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Dr David Tuller: Some Thoughts on IBS, CFS, MUS, PACE, ACTIB and IAPT (Whew!)


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Trial By Error: Some Thoughts on IBS, CFS, MUS, PACE, ACTIB and IAPT (Whew!)
13 FEBRUARY 2020

By David Tuller, DrPH
It might not be clear to many readers just why I’m spending time writing about irritable bowel syndrome when this series is supposed to be about the illness called myalgic encephalomyelitis (also referred to as chronic fatigue syndrome, ME/CFS, CFS/ME and other terms). The reason is that the two conditions have been yoked together as part of the larger category frequently called “medically unexplained symptoms,” or MUS.

As a provisional term for challenging-to-understand ailments, MUS might be as appropriate as any. But the most aggressive promotors of the construct generally seem to mean that these symptoms are not only “unexplained” but “unexplainable” as pathophysiological phenomena–now and in future. The main evidence for this assumption consists of the absence of identified signs of known organic illnesses. In other words, there really isn’t affirmative evidence at all.

The MUS juggernaut is a world-wide phenomenon. Though particularly strong in the UK, Australia, and a few other countries, the US is certainly not immune. Last August, the Mayo Clinic hosted a training program called “A Systematic Approach to Medically Unexplained Symptoms” at the Ritz-Carlton in Marina Del Ray, in southern California. (Wow, looks beautiful from the photos! Wish I’d gone.) ....................
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