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Dr. E.G. Dowsett
describes M.E.
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"To the very few
physicians still practicing today who began seeing patients with
this illness some 40 years ago and who have continued to record
and publish their clinical findings throughout, the current
enthusiasm for renaming and reassigning this serious disability to
subgroups of putative and vague 'fatigue' entities, must appear
more of a marketing exercise than a rational basis for essential
international research.
It was not always so unnecessarily complicated!"
-Dr. E. G. Dowsett-
Redefinitions of ME/CFS –
A 20th Century Phenomenon
 Dr.
E.G. Dowsett,
UK microbiologist, immunologist and virologist, had an interest in
hospital infections and epidemiology when she began collaborating
with Dr. Melvin Ramsay on the study of ME. in 1976. Since
then she has been an outspoken advocate for patients and
researchers on properly distinguishing the well-defined historic
disease ME from CFS. (See
A Rose By Any Other Name)
In her
article with Ramsay, McCartney and Bell, Myalgic
Encephalomyelitis (M.E.) - A Persistent Enteroviral Infection?
(abstract),
Dr. Dowsett states, "In our opinion, two major errors are responsible for
the present confusion surrounding the case definition, aetiology
and diagnosis of M.E. First, there has been a failure to
distinguish the syndrome from post-viral debility following
Epstein-Barr mononucleosis, influenza and other common fevers.
Compared with M.E., these lack the dramatic effect of exercise
upon muscle function, the multi-system involvement, diurnal
variability of symptoms and prolonged relapsing course.
Laboratory tests can distinguish chronic mononucleosis and other
infections which, as our results show, may occasionally co-exist
with M.E. and, by their immunosuppressive effect, precipitate
relapse. Second, there has been a failure to recognize the
unique epidemiological pattern of M.E., which, from earliest
accounts, has led to confusion with non-paralytic poliomyelitis."
Dowsett,
Ramsey, McCartney and Bell Definition summary:
"Endemic
prevalence alternate with periodic
epidemics, showing a curious
predilection for female staff of health care and teaching
institutions. Maximum incidence in both sexes occurs in the
third decade. M.E. is a multi-system syndrome including
nervous, cardiovascular, endocrine and other involvement,
distinguished by severe muscle fatigue following trivial exertion.
Other characteristics include high morbidity, low mortality, a
prolonged relapsing course and variation in intensity of symptoms
within and between episodes, tending to chronicity."
Patient
Selection
"We adopted
the following clinical criteria for investigation of M.E.: a
syndrome commonly initiated by respiratory and/or
gastro-intestinal infection but an insidious or more dramatic
onset following neurological, cardiac or endocrine disability
occurs. The pathognomonic features are: a complaint of
general or local muscular fatigue following minimal exertion with
prolonged recovery time; neurological disturbance, especially of
cognitive, autonomic and sensory functions; variable involvement
of the cardiac and other systems; a prolonged relapsing course."
The full
article
Myalgic Encephalomyelitis (M.E.) - A Persistent
Enteroviral Infection?
is reprinted in Dr. Byron
Hyde's textbook,
The Clinical and Scientific Basis of M.E./CFS.
 LONDON
CRITERIA FOR M.E.
DIAGNOSTIC CRITERIA FOR THE SELECTION OF SUBJECTS FOR RESEARCH
INTO M.E./PVFS EG Dowsett, E Goudsmit, A Macintyre, C
Shepherd, et al., London criteria for M.E., Report from The
National Task Force on Chronic Fatigue Syndrome (CFS), Post Viral
Fatigue Syndrome (PVFS), Myalgic Encephalomyelitis (ME). Westcare,
1994, pp. 96-98.
Comments on the 1994 London Criteria:
“The
LC (‘London’ criteria) were devised so researchers could identify
the ‘real deal’ patients and they did! The abnormalities they
found using the LC, e.g. hypoperfusion, reduced muscle power etc
were found in ALL the patients who met the criteria. Costa et al
was one of the most important studies to date. Too little blood to
the brain. Paul et al was good and that too, was on people with
ME. Those of us who fought for research on real deal patients back
in the early 90s deserve credit. Not denial” (CFS Research, 8th
May 2005)."
-Dr. Ellen Goudsmit
vs.
"In
conclusion, it is submitted that currently, the 'London' criteria
have no justifiable or validated legitimacy that would in any way
provide acceptable criteria for use by the MRC or by any other
research bodies for use in identifying patients with ME/ICD-CFS.
Not only are they now at least eleven years old, they have been
superseded by the more robust and superior
Canadian case
definition (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome:
Working Case Definition, Diagnostic and Treatment Protocols. Bruce
M Carruthers et al. JCFS 2003:11: (1): 7-115)."
-Margaret
Williams
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