On consensus, it all comes down to who is doing the consenting, and what do they know?
CFIDS Association asking expert signatories about their current position on endorsing the CCC
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Looking down the road, trickle down patient symptoms, research and treatment from the VA to DHSS. Does this sound familiar?
Gulf War illness advocates skeptical of institute panel
VA will label it as psychiatric, or, as it has done most recently, lump it into the category of "chronic multisymptom illness." That category includes veterans with post-traumatic stress disorder, which is caused after exposure to trauma, or traumatic brain injuries.
"I am very concerned as an ill Gulf War veteran that IOM Gulf War committees and the board overseeing them are disproportionately made up of individuals predisposed toward views of Gulf War Illness that do not reflect current scientific knowledge, including the idea that it is fundamentally psychiatric or psychosomatic," wrote Anthony Hardie, a Gulf War vet and Research Advisory Committee on Gulf War Veterans' Illnesses, in a letter to the institute.
The Research Advisory Committee was formed after Congress found VA had focused most, if not all, of its attention on psychiatric causes of the illness, which affects about 250,000 veterans of the 1991 Persian Gulf War that drove Iraqi forces from Kuwait.
Since then, researchers have found changes in the veterans' brains that signify physical degeneration, possibly caused by environmental exposure. Other studies have determined that a greater number of troops than initially thought may have been exposed to small doses of Sarin gas after the Air Force bombed an Iraqi chemical factory.
Symptoms include fatigue, muscle pain, cognitive issues, rashes and irritable bowel syndrome.
Last month, committee members accused VA of an attempted gutting of their group, claiming that half of their members were to be replaced and that their chairman, James Binns,was being pushed out.
Secretary of Veterans Affairs Eric Shinseki has altered the charter of an independent board to research Gulf War Illness, cut its budget and limited the board's independence, according to a directive Shinseki signed last month.
"I have discussed these issues with the secretary and have directed the staff to implement a few actions regarding the committee," said Jose Riojas, Shinseki's interim chief of staff, in a May 16 letter to James Binns, the group's director. "In summary, I have directed that one-half of the members remain and one-half be replaced in accordance with VA policy," Riojas wrote.\
Paul Sullivan, a former VA official who now works as a veterans' advocate.
Sullivan also wrote the legislation that created the Research Advisory Committee (RAC) on Gulf War Veterans' Illnesses.
"They are retaliating by firing the chair, removing half the members, and reducing the scope of the committee," Sullivan said. "Without a doubt, it is a complete gutting of the board."
A 2012 report by the group also said that VA staff was working to reverse those findings. For example, a survey VA sent out to Gulf War veterans focused on psychiatric issues, rather than physical exposures.
"It has been accepted science since 2004 that Gulf War Illness is not a psychiatric problem, when Secretary (Anthony) Principi on the recommendation of the RAC forbade further research based on the premise that it was caused by stress," Binns wrote in a letter to Riojas. "It is extremely alarming to see hard-line staff seeking to undermine this knowledge."
Eco
Gulf War illness advocates skeptical of institute panel
VA will label it as psychiatric, or, as it has done most recently, lump it into the category of "chronic multisymptom illness." That category includes veterans with post-traumatic stress disorder, which is caused after exposure to trauma, or traumatic brain injuries.
"I am very concerned as an ill Gulf War veteran that IOM Gulf War committees and the board overseeing them are disproportionately made up of individuals predisposed toward views of Gulf War Illness that do not reflect current scientific knowledge, including the idea that it is fundamentally psychiatric or psychosomatic," wrote Anthony Hardie, a Gulf War vet and Research Advisory Committee on Gulf War Veterans' Illnesses, in a letter to the institute.
The Research Advisory Committee was formed after Congress found VA had focused most, if not all, of its attention on psychiatric causes of the illness, which affects about 250,000 veterans of the 1991 Persian Gulf War that drove Iraqi forces from Kuwait.
Since then, researchers have found changes in the veterans' brains that signify physical degeneration, possibly caused by environmental exposure. Other studies have determined that a greater number of troops than initially thought may have been exposed to small doses of Sarin gas after the Air Force bombed an Iraqi chemical factory.
Symptoms include fatigue, muscle pain, cognitive issues, rashes and irritable bowel syndrome.
Last month, committee members accused VA of an attempted gutting of their group, claiming that half of their members were to be replaced and that their chairman, James Binns,was being pushed out.
Secretary of Veterans Affairs Eric Shinseki has altered the charter of an independent board to research Gulf War Illness, cut its budget and limited the board's independence, according to a directive Shinseki signed last month.
"I have discussed these issues with the secretary and have directed the staff to implement a few actions regarding the committee," said Jose Riojas, Shinseki's interim chief of staff, in a May 16 letter to James Binns, the group's director. "In summary, I have directed that one-half of the members remain and one-half be replaced in accordance with VA policy," Riojas wrote.\
Paul Sullivan, a former VA official who now works as a veterans' advocate.
Sullivan also wrote the legislation that created the Research Advisory Committee (RAC) on Gulf War Veterans' Illnesses.
"They are retaliating by firing the chair, removing half the members, and reducing the scope of the committee," Sullivan said. "Without a doubt, it is a complete gutting of the board."
A 2012 report by the group also said that VA staff was working to reverse those findings. For example, a survey VA sent out to Gulf War veterans focused on psychiatric issues, rather than physical exposures.
"It has been accepted science since 2004 that Gulf War Illness is not a psychiatric problem, when Secretary (Anthony) Principi on the recommendation of the RAC forbade further research based on the premise that it was caused by stress," Binns wrote in a letter to Riojas. "It is extremely alarming to see hard-line staff seeking to undermine this knowledge."
Eco
It seems that our beloved Master Wessely has had a bit of involvement in Gulf War Syndrome.
http://www.meactionuk.org.uk/Arise-Sir-Simon.htm
http://www.meactionuk.org.uk/Arise-Sir-Simon.htm
I agree, that's well put. There is always a conflict of interest in these circumstances. Most orgs are able to overcome it, but it still exists. I too have not seen much evidence that CAA has overcome it.
CAA statement:
http://www.research1st.com/2013/10/02/the-cfids-association-statement-on-the-h-h-s-iom-contract/
The CFIDS Association Statement on the H.H.S. IOM Contract
ASSOCIATION NEWS, PERSPECTIVE, POLICY MATTERS, RESEARCH NEWS | 02. OCT, 2013 BY LEIGH REYNOLDS | 0 COMMENTS
Background:
On Monday, September 23, 2013 Health and Human Services (HHS) announced its decision to award the Institute of Medicine (IOM) a contract to conduct a study on Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). This study grew out of the 2012 CFSAC recommendation to the Secretary to convene a workshop to “reach a consensus for a case definition useful for research, diagnosis and treatment of ME/CFS.”
The IOM committee will meet over an 18-month period. The project scope has been identified to include stakeholder input, include practicing clinicians and patients. As stated on the announcement received through the CFSAC listserv, the scope of work promises, among other things, to use a consensus-building methodology and to develop an outreach strategy to disseminate the definition nationwide to health professionals.
According to the announcement, expert clinicians, researchers and patient advocates will be asked for suggestions for nominees to the committee. At least one open meeting will be planned to enlist comments and concerns from patients, family members and other caretakers, health educators, health care professionals, and advocacy groups (with an open phone line and email available to those who cannot attend in person.) Existing literature, study results and current data will inform the process. Read the full announcement HERE.
Shortly after this announcement was made, a letter signed by 35 clinicians and researchers was sent to HHS Secretary Sebelius, calling for the repeal of the IOM contract and the immediate adoption of the Canadian Clinical Consensus*. Read the letter HERE.
The CFIDS Association was not aware of the letter until it was made public. As noted in our earlier statement, our support of the IOM contract was contingent upon the contract meeting specific criteria, which the HHS announcement addressed. In an effort to better understand the intent of the signed letter from the 35 experts, we reached out to the signatories for further information and input. Our first call was to Dr. Lucinda Bateman, as one of the most respected clinicians in the US.
Dr. Bateman explained that the letter writing effort began when there was little information and early skepticism about the IOM contract. She now believes that the IOM effort as described more comprehensively in the announcement on September 23rd is a positive course of action. Read her most recent statement on the issue HERE.
Position:
The CFIDS Association takes every response and each call to action extremely seriously. We do not make any of these decisions in a vacuum, but draw on the expertise of many. We sought information to better understand all viewpoints on the IOM contract, so we reached out to the remainder of the signatories via email seeking their input. Several signatories stand firm by the letter. Several signatories thought the IOM contract could work. All of them expressed a deep desire to help the patient community. We will use these conversations to help guide us on how best to engage HHS and IOM as the study moves forward.
We all acknowledge the need for evidence based, broadly accepted clinical and research tools that can accurately include or identify all subsets of the broad heterogeneous group that presents under any case definition of ME/CFS. We feel that the Canadian Clinical Consensus* can be optimized as a clinical case definition by applying a standardized methodology of execution, through validation of criteria, and a nationwide dissemination to health professionals.
In order to move forward more swiftly and to achieve better understanding, diagnosis and treatments, we must broaden support for ME/CFS research at all levels. As Dr. Bateman states,
We understand that some patient advocates remain passionately opposed to the IOM contract. Because they have been marginalized, they fear that critical insights from ME/CFS patients and experts will be disregarded. Because they have not always been heard, they are concerned that their words on this issue will fall on deaf ears in the IOM process. In the past, ME/CFS has been minimized, reduced to a mental condition or simply being tired. There is understandable fear and a justified lack of trust that history will repeat itself.
However, we must find better ways to communicate, work together, and build support for ME/CFS research. We will not always agree on specific issues but we all have a common goal: to solve ME/CFS. Now that the IOM contract is in place, we encourage constructive dialogue amidst the many different views held by patients, clinicians, and researchers. We will continue to consult with leading researchers, clinicians, patient advocates and activists to make the best and most informed decisions. Let’s build an open and respectful dialogue that moves us all forward. Millions of lives depend on it.
http://www.research1st.com/2013/10/02/the-cfids-association-statement-on-the-h-h-s-iom-contract/
The CFIDS Association Statement on the H.H.S. IOM Contract
ASSOCIATION NEWS, PERSPECTIVE, POLICY MATTERS, RESEARCH NEWS | 02. OCT, 2013 BY LEIGH REYNOLDS | 0 COMMENTS
Background:
On Monday, September 23, 2013 Health and Human Services (HHS) announced its decision to award the Institute of Medicine (IOM) a contract to conduct a study on Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). This study grew out of the 2012 CFSAC recommendation to the Secretary to convene a workshop to “reach a consensus for a case definition useful for research, diagnosis and treatment of ME/CFS.”
The IOM committee will meet over an 18-month period. The project scope has been identified to include stakeholder input, include practicing clinicians and patients. As stated on the announcement received through the CFSAC listserv, the scope of work promises, among other things, to use a consensus-building methodology and to develop an outreach strategy to disseminate the definition nationwide to health professionals.
According to the announcement, expert clinicians, researchers and patient advocates will be asked for suggestions for nominees to the committee. At least one open meeting will be planned to enlist comments and concerns from patients, family members and other caretakers, health educators, health care professionals, and advocacy groups (with an open phone line and email available to those who cannot attend in person.) Existing literature, study results and current data will inform the process. Read the full announcement HERE.
Shortly after this announcement was made, a letter signed by 35 clinicians and researchers was sent to HHS Secretary Sebelius, calling for the repeal of the IOM contract and the immediate adoption of the Canadian Clinical Consensus*. Read the letter HERE.
The CFIDS Association was not aware of the letter until it was made public. As noted in our earlier statement, our support of the IOM contract was contingent upon the contract meeting specific criteria, which the HHS announcement addressed. In an effort to better understand the intent of the signed letter from the 35 experts, we reached out to the signatories for further information and input. Our first call was to Dr. Lucinda Bateman, as one of the most respected clinicians in the US.
Dr. Bateman explained that the letter writing effort began when there was little information and early skepticism about the IOM contract. She now believes that the IOM effort as described more comprehensively in the announcement on September 23rd is a positive course of action. Read her most recent statement on the issue HERE.
Position:
The CFIDS Association takes every response and each call to action extremely seriously. We do not make any of these decisions in a vacuum, but draw on the expertise of many. We sought information to better understand all viewpoints on the IOM contract, so we reached out to the remainder of the signatories via email seeking their input. Several signatories stand firm by the letter. Several signatories thought the IOM contract could work. All of them expressed a deep desire to help the patient community. We will use these conversations to help guide us on how best to engage HHS and IOM as the study moves forward.
We all acknowledge the need for evidence based, broadly accepted clinical and research tools that can accurately include or identify all subsets of the broad heterogeneous group that presents under any case definition of ME/CFS. We feel that the Canadian Clinical Consensus* can be optimized as a clinical case definition by applying a standardized methodology of execution, through validation of criteria, and a nationwide dissemination to health professionals.
In order to move forward more swiftly and to achieve better understanding, diagnosis and treatments, we must broaden support for ME/CFS research at all levels. As Dr. Bateman states,
“This is an opportunity to build a strong federal base of support from NIH/IOM. This opens the door to validation, funding and future research based on clear identification of gaps in our knowledge, review of our current evidence base, and creative thinking about how to move forward.”
Now that the full statement of work is available from HHS, the Association is reviewing it to see how all stakeholders can best engage in the process. Together we must work to ensure the best experts are placed on the committee and that the patients have as strong a voice as possible. Together we must respond to the committee’s results, promising strong opposition if they fall short. Our shared goal is to ensure the IOM contract results in a quality clinical case definition that can be used nationwide and will move things forward.We understand that some patient advocates remain passionately opposed to the IOM contract. Because they have been marginalized, they fear that critical insights from ME/CFS patients and experts will be disregarded. Because they have not always been heard, they are concerned that their words on this issue will fall on deaf ears in the IOM process. In the past, ME/CFS has been minimized, reduced to a mental condition or simply being tired. There is understandable fear and a justified lack of trust that history will repeat itself.
However, we must find better ways to communicate, work together, and build support for ME/CFS research. We will not always agree on specific issues but we all have a common goal: to solve ME/CFS. Now that the IOM contract is in place, we encourage constructive dialogue amidst the many different views held by patients, clinicians, and researchers. We will continue to consult with leading researchers, clinicians, patient advocates and activists to make the best and most informed decisions. Let’s build an open and respectful dialogue that moves us all forward. Millions of lives depend on it.
If the IOM contract is going ahead, despite our protests, my opinion is that our community should engage fully with it, and protest against it at the same time if necessary. Just my opinion, at the moment.
They write, “As noted in our earlier statement, our support of the IOM contract was contingent upon the contract meeting specific criteria, which the HHS announcement addressed.” But their earlier statement reads:
How could the CFIDS Association be satisfied that the HHS announcement addressed these "specific criteria?"
How could the CFIDS Association be satisfied that the HHS announcement addressed these "specific criteria?"
Yes, indeed. CFIDS Assoc should be pressed regarding IOM's definition of GWI because THAT is the IOM track record. It is not a good track record.
That's what has been done for the last 20 years and it has gotten absolutely nowhere. The CFS/ME Experts have made a definitive statement - they have reached consensus on CCC, period. In fact CCC is what they've been suing - they've rejected the CDC's Fukuda criteria long ago. The Experts have made this stance OPENLY. It is unprecedented in this disease. The ME community needs to take advantage of this momentum, of this united open position, and not accept anything less.
That's what has been done for the last 20 years and it has gotten absolutely nowhere. The CFS/ME Experts have made a definitive statement - they have reached consensus on CCC, period. In fact CCC is what they've been suing - they've rejected the CDC's Fukuda criteria long ago. The Experts have made this stance OPENLY. It is unprecedented in this disease. The ME community needs to take advantage of this momentum, of this united open position, and not accept anything less.
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After the last few years of advancement in legitimizing this illness among the scientific community, CAA actions is so irresponsible because it places the patient population at risk once again in being marginalized by the medical profession. Their actions are reprehensible.
Eco
Eco
Ecoclimber with the contract having now been awarded, what action would you advocate then?
The patient community could continue with their preferred course - my assumption - expressed by the '35' i.e. the CCC and nothing else (although the CCC will need to be operationalised). And it could do so via engagement with the IOM.
Or it could seek to influence the IOM into appointing those to the panel it would most like to see there e.g. perhaps those who contributed to the CCC and/or ICC.
My point is that now we surely need to get over our distaste: and move onto the next stage. What would you suggest we do next as a positive course of action? We can't hope to hold back the tide.
The patient community could continue with their preferred course - my assumption - expressed by the '35' i.e. the CCC and nothing else (although the CCC will need to be operationalised). And it could do so via engagement with the IOM.
Or it could seek to influence the IOM into appointing those to the panel it would most like to see there e.g. perhaps those who contributed to the CCC and/or ICC.
My point is that now we surely need to get over our distaste: and move onto the next stage. What would you suggest we do next as a positive course of action? We can't hope to hold back the tide.
Historically, the IOM prides itself on the diversity of the make-up of their panels and that they act independently. One only needs to look at the panel they chose for GWI. They will look at the nominees and then pick a very diverse group. They seem to be inclined to have a heavy portion from behavior sciences, psychologists and psychiatrists.
I have no idea where people seems to think that we can pressure them as to who to pick. That is not the way their process works. They need to uphold their esteemed name. I will be surprised if from the panel of approximately 15, there will be more that 5 ME/CFS experts.
Why is it that HHS waited until the pen what wet, to inform us of this contract? They were afraid of a protest and didn't give us any time to properly address it, This is transparent democracy?
We are on the rollercoaster and there is no way of stopping it.(imo)
This is the panel that IOM picked for GWI (CMI) case definition.
http://www.scribd.com/doc/150270391/Panel-Members-Biographies-IOM-GWI-CMI-Case-Definition-Panel
http://www.scribd.com/doc/150270391/Panel-Members-Biographies-IOM-GWI-CMI-Case-Definition-Panel
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For the CFIDS organization and all patient advocacy organzations, members of the CFSAC, all clinicians and researchers, patient organizations openly oppose, boycott and disassociate themselves from the IOM committee to redefine this illness until there is absolute assurance that the board clearly represents the views of the ME/CFS clinicians and researchers and accepts in the record the 4,500 published scientific research articles to date. By being a participant, they legitimatize the process.
The same scenario occurred with Gulf War Veterans and GWS. Patient pools were expanded to include non Gulf War Veterans, Scientific data was completely ignored by the clinicians and researchers involved with the GWS the patient community, informaion from the Congressional Research Advisory Committee were ignored. The outcome was already determined before the board convened. GWS was to be redefined as CMI. Given the fact of the similarity of the symptoms in GWS and ME/CFS, the outcome is already predetermined. The information disseminated by the CFIDS is no different than the information received by the GWS patient community. Behind the scenes, decisions have already been made and this is just a facade, an appearance to legitimatize the redefinition before the public.
The only other definition the IOM has taken on is on Gulf War Illness. The chairman of the project and former Institute of Medicine President, Dr. Kenneth Shine, said he couldn’t remember the last time the OMI produced a definition. They’re not exactly experts… Only three of the sixteen panel members had any experience in GWI, and of those, only Suzanne Vernon didn’t have a psychological bias toward it.
In Jennie Spotila blog, she analyzed the double meanings and lack of specificity in the statements by DHSS in the Statement of Work Document.
http://www.occupycfs.com/2013/09/30/the-statement-of-work/
This is similar to the Pace deception in the UK. It seems as though Wessely's influence as reached across the pond!
Eco
The same scenario occurred with Gulf War Veterans and GWS. Patient pools were expanded to include non Gulf War Veterans, Scientific data was completely ignored by the clinicians and researchers involved with the GWS the patient community, informaion from the Congressional Research Advisory Committee were ignored. The outcome was already determined before the board convened. GWS was to be redefined as CMI. Given the fact of the similarity of the symptoms in GWS and ME/CFS, the outcome is already predetermined. The information disseminated by the CFIDS is no different than the information received by the GWS patient community. Behind the scenes, decisions have already been made and this is just a facade, an appearance to legitimatize the redefinition before the public.
The only other definition the IOM has taken on is on Gulf War Illness. The chairman of the project and former Institute of Medicine President, Dr. Kenneth Shine, said he couldn’t remember the last time the OMI produced a definition. They’re not exactly experts… Only three of the sixteen panel members had any experience in GWI, and of those, only Suzanne Vernon didn’t have a psychological bias toward it.
In Jennie Spotila blog, she analyzed the double meanings and lack of specificity in the statements by DHSS in the Statement of Work Document.
http://www.occupycfs.com/2013/09/30/the-statement-of-work/
This is similar to the Pace deception in the UK. It seems as though Wessely's influence as reached across the pond!
Eco