On this page: General Articles and Research Overviews

Articles of increased importance are highlighted in green *O*

Despite popular opinion, Myalgic Encephalomyelitis (and M.E. equivalent CFS) is not ‘medically unexplained’ nor ‘mysterious.’

The reality is that there is an abundance of research which shows that M.E. is an organic illness which can have profound effects on many bodily systems and many aspects of the pathophysiology of the disease have, indeed, been medically explained in volumes of research articles; some dating back to the 1950’s and earlier. Nearly 1000 good articles now support the basic premises of M.E. These are well-documented, scientifically sound explanations for why patients are often bedridden and unable to maintain an upright posture.

Myalgic encephalomyelitis is a systemic acutely acquired illness initiated by a virus infection which is characterised by post encephalitic damage to the brain stem; a nerve centre through which many spinal nerve tracts connect with higher centres in the brain in order to control all vital bodily functions – this is always damaged in M.E. Central nervous system (CNS) dysfunction, and in particular, inconsistent CNS function is undoubtedly both the chief cause of disability in M.E. and one of the most critical in the definition of the entire disease process.

Myalgic Encephalomyelitis is a loss of the ability of the CNS (the brain) to adequately receive, interpret, store and recover information which enables it to control vital body functions (cognitive, hormonal, cardiovascular, autonomic and sensory nerve communication, digestive, visual auditory balance etc). It is a loss of normal internal homeostasis. The individual can no longer function systemically within normal limits. This dysfunction also results in the inability of the CNS to consistently programme and achieve normal smooth end organ response. There is also multi-system involvement of cardiac and skeletal muscle, liver, lymphoid and endocrine organs. Some individuals also have damage to skeletal and heart muscle.

In short, M.E. is characterised primarily by damage to the central nervous system (the brain) which results in dysfunctions and damage to many of the body’s vital systems and a loss of normal internal homeostasis. Therefore although M.E. is primarily neurological, symptoms may be manifested by cardiac, cardiovascular, immunological, endocrinological, respiratory, hormonal, gastrointestinal and musculo-skeletal dysfunctions and damage. More than 64 distinct symptoms have been authentically documented in M.E.

This is not simply theory, but is based upon an enormous body of clinical information. Confirmation of this hypothesis is supported by electrical tests of muscle and of brain function (including the subsequent development of PET and SPECT scans) and by biochemical and hormonal assays. Newer scientific evidence is increasingly strengthening this hypothesis.

As patient advocates Eileen Marshall and Margaret Williams recently explained: ‘The peer-reviewed research data supports the following organic abnormalities in ME:

• there is evidence of disrupted biology at cell membrane level
• there is evidence of abnormal brain metabolism
• there is evidence of widespread cerebral hypoperfusion
• there is evidence of central nervous system immune dysfunction
• there is evidence of central nervous system inflammation and demyelination
• there is evidence of hypomyelination
• there is evidence that ME is a complex, serious multi-system autoimmune disorder (in Belgium, the disorder has now been placed between MS and lupus)
• there is evidence of significant neutrophil apoptosis
• there is evidence that the immune system is chronically activated (eg. the CD4:CD8 ratio may be grossly elevated)
• there is evidence that NK cell activity is impaired (ie. diminished)
• there is evidence that the vascular biology is abnormal, with disrupted endothelial function
• there is novel evidence of significantly elevated levels of isoprostanes
• there is evidence of cardiac insufficiency and that patients are in a form of cardiac failure
• there is evidence of autonomic dysfunction (especially thermodysregulation; frequency of micturition with nocturia; labile blood pressure; pooling of blood in the lower limbs; reduced blood volume (with orthostatic tachycardia and orthostatic hypotension)
• there is evidence of respiratory dysfunction, with reduced lung function in all parameters tested
• there is evidence of neuroendocrine dysfunction (notably HPA axis dysfunction)
• there is evidence of recovery rates for oxygen saturation that are 60% lower than those in normal controls
• there is evidence of delayed recovery of muscles after exercise (note: there is no evidence of deconditioning)
• there is evidence of a sensitive marker of muscle inflammation
• there is evidence that the size of the adrenal glands is reduced by 50%, with reduced cortisol levels [incidentally this is in contrast to the HIGH cortisol levels seen in depressed patients]
• there is evidence of at least 35 abnormal genes (acquired, not hereditary), specifically those that are important in metabolism; there are more abnormal genes in ME than there are in cancer
• there is evidence of serious cognitive impairment (worse than occurs in AIDS dementia)
• there is evidence of adverse reactions to medicinal drugs, especially those acting on the CNS
• there is evidence that symptoms fluctuate from day to day and even from hour to hour
• there is no evidence that ME is a psychiatric or behavioural disorder.’

(Note: This is only a sample of some of the research available, not an exhaustive list)

Yes. Whilst there is as yet no single, definitive laboratory test for M.E., there are a specific series of tests which enable a M.E. diagnosis to be confirmed. Virtually every M.E. patient will also have various abnormalities visible on physical exam.

As M.E. expert Dr Byron Hyde MD explains: ‘The one essential characteristic of M.E. is acquired CNS dysfunction, [not] chronic fatigue. A patient with M.E. is a patient whose primary disease is CNS change, and this is measurable. We have excellent tools for measuring these physiological and neuropsychological CNS changes: SPECT, xenon SPECT, PET, and neuropsychological testing.’ Thus it is these tests which are therefore most critical in the diagnosis of M.E., although various other types of tests are also useful. Some of the series of tests which can (in combination) help to confirm a M.E. diagnosis include:

• SPECT and xenon SPECT scans of the brain MRI scans of the brain PET scans
• Neurological examination and the Romberg or tandem Romberg test
• Various tests of the immune system
• Insulin Levels and Glucose Tolerance Tests
• 24 Hour Holter Monitor
• Tilt Table Examination Exercise testing and chemical stress tests
• Physical exam

While various ‘fatiguing conditions’ with a variety of different aetiology’s may be made up of vague and mild ‘everyday’ type symptoms, have no physical signs and no tests which can aid diagnosis, this is not the case with M.E. M.E. is a distinct neurological illness with a distinct list of symptoms, physical signs and diagnostic (and other) tests – it bears no relationship to such unrelated ‘fatiguing conditions.’ As M.E. authors Verillo and Gellman explain: ‘Contrary to popular belief, ME is a distinct, recognisable entity that can be diagnosed relatively early in the course of he disease, providing the physician has some experience with the illness.’ New clinical guidelines such as the Canadian Criteria now also make diagnosis easier than ever before; even for those with no experience with the illness.

Further recommended reading:

Putting Myalgic Encephalomyelitis Research and Articles into Context Because of the politics and financial interests involved in M.E. research it is vitally important that before you read anything about the illness that you read this paper first and first understand the context in which it was written.

For more information about the series of tests which may aid diagnosis see:

• Testing for M.E. by Jodi Bassett
• The Complexities of Diagnosis by Byron Hyde MD (Word format) (PDF format)

The following texts provide overviews of what is known medically about M.E.:

• Myalgic Encephalomyelitis: The Medical Facts by Jodi Bassett
• Putting Research and Articles into Context by Jodi Bassett
• The effects of CBT and GET on patients with Myalgic Encephalomyelitis by Jodi Bassett
• What is ME? What is CFS? Information for Clinicians & Lawyers by Eileen Marshall, Margaret Williams & Professor Malcolm Hooper, 2001
• Research into ME 1988 - 1998 Too much PHILOSOPHY and too little BASIC SCIENCE! and The Late Effects Of M.E. and A Rose by Any Other Name and Redefinitions of ME - a 20th Century Phenomenon by Dr Elizabeth Dowsett
• ME is not fatigue and Cardiac Insufficiency Hypothesis by Maryann Spurgin Ph.D.
• Illustrations of Clinical Observations and International Research Findings from 1955 to 2005 that demonstrate the organic aetiology of Myalgic Encephalomyelitis / Chronic Fatigue Syndrome by Malcolm Hooper Eileen Marshall Margaret Williams 174 pages.
• An Expert Summary of the Research From the Special Edition - Myalgic Encephalomyelitis: Clinical Working Case Definition. Journal of Chronic Fatigue Syndrome 2003 vol.11(1) p.68

Hundreds of individual research abstracts and articles by some of the world’s leading M.E. experts are also available to view on this site.

The following sections are particularly relevant with regard to GET:

• Cardiac and Cardiovascular Research,
• Exercise Research,
• Metabolic Research, 
• Mitochondrial Muscle Research and General Muscle Research

See all sections on the Research and Articles page

The book: The Clinical and Scientific Basis of Myalgic Encephalomyelitis Edited by Byron Hyde, M.D. is also vital reading for anyone with a real interest in M.E.

This book provides, in one superb 75-chapter source, an up-to-date, comprehensive account of current knowledge concerning the history, epidemiology, children with M.E., investigation, virology, immunology, muscle pathology, host response, food intolerance, brain mapping, neurophysiology, neuropsychology, psychiatry, sleep dysfunction and much more. This is an essential reference book for medical, government and public library reference rooms. This text is a unique vehicle for researchers, physicians and other health education and government officials, and is also easily understandable by the general public.

Also highly recommended is: CFS: A Treatment Guide by Verillo and Gellman. See the Book Reviews section for more information about both of these (and many other) M.E. books.

• Bassett, Jodi 2005. What is Myalgic Encephalomyelitis? A Medical and Political Overview [Online] Available: www.ahummingbirdsguide.com/whatisme.htm
• Williams, Margaret & Marshall, Eileen 2006 Some of the abnormalities that have been demonstrated in ME/CFS [Online] Available: www.ahummingbirdsguide.com/wmarwillsotathbdime.htm

*O* A Rose By Any Other Name by Dr Elizabeth Dowsett

Both the earliest definition (HOLMES et al, 1988) and its revision (FUKUDA, 1994) elevated tonsillitis, glandular enlargement and fatigue to unreal importance while overlooking the characteristic encephalitic features of the genuine illness.  These mistakes also inflated the possibility of a psychiatric diagnosis, leading to the incorporation of such a heterogeneous population of psychiatric and non-psychiatric causes later on, that research groups of different persuasions were unable to compare results or evaluate treatment.

The tools we can use today to study the brain offer possibilities which were unimaginable 50 years ago².  These include Molecular Biology: for example PCR – a microbiological technique capable of amplifying and identifying minute fragments of viral genes, hidden away in internal organs (such as brain, heart or muscle ³) while a test for rapid diagnosis (within five hours) is currently available.  These tests indicate that viruses from the polio group, or related to it, are involved both in the late effects of ME and the Post Polio Syndrome ⁴.  Brain Imaging: the use of CT, MRI, SPECT and PET scans clearly indicates that metabolic dysfunction in the brain stem and the spinal nerve radiations which transverse it, are initially associated with viral (inflammatory) damage and are the major cause of the cardinal symptoms of ME – central fatigue, stress induced weakness, autonomic nervous dysfunction and the breakdown of homoeostasis over hormonal and other vital functions⁵.

*O* The Late Effects Of M.E. - Can they be distinguished from the Post-Polio Syndrome? by Dr Elizabeth Dowsett

"The number likely to be affected by the post-polio syndrome has been calculated as between 200-270/100,000 currently[7], but no account has been taken of survivors from non-paralytic polio which could easily double that figure. Possible costing for ME support has been based on 3 times the cost of maintenance for multiple sclerosis on the supposition that ME is 3 times as common[4]. The only costs that we can be sure of are those derived from the failure of appropriate management, and of inappropriate assessments which waste vast sums of money and medical time while allowing patients to deteriorate unnecessarily.[16]
Research workers must be encouraged and appropriately funded to work in this field. However they should first be directed to papers published before 1988, the time at which all specialised experience about poliomyelitis and associated infections seem to have vanished mysteriously![11,12,13]"

*O* Redefinitions of ME - a 20th Century Phenomenon by Dr Elizabeth Dowsett

"If the cause of a disease, the way in which it is acquired and the processes by which damage is caused are known, no definition is needed.  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!"

*O* Research into ME - 1988-1998 Too much PHILOSPHY and too little BASIC SCIENCE! by Dr Elizabeth Dowsett

WHAT IS RESEARCH? It is simply an attempt to discover the truth.  However, even in 1999, this search may still concentrate on  one of 2 alternate pathways:

a) The METAPHYSICAL (or philosophical) route which seeks to establish truth purely by reason and argument. b) The PHYSICAL (or scientific) path which sets out to determine facts by systematic investigation of material events and by experiment.

The metaphysical approach bears much the same relationship to the scientific as ASTROLOGY (which involves the influence of the stars on human affairs) does to ASTROPHYSICS (which determines the chemical and physical composition of astral bodies).

...1988 The metaphysical approach ousts science once again.  Although research funding  for the study of ME is minimal in the UK, the major sources (totalling some £5 million in recent years) are non governmental agencies such as the Pharmaceutical and other industries.  The major beneficiaries are, without doubt, members of the psychiatric profession who have exhumed ancient terms such as “hysteria” and invented new ones such as “somatisation” to explain that patients suffering from ME perpetuate their own illness.  Previously reputable medical journals concur with this strange philosophy(11.)

A new definition for ME.  Following successful immunisation against poliomyelitis in the early 1960s and the removal of 3 strains of polio virus from general circulation in the countries  concerned, the related non polio entero viruses rapidly filled the vacancy.  By 1961, the prevalence of diseases (such as viral meningitis) caused by these agents soared to new heights.  In the mid 1980’s, the incidence of ME had increased by some seven times in Canada and the UK, while in the USA a major outbreak at Lake Tahoe (wrongly ascribed at first to a herpes virus) led to calls for a new name and new definition for the disease, more descriptive of herpes infection.  This definition based on “fatigue”^(10.) (a symptom common to hundreds of diseases and to normal life, but not a distinguishing feature of myalgic encephalomyelitis) was designed to facilitate research funded by the manufacturers of new anti-herpes drugs.  However, a “fatigue” definition (which also omits any reference to children) has proved disastrous for research in the current decade.  Whether in its original form or in the 4 redefinitions which have followed,  most research workers, led by the Americans are now calling for an urgent change (omitting “fatigue”) so that like can be compared with like in international ME research.

Brain problems in ME – is there a simple explanation? by Dr Elizabeth Dowsett

"A good memory demands normal functioning of almost all areas of the cerebral cortex, the basal nerve centres of the mid brain (eg the thalamus and hippocampus) and their interconnecting pathways through the brain stem. Fluctuations of metabolic activity in these areas (often made worse by physical and mental exhaustion) have been reported in SPECT scans of patients with ME,(2) the vast majority of whom complain of difficulty with short-term memory."

*O*O* A New and Simple Definition of Myalgic Encephalomyelitis and a New Simple Definition of Chronic Fatigue Syndrome & A Brief History of Myalgic Encephalomyelitis & An Irreverent History of Chronic Fatigue Syndrome by Dr Byron Hyde MD (an extract, PDF format)

‘Do not for one minute believe that CFS is simply another name for Myalgic Encephalomyelitis (M.E.). It is not. Though CFS is based upon a typical M.E. epidemic, in my opinion it has always been a confused and distorted view of reality. The invention of Chronic Fatigue Syndrome has to be one of the most curious cases of inventive American scientific imperialism that one could imagine. It is my opinion that the CDC 1988 definition of CFS describes a non-existing chimera based upon inexperienced individuals who lack any historical knowledge of this disease process. The CDC definition is not a disease process.’

*HIGHLY RECOMMENDED*

*O*  The Complexities of Diagnosis by Byron Hyde MD

(Taken from: Handbook of Chronic Fatigue Syndrome by Leonard A. Jason, Patricia A. Fennell and Renée R. Taylor)

The physician and patient alike should remember that CFS is not a disease. It is a chronic fatigue state as described in four definitions starting with that published by Dr. Gary Holmes of the CDC and others in 1988 (Holmes, Kaplan, Gantz, et al., 1988; Holmes, Kaplan, Schonberger, et .al., 1988). The definition created by Lloyd, Hickie, Boughton, Spencer, and Wakefield (1990) is also widely used in Australia. There are two subsequent definitions. The Oxford definition of 1991 (Sharpe et al., 1991) and the 1994 NIH/CDC definitions (Fukuda et al., 1994) are basically, with a few modifications, copies of the first definition. Where the one essential characteristic of ME is acquired CNS dysfunction, that of CFS is primarily chronic fatigue. By assumption, this CFS fatigue can be acquired abruptly or gradually. Secondary symptoms and signs were then added to this primary fatigue anomaly. None of these secondary symptoms is individually essential for the definition and few are scientifically testable. Despite the list of signs and symptoms and test exclusions in these definitions, patients who conform to any of these four CFS definitions may still have an undiagnosed major illness, certain of which are potentially treatable.

Although the authors of these definitions have repeatedly stated that they are defining a syndrome and not a specific disease, patient, physician, and insurer alike have tended to treat this syndrome as a specific disease or illness, with at times a potentially specific treatment and a specific outcome. This has resulted in much confusion, and many physicians are now diagnosing CFS as though it were a specific illness. They either refer the patient to pharmaceutical, psychiatric, psychological, or social treatment or simply say, "You have CFS and nothing can be done about it."

[On the differences between ME and CFS]

*O* Are Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Synonymous Terms? by Byron Hyde MD

Abstract: At the 1998 M.E. /CFS conference in Australia, both Myalgic Encephalomyelitis and Chronic Fatigue Syndrome were used to describe a chronic illness. This paper is a discussion on the similarities and differences in these two terms that may lead to scientific difficulties. The author suggests that the definitional criteria and epidemic history of Myalgic Encephalomyelitis (M.E.) and the inclusion criteria are significantly different from the CDC definitions and history. The three typical phases of M.E. are discussed. A brief review of some of the known deaths in phase 2 of M.E. are also mentioned.

*O* Three Babuska Clusters of Enteroviral-Associated Myalgic Encephalomyelitis by Byron Hyde MD

Although physicians associated with Nightingale have been studying both M.E. and CFS patients since 1984, it was only in 1995 that we began to include in the investigation of each new Nightingale M.E. patient, an evaluation by PCR for chronic persisting enteroviral infection. The material employed was frozen blood serum that was evaluated by the research team of the viral laboratory of Ruchill Hospital in Glasgow. These patients were re-evaluated approximately once or twice a year for a period of three years. Blood serum from control patients of similar age and sex were submitted with serum from M.E. patients. Blood from other patients with various autoimmune diseases or neurological illnesses were also submitted along with our samples. The names were changed in repeat samples. The serum received at Ruchill Hospital was divided into reserves and two blinded samples of this serum were investigated by PCR in different laboratories. Only when each sample source was found to be positive for the same enteroviral code was the serum accepted as having a specific circulating enterovirus.

Clinical Features of M.E./CFS by Byron Hyde MD.

I will call for the recognition of M.E. as a more distinct clinical entity than CFS. I will also note that CDC as described by the CDC and the UK and Australian groups is actually a more diverse disease spectrum associated by a common group of symptoms but often with vastly different etiology, physical findings and clinical outcome.

*O* What is ME? What is CFS? Information for Clinicians & Lawyers  by Eileen Marshall, Margaret Williams & Professor Malcolm Hooper, 2001

Lawyers may wish to consider if a small group of exceptionally influential doctors should be allowed to determine public policy without there being some external moderation. They may wish to consider why disease definition has become socially constructed, resulting in political tensions between sufferers, medical science and the modern State, a consequence of which is the intentional construction of "mental illness" by some groups of medical professionals resulting in stigma caused by the on-going denial. (172)
If clinicians and lawyers are unaware of this background and accept the readily proffered psychiatric explanations as if objective and based on sound scientific research, they will be unable to support their patients / clients with ME / ICD-CFS and will risk failing in their professional duty in this difficult area.

Full title: CONCERNS ABOUT THE FORTHCOMING UK CHIEF MEDICAL OFFICER’S REPORT ON MYALGIC ENCEPHALOMYELITIS (ME) AND CHRONIC FATIGUE SYNDROME (CFS), NOTABLY THE INTENTION TO ADVISE CLINICIANS THAT ONLY LIMITED INVESTIGATIONS ARE NECESSARY

We are unable to agree with advice to clinicians that only limited investigations are necessary or appropriate for ME/CFS sufferers and believe that such a view is medically and scientifically untenable; hence we believe there is a legitimate case for making this known in advance of the Report being issued. In our opinion, it is entirely unacceptable to advise clinicians that investigations on ME/CFS patients should be limited to a minimal basic routine screen, especially as basic screening is known to be often normal in ME/CFS.

In our opinion, when taken in consideration of all that is already known about the biomarkers of ME/CFS, the evidence of serious pathology presented at Seattle emphasises the unacceptability of advising that such pathology should not be fully investigated. It also underlines the fallaciousness of advising that such substantial pathology can be satisfactorily treated by cognitive behavioural therapy or graded exercise; thus we believe it is imperative for people to be aware that the most influential members of the CMO’s Working Group are apparently still determined to proceed along such avenues despite all the evidence which has been put before them.

[Includes a summary of much of the medical research into ME/ICD-CFS]

This present document should be read in conjunction with the amended original Montague / Hooper paper

Montague and Hooper believe that by seeking to equate one specific syndrome or subgroup with another syndrome or subgroup which does not have the same features, the CMO’s Working Group may be doing a grave disservice to both patients and medical science: they believe it is scientifically unacceptable that one name should refer to two different case definitions, each of which having different symptom profiles.  Montague and Hooper are concerned at the repeated refusal by the CMO’s Key Group to acknowledge the clinical difference between ME and other forms of CFS, a difference which many believe has important implications for management and treatment outcomes, as well as for service provision.

[A solid overview of the medical and political facts surrounding M.E. and CFS in the UK.]

*O* Myalgic Encephalomyelitis (ME): a review with emphasis on key findings in biomedical research by Professor Hooper 2006, printed in the BMJ

‘Undoubtedly the perverse use of chronic fatigue syndrome, to impose a psychiatric definition for ME/CFS by allying it to fatigue syndromes, has delayed research, the discovery of effective treatment(s), and care and support for those suffering from this illness

I would propose that the use of CFS should now be abandoned and that, following the Minister of Health’s assurances, the WHO definition is now accepted and used in all official documentations. The excellent work on the biological aspects of ME, already carried out by several leading research groups, now requires significant funding.’

J. Clin. Pathol. published online 25 Aug 2006; doi:10.1136/jcp.2006.042408 Available: http://jcp.bmjjournals.com/cgi/content/abstract/jcp.2006.042408v1

Full title: A CONSIDERATION OF THE ROLE OF PROFESSOR SIMON WESSELY AND OTHER MEMBERS OF THE “WESSELY SCHOOL” IN THE PERCEPTION OF MYALGIC ENCEPHALOMYELITIS (ME) IN THE UK

To the detriment of the sick, the deciding factor governing policies on medical research and on the management and treatment of patients is increasingly determined not by medical need but by economic considerations. Evidence is presented in this document to show that:

In the UK, patients with myalgic encephalomyelitis (ME, also known as Chronic Fatigue Syndrome or CFS), particularly children, have suffered gross and barbaric abuse and persistent denigration as a consequence of the beliefs of certain psychiatrists who are attempting to control the national agenda for this complex and severe neuro-immunological disorder. These psychiatrists are shown to be clearly in breach of the first tenet of medicine --- first do no harm--- in that by their words and deeds they have wreaked havoc in the lives of ME/ICD-CFS patients and their families by their arrogant pursuit of a psychiatric construct of the disorder which ignores the abundant clinical and scientific evidence (widely presented in the international medical and scientific literature) of the organic nature of ME/ICD-CFS

There have been persistent and frequently covert attempts by these psychiatrists to subvert the international classification of this disorder, with destructive consequences for those affected. To the serious disadvantage of patients, these psychiatrists have propagated untruths and falsehoods about the disorder to the medical, legal, insurance and media communities, as well as to Government Ministers and to Members of Parliament, resulting in the withdrawal and erosion of both social and financial support

Influenced by these psychiatrists, Government bodies such as the Medical Research Council have continued to propagate the same falsehoods with the result that patients are left without any hope of understanding or of health service provision or delivery.  As a consequence, Government funding into the biomedical aspects of the disorder is non-existent

This coterie of psychiatrists has proven affiliations with corporate industry and has insidiously infiltrated all the major institutions, directing funding for research into an exclusively psychiatric model of the disorder, focusing on “management strategies” involving psychiatric techniques, even though such techniques have been shown to be at best of no lasting value and at worst to be harmful to patients with ME/ICD-CFS

Having read the report, we conclude that it is like the proverbial curate’s egg:  “good in parts”.  However, in terms of demonstrating an understanding of ME/ICD-CFS and a grasp of the issues (and thus of providing hope of real progress to those whose life is blighted by it), the bad parts seem to outweigh the good: essentially the report is, as widely predicted, simply “more of the same” from a Government agency which is under the nominal political control of the Labour Science Minister Lord (David) Sainsbury (whose Linbury Trust has for so long financially supported those UK psychiatrists of the “Wessely School” who claim that ME does not exist and that “CFS” is a mental disorder which must be managed by cognitive behavioural therapy and graded exercise).

Despite the claims of some psychiatrists, it is not true that there is no evidence of inflammation of the brain and spinal cord in ME; there is, but these psychiatrists ignore or deny that evidence.  It is true that there is no evidence of inflammation of the brain or spinal cord in states of chronic fatigue or "tiredness". 

It is also true that neither the 1991 (Oxford) criteria nor the 1994 (CDC) criteria select those with ME, as they both expressly include those with somatisation disorders and they expressly exclude those with any physical signs of disease (as is the case in ME), so by definition, patients with signs of neurological disease have been excluded from study. 

It is also true that Professor Simon Wessely and his colleagues use the terms "fatigue", "chronic fatigue", "the chronic fatigue syndrome (CFS)" and "myalgic encephalomyelitis (ME)" as synonymous.  Such obfuscation has greatly hindered research.

This is a fully referenced 85 page document which contains colour photographs. It is dedicated to Derek Peters of the Northern Ireland Campaign for ME/CFS Healthcare (who sponsored the publication), to the late Dr John Richardson (a compassionate clinician and champion of more than 4000 ME sufferers for over 50 years) and to “all who suffer with and care for people with ME, who have taught me so much about courage, endurance and being fully human”.

In his customary robust form, Hooper deals with facts, not beliefs or speculation and those facts are soundly based on biochemistry, which those who promote a primary psychiatric pathoaetiology will find difficult to refute with any degree of credibility.

Hooper is explicit: in addition to his scientific investigations of sufferers (which he details in the text), he writes that he has examined much of the ME literature and is “fully persuaded of the organic nature of this illness and the folly and cruelty of attempting to regard it otherwise”.

He explains how he came to be involved with ME and overlapping conditions, and how he discovered “new and disturbing areas of suffering, abandonment by conventional medicine, and heroic persistence in mutual support and the search for understanding, diagnosis, treatment and hope for the future”. (Taken from the 25% Group website)

Dr Paul Cheney on cardiac issues and M.E. and the related Peckerman et al. study.

CFS Compensates for Idiopathic Cardiomyopathy "Let me first of all define heart failure. There are two kinds of heart failure. There's the kind that any cardiologist can diagnose in about a minute. That you do NOT have. Which is why cardiologists missed this. What you have is Compensated Idiopathic Cardiomyopathy." [Idiopathic: cause unknown; Cardiomyopathy: structural or functional disease of heart muscle] "And your primary means of compensation—now this is the big twist—are you ready? Have you got your seat belt on? The primary methodology for compensation for this disorder is in fact CFS itself."

*O* Worldwide Epidemic/Over 1 Million in U.S. Atypical Polio, Myalgic Encephalomyelitis, Gulf War Syndrome Vaccines and Toxic Chemicals Government Agencies Obscuring the Evidence

We are here today, because a widespread epidemic of Myalgic Encephalomyelitis has descended upon this country. In less than twenty years time there are now over 1 million victims in the US alone and millions more worldwide. We are here because the national health agencies have not addressed this danger to the public health nor sought to find the cause or remedies for the suffering.

We are here to inform the public that the national health agency policies are subjecting patients to a systematic denial of medical services and are maintaining doctors all across this country ignorant about this disease. These health agency policies have ensured that the cause of this disease is not discovered. These policies impact the health of thousands already disabled by ME and continue to place everyone at risk.

A principal issue must not be overlooked: Why has ME, which has an historical relationship to Polio, exploded into a worldwide epidemic, and what is the inordinate fear of the DHHS to recognize this and discover its cause?

*O* A Public Statement to Government Health Ministers and an ALERT to citizens worldwide

Just twenty years ago an Epidemic of the infectious neurologic disease Atypical Polio began to skyrocket like never before and the Government agencies have been covering it up ever since. Thousands have died and millions are now disabled.

*O* ME and CFS, The Definitions

All definitions which wear the 'f' word (ie. fatigue) in their name are not ME nor neurological. They are definitions of fatigue conditions. And when these definitions were written it was not neurological ME which they were attempting to define.

*O* Clinical Definition and Diagnosis

Encourage your doctor, hospital, library, to order the Special edition of the JCFS, 2003, vol 11, # 1, Myalgic Encephalomyelitis Clinical Working Case Definition, from The Haworth Document Delivery Service:1-800-HAWORTH. E-mail address: <getinfo@haworthpressinc.com> Website:http://www.HaworthPress.com

A Landmark in ME History

A New Clinical Entity ? THE LANCET. LONDON : SATURDAY, MAY 26, 1956

The Neurology of ME

How Serious is ME

The complete answer to this question is clearly important and not yet fully established. However the families of patients that have succumb to this disease may hold a different opinion. These few brief reports on this page will help demonstrate the diverse course and consequence of infection with Myalgic Encephalomyelitis. ME has a variety of manifestations and outcomes, some patients improve but many more follow a chronic trajectory. Lifelong disability is common.

The full range of symptoms and consequences of ME are too numerous to fully discuss here, however the most dangerous can be described as related to three factors. Infection of the brain, Metabolic changes and Immune dysfunction.

[Contains research]

*O* An interview with Hillary Johnson

Is CFS contagious? There is ample evidence for contagion. Over the last decade, scores of cluster outbreaks of CFS have been reported to the Centers for Disease Control from all over the country. A "cluster" is a sudden outbreak among a group of people who are connected to one another by place of work or residence. These include an outbreak among children in a small, upstate New York town called Lyndonville, an outbreak in a Nevada desert town called Yerington, and an outbreak among policemen in Spokane, Washington. In a 1992 research paper on the Nevada outbreak, Harvard researchers pointed out that there was enough evidence to "suggest the possibility of an infectious agent transmissible by casual contact."

The term Chronic Fatigue Syndrome (CFS) was introduced in 1988 to describe medically unexplained, persistent or relapsing fatigue of new onset.

CFS has come to include what has historically been known as Myalgic Encephalomyelitis (ME).

CFS represents a broad diagnostic category and selects a heterogeneous (mixed) patient population, amalgamating disparate health problems that contain "fatigue" under the umbrella term CFS. Some patient groups adopted the term Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) to differentiate it from idiopathic chronic fatigue.

*O* ME is not fatigue by Maryann Spurgin Ph.D.

M.E. is not a fatigue state, and fatigue is not a defining symptom of M.E. We do not support use of the word "fatigue" either to name this illness or to describe this illness. Patients and patient groups who want to "change the name" must first take responsibility accurately to describe the symptomatology. This is a disease wherein extending beyond a certain threshold of activity leads to symptoms, which can be described in specific, accurate terminology without reference to broad or demeaning terminology such as "fatigue" or "poor stamina.” M.E. is a disease, and patients are sick, with often excruciating symptoms that can be clearly articulated. The defining characteristic of M.E. is that patients relapse with physical exertion and develop disease progression with continued physical exertion. Hence, the defining characteristic is exercise intolerance, post-exertional muscle weakness, generalized weakness, faintness, and pain; and post-exertional relapsing of symptoms. In some cases symptoms remit with rest, and in other cases they do not. In fact, recent research on a prominent subset of the illness showed that postural stress and exercise exacerbated cardiac insufficiency in this disease. If a patient improves with exercise, that patient does not have M.E. and may have some illness other than M.E. (for example, arthritis, depression, osteoporosis, and a number of medical conditions do improve with exercise).

*O* The Need to Abolish the Fatigue Model and to Establish Precise Subsets by Maryann Spurgin Ph.D.

One of the main goals of the M.E. Society is to see the inaccurate, vague, demeaning word "fatigue" eliminated not only from names but also from descriptions of the disease and from scientific discussion. We hold that scientific progress cannot be made when researchers focus on and blend the patients together by the poorly defined symptom of fatigue, which muddies understanding of the disease because it is a symptom of many diseases, of psychiatric diseases, as well as a normal physiological state. We hold that the community of interested parties should use more precise language and focus instead on the neurological, neurocardiac, myocardiac, endocrinological, immunologic, and circulatory models that are now being developed based on current research. We hold that working on subsets using these models and selecting subsets of patients with homogeneous variables -- as opposed to lumping heterogeneous patients together by the vague, poorly defined symptom of "chronic fatigue"--is the key to scientific progress in this area of research

Maryann Spurgin, Ph.D.,reviews the 2003 ME/CFS clinical case definition

In sharp contrast to the 1994 CDC Fukuda criteria, which makes "fatigue" a compulsory symptom but downplays and makes optional post-exertional sickness and other cardinal symptoms, the Canadian clinical case definition specifically selects patients who worsen with exercise. The clinical definition makes it very clear and compulsory that in order to meet the diagnostic criteria, the patient must become symptomatically ill after exercise, and must also have neurological, neurocognitive, neuroendocrine, dysautonomic (for example, orthostatic intolerance), and immune manifestations. That is, worsening with exercise, and many symptoms other than fatigue, must be present for a patient to meet the diagnostic criteria. This case definition will go a long way to help distinguish ME/CFS patients from chronic fatigue patients, depressed patients, patients with PTSD, somatization, fibromyalgia, and other diseases with which ME/CFS has been confused, including those that improve with exercise. The Canadian definition specifically states that patients "become worse after exercise rather than better." This counters the view being put forward by persons such as Wessely and Chalder, who hold that the disease is an unexplained interpretation disorder and behavioral problem leading to deconditioning for which CBT and GET are effective treatments. The new case definition, much of which is backed by research and hard science, is a strong counterstatement to the view held by these psychologists and psychiatrists.

Sophisted Investigation by Cesar Quintero

Much reported controversy surrounds the public health agencies and their handling of investigation into the disease Myalgic Encephalomyelitis.   Surely the most advanced nations with legions of medical scientists would be motivated to meet the challenge and discover the cause of an epidemic striking down its citizens, which leaves large numbers permanently disabled.  Yet the response of the public health agencies has caused particular skepticism.  This has raised many questions.

 Now this question may sound very odd, but consider: How would you Disguise a Disease ?

I doubt there could be too many ways . . . But if that were your intent, Let's see, where would you start --

Camouflage! First declare it is a New illness. (Brilliant!) Declare that there is no epidemic! (Tremendous) Spread the word it is not serious. (Spectacular!!!) Create a smokescreen by using a vague definition so that you can mix in many non-cases, and thus claim it is very hard to identify; then

Cover your tracks! Give the Disguised Disease a variety of New names. (Yes, a trivial absurd name, splendid!) Disassociate it from its previous established name, research, case studies, descriptions and diagnostic ICD classification. (Fantastic) Lets see what else could we do to disguise a disease

Create Confusion! We could tell Drs that this disease is "mysterious" and that there is no need to investigate, "Don't do any testing" (you won't find anything) Its a Mystery.

*O* ME/CFS Politics in a Nutshell (UK) by Kevin Short

Ever mindful of budgets, In the UK, Government Ministers have been captured by the psychologising views of the Wessely School, Insurance Industry and the DWP ⁴ and are pursuing their ‘Pathways to Work’ project - which is set to gain momentum from 2005. A situation where sufferers of a physical neuro-immunological disease (M.E.) will be routinely referred to psychiatrists as mental health patients – and subject to harmful ‘treatment’⁵ upon pain of benefits withdrawal – is being set up. This is NOT exaggeration and I would direct you to the extremely worrying comments of Wessely-School psychiatrist Dr Michael Sharpe: "Those who cannot be fitted into the scheme of objective bodily illness yet refuse to be placed into and accept the stigma of mental illness remain the undeserving sick of our society and health service."⁶

In spite of all the biomedical evidence to the contrary, these vested-interest psychologisers continuously maintain their anti-science mantra: that ‘M.E. is perpetuated by mistaken belief and sick-role behaviour’. Their well-funded lobby

machine relentlessly bombards parliament and the media with disinformation - and they flood medical and trade journals with extremely low quality psychiatric ‘research’ papers.⁷ Inevitably, all of this adversely affects the views of time-pressed GPs who are simply too busy to read all the bio-medical research papers themselves. Adding to this problem is the fact that Wesselyite psychiatrist, Professor Peter White, has even managed to have ME/CFS listed under the heading of "Functional or Psychosomatic Disorders: Medically Unexplained Symptoms" in the main general textbook recommended by the BMA and used by most GPs and medical students.⁸

A Million Stories Untold - on this site.

Fatigue Schmatigue - on this site.

Smoke and Mirrors - on this site.

What is ME? - on this site.

M.E: The Medical Facts - on this site.

The Ultra-comprehensive ME/ICD-CFS Symptom List. - on this site.

3 Part ME/ICD-CFS Ability and Severity Scale - on this site.

A Superb Summary of the Research suitable for doctors and patients from the Myalgic Encephalomyelitis Clinical Working Case Definition.

Advances in the biomedical investigation of ME from MERGE

Severely Overlooked by Science — An Overview of Research on Severely-ill People with ME

Research topics:  General Articles and Research Overviews, Immune System Research, Viral Research, Cardiac Research, Exercise Research, Muscle Research, Metabolic Research, Neurological and Cognitive Research, Genetic Research, Neuroendocrine Research, and Miscellaneous Research.