Wednesday, 25 March 2015
25% Group/Stonebird response to “Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial”
Greg Crowhurst, Simon Lawrence
People with Severe ME are rightly outraged by the latest in a long line of misrepresentative articles suggesting that their disease is a fatigue condition.
People are suffering and have been suffering for decades as a result of the misdirection of ME away from a WHO defined neurological disease.(Hooper et al 2007) It is surely time for this to end.
The so-called "psychiatric lobby" have for many years perpetuated the untruth that ME is a "non disease", a somatoform disorder, maintained by abnormal or unhelpful illness beliefs, condemning patients to decades of neglect, abuse, misunderstanding and mistreatment. It is time that Myalgic Encephalomyelitis is recognised as the serious neurological disease it is and separated once and for all from a sea of ill-defined, vague, misrepresentative fatigue, under psychiatric influence.
The latest paper, (Chalder et al 2015) grotesquely reported in the media, has caused immense distress; echoed around the world the article is given far more authority than it deserves, thus perpetuating a global knock on effect, that will have a devastating negative influence especially for the most ill.
Its central “morally indefensible (Weir 2015)” premise that ME patients are afraid of activity and would benefit from Graded Exercise Therapy and Cognitive Behaviour Therapy, to cure their phobia, ignores the evidence that people with ME are physically harmed by exercise (Crowhurst 2010, Kindlon 2011, VanNess 2014).
The key issue here is the wide and loose definition used to identify the research cohort and the misuse of the name ME to mean CFS, moving the focus and ground away from ME, a neurological disease, to Chronic Fatigue, a mental health condition. Whether ME patients are included or not, within the patient cohort, the potential for harm from wrong treatment is huge. Patients with Myalgic Encephalomyelitis need protecting from the dangers of misinterpretation.
The 25% Severe ME Group and Stonebird call for psychiatry to be removed from first line involvement in ME, for a much clearer definition to be applied across the board to separate ME from CFS, for the development of a biomedical, not a psychosocial pathway and for high end Myalgic Encephalomyelitis not “CFS” research .
A whole new approach to addressing the medical needs of people with Severe ME, which recognises the complexity of hypersensitivity, must be developed, alongside a long overdue medical centre of excellence.
Chalder T, Goldsmith KA, White PD, Sharpe M, Pickles AR.
Rehabilitative therapies for chronic fatigue syndrome: a secondary
mediation analysis of the PACE trial. Lancet Psychiatry 14 Jan 2015,
Crowhurst G (2010) 101 Good Reasons:Why it is wrong to provide CBT and GET to ME Patients.
Hooper M, Marshall E, Williams M (2007) CORPORATE COLLUSION? http://www.meactionuk.org.uk/Corporate_Collusion_2.htm
Kindlon T (2011) Reporting of Harms Associated with Graded Exercise Therapy and Cognitive Behavioural Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Bulletin of the IACFS/ME. 2011;19(2): 59-111
VanNess M (2014) 'Exercise and ME/CFS' at Bristol Watershed. Part One.
Thursday, 19 March 2015
Margaret Mar, Countess of Mar. Presentation to the Royal Society of Medicine.
"The Politics of ME/CFS"
18th March 2015.
ROYAL SOCIETY OF MEDICINE
ME/CFS: Frontiers in research, clinical practice and perception.
THE POLITICS OF ME/CFS.
Ladies and gentlemen, I am grateful to the Royal Society of Medicine who have given me the opportunity to offer a political view of ME/CFS.
I will have been an Independent Crossbench member of the House of Lords for forty years in the autumn. For more than twenty of those years, with the help of a great many other people in the community, I have been trying to persuade governments of different colours that ME/CFS, together with organophosphate sheep dip poisoning, Gulf War Illnesses, Aerotoxic syndrome and other medically unexplained physical symptoms, known as MUPS, are not figments of patients’ imaginations, nor are they nocebo effects, but are very real conditions.
In so far as ME/CFS is concerned I have had some support fromMembers of Parliament who have constituents with the illness, but have been ploughing rather a long and lonely furrow in the Lords. For the sake of brevity, I will call the condition ME, which is what most patients prefer, except where accuracy demands otherwise. I know that the medical profession uses the shortcut term CFS, but that covers a much wider range of conditions that what I know of as classic ME.
I came to ME through parents who had used OP head louse shampoos on their children – treatments recommended by doctors and school nurses. Some children developed symptoms which were labelled ME within months of the treatment. I don’t know whether you recall that the advice was to shampoo the child’s head and, without rinsing, cover the head with a shower cap and leave overnight, to be rinsed off in the morning. Anyone with any knowledge of OPs knows that one of the most absorbent parts of the body is the scalp, and that some individuals are more genetically susceptible than others; so these poor children were poisoned.
Very unfortunately, once a person, be they child or adult, has the ME label all support and assistance from the medical profession and social services seem to vanish into thin air. Despite the World Health Organisation classification of CFS/ME as a neurological condition under ICD 10G93.3 and this classification being accepted by Ministers of both the Department of Health and the Department for Work and Pensions; despite major reports, one by the Chief Medical Officers working group on CFS/ME in 2002 and two others by the All Party Parliamentary Group on ME in 2006 and 2010, all of which recognise the severe impact that this disease can have on many patients’ lives, far too many of those professionals treating and caring for people with ME have not received the message. The CMO Report mentions that “The disbelief and controversy over CFS/ME that exists within the professions has done nothing to dispel public disbelief in the existence of such a seemingly varied and inconsistent illness.” Despite all the fine words of Ministers and report writers, I repeatedly ask myself why it is that the recognition and treatment of this illness has remained in the doldrums for so long.
All Party Parliamentary Groups are supposed to be for the enlightenment of Members of Parliament from both Houses. The purpose of the APPG for ME is to: “Raise awareness of ME and support the improvement of health, social care, education and employment opportunities for people affected by ME.” There was a problem with communicating with Ministers effectively at what turned out to be large public meetings with few MPs present. After consultation with the leaders of the main ME charities and support groups, Forward-ME was formed in 2008 under my chairmanship. We have met successfully with people such as Steven Holgate, Lord Freud, Edward Timpson MP and ATOS as well as others in the health, social care and education world and are, I believe, respected for the respect that we show to each other and to our speakers. The APPG was re-formed in 2010 on these same principles and we now work together very happily, though meetings are still attended by very few MPs.
When we think of politics we tend to think of party politics– what goes on in the Westminster village, in local government or at the parish pump. It was a while before I recognised that amongst other settings there are medical politics. Until the 1980s, when the Press picked up on the ‘Yuppie flu’ diagnosis, there seems to have been tacit acceptance that ME was a real physical condition even though the cause was then, as it is now, unknown. There were a number on notable British doctors, amongst them Dr A Melvin Ramsay, who flew the flag for Myalgic Encephalomyelitis from the 1950s onwards, Dr Elizabeth Dowsett, Dr Alan Franklin and Dr John Richardson who, from their observations of ME patients over decades, were convinced that ME was caused by persistent viral infections. This persistence would appear to be confirmed by Dr Mady Hornig and Dr Ian Lipkin at the Centre for Infection and Immunity at Columbia University’s Mailman School of Public Health in their 27 February 2015paper – ‘Immune Signatures in Blood Point to Distinct Disease Stages, Open Door to Better Diagnosis and Treatment’, who have identified distinct immune changes in patients, said to represent the first robust physical evidence the ME/CFS is a biological illness as opposed to a psychological disorder., though I readily acknowledge that we still have a long way to go.
It was when a small group psychiatrists from the UK, Europe and the USA purloined ME and renamed it CFS in the mid-1980s that the real problems began. They insisted that it was a psychosocial behavioural problem that could be readily overcome with a course of cognitive behavioural therapy and graded exercise. From their earliest beginnings, they managed to attract the attention of the media and of their medical colleagues with their assertions. They found their way onto government advisory committees and research organisations; onto the boards of medical publications and into insurance companies where their message was greeted with apparent delight because these organisations would not have to think any more. The cause and solution were at hand. No need for doctors to do too many investigations; no need to perform anything but psychological research; no need for social security payments by finding that claimants are really fit for work. They developed a means of stifling opposition by refusing to publish papers showing biological causation and, joy of joys for the insurance companies found that patients were reporting a psychological condition which was excluded in their policies. As recently as last year CFS was described as ‘a culturally driven disorder with no known organic cause’ in the BMJ.
This school of psychiatrists has persisted in their view despite more than 6,000 peer reviewed papers, including experimental studies which demonstrate a range of biological findings associated with people with ME. Funding for biological causes and treatments is miniscule against the funding for psychiatric or psychological ones. Researchers such as those funded by Invest in ME and ME Research UK, have funded excellent pilot and seedcorn studies on a shoestring, while a significant number of biomedical research applications have not been funded by the MRC in the past 20 years, including some targeted at pathophysiology. It is hard to believe that all were written so badly that they could be rejected, particularly as some came from established researchers with a track record in this and other fields. Could it be that the expert reviewers were, once again, psychiatrists who appeared to have an interest in supressing research that counters their views? Many suspect this to be the case. This can only be political. It is also political suicide for researchers in major universities to suggest that they conduct studies into biological causes for ME.
The largest and most expensive state-sponsored treatment studies (the PACE and FINE trials) which both focused exclusively on psychosocial management cost in excess of £6 million, dwarfing funding for biomedical intervention, yet both failed to show improvement on real-world outcome measures. These huge sums have taken us no nearer to finding a cure or the underlying cause.
There is a silver lining – more recently MRC funding has been targeted on more biological research, though the amounts of funding allocated are still miniscule in relation to that for other diseases.
It is extraordinary to me that men and women who are trained to “First do no harm” and to “Listen to the patient for they will probably tell you the diagnosis” cannot but be aware of the enormous damage they are doing to a very large number – more than 200.000, patients with this condition. By recommending that too many investigations should not be conducted because they encourage illness behaviour they are risking missing vital findings of treatable conditions such as endocrine dysfunction, rarer medical conditions or even cancers that present with chronic fatigue. How, with all the publicity, can they not be aware of the misery, neglect and, too often, abusive treatment that I can only describe as barbaric that is meted out to patients with a diagnosis of ME?
I am aware that multiple sclerosis, Parkinson’s disease and diabetes were all once in the domain of the psychiatrists and that this domain is shrinking as new discoveries are made. To compensate, we have a compendium of purely subjective conditions with labels such as conversion syndrome, pervasive refusal syndrome, and neurasthenia to name but a few. There is no biological explanation for these, but they do help the uninitiated to believe that the condition is psychological.
How can we change this situation? Frantz Fanon, the French psychiatrist, philosopher and revolutionary from the middle of the last century wrote:
“Sometimes people hold a core belief that is very strong. When they are presented with evidence that works against that belief, the new evidence cannot be accepted.
It would create a feeling that is extremely uncomfortable, called cognitive dissonance.
And because it is so important to protect that core belief, they will rationalise, ignore and even deny anything that doesn’t fit that core belief.”
Ladies and gentlemen, I know how very difficult it is to say “Sorry, I got it wrong”, especially when your whole career has been based on a particular belief. I have been told that, in medicine, nothing will change until the old guard moves on. The history of medicine is littered with instances of this phenomenon. It is my very sincere wish that the situation will change radically long before the changing of the guard.
Tuesday, 17 March 2015
By Jane Colby of the TYMES Trust
Since my last blogpost on the stages of ME, some of you have raised questions about cases that sadly don't ever seem to go into remission, or improve enough for people to enjoy a reasonable quality of life. That's what I am addressing here, grounded both in my own experience and in the knowledge of others. It is part of the spectrum of this disease, and we need to see the whole picture.
I first met microbiologist and ME specialist Dr Elizabeth Dowsett in 1985 when she diagnosed me with ME. Shortly afterwards, she telephoned with the news that my blood tests had revealed a recent infection and several weeks after that, other tests, being analysed as part of a research procedure, showed that the causal agent was the enterovirus (or gut virus) Coxsackie B. In ME, it often is, as she explained. Coxsackie viruses are related to polioviruses, being part of the same family.
What I didn't know at the time – do any of us? - was that mine would develop into almost the worst case of ME that Dr Dowsett had ever seen. I won't attempt to describe that here, although I do intend to publish a personal memoir to convey something of the dramatic severity and trauma associated with that level of disease.
When, years later, I came to interview Dr Dowsett, after a painful endurance test while my body struggled to repair itself, she made clear to me that whilst the body will do its best for us, sometimes it just can't get the job done.
If she was right about the persistence of virus in our tissues (and I have no reason to think she wasn't, given Dr John Chia's discoveries of viral particles persisting many years later in the stomach lining of patients) then we never truly 'recover' in the pure terms of totally eliminating the invading organism. But that happens with other organisms too, such as the herpes virus that causes some people to get recurrent cold sores when they are run down. Most of the time it doesn't bother them. This is a way that the body has learned to accommodate invaders rather than always mounting a deadly battle.
Some people who have been through ME seem to reach periods in their lives when they joyfully find themselves capable of physical things they thought they wouldn't be able to do again. After the worst years, some of us find other, gentler, physical things to replace those we can no longer manage. Can we call any of this 'recovery'? It's an odd word, as people use it in their own way, and even researchers have to define what they mean by recovery, which might not be what we would mean.
I have limitations that have never totally gone, and I live my life around certain restrictions. The R word is bandied around too loosely, but if by 'recover' we mean that we are totally 'over it' forever, then that idea does not seem to be reflected in what happens inside the body. What can happen is an accommodation with the virus that caused the ME in the first place, a sort of equilibrium. This balance, however, can be upset, and indeed, is apparently not reached in every case.
If you haven't read my previous blog post IT'S THE IMMUNE SYSTEM, RIGHT? I would prefer that you read it now, before continuing with this one. It's not all that long. Just scroll down and look through it. Because the next few paragraphs are a bit scary, and if you're feeling upset, miserable or frightened because of what's happening to your body, it's a good idea to reassure yourself by learning how the 'tendency' in ME (as explained to me by Dr Dowsett) is for the body to improve over time as it tries to do what it's programmed to do – heal us. Often this happens in spite of, rather than because of, any therapies or medications or alternative treatments that others recommend.
The body has been injured, damaged. We must look after it, love it, praise it and trust it to do its very best. We must take good care of ourselves and not let people pressurize us into doing things that will interfere with that healing process.
The last thing we want is to provoke a deterioration, even as we naturally try new things when they seem possible. Keeping a balance is important. As I've personally experienced, once a serious setback has happened, it can be a long haul to get back to our previous level of improvement. And we don't even know if we'll get there; uncertainty is perhaps the worst thing of all. What will my future be? We must give it our best shot.
Go off now and read my previous blogpost...
Welcome back. I hope you found that information encouraging. We must, however, validate the experience of those who do not 'recover', for no fault of their own. And we must not hide away the unpalatable truth, that some people suffer continually in darkened rooms unseen by the world. As the Chief Medical Officer's Working Group Report stated in 2002: Overall, there is wide variation in the duration of the illness, with some people recovering [that word again] in less than two years, while others remain ill after several decades. A minority of those with CFS/ME remain permanently severely disabled and dependent on others.
That is a sobering statement. Dr Melvin Ramsay wrote of the spectrum of cases, including one case that had at the time of writing lasted 40 years. He stated: I am fully satisfied that at a conservative estimate 25% of victims of ME have had the disease for 10 years or more. Only Myalgic Encephalomyelitis has such a legacy.
Ramsay was comparing the real, classic, historic ME with other forms of postviral syndrome. Dr Chia's 21 century work corroborates what Ramsay documented, showing double stranded enteroviral RNA present in the stomach lining of patients after 10 years. He is quite adamant that this is a causal relationship, with the level of symptoms reflecting the degree of what I would call infestation.
Ramsay describes two forms of chronic ME. One form shows a recurring cycle of remission and relapse, with remissions lasting as long as three years in his experience. The second form is more tragic in that no remission occurs. He talks of the restricted lifestyle of these patients, and adds: A few of these chronic cases are compelled to sleep upright as a result of permanent weakness of the intercostal and abdominal recti musculature.
I myself find it more comfortable not to lie totally flat when sleeping, and this is a fascinating analysis of why that might be. Despite the persisting weakness in some of my muscles, I am constantly amazed at what my body has managed to achieve. But I try not to take it for granted.
What have others had to say? In a paper published in 1994 by the Nightingale Foundation in Canada, Byron Hyde MD and his colleagues reported that out of 1826 respondents to their survey, the average length of illness was approximately seven years. They found only a two per cent recovery, which, they said, 'suggests that the large number of pharmaceuticals, alternative medicines and various treatments used' had been 'largely ineffective'. We are now 21 years on from that statement, and if anything, we are in a worse situation, with exercise regimes and psychological therapy having provided one huge distraction. We see muddled terminology, mixing of patient groups under the banner of 'CFS', and often misguided treatment. I particularly see this in regular reports from parents stating that their children have been made worse.
In my view, until both the research establishment and Government truly accept the viral nature of this illness, and do something about developing targeted antivirals, and vaccinations, as they have done in other serious disease, it will continue to be down to us as individuals and families to resist over-demand and to insist on taking the very best care of ourselves in order to maximise our chances of 'recovery'.
In my book, I am revisiting my interview with Dr Dowsett and her work. She goes into some detail about the dangers of ignoring the true nature of ME, and what that can lead to.Which is not nice. Not nice at all.
ME has to be taken seriously. That's why I continue to shout about it. To anyone who will listen.
Monday, 9 March 2015
C H Spurgeon’s Morning Devotional for 9th March
"Yea, He is altogether lovely”
Song of Solomon 5:16
The superlative beauty of Jesus is all-attracting; it is not so much to be admired as to be loved. He is more than pleasant and fair, He is lovely. Surely the people of God can fully justify the use of this golden word, for He is the object of their warmest love, a love founded on the intrinsic excellence of His person, the complete perfection of His charms. Look, O disciples of Jesus, to your Master's lips, and say, "Are they not most sweet?" Do not His words cause your hearts to burn within you as He talks with you by the way? Ye worshippers of Immanuel, look up to His head of much fine gold, and tell me, are not His thoughts precious unto you? Is not your adoration sweetened with affection as ye humbly bow before that countenance which is as Lebanon, excellent as the cedars? Is there not a charm in His every feature, and is not His whole person fragrant with such a savour of His good ointments, that therefore the virgins love Him? Is there one member of His glorious body which is not attractive?-one portion of His person which is not a fresh loadstone to our souls?-one office which is not a strong cord to bind your heart? Our love is not as a seal set upon His heart of love alone; it is fastened upon His arm of power also; nor is there a single part of Him upon which it does not fix itself. We anoint His whole person with the sweet spikenard of our fervent love. His whole life we would imitate; His whole character we would transcribe. In all other beings we see some lack, in Him there is all perfection. The best even of His favoured saints have had blots upon their garments and wrinkles upon their brows; He is nothing but loveliness. All earthly suns have their spots: the fair world itself hath its wilderness; we cannot love the whole of the most lovely thing; but Christ Jesus is gold without alloy-light without darkness-glory without cloud-"Yea, He is altogether lovely."
Monday, 2 March 2015
Distinct plasma immune signatures in ME/CFS are present early in the course of illness
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an unexplained incapacitating illness that may affect up to 4 million people in the United States alone. There are no validated laboratory tests for diagnosis or management despite global efforts to find biomarkers of disease. We considered the possibility that inability to identify such biomarkers reflected variations in diagnostic criteria and laboratory methods as well as the timing of sample collection during the course of the illness. Accordingly, we leveraged two large, multicenter cohort studies of ME/CFS to assess the relationship of immune signatures with diagnosis, illness duration, and other clinical variables. Controls were frequency-matched on key variables known to affect immune status, including season of sampling and geographic site, in addition to age and sex. We report here distinct alterations in plasma immune signatures early in the course of ME/CFS (n = 52) relative to healthy controls (n = 348) that are not present in subjects with longer duration of illness (n = 246). Analyses based on disease duration revealed that early ME/CFS cases had a prominent activation of both pro- and anti-inflammatory cytokines as well as dissociation of intercytokine regulatory networks. We found a stronger correlation of cytokine alterations with illness duration than with measures of illness severity, suggesting that the immunopathology of ME/CFS is not static. These findings have critical implications for discovery of interventional strategies and early diagnosis of ME/CFS.
(To read the whole article, click on the link above. A PDF version can be downloaded by clicking here.)
Quo vadis, Science Media Centre? (Saturday 28 February 2015)
Yesterday saw some positive media headlines for the ME community. The research from Columbia University by Hornig et al, concerning the level of cytokine activation as a potential biomarker for ME, looks promising. ME research indicating a biological pathology is often dismissed due to the small number of participants but this was a study comprising 298 ME patients and 348 controls, which will hopefully give it more weight in scientific circles. Unfortunately, as is usual with UK media coverage, reporting was not unequivocally positive; the difference in tone between the UK and US media coverage was marked. In the former, most of the usual suspects promoting the psychogenic paradigm were quoted, aided by the Science Media Centre (SMC). There is little hope of this group of psychiatrists going quietly into the night and we will probably experience a backlash from that quarter; they have much to lose if and when the psychogenic model of ME is discredited and the disease is proven to have a biological foundation.
Regarding specific coverage: ‘First Biological Proof that ME is Real Found by Scientists’ states the Telegraph’s headline. Hardly the first given the thousands of papers published showing biological abnormalities in ME patients, and proof is a charged term in science but quite a good headline for a British newspaper (to be fair the ME Association’s reporting was hardly exemplary). The Independent lives up to its usual poor standards when reporting anything ME related; its headline, ‘Scientists Claim to have ‘Robust’ Evidence that ME has a Biological Cause', being especially bad. Note the use of the word claim and the inverted commas around robust and contrast this with their reporting of the PACE trial based research a few weeks ago, ‘Sufferers of Chronic Fatigue Syndrome can Benefit from Exercise'. No doubt is expressed there in the veracity of the researchers’ claims, the suggestion that ME sufferers can benefit from exercise is stated as fact.
The Science Media Centre surpassed itself in its coverage of the Columbia University study. Of seven experts chosen to respond to the study, not one gives a positive analysis, no medical adviser from an ME charity or, non-psychosomatic promoting, ME researcher is quoted. The featured experts are:
Professors Michael Sharpe and Peter White, and Dr Esther Crawley, all notorious proponents of the psychogenic ME model
Professor Stephen Lawrie, head of The Division of Psychiatry at the University of Edinburgh: ‘This is a small study’ he states; a study encompassing 20 participants is small professor Lawrie, one involving over 600 participants is not. One has to ask why is a psychiatrist being consulted?
Professor Derek Hill, a professor of Medical Imaging Science with no known expertise in the field of ME
Professor Naveed Sattar: Professor of Metabolic Medicine at the University of Glasgow. He does have expertise in the field of biomarkers but has shown zero interest in the field of ME research heretofore
Dr Diana Prata: Group Leader, Institute of Molecular Medicine. Again, no evidence of any interest in the field of ME research ‘This specific illness is not in my area of expertise’ really? Yet the SMC calls you an expert.
If the SMC wanted to skew their response towards dismissing the Columbia study and avoid undermining their preferred psychogenic model of ME it would be hard to choose better sources of expertise. The study is by no means flawless or conclusive (what study is?) but it’s a better piece of work than the SMC would lead you to believe. Connie St Louis, former president of the Association of British Science Writers and a senior lecturer at City University, has detailed the SMC’s malign influence on media reporting of scientific stories in the UK, revealing that over half of the SMC’s expert reactions were covered in the press and in nearly a quarter of stories, the only quotes were from the SMC. Louis states ‘The SMC never claims to deliver a balanced [argument], so it’s really interesting that many of them weren’t using somebody independent of what the SMC offered’. The SMC’s media briefings are reported uncritically, with 60 per cent of articles based on their information containing no non-SMC mediated sources. This is especially relevant concerning ME coverage in the British media and explains its bias towards reporting research from the psychogenic realm.
We recently published a blog post concerning a vitriolic article about ME sufferers from the University of Toronto’s Professor Edward Shorter. One of the particularly insightful claims made in his piece was,
‘There have been no convincing new studies, no breakthrough findings of organicity, nothing.
And there never will be.'
I’m not quite sure why he split the sentence up, no doubt to enhance the effect of such a momentous, nay paradigm-shifting statement, but it looks more foolish now than it did a week ago, which is quite an achievement. Needless to say Professor Shorter’s scientific knowledge is zero, I’m only surprised the SMC didn’t choose him as one of their expert commentators on the Columbia study.
A serious point to finish: let us not forget Karina Hansen, currently being ‘treated’ by Per Fink and his followers in Denmark. I believe forcibly removing a young woman from her home to an institution that restricts her liberty, access to her family and subjects her to who knows what form of ‘therapy’, is nothing less than torture. I also find it disturbing that it is another case of a young woman being abused by middle-aged male members of the medical profession. The current climate surrounding ME, ‘all in the mind’, ‘lazy malingerers’ etc. encouraged by the likes of Wessely, White and Sharpe (and formerly by Beard at al), has allowed such cruelties to be inflicted on ME patients. Hopefully we are coming to the end of this era of abuse and can look forward to more biomedical research and effective medical therapy, consigning the over-used biosocial model and psychogenic explanations for physical illness to the dustbin of history.
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