Patients with chronic fatigue syndrome are being ignored

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7479.1405-c (Published 09 December 2004) Cite this as: BMJ 2004;329:1405
  1. Charles Shepherd (charlesbshepherd{at}lineone.net), medical adviser
  1. ME Association, Buckingham MK18 1TH

    EDITOR—Earlier this year more than 28 000 people signed a petition calling for urgent government funded research into the physical causes of myalgic encephalomyelitis and chronic fatigue syndrome. Such is the frustration of people who do not believe that their views are being listened to by the medical establishment.

    So White's editorial reviewing the possible causes of myalgic encephalomyelitis and chronic fatigue syndrome should be welcome news.1 But is it?

    Many doctors support the idea of a disease model with predisposing, precipitating, and perpetuating factors. However, White does not offer any innovative suggestions as to how this could be used to better understand an illness that now covers a wide variety of clinical presentations and an equally diverse range of patho-physiological findings. Having created this mess, the medical profession must now accept that this heterogeneous group of patients is unlikely to have the same pathoaetiology and respond to the same form of treatment, be it pharmacological or behavioural.

    What is needed is thought provoking research that dispenses with the oversimplistic view that myalgic encephalomyelitis and chronic fatigue syndrome entail little more than a vicious circle of abnormal illness beliefs and behaviour, inactivity, and deconditioning. The World Health Organization now classifies both myalgic encephalomyelitis and chronic fatigue syndrome as neurological disorders in section G93.3 of ICD-10. The time has come to look at the neurology of central fatigue—instead of pouring yet more money into the bottomless pit of psychological research.


    • Competing interests CS is a physician whose myalgic encephalomyelitis was precipitated by chickenpox encephalitis and who used to be physically very active as a child as well as before developing his illness.


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