Journal of IiMER Summary of developments following CMO’s report of 2002 The ME community were by and large delighted at the contents of this Chief Medical Officer’s Report in 2002, with its strong implicit acceptance of ME/CFS as a primarily organic/biological illness. The members of the psychiatric viewpoint were sufficiently disheartened by this to refuse to sign up to the report’s conclusions. In 2004 the RCPCH (Royal College of Paediatrics and Child Health) published paediatric guidelines which were very much in line with the CMO’s report. In 2007 NICE guidelines came out, and for all the criticism of these guidelines, regarding their overemphasis of suggested merits of CBT and GET, these also cemented the concept of ME/CFS as an organic illness and made it “official”. What went wrong post 2002? First and foremost, there was an abdication on the part of adult medicine of responsibility for this condition. This must have been partly due to the tendency to specialisation on the part of even DGH physicians. No specialty would accept responsibility. In particular, the neurologists were very reluctant to be involved despite the WHO’s having designated ME as a neurological disease. The main problem was that there was no “ology” for ME, neither was one created. This failure on the part of general medicine had a knock on effect on general practice. GP’s sensed the reluctance of physicians to accept referrals, thus making ME less of an official disease and more of a “controversial” condition. These factors mitigated against the positive recommendations of the above three reports/guidelines. www.investinme.org Secondly, and as a result of this abdication by adult medicine, when specialist ME centres were set up very few medical specialists came forward, and the only people eager to step into the vacuum were the psychiatrists. (Two exceptions to this rule were in Newcastle and Epsom and St Helier, where immunologists took the lead). There has been widespread patient dissatisfaction with most of these centres. Firstly, the patients seldom saw an actual doctor to at least receive an official medical diagnosis. Secondly, the only support on offer consisted of different forms of CBT and GET which patients found either ineffective or harmful depending on the variety of therapy offered. The very existence of these specialist centres, of course, removed the obligation of DGH physicians and paediatricians to actually see, diagnose, help and support ME patients. Thirdly and most importantly, the psychiatric lobby made a concerted counterattack to recover their lost ground. This was all the more effective for being indirect. Their strategy consisted of the following 1) Ensuring that they were well positioned to influence medical education, both undergraduate and postgraduate. Again, they were filling a vacuum left by organic medicine. The two major medical textbooks (The Oxford textbook of Medicine and Kumar and Clark) have chapters on ME/CFS written by psychiatrists and buried in the section on “Functional illness” or “Medically unexplained symptoms”) Of course, the term “ME” is gradually airbrushed out of the narrative and does not occur in the indexes. Likewise, the major paediatric text Forfar and Arneil had a section on CFS placed in the section Page 40 of 82
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