THE ROYAL COLLEGES PRONOUNCE ON ME AND CHOLERA

Countrygirl

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On Friday, following the publication of the new NICE guidelines for ME, the Royal Colleges courageously expressed their anger with NICE's wayward and blatant adherence to scientific evidence and patient welfare. Following the science rather than eminence-based medical 'evidence' is just not cricket...and certainly not English.

Amazingly, following their statement on Friday (see below), on Sunday they published a startlingly similar pronouncement on cholera. :D:whistle: You might like to visit their Facebook page and express your opinion....politely of course. :angel:

https://www.facebook.com/RoyalCollegeofPhysicians

In case you missed their first offering:

https://www.rcplondon.ac.uk/news/me...SS3CMkT_rhWE7m6I5jDV4QMiYhEixRGLrhGNkDxLhe-w4

Medical leaders have signed a joint statement in response to the National Institute for Health and Care Excellence (NICE) guidance on the treatment and diagnosis of Myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS).

We are pleased that NICE have now published their guidance for the management of ME/CFS which is a chronic, poorly understood condition and can be highly disabling and distressing. It is important that all patients with this condition are given access to the best possible services and treatments available.

The published guideline contains some positive changes, but these do not go as far as we would have liked and understate the importance of activity and exercise in the management of ME/CFS and the connection between people’s mental and physical health. We also do not think the changes represent the positive discussions that have been had with patient groups.

As in many chronic conditions, people’s mental and physical health are intrinsically linked. This guidance risks undermining the importance of these links by dismissing the potential of treatments such as Cognitive Behavioural Therapy (CBT) as of less value in alleviating symptoms than pharmacological interventions.

There is considerable disquiet in the medical profession and some patient groups about the way the data and evidence have been assessed but the important thing now is that services are commissioned in a safe and effective way that does not disadvantage any patients being treated now or in the future.
When commissioning services we would reiterate that:
Graded Exercise Therapy) as defined in the guidance is not reflective of the personalised paced exercise programmes that are currently used in the NHS and termed GET. These have provided benefit to many patients and should not be discontinued. However, we recognise that the phrase GET is unhelpful and this terminology should be dropped to allow clinicians to work with their patients in a more productive way.

CBT remains a valuable treatment for alleviating symptoms in ME/CFS and services should ensure patients have access to this and other psychological therapies.
Specialist rehabilitation medicine services and exercise medicine services regularly look after patients with ME/CFS (and also provide complex care and long-term support for very severe ME/CFS) but are not specifically recommended in the guidance. There are very few dedicated ME/CFS specialist services either in the community or hospital setting and thus if commissioners do not use specialist rehabilitation medicine services and exercise medicine services, these patients will lose out.

Commissioners must also take action to ensure training and support is available for the full range of specialist ME/CFS roles needed and are easily accessible for GPs and other clinicians across the NHS, so that this guidance can effectively be put into practice.

Many patients with ME/CFS have other conditions including chronic pain and fibromyalgia which are improved with exercise as recommended in other NICE guidance. It is important that a holistic approach is taken to ensure that other conditions do not deteriorate.

Royal College of Physicians
Royal College of Physicians of Edinburgh
Royal College of General Practitioners
Royal College of Psychiatrists
Academy of Medical Royal Colleges
Faculty of Sport and Exercise Medicine
Faculty of Occupational Medicine


Now they have added a second article....this time on cholera. Surprisingly, it is remarkably similar. The Royal Colleges must, indeed, be applauded for their continued adherence to their usual standard of scientific rigour and their heroic defence of the status quo, in the face of overwhelming evidence to the contrary. Knighthoods all round. :trophy::cocktail:

Medical leaders have signed a joint statement in response to Dr John Snow’s misguided treatise on the alleged causes and origins of cholera.

We are taken aback at the effrontery of Dr Snow’s unabashedly false statement to the effect that cholera is spread by drinking water. The idea is too repugnant to consider, and this opinion is echoed also in the Lancet, whose authority cannot be challenged. Cholera is an acute, poorly understood condition which can be highly disabling and fatal unless the correct treatments of bloodletting and rectal infusions of mutton puree are administered in a timely fashion. The scientific basis of the way this condition is spread and appropriately treated is now well understood, but only by those whose medical education and intellect is sufficient, unlike that of Dr Snow. It is of obvious importance that all patients with this condition are given access to the best possible services and treatments available. This includes graded amounts of bloodletting and rectal infusions of mutton puree administered by appropriately qualified psychologists. This should be under the supervision of only those specialists of sufficient intelligence to have an understanding of the complexity of the condition.

Dr Snow’s treatise contains some interesting ideas, but these do not go as far as we would have liked and understate the importance of activity and exercise in the management of cholera. Also the obvious connection between a typical cholera sufferer’s mental and physical health was completely ignored by Dr Snow; it is obvious to the medical cognoscenti of the Royal Colleges that the diarrhoea of cholera owes much more to noxious miasmata than to Dr Snow’s extraordinary idea that drinking water is the source.

As with many such conditions, Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) are very useful adjuncts when rectal infusions of mutton puree and bloodletting are the mainstay approaches. The evidence base for such interventions is beyond challenge (because we say so).

There is considerable disquiet in the medical profession and some patient groups about the way the data and evidence have been assessed but the important thing now is that services are commissioned in a safe and effective way that does not disadvantage any cholera patients being treated now or in the future.

When commissioning services we would reiterate that:

Graded Exercise Therapy should be retained for the most severely affected, particularly those who think, misguidedly, that they have severe diarrhoea. The latter of course is simply imaginary, and can be effectively suppressed with Cognitive Behavioural Therapy. These have provided benefit to many patients and should not be discontinued.

CBT and GET thus remain valuable treatments for alleviating the delusional symptoms of cholera – particularly the diarrhoea - and services for this terrible condition should ensure patients have access to this and other psychological therapies.

Royal College of Physicians

Royal College of Physicians of Edinburgh

Royal College of General Practitioners

Royal College of Psychiatrists

Academy of Medical Royal Colleges

Faculty of Sport and Exercise Medicine

Faculty of Occupational Medicine


You might like to join many UK ME patients by visiting their Facebook page (link above) and leaving your comment..........politely. :D
 

Learner1

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It will be ready nice when this topic of CBT and GET gets put to bed, once and for all, and treatments like these can be recommended based on laboratory testing and imaging:
  • Antivirals, and other anti-infectives
  • Immunoglobulins
  • Naltrexone
  • Rituximab and apharesis
  • Antioxidants
  • B vitamins
  • Amino acids
  • Minerals
  • BH4, tetrahydrobiopterin
  • Other mitochondrial nutrients
  • Liothyronine
  • Melatonin
  • Hyperbaric oxygen therapy
  • Spinal injections or surgery
All have helped subgroups of ME/CFS patients sound a lot better than rectal infusions of mutton puree...:eek: it is a pity that the new guidelines don't yet seem to advise testing and treating problems found
 
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As with many such conditions, Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) are very useful adjuncts when rectal infusions of mutton puree
I could develop a strong argument that Mutton Puree enemas are in fact a potentially outstanding treatment for ME.

Definately was on my Tibetan wind diet (to evict this wind, I made lamb bone broths and drank the broth).
 

Alvin2

The good news is patients don't die the bad news..
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The published guideline contains some positive changes, but these do not go as far as we would have liked and understate the importance of activity and exercise in the management of ME/CFS and the connection between people’s mental and physical health. We also do not think the changes represent the positive discussions that have been had with patient groups.
Bothsiderism is not only for politics...

Graded Exercise Therapy) as defined in the guidance is not reflective of the personalised paced exercise programmes that are currently used in the NHS and termed GET. These have provided benefit to many patients and should not be discontinued. However, we recognise that the phrase GET is unhelpful and this terminology should be dropped to allow clinicians to work with their patients in a more productive way.
The dead horse is not ready to let go and hopes it can repackage its nonsense in order to save itself from progress (and reality).