Definition

Exposing the Deception: SEID is not ME!

/ Gabby Klein / 1 Comment

 

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My thanks to advocate Eileen Holderman for her consultation on this blog post

The US government health agencies and some organizations who purport to represent people with ME (pwME) are deceiving this community by purposefully conflating names and criteria for myalgic encephalomyelitis (ME), and the government constructs chronic fatigue syndrome (CFS) and systemic exertion intolerance disease (SEID).  These organizations are complicit with carrying out the government’s nefarious actions in burying a severe neurological disease, ME,  which has killed and rendered hundreds of thousands of Americans severely disabled for many decades.

HHS is Adopting SEID Criteria While Cloaking with ME Name

In defiance of ME stakeholders, the Chronic Fatigue Syndrome Advisory Committee (CFSAC), ME expert doctors and researchers, advocates, and patients, the U.S. Department of Health and Human Services (HHS) has consistently refused to adopt the name myalgic encephalomyelitis with its definition created by ME experts (the latest one being the International Consensus Criteria (ICC)) for the distinct disease. HHS admits that the disease ME, as classified by the World Health Organization (WHO) as a neurological disease since 1969, exists as distinctive and unequal to CFS and SEID, yet they refuse to formally recognize it, adopt its proper name and criteria, fund it and educate about it.

Why would HHS state that ME exists yet deny care for the people suffering from the disease?  There is no question that since the 1980’s there has been an HHS agency-wide effort to cover up facts about ME, including the dozens of outbreaks of ME worldwide. Once they have started on the path of erasing history, HHS cannot politically afford to change course.  Unless exposed publically or challenged legally, HHS will not admit to their malfeasance of attempting to erase a disease and therefore they keep inventing new vague umbrella entities with demeaning names to cover up their wrongful actions.

Organizations Are Adopting SEID Criteria While Cloaking it with ME Name

Some organizations purport to advocate for pwME yet, deceptively, aid the government with the creation, promotion, and dissemination of faulty definitions (SEID being the latest one) and with the conflation and misusing of names. Ironically, they falsely label themselves as ME organizations when in fact they do not advocate for the disease myalgic encephalomyelitis.

These organizations get preferential treatment from the government for their partnership with them.  They get funding for research projects and are rewarded with a seat at the government table.  They are selected to serve on government working groups where they are in place to advise the government on policy decisions. The government also partners with film production companies or organizations to show screenings of their film.

Additionally, HHS arranges private meetings with these organizations where they can meet with high-level government officials.  For example, Dr. Lily Chu, vice president of the IACFSME organization, consulted privately with Donna Pickett of NCHS/CDC (the National Center for Health Statistics – the agency is overseen by the CDC and is in charge of coding) to work on proposals for changes to US ICD coding.

Their consultation led to a presentation of their proposal in a public meeting on September 12, 2018.  This ‘public’ meeting was unannounced to the rest of the “public”.  Therefore, Dr. Chu was able to call in her comments and endorsement of a harmful, unscientific proposal without any challenge from the rest of the community.  Sneaky much?

Classifying SEID as if Equal to ME

According to Donna Pickett of NCHS/CDC and Dr. Chu, all HHS agencies have currently adopted the untested SEID.  At the same time, HHS is using the combination acronym ME/CFS – when in fact SEID is not ME nor is it CFS (this was clarified in the 2015 IOM report)!

The nomenclature deception is purposeful and really serves to confuse and conflate everything into a chaotic mess where names and definitions have lost all meaning.  The government’s hope is that by the wrongful use of the ME/CFS acronym, it will lull pwME into thinking that ME is being included  – when in fact it is the farthest thing from the truth.

Listen to Dr. Lily Chu state in her call-in comment at the September 12, 2018, C & M meeting that all HHS agencies have currently adopted and are using SEID.

The current attempt by  IACFSME/Chu to elevate SEID by classifying it in the US ICD-10-CM under the same heading as ME – as if it is an equal neurological disease – when clearly it is not – is disturbing and dangerous because it will result in the disappearance of ME! (read blog NCHS/CDC Proposal for ICD-10-CM).  Other countries should pay attention because whatever happens in the US usually is followed by other countries.

The organization MEadvocacy who has never wavered from their mission to advocate for the disease ME as defined by ME experts has taken action and submitted comments to object to the NCHS/CDC and IACFSME/Chu proposal.  You can read about their submitted comments here.

Solve ME/CFS Initiative was repeatedly asked by longtime independent ME advocate and past CFSAC voting member, Eileen Holderman, on Twitter what Solve’s response to the dangerous ICD-10-CM proposal was. It was first met with silence, then with a curt reply.  Eventually, Solve sent out this video featuring their CEO, Carol Head.

In this 3 minute video, Carol Head states: “We work with the CDC regarding ICD coding.”  Does SMCI work with CDC behind our backs in secrecy? Did SMCI help write the current proposal for SEID to be classified with ME? We don’t know because there is no transparency in Solve’s actions and they have, to this date, not made an official statement nor revealed if they are submitting comments about NCHS’s proposal for changes to the ICD coding.

*Please note – Finally yesterday Solve ME/CFS Initiative released a policy statement where they openly admit to endorsing the IOM report. The deception and conflation continue and their statement changes nothing written in this blog.

Organizations Hidden Dissemination of SEID

MEAction, Solve ME/CFS Initiative, and Massachusetts ME/CFS & FM Association helped draft a US Senate Resolution for “ME/CFS” featuring the IOM report and its recommendations for the name SEID and the IOM criteria (read the blog Beware of Aiding in the Burial of ME!).  When confronted with this betrayal, MEAction issued a clarification on June 28, 2018, deflecting blame and attributing it to confusing language (as of this date, the same language still stands).

Additionally, MEAction in partnership with #Time for Unrest has created an accredited course for continuing medical education to teach doctors how to diagnose SEID.  Their course, deceptively titled Diagnosis & management of myalgic encephalomyelitis, is actually teaching doctors how to diagnose patients using the actual IOM criteria verbatim.

screencapture-meaction-net-wp-content-upMEAction teaching SEID diagnosis (2)

When ME advocates asked Jen Brea on twitter to explain this disparity, her reply was this:

Brea tweet not advocating SEID

When I further challenged Brea stating that MEAction is currently using IOM/SEID criteria in their educational packets to medical professionals.  This was her reply:

Brea blocked me

So-Called ME Organizations Who Do Not Support ME Experts’ Criteria

I asked MEAction to endorse and promote the #pwME4ICC petition to HHS to recognize and adopt ME as defined by the experts’ criteria – ICC.  They countered that they will share it once on social media but could not sign and endorse it because their organization had not come to a decision yet as to which clinical criteria they chose to endorse.

So, MEAction would not sign nor endorse ME-ICC petition, yet they gladly created a curriculum for an accredited continuing education course for medical professionals using IOM/SEID!   To endorse the experts’ ME-ICC they need to go through a “community consultation” for which the timeline keeps being delayed but, to endorse and disseminate HHS/IOM’s SEID, they don’t need community approval?

I also approached Solve ME/CFS Initiative asking them to sign and share the petition to HHS for recognition of ME as defined by ICC. They promised to look into it. Three months later Solve has still not replied and have not signed or promoted the ME-ICC petition.

Why This is Important

The topic of which definition is being used for clinical and research purposes as well as correct naming is probably the most critical issue for those representing and advocating for pwME. 

The distinct disease myalgic encephalomyelitis as per WHO and experts’ criteria (ICC) is in danger of being totally erased.  If you suffer from ME, you will not get a proper diagnosis.  Doctors in the US will only know how to diagnose SEID and will give you a SEID ICD code – even though SEID is a definition based on fatigue and 5 subjective common symptoms (with no exclusions for psychiatric conditions).

The definition of ME as per ICC is not a fatigue condition; it is rather a neuro-immune disease with most probably an infectious component.  If you are diagnosed with SEID you will not get the proper testing, care, and treatments that would have been geared to a diagnosis of ME.

More disturbingly, IOM/SEID is already being used for research purposes even though the IOM was charged with creating a clinical definition.  Some of the new NIH research consortia are using cohorts provided by Dr. Bateman from her clinical practice which have been diagnosed using the IOM/SEID definition.

How to Fight the Disappearing of ME

PwME need to demand change on a federal level.  They can do this by joining the 5,178 people who have signed the petition so far to HHS for recognition of ME as defined by our experts’ criteria – the International Consensus Criteria (ICC).   They should contact their congressional representatives telling them to press HHS to officially acknowledge their disease ME as defined by ME experts’ criteria – ICC.

PwME should also demand transparency and truthfulness from the organizations that purport to advocate for pwME.  PwME should not be left in the dark about what these organizations are planning and supporting.   If they are supporting SEID, that means that they are not supporting ME and should openly state so!  PwME should demand that any organization that supports SEID should not use the name ME or the conflated name ME/CFS.

#PwME4ICC Are Fighting Back

Hundreds of thousands of Americans suffer from the disabling neuroimmune disease myalgic encephalomyelitis.  They have suffered severely for decades.  Many have died prematurely. They have lost their health, careers, income, healthcare, family relationships, and friends.  On top of that, their own government health agencies refuse to properly and accurately use the experts’ definition and name for their disease. This is malfeasance of the highest order!

Some organizations who should be there for these severely ill patients are the very ones who aid in their betrayal.  These organizations are financially supported by the very ill patients they purport to represent – who are often financially destitute. The organizations should be the ones fighting for these patients for recognition of their disease, myalgic encephalomyelitis as defined by ME experts – yet, shamefully – they are doing the opposite.

Activists and people with ME are fighting back against the deception and silencing tactics by HHS and organizations who are complicit with them.

 

Silence encourages the tormentor, never the tormented. – Elie Wiesel

 

 

 

 

 

Beware of Aiding in the Burial of ME!

/ Gabby Klein / 2 Comments

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Since the Lake Tahoe outbreak of the distinct neuroimmune disease myalgic encephalomyelitis (ME), the US Centers for Disease Control and Prevention (CDC) has extended all their efforts in minimizing, conflating, misbranding, wrongly defining the disease in an attempt to bury the facts and reality of this severely disabling chronic disease affecting an estimated million American men, women and children.  The purpose of their malfeasance is to evade and deflect responsibility for this burdened pandemic.

One of CDC’s methods of cover-up is to refuse to adopt and to diverge from the authentic criteria for ME authored by international ME experts (Ramsay’s, CCC & ICC).  They have managed this by producing and/or acquiring faulty, overly broad criteria that do not describe the actual immunological, neurological and infectious nature of the disease.  Their latest offense is the acquisition of the IOM/SEID criteria. They have used the Institute of Medicine (IOM) (now called National Academy of Medicine) which is perceived to be an independent private organization when in effect most of their work is paid for by HHS – not exactly an unbiased partner. The charge and parameters of the IOM work were set up and controlled by HHS (leaving out many studies into the immunological and infectious nature of the disease) They have done this in an attempt to give their re-branding and redefining effort false legitimacy.  In actuality, this new criteria is yet another vague, ill-defined, fatigue-based definition.

Organizations who claim to represent #pwME like SMCI and MEAction have banded together with the CDC to aid in legitimizing this bad definition which is overly broad and does not define ME.

They have done this by:

  • Sponsoring and arranging a press briefing immediately after the release of the report.
  • Collaborating with CDC with their Technical Development Workgroup (TDW) to aid in embracing and inscribing the faulty definition to the CDC website (list of participants).  MEadvocacy, the patient organization representing #pwME issued a blog explaining why they opted OUT of this workgroup.
  • Collaborating with CDC to work on the new toolkit for healthcare providers and medical continuing education to teach and disseminate the IOM/SEID criteria.

Their latest “service” to the CDC is with their guileful inclusion of the ‘consideration of the recommendation from the IOM relating to ME/CFS’ in their proposed Senate resolution S.Res.508 – dated May 15, 2018,  introduced by Senator Markey and co-sponsored by Senators Collins, King, and Van Hollen to raise awareness about ME/CFS of the following language:

“Resolved, That the Senate

…

(3) encourages—

(A) the National Institutes of Health and other Federal agencies to work with experts, stakeholders, and individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome to—

(i) consider the recommendations of the National Academies of Sciences, Engineering, and Medicine relating to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome;

…”

Remember the National Academies of Sciences was formerly called the “Institute of Medicine”.  So, the Resolution which was drafted by MEAction and SMCI includes a push to implement the IOM recommendations.  Since these organizations were the ones who suggested the draft of the Resolution, they could have added anything, yet they proactively suggested adopting the IOM recommendations. [edited to include exact wording of the specific part of the Resolution and to clarify]

These are the IOM recommendations they are alluding to:

1 – Physicians should diagnose ME/CFS (with IOM criteria), and a new ICD code should be assigned. (please note that  “SEID” or  “ME/CFS” has no US ICD classification or code. The ill-defined conflated term violates ICD rules by combining diagnoses from different ICD sections).

2 – HHS should develop a toolkit for medical practitioners (based on the IOM).

3 – A multidisciplinary group should reexamine the IOM criteria when firm evidence supports modification, or in no more than 5 years.

4 – The committee recommends that this disorder be renamed “systemic exertion intolerance disease” (SEID). SEID should replace ME/CFS for patients who meet the criteria set forth in this report.

The above Senate Resolution is in recognition of May International Awareness month for the disease.  It details some basic stats (some faulty one like women are 4 times more likely to get the disease and neglects to include the cluster outbreaks and blood donation bans due to infectious components and/or etiology as well as state this disease kills patients), the financial burden and the general need for funding, medical care, and education.  Why not just stop it at that? Why did MEAction and SMCI insert the IOM recommendations in this resolution – except for aiding CDC in their burial of the disease, myalgic encephalomyelitis?

Myalgic encephalomyelitis is the distinct severely disabling, multi-system chronic disease that appears in epidemic and a sporadic form.  The symptoms of ME are numerous and include but are not limited to the following: post-exertional collapse, muscle and joint pain, enlarged lymph nodes, chills, low-grade fever, vertigo, extreme fatigue and weakness, cognitive impairment (delayed processing, aphasia, short-term memory loss, etc.), cardiac problems, orthostatic intolerance, sleep dysfunction, headaches, allergies, mold and chemical intolerance, frequent reactivated infections and co-infections.

Myalgic encephalomyelitis is not chronic fatigue syndrome nor is it systemic exertion intolerance disease nor is it chronic fatigue. One cannot claim to represent the entire community when, in effect, not only are they advocating for and promoting recommendations for faulty criteria but, they are aiding in the full burial of the distinct disease ME.

NOTHING ABOUT US WITHOUT US

Organizations and advocates who promote the IOM criteria DO NOT represent #pwME-ICC.  Falsely branding themselves as ME organizations and advocates is deceptive and harmful to this severely ill patient population.  Their attempt to speak for #pwME-ICC when approaching government officials or serving on government or private committees concerning the disease is not authorized by #pwME-ICC.  They are in effect aiding CDC to conflate and confuse while attempting to bury ME-ICC.

The ‘Mah Nishtanah’ of ME

/ Gabby Klein / 14 Comments

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The Jewish Holiday of Passover celebrated this past month, as it is every spring, commemorates the liberation of the Israelites from slavery in Egypt.  Its feature is the Seder when family and friends join together for an elaborate festive meal with specific customs and rituals. For many families, one of the highlights of the Seder night is the Mah Nishtanah, the “four questions” recited by the youngest members of the family.  The questions are about the difference between this night as opposed to all other nights and its purpose is to stimulate interest and thought about the history and traditions involved with Passover.

Isidore Rabi, a winner of a Nobel Prize in physics, was once asked why he became a scientist. He replied, “My mother made me a scientist without even knowing it. Every other child would come home from school and be asked, ‘What did you learn today?’ But my mother used to ask a different question. ‘Izzy,’ she always used to say, ‘did you ask a good question today?’ That made the difference.”

In the tradition of the questions of  ‘mah nishtanah’, I would like to stimulate thought about the history, actions, and state surrounding the acquired neuroimmune disease Myalgic Encephalomyelitis (ME) which manifests itself in epidemic and sporadic form and affects an estimated million American men, women, and children.  There is no FDA approved treatment to date regardless of the fact that it leaves the majority of sufferers disabled from work, housebound or bedbound – some for decades.

From the beginning, when representatives of the CDC were called down to investigate the outbreak at Lake Tahoe in the 1980’s, CDC and other US health agencies have mistreated this disease which has resulted in incalculable harm to the million American men, women and children with ME.  Every item questioned below are actions the government has taken or refused to make based on their attempt to disappear the reality and facts of the real acquired neuroimmune disease ME.

Following the form of ‘mah nishtanah’ questions as in “on all other nights we eat leavened or unleavened bread; tonight we eat only matzah”, here are the questions for ME.

Mah Nishtanah ME Questions

Why is it that:

  • All other complex chronic diseases are named with people’s names, geographical locations or distinctive feature; this complex chronic disease is falsely branded “chronic fatigue syndrome” – after a common symptom of fatigue? (see how diseases are named here)
  • All other complex chronic diseases are defined by non-government medical experts in that specific disease;  this complex chronic disease is repeatedly ill-defined by the government (CDC)? (see Frank Twisk paper here)
  • All other complex chronic diseases are taught in depth in medical and nursing schools; this complex chronic disease is either not taught at all, or mentioned dismissively?
  • All other complex chronic diseases have a medical expertise assigned to them with ample nationwide practitioners caring and treating patients;  this complex chronic disease does not have a distinct medical expertise assigned to it and has very few knowledgeable doctors caring and treating patients?
  • All other complex chronic diseases are placed in a specific NIH Institute who claims responsibility for funding research for it; this complex chronic disease has not been placed in any particular NIH Institute?  (it is currently situated in the Office of Research on Women’s Health which has no specific budget set aside for research)
  • All other complex chronic diseases receive NIH funding commensurate with the disease severity and burden;  this complex chronic disease gets a pitiful fraction of appropriate funding? (see table here)
  • All other complex chronic diseases that render patients unable to of a fair chance to secure Social Security Disability payments; this complex chronic disease has a high rate of denial for SSD, regardless of the severity of symptoms and the disabling nature of them?
  • All other complex chronic diseases that appear in epidemic form are studied for their infectious nature; this complex chronic disease which has appeared in over 50 outbreaks worldwide since the 1930’s (see list here) yet its infectious nature is mostly ignored and covered up by CDC?
  • All other complex chronic diseases have appropriate recommendations for FDA approved treatments; this complex chronic disease has no FDA approved treatments and has recommendations for treatments that are harmful to people with ME (graded exercise therapy [GET] and cognitive behavioral therapy [CBT])? (see a warning about GET from Workwell Foundation here)
  • All other complex chronic diseases that are biological in nature are described, defined and studied as a biomedical disease; this complex chronic disease is falsely labeled, defined and studied as a psychosomatic condition?

Once is happenstance.  Twice is coincidence.  Three times, it’s enemy action.  – Ian Fleming

All these discrepancies and discriminatory actions by HHS are not coincidental.  They all serve the purpose to minimize, marginalize this disease and deflect responsibility from the health agencies whose charge it is to “for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.”

The month of May is awareness month for ME.  It is time to ask the hard questions such as:

  • Why have the government health agencies ignored, neglected and covered up this severely disabling acquired multisystem disease for decades?
  • Why did the government health agencies enable the psych lobby to highjack this disease when they have known for decades that this is a biomedical disease?
  • Why are they so reluctant to properly name and define this disease as recommended by the medical experts and community?
  • How much money has the government withheld with their refusal to properly fund this disease and by their continuous denial of disability coverage?  

This May patients and advocates need to ask deep-seated questions and demand answers. With the insistence and demand that the proper name (myalgic encephalomyelitis) with the appropriate definition (ICC) be used, it will force the government to finally distinguish ME from fatiguing and psychosomatic conditions. It is with this most important distinction that meaningful change will take effect.

CDC’s Staged Call

/ Gabby Klein / 5 Comments

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I wish to thank advocate Eileen Holderman for her consultation with this blog post.

In 2012, The U.S. Centers for Disease Control and Prevention (CDC) instituted the “ME/CFS Stakeholder Engagement and Communication conference calls (SEC)” (previously called PCOCA) series with the stated purpose of sharing information with those interested in ME/CFS as part of their regular outreach and communications efforts. These calls are billed as a form of engagement with the community, but this is just by name – not reality.

CDC’s Phantom Engagement

CDC’s claims of transparency and stated desire to engage with the ME/CFS community is debunked by their consistent underhanded actions.  Their “engagement” call is, in fact, an hour-long one-sided communication.  CDC placed all callers – a group of very sick disabled people – in a silent mode for the hour-long call. CDC falsely alleged they can’t take live calls when many large government events take live questions all the time.

CDC’s 60-minute call devoted 50 minutes to their invited speakers – leaving only a couple of minutes in the end to cover the many crucial questions sent in by ME patients and advocates.  CDC kept us in the dark as to whose questions they selected – never giving us the actual names.

CDC refuses to make the recordings available on their website, even though they tell us that they are being recorded.  CDC is very well aware that this is a community of people who are severely sick and it is too taxing for them to listen in at the appointed time and for a full hour-long call.

Conclusions about CDC’s lack of engagement and consideration of people with ME:

  • CDC stages the call so that they are in complete control of the narrative
  • CDC manipulates the timing of the call as to leave minimal time for public questions
  • CDC refuses to take live calls because they are apprehensive of challenging questions
  • CDC is more concerned about the perception of engagement than an actual one
  • CDC is not worried about federal rules that call for accommodations for the disabled
  • CDC does not want a record of the meeting because they want to avoid activists’ criticism

 

November 2, 2017, CDC Call

The latest  CDC call took place on November 2, 2017.  The topic was:“Take Home Messages from the 2015 Institute of Medicine Report on ME/CFS” with Drs. Lucinda Bateman, Ellen Clayton, and Peter Rowe.  All three speakers served on the IOM panel to create new government-sponsored criteria and a new name – systemic exertion intolerance disease (SEID).

Background of the HHS/IOM Implementation and Stakeholders’ Protests

October 2012

In October 2012, the Chronic Fatigue Syndrome Advisory Committee (CFSAC) sent the following recommendation to Dr. Sebelius, the Secretary of The US Department of Health and Human Services (HHS):  “CFSAC recommends that you will promptly convene (by 12/31/12 or as soon as possible thereafter) at least one stakeholders’ (Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS)experts, patients, advocates) workshop  in consultation with CFSAC members to reach a consensus for a case definition useful for research, diagnosis and treatment of ME/CFS beginning with the 2003 Canadian Consensus  Definition for discussion purposes.”

HHS highjacked and distorted CFSAC’s recommendation, turning their backs on their own advisory committee of experts.  In Septemeber 2013, HHS secretly contracted, sponsored and charged the Institute of Medicine (IOM) to create yet again, another government-controlled clinical definition and a new name for the disease.  Myalgic Encephalomyelitis (ME) stakeholders were outraged at HHS’ deception and exploitation.  Fifty International ME researchers and clinicians wrote an open letter to Secretary Sebelius urging her to stop the IOM contract and to adopt the 2003 Canadian Consensus Criteria (CCC) for clinical and research purposes.  Sixty six ME advocates worldwide signed a letter in support of the Experts’ Letter.   ME patients sent letters to their congressional representatives with the same message – stop the IOM, adopt the CCC.

But, HHS continued to disregard the voice of the international ME community and ignored the continued protests taking place such as a new letter dated December 2013 signed by 197 professionals and advocates with detailed objections to the IOM process.  Advocates also continued their protests in the form of public testimonies at the IOM January 13, 2014, open meeting (see article here).

In February 2015, the IOM panel published their report including new clinical criteria and a new name – systemic exertion intolerance disease (SEID). The new criteria have been heavily criticized by CFSAC, experts, advocates, and patients for:

  • no list of exclusions
  • no objective tests and measures
  • not including exhaustion of the central nervous system after minor physical activity
  • omitting core symptoms such as pain and immune dysfunction
  • the core symptom of cognitive dysfunction is only listed as an option.
  • signs of the infectious nature of the disease such as flu-like symptoms, sore throat, swollen lymph nodes and headaches are absent
  • no autonomic and neuroendocrine symptoms
  • no specificity toward different stages and levels of the disease

In the preface to the ICC, its authors state: “There is a poignant need to untangle the web of confusion caused by mixing diverse and often overly inclusive patient populations in one heterogeneous, multi-rubric pot called ‘chronic fatigue syndrome’. We believe this is the foremost cause of diluted and inconsistent research findings, which hinders progress, fosters skepticism, and wastes limited research monies.”

The new IOM clinical criteria are just another in the string of CDC vague, overly inclusive criteria which have and will continue to confuse and hinder progress in the science and understanding of ME.   In Dr. Leonard Jason’s estimation, the IOM criteria are even broader than the previous CDC criteria – the Fukuda definition.

Alarmingly, the new clinical criteria are now being recommended and used for research.  Dr. Bateman, who served on the IOM panel to create the new vague clinical criteria, has stated she will be using the IOM definition in her studies at the new  NIH ME/CFS Collaborative Research Centers – disregarding the false promise that it will only be used for diagnostic purposes – never for research!

Pushing and Defending the IOM Criteria

Dr. Lee, the previous DFO of CFSAC,  stated at one of their meetings – ‘it is not the job of the government to create definitions for diseases, it has to come from the community of experts.’  Yet, since the 1980’s the CDC has perpetually ignored the name and criteria authored by experts and has produced one faulty definition after another (Holmes, Fukuda, Fukuda, and IOM).

ME experts have developed and have successfully been using the CCC and the International Consensus Criteria (ICC) for years in clinical practice and for research.  It is the government who has repeatedly refused to do so – opting instead to use their own faulty CDC definitions.

CDC refuses to adopt the ME experts’ definitions citing that it is too hard for clinicians to understand. Ironically, Dr. Bateman defended the weaker IOM definition with its 280-page report! She advised clinicians to look at selected chapters of the report to find what should have been part of the core symptoms of the disease.  In reality, reinforcing the fact that the new criteria are inadequate and impractical.

CDC’s patient engagement call was an epic fail.  It was a long infomercial for the faulty CDC/IOM criteria. It was a farce as far as engagement is concerned – there was none!  They refrained from making accommodations to a community of disabled and cognitively challenged people. They falsely claimed they could not take live questions.  They spent a few minutes, in the end, answering four questions for which the origin is unknown.

CDC did not answer these questions – among many others:

Question for Dr. Bateman – from Gabby Klein

You were an author of the 2011 International Consensus Criteria (ICC) which recommended removing CFS from ME.  The ICC states the following: “Not only is it common sense to extricate ME patients from the assortment of conditions assembled under the CFS umbrella, it is compliant with the WHO classification rule that a disease cannot be classified under more than one rubric”.

You were an author of the IOM criteria as well which stated regarding coding: “A new code should be assigned to this disorder in the International Classification of Diseases, Tenth Revision (ICD-10), that is not linked to “chronic fatigue” or “neurasthenia.”

Since the IOM report did not ask to replace the WHO classification of ME, do you, therefore, agree that the IOM criteria do not define the disease Myalgic Encephalomyelitis (ME)?

Question for Dr. Bateman – from Colleen Steckel

The IOM panel was charged by its sponsor, HHS, to ”recommend clinical diagnostic criteria that would address the needs of healthcare providers, patients, and their caregivers.”  In addition, in an interview with Phoenix Rising regarding the IOM criteria, Dr. Bateman stated: “SEID criteria are intended for current use, for doctors to do better at making the diagnosis in a clinical setting. There was no discussion of anything but using them for this purpose.”

Yet, NIH is currently recommending the use of the IOM criteria for their new ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) competitive consortium grants.  Can you explain why new clinical criteria will now be used for research?

The expert criteria ICC would ensure the disease myalgic encephalomyelitis would be the focus of any studies.

Question for Dr. Unger – from Colleen Steckel

Are there any plans to address the concerns raised by MEadvocacy.org in their recent blog labeled “CDC’s Website Revision is No Reason for Celebration”?

Patients continue to be told by doctors that this is just a fatigue illness and refuse to look into immunological, cardiology, and neurological issues.  Patients continue to fend for themselves with little care from mainstream doctors. This continues to lead to despair and suicide within the community.  The CDC needs to do much more in order to change this reality.

Questions to Dr. Unger – from Eileen Holderman

What are the official case definitions for ME that CDC endorses for research and clinical?

As former CFSAC member and Chair of Subcommittee for CDC Website Review, when will CDC take down Toolkit and Resource Guide from the CDC website Stacks? 

Questions from Guido Den Broeder

(1) Will you please once more distinguish between ME and CFS, as you did before?

Myalgic encephalomyelitis (at G93.3 in the ICD-10) is a specific post-viral brain disorder. Much is known about its causes, diagnostics, and treatment.

Chronic Fatigue Syndrome (R53.82 in the ICD-10-CM) is a term for unexplained fatigue and malaise. It is not a disease. In clinical practice, patients with a variety of diseases start out with a diagnosis of CFS, even though this is not a clinical diagnosis.

(2) What are you going to do to prevent ME?

Will Coxsackie B be added to polio vaccinations?

Are you going to follow mononucleosis patients and test their immune system for post-mono abnormalities?

(3) What are you going to do to reduce the clinical use of the CFS label?

Will you increase awareness among physicians of diseases such as ME, EDS, Lyme, Hashimoto, etc.?

Are you going to promote the clinical use of the SEID label as defined by the IOM?

These are only some of the many questions from patients and advocates that CDC has not answered!

 

 

 

Beware of Articles About ME That Conceal Support for GET/CBT

/ Gabby Klein / 2 Comments

Truth lies

Please note – the name chronic fatigue syndrome (CFS) is used on this blog only because that was the name used in the article it refers to.  I and other ME advocates promote the use of the proper name myalgic encephalomyelitis (ME) for this complex neuro immune disease.

I have seen articles and blogs widely shared and recommended by patient advocates and organizations which appear on the surface to be factual and affirmative yet, on close inspection contain misinformation about myalgic encephalomyelitis (ME) and even include recommendations for harmful treatments such as graded exercise therapy (GET) and cognitive behavioral therapy (CBT).

One such example is the September 2017 article in PTinMotion – “The Real Story About Chronic Fatigue Syndrome” by Eric Ries.  Ries tells the story of Nicole Rabanal, a ‘chronic fatigue syndrome’ (CFS) patient, who is also a physical therapist (pt).  Rabanal was a previous skeptic of CFS which she believed to be a catch all term used when medical practitioners did not know what is wrong with a patient. But, when she, herself, became sick in 2014 – suddenly feeling like she was “hit by a truck” and eventually receiving an official diagnosis of CFS – she becomes a believer and understands that this is a real organic disease.

Rabanal, having worked as a physical therapist for 25 years uses her pt skills to treat herself and then other CFS patients as well.  She demonstrates the importance of listening and understanding the signs of when one is pushing beyond their limit and recommends appropriate exercise and stretching routines to avoid harmful effects.

Rabanal explains that due to her disease she can only work two hours at a time with modifications,  “I sit a lot, and lean or move to help manage my orthostatic intolerance—which does not allow me to stand still, unsupported, for more than 5 minutes.”  These physical adaptations and pacing is a lesson for every patient dealing with this disease because overdoing it has damaging, at times permanent, consequences.

But, Rabanal continues with damaging advice to other physical therapists. Her message about recognizing and assigning patients a CFS label using a simple list of symptoms taken from the IOM criteria has dire consequences.  She doesn’t recommend that PTs send patients who they suspect of suffering from the disease to a specialist for a full work-up with tests to exclude possible differential diagnoses, to enable a proper diagnosis.

This has been one of the many reasons why so many in the ME community are opposed to the use of the IOM diagnostic criteria.  HHS charged an IOM panel to create yet another government sponsored definition of the disease with a simple checklist of a few symptoms and no exclusions. This will cause a major overdiagnosis and will further murky the waters of what this disease truly is.  That is why ME advocates and ME organizations prefer and recommend the International Consensus Criteria (ICC) which were created by ME experts for diagnostic and research purposes.

The piece continues its decline when the author contacts other PTs and quotes their views about CFS and how PT’s should treat them.  Although the report warns of PACE’s pitfalls recommending GET and cognitive behavior therapy (CBT), it goes on to recommend both of these (first in hidden than in overt forms).

  • .. “the last piece is to get patients into longer-duration activities by way of gradually building on anaerobic training—while recognizing that the prognosis for full functional recovery is very guarded and limited.”
  •  “When an individual gets that super-malaise from exertion, that can foster kinesiophobia, or fear of movement,” .. “If you can empower the patient to find movements that don’t trigger that, while correlating to patient-identified problems and impairments that you’ve noted, your therapeutic alliance with that patient improves, along with the prognosis“.

The article goes on to portray CFS patients as ‘depressed’ and ’emotionally charged’ (these are common code words used by psych lobby in an attempt to highjack organic disease)

  •  “Ninety percent of our patients with chronic fatigue syndrome start crying during this process (the interview), simply because we’re spending time with them, taking them seriously, and demonstrating that we care about them as human beings.“
  • “You almost need to be part psychologist, to ensure that they get the most out of their treatment sessions.”
  • “While her husband and kids were eating dinner, she was crying in bed by herself,”

The resource section at the bottom of the article reveals serious and damaging lies about the disease, including strong endorsements for harmful treatments that may cause permanent damage as well as death to ME patients!

Physical Therapist’s Guide to Chronic Fatigue Syndrome – This guide promotes exercise for CFS patients.  There are no proper scientific studies proving that exercise is beneficial to ME patients.  Moreover, science, as well as patient testimonies, have shown exercise to be harmful to patients suffering from ME

Mayo Clinic – on CFS – This site is full of outdated information and still features the faulty CDC Fukuda Criteria.  For treatments, they recommend antidepressants, GET and CBT!

“Exercise As Treatment for Patients with Chronic Fatigue Syndrome”

This is a Cochrane review with the following author’s conclusion:
“Patients with CFS may generally benefit and feel less fatigued following exercise therapy, and no evidence suggests that exercise therapy may worsen outcomes. A positive effect with respect to sleep, physical function and self-perceived general health has been observed, but no conclusions for the outcomes of pain, quality of life, anxiety, depression, drop-out rate and health service resources were possible. The effectiveness of exercise therapy seems greater than that of pacing but similar to that of CBT. Randomised trials with low risk of bias are needed to investigate the type, duration and intensity of the most beneficial exercise intervention.”

There are so many articles, blogs, and papers which spread inaccuracies and misconceptions of the disease.  They have caused great harm to ME patients and have given fodder to those who want to spread the lies that this is an imaginary syndrome trumped up by emotionally charged women.  As advocates, we need to weed out those that will perpetuate this harm and only promote those that are factual.