation) on a local hospital website earlier today ( edit: yesterday) but my brain fog/ cognitive issues are currently so bad that I've only just refound it.

18 page document. Selective references on last page, out of date? No mention of genetics, GWAS or Decode. Unfortunately pages not numbered. Document only scanned. Unable to absorb more currently.

There is a lot more from Bacme on the hospital website - link below. Area covered is South West London and Surrey and used to be Dr Bansal's area.
This is all new since then. I wonder when Bacme started to inveigle their way in, both here and in other area clinics.

https://www.epsom-sthelier.nhs.uk/new-myalgic-encephalomyelitischronic-fatigue-syndrome-mecfs. They claim 94% satisfaction level of " very good" with the service. Provides multiple links to various issues.
Thanks. The current version is on the BACME website. I don't know whether it's the same one you found.

I have read it and it's all speculative and based on a very limited set of research papers clearly cherry picked to suit their hypothetical model.

What they can't and therefore don't explain anywhere I can see is why they think it's ethical to be giving patients fairy stories about what's causing their symptoms with the pretence it's settled science, while admitting in their documents that it's all just hypothetical, not settled science.

They compound this further by making the great leap without any scientific basis that these 'dysregulations' and 'central sensitisation' they hypothesise can be treated by the long list of behavioural changes they take the pwME through in their 'therapy', including gradual exposure to increased exertion and sensory stimuli to 'desensitise' and lead to improvement.

That is such a leap in the dark, completely unsupported by any clinical trial evidence, yet they run their whole therapeutic program on the basis of this mix of lies and fantasy, all justified because it's not the same as NICE's narrow definition of GET, and is based on a different biological model, and on the basis of 'lived experience', not clinical trials.

It's unethical, dishonest, unevidenced, wasteful of NHS resources, potentially harmful and wrong.
 
I was at a conference last week where there was a slot on ME. At first I was relieved as there was no mention of GET and then I got more disheartened by all the talk of dysregulation.

I've since gone and read the bacme guide amd done some reading round it all to try amd understand what evidence there might be!!!! Guess what? I haven't found any!

I'm contemplating writing a critique of the guide/the dysregulation therory and wanted to ask if people think this would be useful (and if I can steal any info from this thread to support the critique - anonymously of course)

It has annoyed me so much I feel something needs to be done!!! All and any suggestions gratefully appreciated
Feel free to make use of anything I have posted on this thread. The more we can get published and distributed to key people on this the better.
Let me know if any of your group want to join the forum efforts to produce some sort of position statement as well, though I know you're all busy and your efforts may be better directed at a clinicians group document.
 
I was at a conference last week where there was a slot on ME. At first I was relieved as there was no mention of GET and then I got more disheartened by all the talk of dysregulation.

I've since gone and read the bacme guide amd done some reading round it all to try amd understand what evidence there might be!!!! Guess what? I haven't found any!

I'm contemplating writing a critique of the guide/the dysregulation therory and wanted to ask if people think this would be useful (and if I can steal any info from this thread to support the critique - anonymously of course)

It has annoyed me so much I feel something needs to be done!!! All and any suggestions gratefully appreciated
:)Yes Please do this
 
Can we also get the psycholgists organisation people creating an ME/CFS guide that @Joan Crawford is involved in to join with an effort to get a clinician response published in a medical journal?

Excellent thought. We already have a multidisciplinary team it seems! ;)

And I agree that a clinician response in addition to a forum response would be a good idea.
 
To be fair, p. 2 says


but that's easy to miss. And the denial of reality throughout is still stark. (edited to add) There's nothing in the activity management sections saying that if a patient deteriorates, the therapist should switch to using the guide for severe patients. Because they don't think it's possible for a patient to deteriorate under their management?
That splitting the spectrum so severe isn’t required to always be discussed alongside as a spectrum instead of this pretence we keep having deliberately is a problem (although tbh a problem that allies do a lot too, whilst I know there are reasons I think needs to be stopped as policy for the following)

It is a deliberate ploy to misrepresent what the illness is and how it works. It has no good cure or treatment and anyone can get worse. Particularly given the hostile environment they create

The splitting off the ones they’ve already harmed to severe into a different doc is part of the fairy tale of them delivering something where they don’t care about the consequences on people’s health of what they are selling and imposing on them. But fgs don’t tell them what their future might look like if they do follow their suggestions - ie prevent informed consent

That’s what removing the spectrum for their documents and discussions is. And what psychosomatic is all about - an ideology focused on working out how to evade the informed consent obligation all medicine is required to do but some feel they should be above having that get in their way. Along with safety.

Because given how the illness feels and our intrained myths everyone has of push thru on exercise and work anyway then with the bigotry creating a hostile environment preventing access to anything else for the last decades for us

The one most important thing those who aren’t severe need to know for themselves and for advocacy and to be better allies to those further down the road is that severe and very severe not only exist but that those people aren’t ’exceptional cases different to them who had other whatever’ but that the progression if badly managed

It is the most important thing governments and public need to know - not the nonsense UN-nuanced can be cut and cherry-picked line of ‘if we had a cure they’d all be back to work’ inferring we aren’t all in agony scraping our way thru jobs where we often are not seen with the respect we should due to instead of then realising what we do despite the lies inferring the few slip-ups or adjustments we need are somehow indulgences and our own bad self management. And then we are eventually made so ill by keeping up the impossible we are cast out having had no chance to make preparations as other illnesses might and far far more ill than we ever needed to be.

By us letting them just talk on the mild, until they make them more severe and say ‘they are a different document’ we are perpetuating the ‘manage to destroy as pests, use and abuse non-medical abuse approach’ that this is. Where obsessing over not giving those mild reduced hours to allow them to have a life and career in order to put them thru misery for x years then when they are destroyed by it just en on the heap and refuse wheelchairs and medical care and tell them it’s their mind is what they’ve been doing. Harming people for the sake of not wanting to be disability friendly so destroying them and making them lose independence and everything for the rest of their lives just to extract 4yrs of ‘not giving adjustments’ for the sake of it and destroy their lifetime potential.

And their choice to do that is I’ve realised all purely ideological with no good intentions. ‘Why should they have it a big easy when we can make them hurt themselves’ is that ideology. They aren’t medics and I’d be offended if I worked in that discipline and these people used that term about themselves and these documents because of this truth. Once you start, which it’s now clear they do by choice, deliberately evading measures of safety or checking you aren’t causing harm or deterioration than you are just a danger and exhibiting ‘callous indifference’ to the consequences of what you push.

That’s why they have to fill their documents with lies that are fairy tales to bore readers into getting to the end and they hope people will be too ground down from that to notice any care about safety and it not harming ie the one thing if they were professionals or in medicine it should contain is something entirely evaded. And that it’s just propaganda and not nice propaganda at that.

Mild people will almost certainly notice the impact of the illness when they shower. Anyone claiming they know me/cfs who doesn’t yet and mention showers to demonstrate it is lying and not an expert it’s so clear a thing. Laypersons who came across one person or distant relative know this one.
 
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