Wednesday, March 5, 2008

Two views on dropping CFS as the name

Judith writes:

It is true that I haven't been active online for a long time.  I  simply have
been too sick and scarily undermined financially.  HOWEVER,  I've been
reading lots, was active for years and years re the name of our  illness, and have
respect for some who support "ME/CFS."

I myself have used it with physicians and others.  My reason has been  that
because "CFS" has come to be increasingly recognized as an illness and not 
just some excuse to cover up that I'm totally or majorly psychosomatic, or lazy, 
or all the other demeaning things "CFS" has afflicted me with (!).  I 
thought then that just using "ME" would give me an illness in the eyes of others  as
something they knew nothing about, or as an effort on my part to medicalize 
whatever was wrong with me, and on and on.  And I was worn out having to 
provide explanations that probably wouldn't be accepted anyway since "ME" was  not
something in common or medico-scientific parlance.

HOWEVER, "CFS," the name applied to so many patients and used by some 
respected people who have published in first-rate journals, describes one thing  and
one thing only: the fear, mixed with ignorance and laziness, by some 
physicians in the late '80s to use the name that most closely describes a  disease or
cluster of diseases BECAUSE those doctors wrongly believed that in  order to
be connected to an illness that the rest of the medical world would  respect
that illness had to have some very specific marker.

This fear was seen in other fields that wanted to be considered respectable 
scientifically.  One I'm very familiar with because it was what I studied  was
sociology.  American sociology went off on a very different tangent  from
some of the richest sociological European sociological works and tried to 
describe human behavior in groups by using numbers and numerical scales.  I 
remember sitting in class and saying to myself, "this is crazy"--it adds nothing  to
the understanding much less the predicting or changing of human  behavior. 
And because of that I started to take the maximum number of  courses I could
take in the philosophy of science, where some very good thinkers  "helped" me
understand my reactions.

It has been now stated and recognized that those who first realized that 
there was a disease involving at least the brain and the muscles and maybe the 
immune system have now increasingly been vindicated in their observations.  
And while had this research been done closer to the naming of the illness 
"Myalgic Encephalomyelitis" it might have been named something somewhat  different,
once named and subsequently so validated by increasingly solid  scientific
research and clinical observations that name should be reinstated  until such
time as there is an accumulation of solid scientific grounds to  rename the
disease (which rename will hardly be "CFS" or "CFIDS."

So I have decided that I will give up the comfort of getting the  recognition
that "CFS" is beginning to confer (especially since very few doctors  know
what it depicts anyway, and use "myalgic encephalomyelitis" knowing I do  have
to have the decency to explain that in a lot of the literature and in  popular
parlance this illness has been and will be for a while (unpredictable  how
long) called "CFS."  And if the person wants to know more I'll tell  them, which
of course I wish I didn't have to spend energy on.

But I refuse to be complicit with equating "CFS" with "ME."   Especially
since one is an illness and the other is an interesting but awful  reflection of a
gross misunderstanding of medical nosology not to mention the 
characterization of the symptom clusters that actually exist.

I don't think we should worry about the folks who go bananas about "itis" 
because on conventional measures of inflammation those with ME haven't 
apparently been shown to have inflammation in the "encephalomyo."  There  has been
observed amongst so many patients evidence of this being an illness  where
inflammation of some sort is very much a part, let it be, again, until  there is
some breakthrough in research that might be cause enough to rename  "ME-itis."

Funny thing in a manner of speaking, I am finding that increasingly  clinical
people speak more comfortably of "fibromyalgia" when describing or 
explaining some feature of my many symptoms.  And it's not just the  pain.  It's other
symptoms as well. 

When we get some truly wise epidemiological studies we may begin to see 
certain subgroups emerging that will speak to a number of these issues.  In  fact
it is tragic this hasn't yet been done.  If each of us could imagine  if we
don't have a doctor to whom we can tell all the weird symptoms we have  that
wander through our bodies and don't easily follow patterns but patterns do 
sometimes emerge, each of those stories, those so-called and demeaned anecdotes, 
when compiled, with good demographic categories, and even some diaries, there 
would be I think the clarification of many issues including if FM can be a 
separate disease or always a set of symptoms in a subset of people with ME, of 
portraits that may start sounding like the inflammation that's recognized as 
inflammation in other diseases, and so much more.

I'd love to continue in this discussion but things are sufficiently bad  with
me now that I must, if typing, use those muscles and brain cells for  helping
find money or volunteers and also spending more time pacing, which is  right
now almost mandatory. 

I think I've said this before.  I received Social Security Disability  before
the late 1980's, in 1986, and my doctor, my lawyer, and I used the  British
ME literature which to everyone's surprise got me Social Security  Disability
in the U.S.  It was an accident that I found out about the  disease called ME. 
But I was in a temporary remission and could get to a  medical library and
some librarian, when I mentioned "benign myalgic  encephalomyelitis" which I had
heard used from Alexis Shelokov, M.D. found me an  article on that topic,
which article led me to a British organization who put me  in touch with people
like Betty Dowsett, M.D. and others.  And that was a  very vital set of
connections.  Too bad that SSDI is so pitifully  inadequate for people who haven't
worked at a good job long enough to allow for  a monthly SSDI payment that now
leaves me in penury and cannot be lived  on.

Please, I do beg you, to consider droping the equating of ME with CFS as 
"ME/CFS" which means very specifically "ME or CFS."  They are not either  or. 

Thanks.

Judith Wisdom
USA

Erik responds:

"CFS" has a meaning that everyone should understand:
It is the term that was applied to an illness that the ME literate
doctors present at the time, Gordon, Shelokov and Hyde believed to be
ME.
This re-naming was performed by the CDC for the specific reason of
disallowing credibility for ME.

Whether one chooses NOT to be complicit in connecting ME and CFS is
not really meaningful and changes nothing, as the characteristics of
the illness AND the actions of the ME literate doctors have already
done so in a manner that cannot be "undone".

Just imagine what would have to be accomplished in order to
completely "disconnect" CFS from ME. 
All the copies of Osler's Web would have to be burned, countless
medical records destroyed, many tons of evidence which document the
immune abnormalities must be buried forever, references on the
internet erased, and all the survivors and witnesses would either
have to die off or forget what happened.

Wouldn't it be simpler to just stick to the truth?

"Chronic Fatigue SYNDROME" is the rotten name given to an illness
which is commensurate with ME, but so many people went into mind-melt
moronic-fixation brainlock over the "fatigue" word that they wound up
spending decades fighting with horribly ill people and lumped them
into  "fatigue that is caused by anything and everything", so when we
say "CFS", we are forced to specify exactly what kind of "CFS" we are
referring to - the Canadian Consensus Guidelines kind.

There. 
Isn't that easier and more truthful than the alternative?
-Erik

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