MEAction: Join Our Values and Policy Initiative! September 2019

I would respectfully disagree with your 2 additional statements, @Trish . Taking the second first, MEpedia has all of the strengths and weaknesses of all Wikis. And like all other Wikis, no one should take the information as the final word.

And I don’t believe that statements from senior staff and board members of any advocacy organization should be restricted. Statements from an organization are different, but I don’t think that it’s fair to restrict the speech of an individual because of a position they may hold. Under what circumstances could they express their own opinions?
Thank you for your response, @Wilhelmina Jenkins. I hesitated about saying anything critical about #MEAction specifically, as I see similar problems in other ME organisations.

I would hope #MEAction, as a newer organisation inviting feedback from pwME would want to be wary of falling into the same traps those other organisations have done, that have left people like me feeling we are not being well represented or supported and don't have a home in those organisations because of their actions.

For example, I will not join AfME in the UK, and have let my membership of the MEA lapse because of some of the stuff they have published, of which I have been very critical on this forum.

There is much to admire about #MEAction, and I wish all its board, staff and members well in their endeavours. In my comments I was hoping to point to some of the traps other ME organisations have fallen into, and suggesting that it would be good for #MEAction to write into their principles, safeguards against falling into the same traps.

1. The need for more care by senior staff and board members in their public statements, even when done in a personal capacity. We have seen unfortunate examples recently of individuals with public roles in ME organisations making hypotheses or giving management advice based on personal experience that had no scientific evidence base and were likely to mislead patients and reflect badly on the organsations they represent.
The particular instance I was thinking of here was the MEA in the UK, whose chairman recently published an article of his personal story in which he made unproven and unhelpful recommendations about managing ME based on his own experience.

Even when writing in a personal capacity, he is seen as representative of the organisation, and people with ME and their carers will take his statements seriously. To write that everyone with ME should get out of bed an get dressed every day is unhelpful and unkind to those too sick to do this, and can be misinterpreted as an authoritative recommendation from the organisation he represents.

And yet I also admire and am very grateful to the MEA for a lot of the work they do. If they were to invite comments from pwME about their values and principles, I would want to spell this sort of instance out to them as problematic.

I was simply applying the same sort of idea for #MEAction. To me it does matter what board members and senior staff say publicly, even in a personal capacity, about their own experiences and their theories about them.

2. The need for all publications associated with ME organisations, including, for example, MEPedia, and Action for ME's publications about management of ME, to be soundly science based. If MEPedia is to have any credibility it may need to reconsider its open editing format.

Again, I was thinking of other organisations too. The instance I would give is AfME in the UK, whose publications are seriously problematic, being still based on their idea of 'active pacing' which is GET in all but name. I wrote a very critical letter to them last year about one of their documents about ME and work, which made inappropriate recommendations and statements about forward planning and rehabilitation for pwME. Partly as a consequence of my letter, that document has been withdrawn. But there is still an underlying problem with AfME basing its materials on ideas without scientific basis, and not seeming to understand the problem in this.

It does matter what is published in the name of an ME organisation. My personal view on MEPedia is that is was fine while it stuck to pages on the history and personalities associated with ME, but has come badly unstuck on its science pages. That is not a criticism of the individuals who have put a lot of energy into contributing to it, it is a criticism of the whole enterprise for stepping outside the area of expertise of many of its contributors, and inevitably falling into the trap of enabling unscientific claims and information to be published on the site.

Better, in my opinion, to publish nothing on sceintific issues, than to publish misleading articles. I don't think saying it's a Wiki is good enough. It is an #MEAction project, and, in my view, needs to stand up to scrutiny in the same way as all other publications.

However, I can see we are going to have to agree to disagree on this, so I will say no more.

I apologise to @Michiel Tack for diverting his thread. I will shut up about this now.
 
This.

...Even when writing in a personal capacity, [Neil Riley, Chair, ME Association Board of Trustees] is seen as representative of the organisation, and people with ME and their carers will take his statements seriously. To write that everyone with ME should get out of bed an get dressed every day is unhelpful and unkind to those too sick to do this, and can be misinterpreted as an authoritative recommendation from the organisation he represents...

...I was simply applying the same sort of idea for #MEAction. To me it does matter what board members and senior staff say publicly, even in a personal capacity, about their own experiences and their theories about them...

...It does matter what is published in the name of an ME organisation. My personal view on MEPedia is that is was fine while it stuck to pages on the history and personalities associated with ME, but has come badly unstuck on its science pages. That is not a criticism of the individuals who have put a lot of energy into contributing to it, it is a criticism of the whole enterprise for stepping outside the area of expertise of many of its contributors, and inevitably falling into the trap of enabling unscientific claims and information to be published on the site.

Better, in my opinion, to publish nothing on sceintific issues, than to publish misleading articles. I don't think saying it's a Wiki is good enough. It is an #MEAction project, and, in my view, needs to stand up to scrutiny in the same way as all other publications.
 
But at some point we will need to agree on some description of what ME/CFS is if the term is going to have an understood meaning. What about PEM for example, should people who do not have PEM and were diagnosed with a criteria that didn't require it all be classified into the same group as people who do have PEM. What if in the wider community the majority of people with the ME/CFS label do not have PEM. Should those with PEM and those without PEM all be given the same prognosis, told to try the same treatments, recruited into the same trials.

People who do not experience PEM do not have ME if you look at the ME expert the late Dr Melvin Ramsay's description/observations of hallmark muscle fatigability on trivial exertion. The concern for those of us who have lived with a diagnosis of RamsayME since 1980s - pre-CFS labelling - is that we have had a proliferation of criteria since then and now a hybrid 'ME/CFS'.
 
One area where I see it differently is in how you express the point about neutrality.
Thanks for your response.

Could you give an example of something ME Action might want to do that would be in conflict with the principles I propose?

Suppose that an updated version of the IACFS/ME primer for clinicians comes out that contains the expert treatment advise you described. I think the principles I propose do not prohibit ME Action from sharing that document, as long as it describes and frames it in the right way, namely as expert advice, not scientific evidence.

Their video on diagnosis and management with David Kaufman might be problematic as it contains statements such as "virtually all patients will have a low natural killer cell function." The principles I propose indicate that ME Action should be more careful with promoting these kinds of statements. But since it's merely a principle to strive for, it would not mean that they should delete the video.

Regarding pacing: I think organisations such as ME Action can describe it as a strategy that patients find useful in managing their symptoms, but that it is not a treatment and that there is insufficient evidence for its efficacy. They can also say that PACE is mentioned in the NICE guideline or on the CDC website, and therefore explain what it's about or how it is done.
 
"Adequate" has undertones of mediocre, maybe replace with one of the following: appropriate, suitable, better, good, high-quality, ...?
Thanks for the suggestions Ravn!

I'll go with effective care, let me know if you prefer another term. I'll indicate changes in the text in red.

I do prefer skeptical over critical though, as it focuses more on questioning and doubting things rather than criticizing them.

'First do no harm' might be a little too strong, cause it's not so much about medical treatment but about ensuring that everything that one writes is as accurate as possible and based on facts. So for example in criticizing the GET or CBT approach, it's important not to make overstatements.
 
I just spent some time considering the use of the word effective in the abstract of some paper recently posted. The word needs to some additional description to determine the effects intended. Something ma be effective for some purposes, but not for others; effective for ssome people's requirements, but not for other's. It is a word to be used with caution.
 
To clarify: this text presented above is not a proposal to form an official S4ME response (it would be weird for one organization to say what principles and values another organisation should have).

It's something I would like to be sent to ME Action staff and their board to consider now that they are formulating their core principles and values. This seems like the right time to raise the issue if anyone is interested in doing so. I hope that other ME advocates are willing to sign it as well. The text is open to proposed changes so that we can all agree on it.

You don't have to be a high-profile or well-known advocate to co-sign the statement. What I had in mind is that below the letter, we list the names of co-signees with a very short (1 sentence) description of how they are involved in the ME community or advocacy for patients. If you prefer to use an alias instead of your real name, that's not a problem if you're known that way in the ME community.
 
I just spent some time considering the use of the word effective in the abstract of some paper recently posted. The word needs to some additional description to determine the effects intended.
I agree it's not specific enough to describe a treatment in a scientific paper, where the term should probably not be used in a general sense without specifying on which domains the treatment is effective.

But I think it's different here because we're describing a goal, not a study or evidence base. So a non-specific and general term is appropriate.

I used it because it's the term that ME Action uses in its new mission statement, which reads (my bolding)
We are building a global movement to fight for recognition, education and research so that one day, all people with ME will have access to compassionate, effective care.
Nonetheless, I'm open to better suggestions...
 
The particular instance I was thinking of here was the MEA in the UK, whose chairman recently published an article of his personal story in which he made unproven and unhelpful recommendations about managing ME based on his own experience.

Thanks for giving great context for your suggestions, @Trish . I completely agree about anyone in leadership of an organization giving suggestions about treatments. I just don’t want the leadership of an organization to be unable to express an opinion separate from the organization’s official stance.

As for MEpedia, I see that as different from official publications. All Wikis contain problematic information because anyone can add or alter pages. Just look at what Wikipedia says about this disease! Wikis are constantly in flux and anyone can step in and correct them.

Articles that are written by the leadership, staff, and even volunteers should be held to a much higher standard.
 
Suppose that an updated version of the IACFS/ME primer for clinicians comes out that contains the expert treatment advise you described. I think the principles I propose do not prohibit ME Action from sharing that document, as long as it describes and frames it in the right way, namely as expert advice, not scientific evidence.

Not sure if this is your intent but this statement might suggest that expert advice is not evidence. But as I understand it, evidence-based clinical recommendations can be based on a range of types of evidence, including systematic reviews at one end and clinical experience and best practice at the other. Since research-based evidence of treatments is lacking, all we have is the clinical experience and best practice of disease experts.

Their video on diagnosis and management with David Kaufman might be problematic as it contains statements such as "virtually all patients will have a low natural killer cell function." The principles I propose indicate that ME Action should be more careful with promoting these kinds of statements. But since it's merely a principle to strive for, it would not mean that they should delete the video.

The National Academy of Medicine report concluded "The committee’s literature review yielded data demonstrating poor NK cell cytotoxicity (NK cell function, not number) that correlates with illness severity in ME/CFS patients and could serve as a biomarker for the severity of the disease, although it is not specific to ME/CFS." Wouldn't such a review and the underlying studies from multiple research groups be considered strong evidence for poor NK Cell function, which would be further supported by the clinical experience of disease experts?

Regarding pacing: I think organisations such as ME Action can describe it as a strategy that patients find useful in managing their symptoms, but that it is not a treatment and that there is insufficient evidence for its efficacy.

Re pacing not being a treatment - are you meaning that its a management strategy, not a treatment? I'd agree with that. Or are you meaning something different? Either way, same point as above regarding clinician experience and best practices as evidence.
 
I agree that PEM is emerging as useful distinguishing feature. There are probably also a significant number of patients that have an unexplainable syndrome without PEM that is otherwise similar to ME/CFS.

The ethical response is to include these people in research and efforts to improve care.
I've often thought Fukuda criteria could be really useful in research if used differently, i.e. with cohorts large enough to split into two groups:
Fukuda with PEM and Fukuda without PEM.
Looking for differences between the groups could be interesting.
You can believe whatever you want about ME as far as I'm concerned but for effective advocacy we need to agree on common goals and work together.
Maybe a solution here would be to separate the common "ME/CFS" name back into ME (with PEM) and CFS (without). Like type 1 and type 2 diabetes; there are significant similarities but also major differences. That way you could have organisations advocating for both ME and CFS while still acknowledging the differences.
 
Further email from MEAction

As you may have heard, we launched our “Values and Policy Initiative” this week! We are undertaking a six-month community process to learn, engage, debate and, ultimately, devise the core tenets of our global movement for myalgic encephalomyelitis (ME). Read more.

Our goal is to better clarify our values, tactics and positions so that we are more unified in our work as a large, diverse community.

Last November, we surveyed the community about what topics it wanted to discuss during this initiative. You cited these topics as most important: disease definition and how best to educate health providers; advocacy tactics; devising concrete policy positions; shared values; building a more harmonious community, and more clarity on #MEAction.

Read the full results of the survey below.

Read the Survey Results
Over the next six months, we’ll be rolling out a series of articles and think pieces written by community members and staff for the community to read and debate our values and positions.

All this will culminate in a statement of principles and values as well as a formal policy platform, which the community will ratify with an up-or-down vote.

Visit our Values & Policy webpage below to read more about the topics we will discuss, the timeline and to see published articles.

https://www.meaction.net/meactions-values-policy-initiative/

We look forward to the rigorous conversations and learning we will do together!

ETA: Missing link
 
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The XMRV-saga and the more recent enthusiasm about Rituximab are but two examples of how easily things can go wrong when promising research findings are reported.
I think this needs a tweak, as we don't want anyone thinking that we want to stop or delay promising research being reported. It's not the reporting that creates the trouble, it's the belief that preliminary findings have more value than they do.

Maybe "The XMRV-saga and the more recent enthusiasm about Rituximab are but two examples of how easily things can go wrong when people desperate to regain health assume preliminary findings are correct".
 
Since research-based evidence of treatments is lacking, all we have is the clinical experience and best practice of disease experts.
Ok. But the things I propose do not forbid sharing or giving information about expert advise, as long as the evidence behind it is not overstated and properly framed. So it should be presented as something that ME/CFS experts do, based on their intuition and experience, not something that is supported by scientific evidence.

I'm still not sure what you are disagreeing with in the text itself, but I suppose it's the term 'neutral'? What if I leave that out. So it would read something like this:

Science-based: ME Action has a commitment to science and evidence-based medicine. Our advocacy, policy proposals and information resources are based on the best available science while recognizing the limitations of current research.

Skeptical: ME Action has a commitment to remain skeptical towards scientific hypotheses, proposed treatments and reported findings, as long as these have not been established by robust scientific inquiry from multiple research groups.

Factfulness: ME Action has a commitment to stick to established facts. We strive for high accuracy and prefer to err on the side of caution.​
 
Maybe "The XMRV-saga and the more recent enthusiasm about Rituximab are but two examples of how easily things can go wrong when people desperate to regain health assume preliminary findings are correct".
Thanks for the suggestion.

This does give the impression that it's desperate patients that form the problem, while the issue that I want to raise is more about a lack of caution or skepticism towards biomedical research findings in the ME/CFS community.

What about: "The XMRV-saga and the more recent enthusiasm about Rituximab are but two examples of how easily things can go wrong when promising but preliminary findings are taken at face value."
 
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