Editor's Choice | This Week in BMJ | Press releases
BMJ No 7113 Volume 315 Letters Saturday 11 October 1997
Chronic fatigue syndrome in childrenJournal was wrong to criticise study in schoolchildrenEditor,In his editorial on managing the chronic fatigue syndrome in children H Detailed information on 333,024 pupils and 27,327 staff in 1,098 schools cannot be so lightly dismissed. A balanced response from schools of different types and for different age ranges in widely spaced geographical locations made the rate of response unlikely to produce bias. The accuracy of case ascertainment in each district was easily checked by reference to variables in other diseases reported, such as leukaemia. Difficulties in obtaining responses were clearly explained as resulting from reorganisational demands on British schools concurrent with the study. Competition for funding produces additional pressures on corporate image, as also explained. Schools and local education authorities generally expressed reluctance to provide these statistics. A pilot study in private schools produced a response rate of only 27%, even though details of illness did not differ from those in the public sector. The study also made clear that schools were not involved in medical diagnosis, as suggested by Fiona Godlee.(3) Schools have a legal duty to confirm the veracity of parents' explanations for long term sickness absence; all resulting documentation is confidential, and head teachers' professional probity in supplying accurate data must be respected. Responsibility for any underdiagnosis or overdiagnosis uncovered by the study remains with the primary care doctor, who, in our experience, commonly consults hospital colleagues. In practice, comprehensive tables supplied with this study show little variability in case ascertainment between different local education authorities, with one exception. This authority, while recording the highest number of staff with myalgic encephalomyelitis or the chronic fatigue syndrome, reported only six pupils with the illness. Numbers with this diagnosis over the six districts ranged from 32 to 15 (SD.6.91) among staff and from 63 to 6 (14.43) among pupils; this variability suggests some element of bias peculiar to diagnosis in pupils, and not to us as authors of the study. Arguments should not obscure the findings of the study. Pupils and staff in areas giving low levels of home tuition and a modified timetable were found to be more likely to withdraw from school entirely. Funding for microbiological studies of infections that seem to trigger the onset or relapse of myalgic encephalomyelitis or the chronic fatigue syndrome in schools would be well targeted. E G Dowsett Honorary consultant microbiologist
South Essex Health Trust, Jane Colby Consultant for the education of children with myalgic encephalomyelitis 25 Dakyn Drive, References 1 Marcovitch H. Managing chronic fatigue syndrome in children. BMJ 1997;314:1635-6. (7 June.) 2 Dowsett E G, Colby J. Long-term sickness absence due to ME/CFS in UK schools; an epidemiological study with medical and educational implications. J Chronic Fatigue Syndrome 1997;3:29-42. 3 Godlee F. Plague or pure hype? BMJ 1997;314:1700. (7 June.)
Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline
|