Controversies related to ME/CFS explained

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an illness with a history of controversy. Although it is classified as an organic disease by a majority of researchers, it was historically assumed to be psychosocial, an opinion still held among many physicians.[1] The pathophysiology of ME/CFS remains unclear, there exists many competing diagnostic criteria, and some proposed treatments are controversial.[2] There is a lack of education and accurate information about the condition among a significant number of medical practitioners, which has led to substantiated accusations of patient neglect and harm.

Neglect and lack of awareness

ME/CFS suffers from a lack of awareness among clinical professionals. Despite being a relatively common and disabling disease, a large proportion of professionals are either unaware or dismissive of it. This often leads to patient neglect, which happens in clinical, government, bureaucratic, and research settings.

Lack of awareness in clinical settings

Despite ample evidence ME/CFS is an organic disease, many clinicians do not recognise it as genuine or underestimate its seriousness.[3] [4] A 2020 literature review found that “a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it.”

A substantial proportion of medical schools do not teach about ME/CFS, and the large majority do not provide clinical exposure to ME/CFS patients.[5] In 2021 NICE found that “medical students reported that there is little or no formal training on ME/CFS in the medical curriculum and that their knowledge often comes from media”.[6]

Training influences attitudes towards ME/CFS. One study conducted a relatively brief seminar presenting factual information on the illness to a cohort of fourth year medical students. The authors concluded the information provided was associated with a more favorable attitude toward ME/CFS.[7]

Neglect of patients

Governments, medical institutions, and the medical community have been criticised for neglecting people with ME/CFS.[8] [9] George Monbiot, a journalist for the Guardian, called the neglect and its consequences “the greatest medical scandal of the 21st century”.[10] Individuals with the condition describe the struggle for healthcare and legitimacy due to what is described as bureaucratic denial of the condition because of its lack of a known etiology. Institutions maintain the exclusion of patient support by rhetorical arguments of the open-endedness of science to delay new findings of fact.[11] [12]

A 2006 investigation by a group from the Parliament of the United Kingdom found there was not enough support in the UK for CFS patients in terms of access to government benefits and health care.[13]

Mass hysteria accusations

Epidemic cases of myalgic encephalomyelitis (ME) were called mass hysteria by psychiatrists McEvedy and Beard in 1970,[14] provoking criticism in letters to the editor of the British Medical Journal by attending physicians, researchers, and nurses who fell ill.[15] [16] [17] [18] [19] [20] [21] [22] [23]

The psychiatrists were criticized for not investigating the patients they described,[24] and their conclusions have been refuted.[25] [26] [27] In 1978 a symposium held at the Royal Society of Medicine (RSM) concluded that epidemic myalgic encephalomyelitis was a distinct disease entity.[28]

However, the idea that CFS may be culturally mediated persisted in some quarters. In her 1997 book Hystories: Hysterical Epidemics and Modern Culture, literary critic and feminist Elaine Showalter argues that chronic fatigue syndrome is a "hysterical narrative", a modern manifestation of hysteria, a self-perpetuating "cultural symptom of anxiety and stress" historically assigned to women.[29]

Research related

Lack of funding

Governments and health organisations have been criticised for their lack of funding into ME/CFS research. ME/CFS is one of the most underfunded diseases compared to disease burden.[30] The funds are only approximately 3-7% of what comparable diseases are allocated.[31] Meanwhile the economic impact of ME/CFS is estimated at 149-362 billion USD in the United States alone.

XMRV retrovirus

In 2009, the journal Science[32] published a study that identified the XMRV retrovirus in blood samples of a population of people with CFS. After the Science publication, media attention generated interest in the XMRV virus worldwide.

Many countries reacted quickly to protect the blood supply from the XMRV retrovirus by banning persons with CFS from donating blood. The United States funded a 1.3 million dollar study to try to validate the findings, and some people with the illness started taking antiviral drugs in hopes of symptomatic improvement.[33] Organizations adopting these or similar measures included the Canadian Blood Services,[34] the New Zealand Blood Service,[35] the Australian Red Cross Blood Service[36] and the American Association of Blood Banks.[37] In November 2010, the UK National Blood Service permanently deferred ME/CFS patients from donating blood to prevent potential harm to the donor.[38]

Many studies failed to reproduce this finding,[39] [40] [41] and recriminations of misconduct from the various stakeholders grew angry and bitter.[33]

In 2011, the editor of Science formally retracted its XMRV paper[42] while the Proceedings of the National Academy of Sciences similarly retracted a 2010 paper which had appeared to support the finding of a connection between XMRV and CFS.[43] Studies eventually concluded that neither people nor the blood supply had been infected with the XMRV virus, and the origin of the virus was likely a lab contaminant in the supplies used by the polymerase chain reaction (PCR) process of the studies that found virus in blood.[44]

PACE trial

See main article: PACE trial. PACE was a large trial investigating the efficacy and safety of three treatments adjunctive to specialist medical care (SMC): cognitive behavioural therapy (CBT), graded exercise therapy (GET), and adaptive pacing therapy (APT). The results were published in February 2011 and concluded that CBT and GET were each "moderately" effective compared to SMC alone, while APT was not found to be effective when added to SMC.[45]

The trial generated considerable criticism. Letters to the editor critiqued the definitions of secondary outcomes, questioned post-hoc protocol changes, and expressed concern over generalisability of the results. Patient groups and the IACFS/ME (an organization of researchers and health care professionals interested in CFS)[46] criticized the trial for over-simplified and exaggerated conclusions, for using a flawed psychosocial illness model that ignores biological evidence, for testing a non-representative version of pacing, and because the results seriously conflict with their member surveys which show that pacing is effective and CBT or GET can cause deterioration in many patients who use the treatments.[47] [48] [49]

One researcher submitted a 442-page letter to the Medical Research Council outlining his criticisms of the trial, and a shorter 43-page complaint to the Lancet. The MRC and the Lancet rejected the submissions. A Lancet editorial responded to the adverse criticism by suggesting that some critics could be part of "an active campaign to discredit the research."[50] [51] In 2011, Lancet Editor Richard Horton defended the trial, calling the critics "a fairly small, but highly organized, very vocal and very damaging group of individuals who have, I would say, actually hijacked this agenda and distorted the debate so that it actually harms the overwhelming majority of patients."[52] [53]

More recent criticisms of the trial have come from the scientific community. For example, biostatistician Bruce Levin of Columbia University described the study as "the height of clinical trial amateurism", and Ronald Davis of Stanford University wrote, "I'm shocked that the Lancet published it... The PACE study has so many flaws and there are so many questions you'd want to ask about it that I don't understand how it got through any kind of peer review".[54] In an analysis of the study's design, the mathematician Professor Rebecca Goldin wrote that "There were problems with the study on almost all levels... the flaws in this design were enough to doom its results from the start."[55] Professor Jonathan Edwards of University College London (UCL) has written that the PACE trial "is an unblinded trial with subjective outcome measures. That makes it a non-starter in the eyes of any physician or clinical pharmacologist familiar with problems of systematic bias in trial execution."[56]

The full research data for the PACE trial was requested by both patients acting as citizen scientists, and by other researchers but was initially denied until a 2016 tribunal ordered the data be released. Several researchers published a re-analysis of the PACE trial data, but drawing the conclusion that the CBT and GET treatments were not effective and possibly not safe.[57] [58] [59] [60] The full PACE trial outcome data showed that the treatments did not result in patients being able to return to work or study,[61] and that they were not able to walk significantly further after treatment. This new information was one of several factors that lead to the UK deciding to complete a full review and update to its diagnostic and treatment guidelines for ME/CFS. The 2021 guidelines no longer include GET or CBT as treatments.[62]

Research funding diversions at the CDC

In 1998, William Reaves, a director at the Centers for Disease Control (CDC), alleged deceptive Congressional testimony was given by officials at the agency concerning CFS research activities conducted by the organization; specifically, funds for programs intended for CFS research were diverted to other projects and not reported. He also stated he was retaliated against by his superior, Brian Mahy, after he reported the irregularities.[63] [64]

A Government Accounting Office (GAO) investigation disclosed almost 13 million dollars for CFS research had been redirected or improperly accounted for by the CDC. The agency stated the funds were redistributed in order to respond to other public health emergencies. The director of a U.S. national patient advocacy group charged the CDC had a bias against studying the disease.

In response, the CDC pledged reforms to accounting practices to reduce misuse of funds earmarked for specific diseases. Additionally, the money diverted from CFS research was to be restored over a period of three years.

Harassment of researchers

Researchers have complained of receiving harassment and abuse from activists when working on ME/CFS. While the abuse is primarily directed at researchers looking into psychological aspects of ME/CFS, it has also affected scientists investigating biological mechanisms, such as Myra McClure, who received a "staggeringly shocking" torrent of abuse from patients who believed she had a vested interest in not finding the virus. McClure says that she will not be pursuing any more research into ME/CFS.[65]

In 2012, several UK researchers involved in the PACE trial, who adopted the controversial psychosocial perspective, reported to the press that they had been verbally abused by patients, and one reported receiving death threats.[51] A tribunal judge investigated the claims of harassment in relation to the PACE trial. They ruled that the claims of harassment had been "wildly exaggerated by the trial authors and their expert witnesses".[66] Blease and Geragty found "no compelling evidence" the vast majority of ME/CFS patients or their advocacy organizations had adopted "militant political policies or behaviours", and reported ME/CFS activists used public discourse and scientific publications analogous to 1980s "AIDS" activists. They concluded the medical establishment's negative perceptions of persons with ME/CFS, and indifference to patient's opinions conceptualized the ME/CFS community's discontent.

Harms to patients

Harmful treatments

Reports of medical harm to patients resulting from the use of cognitive behavioral therapy (CBT) as a primary treatment and the use of graded exercise therapy (GET) have arisen.[67] [68] A controversial clinical trial of the Lightning Process in children,[69] led to it being specifically forbidden in the NICE guidelines. A number of publications by Esther Crawley promoting GET have been corrected due to inaccurate ethics statements.[70]

Deaths and suicide

Studies show medical neglect, trivialisation, and psychologization have contributed to increased risk of suicide in patients suffering from ME/CFS.[71] [72] In some severe cases, neglect by clinicians has led to complications of the disease which ultimately led to the death of the patient.[73] [74] Some patients with severe and very severe ME/CFS are unable to swallow or properly digest,[75] when this is neglected or misdiagnosed as a psychological condition (such as anorexia nervosa), malnutrition can follow, with a risk of death.[76] Proper care for patients with severe feeding problems stipulates total parenteral nutrition for short term cases and using feeding tubes for long term cases.

A notable case is that of Maeve Boothby O’Neill, a 27-year-old woman who died from very severe ME/CFS in 2021. As her condition gradually worsened, she became too unwell to properly feed and hydrate herself. At first the NHS doctors gave her feeding aids, but insisted upon feeding her much more than her body could handle which exacerbated her condition through post-exertional malaise. The only feasible option left was total parenteral nutrition, but due to the doctor's belief that her condition was largely psychological, they refused this route. A month later, she died of malnutrition.[77] [78] An inquest into Maeve Boothby O’Neill’s death was opened by the Exeter and Devon Coroners, and is currently ongoing. Dr. Anthony Hemsley, the director of the Royal Devon and Exeter NHS Foundation Trust, has testified that the NHS has no policy and no facilities for treating severe (housebound) or very severe (bedbound) patients anywhere in the United Kingdom.[79]

Misdiagnosis, under-diagnosis, and delays in diagnosis

Because of a lack of awareness and education about ME/CFS in the medical community delays in diagnosis and misdiagnosis are common.[80] A large proportion of ME/CFS patients are undiagnosed; its true prevalence is therefore unknown.[81] ME/CFS patients can be misdiagnosed with a wide variety of conditions, common ones include psychosomatic disease, depression, burnout, and neuresthenia. It is common for diagnosis to take over 5 years post disease onset, and visits to a large number of medical professionals.[82] [83]

Involuntary psychiatric hospitalisation

There have been reported cases of forced psychiatric hospitalisation of ME/CFS patients.[84] [85] [86] In these cases clinicians wrongly assumed ME/CFS was of psychological origin, or misdiagnosed a mental illness.

A notable case is that of Sophia Mirza. Mirza was forcibly removed from her home and sectioned for two weeks by her doctors, who had come to believe her condition was psychosomatic, an action which her mother and sister said severely worsened her condition, through post exertional malaise. Her health deteriorated after being released from the psychiatric unit, and two years later she died.[87] An inquest into her death revealed it to be due to "renal failure as a result of chronic fatigue syndrome".[88]

Naming

There has been much historical debate over whether to use the term Myalgic Encephalomyelitis or Chronic Fatigue Syndrome to describe the disease, therefore, the compromise Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is often used.

The term chronic fatigue syndrome is criticised for focusing on a single symptom, while its use has lead many to confuse ME/CFS with general chronic fatigue. The term “fatigue” trivialises the illness and discourages research into potential treatments.[89] According to a survey of medical trainees at a school in the United States, a condition described as "chronic fatigue syndrome" is considered less serious than a condition described as "myalgic encephalopathy".[90] [91]

The term myalgic encephalomyelitis has also been criticised, as the symptom myalgia (muscle pain) is not experienced by everyone with the disease. Additionally, before ME/CFS was considered a biological condition, the name ME was seen as reinforcing the illness as it “legitimised” patient’s symptoms.

In 2015 the National Academy of Medicine recommended changing the name to Systemic Exertion Intolerance Disease (SEID) in their report "Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness"'. However, this new name was not widely adopted.

Disability compensation

Despite being a disabling condition that leaves around 75% of patients unable to work, people with ME/CFS are often dismissed when applying for disability compensation.[92]

UK psychosocial controversy

Despite being classified as a biological illness by national health bodies, the Department for Work and Pensions classifies ME/CFS as a psychosocial illness, which means sufferers are entitled to lower benefits. A 2006 report by the UK Parliamentary Group on Scientific Research into Myalgic Encephalomyelitis stated that: "CFS/ME is defined as a psychosocial illness by the Department for Work and Pensions (DWP) and medical insurance companies. Therefore, claimants are not entitled to the higher level of benefit payments. We recognise that if CFS/ME remains as one illness and/or both remain defined as psychosocial then it would be in the financial interest of both the DWP and the medical insurance companies." The Group called for investigation of what they called, "numerous cases where advisors to the DWP have also had consultancy roles in medical insurance companies. Particularly the Company UNUMProvident. Given the vested interest private medical insurance companies have in ensuring CFS/ME remain classified as a psychosocial illness there is blatant conflict of interest here."

The Secretary of State for Work and Pensions responded that "Entitlement to Disability Living Allowance depends on the effects that severe physical or mental disability has on a person's need for personal care and/or their ability to walk, and not on particular disabilities or diagnoses. The benefit is available to people with myalgic encephalomyelitis (which can have a physical basis or a psychological basis, or can be due to a combination of factors) on exactly the same terms as other severely disabled people, and they can qualify for it provided that they meet the usual entitlement conditions."[93] This runs contrary to current scientific evidence which shows ME/CFS is "unambiguously biological". [94]

Further reading

Notes and References

  1. Thoma M, Froehlich L, Hattesohl DB, Quante S, Jason LA, Scheibenbogen C . Why the Psychosomatic View on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Is Inconsistent with Current Evidence and Harmful to Patients . Medicina . 60 . 1 . 83 . December 2023 . 38256344 . 10819994 . 10.3390/medicina60010083 . free .
  2. Hooge J . Chronic fatigue syndrome: cause, controversy and care . British Journal of Nursing . 1 . 9 . 440–1, 443, 445–6 . 1992 . 1446147 . 10.12968/bjon.1992.1.9.440 .
  3. Jason LA, Richman JA, Friedberg F, Wagner L, Taylor R, Jordan KM . Politics, science, and the emergence of a new disease. The case of chronic fatigue syndrome . The American Psychologist . 52 . 9 . 973–983 . September 1997 . 9301342 . 10.1037/0003-066X.52.9.973 .
  4. Pheby DF, Araja D, Berkis U, Brenna E, Cullinan J, de Korwin JD, Gitto L, Hughes DA, Hunter RM, Trepel D, Wang-Steverding X . A Literature Review of GP Knowledge and Understanding of ME/CFS: A Report from the Socioeconomic Working Group of the European Network on ME/CFS (EUROMENE) . Medicina . 57 . 1 . 7 . December 2020 . 33374291 . 7823627 . 10.3390/medicina57010007 . free .
  5. Muirhead N, Muirhead J, Lavery G, Marsh B . Medical School Education on Myalgic Encephalomyelitis . Medicina . 57 . 6 . 542 . May 2021 . 34071264 . 8230290 . 10.3390/medicina57060542 . free .
  6. Web site: National Institute for Care and Excellence . Myalgic encephalomyelitis (or encephalopathy) / chronic fatigue syndrome: diagnosis and management [B] Information, education and support for health and social care professionals ]. NICE guideline NG206, Evidence reviews underpinning recommendations and research, recommendations in the NICE guideline . October 2021 .
  7. Friedberg F, Sohl SJ, Halperin PJ. 23465440 . Teaching medical students about medically unexplained illnesses: A preliminary study . Med Teach . 30 . 6. 618–21 . May 2008 . 18608944 . 10.1080/01421590801946970 .
  8. Tschopp R, König RS, Rejmer P, Paris DH . Health system support among patients with ME/CFS in Switzerland . Journal of Taibah University Medical Sciences . 18 . 4 . 876–885 . August 2023 . 36852237 . 9957780 . 10.1016/j.jtumed.2022.12.019 . 15 April 2024 . live . https://web.archive.org/web/20240415113153/https://www.sciencedirect.com/science/article/pii/S1658361222002396?via%3Dihub . 15 April 2024 .
  9. Web site: Chowdhury S . 2023-05-23 . Freedom of Information Findings Report . 2024-04-15 . Action for ME . 14 December 2023 . https://web.archive.org/web/20231214030247/https://www.actionforme.org.uk/uploads/images/2023/05/Action_for_M.E._-_FOI_report.pdf . live .
  10. News: Monbiot G . 2024-03-12 . 'You don't want to get better': the outdated treatment of ME/CFS patients is a national scandal . 2024-04-15 . The Guardian . en-GB . 0261-3077 . 4 April 2024 . https://web.archive.org/web/20240404000359/https://www.theguardian.com/commentisfree/2024/mar/12/chronic-fatigue-syndrome-me-treatments-social-services . live .
  11. Mounstephen A, Sharpe M . Chronic fatigue syndrome and occupational health . Occupational Medicine . 47 . 4 . 217–227 . May 1997 . 9231495 . 10.1093/occmed/47.4.217 . free .
  12. Dumit J . Illnesses you have to fight to get: facts as forces in uncertain, emergent illnesses . Social Science & Medicine . 62 . 3 . 577–590 . February 2006 . 16085344 . 10.1016/j.socscimed.2005.06.018 .
  13. Gibson I . A new look at chronic fatigue syndrome/myalgic encephalomyelitis . Journal of Clinical Pathology . 60 . 2 . 120–1 . February 2007 . 16935965 . 1860614 . 10.1136/jcp.2006.042432 .
  14. McEvedy CP, Beard AW . Concept of benign myalgic encephalomyelitis . British Medical Journal . 1 . 5687 . 11–5 . January 1970 . 5411596 . 1700895 . 10.1136/bmj.1.5687.11 .
  15. Scott BD . Epidemic malaise . British Medical Journal . 1 . 5689 . 170 . January 1970 . 5370039 . 1699088 . 10.1136/bmj.1.111.170 .
  16. Compston ND, Dimsdale HE, Ramsay AM, Richardson AT . Epidemic Malaise . British Medical Journal. 1 . 5692 . 362–363 . February 1970 . 1699022. 10.1136/bmj.1.5692.362-a.
  17. Acheson ED. Epidemic Malaise . British Medical Journal. 1 . 5692 . 363–4 . February 1970 . . 1698971. 10.1136/bmj.1.5692.363-b.
  18. Gosling PH . Epidemic malaise . British Medical Journal . 1 . 5694 . 499–500 . February 1970 . 5435167 . 1699452 . 10.1136/bmj.1.5694.499-b .
  19. Purke GJ . Epidemic malaise . British Medical Journal . 1 . 5694 . 500 . February 1970 . 5435168 . 1699458 . 10.1136/bmj.1.5694.500 .
  20. Hopkins EJ . Epidemic malaise . British Medical Journal . 1 . 5694 . 500–1 . February 1970 . 5435169 . 1699426 . 10.1136/bmj.1.5694.500-a .
  21. Galpine JF . Epidemic malaise . British Medical Journal . 1 . 5694 . 501 . February 1970 . 5435170 . 1699416 . 10.1136/bmj.1.5694.501 .
  22. Poskanzer DC . Epidemic malaise . British Medical Journal . 2 . 5706 . 420–1 . May 1970 . 5420612 . 1700311 . 10.1136/bmj.2.5706.420-b .
  23. Parish JG . Epidemic malaise . British Medical Journal . 3 . 5713 . 47–8 . July 1970 . 4316803 . 1700986 . 10.1136/bmj.3.5713.47-c .
  24. Hooper M . Myalgic encephalomyelitis: a review with emphasis on key findings in biomedical research . Journal of Clinical Pathology . 60 . 5 . 466–71 . May 2007 . 16935967 . 1994528 . 10.1136/jcp.2006.042408 .
  25. Evengård B, Schacterle RS, Komaroff AL . Chronic fatigue syndrome: new insights and old ignorance . Journal of Internal Medicine . 246 . 5 . 455–69 . November 1999 . 10583715 . 10.1046/j.1365-2796.1999.00513.x . 34123925 .
  26. David AS, Wessely S, Pelosi AJ . Postviral fatigue syndrome: time for a new approach . British Medical Journal . 296 . 6623 . 696–9 . March 1988 . 3128374 . 2545306 . 10.1136/bmj.296.6623.696 .
  27. Stricklin A, Sewell M, Austad C . Objective measurement of personality variables in epidemic neuromyasthenia patients . South African Medical Journal = Suid-Afrikaanse Tydskrif vir Geneeskunde . 77 . 1 . 31–4 . January 1990 . 2294610 .
  28. No authors listed . Epidemic myalgic encephalomyelitis . British Medical Journal . 1 . 6125 . 1436–7 . June 1978 . 647324 . 1604957 . 10.1136/bmj.1.2791.1436-a .
  29. Book: Showalter E . Hystories: hysterical epidemics and modern media . Columbia University Press . New York . 1997 . 132 . 978-0-231-10459-3 .
  30. Mirin AA, Dimmock ME, Jason LA . Research update: The relation between ME/CFS disease burden and research funding in the USA . Work . 66 . 2 . 277–282 . 2020-07-20 . 32568148 . 10.3233/WOR-203173 . Mooney A .
  31. Mirin AA, Dimmock ME, Jason LA . 2022-04-03 . Updated ME/CFS prevalence estimates reflecting post-COVID increases and associated economic costs and funding implications . Fatigue: Biomedicine, Health & Behavior . en . 10 . 2 . 83–93 . 10.1080/21641846.2022.2062169 . 2164-1846.
  32. Lombardi VC, Ruscetti FW, Das Gupta J, Pfost MA, Hagen KS, Peterson DL, Ruscetti SK, Bagni RK, Petrow-Sadowski C, Gold B, Dean M, Silverman RH, Mikovits JA . Detection of an infectious retrovirus, XMRV, in blood cells of patients with chronic fatigue syndrome . Science . 326 . 5952 . 585–9 . October 2009 . 19815723 . 3073172 . 10.1126/science.1179052 . 2009Sci...326..585L .
  33. Callaway E . March 2011 . Virology: Fighting for a cause . Nature . 471 . 7338 . 282–5 . 2011Natur.471..282C . 10.1038/471282a . 21412308 . 1416235 . free.
  34. News: 7 April 2010 . No blood from chronic fatigue donors: agency . dead . https://web.archive.org/web/20100411035136/http://www.cbc.ca/health/story/2010/04/07/blood-donations-chronic-fatigue-virus.html . 11 April 2010 . 25 June 2010 . CBC.
  35. Web site: 21 April 2010 . Chronic Fatigue Set To Disqualify Blood Donors . live . https://web.archive.org/web/20100424172954/http://www.voxy.co.nz/national/chronic-fatigue-set-disqualify-blood-donors/5/45805 . 24 April 2010 . 25 June 2010 . Voxy.co.nz . Atkinson K.
  36. Web site: Blood Service updates CFS donor policy . dead . https://web.archive.org/web/20131014065501/http://www.donateblood.com.au/media-centre/latest-national-news/blood-service-updates-cfs-donor-policy . 14 October 2013 . 7 July 2013 . Australian Red Cross Blood Service.
  37. Web site: 18 June 2010 . Recommendation on Chronic Fatigue Syndrome and Blood Donation . dead . https://web.archive.org/web/20100625094629/http://www.aabb.org/pressroom/Pages/cfsrecommendation.aspx . 25 June 2010 . 25 June 2010 . American Association of Blood Banks.
  38. Web site: NHS Blood and Transplant . 5 November 2010 . ME/CFS sufferers permanently deferred from giving blood . live . https://web.archive.org/web/20151128165120/http://www.nhsbt.nhs.uk/news-and-media/news-archive/news_2010_10_07.asp . 28 November 2015 . 9 October 2011.
  39. Erlwein O, Kaye S, McClure MO, Weber J, Wills G, Collier D, Wessely S, Cleare A . Failure to detect the novel retrovirus XMRV in chronic fatigue syndrome . PLOS ONE . 5 . 1 . e8519 . January 2010 . 20066031 . 2795199 . 10.1371/journal.pone.0008519 . Nixon DF . 2010PLoSO...5.8519E . free .
  40. Groom HC, Boucherit VC, Makinson K, Randal E, Baptista S, Hagan S, Gow JW, Mattes FM, Breuer J, Kerr JR, Stoye JP, Bishop KN . Absence of xenotropic murine leukaemia virus-related virus in UK patients with chronic fatigue syndrome . Retrovirology . 7 . 1 . 10 . February 2010 . 20156349 . 2839973 . 10.1186/1742-4690-7-10 . free .
  41. van Kuppeveld FJ, de Jong AS, Lanke KH, Verhaegh GW, Melchers WJ, Swanink CM, Bleijenberg G, Netea MG, Galama JM, van der Meer JW . Prevalence of xenotropic murine leukaemia virus-related virus in patients with chronic fatigue syndrome in the Netherlands: retrospective analysis of samples from an established cohort . BMJ . 340 . c1018 . February 2010 . 20185493 . 2829122 . 10.1136/bmj.c1018 .
  42. Alberts B . Retraction . Science . 334 . 6063 . 1636 . December 2011 . 22194552 . 10.1126/science.334.6063.1636-a . 2011Sci...334.1636A . free .
  43. Lo SC, Pripuzova N, Li B, Komaroff AL, Hung GC, Wang R, Alter HJ . Retraction for Lo et al., Detection of MLV-related virus gene sequences in blood of patients with chronic fatigue syndrome and healthy blood donors . Proceedings of the National Academy of Sciences of the United States of America . 109 . 1 . 346 . January 2012 . 22203980 . 3252929 . 10.1073/pnas.1119641109 . 2012PNAS..109..346. . free .
  44. Johnson AD, Cohn CS . Xenotropic Murine Leukemia Virus-Related Virus (XMRV) and the Safety of the Blood Supply . Clinical Microbiology Reviews . 29 . 4 . 749–57 . October 2016 . 27358491 . 10.1128/CMR.00086-15 . 5010753 .
  45. White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J, Angus BJ, Murphy G, Murphy M, O'Dowd H, Wilks D, McCrone P, Chalder T, Sharpe M . Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial . Lancet . 377 . 9768 . 823–36 . March 2011 . 21334061 . 3065633 . 10.1016/S0140-6736(11)60096-2 .
  46. Web site: IACFS/ME Statement on the PACE Trial: The Issue of Illness 'Reversal' . 24 February 2011 . The International Association for Chronic Fatigue Syndrome/ME (IACFS/ME) . 2011-08-03 . dead . https://web.archive.org/web/20110718151623/http://www.iacfsme.org/PACETrial/tabid/450/Default.aspx . 18 July 2011 .
  47. Web site: PACE: 'surprising and disappointing' . 18 February 2011 . Action for ME . 3 August 2011 . 25 February 2011 . https://web.archive.org/web/20110225030859/http://www.afme.org.uk/news.asp?newsid=1047 . live .
  48. Web site: ME Association press statement about the results of the PACE study . Britton T . ME Association . 18 February 2011 . 3 August 2011 . 27 July 2011 . https://web.archive.org/web/20110727195627/http://www.meassociation.org.uk/?p=4607 . live .
  49. Web site: Falling off the PACE. McCleary K . 26 July 2011. The CAA (CFIDS) Association of America. dead . https://web.archive.org/web/20110625051513/http://cfids.org/pdf/lancet-analysis.pdf . 25 June 2011.
  50. [No authors listed] (Editorial) . 32809857 . Patients' power and PACE . Lancet . 377 . 9780 . 1808 . May 2011 . 21592553 . 10.1016/S0140-6736(11)60696-X .
  51. Hawkes N . 27301336 . Dangers of research into chronic fatigue syndrome . BMJ . 342 . d3780 . June 2011 . 21697226 . 10.1136/bmj.d3780 .
  52. Web site: Comparison of treatments for chronic fatigue syndrome - the PACE trial. 2011-04-15. ABC Radio National. en-AU. 2020-05-24. 12 December 2019. https://web.archive.org/web/20191212031323/https://www.abc.net.au/radionational/programs/healthreport/comparison-of-treatments-for-chronic-fatigue/2993296. live.
  53. Web site: Rehmeyer J . The Debate Over Chronic Fatigue Syndrome Is Suddenly Shifting . Slate Magazine . en . 13 November 2015 . 24 May 2020 . 15 August 2019 . https://web.archive.org/web/20190815121158/https://slate.com/technology/2015/11/chronic-fatigue-pace-trial-is-flawed-should-be-reanalyzed.html . live .
  54. Web site: An open letter to Dr. Richard Horton and The Lancet. www.virology.ws. 13 November 2015. 2016-05-02. 20 April 2016. https://web.archive.org/web/20160420063956/http://www.virology.ws/2015/11/13/an-open-letter-to-dr-richard-horton-and-the-lancet/. live.
  55. Web site: Goldin R . PACE: The research that sparked a patient rebellion and challenged medicine . Sense About Statistics . 21 March 2016 . https://web.archive.org/web/20161221180703/http://www.stats.org/pace-research-sparked-patient-rebellion-challenged-medicine/ . 21 December 2016 .
  56. Edwards J . PACE team response shows a disregard for the principles of science . Journal of Health Psychology . 22 . 9 . 1155–1158 . August 2017 . 28805520 . 10.1177/1359105317700886 . free .
  57. Vink M . 206713549 . PACE trial authors continue to ignore their own null effect . Journal of Health Psychology . 22 . 9 . 1134–1140 . August 2017 . 28805519 . 10.1177/1359105317703785 . free .
  58. Vink M, Vink-Niese A . Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review . Health Psychology Open . 5 . 2 . 2055102918805187 . 2018-10-08 . 30305916 . 6176540 . 10.1177/2055102918805187 .
  59. Twisk FN, Maes M . 2009 . A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS . Neuro Endocrinology Letters . 30 . 3 . 284–99 . 19855350.
  60. Wilshire CE, Kindlon T, Courtney R, Matthees A, Tuller D, Geraghty K, Levin B . Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT . BMC Psychology . 6 . 1 . 6 . March 2018 . 29562932 . 5863477 . 10.1186/s40359-018-0218-3 . free .
  61. Vink M, Vink-Niese F . Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies . Diagnostics . 9 . 4 . 124 . September 2019 . 31547009 . 10.3390/diagnostics9040124 . 6963831 . free .
  62. Vink M, Vink-Niese A . The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS . Healthcare . 10 . 5 . 898 . May 2022 . 35628033 . 9141828 . 10.3390/healthcare10050898 . free .
  63. Dove A . August 2000 . GAO reports on CFS funding controversy . Nature Medicine . 6 . 8 . 846 . 10.1038/78579 . 10932206 . 1431198 . free.
  64. News: Mays P . 1999-07-06 . CDC Diverts Chronic Fatigue Funds . 2020-06-25 . AP NEWS . 25 June 2020 . https://web.archive.org/web/20200625213206/https://apnews.com/4e784fbacb42ff5f4901e39169d66fba . live .
  65. News: Fielden . Tom . 'Torrent of abuse' hindering ME research . BBC News . 29 July 2011.
  66. Blease C, Geraghty KJ . 49677273 . Are ME/CFS Patient Organizations "Militant"? : Patient Protest in a Medical Controversy . Journal of Bioethical Inquiry . 15 . 3 . 393–401 . September 2018 . 29971693 . 10.1007/s11673-018-9866-5 .
  67. Kindlon T, Goudsmit EM . Graded exercise for chronic fatigue syndrome: too soon to dismiss reports of adverse reactions . Journal of Rehabilitation Medicine . 42 . 2 . 184; author reply 184–6 . February 2010 . 20140417 . 10.2340/16501977-0493 . 2020-07-17 . free .
  68. Geraghty KJ, Blease C . 31832147 . Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent . Journal of Health Psychology . 23 . 1 . 127–138 . January 2018 . 27634687 . 10.1177/1359105316667798 . 25 August 2021 . 27 August 2021 . https://web.archive.org/web/20210827121750/https://www.research.manchester.ac.uk/portal/en/publications/cognitive-behavioural-therapy-in-the-treatment-of-chronic-fatigue-syndrome-a-narrative-review-on-efficacy-and-informed-consent(987590d0-a62d-473e-8d46-b74b9247e81c).html . live .
  69. Web site: Coyne JC . 2017-09-27. Parents should have been warned about unprofessional providers in Esther Crawley's SMILE trial. 2020-07-18. Coyne of the Realm. en-US. 18 July 2020. https://web.archive.org/web/20200718043520/https://www.coyneoftherealm.com/2017/09/27/parents-should-have-been-warned-about-unprofessional-providers-in-esther-crawleys-smile-trial/. live.
  70. Web site: Tuller D . 2019-12-13 . BMJ should retract flawed paper on chronic fatigue syndrome . live . https://web.archive.org/web/20201028122107/https://www.statnews.com/2019/12/13/bmj-should-retract-flawed-chronic-fatigue-syndrome-research-paper/ . 28 October 2020 . 2020-07-18 . STAT . en-US . Unfortunately for BMJ, in addition to the mess over the Lightning Process study, Crawley was also directed earlier this year to correct the ethics statements in eleven other published papers – five of them in BMJ journals..
  71. König RS, Paris DH, Sollberger M, Tschopp R . Identifying the mental health burden in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients in Switzerland: A pilot study . Heliyon . 10 . 5 . e27031 . March 2024 . 38434357 . 10907781 . 10.1016/j.heliyon.2024.e27031 . free . 2024Heliy..1027031K .
  72. Chu L, Elliott M, Stein E, Jason LA . Identifying and Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome . Healthcare . 9 . 6 . 629 . May 2021 . 34070367 . 8227525 . 10.3390/healthcare9060629 . free .
  73. News: Sandeman G . 2022-09-22 . Chronic fatigue syndrome patient told: 'You're making it up' . . 2024-04-14 . en . 0140-0460 . 9 December 2023 . https://web.archive.org/web/20231209050716/https://www.thetimes.co.uk/article/chronic-fatigue-syndrome-patient-coroner-inquest-5z8vsxbjq . live .
  74. Web site: 2013-06-23 . Emily didn't 'only' have ME . 2024-04-14 . The Telegraph . en . 8 December 2023 . https://web.archive.org/web/20231208171625/https://www.telegraph.co.uk/news/health/10137694/Emily-didnt-only-have-ME.html . live .
  75. Web site: 2021-10-29 . Overview Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management Guidance NICE . 2024-04-14 . www.nice.org.uk . 4 December 2022 . https://web.archive.org/web/20221204125815/https://www.nice.org.uk/guidance/ng206 . live .
  76. Baxter H, Speight N, Weir W . Life-Threatening Malnutrition in Very Severe ME/CFS . Healthcare . 9 . 4 . 459 . April 2021 . 33919671 . 8070213 . 10.3390/healthcare9040459 . free .
  77. Web site: 2023-12-19 . Daughter's death 'could have been avoided' . 2024-04-14 . BBC News . en-GB . 21 March 2024 . https://web.archive.org/web/20240321005037/https://www.bbc.com/news/uk-england-devon-67748453 . live .
  78. Web site: Tuller D . 2023-01-27 . When the doctor doesn't listen . 2024-04-14 . Coda Story . en-US . 28 December 2023 . https://web.archive.org/web/20231228125259/https://www.codastory.com/waronscience/chronic-fatigue-syndrome-long-covid-unexplained-symptoms/ . live .
  79. News: Humphries W . 2024-04-14 . Hospitals have no services for most severe ME cases, coroner told . . 2024-04-14 . en . 0140-0460 . 30 January 2024 . https://web.archive.org/web/20240130091411/https://www.thetimes.co.uk/article/hospitals-have-no-services-for-most-severe-me-cases-coroner-told-j3q7v7k9p . live .
  80. Bateman L, Bested AC, Bonilla HF, Chheda BV, Chu L, Curtin JM, Dempsey TT, Dimmock ME, Dowell TG, Felsenstein D, Kaufman DL, Klimas NG, Komaroff AL, Lapp CW, Levine SM, Montoya JG, Natelson BH, Peterson DL, Podell RN, Rey IR, Ruhoy IS, Vera-Nunez MA, Yellman BP . Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management . Mayo Clinic Proceedings . 96 . 11 . 2861–2878 . November 2021 . 34454716 . 10.1016/j.mayocp.2021.07.004 . free .
  81. Araja D, Berkis U, Lunga A, Murovska M . Shadow Burden of Undiagnosed Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) on Society: Retrospective and Prospective-In Light of COVID-19 . Journal of Clinical Medicine . 10 . 14 . 3017 . July 2021 . 34300183 . 8303374 . 10.3390/jcm10143017 . free .
  82. Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome . Board on the Health of Select Populations . Institute of Medicine. . Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. . Washington (DC) . National Academies Press (US) . February 2015 . 25695122 .
  83. Arild Angelsen and Trude Schei. 2024. EMEA survey of ME/CFS patients in Europe: Same disease, different approaches and experiences.
  84. Web site: 2010-03-08 . Real life: The long goodbye . 2024-04-15 . Irish Independent . en.
  85. Web site: Karina Hansen is Finally Home (sort of...) . 2024-04-15 . Daily Kos . en.
  86. Web site: 2024-04-12 . Family push for daughter's removal from hospital . 2024-04-15 . BBC News . en-GB.
  87. News: I never imagined my sister would die . 2024-04-15 . The Irish Times . en.
  88. Web site: Hooper R . First official UK death from chronic fatigue syndrome . 2024-04-15 . New Scientist . en-US.
  89. News: Chronic Fatigue Syndrome No Longer Seen as 'Yuppie Flu'. Tuller D. 17 July 2007. The New York Times. 15 June 2009. 17 March 2015. https://web.archive.org/web/20150317132227/http://www.nytimes.com/ref/health/healthguide/esn-chronicfatigue-ess.html. live.
  90. Jason LA, Taylor RR, Plioplys S, Stepanek Z, Shlaes J. 27350772 . Evaluating attributions for an illness based upon the name: chronic fatigue syndrome, myalgic encephalopathy and Florence Nightingale disease . Am J Community Psychol . 30 . 1 . 133–48 . 2002 . 11928774 . 10.1023/A:1014328319297.
  91. Web site: Tuller D . 2015-02-10 . Chronic Fatigue Syndrome Gets a New Name . 2024-04-25 . Well . en.
  92. Podell R, Dimmock ME, Comerford BB . Documenting disability in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) . Work . 66 . 2 . 339–352 . 2020-07-20 . 32568153 . 10.3233/WOR-203178 . Mooney A .
  93. Web site: United Kingdom Parliamentary Group on Scientific Research into Myalgic Encephalomyelitis . Inquiry into the status of CFS/ME and research into causes and treatment . 1 November 2006 . 25 June 2010 . 24 June 2010 . https://web.archive.org/web/20100624004640/http://erythos.com/gibsonenquiry/Report.html . live .
  94. Web site: Science Alert . Landmark Study Confirms Chronic Fatigue Syndrome Is 'Unambiguously Biological' . 24 March 2024 . 13 April 2024 . 4 April 2024 . https://web.archive.org/web/20240404013825/https://www.sciencealert.com/landmark-study-confirms-chronic-fatigue-syndrome-is-unambiguously-biological . live .

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Controversies related to ME/CFS".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.