The illness I have is known by many names: Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), Low Natural Killer Cell Disease and Post Viral Fatigue Syndrome (PVFS) to name but a few. In the UK, the terms ME and CFS are widely considered synonymous while in the United States the term ME is rarely used at all.
It is often said that a rose by any other name would smell as sweet, so when I first heard of a campaign to abolish the term CFS I assumed this was simply dislike of the word ‘fatigue’ which is by no means the predominant symptom of ME. Although I disliked the name CFS as much as anyone I couldn’t help but wonder if it really mattered; surely my symptoms would remain the same regardless what name they were given. The more I learn about the issue however, the more convinced I become that names really are important.
In 1969, Myalgic Encephalomyelitis was formally recognised by the World Health Organisation (WHO) as a neurological disease. The diagnostic criteria required certain neurological features and specifically excluded psychiatric explanations for a patients symptoms. At the time, research carried out by prominent physicians in the field was highly regarded.
In 1970, McEvedy and Beard published articles in the British Medical Journal dismissing outbreaks of ME as mass hysteria due to the predominance of female patients; the same argument once used to dismiss Multiple Sclerosis. Ignoring physical abnormalities found in more than two hundred patients at the Royal Free Hospital, they planted the first seed of doubt in the minds of some clinicians.
The name ME was used throughout the commonwealth, but the illness remained unnamed in the States until 1988 when a cluster of outbreaks and subsequent insurance claims prompted the Centers for Disease Control to introduce the name Chronic Fatigue Syndrome. Three ME specialists present at the meeting refused to sign the new working case definition with its focus on fatigue as it bore so little resemblance to neurological ME. The new name was a gift to medical-insurance companies as it implied the illness was nothing more than perpetual tiredness, a symptom so vague that insurance claims could be easily denied.
Since the 1990s the name CFS has gradually superseded ME in the UK. Many doctors reject the term Encephalomyelitis (meaning inflammation of the brain/spinal cord) even though evidence of such inflammation has been found in patients with ME.
In 2001 it was discovered that CFS/ME had been wrongly reclassified as psychiatric in a UK adaptation of a WHO publication regarding mental health disorders. Despite confirmation from the WHO that this was a mistake, the NICE guidelines continue to offer an almost entirely psychiatric approach to treating the disease.
The psychiatric lobby in the UK ignore well-documented evidence of brain lesions, reduced blood volume and cellular, immunological and cardiovascular abnormalities to insist that ME is simply deconditioning, exercise avoidance and false illness beliefs. Specialist testing (SPECT scans, mitochondrial analysis and tilt-table testing) to confirm physical abnormalities is rarely available on the NHS as doctors cannot justify the expense of tests that don’t lead to any subsequent treatment.
Prominent psychiatrist, Sir Simon Wessely, claims that ME can be successfully treated with Graded Exercise and Cognitive Behavioural therapies (GET/CBT). The government, while failing to fund biomedical research, has spent millions of pounds funding the PACE trials to test this theory. Full data from these trials remains unpublished despite widespread calls for its release.
The selection criteria for PACE excluded the severely affected and those with neurological symptoms but included patients with other conditions such as fibromyalgia or psychiatric disorders. This means few if any of the participants met the criteria for ME, yet the results are being treated as universally applicable. Claims of Wessely’s ‘cure’ for CFS have flooded the media when his trials at best show only moderate improvement in a small number of patients.
Measurable deterioration after even minimal exertion is one of the defining characteristics of ME, making graded exercise potentially harmful. Like many ME patients, CBT made no difference to my symptoms while graded exercise made me substantially worse. Every book or article I have read of CFS patients being cured by GET or CBT described a set of symptoms and a disease process so different to my own that it was hard to reconcile them as the same disease. Put simply, CBT and GET can be very helpful for patients suffering from general fatigue states such as mental health disorders or post-illness deconditioning but if these are the cause of a patient’s fatigue they do not have ME.
Unlike ME, CFS has no internationally agreed definition. The catch-all term encompasses everything from fatal neurological disease to any persistent fatigue of undetermined origin. Definitions of CFS rarely require (and often preclude) physical or neurological abnormalities but may allow for psychiatric causes, making the terms CFS and ME mutually exclusive in such cases.
Chronic fatigue can be a symptom of almost any illness but a single normal blood test is often all that is required for a diagnosis of CFS. It is estimated that only 40-60% of CFS patients meet the criteria for ME. Following diagnosis it is rare for further tests to be carried out and patients receive little support or intervention. This is akin to diagnosing frequent headaches as Chronic Headache Syndrome with no further tests to determine if they are caused by stress, depression, migraines or a brain tumour. It is common for conditions like MS, LYMES Disease and even cancer to be misdiagnosed as CFS, often with irreversable or fatal consequences.
So long as no distinction is made between the many different causes of chronic fatigue, patients around the world will be denied the proper recognition and treatments that their illnesses deserve.
So long as the ill-defined category of Chronic Fatigue Syndrome exists, patients with severe neurological disease, post-viral fatigue states and psychiatric disorders will remain grouped under the same broad umbrella and subjected to one-size-fits-all policies that are useless to some and harmful to others.
So do names really matter?
When patients with serious neurological symptoms are treated as having psychosomatic disorders and end up dying through medical neglect, forced into inappropriate treatments that make them worse, or taken from their families and placed into locked psychiatric wards, than yes, it really does matter.
So I’ll continue to refer to my illness as ME and not CFS in the hope that one day the different pathologies grouped under one vague name will finally be recognised as the disparate conditions many patients and specialists already know them to be.
Over to you: