A user of the Whittemore Peterson Institute Facebook site has kindly
given permission for the following response to be given wider circulation.
Heath reported on WPI Facebook on 12 November that he wrote to the
Department of Health. Their response was:
"Thank you for your email of 28 October to the Department of Health about
xenotropic murine leukemia virus-related virus and chronic fatigue
syndrome/myalgic encephalopathy (CFS/ME).
The Department of Health agrees with the World Health Organization's
classification of CFS/ME as a neurological condition of unknown cause. The
Department also agrees that CFS/ME is a genuine and disabling illness and
can have a profound effect on those living with the condition. That is why
research breakthroughs such as the one outlined in your email, are so
important to developing the knowledge base.
The National Institute for Health and Clinical Excellence (NICE) clinical
guidelines are updated as needed so that recommendations take into account
important new evidence. However, as I hope you will appreciate, as NICE is
an independent body, the time-frame for revising guidance and the evidence
it uses are matters entirely for NICE. You may therefore wish to raise this
issue directly with NICE's Chief Executive, Andrew Dillon, at the following
address:
NICE
MidCity Place
71 High Holborn
London WC1V 6NA
I think it also helpful to emphasise that NICE clinical guidelines are
just that - guidelines for healthcare professionals use in conjunction with
their clinical judgement and based on an individual assessment of each
patient's needs. The guideline recognises that there is no one form of
treatment to suit every patient and it does not force patients into
treatments they do not want.
The guideline emphasises a collaborative relationship between clinician
and patient, that treatment and care should take into account personal
needs and preferences, and that healthcare professionals should recognise
that the person with CFS/ME is in charge of the aims of the treatment
programme.
Cognitive Behavioural Therapy is a rehabilitative approach designed to
modify the way patients think and behave about their illness and so improve
physical symptoms. In common with other illnesses and conditions where it
has been successfully used such as chronic pain, cancer, heart disease and
diabetes, its use does not imply that the cause of the illness is
psychological.
The Department feels that it is not helpful to differentiate between
biomedical and psychosocial treatments as, based on clinical evidence that
is currently available, patients are best served by a holistic approach.
You also comment on the paucity of bio-medical research. I know that many
of the Department's stakeholders see biomedical research as the key to
developing new treatments and the Department appreciates the
concern about a lack of biomedical research in this area.
As you may know, the main agency through which the Government supports
medical and clinical research is the Medical Research Council (MRC). The
MRC is wholly independent in its choice of which research to support and it
does not generally earmark funds for particular topics. It maintains a
rigorous decision making process and only funds research that is likely to
make a significant contribution to knowledge and is a good use of
taxpayers' money. Decisions to support proposals are taken on the grounds
of scientific quality and whether the research proposed would be likely to
inform the knowledge base. There is certainly no bias, and the Department
knows that the MRC remains committed to funding scientific research in all
aspects of CFS/ME.
The Department understands that the MRC continues to attract a small
number of proposals for biomedical research. The problem is that there
appears to be a shortage of good and innovative ideas within the scientific
community itself. This is something the Department knows that the CFS/ME
community and the MRC are aware of, and the MRC have endeavoured to address
this by engaging with patient groups to encourage high quality research
proposals. The MRC continues to acknowledge the importance of research into
CFS/ME, and it is difficult to see what more the MRC could do without
lowering the quality threshold.
I hope this reply is helpful.
Yours sincerely,
Priya Bassan
Department of Health"
----------------
Related information:
Source: ME Research UK
http://www.meresearch.org.uk/information/publications/casetoanswer.html
The Medical Research Council: a case to answer?
[...]
CFS/ME projects currently funded by the MRC
(Sources: MRC website; Hansard, written answers)
.Two large clinical trials of new approaches to treating CFS/ME:
PACE (Pacing, Activity and Cognitive Behaviour Therapy: a
Randomised Evaluation, 2,076,363) [Prof. PD White, Psychological Medicine,
Queen Mary and Westfield College]
FINE (Fatigue Intervention by Nurses Evaluation, 824,129) [Dr
AJ Wearden, Psychological Science, Uni. of Manchester]
.A preliminary epidemiological project to test the feasibility of
identifying the risk factors for persistent symptoms of fatigue and
abdominal and widespread pain (118,263) [Prof. F Creed, Psychological
Medicine, University of Manchester]
.An epidemiological study to assess ethnic variations of the prevalence
of a CFS-like illness, associations with potential risk factors, and coping
behaviours (162,145) [Prof. K Bhui, Cultural Psychiatry and Epidemiolgy,
Queen Mary and Westfield College]
.Indirect support through a trial exploring the management of patients
with persistent unexplained symptoms [Specifics unknown]
.One project was mentioned in Hansard (12th June 2008) but is not on the
MRC website: General and specific risk markers and preventive factors for
chronic fatigue and irritable bowel syndromes (367,000) [Dr C Clark,
Centre for Psychiatry, Barts and The London School of Medicine]
Table. Unfunded applications to the MRC between 2002 and 2008
Time-frame (number of applications) CFS/ME subject area
2002 to 2005 (11 total) Neurophysiology of fatigue;
Population-based/epidemiological studies (4 applications);
Neurotransmitters and stress; Neuroimaging; Clinical and laboratory
characterisation physiology/diagnosis); Dietary intervention - RCT;
Facilitated self-help - RCT; Psychosocial and genetic factors in young
people
2005 to 2006 (12 total) Pathophysiology, including studies regarding
genetics/biomarkers, immunology and neuroimaging (7 applications);
Population-based/epidemiological studies (3); Primary care study;
Experimental medicine study
2006 to April 2007 (7 total) Cognitive outcomes in children -
pathophysiology; Epidemiological studies - epidemiology; Biomarkers;
Pathophysiology (2 applications); Molecular pathogenesis - pathophysiology;
Molecular and genetic characterisation - pathophysiology; Neuroimaging -
pathophysiology
May 2007 to June 2008 (3 total) Biomarkers - pathophysiology; Management
and treatment - intervention; Management and treatment - observational
study
given permission for the following response to be given wider circulation.
Heath reported on WPI Facebook on 12 November that he wrote to the
Department of Health. Their response was:
"Thank you for your email of 28 October to the Department of Health about
xenotropic murine leukemia virus-related virus and chronic fatigue
syndrome/myalgic encephalopathy (CFS/ME).
The Department of Health agrees with the World Health Organization's
classification of CFS/ME as a neurological condition of unknown cause. The
Department also agrees that CFS/ME is a genuine and disabling illness and
can have a profound effect on those living with the condition. That is why
research breakthroughs such as the one outlined in your email, are so
important to developing the knowledge base.
The National Institute for Health and Clinical Excellence (NICE) clinical
guidelines are updated as needed so that recommendations take into account
important new evidence. However, as I hope you will appreciate, as NICE is
an independent body, the time-frame for revising guidance and the evidence
it uses are matters entirely for NICE. You may therefore wish to raise this
issue directly with NICE's Chief Executive, Andrew Dillon, at the following
address:
NICE
MidCity Place
71 High Holborn
London WC1V 6NA
I think it also helpful to emphasise that NICE clinical guidelines are
just that - guidelines for healthcare professionals use in conjunction with
their clinical judgement and based on an individual assessment of each
patient's needs. The guideline recognises that there is no one form of
treatment to suit every patient and it does not force patients into
treatments they do not want.
The guideline emphasises a collaborative relationship between clinician
and patient, that treatment and care should take into account personal
needs and preferences, and that healthcare professionals should recognise
that the person with CFS/ME is in charge of the aims of the treatment
programme.
Cognitive Behavioural Therapy is a rehabilitative approach designed to
modify the way patients think and behave about their illness and so improve
physical symptoms. In common with other illnesses and conditions where it
has been successfully used such as chronic pain, cancer, heart disease and
diabetes, its use does not imply that the cause of the illness is
psychological.
The Department feels that it is not helpful to differentiate between
biomedical and psychosocial treatments as, based on clinical evidence that
is currently available, patients are best served by a holistic approach.
You also comment on the paucity of bio-medical research. I know that many
of the Department's stakeholders see biomedical research as the key to
developing new treatments and the Department appreciates the
concern about a lack of biomedical research in this area.
As you may know, the main agency through which the Government supports
medical and clinical research is the Medical Research Council (MRC). The
MRC is wholly independent in its choice of which research to support and it
does not generally earmark funds for particular topics. It maintains a
rigorous decision making process and only funds research that is likely to
make a significant contribution to knowledge and is a good use of
taxpayers' money. Decisions to support proposals are taken on the grounds
of scientific quality and whether the research proposed would be likely to
inform the knowledge base. There is certainly no bias, and the Department
knows that the MRC remains committed to funding scientific research in all
aspects of CFS/ME.
The Department understands that the MRC continues to attract a small
number of proposals for biomedical research. The problem is that there
appears to be a shortage of good and innovative ideas within the scientific
community itself. This is something the Department knows that the CFS/ME
community and the MRC are aware of, and the MRC have endeavoured to address
this by engaging with patient groups to encourage high quality research
proposals. The MRC continues to acknowledge the importance of research into
CFS/ME, and it is difficult to see what more the MRC could do without
lowering the quality threshold.
I hope this reply is helpful.
Yours sincerely,
Priya Bassan
Department of Health"
----------------
Related information:
Source: ME Research UK
http://www.meresearch.org.uk/information/publications/casetoanswer.html
The Medical Research Council: a case to answer?
[...]
CFS/ME projects currently funded by the MRC
(Sources: MRC website; Hansard, written answers)
.Two large clinical trials of new approaches to treating CFS/ME:
PACE (Pacing, Activity and Cognitive Behaviour Therapy: a
Randomised Evaluation, 2,076,363) [Prof. PD White, Psychological Medicine,
Queen Mary and Westfield College]
FINE (Fatigue Intervention by Nurses Evaluation, 824,129) [Dr
AJ Wearden, Psychological Science, Uni. of Manchester]
.A preliminary epidemiological project to test the feasibility of
identifying the risk factors for persistent symptoms of fatigue and
abdominal and widespread pain (118,263) [Prof. F Creed, Psychological
Medicine, University of Manchester]
.An epidemiological study to assess ethnic variations of the prevalence
of a CFS-like illness, associations with potential risk factors, and coping
behaviours (162,145) [Prof. K Bhui, Cultural Psychiatry and Epidemiolgy,
Queen Mary and Westfield College]
.Indirect support through a trial exploring the management of patients
with persistent unexplained symptoms [Specifics unknown]
.One project was mentioned in Hansard (12th June 2008) but is not on the
MRC website: General and specific risk markers and preventive factors for
chronic fatigue and irritable bowel syndromes (367,000) [Dr C Clark,
Centre for Psychiatry, Barts and The London School of Medicine]
Table. Unfunded applications to the MRC between 2002 and 2008
Time-frame (number of applications) CFS/ME subject area
2002 to 2005 (11 total) Neurophysiology of fatigue;
Population-based/epidemiological studies (4 applications);
Neurotransmitters and stress; Neuroimaging; Clinical and laboratory
characterisation physiology/diagnosis); Dietary intervention - RCT;
Facilitated self-help - RCT; Psychosocial and genetic factors in young
people
2005 to 2006 (12 total) Pathophysiology, including studies regarding
genetics/biomarkers, immunology and neuroimaging (7 applications);
Population-based/epidemiological studies (3); Primary care study;
Experimental medicine study
2006 to April 2007 (7 total) Cognitive outcomes in children -
pathophysiology; Epidemiological studies - epidemiology; Biomarkers;
Pathophysiology (2 applications); Molecular pathogenesis - pathophysiology;
Molecular and genetic characterisation - pathophysiology; Neuroimaging -
pathophysiology
May 2007 to June 2008 (3 total) Biomarkers - pathophysiology; Management
and treatment - intervention; Management and treatment - observational
study
