MEA response to Dr Mark Porter, Evening Standard


22 November 2007


RE: WORRY OVER ME CARE IGNORES REAL ADVANCE (Dr Mark Porter’s Medical Notes: 20 November)

Dr Mark Porter has missed the point about why ME (myalgic encephalopathy/encephalomyelitis) charities are opposing the NICE (National Institute for Health and Clinical Excellence) guideline.

Of course, we welcome the conclusion from NICE that ME is a serious and disabling illness – as this is consistent with the World Health Organisation classification of it being a neurological disorder.

And nobody would dispute the fact that psychological treatments such as cognitive behaviour therapy (CBT) can sometimes help people cope with the emotional distress that may accompany any serious physical illness, including ME.

But in the case of ME, NICE are recommending that CBT, or graded exercise treatment, should be the only forms of specific treatment for everyone in the mild to moderate category – even though patient evidence submitted to the Chief Medical Officer’s report found that these expensive courses of treatments are often ineffective (67% in the case of CBT) and may even be harmful (50% in the case of graded exercise).

If everyone with cancer was being offered CBT as the only basic treatment option available they would be horrified. Exactly the same logic applies to people with ME.

Incidentally, the British Psychological Society, who represent psychologists using CBT, have also criticised the inflexibility of the NICE guideline.

Dr Charles Shepherd
Honorary Medical Adviser, ME Association

4 Top Angel
Buckingham MK18 1TH

MEA website:



Dr Mark Porter’s Medical Notes

I have been surprised by the response to new guidance from the
National Institute for Clinical Excellence (NICE) on how best to
manage chronic fatigue syndrome/ME. I thought patient groups would
have welcomes official confirmation that this is a real, and often
very serious condition, and that most cases can be helped through a
combination of interventions which includes psychotherapy (cognitive
behaviour therapy).

Not so. The inclusion of CBT has upset some campaigners who are
concerned that it will reinforce the misconceptions that CFS/ME is
principally a psychological problem.

It is not “all the mind” but like any long term illness CFS/ME can
have major psychological repercussions. How would your state of mind
be if you had been literally housebound for months?

There is no clear barrier between psychological and physical
illness, it is a continuum that we can ignore at our peril.

Psychotherapy, such as CBT has been used to help people with a range
of primarily physical problems, including intractable pain, MS and
cancer, and while no panacea, it does seem to help a significant
minority with CFS/ME. As such it’s inclusion in the NICE guidance
should be welcomed.