MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

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He concluded his presentation: “It’s confusing, isn’t it?….ICD‐10 is not helpful and I would not suggest, as
clinicians, you use ICD‐10 criteria. They really need sorting out, and they will be in due course, God
willing”.
That was a clear instruction to clinicians to disregard the ICD‐10 classification of ME/CFS as a neurological
disorder.
In an April 2009 paper, Peter White and co‐authors concluded that their data “suggest that fatigue syndromes
are heterogeneous, and that CFS/ME and PVFS should be considered as separate conditions, with CFS/ME having
more in common with IBS (Irritable Bowel Syndrome) than PVFS does. This requires revision of the ICD‐10
taxonomy, which classifies PVFS with ME” (Psychol Med 2009:Apr 15:1‐9 PMID:19366500).
This seems another example of inconsistency on Peter White’s part, because here he is saying that “CFS/ME”
has more in common with irritable bowel syndrome, but this is the exact opposite of his comments to NICE
about the draft Guideline, where he asserted: “bowel symptoms are not part of CFS/ME” (St Bartholomew’s
Hospital Chronic Fatigue Services, Stakeholder comments on Chapter 6 of the draft Guideline on “CFS/ME”,
page 316). Such an assertion is all the more curious because the MRC website includes “gastrointestinal
problems” in its description of “CFS/ME” and Peter White was involved with the 1994 UK Task Force Report
on ME / CFS / PVFS which on page 71 at section 14.6.1 states: “Given that symptoms of irritable bowel syndrome
are common and that some patients develop food sensitivities, this is an area which urgently needs to be further
studied”. It is therefore remarkable that in his Stakeholder submissions to the NICE draft Guideline twelve
years later, Peter White still denied the existence of bowel problems in “CFS/ME”, yet in order to support his
call for a revised ICD taxonomy, he now claims that “CFS/ME” has more in common with irritable bowel
syndrome than with PVFS.
Recent papers by Wessely and Hotopf have discussed fatigue and the evidence for the concept of
neurasthenia – formally classified in ICD‐10 Chapter V at F48.0. As noted above, sixteen years ago, Wessely
asserted that neurasthenia “would readily suffice for ME” (Lancet 1993:342:1247‐1248) and his belief remains
firmly fixed despite the significant biomedical evidence that has emerged in the intervening sixteen years
which proves his belief to be false.
Professor Michael Sharpe and his fellow psychiatrist Professor Francis Creed (leader of the European
Medically Unexplained Symptoms [MUS] Study Group) are members of the DSM‐V (Diagnostic and
Statistical Manual‐V that is due in May 2013) Somatic Distress Disorders Workgroup that is redefining the
so‐called “Somatoform Disorders”.
Of relevance to the PACE Trial is the proposal of the Somatic Distress Disorders Work Group to create a
category of “Psychological factors affecting a medical condition” that would allow a co‐morbid diagnosis of
ʺsomatic symptom disorderʺ, thereby erasing the interface between psychiatry and medicine because this
proposed new category would apply equally to a “well recognized organic disease or a functional somatic
syndrome such as irritable bowel syndrome or chronic fatigue syndrome” (Editorial: J Psychosom Res. 2009:
66(6):473‐6 http://www.jpsychores.com/article/S0022‐3999(09)00088‐9/fulltext ).
As a (nominally) separate project, Professor Michael Sharpe is also the UK Co‐Chair of the international
CISSD (Conceptual Issues in Somatoform and Similar Disorders) Project, for which the charity Action for
ME (to which Professor Sharpe is an ad hoc medical advisor) was the principal administrator. The only
information that Action for ME has ever published on the project is to be found in their accounts and it is
mystifying: it is referred to as the “WHO Somatisation Project” and it says: “This grant is provided to help lobby
the World Health Organisation for the recognition of M.E. and its re‐categorisation as a physical illness”. Given
that the WHO has classified ME as a physical illness for the last 40 years, this statement from Action for ME
is inexplicable.