Just to clarify my position on exclusionary conditions for "CFS", I want to emphasize the bizarre nature of current medical practice, which stops testing for treatable organic illness, in the absence of convenient clinical signs, as soon as a psychiatric label has been applied. One might call this attitude schizophrenic, if one were in a position to apply such labels to those practicing this kind of medicine.
When a group classifies every possible physiological abnormality as an exclusionary condition you can be certain they have defined the problem as functional mental illness in a way that cannot be falsified. This places them outside the scope of mainstream science, not that they are about to admit this.
When they also insist that it is pointless to test for these exclusionary conditions, you know they have decided to simply write off some percentage of patients in order to keep costs down. We don't even know what that percentage may be, though I would be surprised if it were ever less than 10%. This is a value judgment on the human beings involved. The catch here is that you can't easily trace the malpractice to a particular individual who ignored clear signs.
I am particularly concerned about neglect of organic illness which is not merely treatable, but completely curable. Based on other's experience with patients exhibiting unexplained fatigue I would say it is more probable than not that some of the 3158 patients referred for treatment of "CFS" had undiagnosed syphilis, which might not be found for years, after the effects had become devastating. That number is also enough to turn up a fair number of undiagnosed cases of TB or hepatitis. Pulmonary disease in general typically produces fatigue.
Neurological problems like absence seizures or MS can also result in substantial fatigue. (There is a fairly broad region of diagnostic uncertainty for MS or rheumatological diseases like RA, which means that questionable cases should be revisited over a period of years. Does this take place when there is a psychiatric label affixed?) Early stages of slow cancers regularly produce long-lasting unexplained fatigue, catching these early can make the difference between life and death. Really difficult causes of unexplained fatigue, like viral myocarditis, may only be discovered at autopsy.
This above is all connected with non-controversial pathologies, separate from chronic Lyme disease (borreliosis), babesiosis, bartonellosis, toxoplasmosis, etc.
Failure to test for such treatable pathologies necessarily condemns some number of individuals to permanent disability and/or death. Failure to measure the cost of avoiding such malpractice is a strong indication that you have no intention of actually doing anything necessary to avoid it.
