Journal of IiME Volume 2 Issue 2 www.investinme.org R Reeaassoonnss wwhhyy MMEE DDooeess NNoott BBeelloonngg ttoo tthhee MMUUSS CCaatteeggoorryy (continued) http://www.pophealthmetrics.com/content/5/ 1/5 Kathrine Erdman (2008) has published an article in which she explains the biomedical abnormalities that differentiate ME/CFS from depression: http://jaapa.com/issues/j20080301/pdfs/cfs0308 .pdf Harvard-professor Anthony Komaroff has listed up to 10 central findings of biomedical abnormalities in ME/CFS: http://www.cfids.org/cfidslink/2007/062004.pdf Klimas and Koneru (2007) have written an overview of last year’s advances in research. It provides a quick and easy introduction to different areas which document physiological disorders in ME and is highly recommended. ME is not unexplained, it has proven genetic factors, increased inflammation and many immunological changes. There are numerous findings, and one can no longer pretend that the biomedical research does not exist or look away from the biomedical factors in the illness presentation. Lorusso and colleagues (2008) come now up with an article which focuses on the immunological aspects in ME/CFS. They bring forward a high level of cytokines which can explain symptoms such as fatigue and flu like feeling and which can influence NK cell activity. The authors’ hypothesis is that immunological factors form the basis for ME/CFS. Who is best placed at giving the diagnosis? Medicine is based a lot on clinical experience, such has it always been, but with so few patients per general practitioner, it will not be easy to build up enough experience. Based on feedback from patients the Association feels that at present general practitioners do not treat this group of patients in a good enough way (there are exceptions). If the diagnosis is given by a general practitioner, special training is necessary. At present with a demand for a specialist evaluation in NAV (Norwegian Labour and Welfare Organisation) regulations, extensive differential diagnosis and a lot of Invest in ME (Charity Nr. 1114035) clinical experience, the Association can support a trial period of allowing general practitioners to diagnose because there is such a long waiting list for a specialist evaluation. The Association is worried that too many will be diagnosed because general practitioners lack adequate competence (see Dr Spickett’s statements below). It is also pointed out in NAV’s circular that ”The diagnosis of the condition is difficult and labour intensive, and ruling out normal tiredness and other illnesses can be difficult. It is therefore important to perform a thorough medical examination, especially to find out possible other illnesses that can be cured.” http://rundskriv.nav.no/rtv/lpext.dll/rundskriv/r 12/r12-01/r12-p1206?f=templates&fn=documentframe.htm&2.0 Infectious disease specialist Dr Gavin Spickett (2008), specialist in immunology and lead clinician at the Royal Victoria Infirmary, Newcastle upon Tyne, stated at a ME/CFS conference in Cambridge (UK) 6. May 2008 that even though there were strict criteria for referrals to the CFS clinics, there were many who after further investigations turned out to have another diagnosis. ME is a very serious and rare condition. Because the condition is found only in 1-2 per 1000 people, a general practitioner might not have more than 1-2 people with this illness in their practice. Dr Spickett’s presentation dealt with experiences with the so called CFS centres in Great Britain. His focus was on the key role of a medical examination of patients with suspected ME/CFS. When patients were referred to the centre, they underwent a thorough clinical evaluation to rule out other diagnoses that could explain the fatigue and to make sure that patients eventually could get correct treatment if there were other diagnoses. An overview of their work showed that experienced ME/CFS clinicians find other diagnoses among a large proportion of (continued on page 73) Page 72/74
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