The uncertainty inherent in making a diagnosis of chronic fatigue syndrome (CFS) is reflected by the variety of names (such as myalgic encephalomyelitis; ME) it has been given. The names reflect the hope that such labels can impose some certainty where little exists. Many doctors are reluctant to make a diagnosis of CFS, with half not even believing it exists.1 The consequences of this uncertainty and reluctance have been that patients hear mixed messages and often receive poor, if any, care.2 It is therefore a welcome relief that the National Institute for Health and Clinical Excellence (NICE) has just published clinical guidelines on the diagnosis and management of this disease.3 In this week's BMJ, Baker and Shaw summarise the guidelines.4

How has the development of these guidelines come about? Eleven years ago, three UK royal colleges agreed that CFS/ME existed as an independent diagnosis and that treatments were possible.5 Unfortunately, this had little effect on the provision of services. …