BMJ & Guardian team up

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From cancer to the common cold, we tell you which medical treatments really work.

The Guardian has teamed up with the BMJ Group, publishers of the British Medical Journal, to give you the inside information on hundreds of medical conditions, kept up to date with the latest research.

Based on the same information your doctor reads, 'Best treatments' from the BMJ Group is the plain English guide that helps you make the right decisions about your health.
More on the Guardian and BMJ Group partnership
http://www.guardian.co.uk/lifeandstyle/besttreatments
 
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Has anyone posted this before?

http://www.guardian.co.uk/lifeandstyle/chronic-fatigue-syndrome

Chronic fatigue syndrome
What is it?
(1)
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BMJ Group, Tuesday 13 October 2009 00.00 BST
Article history
Feeling tired is very common, especially if you have work or family problems or are under stress for other reasons. Many people say they feel tired most of the time, but very few of them really have chronic fatigue syndrome.

People with chronic fatigue syndrome (CFS for short) feel exhausted and weak a lot of the time for no obvious reason. Often they have other signs of illness too. CFS can affect people of all ages.

There is no simple test for the condition, but your doctor may say you have CFS if you:[1] [2]

Have been feeling exhausted for no known reason for more than six months
Also have other signs of illness, such as muscle pains, sleep problems, headaches and trouble concentrating or remembering things.
There has been a lot of research into CFS but doctors still don't know what causes it. It could have several different causes.

What doctors do know now is that chronic fatigue syndrome is a real illness and not imagined, as was once thought.

Another name for the illness is myalgic encephalomyelitis (ME for short). Sometimes it is also known as CFS/ME. If your doctor finds signs that you have been infected with a virus, he or she may call your illness post-viral fatigue syndrome.

Sometimes chronic fatigue syndrome starts after another illness, like a bad cold or bronchitis. And some people find it starts during a time of stress. But it can come on gradually for no obvious reason.

Some people with CFS have abnormal levels of certain hormones. Doctors have also found they have changes in their immune system (the immune system helps the body fight infection). But no one knows whether these are causes or effects of the illness.

Chronic fatigue syndrome doesn't go on for a set period of time. It can last from a few months to many years, although the symptoms may come and go during that time.

Chronic fatigue syndrome
What are the symptoms?

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BMJ Group, Tuesday 13 October 2009 00.00 BST
Article history
People with chronic fatigue syndrome feel extremely tired and weak most of the time. They often have other signs of illness too.

There is no simple test for the condition, so your doctor will look for a collection of symptoms before deciding whether you have it.

Your doctor may decide you have CFS if:[1]

You have been feeling totally exhausted most of the time for at least six months.
The exhaustion affects you mentally as well as physically.
You might also have:[1]

Pain in your muscles
Difficulty in sleeping
Mood changes.
If you are worried that you or your child might have chronic fatigue syndrome, you should see your doctor. The doctor will probably first carry out some tests to rule out other causes of your tiredness.

Other conditions that can make you feel extremely tired include:[1] [2]

A physical illness, such as an infection you've had for a long time, anaemia, problems with your thyroid gland, or diabetes
Mental health problems, including some types of depression
Dementia
Eating disorders like anorexia and bulimia
Alcohol or drug abuse
Ongoing stress in your personal life, or at work
Being seriously overweight (obese).
If you're a woman, your tiredness could also be caused by pregnancy or by changes in your hormones if you're close to the menopause.

It is important for your doctor to be sure that no other problems are causing your symptoms. If you do have another condition, your doctor may be able to cure it with the right treatment.

References

Sharpe M, Archard LC, Banatvala JE. A report: chronic fatigue syndrome: guidelines for research. Journal of the Royal Society of Medicine. 1991; 84: 118-121.

Fukuda K, Strauss S, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Annals of Internal Medicine. 1994; 121: 953-959.

Chronic fatigue syndrome
How common is it?

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BMJ Group, Tuesday 13 October 2009 00.00 BST
Article history
It is not easy to say exactly how common chronic fatigue syndrome (CFS) is because it can be confused with lots of other illnesses.

Research shows CFS affects anywhere from 6 adults in every 100,000 to as many as 3,000 in every 100,000, depending on how the illness is defined.[1] It is about as common in children (particularly teenagers) as it is in adults.[2] Women get CFS more often than men do.[3] CFS is more common in people who've had mental health problems in life, especially depression or anxiety.[4]

References

Afari N, Buchwald D. Chronic fatigue syndrome: a review. American Journal of Psychiatry. 2003; 160: 221-236.

Royal College of Paediatrics and Child Health. Evidence based guideline for the management of CFS/ME (chronic fatigue syndrome/myalgic encephalopathy) in children and young people. December 2004. Available at http://www.rcpch.ac.uk (accessed on 27 August 2009).

Wessely S. The epidemeology of chronic fatigue syndrome. Epidemiologic Reviews. 1995; 17: 139-151.

Harvey SB, Wadsworth M, Wessely S, et al. The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study. Psychological Medicine. 2008; 38: 933-940.

BMJ Publishing Group Limited ("BMJ Group") 2010

I wont put anymore, but there is more there. What can I say....
 
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The Guardian is not unbiased; it's very biased. It seldom prints anything but the Wessely school of thought on M.E. Even their recent in depth article on M.E. , whilst purporting to show all sides of the situation, if read carefully subtly presented anyone who doesn't accept the useless treatments CBT & GET as conspiracy theorists.

The Guardian printed the 'Dr Crippen' column that regularly poked fun at us. Ben Goldacre, Wessely's colleague, works for the Guardian & has his Bad Science column there.
 

Mark

Former CEO
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Sorry V99, but no, those pages you're highlighting with BMJ advice are not looking good at all to me.

The definitions they are using have far too short a list of symptoms; only the vaguest mention right towards the end of unspecified 'immune' symptoms, where is the emphasis on the well-documented immune abnormalities, sensitivities, frequent colds or not catching cold, all the other stuff we talk about here? No mention of orthostatic intolerance, neurological symptoms, IBS etc? Their definition is so broad as to cover any kind of chronic unexplained fatigue. As my own experience has demonstrated clearly to me, it is possible to get nearly all of the BMJ's listed symptoms from anything that causes ongoing disturbance to sleep. What they describe is extremely vague, so that it includes such a wide range of 'waste basket' conditions that they are all impossible to study. The information strikes me as incredibly thin frankly.

But this is the killer:
http://www.guardian.co.uk/lifeandstyle/besttreatments/chronic-fatigue-syndrome-treatments

From the top...

WARNING: MANY READERS MAY FIND THE FOLLOWING BMJ ADVICE FOR TREATMENT OF CFS DISTRESSING:

Chronic fatigue syndrome

What treatments work?


No one knows what causes chronic fatigue syndrome (CFS), and there is no real cure. But there are some treatments that may help you feel less tired so you can be more active and enjoy life more.
  • Programmes of exercise that start gently and become gradually more energetic can help with chronic fatigue syndrome.
  • A form of talking treatment (psychotherapy) known as cognitive behaviour therapy can also help.
  • There is no reason to believe that resting in bed for a long time will make you feel better. It may even make you feel worse.
We've looked closely at the research and ranked the treatments into categories, according to whether they work. For help in deciding which treatment is best for you, see .
Treatments that are likely to work


Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) is a form of talking treatment that tries to change your thinking and behaviour in a positive way. You meet with a trained therapist for several sessions. The exhaustion you feel with chronic fatigue syndrome is mental as well as physical, which is why this treatment may help.
A review of the research (a systematic review) looked at 15 good-quality studies of CBT for chronic fatigue syndrome.[1] It found that:

  • People who had CBT were more likely to feel less tired at the end of treatment than people who received usual care from their doctor or were on a waiting list for CBT. Overall, 40 in 100 people who had CBT showed improvement, compared with 26 in 100 of those who did not.
  • When researchers followed up with people one to seven months after their treatment had ended, those who'd had CBT still had less tiredness than those who had not.
  • People having CBT were also more likely to feel less tired than those having other types of talking treatment, including relaxation therapy, general counselling, or education and support. Additionally, they were able to do more physically, and had less depression, anxiety and symptoms of distress.
A study not included in the review also found that CBT helped young people (aged between 10 years old and 17 years old) feel less tired and be able to do more, including going to school.[2]
None of these studies found any harmful side effects from CBT. However, in one of the studies, a quarter of the people having CBT or attending support groups dropped out of the study partway through. This could have been a sign that they found it too tiring to take part, or perhaps they just felt it was not helping them.[3]
Graded aerobic exercise

Aerobic exercise is any continuous activity that makes your heart and lungs work faster to supply blood to your body's large muscles (such as those in your legs). It includes walking, cycling and swimming. Graded aerobic exercise is exercise that builds up gradually from a gentle beginning. This type of exercise may help you feel less tired.
Good-quality studies (randomised controlled trials) have found that graded aerobic exercise for chronic fatigue syndrome was more likely to help people feel better than:

  • A treatment that focused on stretching and relaxation[4] [5]
  • A treatment that provided general advice on aerobic exercise[6]
  • Normal care from their family doctor (that did not include advice about exercise).[7]
Another study (a randomised controlled trial) found that people were more likely to feel better if they were taught graded aerobic exercise through an educational programme than if they got written advice on how to do this exercise.[8]
None of these studies found any harmful side effects from doing aerobic exercise. But doctors think that people with CFS may feel worse if they do too much exercise too soon. That's why doctors advise that you should only do graded exercise that is prescribed and supervised by a trained therapist, such as a physiotherapist or sports therapist.[9]
Treatments that need further study


Antidepressants

Antidepressants are medicines that are normally used for depression. There are several different types. The ones used in the studies of people with CFS include fluoxetine (brand name Prozac), sertraline (Lustral), moclobemide (Manerix), and phenelzine (Nardil).
A few good-quality studies (randomised controlled trials) have looked at whether people with chronic fatigue syndrome feel better when they take these antidepressants, but the results of the studies aren't clear.[10]
Also, these drugs can cause side effects, such as sweating, shaking, dry mouth, constipation, dizziness, stomach upsets, anxiety, sleeping trouble and headaches. In one study, a third of people taking fluoxetine stopped taking the drug because of side effects, although a fifth of people taking a dummy treatment (a placebo) for comparison also stopped because of side effects.
Research has found that taking antidepressants of all kinds can make some people more likely to think about suicide or try to harm themselves.[11] Young people under 18 are especially at risk. You are more likely to think about self-harm in the early stages of your treatment, or if the dose of the antidepressant you're taking is changed.[12] If you're taking an antidepressant and are worried about any thoughts or feelings you have, see your doctor or go to a hospital straight away.[12]
Steroids

The full name for these drugs is corticosteroids. They are a group of drugs that are used to treat various illnesses, including ones that affect the immune system (your immune system helps protect you against infection). They are not like the steroids used by bodybuilders (those are called anabolic steroids).
Two of these drugs, fludrocortisone and hydrocortisone, have been studied to see whether they work any better for chronic fatigue than a dummy treatment (a placebo).[10] The results of the research aren't clear.
These drugs can cause side effects. In one study of fludrocortisone, 3 in 25 people found the medicine actually made their symptoms worse.[13] And in another study, high doses of hydrocortisone made 4 in 10 people's adrenal glands stop working properly. Adrenal glands make the body's own corticosteroids.[14]
About 1 in 20 people find that steroid tablets affect their mood.[15] This can happen a few days or weeks after you start treatment. You may be irritable, anxious or confused, or have trouble sleeping. Or you can get an unusually high mood (euphoria). Rarely, people get more serious side effects, such as thinking about suicide or seeing things that aren't really there. It's also possible to get these side effects when you stop taking steroids.
Your doctor should explain the benefits and risks of steroids before you start taking them. If you get any worrying symptoms while you're taking steroids, see your doctor straightaway.
Dietary supplements

One small study (a randomised controlled trial) looked at whether a tablet containing vitamins, minerals and other nutritional supplements worked better for chronic fatigue than a dummy treatment (a placebo).[16] The results weren't clear, possibly because the study was too small to give reliable results. But three people taking the tablet felt sick enough to stop taking part in the study.
Another good-quality study looked at a supplement called BioBran MGN-3. After eight weeks, people who took the supplement still felt just as tired as people who took a placebo.[17]
Evening primrose oil

Evening primrose oil contains an essential fatty acid called GLA. Essential fatty acids have this name because it's essential you get them from your food. Your body cannot make them. Evening primrose oil has been suggested as a treatment for several health problems. The idea is that it may help restore the body's natural balance of fatty acids.
You should talk to your doctor or pharmacist before taking evening primrose oil or other supplements. Some supplements ca


...


the page goes on to list many more treatments - much further down the page - a dumbed-down sentence or two on each, one by one mentioning them in a less than encouraging fashion; really it's that CBT and GET you want...or perhaps antidepressants and steroids?...

No. Guardian needs to challenge the BMJ, BMA, GMC. I'll stick with the Independent, even if I do miss the crossword...
 
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Sorry V99, but no, those pages you're highlighting with BMJ advice are not looking good at all to me.

The definitions they are using have far too short a list of symptoms; only the vaguest mention right towards the end of unspecified 'immune' symptoms, where is the emphasis on the well-documented immune abnormalities, sensitivities, frequent colds or not catching cold, all the other stuff we talk about here? No mention of orthostatic intolerance, neurological symptoms, IBS etc? Their definition is so broad as to cover any kind of chronic unexplained fatigue. As my own experience has demonstrated clearly to me, it is possible to get nearly all of the BMJ's listed symptoms from anything that causes ongoing disturbance to sleep. What they describe is extremely vague, so that it includes such a wide range of 'waste basket' conditions that they are all impossible to study. The information strikes me as incredibly thin frankly.

But this is the killer:
http://www.guardian.co.uk/lifeandstyle/besttreatments/chronic-fatigue-syndrome-treatments

From the top...

WARNING: MANY READERS MAY FIND THE FOLLOWING BMJ ADVICE FOR TREATMENT OF CFS DISTRESSING:

Chronic fatigue syndrome

What treatments work?


No one knows what causes chronic fatigue syndrome (CFS), and there is no real cure. But there are some treatments that may help you feel less tired so you can be more active and enjoy life more.
  • Programmes of exercise that start gently and become gradually more energetic can help with chronic fatigue syndrome.
  • A form of talking treatment (psychotherapy) known as cognitive behaviour therapy can also help.
  • There is no reason to believe that resting in bed for a long time will make you feel better. It may even make you feel worse.
We've looked closely at the research and ranked the treatments into categories, according to whether they work. For help in deciding which treatment is best for you, see .
Treatments that are likely to work


Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) is a form of talking treatment that tries to change your thinking and behaviour in a positive way. You meet with a trained therapist for several sessions. The exhaustion you feel with chronic fatigue syndrome is mental as well as physical, which is why this treatment may help.
A review of the research (a systematic review) looked at 15 good-quality studies of CBT for chronic fatigue syndrome.[1] It found that:

  • People who had CBT were more likely to feel less tired at the end of treatment than people who received usual care from their doctor or were on a waiting list for CBT. Overall, 40 in 100 people who had CBT showed improvement, compared with 26 in 100 of those who did not.
  • When researchers followed up with people one to seven months after their treatment had ended, those who'd had CBT still had less tiredness than those who had not.
  • People having CBT were also more likely to feel less tired than those having other types of talking treatment, including relaxation therapy, general counselling, or education and support. Additionally, they were able to do more physically, and had less depression, anxiety and symptoms of distress.
A study not included in the review also found that CBT helped young people (aged between 10 years old and 17 years old) feel less tired and be able to do more, including going to school.[2]
None of these studies found any harmful side effects from CBT. However, in one of the studies, a quarter of the people having CBT or attending support groups dropped out of the study partway through. This could have been a sign that they found it too tiring to take part, or perhaps they just felt it was not helping them.[3]
Graded aerobic exercise

Aerobic exercise is any continuous activity that makes your heart and lungs work faster to supply blood to your body's large muscles (such as those in your legs). It includes walking, cycling and swimming. Graded aerobic exercise is exercise that builds up gradually from a gentle beginning. This type of exercise may help you feel less tired.
Good-quality studies (randomised controlled trials) have found that graded aerobic exercise for chronic fatigue syndrome was more likely to help people feel better than:

  • A treatment that focused on stretching and relaxation[4] [5]
  • A treatment that provided general advice on aerobic exercise[6]
  • Normal care from their family doctor (that did not include advice about exercise).[7]
Another study (a randomised controlled trial) found that people were more likely to feel better if they were taught graded aerobic exercise through an educational programme than if they got written advice on how to do this exercise.[8]
None of these studies found any harmful side effects from doing aerobic exercise. But doctors think that people with CFS may feel worse if they do too much exercise too soon. That's why doctors advise that you should only do graded exercise that is prescribed and supervised by a trained therapist, such as a physiotherapist or sports therapist.[9]
Treatments that need further study


Antidepressants

Antidepressants are medicines that are normally used for depression. There are several different types. The ones used in the studies of people with CFS include fluoxetine (brand name Prozac), sertraline (Lustral), moclobemide (Manerix), and phenelzine (Nardil).
A few good-quality studies (randomised controlled trials) have looked at whether people with chronic fatigue syndrome feel better when they take these antidepressants, but the results of the studies aren't clear.[10]
Also, these drugs can cause side effects, such as sweating, shaking, dry mouth, constipation, dizziness, stomach upsets, anxiety, sleeping trouble and headaches. In one study, a third of people taking fluoxetine stopped taking the drug because of side effects, although a fifth of people taking a dummy treatment (a placebo) for comparison also stopped because of side effects.
Research has found that taking antidepressants of all kinds can make some people more likely to think about suicide or try to harm themselves.[11] Young people under 18 are especially at risk. You are more likely to think about self-harm in the early stages of your treatment, or if the dose of the antidepressant you're taking is changed.[12] If you're taking an antidepressant and are worried about any thoughts or feelings you have, see your doctor or go to a hospital straight away.[12]
Steroids

The full name for these drugs is corticosteroids. They are a group of drugs that are used to treat various illnesses, including ones that affect the immune system (your immune system helps protect you against infection). They are not like the steroids used by bodybuilders (those are called anabolic steroids).
Two of these drugs, fludrocortisone and hydrocortisone, have been studied to see whether they work any better for chronic fatigue than a dummy treatment (a placebo).[10] The results of the research aren't clear.
These drugs can cause side effects. In one study of fludrocortisone, 3 in 25 people found the medicine actually made their symptoms worse.[13] And in another study, high doses of hydrocortisone made 4 in 10 people's adrenal glands stop working properly. Adrenal glands make the body's own corticosteroids.[14]
About 1 in 20 people find that steroid tablets affect their mood.[15] This can happen a few days or weeks after you start treatment. You may be irritable, anxious or confused, or have trouble sleeping. Or you can get an unusually high mood (euphoria). Rarely, people get more serious side effects, such as thinking about suicide or seeing things that aren't really there. It's also possible to get these side effects when you stop taking steroids.
Your doctor should explain the benefits and risks of steroids before you start taking them. If you get any worrying symptoms while you're taking steroids, see your doctor straightaway.
Dietary supplements

One small study (a randomised controlled trial) looked at whether a tablet containing vitamins, minerals and other nutritional supplements worked better for chronic fatigue than a dummy treatment (a placebo).[16] The results weren't clear, possibly because the study was too small to give reliable results. But three people taking the tablet felt sick enough to stop taking part in the study.
Another good-quality study looked at a supplement called BioBran MGN-3. After eight weeks, people who took the supplement still felt just as tired as people who took a placebo.[17]
Evening primrose oil

Evening primrose oil contains an essential fatty acid called GLA. Essential fatty acids have this name because it's essential you get them from your food. Your body cannot make them. Evening primrose oil has been suggested as a treatment for several health problems. The idea is that it may help restore the body's natural balance of fatty acids.
You should talk to your doctor or pharmacist before taking evening primrose oil or other supplements. Some supplements ca


...


the page goes on to list many more treatments - much further down the page - a dumbed-down sentence or two on each, one by one mentioning them in a less than encouraging fashion; really it's that CBT and GET you want...or perhaps antidepressants and steroids?...

No. Guardian needs to challenge the BMJ, BMA, GMC. I'll stick with the Independent, even if I do miss the crossword...
Sorry Mark. Could not read it all. Did they mention chocolate or pole dancing or Polecats for that matter?