Has there ever been any evidence that health professionals are more represented among ME patients?

How could it be known ? There simply isn't the epidemiology at scale to identify with any certainty occupation trends in ME/CFS. There will be a huge confound in any data because healthcare is female employment heavy and such epedimology that does exists shows a strong gender imbalance toward diagnosis of females - the data is probably good enough to make it certain that a 2:1>3:1 F/M split exists in ME/CFS affectedness and that range pretty much reflects health care employment.

global health care data: Gender equity in the health workforce: Analysis of 104 countries

A similar problem exists with the often repeated claim that teachers are overly represented in ME/CFS diagnosis - global data on teacher employment doesn't seem to be readily available but there's generally agree to be a large disparity in employment with famales being far more predominant in primary and secondary education with males only being in a majority in tertiary education. If ME/CFS has a gender disparity then it's inevitable that female majority employment will feature more strongly in an analysis of ME/CFS patient employment ! To make any sense of these questions it's necessary to have extensive data on patient employment prior to illness onset, and be able to compare employment patterns relative to age, gender etc.

But epidemiology just isn't sexy so we will not doubt contine to waste $millions on endless rounds of lab work to tell us ME/CFS is a bit odd but highly heterogenous, without ever understanding who actually gets ME/CFS.

 

As far as I know health professional over-representation only ever applied to the acute phase of the Royal Free epidemic. Over-representation in an epidemic with hospitalisation seems unsurprising. Lots of health workers got Covid.

 

Wessely makes a couple of references to evidence for this in his article "Old wine in new bottles" but I don't know what his references say, one of them is M Ramsay, not sure if this is the same Ramsay as is often discussed regarding ME.

 

I think it's little more than an assumption, and it might have arisen from the Royal Free studies. There were suggestions then that the people most likely to get ill were those who didn't feel able to take adequate rest and recovery time because they worked as nurses.

It may have been extrapolated to other professions with high levels of personal commitment, such as teachers.

 

Yes that is Melvin Ramsay of the Royal Free epidemic.

 

I think it is a matter of recorded fact that a large number of nurses and less so doctors were hospitalised in the Royal Free case. In those days there were nurses homes and doctors residences and high doses of virus may have spread in the kitchens. And oI think in the 1950s the Royal Free medical school was largely or solely for women so young staff were women too.

The Royal Free was of course the site of another epidemic later - of Legionnaire's disease. But to be fair that was in the dysfunctional hew hospital building.

 

I remember reading about that when I was first diagnosed. But that epidemic wasn't really comparable to the sporadic cases of ME we see now, yet I suspect people might still be drawing on the research as if it were.

 

Incidence of myalgic encephalomyelitis/chronic fatigue syndrome in a large prospective cohort of U.S. nurses

Palacios et al

ABSTRACT
Background: The incidence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), the rates of both under-diagnosis and over-diagnosis, and the nature of the onset of the condition have not been assessed in large studies of health professionals.

Purpose: To determine the cumulative incidence of ME/CFS in a large population of health professionals, to examine the nature of the onset of the illness, and to estimate the frequency of both over-diagnosis and under-diagnosis of ME/CFS.

Methods: We sent an email questionnaire to participants in the Nurses’ Health Study II (NHS II), a large prospective cohort of female nurses. Forty-two thousand three hundred and ninety-four women completed the questionnaire, which included the 1994 Centers for Disease Control and Prevention (CDC) criteria for ME/CFS.

Results: One-hundred and two women (240 per 100,000 surveyed) developed an illness that met criteria for ME/CFS between 1989 and 2009. The onset of ME/CFS was gradual in 40.6%, sudden (following flu-like illness or other precipitating events) in 18.8%, followed emotional or physical trauma in 32.3%, and was uncertain in the rest. Under-diagnosis was common: only 15 (15%) of the women who met criteria for ME/CFS reported having been diagnosed. Over-diagnosis also was common: four times as many subjects had been diagnosed with ME/CFS by community doctors as actually met criteria. The distribution of symptoms was not different in comparing cases with a sudden onset to those with a gradual onset.

Conclusions: In this large cohort of female nurses, we found a low cumulative incidence of ME/CFS. Over-diagnosis and under-diagnosis were high, even in this medically sophisticated population.

Also

https://www.tandfonline.com/doi/abs/10.1080/21641846.2017.1323576

Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)
Additionally, the prevalence in specific populations, such as nurses and Gulf War veterans, seems to be slightly higher (1.62%) than that in the general population (1.45%) (Table 2); however, as others have argued, this difference could result from methodological inconsistencies [18].

In this (narrow) matter Wessely may be blameless :

In The epidemiology of chronic fatigue syndrome referencing Gunn Epidemiology of Chronic Fatigue Syndrome: The Centers for Disease Control Study Wessely writes:

"There is general agreement that CFS as observed in specialist centres has certain characteristics. For example, study after study reports that sufferers are more likely to be females, come from higher socio-economic groups, and indeed show a particular overrepresentation of certain professions, such as teachers or nursing. Of the 3,000 individuals who phone the Center for Disease Control CFS Information Line every month a quarter are medical or para-medical (Gunn, 1993). The occasional attempt is made to explain this finding in terms of viral exposure (both in childhood and at work), and overwork. Such explanations (reminiscent of those advanced to account for the same apparent excess of middle class professionals in the ranks of neurasthenia sufferers (Sicherman, 1977; Wessely, 1994)) , are unconvincing, with the possible exception of EBV virus, since lower socio-economic status is associated with an increased risk of primary EBV infection in childhood (Sumaya & Ench, 1985). Other explanations include access to health care, and differential labelling by both sufferer and doctor. In contrast to the pattern observed in specialist samples of CFS, there is no evidence for any excess of higher socio-economic status for fatigue, chronic fatigue or chronic fatigue syndrome observed in the community
or primary care (Cox et al, 1987; Wessely et al, in press; Fukuda et al, 1997; Shefer et al, 1997). Likewise, strong physical attributions and intense disease conviction are the norm. In contrast, ethnic minorities are rarely encountered."

 

A long time ago I chased down some of the references in SW's papers - in his infamous "Old wine in new bottles" paper, he references the preface to Dr Anne Macintyre's book "M.E. / Post-Viral Fatigue Syndrome, How to live with it", written by Prof. E.J. Field, in support for this supposed over-representation, but, if you track down a copy of the book, you find that the relevant quote is merely this:

That's it - and Field gave no evidence for that assertion. At the CIBA conference, SW elaborated somewhat on his thinking:

At a different point in the CIBA conference, there is also this exchange:

Ramsay also mentions this supposed over-representation several times in his works - e.g. in his "Postviral Fatigue Syndrome" volume, he says:

Those are just a few of the anecdotal references. If you go back further, there are also plenty of references in the historical neurasthenia literature, by which SW was clearly inspired, about the over-representation of "higher" social classes, professionals, and, at least among George Miller Beard's patients, doctors - amongst those diagnosed with neurasthenia.

Lots of anecdotes, but no evidence whatsoever.

 

Yes that is the point. Moreover, the acute phase that got labelled a myalgic encephalomyelitis probably has no more to do with ME as we now know it than glandular fever or Q fever. It is a bit like confusing Covid with Long Covid. Covid affects sexes equally and is much worse in the overweight. Long Covid will very likely turn out to be more common in women and nothing to do with obesity.

 

Not sure that muddling your arguments is blameless. It is quite hard to work out what he is arguing about professions. I presume that professionals are much more likely to phone a helpline simply because they are more likely to have got diagnosed. And 'study after study' does not seem to be referenced.

 

It reminds me a bit of Peter White's claim that for MECFS there is little or no placebo effect, while at the same time saying that CBT works through a placebo effect (encouraging people to believe they can get better). Which is a bit sad for the PACE trial since it means that CBT should not work. Of course it didn't work, but Peter White seems to miss that.

 

I'm struck that Wessely's arguments are well constructed - they're still just crap. Science is basically about measuring things - as per Kelvin*. This, to use one of Jonathan's phrases, is a word salad. Wessely(ism) really only works in the sphere where something is unclear --- lets work for some progress and we can consign this drivel to the House of Lords or some obscure after dinner speech.

*Kelvin - "When you can measure what you are speaking about, and express it in numbers, you know something about it, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind; it may be the beginning of knowledge, but you have scarely, in your thoughts advanced to the stage of science. Tor G.