Published responses to the PULSE Bass article (10.12.08 ) and Pulse response item (18.10.08 ):
http://www.pulsetoday.co.uk/story.asp?sectioncode=18&storycode=4121412&c=1
Tom Kindlon – Dublin | 15 Dec 08
Readers of this article may be interested to know about a recent meta-analysis of the efficacy of CBT for CFS[1]. The studies involved a total of 1371 patients.
This involved calculating the size of an effect measure, the Cohen’s d value.
They calculated d using the following method: “Separate mean effect sizes were calculated for each category of outcome variable (e.g., fatigue self- rating) and for each type of outcome variable (mental, physical, and mixed mental and physical). Studies generally included multiple outcome measures. For all analyses except those that compared different categories or types of outcome variables, we used the mean effect size of all the relevant outcome variables of the study.”
d was calculated to be 0.48.
For anyone unfamiliar with Cohen’s d values, they are not bounded by 1; also, the higher the score, the bigger the “effect size” i.e. the more “effective” a treatment was found to be. Cohen’s d values are considered to be a small effect size at 0.2, a moderate effect size at 0.5, and a large effect size at 0.8[2].
[1] Malouff JM, et al., Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: A meta-analysis. Clinical Psychology Review (2007), doi:10.1016/j.cpr.2007.10.004
[2] Cohen J: Statistical power analysis for the behavioural sciences. Edited by: 2. New Jersey: Lawrence Erlbaum; 1988.
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http://www.pulsetoday.co.uk/story.asp?storycode=4121546
Chronic fatigue syndrome and somatoform disorders, contrary views
18 Dec 08
Dr Christopher Bass’s recent article on somatoform disorders, and in
particular his inclusion of chronic fatigue syndrome and fibromyalgia within
this grouping, has provoked a strong response from sufferers of the
condition
There is a highly vocal ME/CFS lobby which strongly opposes the
categorisation of the condition as a psychiatric/mental disorder, arguing
strongly that it is primarily caused by physical components…
Read full commentary here
Responses
Misdiagnosis wears a new name, a diagnosis of imagined illness in the patient saves the doctor’s day! Unfortunately iatrogenic harm will be on the increase if doctors are diverted from properly investigating patients because of the increase in reporting of so-called somatoform disorders by psychiatrists with unsubstantiated ‘illness beliefs’ about serious medical conditions.
Chronic fatigue syndrome is one of two things: the renaming of multi-systemic disease Myalgic Encephalomyelitis, a serious infectious disease of the CNS classified by the WHO as a neurological disease since 1969; or as a result of the unfortunate renaming and loose criteria a mixed group of undiagnosed patients who do need proper investigation of the underlying cause of their illness. There are guidelines for diagnosing and treating ME/CFS including diagnostic tests for neurological, immune, cardiac abnormalities and viral etiology if doctors care to look for them, there are over 4,000 published studies of the serious abnormalities found in this disease, autopsies proving that there is inflammation of the brain and spinal cord and historical records of outbreaks dating back to the 1930s, and other serious diseases including cancer have been uncovered in patients who were dismissed under the unfortunate CFS label. The proposed ‘psychological’ causes for CFS as outlined in this article have been disproven and the sensitivity to drugs is a sign of the disease, the body’s loss of homeostasis and ability to detoxify properly.
Fibromyalgia is a similar disease recognised by the WHO which often overlaps with other diseases that don’t have a single biomarker like M.E. or Lupus, and recent research suggests that it is a disease of the CNS with evidence of viral etiology. Bass is simply wrong in stating that Fibromyalgia has been renamed as “chronic widespread pain”, that was a rather simplistic view of this disease before much was known about it.
The promotion of these unproven beliefs has no place in medical and scientific discourse, they cause untold harm to patients and loss of respect for the medical profession. Misdiagnosis is a much more serious concern and the medical profession is losing credibility as the everyday stories of misdiagnosis become widespread in the general population.
John Anderson
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Dr Bass is sadly misled in believing that patients with Chronic Fatigue Syndrome (now officially named CFS/ME, Chronic Fatigue Syndrome/Myalgic Encephalomyelitis) are ‘reasonably comfortable’ with the use of the term ‘functional’ or indeed ‘somatoform’ to describe their illness. The reality is quite the opposite. He chooses to ignore the thousands of papers evidencing biological abnormalities (rendering questionable the use of the term ‘medically unexplained’ with reference to this condition) as well as the pressing need for appropriate testing and further biomedical research into ME/CFS.
This is the most disturbingly misleading article refering to CFS that I have read for some considerable time. GPs following Dr Bass’s guidance would be doing both themselves and their patients with CFS/ME a gross disservice.
Jacqui Footman
Information and Publicity Officer, South Molton ME Support Group
www.mecfssupportdevon.org.uk
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It might be useful to attend a few biomedical research conferences about CFS. They are full of objective science and demonstrate that ME/cfs has been shown to be linked to enteroviruses in many cases.
Also, it is a fact that due to lack of investigation, there is a large number of patients who have been misdiagnosed with CFS/ME. They have been found to have: celiac disease, MS, hypothyroidism, IBS, Lupus, cancer and many other extremely physical illnessess.
Johnathan Kerr has identified seven genomic subtypes of CFS/ME.
Remember that in the history of medicine, the following conditions were perceived as psychiatric: epilepsy, brain tumours, parkinson’s disease, colitis, M.S.
Things may be medically unexplained at the moment, but that doesn’t mean that they will remain so.
Jill cooper
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[Ed: Ms Footman has posted the following to the comments section for this item and also written to the Editor.]
This discussion has been introduced with language that suggests Dr Bass is correct in categorising CFS/ME as a psychiatric disorder, when this is not the case. The Pulse Team say that it seeks the views primarily of GPs and other health professionals. I don’t know whether Lord Darzi will be reading this blog in order to comment, but I will quote his comments from Hansard.
“Lord Darzi of Denham: My Lords, the Government have made it clear that they consider that CFS/ME should be classified as a neurological condition. It is for professional bodies to look at the evidence base and I will encourage the Royal College of General Practitioners to look at the WHO classification, which, as I said earlier, is that it is a neurological rather than a mental condition.”
Source: http://www.publications.parliament.uk/pa/ld200708/ldhansrd/text/80602-0001.htm#0806024000007 2nd June 2008
It was subsequently reported, in July 2008 that the Royal College of GPs had amended its erroneous classification of CFS/ME within mental health in its postgraduate training curriculum. ( http://www.meassociation.org.uk/content/view/605/ )
I trust the current (2008) views of Lord Darzi and the RCGP although communicated here by a mere complementary health professional and voluntary officer of an ME patient support group will be adequate to meet the requirements of pulsetoday. I imagine your GP readers would appreciate the most up-to-date information. As I said in my earlier comment, they will be doing not only their patients but also themselves a disservice if they follow Dr Bass’s guidance, by worsening relationships in an already difficult situation. I might add that a member of our group recently made a formal complaint about psychologically-biased treatment of CFS/ME. The complaint was fully upheld at a Local Resolution Meeting involving ICAS.
Jacqui Footman
Information and Publicity Officer, South Molton ME Support Group
www.mecfssupportdevon.org.uk
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