Nice guidelines "unworkable"

Dr Charles Shepherd of the ME Association has had an article published in the British Medical Journal. The article is here, and is very interesting.

It is well worth a look, especially as a lot of money has gone into the making of the NICE guidelines. The ME Association has been opposing the proposals for the guidelines for years and NICE made certain modifications as a result, but the guidelines are still "Unworkable".

Taxpayers Unite! The worst that can happen is that you will save money by stopping its lavish waste on "treatments" that cannot work and spending a fraction of the amount on research into biophysical markers leading to a foolproof diagnostic test. It is because there isn't such a test that quackery abounds as desperate people seek help for a life-stealing illness that may make them too ill to talk, eat, drink, tolerate light or the slightest sound or smell, have very considerable pain levels with sore throats, swollen glands, fever, weakness and serious cognitive impairment.

ME and Chronic Fatigue are not the same thing at all as ME is defined by the World Health Organisation as a neurological illness. CFS could be due to other causes but it lacks the chronic infective symptoms of swollen glands, sore throats and fever that are standard stuff in ME patients.

The word "Fatigue" is problematic because the public associate it with being tired. They very rightly think that they get tired too but don't retire to bed for years on end. The fatigue in everyday tiredness, which is resolved by getting enough rest is like a dripping tap compared to the 'tsunami' of ME. They aren't in the same league and it is foolish to equate them.

People die of ME and have it recorded as the cause of death on death certificates. Nobody dies due to everyday tiredness that a snooze can easily fix up.

This is not to trivialise CFS because it is also serious and debilitating. People may have CFS as a result of debilitating medical treatments such as cancer treatments or as a result of serious illness such as kidney or heart disease. People may have CFS as a result of adrenal exhaustion as a response to chronic severe trauma, or as a symptom of depression or something like Myaesthenia Gravis, Multiple Sclerosis, chronic Brucellosis, TB, Glandular Fever, chronic poisoning or other serious conditions.

So there is 'everyday tiredness' that a cozy snooze will sort out. Then there is CFS which is serious and debilitating and could be due to all sorts of reasons, and then there is ME. It makes no sense to lump all these things together and come up with management advice. A one-size-fits-all approach cannot work any more than a burst appendix turning into peritonitis cannot be effectively dealt with by a routine antacid offered for indigestion.

Treating different conditions differently makes sense to me.
Do gardeners try to grow cactus alongside ferns? No. They are too different.
Do Vets treat budgies the same way they treat leopards? No. They are too different.
Do people use Minis the same way they use tractors? No. They are too different.

These are not difficult concepts. Why is there so much difficulty in grasping that different things, although they may have certain similarities, have to be treated differently if treatment is to have any good effect at all?