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Request for
Congressional Action
Brief picture of the Myalgic
Encephalomyelitis/Chronic Fatigue Syndrome situation:
In 20 years time, the toll has
risen to over 1 million victims in the
US alone and millions more
worldwide. US health agencies have not
addressed this danger to public health nor sought to find the
cause or remedies for the suffering. These
health agency policies have ignored past research in this disease,
patients are systematically denied medical services and US MDs are
misinformed about M.E. and CFS. These
policies impact the health of those disabled by ME/CFS and continue
to place everyone at risk. A principal issue
must not be overlooked: Why has ME/CFS exploded into a worldwide
epidemic, and what is the inordinate fear of the DHHS to recognize
this and discover its cause?
Expert Testimony: "I have
treated more than 2,000 AIDS and CFS patients in my career.
And the CFS patients are MORE sick and MORE disabled every
single day than my AIDS patients are, except for the last two
months of life!" Dr. Marc Loveless who
testified under oath in testimony before Congress in 1995 All
Americans would benefit by our government health agencies using
their publicity contracts effectively to distinguish between
idiopathic chronic fatigue of undetermined pathology and the
neurological disease Myalgic Encephalomyelitis/CFS delineated in
the
2003 Consensus Criteria for ME/CFS
.
Expert Testimony: "In my
experience, (ME/CFS) is one of the most disabling diseases that I
care for, far exceeding HIV disease except for the terminal
stages" Dr. Daniel L.
Peterson: Introduction to Research and Clinical Conference,
Fort Lauderdale,
Florida, October 1994.
The neurological coding for
Myalgic Encephalomyelitis has been in the
WHO International
Classification of Diseases since 1969 (first identified in 1934),
but it was ignored by the CDC epidemiologists when a few notable
outbreaks of the disease occurred in the late1980s, one of the
outbreaks among children in Lyndonville, NY.
Instead of making use of a half-century of research and clinical
information available about Myalgic Encephalomyelitis and its
epidemic nature, the CDC and NIH chose to focus on the non-medical
criteria "fatigue," leading to the mistaken impression both within
and without the agencies that "CFS" was a psychosomatic or minor
illness when ample evidence to the contrary was available. (ref:
Osler's Web: Inside the Labyrinth of the Chronic Fatigue Syndrome
Epidemic, by Hillary Johnson).
The coining of the term
"chronic fatigue syndrome," was a way to ignore a fully recognized
international disease and instead substitute a very common symptom
in many serious disorders, and a symptom healthy people recover from
easily. And there is now a public
relations campaign taking place at the CDC that ignores the
neurological coding and
historic epidemics,
and instead places the disease in the
all-encompassing category of "fatiguing illnesses" which buries
solid research into the clearly defined disease, Myalgic
Encephalomyelitis/CFS. The research case
definition for CFS (Fukuda et al., 1994) developed by CDC
encompasses a very heterogeneous population.
Dr. Jason has requested removal of the present
case definition and drafting a new one based on actual observations,
rather than vague impressions, which is what the CDC committee has
done.
Expert testimony: Dr.
Leonard Jason from
DePaul
University,
Chicago, wrote that it is regrettable that
the disorder is portrayed in such a narrow way, and that flaws in
the case definitions of 'CFS' have led to "inaccurate and biased
characterization of ME/CFS which incorrectly favors a psychiatric
view of the illness". He correctly pointed out
"the erroneous inclusion of people with primary psychiatric
conditions in ME/CFS samples will have detrimental consequences
for the interpretation of treatment efficacy findings".
(This has happened, with many research patient pools
mistakenly including people who have primary psychiatric
conditions and do not meet the internationally-accepted Consensus
Criteria for ME/CFS.)
For 20 yrs., CDC and NIH have not responded to many requests by
ME/CFS patients, caregivers, researchers and clinicians for
truth-telling and proper recognition of this serious neuroimmune
disease. Ignored by the very agencies that are
charged with addressing public health issues such as this, we
remain disabled, misunderstood, denied sensible treatment, and
unable to return to economic productivity, a burden on our
families and society as a whole. Dr.
Leonard Jason recently showed the economic impact of ME/CFS
in a community based versus tertiary based sample, estimating that
the direct and indirect costs of ME/CFS in the
US are $22-28.6 billion
annually.
What can be
done by Congress in this situation?
1.
What to do about CDC misinformation and mismanagement of
research:
Name and Criteria and ICD Coding
CDC needs to relinquish the
"fatiguing illness" construct for patients who meet the criteria
for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
and
allow the development of solid criteria based on the 2003
Consensus Criteria for ME/CFS so that clear patient cohorts can be
identified for research purposes. (Note: The
terms M.E., ME/CFS and ICD-CFS are used internationally to ensure
the distinction between Chronic Fatigue Syndrome [CFS] as classified
in the World Health Organization's International Classification of
Diseases [Re: severely debilitating organic neurological disorder Myalgic
Encephalomyelitis-ICD9 CM 323.9/ICD10 CM G 93 .3] and the
politically and financially motivated, all-encompassing and
broadly-defined 'fatiguing' version of CFS-R53.82, a NOS code or
Ill-Defined Conditions 780.71--two entirely different problems.)
The CDC's coining of the
phrase "chronic fatigue syndrome" was an attempt to ignore
outbreaks of a real disease, Myalgic Encephalomyelitis, as well as
an attempt to downgrade the condition to a stress-based
psychological condition. This misinformation
continues and was part of a recent public awareness campaign about CFS by the CDC to try to distract with their latest flawed
research attempting to place the blame for the disease on genetic
inability to handle stress. In contrast gene
studies in the
UK have shown immune system
problems (Dr. Jonathan Kerr's team has
identified viruses that may perpetuate the disease, which fits
with some current thinking that it results from a persistent
infection. And, in fact, the two medications
shown to bring about improvement in most patients are both
antivirals, thus demonstrating that the problem is viral and not
psychiatric in origin. Dr.
Kerr's gene expression studies are finding three main
abnormalities in ME/CFS patients: these involve the immune system,
mitochondrial function and G-protein signaling.
There are seven genes upregulated in ME/CFS - those
associated with apoptosis, pesticides, mitochondrial function,
demyelination and viral binding sites.)
Expert Testimony: "The worst
cases have both an MS-like and an AIDS-like clinical appearance.
The most difficult thing to treat is the severe pain.
Most have abnormal neurological examination.
80% of cases are unable to work or attend school.
We admit regularly to a hospital with an inability to care
for self." Paul Cheney, Professor of Medicine,
Capital University,
USA: Testimony Before
the FDA Scientific Advisory Committee,
18 February 1993
"The NK (natural killer) cell
is a very critical cell in (ME)CFS because it is clearly
negatively impacted. The most compelling
finding was that the NK cell cytotoxicity in (ME)CFS was as low as
we have ever seen it in any disease. This is
very, very significant data. (In (ME)CFS) the
actual function was very, very low --- 9% cytotoxicity: the mean
for the controls was 25, In early HIV and even well into ARC (AIDS
related complex, which often precedes the fully developed
condition), NK cytotoxicity might be around 13 or 14 percent.
(ME)CFS patients represent the lowest cytotoxicity of all
populations we've studied." Nancy Klimas, Professor of Medicine,
University of Miami School of Medicine; Director of Immunology;
Director of AIDS research and Director of the Allergy Clinic at
Miami.
The false CDC construct of
"fatiguing illnesses" and their 1994 Fukuda criteria become a wide
net that catches a large number of patients who experience the
symptoms of burnout, thyroid problems, or other medical issues
which are incorrectly mixed with the clear and identifiable
criteria of the neuroimmune disease Myalgic Encephalomyelitis/CFS,
i.e., muscle myopathy (loss of muscle power) diagnostically tested
by means of bicycle ergometry testing, neurological diagnostic
testing (brain SPECT scans, PET scans and QEEG scans) showing brain
hypoperfusion, the neurocognitive abnormalities definitively
identified through neurocognitive testing, and the immune system
dysregulation (several tests). In contrast,
the CDC website counsels doctors that there is no definitive
diagnostic testing and that the above listed tests are
unnecessary. This is an ever-present danger
for patients and a disservice to medical doctors who would like to
treat the disease properly.
Expert Testimony: "I take
great issue with the current recommendations that no additional
testing should ever be done. I believe there
are indications for more advanced testing" Dr.
Daniel Peterson: [a Diplomate of the American Board of Internal
Medicine who first identified CFIDS during an outbreak in
Incline Village,
Nevada, in1984] JCFS 1995:
1:3-4:123-125). At the Second World Congress
on ME/CFS and related disorders, held in
Brussels in September 1999, Peterson said
he was amazed at the misconceptions that existed about ME/CFS; he
said that ten years ago, he believed ME/CFS would be resolved by
science; he had now changed his mind and believed it could only be
resolved by politics)
2.
What to do about Placement of ME/ICD-CFS at the NIH:
Proper placement and recognition of neurological coding of M.
E. and appointment of a standing
committee for approval of research projects.
The NIH places the disease in
the area of Office of Women's Health even though 25% of patients
are male. Just as in 1950, MS patients asked
Congress to have the disease MS (formerly called Faker's Disease
or Hysterical Paralysis) placed in the area of Neurological
Disorders, so also Myalgic Encephalomyelitis, exhibiting
detrimental effects on the central nervous system, has a
neurological ICD coding and should be placed in this section of
the NIH and given a standing committee to approve research
projects rather than an ad hoc approval committee as things now
stand. (In 1950, the MS Society persuaded
Congress to establish a special section of the National Institutes
of Health, now called the National Institute for Neurologic
Disorders and Stroke (NINDS).
In the case of Myalgic
Encephalomyelitis/CFS, there is ample evidence of
neurological
abnormalities,
and also ample evidence of
immunological abnormalities. Thus, this disease at NIH
is misplaced in the Office of Women's Health.
Expert Testimony:
"Abnormalities of immune function, hypothalamic and pituitary
function, neurotransmitter regulation and cerebral perfusion have
been found in patients with (ME/CFS). Recent
research has yielded remarkable data. The
symptoms of (ME)CFS have long been viewed as a neurologic pattern,
as confirmed by other names such as myalgic encephalomyelitis.
A link is being forged between the symptoms pattern of (ME)CFS
and objective evidence of central nervous system dysfunction.
The view that (ME)CFS is a primary emotional illness has
been undermined by recent research" Dr. David
S Bell: Instructor in Pediatrics,
Harvard
Medical
School: Chronic Fatigue Syndrome
update: Findings now point to CNS involvement: Postgraduate
Medicine 1994:98:6:73-81) Dr.
Bell was the M. D.
dealing with the epidemic of Myalgic Encephalomyelitis/ICD-CFS
in
Lyndonville,
New York involving both children and
adults.
3.
What immediate actions need to be taken
Require the CDC and NIH to
formally adopt the
2003 Myalgic Encephalomyelitis/Chronic Fatigue
Syndrome Clinical Working Case Definition Diagnostic and Treatment
Protocols; A Consensus Document
to replace the present inadequate and inaccurate 1994 Fukuda
criteria (proven ineffective by Dr. Leonard
Jason in the study cited above. At the same
time, implement the internationally accepted name Myalgic
Encephalomyelitis/CFS to accurately describe what is currently
known about the disease. Instruct the CDC to update the
information it disseminates to reflect the World Health
Organization classification (Myalgic Encephalomyelitis/CFS in the
ICD-10 under the neurological classification G93.3)
Why doing this
makes sense and Why Congress needs to intervene now
1.
Clear research cohorts can be identified in order to find the
cause of the disease so that the small amount of research money can be
used wisely and without resorting to psychiatric explanations for
a biomedical condition.
2. Early
detection can be established rather than waiting for six months of
fatigue in the CDC criteria which can result in less disability
and less money lost by the country in regard to lost productivity.
3.
Patients can be treated more efficiently and correctly, and MDs
can be presented with clearly defined criteria so they are not in
the position of disbelieving patients and being confused by CDC
"fatiguing illnesses" constructs.
The
2003 Consensus Criteria
can be used to clearly diagnose patients rather than the present
scattershot approach of the CDC, and also three or four definitive
tests can be run to clearly identify patients as having Myalgic
Encephalomyelitis/CFS: brain neuro SPECT or PET scan,
neurocognitive testing, Natural Killer Cell Function test, and the
Rnase-L antiviral dysregulation testing.
**********************************************************
References for information in
our statement at the beginning of this post for the reasons for
this Action above:
1.
Dr.
Hyde's Little red book at this site on the top.
Click on the PDF file.
2. Dr.
Malcolm Hooper:
Engaging With M.E. lecture
3. Dr.
Leslie Simpson studies:
** "Myagic Encephalomyelitis
(ME): A Haemorheological Disorder Manifested as Impaired Capillary
blood Flow." Leslie O. Simpson, Ph.D., Journal
of Orthomolecular Medicine Vol. 12, No.
2, 1997. "The consequences of
stiffened, shape-changed red cells would be to impair capillary
blood flow particularly in tissues with smaller than usual mean
capillary diameters. The degree of reduction
in the rates of delivery of oxygen and nutrient substrates would
be related to symptom severity."
** Simpson L.
Red cells in the chronic fatigue syndrome. Med J Aust
1991;154:78.
** Simpson L.
Nondiscocytic erythrocytes in myalgic encephalomyelitis. NZ
Med J 1989;102:126e127.
** Simpson LO, Shand BI, Olds
RJ. Red cell and hemorheological changes in
multiple sclerosis. Pathology 1987;19:51e55.
http://www.nrg.com.au/~nrmecfs/research.htm
http://cfidsreport.com/Articles/researchers/lessimpson.htm
4. Dr.
Nancy Klimas and example of Natural Killer Cell Function
*Fletcher, MA, Maher, K and
Klimas, NG. Natural killer cell function in
chronic fatigue syndrome. Clin Appl Immunol
Rev. 2:129-139, 2002.
**Caligiuri M, Murray C,
Buchwald D, Levine H, Cheney P, Peterson D, Komaroff AL, Ritz J.
Phenotypic and functional deficiency of natural killer
cells in patients with chronic fatigue syndrome.
J Immunol. 1987 Nov 15;139
(10):3306-13.
**Pross, HF.
"Abnormalities of natural killer (NK) cell numbers and
function in patients with chronic fatigue immune dysfunction
syndrome (CFIDS) 1993 In BM Hyde et al., eds.
The clinical and scientific basis for myalgic encephalomyelitis
chronic fatigue syndrome.
Ottawa: Nightingale Research Foundation:
566-572
5. Rnase-L
dysregulation:
**Suhadolnik, R.
A., Peterson, D., Reichenbach, N., Roen, G., Metzger, M.,
McCahan, J., O'Brien, K., Welsch, S., Gabriel, J., Gaughan, J.
and N. McGregor.
2004. Clinical and biochemical characteristics
differentiating chronic fatigue syndrome from major depression and
healthy control populations: relation to dysfunction of the RNase
L pathway. Journal of Chronic Fatigue Syndrome
12: 5-35.
6. Dr.
Melvin Ramsay criteria:
Dr. Melvin
Ramsay, pioneer
UK researcher and clinician,
posits this short description of Myalgic Encephalomyelitis: 1)
Muscle myopathy, which Ramsay describes as a delay in muscle
recovery after exercise. 2) Circulatory
impairment including intolerance to temperature extremes, and
exacerbated by low pressure weather systems.
3) Cerebral (brain)
dysfunction including problems with memory and concentration,
sleep disturbances, noise intolerance, palpitations and
tachycardia.
Dr.
Ramsey's 1986 more complete definition:
A syndrome initiated by a
virus infection, commonly in the form of a respiratory or
gastrointestinal illness with significant headache, malaise and
dizziness sometimes accompanied by lymphadenopathy or rash.
Insidious or more dramatic onsets following neurological,
cardiac or endocrine disability are also recognized.
Characteristic features
include:-
(1) A multisystem disease,
primarily neurological with variable involvement of liver, cardiac
and skeletal muscle, lymphoid and endocrine organs.
(2) Neurological disturbance -
an unpredictable state of central nervous system exhaustion
following mental or physical exertion which may be delayed and
require several days for recovery; an unique neuro-endocrine
profile which differs from depression in that the
hypothalamic/pituitary/adrenal response to stress is deficient;
dysfunction of the autonomic and sensory nervous systems;
cognitive problems.
3) Musculo-skeletal
dysfunction in a proportion of patients (related to sensory
disturbance or to the late metabolic and auto immune effects of
infection)
(4) A characteristically
chronic relapsing course
7.
2003
Consensus Criteria Overview
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