Justice & Recognition of Myalgic Encephalomyelitis + ME & CFS, The Definitions

[Guest guest]

The Committee for Justice

and Recognition of Myalgic Encephalomyelitis

http://www.geocities.com/tcjrme/CurrentTopics2.html

This page will host special commentary and evaluation of current issues

critical to the patient community.

 

THE COMMITTEE feels there has been a particular effort to confuse the public

about Myalgic Encephalomyelitis. Most of this effort has been rooted in the

promotion of the term Chronic Fatigue Syndrome to describe this disease, which

has been spreading in epidemic fashion worldwide during the last twenty years.

Of particular note is the outright effort undertaken since 1988 by the

American CDC to eliminate the name and definition of M.E. and replace it with

CFS.

 

These statements have been selected for our Current Topics pages to help

everyone gain a better understanding of Myalgic Encephalomyelitis and thereby

better understand the truth about ME and the problems patients and doctors face

to

advance the public investigation of our disease. We encourage patients to

learn about ME, its history and the epidemics and the modern research. Do not be

confused by the deceitful propaganda about a “new diseaseâ€.

 

ME and CFS, The Definitions

No CFS definition defines a neurological disease.

 

All definitions which wear the 'f' word (ie. fatigue) in their name are not

ME nor neurological. They are definitions of fatigue conditions. And when these

definitions were written it was not neurological ME which they were

attempting to define.

 

Ramsay's criteria

 

(1) a unique form of muscle fatigability whereby, even after a minor degree

of physical effort, three, four or five days, or longer, elapse before full

muscle power is restored;

 

(2) variability and fluctuation of both symptoms and physical findings in the

course of a day; and

 

(3) an alarming tendency to become chronic (Ramsay 1988).

 

Myalgic Encephalomyelitis is defined as a neurological condition at ICD

G.93.3. Myalgic Encephalopathy is not recognised in any ICD as a condition.

 

Myalgic Encephalomyelitis or Myaglic Encephalopathy? Whats in a name?

 

Myalgic Encephalopathy is not the same as Myalgic Encephalomyelitis. None of

the contemporaries of Ramsay, such as Dowsett and Richardson, who have been

asked to comment on the appropriateness of a change from ME'itis to ME'opathy

have found ME'opathy an acceptable explanation. Myalgia means muscle pain.

Encephalo - means brain, myelitis has two meaningss, some say it refers to

inflammation of the spinal chord, others to inflammation of the myelin, the

covering

of the brain. Both are physical descriptions. Opathy, on the other hand means

pathology - which can mean 'the science or origin, nature, and courses of

diseases', but another meaning is 'any abnormal state: social pathology'

(Delbridge

1998). Hence encephalopathy can mean 'brain abnormal state' and this meaning

would therefore endorse treatments such as CBT and GET - which do not work in

those with neurological ME (which meets the Ramsay criteria). This change of

name to 'opathy' can therefore be seen to endorse psychological therapies as

treatment.

 

Muscle pain brain myelin inflammation is not the same as muscle pain brain

abnormal state. And the neurological damage which is evident in ME can be

explained by myelin inflammation but it cannot be explained by 'brain abnormal

state'. Evidence for brain damage has been found in the research of persons such

as

Casse et al. (2001), Poser (1992) and others. And there is often confusion

with MS by persons in the medical profession - where there is myelin damage.

 

Chronic Fatigue Syndrome Definitions.

 

Holmes et al. (CDC) (1988).

 

When Holmes et al. 1988 was written - the condition which they were trying to

define was Chronic Epstein Barr Virus. The principal symptom was 'fatigue'.

It is interesting to note that those who were familiar with ME on the committee

refused to sign off on this definition - as they pointed out that it was not

a definition of ME. No mention of neurological problems.

 

Major criteria:

1. New onset of persistent or relapsing, debilitating fatigue or easy

fatigability in a person who has no previous history of similar symptoms, that

does

not resolve with bedrest, and that is severe enough to reduce or impair average

daily activity below 50% of the patient's premorbid activity level for a

period of at least 6 months.

 

Minor criteria: 11 are listed or which the patient has to demonstrate 6 and 2

out of three physical criteria. Criteria 1 is also included in the physical

criteria - which relates to mild fever. A diagnosis of CFS is possible without

having 5. muscle discomfort or myalgia, 6. Prolonged (24 hours or greater)

generalised fatigue after levels of exercise that would have been easily

tolerated in the patient's premorbid state 7. Generalised headaches... 8.

Migratory

arthalgia ... 9. Neuropsychologic complaints, etc. (Hyde et al. 1992).

 

Ramsay says: (1) a unique form of muscle fatigability whereby, even after a

minor degree of physical effort, three, four or five days, or longer, elapse

before full muscle power is restored

 

This is hence not a definition of ME.

 

Australian Definitions.

 

Same year as Holmes et al the first Australian definition (Lloyd, Wakefield,

Boughton and Dwyer 1988) was written. It was a definition of Post-Viral

Fatigue Syndrome - describing prolonged fatigue after a viral illness. The

principal

author, Lloyd is an immunologist, as is Dwyer. It is an immunological

definition of fatigue (ignoring neurological signs). By definition the condition

will

resolve in two years.

 

Another Australian definition appeared in 1990 (Lloyd, Hickie (psychiatrist),

Boughton, Spencer, Wakefield). The definition of Post-viral fatigue was given

a tilt in the psychiatric direction of chronic fatigue. These criteria

required the following for a diagnosis of CFS:

1. Chronic persisting or relapsing fatigue of a generalised nature for

greater than six months that is exacerbated by minor exercise and that causes

significant disruption of usual daily activities,

2. neuropsychiatric dysfunction including impairment of concentration

evidenced by difficulty in completing mental tasks which were easily

accomplished

before the onset of the syndrome and new onset of short-term memory impairment,

and

3. no alternative diagnosis found by history or physical exam over a

six-month period. Psychiatric illness is not an exclusion criteria.

 

Ramsay says: (1) a unique form of muscle fatigability whereby, even after a

minor degree of physical effort, three, four or five days, or longer, elapse

before full muscle power is restored

 

Not a definition of ME.

 

Oxford Definition 1991.

 

In 1991 Sharpe, Archard, Banatvala, Wessely, David, White et al. wrote the

Oxford Criteria calling it 'A report - chronic fatigue syndrome: guidelines for

research.’ Only consultant neurologist Lane attended the meeting. P. Behan,

Professor of Neurology, contributed to it but was unable to attend the meeting

and signed it. Seven were psychiatrists or psychologists. Two broad syndromes

were defined - Chronic fatigue syndrome and Post-infectious fatigue syndrome

(PIFS). Signs: There were no clinical signs characteristic of the condition, but

it recommended that patients be fully examined, and the presence or absence

of signs reported. Fatigue was defined as being synonymous with tiredness and

weariness (that is not organic in origin). A clear description of the

relationship of fatigue to activity is preferred to the term fatiguability they

said.

(Hyde et al. 1992). This makes fatigue a psychiatric condition - a form of

avoidance or symptom of depression.

 

Disability, Mood disturbance, Myalgia, Sleep Disturbance, and a general

comment on 'many other symptoms' are all considered. Psychiatric illness is not

an

exclusion criterion. (Mulrow, Ramirez 2001)

 

Myalgia is defined - but as i. this refers to the symptom of pain or aching

felt in the muscles ii. it should be distinguished from feelings of weakness

and from pain felt in other areas such as joints. iii The myalgia should a.

complained of; b. be disproportionate to exertion c. be a change from a previous

state d. should be persistent or recurrent. iv. The symptom should be described

as follows; a. severity: mild, moderate, or severe; b. frequency and

duration; c. relation to exertion; if after exertion the time of onset relative

to the

exertion and duration should be described.

 

The myalgia (meaning muscle pain), the hallmark of Ramsay's ME is optional,

and is not included in the physical criteria either.

 

Ramsay says (1) a unique form of muscle fatigability whereby, even after a

minor degree of physical effort, three, four or five days, or longer, elapse

before full muscle power is restored.

 

This is hence not a definition of ME. It is a description of a condition

which has psychiatric fatigue without physical aetiology.

 

Fukuda et al (CDC) (1992, revised 1994).

 

Then there were the two versions of Fukuda et al. - 1992 and revised in 1994

 

Fatigue is sufficiently severe: of new or definite onset (not lifelong), not

substantially alleviated by rest, and results in substantial reduction in

previous levels of occupational, educational, social or personal activities; and

FOUR or more of the following symptoms (all of which must have started after

the onset of the fatigue) are concurrently present for 6 months:

 

1. Impaired memory or concentration

 

2. Sore throat

 

3. Tender cervical or axillary lymph nodes

 

4. Muscle pain

 

5. Multi-joint pain

 

6. New headaches

 

7. Unrefreshing sleep

 

8. Post-exertional malaise.

 

I note that post-exertional malaise is optional, as is muscle pain. In fact

some of the symptoms of fatigue, impaired memory or concentration, unrefreshing

sleep and new headaches (and throw in some unrelated muscle pain), and could

be taken to describe other conditions - such as premenstrual syndrome! Many

other conditions qualify for the label of chronic fatigue syndrome under these

criteria especially if they are not differentiated by a medical specialist.

Also note that there is no need for infection to be found in this definition nor

an infectious onset - so this also leaves it open for people with other

medical conditions to meet this criteria.

 

The Fukuda Definition excludes the following from a diagnosis of Chronic

Fatigue Syndrome:

 

1. Active medical condition that may explain the chronic fatigue, such as

untreated hypothyroidism, sleep apnoea, narcolepsy;

 

2. Previously diagnosed medical conditions that have not fully resolved, such

as previously treated malignancies or unresolved cases of hepatitis B or C

virus infection;

 

3. Any past or current major depressive disorder with psychotic or

melancholic features, including bipolar affective disorders, schizophrenia,

delusional

disorders, dementias, anorexia nervosa, or bulimia nervosa;

 

4. Alcohol or other substance abuse within two years before the onset of

chronic fatigue and at any time afterward (Komaroff & Buchwald 1998).

 

Psychiatric illness is not an exclusion criteria - Only major psychiatric

illness such as psychotic depression, bipolar disorder and schizophrenia are

excluded (Mulrow, Ramirez et al, 2001).

 

Again the hallmark of Ramsay's is not required.

 

Ramsay says (1) a unique form of muscle fatigability whereby, even after a

minor degree of physical effort, three, four or five days, or longer, elapse

before full muscle power is restored.

 

Other explanations and criteria for chronic fatigue.

 

Other explanations for fatigue conditions have been written: e.g. Royal

Colleges Report 1996, Australian Guidelines (RACP 2002). All are influenced by

psychiatrists and moving along the psychiatric continuum. None equate to the

above

definition by Ramsay.

 

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case

Definition, Diagnostic and Treatment Protocols: A Consensus Document (The

Canadian Clinical Working Case Definition) (2003).

 

The Canadian Clinical Working Case Definition (Carruthers et al. 2003) has

attempted to redress the balance and return to ME.

 

After fatigue there has to be post-exertional malaise and/or fatigue:

There is an inappropriate loss of physical and mental stamina, rapid muscular

and cognitive fatigability, post exertional malaise and/or fatigue and /or

pain and a tendency for other associated symptoms within the patient's cluster

of symptoms to worsen. There is a pathologically slow recovery period - usually

24 hours or longer. There is the need to meet 2 or more

neurological/cognitive manifestations, and also pain. Other criteria are also

listed.

 

This definition does meet Ramsay's criteria.

 

Ramsay says (1) a unique form of muscle fatigability whereby, even after a

minor degree of physical effort, three, four or five days, or longer, elapse

before full muscle power is restored.

 

We can accept this as ME.

 

Only the criteria propounded by Ramsay and his contemporary peers, such as

Dowsett (n.d, 1992), Richardson (1992, 2001), Wallis, et al. (Hyde 1992) defines

ME - and Carruthers et al. (2003) is an acceptable commentary on ME.

 

(No definition includes the cardiac problems being found in ME/CFS.)

 

References:

 

Carruthers, B., Jain, A., De Meirleir, K., Peterson, D., Klimas, N., Lerner,

A., Bested, A., Flor-Henry, P., Joshi, P., Powles, A., Sherkey, J. & van de

Sande, M. 2003, ‘Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical

Working Case Definition, Diagnostic and Treatment Protocols’, Journal of

Chronic

Fatigue Syndrome, K. De Meirleir & N. McGregor (eds.), Haworth, New York.

vol.11, no.1, pp. 7-115.

 

Casse, R., Delfante, P., Barnden, L., Burnet, R., Kitchener, M. & Kwiarek, R.

2002, , The Medical Practitioners' Challenge: Proceedings of the Third Sydney

International Clinical and Scientific Meeting 2001, Alison Hunter Memorial

Foundation, Bowral, NSW, pp.135-142. Abstract at http://AHMF.org

 

Delbridge, A., Bernard, J., Blair, D., Butler, S., Peters, P. & Yallop, C.

(eds.)1998, The Macquarie Dictionary, 3 edit., The Macquarie Library, Sydney.

 

Dowsett, E. n.d. ‘Brain Problems in ME/CFS: Is There a Simple Explanation?’,

Young Action Online, http://www.youngactiononline.com/docs/brain.htm

 

Dowsett E. & Ramsay, A., Myalgic Encephalomyelitis: A persistent Enteroviral

Infection?' The Clinical and Scientific Basis of Myalgic Encephalomyelitis

(Chronic Fatigue Syndrome), B. Hyde, J. Goldstein & P. Levine (eds.), The

Nightingale Foundation, Ottawa.

 

Fukuda, K., Straus, S., Hickie, I., Sharpe, M., Dobbins, J., Komaroff, A. and

the International Chronic Fatigue Syndrome Study Group 1994, ‘The chronic

fatigue syndrome: A comprehensive approach to its definition and study’,

Annals

of Internal Medicine, vol.121, pp.953-959.

 

Holmes, G., Kaplan, J., Gantz, N., Komaroff, A., Schonberger, L., Straus, S.,

Jones, J., Dubois, R., Cunningham-Rundles, C., Pahwa, S., Tosato, G., Zegans,

L., Purtilo, D., Brown, N., Schooley, R. & Brus, I. 1988, ‘The CDC Definition

: Chronic Fatigue Syndrome: A Working Case Definition’, Annals Internal

Medicine, vol.108, no.3, pp.387-389.

 

Hyde, B. 1992a, ‘The Definitions of M.E./CFS, A Review’, The Clinical and

Scientific Basis of Myalgic Encephalomyelitis (Chronic Fatigue Syndrome), B.

Hyde, J. Goldstein & P. Levine (eds.), The Nightingale Foundation, Ottawa.

 

Komaroff, A. & Buchwald, D. 1998, ‘Chronic Fatigue: An Update’, Annual

Review Medicine, vol. 49, pp.1-13 Also at

http://biomedical.AnnualReviews.org/cgl/content/full/8/49/1

 

Mulrow, C., Ramirez, G., Cornell & Allsup, 2001, Defining and Managing

Chronic Fatigue Syndrome, Evidence Report/Technology Assessment, no.42, U.S.

Department of Health and Human Services, AHRQ Publication, Rockville, Maryland.

 

Poser, C. 1992, 'The Differential Diagnosis Between Multiple Sclerosis and

Chronic Fatigue Postviral Syndrome, The Clinical and Scientific Basis of Myalgic

Encephalomyelitis/Chronic Fatigue Syndrome, B. Hyde, J. Goldstein & P. Levine

(eds.), The Nightingale Foundation, Ottawa.

 

Ramsay, A. 1988, Myalgic Encephalomyelitis and Postviral Fatigue States: The

saga of Royal Free Disease, Gower Medical Publishing, London.

 

RACP 2002, Chronic Fatigue Syndrome Clinical Practice Guidelines - 2002,

Health Policy Unit, Royal Australasian College of Physicians, Sydney, The

Medical

Journal of Australia, Vol. 176, Supplement.

 

Richardson, J. 2001, Enteroviral and Toxin Mediated Myalgic Encephalomyelitis

/ Chronic Fatigue Syndrome and Other Organ Pathologies, The Haworth Press

Inc. New York.

 

Richardson, J. 1992, ‘M.E., The Epidemiological and Clinical Observations of

a Rural Practitioner,’ The Clinical and Scientific Basis of Myalgic

Encephalomyelitis/Chronic Fatigue Syndrome, B. Hyde, J. Goldstein & P. Levine

(eds.),

The Nightingale Foundation, Ottawa.

 

Sharpe, M. Archard, L. Banatvala, J., Borysiewicz, L., Clare, A., David, A.,

Edwards, R., Hawton, K. Lambert, H., Lane, R., McDonald, E., Mowbray, J.,

Pearson, D., Peto, T., Preedy, V., Smith, A,., Smith, D., Taylor, D., Taylor,

D.,

Tyrell, D., Wessely, S., White, P., Behan, P., Rose, F., Peters, R., Wallace,

P., Warrell, D. & Wright, D. 1991, ‘A report - Chronic fatigue syndrome :

Guidelines for research’, Journal of the Royal Society of Medicine, vol.84,

pp.118-

121. (The Oxford Definition).

 

© 2003.

 

 

ME is Distinct from all other illnesses

 

Myalgic Encephalomyelitis is different form all other illnesses and as is

very clearly pointed out above, M.E. is different from all the definitions of

CFS.

 

Concerned that there may be attempts to confuse ME with other conditions, in

1989 Dr. Ramsay wrote a concise statement to clarify that M.E. is distinct and

identifiable and is not to be confused with other forms of debility or flu or

fatigue or post flu.

 

As we know, ME has many, many, many symptoms but Dr Ramsay presents this

statement to clarify how ME is different from all other conditions, and a

definite

case can be recognized clinically by a triad of particular muscle, brain and

circulatory dysfunctions that are characteristic.

 

We are indebted to Dr Ramsay, an outstanding infectious disease specialist

who devoted much effort to the investigation of our disease from the time that

he was confronted with the epidemic at the London hospitals in the 1950’s. Dr

Ramsay is the recognized authority in ME, established upon his direct personal

involvement in the investigation of the epidemics, research and scientific

studies and the examination and treatment of individual patients for over 30

years. Dr. Ramsay’s fame and standing are no accident and we can see that

his

descriptions of what make this disease unique are accurate and Ramsay’s M.E.

is

the same disease we have today.

 

It is clear that attempts at confusion and name changes would serve to

obscure its history and also its origins. So we must never forget Ramsay. The

worldwide epidemic we have today is the same disease that Ramsay encountered

many

years ago.

 

--------------------

( It is fortunate that a second edition of my monograph affords me the

opportunity to demonstrate that the clinical features of Myalgic

Encephalomyelitis

provide a sharp contrast to all other forms of postviral fatigue syndrome.)

 

The Myalgic Encephalomyelitis Syndrome

A. Melvin Ramsay M.A. M.D.

 

The clinical identity of the Myalgic Encephalomyelitis syndrome rests on

three distinct features, namely:

 

A. A unique form of muscle fatiguability whereby, even after a minor degree

of physical effort, 3, 4, 5 days or longer elapse before full muscle power is

restored.

 

B. Variability and fluctuation of both symptoms and physical findings in the

course of a day. And,

 

C. An alarming tendency to become chronic.

 

If we take the well known condition of post influenzal debility as an example

of a postviral fatigue state we see that in all these particulars it

constitutes a complete contrast. The fatigue of post influenzal debility is part

of a

general debility with no distinguishing characteristic of its own, it shows no

variation in intensity in the course of a day and although it may last weeks

or even many months it has no tendency to become chronic.

 

The clinical course of the Myalgic Encephalomyelitis syndrome is consistent

with a virus type of infection. It most commonly commences with an upper

respiratory tract infection with sore throat, coryza, enlarged posterior

cervical

glands and a characteristic low-grade fever with temperatures seldom exceeding

101°F. Alternatively there may be a gastro-intestinal upset with diarrhoea and

vomiting. In 10% of the 53 cases we reported between 1955 and 1958 the onset

took the form of acute vertigo often accompanied by orthostatic tachycardia.

 

The prodromal phase is characterised by intense persistent headache,

paraesthesiae, blurring of vision and sometimes actual diplopia. Intermittent

episodes

of vertigo may occur at intervals both in the prodromal and later phases of

the disease. Loss of muscle power is accompanied by an all-pervading sense of

physical and mental wretchedness. Some patients lack the mental initiative to

cope with the situation; on the other hand the more extrovert types show a

determination not to give in to the disease but their efforts to compel their

muscles to work only serves to make the condition worse.

 

Once the syndrome is fully established the patient presents a multiplicity of

symptoms but these can conveniently be discussed under three headings,

namely:

 

1. Muscle Phenomena

 

The unique form of muscle fatiguability described above is virtually a

sheet-anchor in the diagnosis of Myalgic Encephalomyelitis and without it a

diagnosis should not be made. I am informed of two families who are said to have

all

the conditions conforming to the clinical picture but lacking the muscle

fatiguability. These cases should be very carefully reviewed. It is quite common

to

find that muscle power is normal during a remission and in such cases tests

for muscle power should be repeated after exercise.

 

In severe cases of M.E. muscle spasm and twitchings are a prominent feature

and these give rise to acute muscle tenderness. In less severe cases muscle

tenderness may not be so readily elicited but careful palpation of the trapezii

and gastrocnemii (the muscle groups most commonly involved in M.E.) with the

tip of the forefinger should enable the examiner to detect minute foci of

exquisite tenderness. It is interesting to note that Dr. Garnet Simpson in

Sydney,

Australia (1986) without any prior knowledge of my writings devised the

identical technique and found that detection of these foci 'will make the

patient

yelp'. In the aftermath of the disease patients frequently complain of a

tendency

to 'fumble' with relatively simple manoeuvres such as turning a key in the

lock or taking a cork out of a bottle.

 

2. Circulatory Impairment

 

Most cases of M.E. have cold extremities and hypersensitivity to climatic

change but the most striking illustration of this conditionis the observation by

relatives or friends of an ashen-grey facial pallor some 20 or 30 minutes

before the patient complains of feeling ill.

 

3. Cerebral Dysfunction

 

Impairment of memory, impairment of powers of concentration and emotional

lability are the cardinal features. Inability to recall recent events,

difficulty

in completing a line of thought thus becoming 'tongue-tied' in the middle of

a sentence and a strong inclination to use wrong words, saying 'door' when

they mean 'table' or 'hot' when they mean to say 'cold' are all common

deviations

from normal cerebral function. Complete inability to comprehend a paragraph

even after a second reading is very noticeable. These may be accompanied by

bouts of uncontrollable weeping which proves acutely embarrassing to those of a

stoical temperament who regard such an event as demeaning to their philosophy

of life. Alterations of sleep rhythm and/or vivid dreams are common and these

occur in patients with no previous experience of such phenomena. In a very

tragic case in a young University student complete reversal of sleep rhythm led

to

suicide.

 

Frequency of micturition and hyperacusis are an almost invariable

accompaniment of these cerebral features and together with episodic sweating and

orthostatic tachycardia can only be attributed to involvement of the autonomic

nervous

system. Though less frequently encountered episodic sweating is a very

striking event. The wife of one such case is a trained nurse and reports that

her

husband may wake around 4 a.m. lying in a pool of water and with a temperature

of 94 to 95°F. I diagnosed this patient as a case of M.E. fifteen years ago;

the sweating episodes still persist.

 

Variability and fluctuation of both symptoms and physical findings in the

course of a day is a constant feature in the clinical picture of M.E.

 

The Chronicity of Myalgic Encephalomyelitis

 

The alarming tendency of M.E. sufferers to become chronic is the final

distinguishing feature from all other forms of postviral fatigue syndrome. In a

group of 150 members of the Association in the North of England 36 have had the

disease for 10 years or more. Of 55 members in a small group in Surrey 29 have

had the disease for 10 years or more; of these 4 have had the disease for over

20 years, 4 have had it for over 30 years and one for over 40 years. One

member in the north country group has also had it for over 40 years. I am fully

satisfied that at a conservative estimate 25% of victims of M.E. have had the

disease for 10 years or more. Only Myalgic Encephalomyelitis has such a legacy.

 

The chronic case of M.E. can take two different forms. In the first there is

a recurring cycle of remission and relapse. In three doctors who contracted

the infection between 1955 and 1958 the endless alternation of remission and

relapse, still continues. In my experience a remission can last as long as 3

years. Marinacci and Von Hagen record one of seven years. The second form of

chronic M.E. is more tragic in that no remission occurs. The patient lives a

very

restricted existence, unable to walk more than a short distance and that with

considerable difficulty, unable to read for any length of time and in many

cases subject to disturbance of sleep rhythm and/or vivid dreams and always the

almost invariable frequency of micturition, hyperacusis and dizzy spells. A few

of these chronic cases are compelled to sleep upright as a result of permanent

weakness of the intercostal and abdominal recti musculature.

 

===================================================

 

A very important presentation was delivered at a 1998 international research

meeting that we all should be aware of, it explains that CFS appears to be the

invention of an unnatural disease and a fiction, devised by a group of US

government employees in 1988 to describe the epidemic of Myalgic

Encephalomyelitis that was exploding worldwide.

 

See Dr. BM Hyde’s paper here: http://www.nightingale.ca/ICaustralia2.html

 

==============================================

 

The Committee encourages everyone to voice their support for the efforts to

demand the US Department of Health fully Recognize Myalgic Encephalomyelitis by

signing the Petition which can be seen here:

http://www.petitiononline.com/MEitis/petition.html