Editorial on CFS was biased, inaccurate, and misleading

Editor—As a member of the chief medical officer's working group on chronic fatigue syndrome, I consider that Straus has failed to appreciate the difficulties of deciding what constitutes evidence in an illness as uncertain and heterogeneous as this.¹ He also misunderstood, or took out of context, some of the key conclusions and recommendations in the chief medical officer's report.

Although it was agreed that evidence should not just be limited to the results of randomised controlled trials, the findings of the York systematic review were frequently cited. It was therefore disingenuous of Straus to state that information from this review did not influence the report's conclusions about a wide range of therapeutic interventions. It did.

Equally, it would have been a serious omission if the report had failed to refer to the feedback from patients contained in three large surveys on attitudes to management, as well as two events where patients and carers met with the working group. All three surveys concluded that graded exercise as is currently being done made more people worse than any other intervention. Pacing, however, was found to be beneficial by around 90% of respondents. By dismissing such views as anecdote, Straus fails to appreciate that the Department of Health is encouraging patients to enter into a therapeutic relationship with the medical profession in the management of chronic conditions such as this.²

The recommendation that an incipient diagnosis of chronic fatigue syndrome should be considered after six weeks of characteristic symptomatology was taken out of context. Current diagnostic criteria for the syndrome have been heavily criticised for their emphasis on selecting patients for research rather than routine clinical assessment, and there was widespread agreement that early diagnosis with advice on management could reduce long term morbidity. Does Straus believe that these patients should have to endure six months of quite severe ill health before they can be offered a presumptive diagnosis and advice on management? The report clearly concluded that this should no longer be the case.

Despite his generally dismissive view of much of the section on management, Straus nevertheless welcomes the main conclusion: that this is a genuine and disabling illness that can no longer be ignored by clinicians and researchers.