Re::Will adopting the Canadian criteria improve the diagnosis of chronic fatigue syndrome?
The Continuing Saga over CFS/ME
The tug-of war waging over CFS/ME strikes me as ironic and futile.
There have been appeals for sympathy and also emphatic voices implying
that they know best with regards to CFS/ME.
In the field of disease and suffering, tug-of-wars don't win laurels;
The effective relief of suffering,however, undeniably does.
I would like to make some simple and common-sense observations:-
1) In the field of medical research, concrete disease criteria form
the foundation-stone for diagnostic research. In better understood medical
conditions this is relatively easily defined .
In the case of CFS/ME which is less well understood and where the
margins are blurry and the clinical manifestation somewhat nebulous, the
task is monumental, and perhaps, presently unachievable.
Certain diagnostic criteria are easier to research than others and may be
chosen at the exclusion of the latter. While knowledge on CFS/ME is still
limited, one can understand this failing. However, exclusion of such
difficult-to-research criteria must be highlighted as such so that in the
light of enhanced knowledge in the future research can focus on these.
2) It is said that only the sufferer from an illness can fully
appreciate the true extent of his/her suffering.
How many researchers on CFS/ME have so far considered it relevant as
part of their research to spend 10-14 days living with the afflicted
person . Not only will this give first-hand witness knowledge of that
which they have set out to research; It would, additionally, give a rare
insight into understanding the illness and suffering of CFS/ME. And, it
would instil empathy and discernment beyond measure.
3) Why is CFS/ME so often the domain of interest of the psychiatrist?
Is it because so much of the symptomatic picture is difficult to define
and crystallize?
Regrettably, it gives CFS/ME the badge of being a psychiatric ailment
or being something which is "only in the mind" and lacking a physical
causative basis.
I am inclined to feel that the interest in CFS/ME should perhaps shift to
General Physicians to give it a different image and feel.
4) There are staunch proponents who strongly recommend CBT and graded
-exercise therapy and are covinced that these are effacious in the
treatment of CFS/ME.
Practical experience proves that CBT and graded-exercise therapy are of
limited value and any accrual benefit is of short duration. If their
benefits were truly durable, I am certain that patients with CFS/ME with
their severely limited energy would be fruitfully employing their time
availing of these 'therapies' instead of engaging in the present tug-of-
war of words.
Dr R N Tiwary, General Practitioner with special interest in CFS
1. Godlee F. Ending the statemate over CFS/ME[editor's choice]. BMJ
2011;342:d3956.(22 June)
Rapid Response:
Re::Will adopting the Canadian criteria improve the diagnosis of chronic fatigue syndrome?
The Continuing Saga over CFS/ME
The tug-of war waging over CFS/ME strikes me as ironic and futile.
There have been appeals for sympathy and also emphatic voices implying
that they know best with regards to CFS/ME.
In the field of disease and suffering, tug-of-wars don't win laurels;
The effective relief of suffering,however, undeniably does.
I would like to make some simple and common-sense observations:-
1) In the field of medical research, concrete disease criteria form
the foundation-stone for diagnostic research. In better understood medical
conditions this is relatively easily defined .
In the case of CFS/ME which is less well understood and where the
margins are blurry and the clinical manifestation somewhat nebulous, the
task is monumental, and perhaps, presently unachievable.
Certain diagnostic criteria are easier to research than others and may be
chosen at the exclusion of the latter. While knowledge on CFS/ME is still
limited, one can understand this failing. However, exclusion of such
difficult-to-research criteria must be highlighted as such so that in the
light of enhanced knowledge in the future research can focus on these.
2) It is said that only the sufferer from an illness can fully
appreciate the true extent of his/her suffering.
How many researchers on CFS/ME have so far considered it relevant as
part of their research to spend 10-14 days living with the afflicted
person . Not only will this give first-hand witness knowledge of that
which they have set out to research; It would, additionally, give a rare
insight into understanding the illness and suffering of CFS/ME. And, it
would instil empathy and discernment beyond measure.
3) Why is CFS/ME so often the domain of interest of the psychiatrist?
Is it because so much of the symptomatic picture is difficult to define
and crystallize?
Regrettably, it gives CFS/ME the badge of being a psychiatric ailment
or being something which is "only in the mind" and lacking a physical
causative basis.
I am inclined to feel that the interest in CFS/ME should perhaps shift to
General Physicians to give it a different image and feel.
4) There are staunch proponents who strongly recommend CBT and graded
-exercise therapy and are covinced that these are effacious in the
treatment of CFS/ME.
Practical experience proves that CBT and graded-exercise therapy are of
limited value and any accrual benefit is of short duration. If their
benefits were truly durable, I am certain that patients with CFS/ME with
their severely limited energy would be fruitfully employing their time
availing of these 'therapies' instead of engaging in the present tug-of-
war of words.
Dr R N Tiwary, General Practitioner with special interest in CFS
1. Godlee F. Ending the statemate over CFS/ME[editor's choice]. BMJ
2011;342:d3956.(22 June)
Competing interests: No competing interests