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March 2008

Move Nomenclature from Chronic fatigue syndrome to ME/CFS nomenclatures per talk. Ward20 (talk) 01:31, 16 March 2008 (UTC)

Article clean up discussion from Chronic fatigue syndrome for ref

In 1988 both the UK Department of Health and Social Services and the British Medical Association officially recognized it as a legitimate and potentially distressing disorder.

Mentioned in letters between the Countess of Mar and the Dean of the Institute of Psychiatry Dr George Szmukler. She says it is matter of record, but I have not been able to find a RS. More interesting information about the recognition of ME in England is given here in paragraphs 2-5 but need to track down RS for these statements. Ward20 (talk) 18:09, 6 March 2008 (UTC)

Would Hansard not support the later statements? Jagra (talk) 23:53, 7 March 2008 (UTC)

Internet access to Hansard seems only to be accessible back to 22 November 1988.Ward20 (talk) 21:25, 10 March 2008 (UTC)

Moved Ward20 (talk) 01:31, 16 March 2008 (UTC)

Yuppie flu

The article erroneously states that the term "yuppie flu" originates from 1990. In reality it is at least several years older. For example, my Finnish CFS/ME website features a letter sent by one of our members in response to a Finnish news article about "yuppie flu", dated March 1988. It would be great if someone could dig up a more accurate source for its origins. DiamonDie (talk) 13:10, 24 April 2008 (UTC)

Totally disputed

Since User:Sciencewatcher keeps adding intentionally false information, I have no choice but to tag the article as totally disputed. Note that it is not allowed to remove such a template until the issue is resolved. Guido den Broeder (talk, visit) 01:12, 11 September 2008 (UTC)

Please discuss this rationally. What is the problem? --Sciencewatcher (talk) 17:44, 11 September 2008 (UTC)

Totally disputed (2)

Now that WLU has removed ME from the title, most of the content has become incorrect. Many of the listed terms are alternative names for ME, but not for CFS. Note: a good number of alternative names for ME have already been removed by WLU, but others still remain. Guido den Broeder (talk, visit) 07:43, 11 September 2008 (UTC)

Dude, discuss at Misplaced Pages talk:Manual of Style (medicine-related articles)#ME.2FCFS therapies move, don't forum shop to every single page. Those that I removed were unsourced. Per WP:PROVEIT, if you want the names replaced, find sources. WLU (t) (c) 13:48, 11 September 2008 (UTC)

Based on Colin's comment, this probably would be a better venue for discussing the names. So I'll post messages to centralize here for the naming conventions. Below is as good a place as any. WLU (t) (c) 17:55, 11 September 2008 (UTC)

WHO classification

The ICD10 classifies Neurasthenia (F48.0) thus :

Excludes:

• asthenia NOS ( R53 )
• burn-out ( Z73.0 )
• malaise and fatigue ( R53 )
• postviral fatigue syndrome ( G93.3 )
• psychasthenia ( F48.8 )

ME is listed under postviral fatigue syndrome, i.e. neurasthenia explicitly excludes ME, as well as all other terms that have the code G93.3. Some of the confusion stems from the fact that neuromyasthenia used to be an alternative term for ME. Almost the same word, but biological rather than psychosomatic. Guido den Broeder (talk, visit) 14:27, 11 September 2008 (UTC)

And many researchers think that ME and neurasthenia are the same thing, although this is better discussed on the talk page. And I'm happy to add individual refs for each illness in the psychosomatic article if that is what the consensus is. Again let's discuss it on the page for the article itself, not here. As I said in the talk page, the reason I removed the pov tag was because it was inappropriate in that case. --Sciencewatcher (talk) 17:19, 11 September 2008 (UTC)

(cut & pasted above from WP:ANI.) I think that since the ICD10 doesn't ever mention the term "chronic fatigue syndrome", the whole claim ought to be removed. Mangojuice 17:45, 11 September 2008 (UTC)

Google scholar turns up 30K for CFS, 2K for myalgic encephalomyelitis, 145 individual hits for myalgic encephalopathy (assuming no typos or spelling mistakes). 3 million, 220K and 17K for straight-up google. Pubmed doesn't aggregate search results in a linkable fashion, but I get 3705 for CFS, 225 for myalgic encephalomyelitis, 8 for myalgic encephalopahty. Amazon.co.uk gives 48, 46 and 0, .ca gives 48, 15 and 0, and .com isn't really reliable 'cause they sell stuff. CFS comes out pretty clearly ahead in all measures, including the UK (google UK - 3 million, 60K and 8K) where you would expect the numbers to be reversed. There's no deadline and it's not a book, so if the world health community comes to a decision that CFS is to go the way of the dodo, we'll document and change. Until then, I've yet to see any evidence based on the most reliable sources to distinguish, change or adjust away from what it currently is. Haven't we already had this discussion? What do people think of the new lead on CFS, with it's greater prominence given to the name issue? WLU (t) (c) 18:10, 11 September 2008 (UTC)

You will probably find even more hits for cancer. That doesn't mean that cancer and CFS are the same, or that CFS should be replaced with cancer, although they have several symptoms in common. There are more CFS hits than ME hits simply because there is more CFS research than ME research. Guido den Broeder (talk, visit) 19:09, 11 September 2008 (UTC)

That's a pretty dumb argument. I have never heard of any researcher saying that CFS and cancer are the same illness, but the mainstream opinion is that CFS and ME are the same. --Sciencewatcher (talk) 19:55, 11 September 2008 (UTC)

Are WHO and CDC not part of the mainstream? Back up your statement with sources. Guido den Broeder (talk, visit) 20:00, 11 September 2008 (UTC)

Yes, they certainly are mainstream. If you look at this page on the CDC's website they say in their glossary "myalgic encephalomyelitis - A synonym for chronic fatigue syndrome in common usage in the United Kingdom and Canada." The WHO doesn't seem to have any opinion. --Sciencewatcher (talk) 20:12, 11 September 2008 (UTC)

So some assistant made a glossary. That is not a statement. This one is: 'Despite an intensive, nearly 20-year search, the cause of CFS remains unknown.' I.e., according to the CDC, no equivalent diagnosis existed before CFS. Guido den Broeder (talk, visit) 20:27, 11 September 2008 (UTC)

The WHO have been asked about their opinion on this matter on various occasions, a.o. by the RIVM on my behalf. I have a letter that says the WHO considers them different entities. Also, the WHO have announced that CFS will not have altogether the same code as ME in the ICD11. Guido den Broeder (talk, visit) 20:27, 11 September 2008 (UTC)

Misplaced Pages is not bound by the WHO's classification, which has been criticised for creating a dichotomy here. Misplaced Pages operates by consensus, and some fairly strong arguments have been presented that CFS is the main name for the condition. That doesn't mean that we cannot discuss ME, its history, the possibility that it might be an independent condition (as asserted by a small group of vocal researchers such as Byron Hyde) etc etc. But I think the above arguments support the conclusion that the page titles should not accord ME the same prominence as CFS, because that is simply not borne out empirically. JFW | T@lk 23:17, 11 September 2008 (UTC)

I'm still waiting for a source to support such a statement. Think what you may about the WHO, but it is an, if not the, authority on these matters. Guido den Broeder (talk, visit) 23:29, 11 September 2008 (UTC)

Still waiting for which source? When did you ask for it? And with regards to the WHO: it is indeed an authority, but that doesn't mean that in cases such as these we should accept its classification as the guiding principle for Misplaced Pages articles. JFW | T@lk 23:36, 11 September 2008 (UTC)

Actually it does, unless you have sources with more weight that say different. Guido den Broeder (talk, visit) 23:40, 11 September 2008 (UTC)

I'm no longer sure what we're debating here. ME and CFS are the same thing, or different? There's arguments for both, and both statements should be present. The real discussion should be is it portrayed as "ME and CFS are considered by most to be the same thing but some disagree" or "ME and CFS are considered by most to be different but some disagree". From my reading, most consider it the same condition. , , , , . I only find one reference GDB provided here - who is Westcare? And if the North American Journal of Psychology is the best we've got, well, it doesn't seem to show up on pubmed. What's the impact factor of NAJP?

Guido, can you stop trying to be clever and simply answer the question. Or even pose it, I'm not sure what we're discussing anymore. WLU (t) (c) 23:53, 11 September 2008 (UTC)

Does anyone else read this as a reason to stop the discussion, hide the section and get on with our lives? If we're not going to have a reason to change the name for five years, that gives me five years to rack up another 100K or so worth of edits before I have to pay attention to this again. WLU (t) (c) 00:02, 12 September 2008 (UTC)

I'm not sure what the current question is, but I'll try to explain better.

1. Patients are ill, you can say that they have some condition, illness or disorder.
2. ME and CFS are different diagnoses, different types of diagnosis even, attached to the same condition. They are labels, not the condition itself.
3. The old diagnosis ME is a disease diagnosis. Its definition does not change over time. It either describes the condition correctly or it doesn't. For some time since the early 1990's, it was believed by many of the large, new generation of researchers (those that learned of the condition from the CFS definition) that it didn't describe it adequately. With new biomedical results coming in since 2004, this is being reconsidered.
4. The new diagnosis CFS is a syndrome diagnosis, specifically a working diagnosis for research only. It was never intended to replace ME. We change its definition each time that we consider this helpful for the selection of patients. There is no CFS definition before Holmes. Nobody used a working diagnosis before then. Therefore, we cannot attach the term to anything that happened before its first application. CFS simply did not exist.
5. Because so far no definition for CFS listed all essential aspects of the condition, many people have been diagnosed with CFS that do not qualify for the diagnosis of ME. These people probably suffer from a different condition. Realising this, several groups of experts discussed how to deal with the situation, and came up with a number of suggestions.
6. Since the beginning of 2007, the international association of ME/CFS clinicians and researchers are advocating the use of the combination CFS/ME or ME/CFS for the time being, and so are most patient organizations.
7. For the near future, we are waiting for the results from CFS subgroup studies to come in. There are preparations by the CDC to redefine CFS again, this time based on a functional score. At the same time, it has been announced by the WHO that CFS will appear in two places in the ICD11: one coinciding with ME (postviral), the other to capture the remainder (non-specific CFS).

Hope this helps. Regards, Guido den Broeder (talk, visit) 00:54, 12 September 2008 (UTC)

WP:OR, WP:SYNTH, no WP:MEDRS. No reason to change the page. WLU (t) (c) 01:06, 12 September 2008 (UTC)

Like I said before. This is Misplaced Pages, bias rules. Guido den Broeder (talk, visit) 01:20, 12 September 2008 (UTC)

Yep, there is indeed bias against your viewpoints, because everyone perceives them to be a minority perspective. How do you explain the fact that the term "chronic fatigue syndrome" is used in all those publications since 2004 that you suggest support a biological etiology (did anyone else say otherwise?)

How does the CDC classify ME? As a synonym for CFS. JFW | T@lk 05:28, 12 September 2008 (UTC)

The same way as I did yesterday: if they called it CFS research, that is because they did CFS research. If they did cancer research, they called it cancer research. The CDC does not classify diseases. I have not given you my personal perspective, thanks; that is significantly different. I just gave some facts. You can find them all in sources already provided. Please remain civil. Guido den Broeder (talk, visit) 07:14, 12 September 2008 (UTC)

Some people above have quoted a "glossary" from the CDC stating that ME has been used as a synonym for CFS, as if that's the final word from the CDC on the issue on classification. About 3 months ago at the CFS talkpage, Bricker presented the following statement(s) from the CDC, which imply that doing so is inaccurate: "Various terms are incorrectly used interchangeably with CFS. CFS has an internationally accepted case definition that is used in research and clinical settings. ... The name myalgic encephalomyelitis (ME) was coined in the 1950s to clarify well-documented outbreaks of disease; however, ME is accompanied by neurologic and muscular signs and has a case definition distinct from that of CFS." - Tekaphor (TALK) 08:14, 12 September 2008 (UTC)

Thanks Tekaphor, I was looking for that. Maybe we should keep all the demystifying stuff on a separate page, since it so quickly gets snowed under. Guido den Broeder (talk, visit) 08:27, 12 September 2008 (UTC)

Undent. Guido, until they produce research that shows ME and CFS are different, they will be the same regardless of your beliefs to the contrary. I'm convinced by a CDC page, I'm unconvinced by your protestations. Tekaphor, the problem with the term ME is it's quite generic (painful muscles with CNS swelling, not that CFS is much better) and can be used to describe any condition producing painful muscles with CNS swelling, or the condition now known as CFS - that's how I read the CDC course document. The delicate issue in all pages with contested subjects is how to best portray the scholarly majority opinion to avoid undue weight; selecting single sources that represent a particular point, particularly when that single source isn't particularly weighty (it's a course overview, not a textbook, journal article or official statement) isn't the best approach. It's not an easy thing to do, and it should be negotiated, but always in keeping with wikipedia's policies and guidelines. That's the only real touchstone we have. WLU (t) (c) 11:34, 12 September 2008 (UTC)

So why do you ignore the page Tekaphor just gave?

No, ME is not so generic at all. If you do not have CNS inflammation, you do not have ME.

The research showing that ME and CFS are different will not be coming because they are different by definition (the definition of CFS changes over time, so it is already logically not possible that these are all the same as the definition of ME which is fixed).

What we have, however, is research that patients diagnosed with ME (or ME/CFS) differ in illness from patients diagnosed with CFS (Fukuda) but not ME, by a.o. DeMeirleir and Jason. Such research is rare, because almost nobody funds fundamental research, but it does exist.

I have yet to see a single reference to support your position. If you don't produce any, I suggest that we rename the articles again (note: but not to undo all you did, you also made some good improvements). Guido den Broeder (talk, visit) 12:51, 12 September 2008 (UTC)

I like Tekaphor's source. Do we have any sources that actually claim ME and CFS are the same? The CDC glossary source mentioned above, I think, doesn't do much to balance this source from Tekaphor, because it cannot be expected to have the same level of reliability. And while there are surely many examples of use of the term ME vs. CFS, we ought to set a higher standard -- a mere example may be an example of misuse as much as it may be an example of use. We should expect a source that explicitly addresses both terms and talks about them being the same. Mangojuice 13:53, 12 September 2008 (UTC)

Mango - the glossary that JFW cited is also from the CDC. The link cited by Tekaphor is to an on-line continuing education course. Both are produced and hosted by the CDC. Guido - did you see these links: , , , , ? All use ME/CFS interchangeably, just as the CDC link suggests. The course states that "Various terms are incorrectly used interchangeably with CFS." but provides no reference for this statement. The CDC website has several contradictory statements about it - the definition says they're the same. They cite NICE, which says they are the same, but they also say that A number of illnesses have been described that have a similar spectrum of symptoms to CFS. These include fibromyalgia syndrome, myalgic encephalomyelitis, neurasthenia, multiple chemical sensitivities, and chronic mononucleosis. Although these illnesses may present with a primary symptom other than fatigue, chronic fatigue is commonly associated with all of them. It goes on to say "In addition, there are a large number of clinically defined, frequently treatable illnesses that can result in fatigue. Diagnosis of any of these conditions would exclude a definition of CFS unless the condition has been treated sufficiently and no longer explains the fatigue and other symptoms. These include hypothyroidism, sleep apnea and narcolepsy, major depressive disorders, chronic mononucleosis, bipolar affective disorders, schizophrenia, eating disorders, cancer, autoimmune disease, hormonal disorders*, subacute infections, obesity, alcohol or substance abuse, and reactions to prescribed medications. " ME isn't there. CDC is quite equivocal by my reading. E-medicine lists ME as a synonym or related term. Picking the one source that agrees with a position and writing it as the minority isn't a good idea. WLU (t) (c) 14:39, 12 September 2008 (UTC)

NICE, and anything derived thereof, is not a reliable source. It is the subject of a court case. Your other references do not support your position but instead reject it. These publications use the compound ME/CFS, as we did before you came along. Guido den Broeder (talk, visit) 14:54, 12 September 2008 (UTC)

Guido, I think WLU doesn't have a set position on this. WLU - I understood that both sources were from the CDC. I still say that Tekaphor's source is more reliable. Both are from the CDC, so they are published respectably. However, the glossary entry doesn't go into any depth, and says that the term ME is in "common usage," not that they are appropriately regarded as the same. On the other hand, Tekaphor's source is in-depth and focused on CFS, and addresses the point explicitly. I agree we should not be cherry-picking sources, but we have to look at what the sources say about the issue in question. I think it is reasonably established that there is a good reason to think that the interchangeable use of ME and CFS may be a mistake. So I don't think that examples of reliable entities such as NICE choosing to use the terms interchangeably makes any argument against that. What *would* be a counter-argument would be sources on the other side explicitly discussing the terminology / definition question and coming to the opposite conclusion. The CDC glossary might be on the other side but it doesn't go into enough detail to say. Right now I envision text in the article that says that the terms CFS and ME are often used interchangeably, although some sources criticize this as inaccurate. (Tekaphor's source actually backs up both points there, and the CDC glossary source further backs up the first point.) Mangojuice 17:29, 12 September 2008 (UTC)

Cleanup

As a beginning, I have changed the lead to more adequately describe the actual situation and controversies. If this stands, the template is no longer needed. Guido den Broeder (talk, visit) 13:29, 12 September 2008 (UTC)

WLU, please explain why you reverted my edit that was intended to resolve the main issue with this article. Try to work with the regular contributors, not against them. Guido den Broeder (talk, visit) 15:11, 12 September 2008 (UTC)

I agree with WLU, that wording wasn't ideal. I still don't understand why we should emphasize the WHO's viewpoint so much when it says almost nothing directly about the issue. Mangojuice 17:30, 12 September 2008 (UTC)

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