As I am neither a lawyer nor a paralegal, I prefer not to comment on the
Page v Smith case or on Prof Hooper's comments in relation to this case, but I would like to add the following.
Let's throw some logic at this:
In his
commentary of February 27, Prof Hooper has stated:
'...it is encouraging to note that on 12th February 2014 the WHO publicly confirmed that: “Fibromyalgia, ME/CFS are not included as Mental & Behavioural Disorders in ICD-10, there is no proposal to do so for ICD-11”'
To the best on my knowledge and according to my extensive researches, the only recent public comment made in respect of the classification of ME/CFS for ICD-11 in relation to Chapter 05 Mental and behavioural disorders are the replies left on the WHO's Twitter account, by an unidentified WHO Twitter account admin, in response to several members of the public.
It is not yet established on whose authority those replies were made, that is, whether the (unnamed) WHO Twitter admin made these responses in their own name or whether they were made on the authority of WHO HQ, Geneva, and if so, on whose authority (for example, some stand alone WHO tweets are posted as statements attributable to M Chan (Dr Margaret Chan).
It remains unknown then, who is responsible for this position and its conveyance to several members of the public: has it come from a senior WHO staffer; or the Chair of the Revision Steering Group (RSG) that is responsible for the development of ICD-11; or the Chair of the ICD Revision Topic Advisory Group (TAG) for Neurology; or the Managing editor for TAG Neurology; or the Chair of the
International Advisory Group for the Revision of ICD-10 Mental and Behavioural disorders; or the Project Manager for the revision of the Mental and behavioural disorders chapter, who also has some responsibility for Chapter 07 since some categories straddle both chapters?
Unless and until these Twitter replies have been ratified via a formal, signed WHO statement of clarification that is placed in the public domain or which can be made public (as has been requested), I regard them as informal, unauthorized responses on a social media platform, and not official WHO position statements.
Prof Hooper goes on to state:
"...and that this has been accepted by the UK Parliamentary Under-Secretary of State for Health (Jane Ellison MP)..."
Can we safely assume that?
Thus far, there has been no clarification forthcoming from the Parliamentary Office of Jane Ellison MP for the source on which she based her Oral Answer to Annette Brooke MP, on February 25.
Annette Brooke is my MP. I have asked Annette what was Jane Ellison's source and Annette says she does not know, and neither does AfME's Sonya Chawdhury have this information.
I have a formal request for information on government departments and Ministers [Case ref: DE00000844965] submitted online to the DoH for the source of the public statement that informed Ms Ellison's Oral Answer, which is due for fulfillment on or before March 18.
Until the source of the public statement on which Ms Ellison relied to inform her Oral Answer has been confirmed and a copy obtained for comparison, I consider that it cannot safely be assumed that Ms Ellison
has relied on the unsigned responses provided by an unnamed WHO Twitter admin, on a social media platform, between February 12-14.
Prof Hooper further states:
'...who, on 25th February 2014 stated on the record: “The World Health Organisation is currently developing the 11th version of the International Classification of Diseases, which it aims to publish in 2017. No discussions have taken place between the Department and the WHO on the reclassification of ME/CFS, but the WHO has publicly stated that there is no proposal to reclassify ME/CFS in ICD-11”.'
"but the WHO has publicly stated that there is no proposal to reclassify ME/CFS in ICD-11”.
No WHO hasn't said this.
Not if Ms Ellison has relied solely on the unsigned tweets by an unnamed WHO Twitter admin to several members of the public, between February 12-14.
The tweet by WHO of February 12 does
not state,
“…there is no proposal to reclassify ME/CFS in ICD-11.”
It states only that there is no proposal to include ME/CFS as
Mental and behavioural disorders in ICD-11.
It does
not confirm an intention to retain PVFS, ME and CFS within
Chapter 07.
It does not deny any proposal for coding one or more of these terms under dual parent classes
(which is allowable for ICD-11 and many categories are already assigned to dual parents or to dual chapters) or for coding to dual parent classes under more than one chapter,
other than Chapter 05 - which may or may not include
retention in Chapter 07 Diseases of the nervous system.
Those WHO Twitter replies leave the door open, theoretically, for coding these three terms under chapters like Chapter 19 Symptoms and signs.
Or for coding dual coding under both Chapter 07 and Chapter 19 or another chapter.
Note that I am not saying that this is ICD-11's intention, but since the three terms are currently absent from the public version of the Beta draft, and since I have no privileged information about ICD-11's intentions and since WHO/ICD Revision will not respond to my requests for clarifications, it cannot be deduced from the Beta draft alone or from what was said by an unnamed, unsigned response on a social media platform that
the intention is to retain all three terms within Chapter 07.
There is also the issue of the potential for multiple parentage for multi-system disorders. The ICD Revision proposal of 2010 for a potential new Multi-System Disorders chapter has been rejected in favour of a proposal to classify some diseases and disorders across two or more chapters [1]. So again, in theory, the intention could be to assign multiple parent classes in chapters other than Chapter 05.
The responses do not provide any explanation for the year long absence of these three ICD-10 terms from the ICD-11 Beta draft. They do not set out proposals for hierarchies, that is, which term(s) are proposed to be assigned ICD Title codes and given Definitions and various other “Content Model” descriptors, and which are proposed to appear listed only as Inclusion terms or under Synonyms to ICD Title codes. They do not clarify the proposed content of Long or Short “Content Model” Definitions.
So, until WHO/ICD Revision is prepared to be transparent about its intentions for these three terms, which,
until early 2013, were displaying in the Beta draft, and provides a public, official clarification of intention and reason(s) for current absence, then the tweets of February 12-14 and Ms Ellison's reference to public statements for which she gives no source and for which no source has been given in Hansard, ain't worth tuppence.
And I really wish folk would slow down and scrutinize what is actually being said and demand sources for all statements, whether these come from organizations, parliamentarians, journalists or advocates.
[1]
http://dxrevisionwatch.files.wordpress.com/2010/1/considerations20on20multisystem_diseases_201008181.doc
White Paper: Multisystem Disorders Aymé, Chalmers, Chute, Jakob
This ICD-11 RSG document discusses the outcomes of discussions around the potential for a Multisystem Disorder chapter or otherwise accommodating multisystemic disorders within ICD-11:
http://informatics.mayo.edu/WHO/ICD11/collaboratory/attachment /208/19.Multisystem_Diseases_Chapter.v1.2.docx