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ME/CFS controversies

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Two contrasting viewpoints among ME/CFS experts have become apparent. In a letter to the Lancet, psychiatrists David and Wessely contested the WHO classification, arguing that CFS was a form of neurasthenia to be classified as a psychiatric condition.[1] Dutch researchers tested a model where behavioral, cognitive, and affective factors played a role in perpetuating fatigue, and concluded that this was the correct model for CFS.[2] This result could, however, not be replicated in a population-based study, where fatigue in psychiatric disorders, but not in CFS, proved to be a match.[3]

In 2001 the WHO's Collaborating Center, King's College, London, published a "Guide to Mental Health in Primary Care", in which both ME and CFS were reclassified as mental illnesses in ICD-10, under the code F48.0. The guide was also on the website of The Collaborating Center; King's College. In response to activist protests to the Collaborating Center and the WHO's Headquarters, the web page was corrected and a correction to the Guide promised. The latter was tardy and when a correction slip was printed around 30,000 copies had already been distributed. On 28th June 2001 Andre L'Hours, Technical Officer at the WHO headquarters in Geneva, confirmed that it was "unacceptable" to classify one disorder in two places in the ICD-10 under the WHO's rubric.

The Countess of Mar brought the matter to the attention of the House of Lords on January 22nd, 2004, citing WHO Headquarters position[4] of how ME and CFS are classified (G93.3), and that WHO intend no changing of this. Subsequently Lord Warner wrote[5]stating The London WHO Collaborating Center had ceded to WHO authority and would ensure future editions of the Guide were corrected. In response to an activist, Professor Anthony Sheehan, Professor of Care Services at the Department on Health, on behalf of Sir Liam Donaldson, then Medical Chief Officer, replied "The WHO; the WHO Collaborating Centre; and the Department of Health have now agreed a position on the classification of CFS/ME. It has been agreed that the second edition of the WHO Guide to Mental Health and neurology in primary care will have only one ICD-10 code for CFS. This is G93.3. [...] I can only say that the Department of Health has no plans to seek a reclassification of CFS within ICD-10."

A common misconception is that ME was initially classified at G93.3 due to political activist pressure; however this is not true. The WHO recognised ME in 1965 at a time it was well established with many supporting papers and inclusion medical textbooks. The WHO classified ME in 1969, some years before the first patient support/activist groups were formed. Again in 1992 the WHO maintained their rubric with no need of patient pressure; the only interference has of late come from psychiatric disgruntlement and the only propaganda a distortion of these facts.

ReferencesEdit

  1. David A, Wessely S (1993). Chronic fatigue, ME, and ICD-10. Lancet 342 (8881): 1247–8.
  2. Vercoulen JHMM, Swanink CMA, Galama JMD, Fennis JFM, Jongen PHJ, Hommes OR, Van der Meer JWM, Bleijenberg G. (1998), "The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model. Journal of Psychosomatic Research", 45, 507 – 517
  3. Song, S, Jason, LA (2005), "A population based study of CFS experienced in differing patient groups. An effort to replicate Vercoulen et al.'s model of CFS", Journal of Mental Health, 14, 3, 277-289
  4. Saraceno B, 16th October 2001 (letter), World Health Organisation[1]
  5. Warner N, 11 february 2004 (letter) Department of Health, Whitehall, London [2]


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