аЯрЁБс>ўџ 57ўџџџ4џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС#` №Пњ%bjbj\.\. .2>D>DY џџџџџџЄ0T T T 8Œ Ј 0ћ .Ш Ш Ш Ш Ш Ш Ш Ш z | | | | | | $)h‘r  Ш Ш Ш Ш Ш   Ш Ш Е * * * Ш ОШ Ш z * Ш z * * * Ш М Р@•ƒЧT † ‚* z Ы 0ћ *  И* * PШ Ш * Ш Ш Ш Ш Ш     Р jШ Ш Ш ћ Ш Ш Ш Ш 000$T 000T 000џџџџ  Dr Ian Gibson MP and his committee has conducted an inquiry, “without any official funding or support” into CFS/MS and published its report in November 2006. Although the report strives to be even-handed in admitting the controversy that exists in this field the foreword concludes with an expression of condolence to the family of a patient who died “suffering from ME” whilst the hearings were in progress. This may be a necessary gesture but it does somewhat set the scene for what follows. Myalgic encephalomyelitis was an expression coined in the 1950s. Chronic fatigue syndrome became common usage in the 1980s but is contentious as fatigue is a common feature of many illnesses and there is not a pathological term. The report concludes that until there is more evidence about the specific pathology of the illness there is little use in considering alternative names and as CFS/ME is the recognised term in the UK it is used in the report. The terms are, however, alternated so as not to give undue prominence to either component – rather like Londonderry/Derry used to be! It is hoped that it will follow on from the CMO’s Working Group Report on CFS/ME in 2002 and spark interest and action particularly in government. After the CMO report Ѓ8.5m was ring fenced for 13 treatment centres that will cater for 21,000 patients annually but there has been much disappointment expressed that many of the CMO’s recommendations for further research have been ignored. The recent draft NICE guidelines have been particularly criticised in this respect as they do not mention the possibility of an organic cause. The committee sets out that its task was to “highlight the ongoing struggle of the CFS/ME community and to ensure that the voice of the patient is heard.” It is perhaps here that the fundamental question is raised: modern evidence-based orthodox medicine relies on the clinical controlled trial. The attitude towards CFS/ME as represented by some of the pressure groups must represent the absolute antithesis of this approach: it could be parodied on the one hand as superstition or alternatively regarded as demonstrating the ultimate patient centred approach. Notable is the strong resistance to the idea that CFS/ME is a “mental” illness, or even that it has a psychological component although the committee does acknowledge that many patients become depressed as a result of their illness. “In the absence of known causes or cures patients require considerable care, compassion, understanding and support and, in particular, acceptance that they have a genuine and serious illness (my italics). Government should fund more research into potential causes, which might lead to “better” diagnostic tests. On a detailed note the report recommends that the Canadian Clinical Criteria devised by Dr Bruce Carruthers be used rather than the Oxford Criteria first published in 1981 as the latter is too general and, in particular, may risk including those without “authentic CFS/ME” in research. Carruther’s diagnostic criteria are reproduced in full. He recognises that each patient may have his or her own unique symptom cluster but, nevertheless, the reviewer will be keeping them handy for future reference in his practice. There is an interesting section in which the latest scientific theories are briefly outlined including genetic, endocrine and biomedical fields of research. Unsurprisingly, “the overwhelming message…was that more money was needed to develop knowledge in this contentious area.” Mention is made that Prof. Simon Wessley, whose research is based on a psychosocial model of illness and whose treatment methods are based on the results of controlled clinical trials, declined to give evidence to the committee, although some of his colleagues did. Cognitive behavioural and graded exercise therapy (CBT & GET) are most effective for those with less severe CFS/ME and this has led groups representing severe sufferers to deny that those responding to it have the “true” disease. That GET may make severe sufferers feel worse has “lent fuel” to the antipathy towards doctors offering it. It is said that Prof. Wessely has stopped his work in this area because of the intimidation he received from a “fringe” group. Patients should be advised of possible risk before embarking on GET. The report says that drug treatments are “uniformly disappointing” but that irritable bowel syndrome and depression should be treated the latter specifically after a “full explanation.” Dietary supplements and vitamins may help individuals but searching “through the shelves of the health food shops should not be encouraged with any optimism.” Complementary and alternative therapies that are being used with success in palliation in terminal disease (an analogy much favoured by groups representing severe sufferers) should be made available for CFS/ME on the NHS. The group was “intrigued but sceptical” about the claims made for “unorthodox therapies” and recommended independent assessment of, for example, the Perrin technique that aims to increase lymphatic drainage from the neck and chest. The treatment centres would be ideal places to undertake such assessments and also to undertake large scale epidemiological studies, “providing they were conducted according to acceptable criteria.” The Medical Research Council comes in for particular criticism for turning downing funding for research other than in the “psychiatric/psychosocial domain.” The MRC advocates research effort into case management and potential interventions rather than into causes or diagnostic tests. The parliamentary group feels that CFS/ME “cannot be viewed in the same light as other illnesses of unknown cause such as the malignant diseases which can be diagnosed with appropriate existing investigations. The crucial issue…is to identify diagnostic tests for it even before its cause is clarified.” The group castigates the DWP for defining CFS/ME as a psychosocial illness and medical insurance companies thus denying suffers from receiving higher level benefits. It even cites examples of DWP advisors being also involved in insurance companies, thus having vested interests in maintaining the status quo and points out that such a “blatant conflict of interest” calls for a full investigation by the appropriate standards body. It may be that CFS/ME sufferers require different methodology in their assessment for benefits but what form this could take is not discussed. The report concludes that this condition be recognised as requiring an approach as serious as that taken to heart disease or cancer. Despite there being no compelling evidence that it is a purely psychosocial condition this is entirely the approach implicit in the draft guidelines from NICE. The report concludes this repeated expression of exasperation and another plea that research must be done to find alternatives. The cynic might reflect that, like the famous definition of metaphysics, further investment in researching causes might be like setting two blind men to look in a dark cellar for a black cat that isn’t there. The DH and NICE, rather like the authors of this report, are simply too polite, or too afraid, to say so. The reviewer simply concludes that there are some very unwell patients out there, but as in other conditions, they are not necessarily unwell in the way they believe themselves to be. Compassion, understanding and clinical caution will always have a place in medicine.     Inquiry into the status of CFS/ME and research into the causes and treatment Parliamentary Group on Scientific Research into ME The Gibson Report \ № ё И  < >   B ЗИыю…ѕџ,-ЅІsƒУЌ­ЭймшќэоэоЯУЯоДоДоДЈДоД™‰™‰y™Д™j™j™j[Ј[hІОhWяCJOJQJaJhІОh?s№CJOJQJaJhІОhЫcŸ6CJOJQJaJhІОhс\6CJOJQJaJhІОhс\CJOJQJaJhІОCJOJQJaJhІОhЫcŸCJOJQJaJh5сCJOJQJaJhІОhЙ6хCJOJQJaJhІОhСvПCJOJQJaJhІОh_>ЋCJOJQJaJh_>Ћ"ё ђ юяІЇ­ЎклмCD _!`!##R%S%T%U%W%X%Y%§§ѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕѕ$a$gd_>ЋY%љ%ўўшBD МЦђх!####d#z#€#‡#‹##B$ћ$§$,%1%Q%R%S%T%U%V%W%Y%Z%\%ётётвтУёУДЈДЈДЈДœДœДЈДЈœЈЈДёrc[WhSlJjhSlJUhІОhСvПCJOJQJaJhІОh?s№CJOJQJaJhІОhWяCJOJQJaJhЙ6хCJOJQJaJh5сCJOJQJaJhІОCJOJQJaJhІОhІОCJOJQJaJhІОhЙ6хCJOJQJaJhІОhМ Х6CJOJQJaJhІОhМ ХCJOJQJaJhІОhBCJOJQJaJ"Y%[%\%^%_%a%b%d%e%В%х%ї%ј%љ%њ%§§§§§§§§ѕѕѕ§§э$a$gd_>Ћ$a$gd_>Ћ\%]%_%`%b%c%e%В%ї%ј%љ%њ%їѓїѓїѓугЯѓРhІОhСvПCJOJQJaJhТ0h_>Ћh_>Ћ5CJOJQJaJh_>Ћh_>Ћ5CJOJQJaJhSlJjhSlJU ,1hА‚. 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