NICE Guideline review: Call for evidence on myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome, deadline 16th Oct 2019

Cardiovascular:

"Abnormal impedance cardiography predicts symptom severity in chronic fatigue syndrome":

Abstract:
https://www.ncbi.nlm.nih.gov/pubmed/12920435


Full article:
https://pdfs.semanticscholar.org/45f6/9030ef424630a237ff36c3db69994e6c28de.pdf

This study was cited, page 18 of the Canadian Consensus Criteria Overview (CCC) - https://www.mefmaction.com/images/stories/Overviews/ME-Overview.pdf:



Exercise capacity:

"Exercise Capacity in Chronic Fatigue Syndrome":

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485564



School absence:


"Long-Term Sickness Absence Due to ME/CFS in UK Schools":
https://www.tandfonline.com/doi/abs/10.1300/J092v03n02_04

ETA: all above studies cited in the CCC Overview.
 
we are totally screwed then because just about the only RCTs/papers on this are done by bPS researchers.
Is there any way to ensure that 'evidence' of this type is accompanied by any papers (eg by Mark Vink) that rebutt the findings/expose the flawed methodology?

(The recent research on the clinics not actually recording Treatment-related adverse effects or rather not seeing the need to as the treatments are judged to be unharmful) TK,BH,GM et al
I believe somewhat formalised surveys (like the Oxford Brookes/Forward-ME one) probably count in this instance. It doesn't have to be RCTs.

What NICE presumably doesn't want is, say, the maker of a medical device (or whatever) submitting customer testimonials about how amazing their device is.
 
Well surely all BPS research results are opinion based, with patients giving their opinion as to whether they think CBT/GET have helped or not.

https://www.thefreedictionary.com/opinion
Opinion - A belief or conclusion held with confidence but not substantiated by positive knowledge or proof

So why do they give any credence to any of it?
Unfortunately they have the requisite rubber stamping.
 
we are totally screwed then because just about the only RCTs/papers on this are done by bPS researchers.
Is there any way to ensure that 'evidence' of this type is accompanied by any papers (eg by Mark Vink) that rebutt the findings/expose the flawed methodology?

(The recent research on the clinics not actually recording Treatment-related adverse effects or rather not seeing the need to as the treatments are judged to be unharmful) TK,BH,GM et al

Significant evidence from WorkWell Foundation and Leonard Jason on many of these
 
Common Data Elements
it would be a great help for some to go through what's most relevant here

https://www.commondataelements.ninds.nih.gov/Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Please, please please can people look for what's there on very severe ME - what would help Whitney? What would avoid harm?

Mortality


Assessing symptoms

Unpublished trials
* Cortene CT38
https://clinicaltrials.gov/ct2/show/NCT03613129 - trial registered (blog https://www.healthrising.org/blog/2...new-drug-for-chronic-fatigue-syndrome-me-cfs/) * needs results *

Experiences survey

Quality of life - Stigma

Psychological status / exercise

Methods of monitoring and/or reviewing people with a diagnosis of ME/CFS
Physical functioning
Care levels
  • Norwegian severe ME survey - charts including profound ME
Patient experiences / psychological / protection from harm
  • KNOWLEDGE IN THE HOPE OF PROTECTING M.E. SUFFERERS FROM UNNECESSARY SECTIONING - Preventing the unnecessary forced mental health sectioning of severely ill patients - The Grace Charity for M.E. with 25% ME Group - help prevent deaths like Sophia Mirza's https://25megroup.org/download/2527/
Equality / Disability
  • Yet another insanely short deadline from NICE, who could have given us these questions last month and keep ignoring the fact we are ill
  • NICE 2007 guidelines - zero requirements for CFS out-patient clinics to be wheelchair accessible (some are not)
  • NICE 2007 guidelines - any CFS out-patient service can deny treatment purely because a person is housebound
  • NICE 2007 guidelines - CFS out-patient services are NOT required to by led by doctors or even to employ them. Some have none. (s4me - message if you want an example)
  • Social support needs for equity in health and social care: a thematic analysis of experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis https://equityhealthj.biomedcentral.com/articles/10.1186/1475-9276-10-46

Carers
Psychological
 

Attachments

From the linked website

What we need

We need evidence from the areas listed below for the guideline we are developing on Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome:

1. Studies that evaluate:
  • Management strategies that are adopted while someone is being assessed for a diagnosis of ME/CFS.
  • Methods of monitoring and/or reviewing people with a diagnosis of ME/CFS
We are looking for trials that compare different strategies or different methods of monitoring and review. Systematic reviews, randomised controlled trials, non- randomised trials that are prospective or retrospective cohort studies will be considered for inclusion in the guideline.

We would like studies that report measurable outcomes on:
  • Mortality
  • Quality of life
  • Fatigue /fatiguability
  • Physical functioning
  • Cognitive function
  • Psychological status
  • Pain
  • Sleep quality
  • Treatment-related adverse effects
  • Activity levels
  • Return to school or work
  • Exercise performance measures.
  • Care needs
  • Impact on families and carers
We cannot accept non comparative studies, promotional material, non-evidence-based assertions of effectiveness or opinion pieces.

2. Evidence on the experience of people who have had interventions for ME/CFS.


We are looking for evidence that explores and evaluates people’s experience of interventions for ME/CFS. Qualitative studies evaluating focus groups and interviews and surveys will be considered for inclusion in the guideline.

We cannot accept case series, case studies, individual accounts of experience, promotional material, non-evidence-based assertions of effectiveness or opinion pieces.

We are particularly interested in information promoting equality of opportunity relating to age, disability, gender, gender identity, ethnicity, religion and belief, sexual orientation or socio-economic status.

Re: BELIEFS

Any interventions that specifically aim to target beliefs about the illness are totally unacceptable and would not be tolerated for any other illness.

This has been one of the most damaging things, and has led to persistent gaslighting by professionals who attempt to bully patients into accepting ridiculous beliefs, for example the "fear of exercise" belief we are told we have.

It is difficult to find much, if anything, on the harmful impact of this.
 
@Jonathan Edwards it seems they are trying to forcibly limit their "evidence" to psychosocial trials, what can we do about this?
This isn't true. As mentioned above, the Forward-ME/Oxford Brookes survey is specifically the kind of thing they're looking for here.

You can send in any trial, including biomedical ones, which you think address the areas NICE wants further evidence for. You probably can't send in individual anecdotes.
 
You can send in any trial, including biomedical ones, which you think address the areas NICE wants further evidence for.
Seems to me that NICE are likely to see a lot of duplication as we don't know what papers they have looked at already. I assume that they won't, but it would help all concerned if they revealed what papers have been included already.
 
Seems to me that NICE are likely to see a lot of duplication as we don't know what papers they have looked at already. I assume that they won't, but it would help all concerned if they revealed what papers have been included already.
They have been incredibly thorough and I've been sending them studies too. But I would veer on the side of caution and send again, in any case. Duplication isn't really a problem. It's better that they have to ignore stuff they've already seen than missing out on something important, but that's just my view.
 
They have been incredibly thorough and I've been sending them studies too. But I would veer on the side of caution and send again, in any case. Duplication isn't really a problem. It's better that they have to ignore stuff they've already seen than missing out on something important, but that's just my view.
I should also add that the committee can also raise things that fall through the cracks (e.g., anecdote, polls, etc) if they're relevant, so keep tagging me in things on here.
 
http://nandsme.blogspot.com/p/patient-survey.html

Survey



Evaluated by leading ME researchers and doctors;
Dr Pheby, Dr. Derek F. H. Pheby, BSc, MB, BS, LLM, MPhil, FFPH, is a Visiting Professor of Epidemiology, Buckinghamshire New University, Wycombe, England, United Kingdom. He served as the Project Coordinator of the National ME Observatory, a collaborative project involving three universities, aiming to fill gaps in research knowledge.[1] He was a former member of the Chief Medical Officer’s Working Group on CFS/ME and former trustee of Action for ME.[

Dr. Nacul and Lacerda from LSHTM BioBank and

Professor Bernie Carter
Professor of Children’s Nursing
Bernie-photo-2016-3-300x300.jpg

PhD, PGCE, PGCE, BSc, RSCN, SRN


Faculty of Health and Social Care
H217a, FOHSC Building
bernie.carter@edgehill.ac.uk
01695 657771

2009 Patient Survey Report

This report is lengthy, but it does justice to the efforts that you made in completing the surveys. This couldn't have happened without you!

See the full survey report [pdf]

A results summary can be found on page 5 with key messages on page 6 and recommendations on page 7. Page 9 onwards looks at the results in detail and features many comments from individual respondents.

Summary
NHS services for people with ME and CFS in Norfolk and Suffolk are being re-designed. NHS Gt Yarmouth & Waveney had not carried out any patient satisfaction surveys regarding the current ME and CFS Service. Patient Representatives wanted to find out in detail what people think of the current ME and CFS Service and what they want and don’t want from the new service. We therefore launched the 2009 Patient Survey in January 2009. The NHS was invited to participate, but declined.

Patient and Carer Representatives would like to thank everyone who participated in our 2009 Patient Survey. We would also like to thank all local ME and CFS support groups for taking part in this initiative.

Great Yarmouth and Waveney NHS wanted to provide a service based on the NICE Guidelines. This is despite the fact that the Guidelines have been condemned as ‘unfit for purpose’ by virtually all patient groups and charities. The Norfolk and Suffolk ME and CFS Service 2009 Patient Survey provides detailed evidence that:
  • The current level of service provision is inadequate
  • A service based on the NICE Guidelines will not meet the needs of people with ME and CFS in Norfolk and Suffolk
The survey has demonstrated that respondents want:
  • A biomedical consultant led service
  • A team of healthcare professionals who have the skills and expertise to care for people of all ages, of all levels of severity and complexity
  • Ongoing care for all with reviews between 1 month and 6 months depending on severity and need
  • Treatment and management to consist of:
    • Self management, e.g. pacing, activity management
    • Pharmacological treatment
  • Clinics closer to home, the option to self refer and a prescribing service
  • Support for patients and carers including liaison with employers, education services, voluntary services, DWP and JCP
  • Information to facilitate informed choice regarding treatment options
  • Access to aids and equipment
  • Onward referral to other services e.g. pain clinic
  • GP training to ensure prompt recognition of ME and CFS and prompt referral
  • Support for people with ME and CFS
Respondents found the most helpful and least harmful interventions were:
  • Pacing, rest, relaxation and meditation
  • Medication for symptoms, massage and dietary changes are also worth considering
Respondents found the least helpful and most harmful interventions were:
  • Graded Exercise Therapy
  • Cognitive Behavioural Therapy

Respondents were significantly more satisfied with the service provided by Occupational/Physiotherapists than with GP’s with a Special Interest in ME/CFS.

Click here to view the full 2009 Patient Survey [pdf]
 
http://nandsme.blogspot.com/p/patient-survey.html

All Party Parliamentary Group on ME
In March 2010 part of our survey was included in the All-Party Parliamentary Group on ME 'Inquiry into NHS Service Provision for ME/CFS' (p6).

The APPG commented on page 8 of their report:
'While the APPG recognises that it is impossible for all treatments in any disease area to be side-effect free, if CBT and GET were licensed medication, this number of patients claiming devastating side effects would undoubtedly have led to a review by NICE. The same standards should apply to CBT and GET.' It is vital to provide information regarding potential benefits and adverse effects of interventions so that patients can make informed choices regarding their care.


ME Association Survey - May 2010
A total of 3,494 people answered the questions on-line. Another 723 completed the paper questionnaire. The results of the survey 'Managing my ME' can be found here


Action for ME Survey - May 2008
A survey of over 2,760 people with ME was carried out focusing on their health and welfare. To read the report please click here


Survey - People with Severe ME/CFS
In 2007 a survey was undertaken in conjunction with the 25% Group to gather the views and experiences of those in our area who are severely affected by ME/CFS. For a copy of the report please click here
 
This is a specific restriction knowing it will only include psychosocial trials. Blatant, as usual.
Systematic reviews are allowed, and other comparative studies. The FINE trial's nil outcome can be used.

It makes no sense to ask for trials/reviews about management strategies during assessment, or monitoring / reviewing a diagnosis - how can either be a trial, review or comparative study?

How can you have a trial / comparative study about monitoring pain or PEM?

I don't really understand what they want.
 
http://nandsme.blogspot.com/p/patient-survey.html

Survey



Evaluated by leading ME researchers and doctors;
Dr Pheby, Dr. Derek F. H. Pheby, BSc, MB, BS, LLM, MPhil, FFPH, is a Visiting Professor of Epidemiology, Buckinghamshire New University, Wycombe, England, United Kingdom. He served as the Project Coordinator of the National ME Observatory, a collaborative project involving three universities, aiming to fill gaps in research knowledge.[1] He was a former member of the Chief Medical Officer’s Working Group on CFS/ME and former trustee of Action for ME.[

Dr. Nacul and Lacerda from LSHTM BioBank and

Professor Bernie Carter
Professor of Children’s Nursing
Bernie-photo-2016-3-300x300.jpg

PhD, PGCE, PGCE, BSc, RSCN, SRN


Faculty of Health and Social Care
H217a, FOHSC Building
bernie.carter@edgehill.ac.uk
01695 657771

2009 Patient Survey Report

This report is lengthy, but it does justice to the efforts that you made in completing the surveys. This couldn't have happened without you!

See the full survey report [pdf]

A results summary can be found on page 5 with key messages on page 6 and recommendations on page 7. Page 9 onwards looks at the results in detail and features many comments from individual respondents.

Summary
NHS services for people with ME and CFS in Norfolk and Suffolk are being re-designed. NHS Gt Yarmouth & Waveney had not carried out any patient satisfaction surveys regarding the current ME and CFS Service. Patient Representatives wanted to find out in detail what people think of the current ME and CFS Service and what they want and don’t want from the new service. We therefore launched the 2009 Patient Survey in January 2009. The NHS was invited to participate, but declined.


Patient and Carer Representatives would like to thank everyone who participated in our 2009 Patient Survey. We would also like to thank all local ME and CFS support groups for taking part in this initiative.

Great Yarmouth and Waveney NHS wanted to provide a service based on the NICE Guidelines. This is despite the fact that the Guidelines have been condemned as ‘unfit for purpose’ by virtually all patient groups and charities. The Norfolk and Suffolk ME and CFS Service 2009 Patient Survey provides detailed evidence that:
  • The current level of service provision is inadequate
  • A service based on the NICE Guidelines will not meet the needs of people with ME and CFS in Norfolk and Suffolk
The survey has demonstrated that respondents want:
  • A biomedical consultant led service
  • A team of healthcare professionals who have the skills and expertise to care for people of all ages, of all levels of severity and complexity
  • Ongoing care for all with reviews between 1 month and 6 months depending on severity and need
  • Treatment and management to consist of:
    • Self management, e.g. pacing, activity management
    • Pharmacological treatment
  • Clinics closer to home, the option to self refer and a prescribing service
  • Support for patients and carers including liaison with employers, education services, voluntary services, DWP and JCP
  • Information to facilitate informed choice regarding treatment options
  • Access to aids and equipment
  • Onward referral to other services e.g. pain clinic
  • GP training to ensure prompt recognition of ME and CFS and prompt referral
  • Support for people with ME and CFS
Respondents found the most helpful and least harmful interventions were:
  • Pacing, rest, relaxation and meditation
  • Medication for symptoms, massage and dietary changes are also worth considering
Respondents found the least helpful and most harmful interventions were:
  • Graded Exercise Therapy
  • Cognitive Behavioural Therapy

Respondents were significantly more satisfied with the service provided by Occupational/Physiotherapists than with GP’s with a Special Interest in ME/CFS.

Click here to view the full 2009 Patient Survey [pdf]

These are useful. Do send them in officially so there's a record.
 
Should also include the full "rebuttal chain" to clarify and expose how BPS researchers' alleged rebuttals are nothing of the sort; far from being watertight, actually leak like sieves. Also avoid them whinging their counter-rebuttals not being presented ... actually they do us a favour.
Should especially include the infamous "we prefer" supposed rebuttal by MS.

I appreciate @dave30th's endeavours would fall outside the scope of what is allowed for NICE evaluation, but there are a hell of a lot of good hard facts in there, showing how unscientific the PACE scientists have been. Could these facts be distilled out in some way to provide something usable with NICE?

Even the "we prefer" (supposed) rebuttal is solidly factual ... it is an unequivocal written statement by a PACE author which clearly contravenes all well accepted standards of scientific trials methodology, and on its own deeply undermines their integrity as scientists, and the integrity of their published PACE results.
 
Systematic reviews are allowed, and other comparative studies. The FINE trial's nil outcome can be used.

It makes no sense to ask for trials/reviews about management strategies during assessment, or monitoring / reviewing a diagnosis - how can either be a trial, review or comparative study?

How can you have a trial / comparative study about monitoring pain or PEM?

I don't really understand what they want.
You could study which tools are most useful to measure a symptom or not, and how often symptoms change or evolve to suggest frequency of review. Basically, the question is: when should we review patients, how often, and by which measures?

As for initial assessment: they're looking for evidence of early interventions and what they might look like, how to prevent delayed interventions, warning signs around future severity, etc. In other words: how do we best help people in the early days of their illness, and avoid delays in diagnosis or treatment?

The bit about patient responses to treatments could include improvement/worsening, suitability, provision (or lack of) and patient preference. It could also relate to general quality of service delivery and strengths/failures of existing clinics. For example, the Trafford Healthwatch report on ME treatment provision in Manchester and the Suffolk and Norfolk survey above would probably count.

There may be more systems and reports like those out there, done on a local, regional or national level, which weren't published scientific papers but which could be instructive in their own way. Now is the time to collate them. Local groups probably have a wealth of info on their local areas which could contribute to a fuller picture of what's going on around the country.

These are all really important questions; they're just written in bureaucrat speak.

Edited: Wrote Healthwise, but meant Healthwatch.
 
Last edited:
Back
Top Bottom