Tuesday, December 31, 2013

2013 - A Year to Remember

Bob Miller skydiving for ME on May 12
By Erica Verrillo

What a year this has been for the ME/CFS community!

With four major conferences held in the US, the UK, and Australia, the inauguration of two new research and treatment centers, the first FDA meeting to discuss drug development for ME/CFS, fireworks at the CFSAC, the still unabated IOM controversy, an unprecedented consensus from the top 50 ME/CFS experts, two exciting new documentary projects, and an upsurge in advocacy efforts, this has been a year to remember.

Meetings: FDA Developments and Fireworks at CFSAC

The FDA held its first ever ME/CFS workshop, Drug Development for Myalgic Encephalomyelitis Chronic Fatigue Syndrome (ME and CFS), April 26 and 27, 2013 in Washington, D.C. The first day of the meeting was titled “Disease Symptoms and Daily Impacts That Matter Most to Patients” and featured presentations by patients, including Dr. Jon Kaiser, Joseph Landson, Charlotte Von Salis, Tasha Kelemen, Matina Nicholson, Mary Schweitzer, Mindy Kitei, and many others. Patient advocates Mary Dimmock, Dr. Janet Smith and Denise Lopez-Majano also described how the illness has affected their family and friends. ME/CFS physicians and researchers Dr. James Baraniuk, Dr. Charles Lapp, Dr. Steven Lempert, Dr. Judy Mikovits, Dr. Derek Enlander and Dr. Dan Peterson addressed the necessity of developing treatments, even if the cause remains unidentified. (You can read about the first day of the FDA workshop HERE.)

The second day of the FDA development workshop for ME/CFS focused on clinical trial design, outcome measures, regulatory issues and possible pathways to expedite drug development for CFS and ME, as well as the development of clinical trials. (You can read about the second day of the FDA workshop HERE and HERE.)

The May 22-23 CFS Advisory Committee (CFSAC) meeting was held, as usual, in
Eileen Holderman
Washington, D.C. The meeting, which was streamed live, was chaired by Gailen Marshall, and attended by Wanda Jones, former chair of the committee, Kim McCleary, CEO of the CFIDS Association of America, Fred Friedberg, president of the International Association of CFS, Ken Friedman, representing the New Jersey CFS Association, Ermias Belay of the CDC, Susan Maier of the NIH, Theresa Michele of the FDA, Mary Ann Fletcher, Dane Cook, Steve Krafchick, and Eileen Holderman, among others. While the first day revolved around ongoing government projects, such as the CDC’s multi-site study, the second day of the meeting produced fireworks when voting member Eileen Holderman accused the Designated Federal Officer, Nancy Lee, of intimidation. The negative publicity generated by Ms. Holderman’s (and Ms. Mary Ann Fletcher’s) contention that they had been bullied and threatened with expulsion for stating their views ultimately led to the demotion of the fall CFSAC meeting to a webinar.

Conferences at Home and Abroad

On January 26, The Institute for Neuro Immune Medicine hosted a patient conference about Gulf War
Nancy Klimas (center) and staff
Illness and ME/CFS in the DeSantis Center at Nova Southeastern University. Speakers included Dan Peterson, MD; Gordon Broderick, PhD; Mady Hornig, MD; Connie Sol, MS; Irma Rey, MD; Sue Levine, MD; Nancy Klimas, MD; Dolores Perdomo, PhD; Lynn Rafferty, PharmD; Scott Carlson (Exec. Director Chronic Fatigue Initiative); and Rebecca Halstead (Army Brigadier General, retired). Because this was a patient-centered conference, presentations included new treatments, coping techniques, and stories of recovery. (Videos of the conference can be viewed HERE.)

On May 31st, Invest in ME, a UK charity, held its 8th annual conference to explore biomedical research into ME. This year's conference, titled "Mainstreaming ME Research: Infections, Immunity and Myalgic Encephalomyelitis,” featured a roster of noted physicians and researchers: Dan Peterson and Andreas Kogelnik, who shared the keynote address; Mady Hornig on pathogen discovery in ME; Olav Mella and Oystein Fluge speaking about Rituximab, and more. (For a full program of presentations go HERE. Read Mark Berry's excellent report on this fascinating conference HERE.)

Dr. Derek Enlander
Hemispherx Biopharma, the makers of Ampligen, sponsored a conference at the New York Academy of Medicine on "Diagnosis, Treatments and New Developments in ME and CFS" on November 20th. Speakers included Dr. Nancy Klimas, Institute for Neuro Immune Medicine at Nova Southeastern University; Dr. Daniel Peterson, Sierra Internal Medicine; Dr. Judy Mikovits, Dr. Eric Schadt, Institute for Genomics and MultiScale Biology at Mount Sinai Hospital; and Dr. Derek Enlander. The Q&A panel included Dr. Francis Ruscetti, National Institute of Health and Dr. Christian Becker, Critical Care Medicine in New York. Regrettably, the conference was not filmed.

The 2nd International Symposium for CFS/ME was held on December 2nd, in conjunction with the opening of the National Centre for Neuroimmunology and Emerging Diseases (NCNED) at Griffith University. Hugh Perry (Southampton, UK) gave the inaugural Alison Hunter Memorial Foundation address, including a
Hugh Perry
detailed presentation on the neurological effects of ME titled “Impact of Systemic Inflammation on the Brain.” Presentations included: Elena Gonzalez-Rey (Granada, Spain) –“ Cortistatin – A Possible Future Therapy for Chronic Fatigue Syndrome,” Mario Delgado (Granada, Spain) – “Vasoactive Intestinal Peptide – A Potential Therapy for ME/CFS?,” Gilles Guillemin (Sydney, Australia) – “Tryptophan Metabolism,” Richard Kwiatek (Adelaide, Australia) – “Neuroimaging, Chronic Fatigue Syndrome, Depression and Anxiety: Similarities and Differences,” Sonya Marshall-Gradisnik (Gold Coast, Australia) – “NCNED’s Research Direction,” Ekua Brenu (Gold Coast, Australia) – “Immune System Overview,” Sharni Hardcastle (Gold Coast, Australia) – “Immunological Profile,” Samantha Johnston (Gold Coast, Australia) – “The Definition Question,” Dan Peterson (Simmaron Research Foundation, Nevada, USA) – “Diagnosis and Management,” Kathy Rowe (Melbourne, Australia) – “Prognosis for Adolescents with Chronic Fatigue Syndrome,” Sarah Knight (Melbourne, Australia) – “Children with ME/CFS,” Rosamund Vallings (Auckland, NZ) – “Educating Doctors,” and Warren Tate (Dunedin, NZ) – “Molecular Pathways in ME/CFS.” (You can read Ros Vallings' excellent summary of the conference HERE.)

Advocacy Efforts

Bob Miller
2013 was a very busy year for advocates. The year started with a bang when Bob Miller began a 12-day hunger strike over the FDA’s continued refusal to approve Ampligen, the only ME/CFS pharmaceutical medication that has ever been in clinical trials. Bob, who himself is taking Ampligen, also delivered a petition with 3,890 signatures to the FDA and Secretary of Health seeking Ampligen’s approval. Bob ended his hunger strike on February 10th, after receiving the assurance of Wanda Jones at the Assistant Secretary of Health’s office that Secretary Sebelius would make a serious commitment to address the unmet needs of the ME/CFS community. Ampligen was not approved.

The secret attempt of CSFAC in January to shorten (and alter) the wording of the list of priorities led Jennie Spotila to contact Public Citizen, a watchdog non-profit that has litigated cases under FACA in the past. Public Citizen sent a letter of protest to the Acting General Counsel of HHS on February 14, 2013. The letter points out that the FACAviolations deprived “Ms. Spotila and the public generally of important rights to write a letter calling for an immediate investigation into threats made against three members of the CFS Advisory Committee (CFSAC).
Jennie Spotila
observe and participate in the advisory committee process.” Public Citizen asked that the General Counsel “act to ensure that CFSAC complies with FACA and with its own charter going forward. Despite Jennie’s worthy attempts at setting CFSAC on a straight course, it continued to veer into questionable political territory when, in May, Eileen Holderman and other CFSAC members reported harassment by Nancy Lee, the Designated Federal Officer. This prompted twelve ME/CFS patient organizations and 23 patient advocates to

HHS dealt with the demand for an investigation with characteristic torpor. After more than four months, Assistant Secretary Dr. Howard Koh finally responded to the request for an investigation with the statement that “Dr. Nancy C. Lee has authority to engage in private conversations with individual members of CFSAC.” After finding Dr. Koh’s letter “completely unacceptable,” Mary Dimmock wrote a second letter to HHS demanding an investigation. As of this writing, the matter is still unresolved.

Mary Dimmock
In similar fashion to its highhanded treatment of CFSAC complaints, over Labor Day weekend HHS announced that it would be contracting the IOM to devise a new case definition for CFS. Given the IOM’s previous history of mishandling the definition of Gulf War Illness (relabeled as “Chronic Multi-System Illness"), advocates immediately demanded that the contract be rescinded, as did 50 of the top international experts in the illness. Over 6,000 people signed two petitions calling for the cancellation of the IOM contract and the adoption of the Canadian Consensus Criteria. The experts’ letter marks what can only be called a sea change in the relationship between advocates and clinicians. For the first time, the two groups stood united in their criticism of the way HHS has historically treated the ME/CFS community. They were also united by their goal, the immediate adoption of the Canadian Consensus Criteria. By the end of 2013, the controversy still has not abated, and it promises to extend well into 2014.

At the end of 2013, I am sad to report that Karina Hansen, a 24-year-old severely ill ME patient, is still
Karina Hansen
incarcerated in a psych ward in Hammel Neurocenter in Denmark. On Feb 12th, 2013, five policemen from Holstebro county, Denmark, came to Karina’s house and forcibly removed her from her bed. She was then taken to Hammel Neurocenter, where she is being treated for “psychosomatic illness” with CBT and exercise by psychiatrist Nils Balle Christensen. After almost nine months of daily “rehabilitation,” Karina is still not able to walk. Nils Balle Christensen has declared Karina incompetent in any matters regarding her treatment, and has banned her parents from visiting her. (The case of Justina Pelletier, a 15-year-old with mitochondrial disease who has been confined to a psych ward at Boston Children’s Hospital, bears remarkable similarity to Karina Hansen’s story.) In their most recent public statement, Karina’s parents said that “Karina has become an involuntary guinea pig for psychiatry.”

New Research and Treatment Centers

Nancy Klimas
On February 12th, Nova Southeastern University’s College of Osteopathic Medicine held a grand opening for America’s first Institute for Neuro Immune Medicine. The Institute, directed by Nancy Klimas, is the only one of its kind in the United States that treats patients with CFS/ME and Gulf War Illness (GWI), as well as conducting basic and clinical research under one roof. The Institute is the first in the nation to study neuroinflammatory and neurodegenerative disorders such as CFS/ME, GWI, Parkinson’s Disease and multiple sclerosis using the newest genomic techniques. “We have created a one-of-a-kind think tank that will become the leading neuro immune medicine institute of its kind in the United States,” said Nancy Klimas, M.D. (Read the announcement HERE.)

Griffith University (Australia) opened a new facility, the National
Sonya Marshall-Gradisnik
Centre for Neuroimmunology and Emerging Diseases (NCNED), on December 2nd. The new center, directed by one of the world’s foremost experts on CFS/ME, Professor Sonya Marshall-Gradisnik, is dedicated to researching the interactions between the nervous system and the immune system.  In February 2014 the center plans to open a specialized CFS/ME Clinic. The facility will provide treatment for patients with the illness, and will build on the research being conducted at the center.

New ME/CFS Film Projects

Ryan Prior’s documentary film project, The Blue Ribbon:
Ryan Prior
ME/CFS and the Future of Medicine, garnered over $17,000 on Kickstarter. The idea for the film began with a story Ryan wrote for USA TODAY about his own struggle with ME/CFS over the last 6 years. The response to the article was dramatic, prompting Ryan to embark on a film that would tell the stories of the many people suffering from this illness. To support his film, Ryan launched the Blue Ribbon Foundation, which aims to raise money for the completion and distribution of his film.

Jennifer Brea, winner of ProHealth’s 2013 Advocate of the Year Award, raised an impressive $210,000 for her full-length
Jennifer Brea
documentary, Canary in a Coal Mine. Her project also won Tribeca’s Project of the Month for November. Jennifer contracted ME/CFS while finishing her doctorate at Harvard. Her background in political science and statistics prompted her to investigate the illness, and to question the prevailing attitude in medicine that it is a disease that has no cause, no cure, and no explanation. Jennifer hopes that to convince clinicians and researchers that this is not only a serious illness worthy of their attention, but, in her words, “it’s also a fascinating puzzle.”

Prediction for 2014

2013 was a year we will all remember, because it was marked by rising expectations. The FDA meetings seemed to signal a renewed interest on the part of the federal government to help ME/CFS patients in our quest for effective treatment, as did the acknowledgment that it was a serious and debilitating disease. The building – and dashing – of those expectations has sparked an outpouring of advocacy efforts unprecedented in recent years. Jeannette Burmeister’s call for the approval of Ampligen, citing “unequal treatment” regarding FDA’s rapid approval of Bexsero vaccine for a Princeton students, is another step along the path we will surely continue to take in 2014.

My prediction for 2014 is that it will be the “Year of the Advocate.”  2014 marks the 30-year anniversary of the Incline Village outbreak, the epidemic that saddled us with the name “chronic fatigue syndrome.” It is clear that those who have been ill since the 1980s have run out of patience. Cort Johnson’s recent analysis of HHS’s lack of commitment to people with ME/CFS is a harbinger of things to come. In the following months there will be more protests, more petitions, more demands for funding, and more exposes of government neglect.

What is truly astonishing, is that after 30 years of being blacklisted, after watching our young people with ME thrown into psych wards, after having research funds “redirected,” after the insults, the derision, the blatant dismissal of an illness which has robbed us of our lives – we are still here, still fighting to make our voices heard … still undefeated.

Originally published on ProHealth.

Saturday, December 21, 2013

“We will speak our truth” - Susan Kreutzer Goes to Washington, DC

Susan Kreutzer at the White House: Image by Nigel Lyons
By Erica Verrillo

On Tuesday, December 10th, Susan Kreutzer continued her campaign to draw attention to the plight of nearly one million ME/CFS patients in the US, by taking her cause to the nation’s capital.

As fate would have it, December 10th was the day Washington experienced one of its rare snow storms. Federal offices were shut down, but that did not prevent Susan from following her plan.

The timing of Susan’s visit was crucial. December 10th and 11th were the days scheduled for the semi-annual meeting of the CFS Advisory Committee (CFSAC – pronounced “sieve-sack”). This year, for the first time since its inception in 2003, the meeting was to be held as a webinar.

In spite of the fact that the CFSAC meeting was canceled that day due to the weather, Susan set up her table at the entrance to HHS headquarters and displayed a scroll with 3,000 signatures from a petition demanding the cancellation of the IOM contract. Nigel Lyons, a capital area cinematographer, was the only person to accompany Susan. The snow was falling heavily, but Nigel filmed until he could “no longer hold the camera.”

After submitting two petitions totaling 6,000 signatures for delivery to Secretary Sebelius, Susan tried to set up appointments with representatives on the Hill. Only one, Congressman John Garamendi (D-CA), had an opening.

Wednesday found Susan at the Rayburn House Office Building, where she met with Emily Burns, Legislative
Image: Nigel Lyons
Correspondent and assistant to Representative Garamendi. There, Susan made the case for increased funding for researching ME/CFS.

“Male pattern baldness gets $16 million a year in federal funding,” she said, “while ME/CFS gets only $6 million.” The contrast between an illness that leaves people confined to their beds with one merely affecting vanity could not have been made more succinctly. Nor could the pleas of the ME/CFS community to “take us seriously” have been more concrete than the two petitions Susan handed to Ms. Burns that morning.

Susan intends to make another trip to Washington on January 26, during the week of the State of the Union Address, to finish what she started – handing the two petitions to 20 additional representatives.
In a final statement, Nigel filmed Susan in front of the White House, where she made her purpose clear. “For people who are in bed, and who can’t get out here, we are going to find a way for you to have a voice.”

“We will speak our truth.”

This article first appeared on ProHealth.

Wednesday, December 18, 2013

New Advocates’ Letter to Secretary Sebelius Re IOM Contract Open for Signatures

Below is a letter written by Lisa Petrison and Jeannette Burmeister. I signed the first advocates' letter, and have signed this one. It is quite unlikely, given their previous definition of Gulf War Illness as "chronic multi-symptom illness," that the IOM will come up with anything less heinous for us.

Following is a letter regarding the IOM contract that will be sent to HHS Secretary Kathleen Sebelius and other government officials this coming weekend.

We hope that everyone who signed the first advocates’ letter to Secretary Sebelius will choose to sign this one (and that we pick up some additional signatures as well!).

Due to time limitations, we are asking that those wishing to sign send notice of this by Friday, December 20, to our email address at:


You also can help out by letting others know about this letter and encouraging them to sign it.

Note that as in the past, this letter is open only to people acting as advocates for the disease (in a volunteer or professional capacity), rather than to all patients or to the public at large.

However, especially since the limitations of this illness make it difficult for many patients to do very much work, we are defining the word “advocates” broadly.

If you have provided information about this disease to others, or answered questions from newly diagnosed patients on a forum, or shared your views or experiences publicly, or discussed with other patients strategies about how to make the world a better place for people with this disease, or helped out in other ways — then you count as an advocate. Please join us!

The basic format for signatures is as follows:


Degree, School

Former Job (age or year disabled)

Advocacy Position (or “Patient Advocate”)

Website or Email Address (if desired)

Here is the link related to the discussion in the letter of the IOM committee advising the government about the disease formerly known as Gulf War Illness: http://bit.ly/1fBJ8sF

Here is the link related to the budget disparities between ME/CFS and other diseases with similar prevalence and severity: http://report.nih.gov/categorical_spending.aspx

Thanks much to everyone for participating.

Lisa Petrison

Jeannette Burmeister


An Open Letter to the Honorable Kathleen Sebelius, U.S. Secretary of Health and Human Services

December 22, 2013

Dear Secretary Sebelius,
We are writing as researchers, physicians, authors, filmmakers, patient forum leaders, not-for-profit organization managers, bloggers and other advocates working on behalf of individuals with Myalgic Encephalomyelitis (ME), a disease that the U.S. government has historically referred to by the misleading name of Chronic Fatigue Syndrome (CFS) and more recently has called ME/CFS.

The purpose of this letter is to inform you that our previously expressed position regarding the government’s plan to redefine this disease through the Institute of Medicine (IOM) remains unchanged.

Since the September announcement of the contract with the IOM, concerned stakeholders have conveyed to you their opposition to the involvement of the IOM in the re-definition of the disease in a number of ways (including an experts’ group letter, an advocates’ group letter, multiple petitions and many individual emails).

IOM has now released a slate of proposed committee members, asking for comments. This proposed list is unacceptable for a number of reasons. The majority of the named individuals are not experts in ME/CFS; the committee chair appears to have no ME/CFS experience at all; and several of the proposed members have backgrounds focusing on mental health issues.

These problems reinforce the concerns generated by the initial report from the IOM committee charged with providing guidance to the government on Gulf War Illness, released earlier this year. That committee gave the disease an inappropriate new name; mentioned that it has symptoms overlapping with those of “Chronic Fatigue Syndrome”; and discussed the effectiveness or need for study only of treatments that are appropriate for depression but have been shown to be ineffective or harmful for ME/CFS patients (including antidepressants, cognitive behavioral therapy and aerobic exercise). Considering that this IOM panel also was dominated by non-experts in the disease being discussed and included a number of members with backgrounds in mental health, our concerns about the likely outcome of the IOM effort to redefine ME/CFS remain very high.

We again request that the IOM contract be cancelled and that the government adopt the Canadian Consensus Criteria as the definition for this disease.

In addition, we request that the government increase the budget for biomedical research into this disease to become more equitable with the budgets for other diseases with a similar level of prevalence and severity. For instance, NIH spends more than 600 times as much on HIV/AIDS as it does on ME/CFS (with a 2014 budget of $3.1 billion for HIV/AIDS vs. a trivial $5 million for ME/CFS). Considering that the number of U.S. patients living with ME/CFS (1 million) is roughly the same as the number of people in this country living with HIV, and considering that the level of suffering endured by many ME/CFS patients is equal to that experienced by untreated AIDS patients prior to their deaths, ME/CFS is woefully underfunded. This needs to be rectified immediately.

Finally, we request that the government consistently refer to this disease by its proper name, Myalgic Encephalomyelitis (ME).

Thank you for your attention to this matter.




Barack Obama, President of the United States of America

Senator Tom Harkin, Chairman, Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Senator Jerry Moran, Ranking Member, Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Jack Kingston, Chairman, U.S. House of Representatives Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Rosa DeLauro, Ranking Member, U.S. House of Representatives Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Lucille Roybal-Allard, U.S. House of Representatives Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Barbara Lee, U.S. House of Representatives Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Mike Honda, California, U.S. House of Representatives Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Danile R. Levinson, Inspector General, U.S. Department of Health and Human Services

Adam Trzeciak, Inspector General, U.S. Government Accountability Office

Dr. Harvey Fineberg, President, Institute of Medicine

Dr. Howard Koh, Assistant Secretary for Health, Department of Health and Human Services

Dr. Wanda Jones, Principal Deputy Assistant Secretary for Health, Department of Health and Human Services

Dr. Richard Kronick, Director, Agency for Healthcare Research and Quality

Dr. Thomas Frieden,Director, Centers for Disease Control and Prevention

Ms. Marilyn Tavenner, Administrator, Centers for Medicare and Medicaid Services

Dr. Margaret Hamburg, Commissioner, U.S. Food and Drug Administration

Dr. Mary Wakefield, Administrator, Health Resources and Services Administration

Dr. Francis Collins, Director, National Institutes of Health

Dr. Harold Varmus, Director of the National Cancer Institute

Dr. Anthony Fauci , Director of the National Institute for Allergy and Infectious Diseases

Ms. Carolyn W. Colvin, Commissioner, Social Security Administration

Saturday, December 14, 2013

HHS to ME/CFS Community: We don't care what you think.

Two days ago, Jennie Spotila gave a "(Lack of) Progress Report" on the December CFS Advisory Committee webinar. (See her blog, Occupy CFS.) By all accounts, the event was a disaster.

For those who are not familiar with CFSAC (pronounced "sieve-sack"), it was formed in 2003 to advise the Secretary of the Department of Health and Human Services on issues affecting patients with CFS, such as healthcare, the science and definition of CFS, education and other public health matters related to the disease. During the last ten years, CFSAC has made more than 70 recommendations to the Secretary on important issues, including research funding, Centers of Excellence, provider education, pediatric issues, case definition, and a name change. CFSAC is our community's only direct avenue for communicating with HHS, and therefore occupies a unique, and important, position in terms of influencing federal policy.

Over the past year or so, CFSAC appears to have sunk in a morass of political slime. In January 2012, it violated its public Charter and acted in secret to "narrow down" its list of priorities. (You can read about this sleight of hand HERE.) By making decisions hidden from the public eye, CFSAC not only violated its Charter, it effectively relegated the ME/CFS community to the role of passive recipients, rather than active participants in decisions that will affect us for years to come.

The second nail in CFSAC's coffin came last May when Eileen Holderman reported that she had been threatened with expulsion from the committee by the Designated Federal Official, Nancy Lee, simply for acting as a patient advocate. She said the chair was ‘shutting her down and shutting other people out.’ Most significantly, she stated that "to hijack our recommendation and pretend like it’s being done, that’s wrong.” Mary Ann Fletcher also reported having been threatened with eviction for "expressing her opinion." (Read Mark Berry's article HERE.)

The third (but probably not final) nail was hammered home when December's CFSAC meeting was transformed into a webinar. Claiming "lack of funds," HHS decided to do away with 20 years of face-to-face dialogue, substituting a venue in which participants could not - like Eileen Holderman - report bullying or harassment. Nor could they express the community's ongoing concerns over the IOM contract.

Instead of a meeting, those who signed up for the webinar got dead air, glitches, and "technical difficulties." There was no audio, so people listening on their computers heard nothing for the first 20 minutes, slides went astray, and public comments were not broadcast. As Jennie pointed out, there is no excuse for this kind of mismanagement. Ultimately, the degree to which CFSAC has been completely derailed from its original purpose can only be interpreted as a deliberate act of sabotage.

Jennie sums up the meeting with the following statement:
"This meeting accomplished two things: the public airing of the lack of progress across multiple domains and an exponential increase in frustration in the advocacy community. As many people pointed out yesterday, there is a serious disconnect in communications between HHS and the advocacy community. The decision to go ahead with this meeting was a terrible capstone to the precipitous decline in the HHS-advocacy relationship. Unless, as I said in my written comments, “HHS intends to send the message to the ME/CFS community and to you, CFSAC members, that it does not care what we think, it does not want our input, and it does not intend to do anything beyond or better than what it is already doing.”
If that’s the case, mission accomplished."

Thursday, December 12, 2013

“To have to go to court to get these things is just ridiculous.”

Findlay, age 16, and his mother, Jane Waters
This story is about a mother who is being forced to go to court to get a tutor for her son, who contracted ME/CFS in 2011 after a viral illness. 

For those who are not familiar with the UK system, The General Certificate of Secondary Education (GCSE) is an academic qualifying exam given for specific subjects (somewhat like the SATs in the US). Without tutoring it is unlikely that Findlay Waters will be able to attend college.

My own experience mirrors that of Jane Waters. In the US, the Americans With Disabilities Act is supposed to provide tutoring for any child suffering from a disability or ailment that prevents him or her from attending school. But when my daughter contracted ME/CFS in 1992, her school resisted providing tutoring for her on the grounds that she did not have a "real disease."

Mum facing council at tribunal over son's education at St Ivo School

By Eleanor Dickinson for Cambridge News, December 4, 2013
A desperate mother has launched a fight for her sick son’s chance to have an education after his illness forced him to leave school two years ago.

Jane Waters, from Arrington, has been at loggerheads with Cambridgeshire County Council since 2011, when her son Findlay found himself unable to attend St Ivo School, St Ives, due to severe chronic fatigue syndrome (CFS).

Mrs Waters and her husband Richard are facing the council at a tribunal today (Wednesday, December 4).

The 59-year-old said: “The council has failed our son. His illness means he cannot attend school and he desperately needs a tutor to come teach him and a computer with the right software so he can use distance learning to get the education he needs.

“To have to go to court to get these things is just ridiculous.”

Findlay, 16, began suffering from CFS in September 2011 after the whole family was struck down by a virus during the summer holidays.

Finding himself crippled with extreme fatigue, sickness and mental confusion, Findlay was forced to drop out school completely by January 2012, despite his best efforts to keep attending. Now more than two years later, the once active teenager finds himself mostly confined to his bed and without any GCSEs.

His mother said: “He is a very bright and intelligent boy. Before he became ill, he struggled with dyslexia and dyspraxia, and yet achieved a grade 8 in his maths in his Year 9 exams and was set to do 10 GCSEs.

“He really wants to study maths and physics at Cambridge University. But since his illness he has had no tuition in either of those subjects and has only been given 35 hours of tuition in English.”

Mr and Mrs Waters were facing County Council representatives at a Special Educational Needs and Disability tribunal in Cambridge yesterday in the hope of gaining a maths and physics tutor and the rights computer equipment so Findlay can get back on the educational tracks.

A spokesman for Cambridgeshire County Council said: “The council has offered appropriate tuition and continues to engage with the family to find the best way to meet their son’s needs.

“A parental appeal is being made to HM Court first tier tribunal and as such it would not be right for us to comment further.”

St Ivo School declined to comment.

Monday, December 9, 2013

"We've had enough."

From left to right: Susan Kreutzer, Edward Burmeister,
Jeff Kreutzer, Jane Pannell, Susan Stapp.
Photo: Erica Verrillo
By Erica Verrillo

On Monday, December 9, 2013, a small group of ME/CFS activists gathered in front of the San Francisco Federal Building to protest the IOM contract. The demonstration was organized by Susan Kreutzer, a former attorney and long-time ME/CFS patient.

The purpose of the demonstration was to draw attention to the continuing governmental neglect of over one million ME/CFS sufferers in the United States – 17 million worldwide - and to hand deliver two petitions totaling 6,000 signatures to the regional HHS office located in the Federal Building. The petitions demand an increase in funding for research into ME/CFS, the immediate adoption of the Canadian Consensus Criteria (CCC) to define the illness, the canceling of the IOM (Institute of Medicine) contract to define ME/CFS, and officially dropping the misleading name “chronic fatigue syndrome” in favor of the term used by the World Health Organization, myalgic encephalomyelitis (ME).

To start the event, Jeff Kreutzer and Edward Burmeister unfurled a seven-by-six-foot banner displaying the 3,000+ signatures from a petition initiated by Patricia Carter. The 95-page petition demands the cancelation of the IOM contract and the adoption of the CCC. A second petition with nearly 3,000 signatures, started last summer by Mary Dimmock, also demands the adoption of the CCC and the elimination of the demeaning name “chronic fatigue syndrome.” To bring the point home that ME/CFS affects people everywhere, Susan arranged a display of flags representing the home states and countries of those who had signed the petitions – all 50 states, the District of Columbia, Puerto Rico, and 34 countries spanning the globe.

Susan Kreutzer, Jane Pannell, an RN disabled by ME/CFS, and Edward Burmeister spoke about the inequities of NIH funding, the ramifications of yet another vague definition resulting from the IOM contract, and the devastating impact of the illness on millions of people all over the world.

Nothing could express the frustration of the ME/CFS worldwide community better than the comments on the petitions. “Walk a mile in my shoes!” says Carol Baker (Australia) in a direct challenge to officials who have designed policies preventing funding and halting the development of treatments. Many more patients wrote that there was “no way to describe this illness” and explained how they had lost their careers, friends, and lives to the disease. In one particularly poignant message, Jana Buzolic (Croatia) wrote, “I got ill when I was 22 years old. This is when my life ended and the twilight began.”

Tomorrow Susan Kreutzer will again demonstrate at HHS headquarters in Washington, DC. We can only hope that when she hand delivers the bound copies of these petitions to Secretary Sebelius, and to 21 Congressmen and Senators on Wednesday, that they will take the time to read what these 6,000 people have written.

“For 30 years,” says Susan, “we have waited in line for the government to listen to us. We’ve had enough.”

This article originally appeared on ProHealth.

Sunday, December 8, 2013

Demos in San Francisco and Washington, DC - Can you come?

Below is a Call to Action posted by Susan Kreutzer on ME/CFS Forums. Anyone who is in the Bay Area on Monday or in Washington on Tuesday is welcome to attend. The demonstration will take one hour. Afterwards, Susan will be hand delivering three petitions to HHS and to her Representatives. (You can still sign them!)

West Coast Event:
WHEN: Monday, December 9th, 10AM
WHERE: 90 7th St., San Francisco

Hope to see you there!
To All My Fellow Canaries, 

One of the best ways for multiple voices to amplify a message is by taking the message out into public view using our “outside” voices. It sure feels to me like the ME patient community is long overdue in staging a public demonstration to shine a spotlight on the U.S. Dept. of Health and Human Services (HHS) contract with the Institute of Medicine (IOM), as well as addressing the pitiful amount of funding and resources that the U.S. Government has allocated to this illness. 

If you feel the same way as I do and you are interested in joining me in San Francisco on December 9th and/or in Washington D.C. on December 10th for a series of demonstrations to very publicly raise your concerns with the IOM/HHS contract and funding for this illness. Then I welcome you to join me in together raising our voices in support of ME (CFS) patients throughout the world.

I am handling the logistical side of the planning of these demonstrations, which includes the location in downtown S.F. of the Regional Office of HHS, the headquarters of HHS located in Washington D.C., and the U.S. State Capitol and White House, also located in Washington D.C. 

I will have props to assist us in getting out our message, as well as alerting media outlets of these planned demonstrations. On December 10th, I will also be hand delivering the online IOM/HHS petition (on behalf of Patricia C.) to HHS Secretary Kathleen Sebelius, select members of Congress and President Obama at the White House. See,

I will be in S.F. in front of the HHS S.F. office on Monday, December 9, 2013 at 10:00 am. The following day (Tuesday, Dec. 10th) I will be in Washington D.C. at HHS headquarters at 9:00 am. At approximately10:00 am, I will move a short distance up the street to the nation’s Capitol. Finally at approximately 11:00 am I will move to the White House located approximately 12 blocks from Capitol on Pennsylvania Avenue. I will try to capture the events on both of these days in photographs and on video (subject to the number of extra pairs of hands available on either of those days) to share these activities with patients (and others) who want to support these demonstrations, but are unable to attend in person.

For more details about the demonstrations scheduled for December 9th and 10th, please contact me through this thread on the Phoenix Rising Forum, or the posting I have made on the MECFS Forum, or directly through my e-mail address at WallaceAlvinCleaver@gmail.com.

In addition to the HHS's headquarters in Washington D.C., there are 10 other regional offices spread across the U.S. in the following cities: 1) Atlanta, 2) Boston, 3) New York, 4) Philadelphia, 5) Chicago, 6) Kansas City, 7) Denver, 8) Dallas, 9) San Francisco and 10) Seattle. See, http://www.hhs.gov/about/regions/ and http://www.hhs.gov/about/hhh.html. If you are interested in holding a similar demonstration at one of these locations, I would be glad to share with you the steps required to set up such a demonstration..

No matter what size of a group shows up to demonstrate, even a small group can make an impact on a wider audience if their message is delivered with clarity and passion. We need to be able to find ways to interest the media into covering our story, so we can leverage the reach of their audience to our advantage. As well as using social media to spread our message even if many patients can only dream about participating in life outside the confines of their home/bed. We already have seen how this type of a demonstration can bring much needed awareness of this illness to mainstream media outlets as demonstrated by patient advocate Rivka Solomon in the 2011 demonstrations she planned.

Friday, December 6, 2013

ME/CFS Activists Take to the Streets of Washington, DC

This article by Llewellyn King appeared today on the White House Chronicle. King has been a long-time advocate for people with ME/CFS. He has repeatedly stressed the need to take action in Washington, DC, where it will have an impact. On December 10, a group of activists will be doing just that.

David and Goliath, or, the Sick and the Bureaucracy

By Llewellyn King, White House Chronicle, December 6, 2013

Malcolm Gladwell, the New Yorker writer, has grown rich with a series of books exploring the sociological dimensions of success and failure. In his latest, “David and Goliath: Underdogs, Misfits and the Art of Battling Giants,” Gladwell celebrates the many Davids who triumphed over the odds because they were nimble and resourceful.

If he wants to observe a classic David-versus-Goliath rumble, Gladwell might want to go to Washington on Tuesday (Dec. 10). He will see a frail woman go up against the federal government with a humble petition and a small following of mostly very sick people.

Her name is Susan Kreutzer and she suffers from the debilitating and mysterious disease Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis, which is the name patients favor.

Kreutzer and others will begin their demonstration at 9a.m. outside the headquarters of the Department of Health and Human Services on Independence Avenue, where she will hand over a petition. Then she will move up the street to Capitol Hill to demonstrate and hand-deliver petitions to members of Congress. She will end her day of petitioning her government outside the White House.

Kreutzer has no idea how many, if any, demonstrators will join her, but she assures me she has the required permits to demonstrate. Another time, only six demonstrators turned out, but they unfurled a huge banner and stood on the street telling the oft-ignored story of their suffering to anyone who would listen.

Telling your story in Washington without a big-bucks lobbying firm or celebrity friends is not an easy assignment. Not only is there the high chance of being ignored but there is also the chance of being discounted as one of the apocalyptic “end of days” proselytizers, or those who believe the CIA has it in for them and who habitually assemble at the White House and elsewhere. In other words, it is easy to be dismissed as a “crazy.”

But Kreutzer, who will have a warm-up demonstration on Dec. 9 in San Francisco at the HHS offices there, believes in the strength of small voices, of a murmur in the cacophony of Washington petitioning. “I feel I have to do this,” she said.

This year, the victims of CFS are particularly upset with HHS and its dependent agency the National Institutes of Health. They are fuming at the decision of NIH to seek a new clinical definition of their disease, supplanting the Canadian Consensus Criteria, which has been the diagnostic gold standard for researchers who are deeply committed to finding a cure for a disease that affects as many as 1 million Americans and another 17 million people worldwide.

It is a disease that simply confiscates normal life and substitutes an existence in purgatory, where victims can be confined for decades until death. Sometimes they will be so sick they must lie in darkened rooms for months or years; sometimes they can function for a few hours a day, usually followed by collapse. Dysphasia — word confusion — increases. Lovers leave, spouses despair and the well of family compassion runs dry.

The first and major complaint of all those in researching the disease and those suffering from it is that NIH spends a trifling $6 million on this circle of hell that could have been invented by Dante.

The second and immediate source of anger laced with despair is that NIH has, apparently arbitrarily, decided to have the clinical definition of the disease reclassified by the Institute of Medicine and has diverted a precious $1 million to this purpose. Thirty-six leading researchers and physicians from the United States, risking retribution in funding, protested the move but were ignored. They were joined by colleagues from abroad, bringing the blue-ribbon protesters to 50.

Still nobody knows why the move to reclassify the disease. One school of thought is that NIH would like to abandon the current and well-accepted diagnostic criteria, known as the Canadian Consensus Criteria, in order to treat the disease as more of a mental one rather than a physical one.

I approached HHS for a comment and for a word with Dr. Howard Koh, the assistant secretary in charge, but have received no response.

Will this David, Susan Kreutzer, fell this Goliath, HHS?

— For the Hearst-New York Times Syndicate

Monday, December 2, 2013

Voting Time! Your vote can help the National ME/FM Action Network win $100,000!

Your help ensured the National ME/FM Action Network of Canada made it through to the Semi-Finals. Now we need everyone to vote again and see them through to the Finals and a chance at that all important $100,000, to be used to help raise awareness on 12th May 2014!  Vote online, each and every day from 2nd - 11th December 2013!

Voting is easy!

You do not need to be resident in Canada to vote, but your vote can help to ensure that one of the more proactive organizations in the world is better able to raise effective awareness of our disease beginning on international awareness day 2014. Please join with thousands of others from around the world and help raise awareness of your disease!

If you have voted before, just click HERE. Then vote!

If you have not voted before, don't worry, signing up is simple.
  1. Go HERE and click on REGISTER in the top right corner.
  2. Enter your email address and a password. Or you can register using your Facebook account.
  3. A message will pop up that an email has been sent to confirm your registration. Go to your email inbox, open the email and click the link provided to confirm your registration.
  4. Now click HERE. Then click on the VOTE button and you are done for the day.
You can vote every day until December 11th.

To date the May 12th Fundraising Group has won over $10,000 for the National ME/FM Action Network of Canada and worldwide over $650,000 for charities. All has been made possible just by having the support of people like you to vote for our nominated causes in competitions like this one. Your votes can help make such a difference - so please vote every day.

Please consider sharing this article to your own Facebook page and help bring greater awareness to the competition: 

Thank you all for your continued support.

The National ME/FM Action Network of Canada

The Action Network's contest statement is below:

“Our dream begins with awareness. May 12th Awareness Day is a chance for the 750,000 people living with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia (FM) to be seen and heard! These illnesses are real; the people are real; and they need help NOW!

ME/CFS and FM are chronic and severely disabling illnesses. They are as disabling as MS and are more prevalent in Canada than breast cancer, MS and AIDS combined! People are frequently bedridden and become isolated from friends and family – invisible in their own communities.

Dr Nancy Klimas, an expert in both ME/CFS and AIDS, was quoted as saying “A CFS patient feels the same or worse than congestive heart failure. The same or worse than late stage AIDS. If I had to choose between the two illnesses I would rather have H.I.V.”

These illnesses do not discriminate. All races, men and women, rich and poor, adults and children can be afflicted. It is devastating when a child is forced to cope with such a disabling illness.

We are on a mission to bring awareness in Canada for this community of people living with these illnesses and to set the stage for fundraising for research and more physician education. To date our volunteer efforts have been handcuffed as not only is our community very disabled, many are in financial distress. The illness limits our ability to raise the substantial amounts required to mount a large scale awareness event and to fund the desperately needed research. It is the dream of our community to erase stigma and finally be taken seriously by friends, family, researchers, government and those in our local communities.

This contest gives us a chance to fund a nation wide awareness campaign for 2014, the 22nd Anniversary of May 12th Awareness Day. It will also define Canada as a world leader in raising awareness as this day is also an international event. It will not only benefit 750,000 Canadians, but it will indirectly benefit the 20 million people that suffer worldwide.
We will use the funds to hold events in as many communities across Canada as possible which will lay the foundation for a strong network of organizations in Canada and future fund raising for education and research. We’ll connect with every MP and provincial/territorial representative in Canada and have May 12th proclaimed in cities nationwide. We’ll sport t-shirts, carry signs and have engaging speakers in as many communities as possible.

Each event will have its own venue but will share elements common to all. In order to unite the larger community across Canada we’ll also advertise in national and local papers, and, if funding permits, on TV and radio. As education is so critical, we will also target physicians, medical students and other health professionals with our letters and/or advertising. Brochures and a white board medicine video are planned.

We believe with awareness, will come action! Our community is desperately in need of treatment facilities and funding is required to support research and our scientists. A successful May 12th will bring many rewards for years to come. These activities will not only benefit us today, but they will be an investment in our future.

Aviva’s gift will help to unite our national and local communities and make a difference to the lives of many Canadians. It will give us credibility in our quest for treatment and a cure and hope for a better tomorrow.”

To quote Helen Keller – “Alone we can do so little; together we can do so much.”

Wednesday, November 27, 2013

Sloppy Medicine, Silly Syntax, and CFS "Subgroups" - HHS Continues to Sink Our Ship

This post by Mary Dimmock appeared today on Occupy CFS. Mary raises some valuable points that have profound implications not just for people with ME, but for those with GWI, cancer, thyroid conditions, MS, and a host of other diseases. If ME is to be subsumed into a vague general category of "fatiguing illnesses" what's to prevent the IOM from "undefining" other diseases as well? (The IOM has already "undefined" GWI.) Will IBS, Interstitial Cystitis, and chronic Lyme follow suite? Will the remedies for these problems consist of a talk and a walk?

This scenario is not as far-fetched as it seems. Sloppy medicine breeds sloppy science (and vice versa). In this case, sloppy medicine could lead to a Pandora's Box of repercussions.
Which Disease Is HHS Studying?

By Mary Dimmock

HHS recently issued an FAQ about the IOM contract. As Jennie Spotila, Erica Verrillo, Lois Ventura and Jeannette Burmeister pointed out, the FAQ falls far short of providing useful answers, is misleading and leaves critical questions unanswered.

Like the fundamental question: “What disease is HHS developing definitions for – ME or the diverse conditions that meet the overly broad “CFS” criteria?

I recently asked that question of both IOM’s Kate Meck and HHS’ Dr. Nancy Lee. From their answers, which I summarized below, the only possible conclusion is that the IOM study is intended to establish diagnostic criteria for the diverse conditions that meet the overly broad “CFS” criteria and that ME will be treated as a subgroup.

All of us, patients, advocates and experts alike, must reject this as completely unacceptable. We must call on HHS to acknowledge that ME is not part of the overly broad CFS. We must continue to call on HHS to adopt the Canadian Consensus Criteria.

We all know the problem. ME, the neurological disease characterized by post-exertional malaise, cognitive issues and immunological dysfunction has been buried inside of “CFS”, a diverse collection of medically unexplained fatiguing conditions. Numerous authors, especially Dr. Jason of DePaul, have reported extensively on the serious research and clinical problems caused by these overly broad CFS definitions, definitions that lump biologically unrelated conditions together. Dr. Bruce Carruthers summed it up simply, “There is a poignant need to untangle the web of confusion caused by mixing diverse and often overly inclusive patient populations in one heterogeneous, multi-rubric pot called ‘chronic fatigue syndrome.”

Having rejected the Canadian Consensus Criteria as unacceptable, HHS is conducting three separate initiatives to develop its own criteria. But what does HHS intend to do about the “web of confusion” that has been created by “CFS”? What disease will these new criteria describe?

The ME/CFS IOM Statement of Work is ambiguous on this point as it uses the same jumbled, non-specific disease labels that have gotten us into this mess to begin with. The SOW states:
"the Committee will consider the various existing definitions and recommend consensus clinical diagnostic criteria for this disorder [ME/CFS]. . .
The Committee will also distinguish between disease subgroups . . .
For the purposes of this document, ME/CFS shall be used to refer to Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Neuroendocrine Immune Disorder, and other terminologies in use for this illness."
I asked both Kate Meck at the IOM and Dr. Lee, the designated federal official for the CFS Advisory Committee (CFSAC) to clarify what “scope of disease” had been specified in the IOM contract. Has the IOM been contracted to develop clinical criteria specifically for ME? Or has IOM been contracted to develop clinical criteria for the range of unrelated fatiguing conditions that meet the “CFS” criteria? I asked Dr. Maier of NIH and Dr. Beth Collins-Sharp of AHRQ a similar question on the NIH Evidence Based Methodology Workshop process and am waiting on a promised response.

Here’s a summary of the responses I received from Dr. Lee of HHS and Kate Meck of the IOM:
  • Both Dr. Lee and Ms. Meck said that the scope of disease to be covered by the new clinical criteria has not been specifically defined at this point and that this will need to be defined as the process goes forward.
  • Dr. Lee indicated that the panel itself would need to resolve this issue and that possible outcomes could be ME as a subgroup of the broader CFS, ME as part of a spectrum that includes these other conditions, or ME as a separately defined disease. Ms. Meck indicated that HHS would be asked to clarify what scope of disease was intended at the first meeting. I raised the concern with Ms. Meck that the scope of disease directly affects panel selection and evidence base selection but she felt that the panel and process would be able to adjust as needed.
  • In a follow-up email, Dr. Lee confirmed the above statements but also reiterated an earlier point she had made that the IOM task list specifies that the “committee will also distinguish between disease subgroups”. She also said that in order for the target audience – defined as the primary care physicians – to effectively use the resultant guidance, “it is important to start a bit broad and then have criteria which distinguishes between subgroups.”
These answers are profoundly disturbing.

First, the statement that the scope of disease has not yet been defined is frankly hard to believe. This is a million dollar contract and panel selection is due to be announced soon. How can such a critical issue as the scope of disease to be covered by the new criteria be undecided at this point? If it really is undecided, who will decide and how? What criteria have been used to select the panel? And will that panel still be the appropriate one once a decision is reached on what disease or diseases the new criteria will cover?

But the statements about subgroups and spectrum of illnesses are much more disturbing.

Yes, ME is a complex disease that needs to be broken down into legitimate subgroups in order to better understand the disease and the treatment options. Perhaps those subgroups are based on whether onset is sudden or not, the level of severity of the disease or the nature of the immune profile and viral load. But let’s be realistic. What is the likelihood that the panel selected for the IOM study is going to be able to identify proper subgroups of ME itself when our experts are still working through that? Or when the evidence base lacks the ME specific studies – studies done with proper ME definitions – that would be needed to substantiate ME subgroups?

At the same time, we have an agency with a long-term commitment to studying medically unexplained chronic fatigue as the single clinical entity, “CFS”. We have an agency that has taken the position that Oxford, Fukuda and the Canadian criteria all describe the same set of patients for whom one set of clinical guidance is appropriate. We have an agency that questions the scientific evidence surrounding even post-exertional malaise and its measurement while simultaneously rejecting the Canadian Consensus Criteria because it does “not account for scientific evidence developed since 2003.” We have the CDC’s Dr. Unger, rhetorically asking at the May 2013 CFSAC “If a patient doesn’t have [PEM], wouldn’t you still manage them as a “CFS” patient?” And we have the IOM adopting the same overly broad view of CFS as HHS in recent IOM publications on Gulf War Illness.

Now we have Dr. Lee stating that the target audience of the new criteria is the primary care physicians and that they need criteria that start broader and then distinguish between subgroups. What about the patients who desperately need criteria that accurately reflect their disease?

What are we to conclude from all this? HHS has not committed to criteria specific to ME. HHS is not talking about the proper subgroups of ME that we all envision. HHS intends the IOM study to define criteria for the broader set of CFS conditions, with ME characterized as a subgroup. Or worse, ME becomes a subgroup of the even broader chronic multisymptom illness (CMI).

Either way, this will be a disaster that will degrade ME research and worsen the abysmal clinical care and stigma that ME patients receive today. This is the nightmare scenario that we all fear.

If HHS truly wants to reverse the chaos and the grievous harm to patients caused by years of sloppy definitions, it will first and foremost declare that ME, the disease described by the Canadian Consensus Criteria, is not the same disease as the overly broad “CFS” and should not be considered as either a subgroup of CFS or part of a spectrum of CFS diseases.

And if HHS cares not only about primary care physicians but also about the ME patients that they treat, it will acknowledge the harm done to patients by its clinical guidelines as reported at a recent Mount Sinai conference. CDC will immediately highlight PEM as a hallmark symptom of ME, will provide “black box warnings” about the adverse effects of exercise on ME patients and will point clinicians to the Canadian Consensus Criteria and the IACFS/ME primer.

Beyond that, HHS needs to immediately require that the Canadian Consensus Criteria be used in every study funded by NIH, even if it is used in parallel with Fukuda as an interim step.

Patients, advocates and experts alike must demand and accept no less, especially in the context of the IOM study and the NIH Evidence Based Methodology process.

Monday, November 25, 2013

Move along, nothing to see here

Jennie Spotila, ME/CFS Advocate, posted this piece on her blog, Occupy CFS, today. (Reprinted with permission) For those who have been wondering whatever happened to the request for an investigation into the intimidation of CFSAC members who sought to represent patient interests, the answer has finally come. And the answer is ... 
Nothing to See Here

By JennieSpotila, Occupy CFS

After more than four months, Assistant Secretary Dr. Howard Koh has finally responded to our request for an investigation into the allegations that Dr. Nancy Lee attempted to intimidate at least two voting members of the CFS Advisory Committee. His response boils down to something along the lines of, “OK people, move along, nothing to see here.” In fact, his letter is so dismissive of the allegations and so vague on what he’s done about it, that it barely qualifies as a response at all.

Quick Review of The Facts

At the May 2013 CFSAC meeting, Eileen Holderman and Dr. Mary Ann Fletcher said that they had been intimidated by Dr. Nancy Lee and threatened with removal from the Committee for expressing their views. They said a third CFSAC member had also been intimidated.

On June 12, 2013, forty-six organizations and advocates wrote to the General Counsel and requested that he investigate the allegations.

On June 21st, the matter was referred to Assistant Secretary Koh. On August 22nd and September 20th, we wrote to Dr. Koh and requested an update on the investigation. We received no response or acknowledgement of our requests.

A Non-Responsive Response

In an letter to Mary Dimmock dated October 31st (but not received by her until November 7th), Dr. Koh finally responded. You can see the full letter here, but I’ll parse the salient points for you:
"The concerns that have been expressed by the members will be taken into consideration as the Committee moves forward in working to accomplish its mission."
This makes no sense at all. Eileen Holderman and Dr. Fletcher did not express “concerns.” A concern is something along the lines of I’m-concerned-that-we-don’t-get-meeting-materials-in-advance. That’s a concern that can be “taken into consideration.” Holderman and Fletcher made allegations of improper conduct by the Designated Federal Officer of the Committee. That’s more than a concern. But Koh doesn’t even acknowledge the nature of the allegations. Nor does he describe what he did to investigate them.
"However, it is important to understand that the Designated Federal Officer for CFSAC, Dr. Nancy C. Lee, has authority to engage in private conversations with individual members of CFSAC."
I am not aware of anyone disputing that Dr. Lee can talk to individual members of CFSAC. The allegations were not about the propriety of Dr. Lee talking to CFSAC members. The allegations were about what she said.  This is what we asked the General Counsel to investigate: Did Dr. Lee tell one or more members of CFSAC that he or she could be removed from the Committee for expressing a point of view? That is the question that must be answered.
"These discussions may be confidential in nature . . ."
Um, okay. As far as I am aware, CFSAC doesn’t deal in matters of national security. They don’t receive confidential corporate documents the way members of FDA advisory committees do. I have no idea what’s so hush hush about it. But even if I accept the proposition that certain discussions are confidential, I hear something a bit ominous in this comment from Dr. Koh. By telling us that those discussions might be confidential, is he saying that Holderman and Fletcher have done something wrong in making their allegations public? Is he actually claiming that they are not permitted to disclose conversations that, at least in their opinion, represent improper behavior by a federal official? Seriously? Is he suggesting that there will be a backlash against any member who speaks out about that kind of behavior? Really?

". . . and also may involve providing information about the rules and regulations of the Federal Advisory Committee Act as they relate to managing CFSAC and the roles and responsibilities of the Committee members."

Permit me to decode this for you.  What this sentence tells me is that Dr. Koh did look into the allegations, although he is completely silent on who he spoke with or what that involved. The sentence also tells me that his conclusion is that Dr. Lee provided information to Holderman and Fletcher (and perhaps the third member too) about the rules and regulations of FACA as it applies to them, and that is the only thing Dr. Lee did.

This simply does not add up. FACA does not state that advisory committee members can be removed for expressing their points of view.  After all, the advisory committee exists for members to do precisely that. Furthermore, FACA requires that advisory committees have a balance of membership and views, so removing a member for expressing a different point of view would unbalance the committee and potentially violate FACA.

Either Fletcher and Holderman are not telling the truth about what Dr. Lee said to them, or Dr. Lee is not telling the truth about what she said to them, or there has been some kind of epic misunderstanding that Koh has failed to identify. And since Koh’s letter gives us no information about whether an investigation was conducted, who was interviewed, and what the findings were, we have no ability to unravel this mess.
"All engaged in this activity should conduct themselves in a manner that is conducive to respectful and candid discussions."
I think this sentence is code for: one or more people are not conducting themselves appropriately and they should knock it off. Of course, the letter does not specify who needs to knock it off. But read between the lines. He has already said that Lee behaved appropriately. So the only people left to knock it off would be the CFSAC members who complained.

Completely Unacceptable

This non-responsive response is unacceptable for so many reasons, it’s hard to know where to begin. We started with seeking advice from multiple sources, including legal, political and advocacy sources. After consultation with a variety of sources, Mary Dimmock has sent a second letter to the General Counsel of HHS. You can read the full letter here, but these are the main points:

  • Dr. Koh failed to adequately investigate and resolve the allegations.
  • Dr. Koh’s letter contains no evidence or assurance that these allegations are unfounded.
  • The failure to resolve the allegations is not at all conducive to respectful and candid discussions.
  • Public trust and confidence in the work of the Committee has been undermined and all but destroyed.
  • The public cannot trust that Committee members are free to provide honest advice to the Secretary.

The letter then renews our request, that the General Counsel and not Dr. Koh:
"investigate these allegations immediately, and establish whether any voting member of the CFSAC has been intimidated or threatened for expressing their opinions. At a minimum, your response should detail what steps were taken to investigate, your findings on the facts that support or refute the allegations, and what specific corrective action has been taken."
Will it work? I’m not certain. On the one hand, the General Counsel handed us off to Koh before. On the other, Koh’s response is so vague and the issue of public trust so significant, that the General Counsel certainly should step in and do the right thing. I think it’s vitally important to get matters like this on the public record. We are accumulating more and more evidence of a systematic pattern of ignoring our concerns, downplaying the seriousness of the situation, and flat out subversion of good government practices. There are plenty of other people who are interested in this sort of thing, even if the General Counsel isn’t.

It never ceases to amaze me. Do they think we’re stupid? Do they think that hand waving and “These aren’t the droids you’re looking for” Jedi mind tricks actually work? Or are they counting on the media or Congress or the Office of Inspector General* being completely uninterested in what’s going on? We’ll see.

Note: Remember, there is a difference between the Office of the General Counsel (which “supports the development and implementation of the Department’s programs by providing the highest quality legal services”) and the Office of Inspector General (which is “dedicated to combating fraud, waste and abuse and to improving the efficiency of HHS programs.”)

Source: Jennie Spotila, Occupy CFS, Nov 25, 2013

Saturday, November 23, 2013

Sir Wessely Rides Again

This critical essay appeared on ME Action recently. Simon Wessely is not the only proponent of the "it's all in their heads" theory of ME, but he is the most influential. In spite of overwhelming evidence to the contrary, Wessely, a devotee of armchair reasoning, has clung to the quaint Freudian notion that illnesses are created by the mind (hysteria, aka conversion disorder). This type of voodoo medicine, as Margaret Williams has so aptly pointed out, has absolutely nothing to do with science - or medicine.

Professor Sir Simon Wessely – Right or Wrong?

Margaret Williams    ~   28th October 2013

When a professional person – especially a doctor – has repeatedly been shown to be wrong in their professional judgment and, as a direct consequence, people have been harmed, that doctor should surely be held personally responsible and accountable: in such circumstances legitimate criticism should not be dismissed as an ad hominem (personal) attack.

Following the award of the inaugural John Maddox Prize to psychiatrist Professor Sir Simon Wessely for his alleged “courage” in “standing up for science” and for promoting “sound science” about ME/CFS in the face of “hostility” in doing so, a letter published on 13th January 2013 by the Countess of Mar, Professor Malcolm Hooper and Dr William Weir in The Independent on Sunday was explicit that criticism of Wessely’s hypothesis about ME/CFS is scientifically legitimate:

Scientific understanding always depends upon sound evidence….For scientific understanding to prevail, the extensive biomedical evidence-base of ME/CFS must now be recognised by all researchers in the field.  The idea that ME/CFS is due to a dysfunctional psyche is a hypothesis without an evidence-base. The Maddox Prize was therefore awarded to the defender of an hypothesis with no evidence-base rather than to someone who was upholding true scientific inquiry.  Personal attacks against Professor Sir Simon Wessely do not advance the cause, but it is scientifically legitimate to direct criticism at the hypothesis both he and Professor White (chief Principal Investigator of the MRC’s PACE trial on ME/CFS) continue to espouse”.

It has been shown time and again that Professor Sir Simon’s published assertions about disorders such as ME/CFS, fibromyalgia, Gulf War Syndrome, the Camelford drinking water poisoning, and interstitial cystitis are simply wrong. Merely stating so is likely to result in yet more claims by him of “harassment” and “attack” upon him but, in the words of Professor Martin Bland, one of the UK’s leading medical statisticians, it is important that false information should not remain on the record to be quoted uncritically by others: “Potentially incorrect conclusions, based on faulty analysis, should not be allowed to remain in the literature to be cited uncritically by others” (Fatigue and psychological distress. BMJ: 19th February 2000:320:515-516). Wessely’s “incorrect conclusions”, however, remain in the literature to be cited uncritically by others and therefore may result in iatrogenic harm.


For over 25 years Wessely’s dismissal and rejection of the biomedical evidence on ME has continued unabated, even though there is substantial evidence of on-going inflammation throughout the body; systems prominently affected are the central and autonomic nervous systems, the immune system and the cardiovascular, endocrine, gastro-intestinal and musculoskeletal systems.

Unscientifically, he conflates ME, CFS, PVFS and chronic “fatigue” into what he refers to as “CFS”. This has become a waste-basket label, with 40% of those afforded it subsequently being shown to have other diagnoses (J R Coll Physicians Edinb, 2010:40(4):304-307).

Despite the extensive biomedical evidence that shows him to be wrong, Wessely is certain that he is right: he believes that ME/CFS is a behavioural disorder that should be managed with “cognitive restructuring”specifically designed to convince sufferers that they are not physically sick.

Indeed In October 2003, in a frenzied attack on people with ME and on those scientists and clinicians who regard it as an organic disorder, Wessely raged that those who disagree with him and believe ME to be an organic disorder (to whom he referred as “the radicals”) are “crazy” and that they are “engaged in fantasies, lies and gross distortions”. He wrote that the “radicals” are left “fighting yesterday’s battles” (seemingly because he believes he has established that ME does not exist except as a false illness belief), that they need a “reality check” and that “their behaviour is outrageous” (private communication; available to Medical Defence Union lawyers on legitimate request).

Ten years later, his views have not progressed in line with the advancement of medical science: at a medical meeting in March 2013 held in Bristol, Wessely informed attendees that ME has been caused almost entirely by what he called the “shockingly” negative way in which some ME charities, in particular the ME Association, portray it as a viral illness, saying that this has harmed patients as it encourages them to focus too much on symptoms and to be fearful of activity, resulting in a vicious cycle of deconditioning. Making no distinction between chronic “fatigue” and ME/CFS, doctors were assured by Wessely that all patients with CFS would benefit from the same management regime, namely behavioural therapy and exercise (Research in Chronic Fatigue Syndrome – ups and downs; Bristol Medico-Chirurgical Society; 13th March 2013: approved as a Continuing Medical Education module).

The continued propagation of such erroneous beliefs is a matter of significant concern because of their potential harm to very sick people, so it may be appropriate to re-consider the evidence that proves Professor Sir Simon to be wrong about four other issues as well: fibromyalgia, Gulf War Syndrome, the Camelford poisoning tragedy, and interstitial cystitis.


As with ME/CFS, Simon Wessely believes that fibromyalgia (FM) is a functional somatic disorder (Lancet 1999:354:936-939), despite the fact that FM is formally classified in the World Heath Organisation’s ICD-10 at M79 as a soft tissue disorder.  FM was officially recognised as a syndrome on 1st January 1993 by the WHO as a result of the Copenhagen Declaration (Consensus Document on Fibromyalgia: The Copenhagen Declaration 1992). It is a systemic disorder and affects not only the muscles – including the heart – but also the gut and immune system, and these are all recognised features of FM. 

Israeli researchers have pointed out that FM is believed to be the result of a central nervous system malfunction and emphasised that: “many of the differential diagnoses can be excluded by means of an extensive clinical examination and patient history” (Autoimmun Rev 2012 Jun:11(8)585-588), but Wessely advises against extensive clinical examination, claiming that it supports patients’ false beliefs that they are physically ill.

Whilst Wessely has not changed his position that fibromyalgia is but one part of a unified functional somatic syndrome, medical science has shown that in fibromyalgia, there is objective evidence of:

·         abnormal nerve fibres in the skin, showing enlarged Schwann cells which relay information from tissues to brain and produce cytokines, resulting in pain (Clin Rheumatol 2008:27:407-411)
·         central nervous system malfunction which increases pain transmission and perception (Autoimmun Rev, June 2012)
·         autoimmune thyroid disease being highly associated with fibromyalgia (J Rheumatol, June 2012)
·         overlap with inflammatory back pain (Clin Exp Rheumatol, August 2012)
·         interstitial cystitis and irritable bowel syndrome as co-morbidities (Front Neurosci, August 2012)
·         altered cerebral blood flow dynamics with an enhanced haemodynamic response (Psychosom Med, Sept 2012)
·         self-management programmes being ineffective (BMC Musculoskelet Disord, September 2012)
·         inflammatory dysregulation (Neuroimmunomodulation, Sept 2012)
·         neuromuscular fatigue and lowered exercise capacity (Arthritis Care Res, September 2012)
·         mitochondrial dysfunction  (Antioxid Redox Signal, Sept 2012)
·         small-fibre polyneuropathy with evidence of nerve loss (American Neurological Association 137th Annual Meeting in partnership with the Association of British Neurologists; Abstract W1409;  7-9th October 2012)
·         abnormally high muscle membrane conduction velocity (Clin Exp Rheumatol 2012: November 22)
·         FM commonly occurring in patients with autoimmune disorders such as lupus, Sjogren’s Syndrome and rheumatoid arthritis (BMC Clinical Pathology, 17th December 2012:12:25)
·         aberrant expression of immune mediators (cytokines), with impairment of cell-mediated immunity, providing evidence that FM is an immunological disorder which occurs independently of any subjective features (BMC Clinical Pathology, 17th December 2012:12:25)
·         hearing difficulties, hair loss and easy bruising (Clin Exp Rheumatol 2012:30:S88-S93)
·         impaired small-fibre function, pointing towards a neuropathic nature of pain in FM (http://brain.oxfordjournals.org/content/early/2013/03/09/brain.awt053.short)
·         biochemical differences (changes in tryptophan catabolism pathway) that are quite distinctive from those found in osteoarthritis or rheumatoid arthritis (Analyst Issue 16, 2013)
·         a mismanaged blood flow and low levels of inflammation, with a unique peripheral neurovascular pathology consisting of excessive peptidergic sensory innervation of cutaneous arteriole-venule shunts (AVS) in the skin of FM patients confirmed by multimolecular immunocytochemistry, with blood flow dysregulation as a result of excessive innervation to AVS contributing to widespread deep pain and fatigue (Pain Medicine: June 2013:14:6:895-915)
·         heart rate variability (HRV) aberrances, indices of increased sympathetic activity and a blunted autonomic response to stressors (Semin Arthritis Rheum 2013:6th July)

In addition to these demonstrable abnormalities, there is no objective link to psychiatric disease in fibromyalgia (BMC Clinical Pathology 2012:12:25) and furthermore, there is evidence that the use of antidepressants in long-term treatment of fibromyalgia resulted in a worse impact of the disease on patients’ daily lives, with worsened quality of life and deterioration in long-term management (Clin Pract Epidemiol Ment Health 2013:9:120-124).

Evidentially, Wessely’s aberrant belief that fibromyalgia is but one component of a single functional somatic syndrome has been vitiated and he has been proved wrong.

Gulf War Syndrome

Simon Wessely was knighted in the 2013 New Year Honours List for his work on “military health”; he is civilian psychiatric advisor to the UK Ministry of Defence where, despite his having no case definition of Gulf War Syndrome (GWS), he has consistently denied its existence, ascribing it to “stress of combat” and to a “belief” of exposure to a chemical attack (Lancet: 16th January 1999:353:169-178). Despite having been funded to the tune of $1 million by the US Pentagon, Wessely and his co-psychiatrist Professor Anthony David (both described as “specialists in unexplained syndromes”) definitively concluded that exposure to chemical weapons was not the cause of Gulf War veterans’ health problems (US cash for study of Gulf victims. Jeremy Laurence. Independent: 4” June 1997).

Sixteen years later, Wessely’s view apparently still pertains throughout the UK Ministry of Defence.

In contrast, US scientists have shown that Gulf War veterans’ chronic ill-health is indeed linked to toxic causes and it is clear that Gulf War Illness/Syndrome cannot be associated with stress or any psychiatric disorder: it is associated with poisoning by the cholinesterase inhibitors sarin and organophosphates (these being known neurotoxins which give rise to multi-system illness) combined with the effect of pyridostigmine bromide which acts synergistically with them (US Congressionally Mandated Report of the Research Advisory Committee on Gulf War Illness – Findings and Recommendations; 13th June 2012). 

Further, a large study led by Robert Haley, Professor of Internal Medicine and Chief, Division of Epidemiology, University of Texas Southwestern Medical Centre, confirmed cholinergic dysfunction in affected Gulf War veterans (Archives of Neurology, 26 November 2012: 1-10). The authors concluded: “Autonomic symptoms are associated with objective, predominantly cholinergic autonomic deficits in the population of Gulf War veterans”, with affected veterans displaying orthostatic intolerance, secretomotor dysfunction, upper gastrointestinal dysmotility, sleep dysfunction, urinary dysfunction and autonomic diarrhoea.

As Haley pointed out: “It takes this out of the realm of psychological illness into the realm of a brain illness” (Gulf War Illness linked to Cholinergic Abnormalities.  Pauline Anderson: Medscape 26 November 2012).

The statistics show that almost one third of UK troops who were deployed or were prepared for deployment to the Gulf (which equates to between 13,250 and 15,900 previously fit and healthy personnnel) remain chronically sick. Death statistics from GWS are impossible to obtain because once the sick Gulf War veterans have left the armed forces, they are passed to the care of the NHS and no extant medical records for service personnel are made available to the NHS – they have been either destroyed or retained by the MoD.  (It is notable that in 1997, Wessely forecast that Gulf War veterans’ “contemporary records…may be difficult to obtain”: BMJ 1997:314:239-240).

Thus convincing evidence exists that proves Wessely is wrong in asserting that Gulf War Syndrome does not exist and that veterans’ ill-health is merely the result of their own misperceptions.

The Camelford water poisoning tragedy
Wessely not only denies the existence of ME and of Gulf War Syndrome: he has denied that residents of Camelford were poisoned by aluminium sulphate. In July 1988, 20 tonnes of aluminium sulphate were accidentally pumped into the drinking water supplies of the small town of Camelford in Cornwall. It was reported that in the Camelford catastrophe, seven people died; 25,000 suffered serious health effects, and 40,000 animals were affected. (Dr Douglas Cross. The Ecologist:1990:20:6:228-233). Five years later, an article by Bernard Dixon entitled “Still waters” was published in the BMJ (5th August 1995: 311:395); it informed readers that: “mass hysteria was largely responsible for the furore”. Dixon’s article was based on a 1995 “re-assessment” of the Camelford incident by psychiatrists Anthony David and Simon Wessely which was published in the Journal of Psychosomatic Research  (1995:39:1-9).  Dixon noted that David and Wessely had found that anxiety was the cause of the symptoms and that there was no evidence of long-term adverse effects on health as a consequence of the drinking water contamination.
However, David and Wessely’s confident assertion that mass hysteria and/or anxiety were responsible for the supposed suffering of those in the Camelford area at the time of the incident has been shown to be wrong. Paul Altman et al showed that Camelford residents who were exposed to aluminium sulphate-contaminated drinking water suffered considerable damage to cerebral function which was not related to anxiety, and that there was objective evidence of organic brain damage compatible with the known effects of exposure to aluminium (BMJ 1999:319:807-811). Altman et al reported that previous psychological studies on victims of the Camelford incident which concluded that: “the perception of normal and benign somatic symptoms (physical and mental) by both subjects and health professionals was heightened and subsequently attributed to an external cause, such as poisoning” were demonstrably erroneous.

Twenty-five years after the catastrophe, the UK Government apologised to those affected “unreservedly” for the way in which the incident was dealt with at the time (BBC News Cornwall, 19th September 2013).

It remains to be seen if Simon Wessely will also apologise unreservedly to those whom he denigrated by dismissing their symptoms as anxiety. Quite how hair, skin and nails turning blue, and bone biopsies showing stainable aluminium over six months later could possibly be due to anxiety has not been explained by Wessely.

Again, Wessely has been proved wrong in ascribing serious and chronic physical ill-health to aberrant perception not only by those afflicted but also by those medical professionals who supported them.

Interstitial cystitis

In 2009 the BMJ carried a well-structured Clinical Review of interstitial cystitis/bladder pain syndrome (Serge Marinkovic et al: BMJ 2009:339:337-342) in which the authors provided a compelling case – based on evidence of bladder epithelial damage and related blood vessel transitions activating mast cells and generating an autoimmune response – of likely autoimmune causation.

At once Wessely sprang into action, rejecting outright any autoimmune or allergic component and noting the association with chronic fatigue syndrome, asserting that there was “good evidence” for the role of psychological factors in both the aetiology or maintenance of both conditions and stating that physical pathology cannot fully account for the symptoms (http://www.bmj.com/cgi/eletters/339/jul31_2/b2707#218935). He criticised Marinkovic for resisting in his review his (Wessely’s) own proposition that they are simply part of one functional somatic syndrome in which psychological factors contribute to the aetiology and for omitting to mention  that psychological interventions (CBT) deserve a place in any review of the disorder (see http://www.meactionuk.org.uk/Interstitial_cystitis_and_Chronic_Fatigue_Syndrome.htm ).

In 2012 it was established that patients with interstitial cystitis/painful bladder syndrome demonstrated measurable systemic dysfunction, with central and autonomic nervous system disorders and high rates of syncope as well as gastrointestinal dysfunction (Chelimsky G et al. Front Neurosci 2012:6:114: Epub 10 August 2012).

In October 2013, researchers again proved Wessely wrong (Jiang Y-H et al; Increased Pro-Inflammatory Cytokines, C-Reactive Protein and Nerve Growth Factor Expression in Serum of Patients with Interstitial Cystitis/Bladder Pain Syndrome: PLoS ONE 8(10): e76779. doi:10.1371/journal.pone.0076779).They demonstrated increased pro-inflammatory cytokine/chemokine (IL-1ß, IL-6, TNF-α and IL-8) expression in the sera of IC/BPS patients, implying not only mast cell activation but also that other inflammatory mediators play important roles in the pathogenesis, and supporting the fact that interstitial cystitis/bladder pain syndrome is now considered a chronic inflammatory disease.


Wessely’s attempts to re-classify as a single somatoform disorder various disparate physical syndromes have failed. As the Countess of Mar et al so concisely commented, the Maddox Prize was “awarded to the defender of a hypothesis with no evidence-base rather than to someone who was upholding true scientific inquiry”. There are many who maintain that, contrary to “standing up for science”, the award to Wessely militates against medical science and actively devalues it.

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