UpToDate ME/CFS information

Webdog

Webdog

Senior Member (Voting Rights)
As an aside, Komaroff is an editor for UpToDate's CFS content, which still promotes CBT/GET. The content screenshotted below was "last updated: Apr 10, 2018."
UpToDate said:
UpToDate is an evidence-based, physician-authored clinical decision support resource which clinicians trust to make the right point-of-care decisions.

More than 6,500 world-renowned physician authors, editors, and peer reviewers use a rigorous editorial process to synthesize the most recent medical information into trusted, evidence-based recommendations that are proven to improve patient care and quality.

Over 1.3 million clinicians in 187 countries and nearly 90% of major academic medical centers in the United States rely on UpToDate to provide the best care.
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https://www.uptodate.com/contents/t...yndrome-systemic-exertion-intolerance-disease

uptodate2.png
 
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NelliePledge said:
have you got them on your list of websites you're challenging about CBT/GET @Webdog ?
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Haha, you know me too well. ;)

I have previously (unsuccessfully) complained to UpToDate about their CFS content. I fired off another message to them this morning.

If anyone else wants to do similar:

UpToDate's Editorial Policy: https://www.uptodate.com/home/editorial-policy
End User Support Contact Page: https://www.uptodate.com/home/contact-us#end-user-support
Email: customerservice at uptodate.com
Phone: 1-800-998-6374 or +1-781-392-2000 Monday through Friday, 7 a.m. – 9 p.m. (Eastern)​
 
Webdog said:
Haha, you know me too well. ;)

I have previously (unsuccessfully) complained to UpToDate about their CFS content. I fired off another message to them this morning.

If anyone else wants to do similar:

UpToDate's Editorial Policy: https://www.uptodate.com/home/editorial-policy
End User Support Contact Page: https://www.uptodate.com/home/contact-us#end-user-support
Email: customerservice at uptodate.com
Phone: 1-800-998-6374 or +1-781-392-2000 Monday through Friday, 7 a.m. – 9 p.m. (Eastern)​
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do you reckon it could be worth writing to Dr Komaroff himself??
 
Got a quick note from UpToDate regarding their CFS page. I had asked them to 1) change the name of the disease to ME/CFS, and 2) remove the recommendations for GET/CBT. I felt these were the most glaring issues.
UpToDate said:
Thank you for contacting UpToDate.

The ME/CFS topics are currently being revised and appropriate changes will be made.

Daniel Sullivan, MD, MPH
Deputy Editor, Internal Medicine
UpToDate
Wolters Kluwer Health


Date: 2018-06-14 12:10:01
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@NelliePledge
 
Revisiting UpToDate again. After a strongly worded message yesterday, I got a ping back today.
UpToDate said:
Thank you for your email. We are actually in the process of updating the topics, and will definitely be incorporating information from the updated CDC website. I don't have an exact publication date, but it will be in the near future.
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I requested UpToDate remove the old inaccurate ME/CFS content until the new content is available.
 
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WillowJ said:
UpToDate
I think he is newly listed because he’s in the process of revising it. Someone else can likely say more.
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That's what Dr. Komaroff has said. He was added as a section chief at the point that he agreed to work with them. UpToDate's last update incorporated info about the criticisms of the PACE trial and Oxford definition and AHRQ's decision to downgrade CBT and GET but then inexplicably still recommended CBT and GET.

Hopefully they’ll have removed Gluckman, who seems to be incapable of sifting through the research problems in this area, when the revision is done.
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Gluckman is also the author on the Merck Manual guide which also recommends CBT and GET. - https://www.merckmanuals.com/profes...nic-fatigue-syndrome/chronic-fatigue-syndrome

Before July 2018, that said "Cognitive-behavioral therapy and a graded exercise program are the only interventions proven helpful" but now says that they may help some people.
 
Noticing some changes on the UpToDate website. There is no longer any mention of GET/CBT the front page. The article, however, still uses the bizarre term "CFS/SEID".

https://www.uptodate.com/contents/c...yndrome-systemic-exertion-intolerance-disease

I don't have an UpToDate subscription, and am trying to figure out if my wife has access through work. If not, I'll probably pay for a 30 day sub to read the full article and give further feedback.
 
WillowJ said:
UpToDate
I think he is newly listed because he’s in the process of revising it. Someone else can likely say more.

Hopefully they’ll have removed Gluckman, who seems to be incapable of sifting through the research problems in this area, when the revision is done.
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Thank you, so I misunderstood it.
 
WillowJ said:
UpToDate
I think he is newly listed because he’s in the process of revising it. Someone else can likely say more.

Hopefully they’ll have removed Gluckman, who seems to be incapable of sifting through the research problems in this area, when the revision is done.
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I'll simply say it's not Komaroff and it's not Gluckman doing the updates and responding to my emails. :rolleyes:
 
Webdog said:
I'll simply say it's not Komaroff and it's not Gluckman doing the updates and responding to my emails. :rolleyes:
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Interesting. Glad you’re mailing them, whoever they are.

Medfeb said:
Before July 2018, that said "Cognitive-behavioral therapy and a graded exercise program are the only interventions proven helpful" but now says that they may help some people.
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That’s a small improvement but an odd conclusion as there’s some evidence that it doesn’t help anyone, even ICF. Better to not advertise these at all, IMO.
 
Medfeb said:
Before July 2018, that said "Cognitive-behavioral therapy and a graded exercise program are the only interventions proven helpful" but now says that they may help some people.
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This is essentially what Healthwise said (in addition to citing NICE guidelines) when they downgraded GET/CBT, but didn't remove them. Healthwise asserted GET/CBT anecdotally remained helpful for some patients, and didn't want to completely remove this treatment option.

It took another year before Healthwise agreed to completely remove GET/CBT from their ME/CFS content (and we still only have their promise that it will happen this fall).
 
Touched base with UpToDate today. Spoke with the deputy editor of infectious diseases at UpToDate (should be fairly easy to look up the name for anyone interested). She said the rewrite is still ongoing, but can't tell me the publication date. I was again told the new content should be in agreement with the CDC website.

I stressed the urgency of having current (up-to-date?) ME/CFS information available to doctors as soon as possible so that patients can receive appropriate clinical care.
 
@dave30th @Medfeb

UpToDate finally released their new "Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)" information on October 11. A subscription is needed to see the full content.

I'm sorry to say that GET and CBT have not been removed, but they have been downgraded. Treatment-wise, UpToDate is where Healthwise was in their Fall 2017 update. Clinging to NICE and the idea that GET, can still be beneficial to a subgroup of patients, when done carefully.

The CFS information is broken down into 3 different content sections, Clinical features and diagnosis, Treatment, and Fatigue (below). CFS is identified as a subset of fatigue patients (sigh).

Clinical features and diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome
https://www.uptodate.com/contents/c...ic-encephalomyelitis-chronic-fatigue-syndrome

Treatment of myalgic encephalomyelitis/chronic fatigue syndrome
https://www.uptodate.com/contents/treatment-of-myalgic-encephalomyelitis-chronic-fatigue-syndrome

Approach to the adult patient with fatigue
https://www.uptodate.com/contents/approach-to-the-adult-patient-with-fatigue

Some issues I still see are:
  • CFS used as the primary term, not ME/CFS.
  • CFS is identified as a fatigue illness.
  • Ancient research, including several papers from the 1980s, are often used as supporting evidence.
  • Although physical abnormalities are discussed, CFS is not explicitly stated to be a biological illness. Only that CFS "is an illness of uncertain cause." Depression is given as a possible cause of symptoms, and "Three observational studies verified that two-thirds or more of patients with CFS met existing psychiatric criteria for anxiety disorders, dysthymia, or depression after becoming ill"
  • GET/CBT is still recommended for some patients, but not as strongly. CDC and AHRQ are mentioned as no longer supporting GET/CBT, but NICE is cited in support of these treatments:
UpToDate said:
Counseling therapies (eg, cognitive behavioral therapy [CBT]) and graded exercise therapy (GET) may produce meaningful benefits in some patients, but for others, CBT and GET can trigger post-exertional malaise and worsening of symptoms.
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UpToDate said:
Overall, the data support some benefit to GET.
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UpToDate said:
Guidance from national organizations regarding these interventions is somewhat mixed. The CDC in the United States removed discussion of CBT or GET from its patient information website, and it suggests avoiding "push and crash" cycles [4]. In the United Kingdom, the National Institute for Health and Care Excellence (NICE) guidelines from 2007 endorsed CBT and GET and noted insufficient evidence to suggest pacing; these are undergoing review [58]. Guidance from a major physicians' organization in Alberta, Canada presents both GET and pacing as evidence-based strategies and acknowledges the debate about the relative merits [59].
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