Yes Bob, its become clear we also have to look at what NICE says. There are so many definitions its very confusing without context. For one thing I want to know if it can be confirmed if fibro patients were included. I would also like a copy of the original White statement so I can compare what was actually said and the context in which it was said.
Fibro might be a special case due to its comorbidity. However just meeting Oxford criteria could be an issue. The guide "unexplained by other conditions" is critical in NICE according to your quote. Fibro includes fatigue as symptom, though typically its secondary to pain and may not always be present.
http://www.pacetrial.org/faq/faq2.html
What are the “Oxford” criteria for CFS? These require that a person has had at least six months of severe fatigue, with fatigue being their main symptom, which is disabling and is usually accompanied by other symptoms. No other medical or psychiatric explanation for the symptoms has been found. All patients in the PACE trial met these criteria.
Why did you choose the Oxford criteria for defining CFS? We chose the Oxford criteria for several reasons: (a) we wanted to find out which treatments were best in those who had fatigue as their principal symptom. Some patients, clinically diagnosed as having CFS, may have another symptom, such as pain, as their primary symptom. (b) The Oxford criteria include a greater number of patients with CFS, by not requiring a specific number of additional symptoms, as other definitions of CFS do. (We wanted to make sure our findings applied to the greatest number of patients.) (c) The Oxford definition of CFS is the most straightforward to use in clinical practice.
http://www.mecfsforums.com/wiki/Oxford_definition
"(f) Certain patients should be excluded from the definition. They include:
(i) Patients with established medical conditions known to produce chronic fatigue (eg severe anaemia). Such patients should be excluded whether the medical condition is diagnosed at presentation or only subsequently. All patients should have a history and physical examination performed by a competent physician.
(i) Patients with a current diagnosis of schizophrenia, manic depressive illness, substance abuse, eating disorder or proven organic brain disease. Other psychiatric disorders (including depressive illness, anxiety disorders, and hyper- ventilation syndrome) are not necessarily reasons for exclusion."
Exclusion by other conditions does not
specifically include fibro if this definition actually reflects the Oxford definition, but it is
implied. I wonder if they would say fibro is just another FSS so shouldn't be used for exclusion. After all, they would probably argue, a similar treatment should work for fibro.
I do find the "proven organic brain disease" bit amusing in a grim kind of way as this may be proven in around three quarters of us on autopsy due to dorsal root gangia and brain stem lesions. Similarly heart damage can often be shown, again typically on autopsy.
I also find vascillation between CFS/ME and CFS in its various guises problematic. ME/CFS is different again, despite the similarity to CFS/ME. By creating so many different variations they sow seeds of doubt due to the imprecise language.
Trying to pin down the language is something I will be attempting over the next several years. I am fairly sure it can be proved this has led to invalid reasoning.
Bye, Alex