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BBC - Chronic fatigue syndrome on rise among 16-year-olds

Large Donner

Senior Member
Messages
866
If ME/CFS is a diagnosis of exclusion by means of investigating other potential causes for the symptoms by means of physician investigation and medical tests how exactly can a random subjective questionnaire of the parents claim to be dealing with an ME or CFS cohort?

Secondly as its obvious no further investigation was carried out on these kids how irresponsible is it of the investigators to not provide further information for potential other causes and means to follow up with the participants personal physicians.

Lastly how irresponsible would it be to make public statements of proliferation of lets say cancer, HIV or diabetes using such methods?
 

BurnA

Senior Member
Messages
2,087
Thanks for your answer @charles shepherd
The gap between the proponents of Oxford CFS curable with CBT and GET and those who think MECFS is a serious organic disease is so huge I don't see how it can lead to something.

Isnt this the root of the problem ?
I think if we could achieve one thing it would be retirement of Oxford definition.
Why do these people still use it ? Have they ever answered that ?

Another thing could be worth considering, why doesn't every organisation ( charities and researchers ) associated with ME, nail their colours to the mast and declare which definition they use and which treatment / research they support.
Then there can be a nice orderly split ? A group that has completely opposed views on the fundamentals is not a group that has anything useful in common.
 
Messages
85
Isnt this the root of the problem ?
I think if we could achieve one thing it would be retirement of Oxford definition.
Why do these people still use it ? Have they ever answered that ?

Another thing could be worth considering, why doesn't every organisation ( charities and researchers ) associated with ME, nail their colours to the mast and declare which definition they use and which treatment / research they support.
Then there can be a nice orderly split ? A group that has completely opposed views on the fundamentals is not a group that has anything useful in common.

I'm starting to think this would be a good idea for the charities but it's never going to happen with the CMRC Collabrative and while I feel a bit pessimistic about it, I'm very glad that Dr Shepherd is involved. I'm getting mighty sick of having to read between the lines with a couple of ME Charities.
 

Large Donner

Senior Member
Messages
866
I'm starting to think this would be a good idea for the charities but it's never going to happen with the CMRC Collabrative and while I feel a bit pessimistic about it, I'm very glad that Dr Shepherd is involved. I'm getting mighty sick of having to read between the lines with a couple of ME Charities.

I haven't trusted the CMRC from the start. Crawley has got herself on a nice little number there. Talk a big bag of shit, get funded for a big bag of shit and publish a big bag of shit. then hide out under the protection of the CRMC, "one cannot be criticized" or "attacked" by other members of the CMRC.

Its really quite sadisitc and yet another strategic controlled opposition move by the BPS crowd.
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
The authors said:
UK National Institute for Health and Care 73 Excellence (NICE) guidelines state that diagnosis of CFS should be made after 3 months of persistent or recurrent fatigue which is not the result of ongoing exertion, not substantially alleviated by rest, has resulted in a substantial reduction in activities, and has no other known cause.
Can someone clarify is this is right? Thanks

I've never been up on NICE guidelines, let alone the pediatric ones, but here's what I found online. As far as I can tell, persistent fatigue is just one part of it
Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management | 1-recommendations | Guidance and guidelines | NICE
Diagnosis requires fatigue
and

one or more of the following symptoms:
  • difficulty with sleeping, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep–wake cycle
  • muscle and/or joint pain that is multi-site and without evidence of inflammation
  • headaches
  • painful lymph nodes without pathological enlargement
  • sore throat
  • [etc]

...The diagnosis of CFS/ME should be reconsidered if none of the following key features are present:
  • post-exertional fatigue or malaise
  • cognitive difficulties
  • sleep disturbance
  • chronic pain.


And NICE say a full work-up is also required, not just parental self-report:
  • A full history (including exacerbating and alleviating factors, sleep disturbance and intercurrent stressors) should be taken, and a physical examination and assessment of psychological wellbeing should be carried out...
  • The following tests should usually be done:...
 
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Countrygirl

Senior Member
Messages
5,476
Location
UK
I have just read through the NICE guidelines, @Simon and, of course, you are absolutely correct. One of the authors I understand was Dr Crawley herself, who seems to ignore her own advice. Her version of CFS does not appear in the guideline. In a similar vein, she also contradicts the advice given to parents in a book for parents of ME on the AYME site which trumpets the fact that they are condoned and approved by Dr Esther Crawley http://www.ayme.org.uk/documents/10228/11022/Your child and M.E..pdf

She has also eradicated severe ME as she informs paediatricians who now contact her from all parts of the UK that being bedbound is not part of ME and is a sign of Pervasive Refusal Syndrome that requires psychiatric intervention. How long will it take for this to include bed bound or house bound adults? (From personal communications)

Actually, I can answer my own question. A friend who is a doctor who visits patients at home as an assessor for ATOS says she has witnessed the ME diagnosis of housebound adults, even those who are now in their 60s, converted from ME to PRS and this is being used as an excuse by the DWP to remove benefits. It is already happening.
 

Scarecrow

Revolting Peasant
Messages
1,904
Location
Scotland
Can someone clarify is this is right? Thanks
Yes, that's right. Three months for a child and four months for an adult. (I think it used to be six for an adult.)

Worth stressing as well that the fatigue must meet all of the following:
  • new or specific onset (that is, it is not lifelong)
  • persistent and/or recurrent
  • unexplained by other conditions
  • has resulted in a substantial reduction in activity level
  • characterised by post-exertional malaise and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over several days)
 

Chrisb

Senior Member
Messages
1,051
How times change. All that is needed is a little power. Here is the early treatment advice-which I shall have to type because the computer does not want to copy it.

"Treatment must involve tender loving care. The carers must be very patient and sensitive. It takes a long time for patients to recover, and pressuring them makes their condition worse. It typically takes a few months of treatment before it becomes possible to implement a very gradual rehabilitation programme. Therapeutic enthusiasm in the early stages is almost always counterproductive."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762526/

Purveyors of this syndrome appear to have a very simplistic view of what constitutes refusal:

"Refusal........ is a state in which one is unwilling to do something."

This seems to completely neglect the issue of the objective and subjective assessments by the clinician of the capacity of the patient to do that something. It would be extremely unusual usage of the English language to say that someone refuses to do something which they lack capacity to do.

It then totally neglects the question of mitigating circumstances. If one refuses to do something because of expectation, based on past experience, that doing that something will worsen the condition the clinician will have to have made a clear assessment of the risks involved before proceeding.

These issues appear to be only addressed in the diagnostic criteria by:

"No organic condition to account for the degree of severity of the symptoms."

It is something of hostage to fortune that it does not say "no known organic condition".
 

BurnA

Senior Member
Messages
2,087
I haven't trusted the CMRC from the start. Crawley has got herself on a nice little number there. Talk a big bag of shit, get funded for a big bag of shit and publish a big bag of shit. then hide out under the protection of the CRMC, "one cannot be criticized" or "attacked" by other members of the CMRC.

Its really quite sadisitc and yet another strategic controlled opposition move by the BPS crowd.

From the meassociation website:
"The overall aim of the collaborative is to promote the highest quality of basic and applied evidenced based and peer reviewed research into ME/CFS."

So why isn't the first priority to officially retire the Oxford definition and denounce any researchers who use it ?
 

beaker

ME/cfs 1986
Messages
773
Location
USA
With any other condition these researchers would have been able to obtain funding to do a proper study and actually investigate these cases clinically to get a more realistic estimate.

Alas, all we have is sloppy vague questionnaire based 'research'.
Do you think it would matter if the researcher was the same ? That would have to be changed as well.
 

Never Give Up

Collecting improvements, until there's a cure.
Messages
971

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
Thanks. That article
How Common Is Chronic Fatigue Syndrome In Teens? - Forbes
mentions this 2011 Dutch study in the same journal as this new paper - which found a much lower prevalence rate of 0.1% (vs 1.9% in the new study, 0.6% after excluding cases with 'high levels of depressive symptoms')
(2011: Adolescent Chronic Fatigue Syndrome: Prevalence, Incidence, and Morbidity | Articles | Pediatrics)

Crucially, the Dutch study had more rigorous diagnosis (if not ideal): the surveyed GPs, who had presumably examined the patients as well as knowing more about CFS vs chronic fatigue than most parents. The patients also seemed to be more disabled than those in the new study
Forty-five percent of patients with CFS reported >50% school absence during the previous 6 months.
The average in the new study was half a day (10% school absence).

Which is more evidence that the 1.9% prevalence figure from the new study is a bit on the high side.

Added:
Also (Jordan, and Jason/Katz) 2006 study
Prevalence of Pediatric Chronic Fatigue Syndrome in a Community-Based Sample -
Methods: A community-based sample of children and adolescents aged 5 to 17 were screened for symptoms of chronic fatigue syndrome by telephone. Those reported to suffer from CFS-like symptoms were given medical and psychological evaluations to allow a determination of the CFS diagnosis.

..The prevalence for the adolescents (aged 13 to 17) was 181 per 100,000 or 0.181%.
This looks like the best study: telephone screen of population for CFS-like illness, followed by proper work up. Gives 0.18%, approximately a tenth of the new study. It's higher than that Dutch study (0.1%), but you'd expect that to miss quite a few cases while a population study should be more reliable.
 
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BurnA

Senior Member
Messages
2,087
You may have seen these notes on the CMRC before but I'll post them again of the benefit of people who have not seen them

Re: But I'm really desperate that any of the money spent will bring anything good.

I ought to stress that the CMRC does not have any funding or staff and does not/will not be funding any ME/CFS research - certainly in the foreseeable future

A few quick points that people may like to bear in mind when discussing the UK Research Collaborative (CMRC):

1 Like many health professional initiatives in the area of ME/CFS, this involves a group of people who are adding a significant amount of voluntary work to an already very full workload. The Collaborative has no external funding and no permanent staff. If you add up the time taken for meetings, conference attendance and homework, in my case this means adding at least another 7 working days to a voluntary MEA etc workload that is already in excess of 50 hours a week. So there is a limit to what we can achieve with the human and financial resources available.

2 There are a number of positive developments that are taking place/have taken place as a result of the work we have been doing over the past 3 years:

3 A two day annual research conference has been established (which does take a lot of time to organise) that is almost exclusively concerned with biomedical research. The conference is open to any researcher who wishes to attend and we have managed to bring in an excellent mix of UK based and overseas researchers who are already involved in ME/CFS research as well as researchers who are new to the subject. In addition, we have a growing number of researchers from overseas, PhD students and medical students. There is no other annual ME/CFS research conference taking place anywhere else in the world that is organised on this basis.

4 We are progressively bringing in major research funding organisations into the collaborative - recent examples include Arthritis Research UK and The Welcome Trust - and have established firm links with all the major government research funders (eg MRC, NIHR)

5 We are now working on Professor Stephen Holgate's Grand Challenge. This will involve the collection of a vast amount of clinical data and biological samples from over 10,000 people with ME/CFS here in the UK. A wide range of experts in epidemiology, genomics, metabolomics, proteomics etc have accepted the inivitation to attend the RC Workshop in April. This will then proceed to preparing what is possibly the largest ever reseach funding application in the history of ME/CFS being made

6 As with all collaboratives there are differences of opinion relating to almost everything we discuss and I clearly have disagreements relating to how to deal with criticism of research that involves another member of the collaborative and the role of the SMC. But these are relatively minor issues and only take up a very small proprtion of our time (the discussion on the new Code of Conduct took about 10 minutes at rhe Board meeting last week)

7 Professor Stephen Holgate has played a crucial role in setting up the CMRC - partly based on a research collaborative that he set up for lung disease, which is his speciality. Anyone who has met and spoken with Stephen will know that he is a very caring and compassionate physician who reallly wants to get to the bottom of what is causing this illness and to find effective forms of treatment. There aren't any other doctors around who have real influence in high places when it comes to biomedical research into ME/CFS and who can succeed in binging in colleagues like Professor Hugh Perry (Chair of MRC Neurosciences Board and a Professor of Experimental Pathology) into a group like this.

8 So, in my opinion, the positives associated with setting up the CMRC far outweigh any disadvantages

9 Would research into ME/CFS here in the UK really be in a better position if, as some people want, the CMRC packed up, or some of the charity members left? I think not…..

Dr Charles Shepherd

@charles shepherd I think the work you do for the ME community is incredible and we would definitely be in a worse place without you.

I am not convinced about the CMRC but time will tell. For now I think it is useful for you to be there if only to keep an eye on others and to ensure that it is at least being steered in the right direction, even if it might take many years to get to where it needs to be.

My main concern is the association with the likes of Esther Crawley. In the BBC article to which this thread refers she is quoted as follows
She said experts still did not know exactly why or how the condition is triggered, but research showed it could be successfully treated with cognitive behavioural therapy (CBT) in young people.

Can you comment on this and do you think there is anything worthwhile you or the MEA can do to correct this nonsense ?

In your report on the collaborative in Newcastle last year it seems the very first item is agreement on a case definition for ME/CFS.
If Esther Crawley is talking about 1in 50 16 year olds having ME then clearly her case definition is at odds with most others. The fact that she claims 1 in 33 has it for more than 3 months further illustrates this. Worse, she is saying ( if you do the math ) that 1 in 3 cases therefore make a full recovery.

To me this is exactly the nonsense that needs to stop and when this is being perpetuated by a member of the UK CMRC you can see why I ( and presumably others ) are concerned.

Are you aware of any plans to prevent this from happening again ?
 

Art Vandelay

Senior Member
Messages
470
Location
Australia
What percentage of Crawley's recent papers have really just been arguing "Give Me £££"? It seems like most are utterly worthless for moving our understanding foreward, and are only really political documents.

Spot on. This is just a grab for funds.

While Crawley may be an incompetent researcher and an awful medical professional, she and the others in the Wessley school have shown themselves to be good little bureaucrats. That is, they are exceptional political operatives, lobbyists and rent-seekers.

By exaggerating the numbers of children with CFS, thus getting sensationalistic media coverage, Crawley is essentially placing pressure on those that handle the purse-strings to grant her additional funds from taxpayers to expand her empire. No doubt we'll see more research proposals (with creepy Orwellian acronyms) from her and expansion of her fiefdom in the NHS

Speaking of creepy, does anyone else automatically think of Creepy Crawley whenever her name is mentioned?
 
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PhoenixDown

Senior Member
Messages
456
Location
UK
Just found this article in Pulse: http://www.pulsetoday.co.uk/clinica...fects-2-of-teens-study-finds/20030965.article

Notice how they've put it in the mental health section. I hope not many GP's take this magazine seriously.

Note the comments
Ha ha ha ha ha - no they don't!

Researchers trying to make a name for themselves invent a questionnaire that delivers the results they are after. End result: more overmedicalisation. Bingo! More research contacts coming our way!
When the researchers point out that current CFS criteria apply to 2% of teenagers, are they telling us something about teenagers, or are they telling us something about the usefulness of current CFS criteria?