Two articles follow below. For general information about the CFS-NEWS
Electronic Newsletter, click here.
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Report from CFS-NEWS number 62: October 8, 1996
>>>2. British report on CFS/M.E.
A major British medical report on CFS/M.E. was published last week,
and is being widely discussed in the British news media. The
reports' major points are that:
- CFS/M.E. is a serious and debilitating illness
- it is both physical and psychological in nature, and it is
apparently not caused by any common viral infection
- treatments based on long periods of rest are not very useful, but
treatments such as graded exercise and cognitive behavioral
therapy appear much more effective
- the name of the illness should not be "myalgic encephalomyelitis"
but rather "chronic fatigue syndrome"
The report was issued jointly by the Royal Colleges of Physicians,
Psychiatrists, and General Practitioners. Writing in the British
Medical Journal, Dr. Stephen Straus of the USA's National Institutes
of Health hailed the report as "the finest contemporary position
statement in the field ... physicians and patients are well advised
to read it, but it is sure to engender disagreement on both sides of
the Atlantic." Straus goes on to recommend modifications to the
report's stated treatment regimen.
Four M.E./CFS advocacy groups in Britain have issued a joint press
release which welcomes the recognition of the seriousness of the
illness but criticized the medical report for its "bias towards
psychiatric models of causation and treatment for all patients", and
for using prevalence figures that reflect the incidence of chronic
fatigue rather than CFS/M.E. specifically. The advocacy groups call
upon the UK government's Department of Health to work together with
both scientist and patient groups to meet the challenge of CFS/M.E.
One advocacy group official expressed particular concern about the
recommended change of name from "M.E." to "CFS".
The Persistent Virus Disease Research Foundation challenged the claim
that science has ruled out viral causes.
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Additional resources: The text of some of the media reports, the
Straus article, and the advocates' press release are available as
files on the Internet.
File description Message for retrieval
---------------- ----------------------------
Media reports GET CFS RCP-NEWS
Straus article GET CFS RCP-SS
Advocates' response GET CFS RCP-ME
Send any or all of the above retrieval messages as e-mail to address
LISTSERV@SJUVM.STJOHNS.EDU and the relevant file(s) will be sent to
you.
[The article above is based on reports from the BBC, the Times of
London, the Telegraph, and the M.E./CFS Charities Alliance. Thanks
for help with this report to Marc Fluks, David Ward, Kim Guest, Zoe
James, Jeff Bock-Brown, Alan Zelicoff, Sarah Marsh and Shaw
Carruthers.]
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Report from CFS-NEWS number 64: February 20, 1997
>>>2. Controversies about the Royal Colleges report
Since CFS-NEWS first covered the British Royal Colleges' report on
CFS (October, 1996), criticism has been published by the staff of the
medical journal Lancet and by a new report being released this week
by the CFIDS Association of America.
Britain's ME/CFS Charities Alliance had previously challenged the
Royal Colleges report "bias towards psychiatric models of causation
and treatment for all patients".
The report was strongly supported, however, by the British Medical
Journal in a guest editorial written by Dr. Stephen Straus of NIH.
Straus praised the report as being "arguably, the finest contemporary
position statement in the field". He describes the report's finding
of insufficient evidence for viral causes or documented immunologic
abnormalities, although this jury is still out reagrding possible
neuroendocrine abnormalities. Straus cautions that the report's
recommendation for a bio-psycho-social approach to treatment will be
difficult to implement since most primary care settings are not
equipped with the multi-disciplinary staff needed for such a program.
Straus supported the report's endorsement of the name "chronic
fatigue syndrome" rather than "myalgic encephalomyelitis" or "CFIDS".
The Lancet
In its editorial of Oct. 12, 1996, the Lancet notes that the Royal
Colleges report cites prevalence figures that are far above those
published by the Persistent Virus Disease Research Foundation and by
the ME/CFS Charities Alliance, and that Britain's Department of
Health (which originally commissioned the Royal Colleges' report) has
failed to endorse those high figures. Also, the Royal Colleges'
report finds no evidence of brain abnormalities in CFS patients
despite a clear finding to the contrary, according to the Lancet.
The Royal Colleges' report says the illness should not be referred to
as "myalgic encephalomyelitis" but rather as "chronic fatigue
syndrome". Lancet editorial points out that the British Department
of Health has not adopted the report's recommendation. It also
describes the ME/CFS Charities Alliance claim that the report
committee was top-heavy with psychiatric experts, and it quotes Dr.
Charles Shepherd as saying "the committee was rigged, with dissenting
voices excluded."
The Lancet concludes that the Royal Colleges report was "haphazardly
set-up, biased and inconclusive, and is of little help to patients or
their physicians."
CFIDS Chronicle
The CFIDS Chronicle has this week published a six page critique of
the Royal Colleges report. The critical analysis was written by Dr.
Terry Hedrick, PhD., a psychologist who has chaired many program
evaluation projects in academia and in government and who has
co-authored the textbook "Applied Research Design: A Practical
Guide".
Hedrick discusses in detail three kinds of biases that she sees in
the report:
- it provides an incomplete and selective literature review
- it often speculates beyond the available data and in favor of
psychological factors
- it dismisses those studies which conclude that there may be an
organic basis for CFS, and it does so by holding such studies to a
different standard than others which highlight psychological
factors.
Hedrick states that:
The report's pervasive psychiatric bias will likely fan ongoing
controversies, continue misunderstandings about the illness and
cause harm to CFS sufferers. General practitioners will need to
look elsewhere to obtain a balanced view of the CFS literature.
... Psychologists and psychiatrists definitely have valid
therapeutic and research roles in the treatment and study of CFS.
The challenge is to base these roles on sound research, not
speculation.
Hedrick concludes by noting that many improved research studies are
on the verge of being published, and that those who are concerned
about CFS should demand that *all* areas of CFS research should be
held to rigorous standards.
Resources and references
All of the material mentioned above can be found on the Internet at
the following web page:
http://www.cfs-news.org/rcp.htm
This site includes links to the full text of the Royal Colleges
report, the responses by the ME/CFS Charities Alliance, the BMJ
editorial by Dr. Stephen Straus, the previous report in CFS-NEWS
(October, 1996), the Lancet editorial, and Terry Hedrick's article as
provided by the CFIDS Association of America.
If you already subscribe to the CFIDS Chronicle, you will be
receiving the Winter 1997 edition soon. Terry Hedrick's article
appears on pages 8 through 13. For those who are not subscribed,
sending in $35 now ($45 Canada, $60 overseas) will enable you to
receive the Chronicle for the next year, and if sent in by March 21st
you will receive the Winter 1997 edition which includes Hedrick's
article. This edition can also be purchased separately for $16.
Send a check to:
The CFIDS Association of America
P.O. Box 220398
Charlotte, NC 28222-0398
USA
or phone 1-704-365-2343 Monday through Thursday from 9:30 to 5:30
(Eastern time, USA) or Fridays from 9:30 to 1:00. Hedrick's article
can also be viewed at the CFIDS Association's web site at
http://cfids.org/cfids/royal.html . An e-mail copy can be obtained
by creating a message which says GET CFIDS971 ROYAL which should be
sent by e-mail to LISTSERV@SJUVM.STJOHNS.EDU . (That address may
change in the near future. If that address fails to respond, then
send to the new address at LISTSERV@MAELSTROM.STJOHNS.EDU .)