A message from ME Australia
ME Australia
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Opinion and recommendations on the UK’s NICE Round Table -
Andrew James Bretherton
September 2021
The current NICE debacle and extraordinary deviation from normal procedure and published protocol is evidence of institutionalised discrimination by large sections of the UK medical establishment. That the ME patient group should be treated completely differently from all other diseases, in a manner that’s at odds with clear and growing scientific knowledge, is incredibly discriminatory and thus unlawful. That this behaviour is accepted unchallenged shows that such discrimination against the ME patient group is systemic, normalised and habitual in the UK.
There is NO legitimate reason for any further discussion before publication of guidelines which have been formulated through a proper scientific review process. Where appropriate, discussions can be held with frontline organisations around implementation of the guidance once they are published, and to guide professionals and frontline services on the lawful discharge of their duties.
ME patients are now being held hostage and forced to participate in a highly opaque Round Table process of dubious purpose, with publication of the guidelines conditional upon it. ME patients are rightfully concerned that a less than satisfactory outcome will be rubber stamped by this process, attached to arbitrary and false claims that patients had been “listened to”.
If this is not NICE’s intention, NICE will thus need to provide for a fair and transparent process. A fair and transparent Round Table process would set out all of the following in a publicly available published protocol:
1. A transparent overview, structure and documentation. The published protocol would provide:
o The reasons for and purpose of the meeting.
o Any objections or concerns to be discussed.
o A well defined structure to the meeting.
o The meeting to be recorded on video and this video to be made public afterwards.
2. Fair agenda setting.
Agenda items to be submitted by both sides ahead of time and listed. No agenda items not submitted in advance and listed in the published protocol may be discussed. Any agenda items rejected to also be listed in the published protocol, with explanations as to why they are rejected.
3. Fair representation.
Information on who is invited and why they are chosen and who they are representing. A roundtable that has majority attendance of the BPS school and GET/CBT clinics cannot be relied upon as being impartial or representative of ME patients
4. Fair adjudication.
The chair of the meeting or adjudicator is to have had no prior links to the psychosocial narrative of illness in ME, or there related research or treatments, nor should they have any conflicts of interest that could be tied to financial or economic outcomes. For example they must not have had any previous ties to insurance companies, “fatigue clinics” or government agencies like the department of work and pensions (DWP).
They must also be in line with the known pathophysiology of ME and the findings of NICE’s completed scientific review. This appointment must be agreed by those representing ME patients. Information on how this person is a legitimate, non bais and impartial choice to be provided.
5. Reasonable adjustments to enable meaningful participation from the patient community.
i) Stakeholders who cannot attend in person to be allowed to attend remotely.
ii) Accessibility requirements for stakeholder organisations being represented by people with ME, either in person or remotely, to each be allowed to send two representatives, to help compensate for the cognitive impairments of ME, which include slow processing speed, poor memory and concentration, and limited cognitive stamina.
iii) Pacing requirements for people with ME must be allocated. the opportunity for breaks in proceedings and facilities for rest to be provided as required by ME patients who are attending.
NICE is now the outlier on the global scientific stage:
The CDC has removed GET/CBT:
http://bit.ly/CDCme-cfsHP
The Mayo Clinic has removed GET/CBT, one week after NICE’s high profile “pause”:
https://doi.org/10.1016/j.mayocp.2021.07.004
In the week of the “pause”, the International Association for CFS/ME (IACFS/ME) held its conference, discussing the latest biomedical science in the field.
Ron Davis, Nobel laureate and Chair of OMF Scientific Advisory Board, comments on NICE’s reasoning and credibility:
https://www.omf.ngo/ron-davis-issues-a-statement-on-the.../
Advances in Understanding the Pathophysiology of Chronic Fatigue Syndrome by Anthony Komaroff of Harvard Medical School:
https://jamanetwork.com/jou.../jama/article-abstract/2737854
Diagnosing and Treating MYALGIC ENCEPHALOMYELITIS/ CHRONIC FATIGUE SYNDROME (ME/CFS) by the U.S. ME/CFS Clinician Coalition:
https://y9ukb3xpraw1vtswp2e7ia6u-wpengine.netdna-ssl.com/...
The Bateman Horne Centre:
https://batemanhornecenter.org/education/me-cfs/
If NICE capitulates to vested interests and throws out its own scientific review, it:
Chooses discrimination and ableism over science.
Makes a public statement that its scientific review processes means nothing.
Raises questions even on the point of its existence.
Feeds into doctors with ME (DwME) call to have it subsumed into the MHRA, in order that proper safety standards will be applied to non-pharmacological therapies from now on.
https://doctorswith.me/public-letter-to-dhsc-mhra-hoc.../
If NICE knowingly publishes unlawful guidance that contradicts the science, for the safety of patients clinicians and practitioners must ignore them and practice on the right side of the law. There is now sufficient scientific knowledge, alternative compliant guidelines, and educational resources that are now available to enable them to do so.
(This article was written with help via a support worker and advice from various ME Advocates in Australia and the UK)