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"Managing chronic fatigue syndrome in U.K. primary care: challenges and opportunities" (Wearden '06)

Discussion in 'Latest ME/CFS Research' started by Tom Kindlon, Mar 25, 2014.

  1. Tom Kindlon

    Tom Kindlon Senior Member

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  2. Tom Kindlon

    Tom Kindlon Senior Member

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    Here's a post of mine on this from 2006

    ---------

    I read the full paper "Managing chronic fatigue syndrome in U.K. primary care: challenges and opportunities" last night.

    I found it depressing e.g. the lack of suggesting other treatment lines or trying to understand the pathophysiology/aetiology of the illness more.

    As many people know, Alison Wearden is leading the FINE trial amongst other things. [Aside: For those that don't know, the FINE trial is officially called "Randomised controlled trial of nurse led self-help treatment for primary care patients with chronic fatigue syndrome". It is mainly funded by the (UK's) Medical Research Council (MRC) - their bit is £736,000 = US$1,446,210 = 1,095,990 EURO, with further money coming from the NHS to bring the full cost to over £1,000,000]

    The sort of explanations for symptoms that they are talking about to be seen at: http://tinyurl.com/yf2fnc i.e. http://www.kcl.ac.uk/projects/cfs/patients/physiology.html?m=print
    [2014: Those links no longer work. It is this article: "Physiological Aspects of CFS" http://www.kcl.ac.uk/innovation/groups/projects/cfs/patients/physiology.aspx ]

    The paper certainly doesn't discourage me from trying to help support research that is trying to understand the biology of this illness.

    I just marked a few quotes for myself which may or may not be of interest to others.

    Tom K.



    - "medically unexplained conditions" are mentioned a lot:

    - About the only reference to biological research:
    -
    -
    The views of those that don't take this view don't seem to be discussed

    -
    There have been more than "several" approaches tried of course.

    - Possibly an interesting quote when discussing what CBT is seen as in relation to CFS:
    -
    The reference for this is: 50. Powell P, Edwards R, Bentall R. The treatment of wheelchair-bound chronic fatigue syndrome patients: **two case studies** of a pragmatic rehabilitation approach. Behav Cognit Psychother 1999; 27: 249–60.

    -their discussion of the crucial "drop out" issue isn't exactly very detailed at least here:

    -
    but they don't mention that maybe efforts should be made to try to understand the condition.

    - They don't necessarily use it in a good way but thought this was an interesting/useful statistic:
    68. Broom DH, Woodward RV. Medicalisation reconsidered: toward a collaborative approach to care. Soc Health Illness 1996; 18: 357–78.

    - I don't like the reasoning/methods in this quote:
    - They are happy to believe that GET and CBT have been shown to be effective and don't provide other suggestions:
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  3. Esther12

    Esther12 Senior Member

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    No.

    Provide explanations for patient's symptoms that aren't supported by the evidence and you're a quack. That this sort of approach was (is) taken without informed consent is utterly repulsive.

    I'm guessing that reference 73 or 74 is that 'empowering' paper that really showed nothing, but has been used as an excuse for all manner of quackery. It's still shocking how poor a lot of the evidence used to support justifications for asserting authority over the cognitions and behaviours of others are.
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  4. Tom Kindlon

    Tom Kindlon Senior Member

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    References for that extract, FWIW:

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  5. Esther12

    Esther12 Senior Member

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    Thanks. I got the number wrong - I was thinking of 72.

    The full paper is here:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27727/

    It was a qualitative study and they decided to split approaches up into three types: rejecting, colluding and empowering. Guess which one was best? Cited 251 times.
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